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  1. COPD: the patient perspective

    Directory of Open Access Journals (Sweden)

    Jones PW

    2016-02-01

    Full Text Available Paul W Jones,1 Henrik Watz,2 Emiel FM Wouters,3 Mario Cazzola4 1Division of Clinical Science, St George’s, University of London, London, UK; 2Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN, Member of the German Center for Lung Research (DZL, Grosshansdorf, Germany; 3CIRO+, Department of Respiratory Medicine, Maastricht University, Maastricht, the Netherlands; 4Unit of Respiratory Clinical Pharmacology, Department of Systemic Medicine, University of Rome ‘Tor Vergata,’ Rome, Italy Abstract: Chronic obstructive pulmonary disease (COPD is a highly prevalent disease characterized by nonreversible airway obstruction. Well-characterized symptoms such as exertional dyspnea and fatigue have a negative impact on patients’ quality of life (QoL and restrict physical activity in daily life. The impact of COPD symptoms on QoL is often underestimated; for example, 36% of patients who describe their symptoms as being mild-to-moderate also admit to being too breathless to leave the house. Additionally, early morning and nighttime symptoms are a particular problem. Methods are available to allow clinicians to accurately assess COPD symptoms, including patient questionnaires. Integrated approaches to COPD management, particularly pulmonary rehabilitation, are effective strategies for addressing symptoms, improving exercise capacity and, potentially, also increasing physical activity. Inhaled bronchodilators continue to be the mainstay of drug therapy in COPD, where options can be tailored to meet patients’ needs with careful selection of the inhaled medication and the device used for its delivery. Overall, an integrated approach to disease management should be considered for improving QoL and subsequent patient outcomes in COPD. Keywords: COPD, patients, physical actiity levels, pulmonary rehabilitation

  2. Preoperative Strength Training for Elderly Patients Awaiting Total Knee Arthroplasty

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    D. M. van Leeuwen

    2014-01-01

    Full Text Available Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA. Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard training group or a group receiving standard training with additional progressive strength training for 6 weeks. Isometric knee extensor strength, voluntary activation, chair stand, 6-minute walk test (6MWT, and stair climbing were assessed before and after 6 weeks of training and 6 and 12 weeks after TKA. Results. For 3 of the 11 patients in the intensive strength group, training load had to be adjusted because of pain. For both groups combined, improvements in chair stand and 6MWT were observed before surgery, but intensive strength training was not more effective than standard training. Voluntary activation did not change before and after surgery, and postoperative recovery was not different between groups (P>0.05. Knee extensor strength of the affected leg before surgery was significantly associated with 6-minute walk (r=0.50 and the stair climb (r−=0.58, P<0.05. Conclusion. Intensive strength training was feasible for the majority of patients, but there were no indications that it is more effective than standard training to increase preoperative physical performance. This trial was registered with NTR2278.

  3. Cinacalcet to prevent parathyrotoxic crises in hypercalcaemic patients awaiting parathyroidectomy

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    Rostoker, Guy; Bellamy, Jean; Janklewicz, Philippe

    2011-01-01

    Primary hyperparathyroidism is the third most common endocrine disorder. Hypercalcaemia exceeding 3 mmol/l is a major risk factor for parathyrotoxic crises, and management of patients at risk remains a medical challenge. The authors recently managed three such patients referred for severe nephrolithiasis. All had severe hypercalcaemia (at least 3 mmol/l). Instead of the usual management, which involves hospitalisation in an intensive care environment (for about 5–7 days) for rehydration and infusion of intravenous bisphosphonates, followed by emergency parathyroidectomy, the three patients received ambulatory cinacalcet (not an approved indication), 30 mg twice a day. The serum calcium normalised in two cases and declined to a safe level in the third case, allowing minimally invasive parathyroidectomy to be performed at a date chosen according to the patients’ and surgeon’s respective schedules. The authors consider that cinacalcet may benefit severely hypercalcaemic patients awaiting surgery for primary hyperparathyroidism. PMID:22696718

  4. Outcomes of Chinese Patients with End-stage Pulmonary Disease while Awaiting Lung Transplantation: A Single-center Study

    Institute of Scientific and Technical Information of China (English)

    Wen-Xin He; Yu-Ling Yang; Yan Xia; Nan Song; Ming Liu; Peng Zhang; Jiang Fan

    2016-01-01

    Background: The factors affecting the outcome of patients referred for lung transplantation (LTx) still have not been investigated extensively.The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.Methods: From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively.The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model.Results: Twenty-five patients (24.3%) died while awaiting the LTx.Fifty patients (48.5%) underwent LTx, and 28 patients (27.2%) were still on the waitlist.Compared to the candidates with chronic obstructive pulmonary disease (COPD), patients with idiopathic pulmonary fibrosis (IPF) had a higher mortality while awaiting the LTx (40.0% vs.12.3%, P =0.003).Patients requiring mechanical ventilation (MV) had a higher mortality while waiting than others (50.0% vs.20.2%, P =0.038).Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist (hazard ratio [HR] =56.048, 95% confidence interval [CI]: 3.935-798.263, P =0.003 and HR =14.859, 95% CI: 2.695-81.932, P =0.002, respectively).Conclusion: The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.

  5. Serum ferritin concentration predicts mortality in patients awaiting liver transplantation.

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    Walker, Nicole M; Stuart, Katherine A; Ryan, Rebecca J; Desai, Shireena; Saab, Sammy; Nicol, Jennifer A; Fletcher, Linda M; Crawford, Darrell H G

    2010-05-01

    Additional markers are required to identify patients on the orthotopic liver transplant (OLT) waiting list at increased risk of death and adverse clinical events. Serum ferritin concentration is a marker of varied pathophysiological events and is elevated with increased liver iron concentration, hepatic necroinflammation, and systemic illness, all of which may cause a deterioration in liver function and clinical status. The aim of this study was to determine whether serum ferritin concentration is an independent prognostic factor in subjects awaiting OLT. This is a dual-center retrospective study. The study cohort consisted of 191 consecutive adults with cirrhosis accepted by the Queensland (Australia) Liver Transplant Service between January 2000 and June 2006 and a validation cohort of 131 patients from University of California Los Angeles (UCLA) Transplant Center. In the study cohort, baseline serum ferritin greater than 200 microg/L was an independent factor predicting increased 180-day and 1-year waiting list mortality. This effect was independent of model for end-stage liver disease (MELD), hepatocellular carcinoma, age, and sex. Subjects with higher serum ferritin had increased frequency of liver-related clinical events. The relationship between serum ferritin and waiting list mortality was confirmed in the UCLA cohort; all deceased patients had serum ferritin greater than 400 microg/L. Serum ferritin greater than 500 microg/L and MELD were independent risk factors for death. Serum ferritin concentration is an independent predictor of mortality-related and liver-related clinical events. Baseline serum ferritin identifies a group of "higher-risk" patients awaiting OLT and should be investigated as an adjunct to MELD in organ allocation.

  6. Vaccines for Patients with COPD.

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    Moreno, Dolores; Barroso, Judith; Garcia, Alexis

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow limitation. This disease is currently the fourth higher cause of death in the world, and it is predicted to be the third by the year 2020. Patients with COPD are frequently exposed to Human Rhinovirus, Respiratory Syncytial and Influenza Virus, as well as to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. These infectious agents are responsible for exacerbations increasing morbidity and mortality in COPD patients. Prevention of infectious exacerbations by vaccination would improve quality of life and patient survival. A literature search: "vaccination of COPD patients" was performed using Medline, the Cochrane Library and other Non-Indexed Citations for this review. This article presents a brief overview of the different studies found, on the new patents, and the future strategies on the field.

  7. Cause of death in patients awaiting bariatric surgery.

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    Lakoff, Joshua M; Ellsmere, James; Ransom, Tom

    2015-02-01

    Obesity is associated with increased mortality. Bariatric surgery is becoming an important treatment modality for obesity, with an associated reduction in mortality. There are few data available on the incidence and cause of death in referred patients while they are waiting for bariatric surgery. We retrospectively examined all cases of death in patients who were referred for bariatric surgery assessment but who had not yet undergone bariatric surgery at a tertiary care centre in Halifax, Nova Scotia. The wait list comprised patients referred for surgery between March 2008 and May 2013. All cases of death were reviewed to determine age, sex, time of referral, time spent on the wait list, cause of death, comorbidities and body mass index (BMI). Of the 1399 patients referred, 22 (1.57%) died before receiving surgery. The mean age of these patients was 62.7 (range of 32-70) years. The average time from referral to death was 21.6 months, and the average BMI was 51.5. The most frequent cause of death was cancer, followed by cardiac and infectious causes. This study provides useful information about mortality and causes of death among patients awaiting bariatric surgery at our centre. Our results will help guide the development of a judicious system for triage in light of long wait times.

  8. CD4-regulatory cells in COPD patients

    DEFF Research Database (Denmark)

    Smyth, Lucy J C; Starkey, Cerys; Vestbo, Jørgen

    2007-01-01

    BACKGROUND: The numbers of airway CD8 and B lymphocytes are increased in COPD patients, suggesting an autoimmune process. CD4-regulatory T cells control autoimmunity but have not been studied in patients with COPD. OBJECTIVE: To compare T-regulatory cell numbers in the BAL from COPD patients, smo...

  9. CD4-regulatory cells in COPD patients

    DEFF Research Database (Denmark)

    Smyth, Lucy J C; Starkey, Cerys; Vestbo, Jørgen

    2007-01-01

    BACKGROUND: The numbers of airway CD8 and B lymphocytes are increased in COPD patients, suggesting an autoimmune process. CD4-regulatory T cells control autoimmunity but have not been studied in patients with COPD. OBJECTIVE: To compare T-regulatory cell numbers in the BAL from COPD patients......, smokers with normal lung function, and healthy nonsmokers (HNS). METHODS: BAL and peripheral blood mononuclear cell (PBMC) samples were obtained from 26 COPD patients, 19 smokers, and 8 HNS. Flow cytometry was performed for regulatory phenotypic markers. RESULTS: COPD patients had increased BAL CD8...... numbers compared to smokers and HNS. CD4 numbers were similar between groups. There was increased BAL CD4CD25(bright) expression in smokers (median 28.8%) and COPD patients (median 23.1%) compared to HNS (median 0%). Increased FoxP3 expression was confirmed in BAL CD4CD25(bright) cells. BAL CD4CD25 cells...

  10. Cognitive performance in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Postma, DS; Beukema, RJ; ten Hacken, NHT; van der Molen, T; Riemersma, RA; van Zomeren, EH; Kerstjens, HAM

    2004-01-01

    Background: Hypoxemic patients with Chronic Obstructive Pulmonary Disease (COPD) have impaired cognitive performance. These neuropsychological impairments are related to the degree of hypoxemia. So far, cognitive performance has not been tested in non-hypoxemic patients with COPD. Methods: We recrui

  11. Optimizing care of your patients with COPD

    Directory of Open Access Journals (Sweden)

    Garvey C

    2014-02-01

    Full Text Available Chris Garvey,1 Nicola A Hanania,2 Pablo Altman3 1Seton Pulmonary and Cardiac Rehabilitation, Daly City, CA, USA; 2Asthma Clinical Research Center, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA; 3Mylan Specialty LP, Basking Ridge, NJ, USA (formerly Abstract: Chronic obstructive pulmonary disease (COPD is now the third-leading cause of death in the US. The primary risk factor for COPD is smoking. COPD is underdiagnosed, and spirometry, the main method for its diagnosis, is underutilized. Nurses can play an essential role in improving patient outcomes, in part by helping to apply clinical guidelines for care. Management of COPD consists of reduction of risk factor exposure (for example, smoking cessation, influenza vaccination, pharmacotherapy, and pulmonary rehabilitation. Comorbidities may pose a special challenge in patients with COPD and they may compete with COPD for attention during office visits. Of particular note with regard to pharmacotherapy is the choice of delivery system. Handheld inhalers form the mainstay of treatment of COPD; however, some patients have difficulty using inhalers because of an inability to generate sufficient inspiratory flow, impaired manual dexterity, or cognitive impairment that leads to difficulties in following instructions concerning how to use the inhaler. In such patients, nebulization may be an effective alternative. In this review, we provide a list of best practices that can assist nurses in the optimal care of patients with COPD. Keywords: chronic obstructive pulmonary disease, exacerbation, long-acting beta-agonist, bronchodilators, nebulization

  12. STRUCTURE OF PULMONARY HYPERTENSION IN PATIENTS AWAITING HEART TRANSPLANTATION

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    A. A. Piontek

    2009-01-01

    Full Text Available The selection of recipients for the orthotopic heart transplantation is of great importance. In 2006–2009 we examined 25 tests on reversibility of pulmonary hypertension, i.e. in 14 patients with dilated cardiomyopathy (DCM (11 males and 3 females aged 41,1 ± 9,3 and in 11 patients with coronary artery disease (CAD (all males aged 50 ± 4.9. Initial pulmonary vascular resistance (PVR was 3,61 ± 1,02 and 3,59 ± 0,98 respectively. Alprostadil was infused to all the patients. Pulmonary hypertension was irreversible in 4 (28,5% DCM patients and in 2 (18% CAD patients. Initial PVR in those patients was 6,27 ± 3,2 and 5,7 ± 2,4 respectively. The average alprostadil dose necessary for the reverse of pulmonary hypertension was 0,054 ± 0,027 μg/kg/min in DCM patients, and 0,047 ± 0,022 μg/kg/min in CAD patients. Thus, the application of alprostadil for the pharmacological correction of pulmonary vascular resistance is most effective in patients with moderate pulmonary hypertension according to Rich classification. 

  13. Balance impairment in patients with COPD.

    Directory of Open Access Journals (Sweden)

    Alexandru Florian Crişan

    Full Text Available Chronic obstructive pulmonary disease (COPD is a respiratory disease that results in progressive airflow limitation and respiratory distress. Physiopathological features of COPD suggest that people who suffer from this disease have many risk factors for falls that have been identified in older individuals. The aim of the study was to compare and quantify functional balance between COPD patients and healthy subjects; to investigate the risk of falls in acute stages of the disease and to identify risk factors that could lead to falls.We studied 46 patients with moderate-severe COPD (29 stable and 17 in acute exacerbation--AECOPD and 17 healthy subjects (control group having similar demographic data. We analyzed the difference in Berg Balance Scale (BBS, Single Leg Stance (SLS and Timed Up and Go test (TUG between these three groups and the correlation of these scores with a number of incriminatory factors.The presence of COPD was associated with significant worsening of balance tests: BBS (55 control, vs. 53 COPD, vs. 44 AECOPD points p<0.001, TUG (8.6 control vs. 12.3 COPD vs. 15.9 AECOPD seconds. p<0.001, SLS (31.1 control vs. 17.7 COPD vs. 7.2 AECOPD seconds p<0.001 which may be associated with an increased risk of falls. Anxiety and depression were significantly associated with decreased balance test scores; anxiety (2 control vs. 6 COPD vs. 9 AECOPD points p<0.001 depression (2 control vs. 7 COPD vs. 12 AECOPD points p<0.001.According to our results COPD patients in moderate-severe stages and especially those in exacerbation have a high risk of falls.

  14. Chest computed tomography scores are predictive of survival in patients with cystic fibrosis awaiting lung transplantation

    NARCIS (Netherlands)

    M. Loeve (Martine); W.C.J. Hop (Wim); M. de Bruijne (Marleen); P.Th.W. van Hal (Peter); P. Robinson; A. Aitken; J.D. Dodd (Jonathan); H.A.W.M. Tiddens (Harm)

    2012-01-01

    textabstractRationale: Up to one-third of patients with cystic fibrosis (CF) awaiting lung transplantation (LTX) die while waiting. Inclusion of computed tomography (CT) scores may improve survival prediction models such as the lung allocation score (LAS). Objectives: This study investigated the

  15. Diaphragm adaptations in patients with COPD

    Directory of Open Access Journals (Sweden)

    Heunks Leo MA

    2008-01-01

    Full Text Available Abstract Inspiratory muscle weakness in patients with COPD is of major clinical relevance. For instance, maximum inspiratory pressure generation is an independent determinant of survival in severe COPD. Traditionally, inspiratory muscle weakness has been ascribed to hyperinflation-induced diaphragm shortening. However, more recently, invasive evaluation of diaphragm contractile function, structure, and biochemistry demonstrated that cellular and molecular alterations occur, of which several can be considered pathologic of nature. Whereas the fiber type shift towards oxidative type I fibers in COPD diaphragm is regarded beneficial, rendering the overloaded diaphragm more resistant to fatigue, the reduction of diaphragm fiber force generation in vitro likely contributes to diaphragm weakness. The reduced diaphragm force generation at single fiber level is associated with loss of myosin content in these fibers. Moreover, the diaphragm in COPD is exposed to oxidative stress and sarcomeric injury. This review postulates that the oxidative stress and sarcomeric injury activate proteolytic machinery, leading to contractile protein wasting and, consequently, loss of force generating capacity of diaphragm fibers in patients with COPD. Interestingly, several of these presumed pathologic alterations are already present early in the course of the disease (GOLD I/II, although these patients appear not limited in their daily life activities. Treatment of diaphragm dysfunction in COPD is complex since its etiology is unclear, but recent findings indicate the ubiquitin-proteasome pathway as a prime target to attenuate diaphragm wasting in COPD.

  16. Smoking cessation strategies in patients with COPD

    DEFF Research Database (Denmark)

    Warnier, Miriam J; van Riet, Evelien E S; Rutten, Frans H

    2013-01-01

    Smoking cessation is the cornerstone of treatment of chronic obstructive pulmonary disease (COPD) patients. This systematic review evaluates the effectiveness of behavioural and pharmacological smoking cessation strategies in COPD patients. MEDLINE was searched from January 2002 to October 2011....... Randomised controlled trials evaluating the effect of smoking cessation interventions for COPD patients, published in English, were selected. The methodological quality of included trials was assessed using the Delphi list by two reviewers independently. The relative risks of smoking cessation due...... to be of acceptable quality. Pharmacological therapy combined with behavioural counselling was more effective than each strategy separately. In COPD patients, the intensity of counselling did not seem to influence the results, nor did the choice of drug therapy make a difference. This systematic review makes clear...

  17. Risk factors for death while awaiting lung transplantation in Israeli patients: 1997-2006.

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    Shitrit, David; Gershman, Yvgeni; Peled, Nir; Medalion, Benjamin; Saute, Milton; Amital, Anat; Kramer, Mordechai R

    2008-08-01

    Patients with end-stage lung disease very frequently die while awaiting lung transplantation. The aim of this study was to identify factors associated with mortality in patients referred for lung transplant assessment. The files of all consecutive patients listed for lung transplantation in Israel between 1997 and 2006 were reviewed and the data were compared statistically between those who survived to transplantation. A total of 229 patients were listed for lung transplantation, of whom 42 (18.3%) died while awaiting transplantation. Comparison of the patients who survived to transplantation with those who did not using univariate analysis revealed that the died-waiting group was significantly older, used steroids to a greater extent, had more IPF patients and less emphysematous, and lower mean oxygen saturation at rest (p=0.005). There were no between-group differences in comorbid diseases or pulmonary function measurements. The 6 min walk distance was strongly and inversely correlated with risk of death before transplantation (p=0.005). On multivariate analysis, only oxygen saturation at rest was a significant independent risk factor for death while awaiting transplantation (OR 0.886; C.I. 0.805-0.974). There are several risk factors for death in the Israeli population listed for LTX, including age, steroid use, emphysematous patients and lower saturation at rest.

  18. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

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    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Background Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. Objective The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8) to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1.78, all P<0.01). Conclusion Adherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD

  19. The extent of emphysema in patients with COPD

    DEFF Research Database (Denmark)

    Shaker, Saher Burhan; Stavngaard, Trine; Hestad, Marianne

    2009-01-01

    BACKGROUND AND AIMS: The global initiative for COPD (GOLD) adopted the degree of airway obstruction as a measure of the severity of the disease. The objective of this study was to apply CT to assess the extent of emphysema in patients with chronic obstructive pulmonary disease (COPD) and relate...... this extent to the GOLD stage of airway obstruction. MATERIALS AND METHODS: We included 209 patients with COPD. COPD was defined as FEV(1)/FVC or=20 pack-years. Patients were assessed by lung function...... increases with increasing severity of COPD and most patients with COPD have emphysema. Tissue destruction by emphysema is therefore an important determinant of disease severity in COPD....

  20. The cost of treating patients with COPD in Denmark--a population study of COPD patients compared with non-COPD controls

    DEFF Research Database (Denmark)

    Bilde, L; Rud Svenning, A; Dollerup, J;

    2007-01-01

    population than in the control group. COPD patients contacted their general practitioner 12 times more per year than non-COPD controls, but for specialist and paramedic treatment in the primary care sector there was no significant difference between COPD patients and non-COPD controls. Only one third...

  1. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients.

    Science.gov (United States)

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. COPD patients were identified using a large administrative claims database. Selected patients were 40-89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38-1.78, all PAdherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD medications.

  2. Evaluation of atopy in patients with COPD*

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    Neves, Margarida Célia Lima Costa; Neves, Yuri Costa Sarno; Mendes, Carlos Mauricio Cardeal; Bastos, Monalisa Nobre; Camelier, Aquiles Assunção; Queiroz, Cleriston Farias; Mendoza, Bernardo Fonseca; Lemos, Antônio Carlos Moreira; Junior, Argemiro D'Oliveira

    2013-01-01

    OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. PMID:23857681

  3. Caregivers' burden in patients with COPD.

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    Miravitlles, Marc; Peña-Longobardo, Luz María; Oliva-Moreno, Juan; Hidalgo-Vega, Álvaro

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD. We used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions. A total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients. The results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions.

  4. Central airways remodeling in COPD patients

    Directory of Open Access Journals (Sweden)

    Pini L

    2014-09-01

    Full Text Available Laura Pini,1 Valentina Pinelli,2 Denise Modina,1 Michela Bezzi,3 Laura Tiberio,4 Claudio Tantucci1 1Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, 2Department of Respiratory Medicine, Spedali Civili di Brescia, 3Department Bronchoscopy, Spedali Civili di Brescia, 4Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy Background: The contribution to airflow obstruction by the remodeling of the peripheral airways in chronic obstructive pulmonary disease (COPD patients has been well documented, but less is known about the role played by the large airways. Few studies have investigated the presence of histopathological changes due to remodeling in the large airways of COPD patients. Objectives: The aim of this study was to verify the presence of airway remodeling in the central airways of COPD patients, quantifying the airway smooth muscle (ASM area and the extracellular matrix (ECM protein deposition, both in the subepithelial region and in the ASM, and to verify the possible contribution to airflow obstruction by the above mentioned histopathological changes. Methods: Biopsies of segmental bronchi spurs were performed in COPD patients and control smoker subjects and immunostained for collagen type I, versican, decorin, biglycan, and alpha-smooth muscle actin. ECM protein deposition was measured at both subepithelial, and ASM layers. Results: The staining for collagen I and versican was greater in the subepithelial layer of COPD patients than in control subjects. An inverse correlation was found between collagen I in the subepithelial layer and both forced expiratory volume in 1 second and ratio between forced expiratory volume in 1 second and forced vital capacity. A statistically significant increase of the ASM area was observed in the central airways of COPD patients versus controls. Conclusion: These findings indicate that airway remodeling also affects

  5. Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Pompili, Maurizio, E-mail: mpompili@rm.unicatt.i [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy); Pacella, Claudio Maurizio, E-mail: claudiomauriziopacella@gmail.co [Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via S. Francesco D' Assisi, 50, 00041 Albano Laziale (RM) (Italy); Francica, Giampiero, E-mail: giampierofrancica@tin.i [Department of Interventional Ultrasound, Presidio Ospedaliero Camilliani, S. Maria della Pieta, Via S. Rocco, 9, 80026 Casoria (Namibia) (Italy); Angelico, Mario, E-mail: angelico@med.uniroma2.i [Hepatology Unit, Universita di Tor Vergata, Viale Oxford, 81, 00133 Rome (Italy); Tisone, Giuseppe, E-mail: tisone@med.uniroma2.i [Transplant and General Surgery Unit, Universita di Tor Vergata, Ospedale S. Eugenio, Piazzale dell' Umanesimo 10-00144 Rome (Italy); Craboledda, Paolo, E-mail: paolo.craboledda@virgilio.i [Department of Pathology, Ospedale S. Eugenio, Piazzale dell' Umanesimo, 10-00144 Rome (Italy); Nicolardi, Erica; Rapaccini, Gian Ludovico; Gasbarrini, Giovanni [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy)

    2010-06-15

    Objective: The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. Materials and methods: The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. Results: No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. Conclusion: In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.

  6. Why Do Patients with COPD Decline Rehabilitation

    DEFF Research Database (Denmark)

    Mathar, Helle; Fastholm, Pernille; Hansen, Ida Rode

    2016-01-01

    AIM: This paper aimed to suggest possible answers to the question: Why do patients with COPD decline pulmonary rehabilitation (PR)? METHOD: The study is a metasynthesis inspired by Noblit of the existing qualitative research on the area. The data were collected during 2014. Six studies were found...

  7. Frailty syndrome in ambulatory patients with COPD

    Directory of Open Access Journals (Sweden)

    Limpawattana P

    2017-04-01

    Full Text Available Panita Limpawattana,1 Siraphong Putraveephong,2 Pratchaya Inthasuwan,2 Watchara Boonsawat,3 Daris Theerakulpisut,4 Jarin Chindaprasirt5 1Division of Geriatric Medicine, 2Department of Internal Medicine, 3Division of Respiratory System, Department of Internal Medicine, 4Division of Nuclear Medicine, Department of Radiology, 5Division of Oncology Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Abstract: Frailty is a state of increased risk of unfavorable outcomes when exposed to stressors, and COPD is one of the several chronic illnesses associated with the condition. However, few studies have been conducted regarding the prevalence of COPD and its related factors in Southeast Asia. The objectives of this study were to determine the prevalence of frailty in COPD patients and to identify the associated factors in these populations. A cross-sectional study of COPD patients who attended a COPD clinic was conducted from May 2015 to December 2016. Baseline characteristics were collected, and the diagnosis of frailty was based on the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight scale. Descriptive statistics were used to analyze baseline data. Factors associated with frailty were analyzed using univariate and multivariate regression analyses. The results showed that the prevalence rates of frailty and pre-frailty were 6.6% (eight out of 121 cases and 41.3% (50 out of 121 cases, respectively, among COPD patients. Fatigue was the most common component of the FRAIL scale that was found more frequently in frail patients than in non-frail patients (odds ratio [OR] 91.9. Factors associated with frailty according to multivariate analyses were comorbid cancer (adjusted OR [AOR] 45.8, at least two instances of nonelective admission over the past 12 months (AOR 112.5, high waist circumference (WC (AOR 1.3, and presence of sarcopenia (AOR 29.5. In conclusion, frailty affected 6.6% of

  8. Altered mitochondrial regulation in quadriceps muscles of patients with COPD

    DEFF Research Database (Denmark)

    Naimi, Ashley I; Bourbeau, Jean; Perrault, Helene

    2011-01-01

    to complex I (COPD 38·28 ± 3·58 versus control 42·85 ± 3·10 pmol s(-1) mg tissue(-1) ), but O(2) flux with addition of succinate was lower in COPD patients (COPD 63·72 ± 6·33 versus control 95·73 ± 6·53 pmol s(-1) mg tissue(-1) ); (iii) excess capacity of cytochrome c oxidase in COPD patients was only ~50...

  9. Patient needs and medication styles in COPD

    Directory of Open Access Journals (Sweden)

    L. M. Osman

    2005-12-01

    Full Text Available Patient self-care in illnesses such as chronic obstructive pulmonary disease (COPD is influenced by "trade-offs" that patients make between their social and psychological needs, and the "best practice" clinical management of their illness. Patients weigh the benefits of taking medication against the costs, such as symptoms. Personal styles of medication use and decision-making also affect how well COPD patients respond to treatment plans and their acceptance of particular treatments, including inhalers. The large amount of information now available may have made patients more autonomous than before, but the actual locus of control varies widely between patients. Patients seem to take a pragmatic approach when assessing inhaler devices, basing preference on how effective they perceive the device to be. Patients with COPD show loyalty to devices and, in the main, try to comply with instructions given by the healthcare provider. The health path for chronic obstructive pulmonary disease, which describes the course the disease typically takes, is a progressive deterioration. Patients therefore adopt a conservative attitude to their health goals and what they expect to gain from treatment and management plans. An understanding of these influences will help healthcare providers support the patient better and give the appropriate advice at each phase of a patient's health path.

  10. Caregivers’ burden in patients with COPD

    Science.gov (United States)

    Miravitlles, Marc; Peña-Longobardo, Luz María; Oliva-Moreno, Juan; Hidalgo-Vega, Álvaro

    2015-01-01

    Objective Chronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD. Methods We used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions. Results A total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients. Conclusion The results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions. PMID:25709429

  11. Pharmaceutical costs of desensitization therapy in patients awaiting lung transplantation in France.

    Science.gov (United States)

    Liu, Annaë; Bernard, Mélisande

    2014-02-01

    Based on solid experience in renal transplant, new treatments aiming to decrease anti-human leukocyte antigen (HLA) antibodies in patients awaiting lung transplant have recently been developed. The off-label use of high-dose intravenous polyvalent immunoglobulins (IVIg) and/or plasmapheresis changes the economical weight of pharmaceutical cost before lung transplantation. Our objective was to assess the budgetary impact of pharmaceutical costs of desensitization therapy. Two observational studies were conducted in 2009 and 2010 at the Bichat Claude Bernard (BCB) hospital in France. The first assessed the real pharmaceutical costs, and identified cost drivers, of desensitized (D+) patients awaiting lung transplantation. The second compared pharmaceutical and clinical data between D+ and non-treated (D-) patients. The major cost drivers were IVIg, representing 89.7 % of pharmaceutical costs. The real cost of drugs was €4,392 ± 647 per hospitalization. Mean hospitalization and annual pharmaceutical costs per patient were significantly higher for D+ than for D- patients (€6,972 vs. 2,925 and €13,074 vs. 399). D+ patients had a significantly higher average number of annual hospitalizations than did D- patients. Total IVIg costs represented 98 % of the pharmaceutical costs for desensitization stays. Pharmaceutical costs represented 40 % of total hospitalization costs for D+ versus only 7 % for D-. New desensitization protocols can help to manage the immunological hurdle of anti-donor antibodies in lung transplantation. They are expensive and not yet correctly covered by national health insurance, as they are supported by hospital budgets. A medico-economical evaluation of IVIg use in this indication seems necessary.

  12. Risk Factors for Portal Vein Thrombosis in Patients With Cirrhosis Awaiting Liver Transplantation in Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    Bagheri Lankarani

    2015-12-01

    Full Text Available Background Portal vein thrombosis is a fairly common and potentially life-threatening complication in patients with liver cirrhosis. The risk factors for portal vein thrombosis in these patients are still not fully understood. Objectives This study aimed to investigate the associations between various risk factors in cirrhotic patients and the development of portal vein thrombosis. Patients and Methods In this case-control study performed at the Shiraz organ transplantation center, Iran, we studied 219 patients (> 18 years old with liver cirrhosis, who were awaiting liver transplants in our unit, from November 2010 to May 2011. The patients were evaluated by history, physical examination, and laboratory tests, including factor V Leiden, prothrombin gene mutation, Janus Kinase 2 (JAK2 mutation, and serum levels of protein C, protein S, antithrombin III, homocysteine, factor VIII, and anticardiolipin antibodies. Results There was no statistically significant difference in the assessed hypercoagulable states between patients with or without portal vein thrombosis. A history of previous variceal bleeding with subsequent endoscopic treatment in patients with portal vein thrombosis was significantly higher than in those without it (P = 0.013, OR: 2.526, 95% CI: 1.200 - 5.317. Conclusions In our population of cirrhotic patients, treatment of variceal bleeding predisposed the patients to portal vein thrombosis, but hypercoagulable disorders by themselves were not associated with portal vein thrombosis.

  13. COPD

    Science.gov (United States)

    COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate ...

  14. Loco-regional therapies for patients with hepatocellular carcinoma awaiting liver transplantation: Selecting an optimal therapy.

    Science.gov (United States)

    Byrne, Thomas J; Rakela, Jorge

    2016-06-24

    Hepatocellular carcinoma (HCC) is a common, increasingly prevalent malignancy. For all but the smallest lesions, surgical removal of cancer via resection or liver transplantation (LT) is considered the most feasible pathway to cure. Resection - even with favorable survival - is associated with a fairly high rate of recurrence, perhaps since most HCCs occur in the setting of cirrhosis. LT offers the advantage of removing not only the cancer but the diseased liver from which the cancer has arisen, and LT outperforms resection for survival with selected patients. Since time waiting for LT is time during which HCC can progress, loco-regional therapy (LRT) is widely employed by transplant centers. The purpose of LRT is either to bridge patients to LT by preventing progression and waitlist dropout, or to downstage patients who slightly exceed standard eligibility criteria initially but can fall within it after treatment. Transarterial chemoembolization and radiofrequency ablation have been the most widely utilized LRTs to date, with favorable efficacy and safety as a bridge to LT (and for the former, as a downstaging modality). The list of potentially effective LRTs has expanded in recent years, and includes transarterial chemoembolization with drug-eluting beads, radioembolization and novel forms of extracorporal therapy. Herein we appraise the various LRT modalities for HCC, and their potential roles in specific clinical scenarios in patients awaiting LT.

  15. [Cytotoxicity of natural anti-HLA antibodies in Moroccan patients awaiting for kidney transplantation].

    Science.gov (United States)

    Benseffaj, Nadia; Ouadghiri, Sanae; Bourhanbour, Asmaa Drissi; Zerrouki, Asmae Noor; Essakalli, Malika

    2017-02-01

    The presence of anti-HLA antibodies in the serum of a patient result from an immune response produced during an immunizing event as transfusion, pregnancy or graft. These antibodies can be cytotoxic by activating the complement pathway via C1q and may cause organ rejection during the transplant. Some male patients awaiting kidney transplantation are seropositive for anti-HLA antibodies when they have no immunizing antecedent event. These antibodies are qualified as natural antibodies. Our work is to assess the cytotoxicity of natural anti-HLA antibodies in patients followed at the immunology laboratory of the blood transfusion service and hemovigilance (STSH) as part of the kidney transplant. We evaluated the cytotoxicity of HLA antibodies detected in male Moroccan patients without immunization history using C1qScreen One Lambda reagent for Luminex™. Non-immunized men were positive for HLA antibodies screening in 25.4%. These antibodies are not cytotoxic. Our study showed a positivity rate of natural HLA antibody low than the literature (25.4% against 63%). It appears that these natural antibodies are not cytotoxic and their involvement in renal transplant remains to be determined. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  16. Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2011-02-01

    Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD.

  17. Association of lung perfusion disparity and mortality in patients with cystic fibrosis awaiting lung transplantation.

    Science.gov (United States)

    Stanchina, Michael L; Tantisira, Kelan G; Aquino, Suzanne L; Wain, John C; Ginns, Leo C

    2002-02-01

    The risk of death for patients with end-stage cystic fibrosis awaiting lung transplantation remains high and most patients succumb to respiratory failure. This study was conducted to evaluate the usefulness of ventilation-perfusion scintillation scans, obtained during the pre-transplant period, to identify patterns that predict prognosis while on the waiting list. These patterns were compared with other pulmonary physiologic markers of ventilation and perfusion obtained from pulmonary function and cardiopulmonary exercise tests. From November 1990 to January 1999, 46 patients with cystic fibrosis were listed for bilateral lung transplantation. Fourteen (30.4%) died while waiting for a transplant (Group 1), whereas 32 were transplanted successfully or remain alive and waiting (Group 2). Mean arterial blood gas values, Brasfield radiograph scores, cardiopulmonary exercise data and the degree of scintillation scan abnormalities between lungs were compared for each group. Mean survival for Group 1 was 10.2 +/- 1.7 months, and for Group 2 was 23.5 +/- 3.0 months (p < 0.001). The right upper lung zone was the most severely affected segment. The Cox proportional hazards model revealed an increased perfusion disparity and resting hypercapnia as the main predictors of death while on the transplant list. The Kaplan-Meier analysis indicated greater survival for the groups with <30% disparity between lungs on the pre-transplant scintillation scans. The results suggest that severe, unilateral perfusion abnormalities seen on scintillation scans in patients with cystic fibrosis are associated with an increased risk of dying while on the lung transplant waiting list and may be helpful in identifying patients who should be considered for early or living-donor transplantation.

  18. Human leucocyte antigens: their association with end-stage renal disease in Saudi patients awaiting transplantation.

    Science.gov (United States)

    Almogren, A; Shakoor, Z; Hamam, K D

    2012-01-01

    Most patients with chronic renal failure develop end-stage renal disease (ESRD) that requires renal transplantation. This study investigates the possible associations between human leucocyte antigen (HLA) Class I and Class II molecules with ESRD. Genotyping data (HLA) obtained between 2005 and 2009 on 235 unrelated Saudi patients (147 males, 88 females; mean age: 58 +/- 7 years) with ESRD awaiting renal transplantation were assessed retrospectively at the King Khalid University Hospital. Data were compared with the results on 60 normal, healthy, unrelated Saudi individuals (37 males and 23 females; mean age: 51 +/- 5 years). HLA Class I and Class II antigens were detected by lymphocytotoxicity and a polymerase chain reaction (PCR) method using DNA sequence-specific primers. Although present in small numbers, HLA Cw2 was found in significantly fewer patients (n = 11; 4.68%) compared to normal subjects (n = 9; 15%) and was found to confer protection against ESRD (P = 0.005; relative risk [RR]: 3.594, 95% confidence interval [CI]: 1.415-9.126). Among the HLA Class II antigens, HLA DQB1*03(8) was detected more frequently in the patient group (n = 65; 27.6%) than in the normal controls (n = 9; 15%) and was positively associated with risk of ESRD (P = 0.04; RR: 0.462, 95% CI: 0.215-0.991). No significant differences were observed between the two groups in respect of HLA-A2, HLA-B50(21), HLA-B51(5) and HLA-Cw7 (HLA Class I), and HLA-DRB1*04, HLA-DRB1*07 and HLA-DQB1*02 (HLA Class II). Occurrence of the most frequent HLA alleles was no different between the ESRD group and the controls. The protective role of HLA-Cw2 and the marginal susceptibility associated with HLA-DQBI*03(8) for ESRD requires further investigation.

  19. Red blood cell and leukocyte alloimmunization in patients awaiting kidney transplantation

    Science.gov (United States)

    da Silva, Silvia Fernandes Ribeiro; Ferreira, Gláucia Maria; da Silva, Sonia Leite; Alves, Tânia Maria de Oliveira; Ribeiro, Ilana Farias; Ribeiro, Thyciana Rodrigues; Cavalcante, Maria do Carmo Serpa

    2013-01-01

    Objective To determine the rates of red blood cell and leukocyte alloimmunization in patients with chronic kidney disease awaiting kidney transplantation. Methods In this cross-sectional and prospective study, the serum of 393 chronic kidney disease patients on a transplant waiting list in Ceará, Northeastern Brazil were tested for red cell and leukocyte antibodies. In addition, demographic, clinical and laboratory data were collected. Results The average age in the sample of 393 patients was 34.1 ± 14 years. Slightly more than half (208; 52.9%) were male. The average numbers of transfusions and gestations were 3.1 ± 3.3 and 1.6 ± 6, respectively. One third (33.6%) were alloimmunized: 78% with leukocyte antibodies, 9.1% with red cell antibodies and 12.9% with both. Red cell antibodies were detected in 29 cases (7.4%), 17 of whom were women, who had received more transfusions than the males (p-value < 0.0001). The most frequently detected red cell antibodies belonged to the Rh (24.1%) and Kell (13.8%) blood group systems. Leukocyte antibodies were detected in 30.5% of cases, 83 of whom were women, who had received more transfusions than the males (p-value < 0.0001) and were more reactive to panel reactive antibodies (p-value < 0.0001). The mean alloreactivity to panel reactive antibodies was 47.7 ± 31.2%. Conclusion Chronic kidney disease patients on the transplant waiting list in Ceará, Brazil, display high rates of red cell (7.4%) and leukocyte (30.5%) alloimmunization. In this sample, alloimmunization was significantly associated with the number of transfusions and gender. PMID:23904808

  20. Undernutrition in Patients with COPD and Its Treatment

    Directory of Open Access Journals (Sweden)

    Hiroyuki Nakamura

    2013-04-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a chronic inflammatory disorder of the lung and whole body caused mainly by tobacco smoking. Patients with advanced COPD are in a state of undernutrition, referred to as pulmonary cachexia; the exercise performance and quality of life (QOL of these patients are deteriorated, the vital prognosis is unfavorable, and the medico-economic burden posed by poorly nourished COPD patients is high. The mainstays of COPD treatment are pharmacotherapy, mainly with bronchodilators, and non-pharmacotherapeutic approaches such as respiratory rehabilitation and nutrition counseling. Nutritional supplement therapy, consisting primarily of high calorie intake, has been demonstrated to be effective for maintaining and improving the muscle strength and exercise tolerance in poorly nourished COPD patients. The efficacy of intake of various nutrients, besides a high calorie intake, for amelioration of the disease state of COPD has also been reported. The roles of adipokines in the pathophysiology of COPD have begun to receive attention recently, and not only their regulatory effects on appetite and nutritional status, but also their influence on systemic inflammation have been increasingly clarified. We review the papers on COPD and nutrition and discuss the role of nutritional supplement therapy in the treatment of COPD.

  1. Evaluating inhaler use technique in COPD patients

    Directory of Open Access Journals (Sweden)

    Pothirat C

    2015-07-01

    Full Text Available Chaicharn Pothirat, Warawut Chaiwong, Nittaya Phetsuk, Sangnual Pisalthanapuna, Nonglak Chetsadaphan, Woranoot Choomuang Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: Poor inhalation techniques are associated with decreased medication delivery and poor disease control in chronic obstructive pulmonary disease (COPD. The purpose of this study was to evaluate techniques for using inhaler devices in COPD patients.Methods: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across four regimens, ie, the pressurized metered-dose inhaler (pMDI, the pMDI with a spacer, the Accuhaler®, and the Handihaler®. The percentage of compliance with essential steps of correct device usage for each regimen was recorded without prior notification when COPD patients presented for a routine visit, and 1 month after receiving face-to-face training. We compared the percentage of compliance between the devices and risk factors related to incorrect techniques using logistic regression analysis. Percentage of patient compliance with correct techniques was compared between the two visits using the chi-square test. Statistical significance was set at P<0.05.Results: A total of 103 COPD patients (mean age 71.2±9.2 years, males 64.1%, low education level 82.5%, and percent predicted forced expiratory volume in 1 second 51.9±22.5 were evaluated. Seventy-seven patients (74.8% performed at least one step incorrectly. Patients using the Handihaler had the lowest compliance failure (42.5%, and the odds ratio for failure with the other devices compared with the Handihaler were 4.6 (95% confidence interval [CI] 1.8–11.8 for the pMDI, 3.1 (95% CI 1.2–8.2 for the pMDI with a spacer, and 2.4 (95% CI 1.1–5.2 for the Accuhaler. Low education level was the single most important factor related

  2. How do COPD patients distribute their daily activities?

    NARCIS (Netherlands)

    Tabak, Monique; Vollenbroek-Hutten, Miriam Marie Rosé; van der Valk, P.; van der Palen, Jacobus Adrianus Maria; Tönis, Thijs; Hermens, Hermanus J.

    2011-01-01

    Better insight in daily activity behaviour of COPD patients is needed as a first step to enable a tailoring of their treatment. The objective of this study was to measure the daily activity of COPD patients and to compare the daily activity distribution with asymptomatic controls, using triaxial acc

  3. Determinants of elevated healthcare utilization in patients with COPD

    Directory of Open Access Journals (Sweden)

    Bernhard-Scharf Barbara J

    2011-01-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Methods Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL indices were obtained using validated questionnaires among a subsample of 177 patients. Results Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p Conclusion Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

  4. [Inhaled corticosteroids in patients with COPD: maintain current guidelines

    NARCIS (Netherlands)

    Heijdra, Y.F.

    2007-01-01

    The use of inhaled corticosteroids (ICS) is one of the most controversial issues in COPD treatment. There is evidence that ICS with or without long-acting beta-2-adrenergics (LABA) reduce exacerbation rates and improve the health status of severe COPD patients. The effects on FEV1 are limited and th

  5. [Smoking cessation in patients with COPD].

    Science.gov (United States)

    Andreas, S; Batra, A; Behr, J; Chenot, J-F; Gillissen, A; Hering, T; Herth, F J F; Kreuter, M; Meierjürgen, R; Mühlig, S; Nowak, D; Pfeifer, M; Raupach, T; Schultz, K; Sitter, H; Walther, J W; Worth, H

    2014-04-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Cigarette smoking is the main cause of COPD. Quitting smoking is thus the most effective treatment strategy and central in COPD prevention. A number of guidelines on prevention, diagnosis, therapy and rehabilitation of COPD have been published. To help implementing and standardizing smoking cessation in COPD a guideline was published 2008 in Germany focusing on this complex issue. The present guideline is an update of the 2008 guideline and has a high grade of evidence (S3 according to the AWMF; Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften). The guideline gives comprehensive and practical information on how to integrate smoking cessation as an central part of COPD therapy.

  6. Patients with COPD have low adherence to inhaled medicine

    DEFF Research Database (Denmark)

    Lange, Peter; Toettenborg, Sandra; Topp, Marie

    2014-01-01

    describe results of previous studies on prevalence of adherence to inhaled medicine in COPD, and define characteristics of the patients and treatment associated with degree of adherence. We conclude that health professionals should always consider non-adherence, strive to simplify regiments......Medicine adherence in patients with obstructive pulmonary disease (COPD), has not been studied in Denmark. Studies from other countries, however, unequivocally report low prevalence of patients who follow their doctor's advice and have sufficient adherence to inhaled medicine. In this review we......, and that there is an urgent need of studies aiming at improving adherence in patients with COPD....

  7. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

  8. Prevalence of Metabolic Syndrome in COPD Patients and Its Consequences

    Science.gov (United States)

    Breyer, Marie-Kathrin; Spruit, Martijn A.; Hanson, Corrine K.; Franssen, Frits M. E.; Vanfleteren, Lowie E. G. W.; Groenen, Miriam T. J.; Bruijnzeel, Piet L. B.; Wouters, Emiel F. M.; Rutten, Erica P. A.

    2014-01-01

    Background The prevalence of metabolic syndrome in COPD patients and its impact on patient related outcomes has been little studied. We evaluated the prevalence of metabolic syndrome and clinical and functional characteristics in patients with COPD and healthy subjects. Methods 228 COPD patients and 156 healthy subjects were included. Metabolic syndrome was defined using criteria of the IDF. In all patients spirometry, body composition, functional exercise performance, and mood and health status were assessed. Groups were stratified for BMI and gender. Results Metabolic syndrome was present in 57% of the COPD patients and 40% of the healthy subjects. After stratification for BMI, presence of metabolic syndrome in patients with a BMI ≥25 kg/m2 was higher than in healthy peers. Patients with metabolic syndrome and a BMI metabolic syndrome. Spirometry, maximal ergometry, mood and health status, and blood gases were not different between those groups. In COPD patients with metabolic syndrome self-reported co-morbidities and medication use were higher than in those without. Conclusion Metabolic syndrome is more prevalent in overweight or obese COPD patients than in BMI matched healthy subjects. Metabolic syndrome did not additionally impact patients' functional outcomes, but did impact the prevalence of co-morbidities. PMID:24950070

  9. The impact of treatment with indacaterol in patients with COPD

    DEFF Research Database (Denmark)

    Kerstjens, Huib A M; Deslée, Gaëtan; Dahl, Ronald

    2015-01-01

    BACKGROUND: Indacaterol is an inhaled, once-daily, ultra-long-acting β2-agonist for the treatment of chronic obstructive pulmonary disease (COPD). We report on the effectiveness of indacaterol and other bronchodilators compared with placebo in patients across the Global Initiative for Chronic...... treatment of COPD. Indacaterol 150 and 300 μg effectively improved lung function and symptoms in patients across all GOLD 2011 categories....

  10. L-Arginine Pathway in COPD Patients with Acute Exacerbation

    DEFF Research Database (Denmark)

    Ruzsics, Istvan; Nagy, Lajos; Keki, Sandor

    2016-01-01

    (ADMA, SDMA) is related to hypoxia. In COPD, a rise in ADMA results in a shift of L-arginine breakdown, contributing to airway obstruction. We aimed to compare serum levels of ADMA, SDMA and L-arginine in patients with and without AECOPD. METHODS: L-arginine metabolites quantified by high......-performance liquid chromatography in venous blood samples and partial capillary oxygen pressure were prospectively investigated in 32 patients with COPD, 12 with AECOPD and 30 healthy subjects. RESULTS: Both ADMA and SDMA were significantly higher in AECOPD compared to stable COPD (p = 0.004 and p ....001, respectively). Oxygen content in capillaries correlated with serum ADMA concentration. However, the concentration of L-arginine was not different between AECOPD and stable COPD. Both ADMA and SDMA separated AECOPD with high sensitivity and specificity (AUC: 0.81, p = 0.001; AUC: 0.91, p

  11. Clinical implications of blood eosinophil count in patients with non-asthma–COPD overlap syndrome COPD

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    Song JH

    2017-08-01

    Full Text Available Jin Hwa Song,1 Chang-Hoon Lee,1 Jin Woo Kim,2 Won-Yeon Lee,3 Ji Ye Jung,4 Joo Hun Park,5 Ki Suck Jung,6 Kwang Ha Yoo,7 Yong Bum Park,8 Deog Keom Kim9 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 2Division of Pulmonology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 3Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, 4Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 5Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 6Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Gyeonggi-do, 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 8Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea Background: Recent studies that assessed the relevance of the blood eosinophil count as a biomarker in patients with COPD may have overestimated it because they included patients with asthma–COPD overlap syndrome (ACOS. We investigated the clinical implications of the blood eosinophil count in patients with non-ACOS COPD.Patients and methods: From a Korean COPD Subtype Study (KOCOSS cohort, we selected patients with non-ACOS COPD after excluding ACOS patients according to Spanish criteria. Clinical characteristics and the incidence of moderate-to-severe exacerbation were compared

  12. COPD in primary lung cancer patients: prevalence and mortality

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    Ytterstad E

    2016-03-01

    Full Text Available Elinor Ytterstad,1 Per C Moe,2 Audhild Hjalmarsen3 1Department of Mathematics and Statistics, UiT The Arctic University of Norway, 2Department of Pulmonary Medicine, University Hospital of North Norway, 3Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway Background: Previous studies have relied on international spirometry criteria to diagnose COPD in patients with lung cancer without considering the effect lung cancer might have on spirometric results. The aim of this study was to examine the prevalence of COPD and emphysema at the time of primary lung cancer diagnosis and to examine factors associated with survival.  Materials and methods: Medical records, pulmonary function tests, and computed tomography scans were used to determine the presence of COPD and emphysema in patients diagnosed with primary lung cancer at the University Hospital of North Norway in 2008–2010.  Results: Among the 174 lung cancer patients, 69% had COPD or emphysema (39% with COPD, 59% with emphysema; male:female ratio 101:73. Neither COPD nor emphysema were significantly associated with lung cancer mortality, whereas patients with non-small-cell lung cancer other than adenocarcinoma and squamous cell carcinoma had a risk of lung cancer mortality that was more than four times higher than that of patients with small-cell lung cancer (hazard ratio [HR] 4.19, 95% confidence interval [CI] 1.56–11.25. Females had a lower risk of lung cancer mortality than males (HR 0.63, 95% CI 0.42–0.94, and patients aged ≥75 years had a risk that was twice that of patients aged <75 years (HR 2.48, 95% CI 1.59–3.87. Low partial arterial oxygen pressure (4.0–8.4 kPa increased the risk of lung cancer mortality (HR 2.26, 95% CI 1.29–3.96. So did low partial arterial carbon dioxide pressure (3.0–4.9 kPa among stage IV lung cancer patients (HR 2.23, 95% CI 1.29–3.85. Several patients with respiratory failure had previously been diagnosed

  13. BMI AS A MARKER OF SEVERITY IN PATIENTS WITH COPD

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    Mohammed Soheb Sadath Ansari

    2017-02-01

    Full Text Available BACKGROUND COPD has evolved overtime as a clinical syndrome rather than a disease that is limited to respiratory system and presently the systemic manifestations and comorbid illnesses are much better understood and known. Globally, as well as in India, the burden of COPD continues to increase and by 2030 it is expected to be the third leading cause of death. Although, the back bone of therapy is pharmacotherapy, the role of rehabilitation and management of systemic problems in COPD is increasing. One of the components of management of COPD other than the lungs include maintenance of nutrition and body weight of COPD patients as it has been shown in many studies that BMI tends to fall as the disease progresses and can be considered as a marker of severity. In this study, we have tried to study the nutritional state of COPD patients and correlate it with disease severity. In this study, the COPD patients were graded into three groups and percentage of patients with low normal and below normal BMI were studied in each group. MATERIALS AND METHODS A total of 108 COPD (chronic obstructive pulmonary disease patients diagnosed based on smoking history and spirometry with post bronchodilator FEV1/FVC <0.7 were taken into the study at Bhaskar Medical College between 2015 and 2016. The severity of COPD was graded based on FEV1 (forced expiratory volume in first second values recorded from spirometry after calibrating the spirometer daily with 3 litre syringe. The height and weight were recorded and BMI calculated by dividing weight in kilograms by height in metre square and then the BMI was graded as per WHO guidelines. RESULTS The BMI was low normal and below normal in 18.75% of patients with mild and moderate disease group (FEV1 50-80%. In patients with severe disease group (FEV1 30-50%, the BMI was low normal and below normal in 43.3% and in very severe disease group (FEV1 <30%, the BMI was low normal and below normal in 57.14%. The results has shown

  14. Evaluation of von Willebrand factor in COPD patients

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    Thiago Prudente Bártholo

    2014-08-01

    Full Text Available OBJECTIVE: To compare the absolute serum von Willebrand factor (vWF levels and relative serum vWF activity in patients with clinically stable COPD, smokers without airway obstruction, and healthy never-smokers. METHODS: The study included 57 subjects, in three groups: COPD (n = 36; smoker (n = 12; and control (n = 9. During the selection phase, all participants underwent chest X-rays, spirometry, and blood testing. Absolute serum vWF levels and relative serum vWF activity were obtained by turbidimetry and ELISA, respectively. The modified Medical Research Council scale (cut-off score = 2 was used in order to classify COPD patients as symptomatic or mildly symptomatic/asymptomatic. RESULTS: Absolute vWF levels were significantly lower in the control group than in the smoker and COPD groups: 989 ± 436 pg/mL vs. 2,220 ± 746 pg/mL (p < 0.001 and 1,865 ± 592 pg/mL (p < 0.01. Relative serum vWF activity was significantly higher in the COPD group than in the smoker group (136.7 ± 46.0% vs. 92.8 ± 34.0%; p < 0.05, as well as being significantly higher in the symptomatic COPD subgroup than in the mildly symptomatic/asymptomatic COPD subgroup (154 ± 48% vs. 119 ± 8%; p < 0.05. In all three groups, there was a negative correlation between FEV1 (% of predicted and relative serum vWF activity (r2 = −0.13; p = 0.009. CONCLUSIONS: Our results suggest that increases in vWF levels and activity contribute to the persistence of systemic inflammation, as well as increasing cardiovascular risk, in COPD patients.

  15. Hospitalized patients with COPD: analysis of prior treatment

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    Irai Luis Giacomelli

    2014-06-01

    Full Text Available Objective: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. Methods: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook. Results: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. Conclusions: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.

  16. Mortality associated with bone fractures in COPD patients

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    Yamauchi Y

    2016-09-01

    Full Text Available Yasuhiro Yamauchi,1 Hideo Yasunaga,2 Yukiyo Sakamoto,1 Wakae Hasegawa,1 Hideyuki Takeshima,1 Hirokazu Urushiyama,1 Taisuke Jo,1,3 Hiroki Matsui,2 Kiyohide Fushimi,4 Takahide Nagase1 1Department of Respiratory Medicine, Graduate School of Medicine, 2Department of Clinical Epidemiology and Health Economics, School of Public Health, 3Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 4Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan Background and objective: COPD is well known to frequently coexist with osteoporosis. Bone fractures often occur and may affect mortality in COPD patients. However, in-hospital mortality related to bone fractures in COPD patients has been poorly studied. This retrospective study investigated in-hospital mortality of COPD patients with bone fractures using a national inpatient database in Japan.Methods: Data of COPD patients admitted with bone fractures, including hip, vertebra, shoulder, and forearm fractures to 1,165 hospitals in Japan between July 2010 and March 2013, were extracted from the Diagnosis Procedure Combination database. The clinical characteristics and mortalities of the patients were determined. Multivariable logistic regression analysis was also performed to determine the factors associated with in-hospital mortality of COPD patients with hip fractures.Results: Among 5,975 eligible patients, those with hip fractures (n=4,059 were older, had lower body mass index (BMI, and had poorer general condition than those with vertebral (n=1,477, shoulder (n=281, or forearm (n=158 fractures. In-hospital mortality was 7.4%, 5.2%, 3.9%, and 1.3%, respectively. Among the hip fracture group, surgical treatment was significantly associated with lower mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.32–0.56 after adjustment for patient backgrounds. Higher in-hospital mortality was

  17. Empowering Patients with COPD Using Tele-Homecare Technology

    DEFF Research Database (Denmark)

    Huniche, Lotte

    2010-01-01

    Abstract. This paper describes how a tele-rehabilitation program using home tele-monitoring empowers patients with COPD. The paper is based on findings from an ongoing research and innovation project, called “Telehomecare, chronic patients and the integrated healthcare system” (the TELEKAT project......) that employs triple interventions related to patients, professionals, and the organisation of care. The ways COPD patients utilize home tele-monitoring in the TELEKAT project points to the relevance of empowerment, as rooted in ideologies of social action, and focusing on the improvement of both personal...

  18. Enteral nutrition in the chronic obstructive pulmonary disease (COPD) patient.

    Science.gov (United States)

    DeBellis, Heather F; Fetterman, James W

    2012-12-01

    Chronic obstructive pulmonary disease (COPD) is a progressive, chronic disease, in which malnutrition can have an undesirable effect. Therefore, the patient's nutritional status is critical for optimizing outcomes in COPD. The initial nutrition assessment is focused on identifying calorically compromised COPD patients in order to provide them with appropriate nutrition. Nutritional intervention consists of oral supplementation and enteral nutrition to prevent weight loss and muscle mass depletion. Evaluation of nutritional status should include past medical history (medications, lung function, and exercise tolerance) and dietary history (patient's dietary habits, food choices, meal patterns, food allergy information, and malabsorption issues), in addition to physiological stress, visceral proteins, weight, fat-free mass, and body mass index. The current medical literature conflicts regarding the appropriate type of formulation to select for nutritional intervention, especially regarding the amount of calories from fat to provide COPD patients. This review article focuses on the enteral product formulations currently available, and how they are most appropriately utilized in patients with COPD.

  19. Attitudes of COPD patients towards tele-rehabilitation

    DEFF Research Database (Denmark)

    Dinesen, Birthe; Huniche, Lotte; Toft, Egon

    2013-01-01

    the intervention group, 22 COPD patients were selected for qualitative interviews and participant observation in their homes. The theoretical framework for this study is based on learning theory and the “communities of practice” approach inspired by Etienne Wenger. COPD patients exhibit four types of attitudes...... surroundings. A total of 111 COPD patients were included in the study, and they were randomized into an intervention group (n = 60) and a control group (n = 51). However, a non-randomized design was used to analyze the qualitative perspectives of the patients’ attitudes towards tele-rehabilitation. From...... about their tele-rehabilitation: indifference, learning as part of situations in everyday life, feeling of security and motivation for performing physical training. The patients express the view that they circulate between these attitudes depending on their physical and emotional state as they perform...

  20. Distribution of Pneumocystis jirovecii in lungs from colonized COPD patients

    Science.gov (United States)

    Sivam, Sheila; Sciurba, Frank C.; Lucht, Lorrie A.; Zhang, Yingze; Duncan, Steven R.; Norris, Karen A.; Morris, Alison

    2011-01-01

    Pneumocystis jirovecii has been detected in lung tissue from patients with chronic obstructive pulmonary disease (COPD) and is associated with disease severity. The regional distribution of the organism in lungs is unknown, but differences in distribution of Pneumocystis could affect estimates of colonization prevalence. We examined the distribution of Pneumocystis in the lungs of 19 non-HIV-infected patients with COPD who were undergoing lung transplantation. DNA was extracted from explanted lungs. We found Pneumocystis colonization in lung tissue of 42.1% of patients with advanced COPD; however, there was significant regional variation in colonization between lung segments of individual patients. Colonization was detected more commonly in the lower and middle lobes than the upper lobes. These findings suggest that single samples from an individual may underestimate the prevalence of Pneumocystis colonization and future studies may obtain a higher yield of Pneumocystis colonization detection when sampling the lower lobes. PMID:21851870

  1. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

    NARCIS (Netherlands)

    Yohannes, A.M.; Hann, M.; Sibbald, B.S.

    2011-01-01

    AIMS: We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. BACKGROUND: Depression is common in patients with COPD. Untreated

  2. Barriers associated with reduced physical activity in COPD patients

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    Priscila Batista Amorim

    2014-10-01

    Full Text Available OBJECTIVE: To evaluate the ability of COPD patients to perform activities of daily living (ADL; to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT, and an ADL limitation score. METHODS: In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. RESULTS: We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5 ± 25.8 min/day vs. 105.2 ± 49.4 min/day; p < 0.001, as was the distance walked (3.9 ± 1.9 km/day vs. 6.4 ± 3.2 km/day; p < 0.001. The COPD patients also walked fewer steps/day. The most common self-reported barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. CONCLUSIONS: Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures.

  3. Cardiovascular events in patients with COPD: TORCH study results

    DEFF Research Database (Denmark)

    Calverley, Peter M A; Anderson, Julie A; Celli, Bartolome;

    2010-01-01

    BACKGROUND: Previous studies have suggested that long-term use of beta agonists to treat chronic obstructive pulmonary disease (COPD) may increase the risk of cardiovascular adverse events. In this post hoc analysis, data from the TOwards a Revolution in COPD Health (TORCH) study were used...... to investigate whether use of the long-acting beta(2) agonist salmeterol over 3 years increased the risk of cardiovascular adverse events in patients with moderate to severe COPD. METHODS: TORCH was a randomised, double-blind, placebo controlled study conducted at 444 centres in 42 countries. Patients (n=6184.......2% for placebo, 22.7% for salmeterol, 24.3% for fluticasone propionate and 20.8% for SFC. Although a history of myocardial infarction doubled the probability of cardiovascular adverse events, the event rates remained similar across treatment groups. CONCLUSION: Post hoc analysis of the 3-year TORCH dataset...

  4. Does roflumilast induce phagocytic activity in COPD patients?

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    Ghosh B

    2015-09-01

    Full Text Available Baishakhi Ghosh,1,2 Nitin V Vanjare1 1Chest Research Foundation (CRF, Pune, Maharashtra, India; 2Faculty of Health and Biomedical Science (FOHBS, Symbiosis International University, Pune, Maharashtra, IndiaWe read the article by Porpodis et al1 with great interest. In this study, the authors have evaluated the effect of roflumilast on the phagocytic activity of systemic phagocytes in severe and very severe COPD patients by measuring the oxidative burst post-bacterial stimulation. The study group for this study involved 21 severe or very severe COPD patients who were administered roflumilast in addition to other COPD treatments such as long-acting beta-adrenoceptor agonists (LABA + inhaled corticosteroids (ICS + long-acting anti-muscarinic agent (LAMA or ICS + LABA.View original paper by Porpodis and colleagues.

  5. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia

    OpenAIRE

    Sibila, Oriol; Mortensen, Eric M.; Anzueto, Antonio; Laserna, Elena; Restrepo, Marcos I.

    2013-01-01

    There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia.

  6. [Preoperative Spirometry Leads Latent COPD Patients to be Discovered and Treated].

    Science.gov (United States)

    Watari, Masanobu; Kumada, Takashi; Shimada, Emi; Nagao, Atsushi

    2015-03-01

    We have noticed the possibility that preoperative spirometry may discover latent COPD patients. When COPD is discovered before operation, we can start to treat COPD promptly. Consequently, the better perioperative care is given to COPD patients. On discharge, patients are referred to their family doctors, so that they can receive COPD treatment. There activities were started in July 2012. During the initial twelve months, 90 patients of COPD II x III were discovered and treated before admission. FEV1.0 was significantly improved (1.54 l vs. 1.71 l in average) on repeated spirometry on admission. There was no adverse event in COPD treatment All patients have shown good clinical courses. Latent COPD patients can be discovered by preoperative spirometry.

  7. Clinical use of aclidinium in patients with COPD

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    Reid DJ

    2014-04-01

    Full Text Available Debra J Reid, Alexa A CarlsonDepartment of Pharmacy Practice, Northeastern University, School of Pharmacy, Boston, MA, USAAbstract: Chronic obstructive pulmonary disease (COPD is the sixth-leading cause of death in the US. The Global initiative for chronic Obstructive Lung Disease (GOLD guidelines provide evidence-based recommendations for the clinical management of chronic COPD. Long-acting inhaled bronchodilators continue to be the mainstay of current management. Aclidinium bromide (Tudorza™ Pressair™ joins tiotropium as a long-acting inhaled antimuscarinic bronchodilator approved by the US Food and Drug Administration for the maintenance treatment of COPD. Early studies demonstrated aclidinium’s significant bronchodilatory effects supporting once-daily dosing; however, two Phase III studies, Aclidinium Clinical Trial Assessing Efficacy and Safety in Moderate to Severe COPD Patients (ACCLAIM/COPD I and ACCLAIM/COPD II, in which patients were randomized to receive aclidinium 200 µg daily, failed to achieve the minimal clinically important difference in improvement of trough forced expiratory volume in 1 second (FEV1, suggesting the need for higher doses or more frequent dosing. Additional studies – Aclidinium to Treat Airway Obstruction in COPD Patients (ATTAIN and Aclidinium in Chronic Obstructive Respiratory Disease (ACCORD I – were undertaken to compare 200 and 400 µg twice-daily dosing. The mean improvements from baseline in trough FEV1 in the 400 µg groups were +129 mL over 24 weeks and +124 mL over 12 weeks in ATTAIN and ACCORD I, respectively. Aclidinium also had beneficial effects on health-related quality of life and other endpoints, such as rescue medication use and rates of exacerbations. Aclidinium bromide inhalation powder is generally well tolerated in patients with COPD, with headache, cough, diarrhea, and rhinosinusitis among the most commonly reported adverse events. Cardiovascular side effects were rarely reported

  8. Identifying possible asthma–COPD overlap syndrome in patients with a new diagnosis of COPD in primary care

    Science.gov (United States)

    Baarnes, Camilla Boslev; Kjeldgaard, Peter; Nielsen, Mia; Miravitlles, Marc; Ulrik, Charlotte Suppli

    2017-01-01

    The asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) remains poorly characterised. Our aim was to describe an algorithm for identifying possible ACOS in adults with newly diagnosed COPD in primary care. General practitioners (n=241) consecutively recruited subjects ⩾35 years, with tobacco exposure, at least one respiratory symptom and no previous diagnosis of obstructive lung disease. Possible ACOS was defined as chronic airflow obstruction, i.e., post-bronchodilator (BD) forced expiratory volume 1/forced vital capacity (FEV1/FVC) ratio<0.70, combined with wheeze (ACOS wheeze) and/or significant BD reversibility (ACOS BD reversibility). Of 3,875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD, i.e., symptom(s), tobacco exposure and chronic airflow obstruction. Indications for ACOS were found in 264 (38%) of the COPD patients. The prevalence of ACOS wheeze and ACOS BD reversibility was 27% (n=190) and 16% (n=113), respectively (P<0.001), and only 6% (n=39) of the COPD patients fulfilled both criteria for ACOS. Patients with any ACOS were younger (P=0.04), had more dyspnoea (P<0.001), lower FEV1%pred (67% vs. 74%; P<0.001) and lower FEV1/FVC ratio (P=0.001) compared with COPD-only patients. Comparing subjects fulfilling both criteria for ACOS with those fulfilling criteria for ACOS wheeze only (n=151) and those fulfilling criteria for ACOS BD reversibility only (n=74) revealed no significant differences. Irrespective of the applied ACOS definition, no significant difference in life-time tobacco exposure was found between ACOS- and COPD-only patients. In subjects with a new diagnosis of COPD, the prevalence of ACOS is high. When screening for COPD in general practice among patients with no previous diagnosis of obstructive lung disease, patients with possible ACOS may be identified by self-reported wheeze and/or BD reversibility. PMID:28055002

  9. Roflumilast: clinical benefit in patients suffering from COPD

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Calverley, Peter Michael Anthony

    2010-01-01

    BACKGROUND AND AIMS:  Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity and mortality and is characterised by persistent airway inflammation, which leads to impaired airway function, quality of life and intermittent exacerbations. In spite of recent advances in...... as an alternative to inhaled corticosteroids in more symptomatic COPD patients with frequent exacerbations, although direct comparisons are currently lacking.......: The available long-term clinical studies reviewed here suggest that the clinical efficacy of roflumilast is likely because of the suppression of airway inflammation and not through bronchodilation. Furthermore, the clinical studies have shown a modest improvement in airway function, including FEV(1...

  10. Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy

    Science.gov (United States)

    Martin, Mickaël; Almeras, Natalie; Després, Jean-Pierre; Coxson, Harvey O; Washko, George R; Vivodtzev, Isabelle; Wouters, Emiel FM; Rutten, Erica; Williams, Michelle C; Murchison, John T; MacNee, William; Sin, Don D; Maltais, François

    2017-01-01

    Background Obesity is increasingly associated with COPD, but little is known about the prevalence of ectopic fat accumulation in COPD and whether this can possibly be associated with poor clinical outcomes and comorbidities. The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) substudy tested the hypothesis that COPD is associated with increased ectopic fat accumulation and that this would be associated with COPD-related outcomes and comorbidities. Methods Computed tomography (CT) images of the thorax obtained in ECLIPSE were used to quantify ectopic fat accumulation at L2–L3 (eg, cross-sectional area [CSA] of visceral adipose tissue [VAT] and muscle tissue [MT] attenuation, a reflection of muscle fat infiltration) and CSA of MT. A dose–response relationship between CSA of VAT, MT attenuation and CSA of MT and COPD-related outcomes (6-minute walking distance [6MWD], exacerbation rate, quality of life, and forced expiratory volume in 1 second [FEV1] decline) was addressed with the Cochran–Armitage trend test. Regression models were used to investigate possible relationships between CT body composition indices and comorbidities. Results From the entire ECLIPSE cohort, we identified 585 subjects with valid CT images at L2–L3 to assess body composition. CSA of VAT was increased (P<0.0001) and MT attenuation was reduced (indicating more muscle fat accumulation) in patients with COPD (P<0.002). Progressively increasing CSA of VAT was not associated with adverse clinical outcomes. The probability of exhibiting low 6MWD and accelerated FEV1 decline increased with progressively decreasing MT attenuation and CSA of MT. In COPD, the probability of having diabetes (P=0.024) and gastroesophageal reflux (P=0.0048) at baseline increased in parallel with VAT accumulation, while the predicted MT attenuation increased the probability of cardiovascular comorbidities (P=0.042). Body composition parameters did not correlate with coronary

  11. Development and validity of the Patient-centred COPD Questionnaire (PCQ)

    DEFF Research Database (Denmark)

    Pommer, Antoinette M; Prins, Lonneke; van Ranst, Dirk;

    2013-01-01

    ; although highly recommended, both have several limitations regarding structure, content, and/or methodological qualities. In the present study a new COPD-specific instrument was developed to measure impairment: the 'Patient-centred-COPD-Questionnaire' (PCQ). METHODS: Six focus groups with COPD patients...

  12. Relation Between Amoxicillin Concentration in Sputum of COPD Patients and Length of Hospitalization

    NARCIS (Netherlands)

    Brusse-Keizer, Marjolein; ten Bokum, Leonore; Movig, Kris; van der Valk, Paul; Kerstjens, Huib; van der Palen, Job; Hendrix, Ron

    2011-01-01

    Amoxicillin is a widely used antibiotic in COPD. Little is known about the transfer of amoxicillin into sputum of COPD patients. The objective was to investigate the relationship between the concentration of amoxicillin in sputum in hospitalized COPD patients and length of hospitalization. To be eff

  13. Home based rehabilitation for patients with COPD : an attractive alternative

    NARCIS (Netherlands)

    Wijkstra, Peter

    2007-01-01

    Pulmonary rehabilitation programs are well established to provide a multidisciplinary approach to control and alleviate symptoms and to optimise functional capacity in patients with chronic obstructive pulmonary disease (COPD). In the last decade a large number of studies have investigated the effec

  14. Bacterial aetiology and mortality in COPD patients with CAP: results from the German Competence Network, CAPNETZ.

    Science.gov (United States)

    Braeken, D C W; Franssen, F M E; von Baum, H; Schütte, H; Pletz, M W; Rupp, J; Stassen, F; Mooij, M J; Rohde, G G U

    2017-02-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood. 1) To assess the bacterial aetiology of CAP only and CAP-COPD, and 2) to study the association between bacterial aetiology, empirical antibiotic treatment, serum markers and mortality. Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons. Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P CAP-COPD patients without pathogen detection (P CAP-COPD without pathogen detection. It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.

  15. [Assessment of nutritional status of patients with chronic obstructive pulmonary disease (COPD) and the impact of diet on COPD risk].

    Science.gov (United States)

    Posłuszna, Dominika; Doboszyńska, Anna

    2011-01-01

    It is estimated that in patients with COPD malnutrition affects 10-15% of patients with mild to moderate stage of disease and 50% of patients with advanced stage of disease. Available studies indicate that weight loss and muscle mass loss are negative prognostic indicators, therefore early diagnosis of malnutrition seems to be a key measure in the treatment of COPD. In the article the authors discuss and compare the most commonly used methods to assess nutritional status and provide information on the impact of diet on risk of COPD in the future. Nutritional status of patients with COPD is difficult to assess. To date, no published standards are available. Reliable and accurate assessment of nutritional status is essential for planning further care and may contribute to the improvement of nutritional status and contribute positively to the course of the disease.

  16. Credential Application Awaiting Information

    Data.gov (United States)

    Department of Homeland Security — When a Credential application or required documentation is incomplete, an Awaiting Information letter is issued. The application process cannot continue until all...

  17. Hypoxemia in patients with COPD: cause, effects, and disease progression

    Directory of Open Access Journals (Sweden)

    Brian D Kent

    2011-03-01

    Full Text Available Brian D Kent1,2, Patrick D Mitchell1, Walter T McNicholas1,21Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Dublin; 2Conway Institute of Biomolecular and Biomedical Research, University College Dublin, IrelandAbstract: Chronic obstructive pulmonary disease (COPD is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.Keywords: COPD, hypoxia, sleep, inflammation, pulmonary hypertension

  18. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Cheng-Hua Ni

    2013-01-01

    Full Text Available The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil and control (water vapor conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.

  19. Intravenous iron sucrose for treatment of anemia in gynecology patients awaiting surgery

    Directory of Open Access Journals (Sweden)

    Animesh Gandhi

    2016-10-01

    Conclusions: Parenteral iron therapy was not safe in the past but iron sucrose has made it the safest and effective therapy. Parenteral iron therapy can be used for patients with Hb level between 6-8mg/dl It is highly efficacious and reliable way to achieve the desired Hb level patient compliance is assured with intravenous iron sucrose patient can be satisfactorily posted for surgery within a period of 3 weeks i.e. within her next menstrual period by reliably and effectively correcting her anemia with intravenous iron sucrose. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3453-3460

  20. A Qualitative Study of Televideo Consultations for COPD Patients

    DEFF Research Database (Denmark)

    Mathar, Helle; Fastholm, Pernille; Sandholm Larsen, Niels

    2015-01-01

    . In public the expectations are high that digital mediation between clients' everyday lives and the health care system can strengthen patients' abilities regarding their self-management. Nonetheless, the study shows that patients have a number of reservations concerning televideo consultations at home......This article presents results from a small qualitative study investigating COPD patients' experiences with televideo consultations at home as a supplement to conventional control and treatment. The research question is: what are the experiences and preferences of COPD patients related to discharge...... from hospital with televideo consultations? The study shows that the patients' assessments of the effectiveness and value of the televideo consultations in their everyday lives are based on tough cost-benefit calculation of the extent to which the intervention makes their lives easier or more difficult...

  1. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD

    Directory of Open Access Journals (Sweden)

    Laura Miranda de Oliveira Caram

    Full Text Available ABSTRACT Objective: To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD in COPD patients according to disease severity. Methods: The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted. Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS score was determined. Results: Of the 50 patients evaluated, 38 (76% had been diagnosed with at least one comorbidity, 21 (42% having been diagnosed with at least one CVD. Twenty-four patients (48% had more than one CVD. Eighteen (36% of the patients were current smokers, 10 (20% had depression, 7 (14% had dyslipidemia, and 7 (14% had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively. The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. Conclusions: Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression, appear to be more prevalent in patients with mild-to-moderate COPD.

  2. Nutritional Status and Body Composition of Adult Patients with Brain Tumours Awaiting Surgical Resection.

    Science.gov (United States)

    McCall, Michele; Leone, Ashley; Cusimano, Michael D

    2014-09-01

    To measure the prevalence of malnutrition, risk factors for poor dietary intake and body composition in patients with brain tumours admitted to hospital for surgical resection. In this study, 316 patients admitted for brain tumour resection to the Neurosurgical service at St. Michael's Hospital were screened. Assessment tools included the Subjective Global Assessment (SGA) for nutritional status and Bioelectrical Impedance Analysis (BIA) for body composition. All measurements were performed by one research dietitian. Information regarding medical history, symptomology, and tumour pathology was recorded. One hundred and nine participants were recruited. Malnutrition was present in 17.6% of patients, of whom 94.7% were moderately malnourished (SGA-B) and 5.3% severely malnourished (SGA-C). Key symptoms contributing to malnutrition included weight loss, nausea, vomiting, dysphagia, headaches, and fatigue. Patients with malignant tumors were more likely to have weight loss and lower fat mass. This study demonstrated that patients admitted for brain tumour resection have a low prevalence of malnutrition compared with other cancer populations. Useful parameters for nutritional screening of inpatient admissions include weight loss >5% of usual weight, nausea, vomiting, dysphagia, and headaches.

  3. Regression of Hypervascular Nodules in a Patient with Wilson's Disease Awaiting Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Alcindo Pissaia

    2009-01-01

    Full Text Available This paper describes the regressive course over one year of hypervascular nodules in a patient with Wilson's disease. CT revealed multiple, enhancing nodules (up to 3 cm in diameter detected in the liver in the early arterial phase after the administration of intravenous contrast material. Most of these nodules became isodense in the portal venous phase. After one year of efficient therapy combining d-penicillamine and zinc acetate, most of the nodules had disappeared, while the liver contours had become more regular. To our knowledge, the regression of large hypervascular nodules has not previously been reported in patients with Wilson's disease.

  4. Safety of indacaterol in the treatment of patients with COPD.

    Science.gov (United States)

    Donohue, James F; Singh, Dave; Kornmann, Oliver; Lawrence, David; Lassen, Cheryl; Kramer, Benjamin

    2011-01-01

    Pooled data were analyzed to evaluate the safety and tolerability of indacaterol, a once-daily inhaled long-acting β(2)-agonist for chronic obstructive pulmonary disease (COPD). Data were pooled from clinical studies of 3-12 months' duration in patients with moderate-to-severe COPD receiving double-blind indacaterol 75 μg (n = 449), 150 μg (n = 2611), 300 μg (n = 1157), or 600 μg once daily (n = 547); formoterol 12 μg twice daily (n = 556); salmeterol 50 μg twice daily (n = 895); placebo (n = 2012); or tiotropium 18 μg once daily, given open label or blinded (n = 1214). Outcomes were adverse events, serious adverse events and deaths, plasma potassium, blood glucose, and QTc interval and vital signs. The commonest adverse events with indacaterol were COPD worsening, nasopharyngitis, and headache; most cases were mild or moderate and incidence was generally similar to placebo and other active treatments. The risk of acute respiratory serious adverse events (leading to hospitalization, intubation, or death) was not significantly increased with any of the active treatments compared with placebo. COPD exacerbation rates (analyzed in the intent-to-treat population) were significantly reduced with all active treatments versus placebo. Hazard ratios versus placebo for major cardiovascular adverse events were indacaterol doses. Notable values for vital signs and measures of systemic β(2)-adrenoceptor activity were rare with indacaterol. The number of deaths adjusted per patient-year was lower with indacaterol (all doses combined) than with placebo (relative risk 0.21 [95% confidence interval 0.07-0.660], P = 0.008). Indacaterol has a good profile of safety and tolerability that is appropriate for the maintenance treatment of patients with COPD.

  5. Internet access and use by COPD patients in the National Emphysema/COPD Association Survey

    Science.gov (United States)

    2014-01-01

    Background Technology offers opportunities to improve healthcare, but little is known about Internet use by COPD patients. We tested two hypotheses: Internet access is associated with socio-demographic disparities and frequency of use is related to perceived needs. Methods We analyzed data from a 2007–2008 national convenience sample survey of COPD patients to determine the relationship between Internet access and frequency of use with demographics, socio-economic status, COPD severity, and satisfaction with healthcare. Results Among survey respondents (response rate 7.2%; n = 914, 59.1% women, mean age 71.2 years), 34.2% reported lack of Internet access, and an additional 49% had access but used the Internet less than weekly. Multivariate models showed association between lack of access and older age (OR 1.10, 95% CI 1.07, 1.13), lower income (income below $30,000 OR 2.47, 95% CI 1.63, 3.73), less education (high school highest attainment OR 2.30, 95% CI 1.54, 3.45), comorbid arthritis or mobility-related disease (OR 1.56, 95% CI 1.05, 2.34). More frequent use (at least weekly) was associated with younger age (OR 0.95, 95% CI 0.93, 0.98), absence of cardiovascular disease (OR 0.48, 95% CI 0.29, 0.78), but with perception of needs insufficiently met by the healthcare system, including diagnostic delay (OR 1.72, 95% CI 1.06, 2.78), feeling treated poorly (OR 2.46, 95% CI 1.15, 5.24), insufficient physician time (OR 2.29, 95% CI 1.02, 5.13), and feeling their physician did not listen (OR 3.14, 95% CI 1.42, 6.95). Conclusions An analysis of the characteristics associated with Internet access and use among COPD patients identified two different patient populations. Lack of Internet access was a marker of socioeconomic disparity and mobility-associated diseases, while frequent Internet use was associated with less somatic disease but dissatisfaction with care. PMID:24755090

  6. Color Doppler Misoprostol Response Study (CDMRS: An Evaluation Tool for Patients Awaiting Myomectomy

    Directory of Open Access Journals (Sweden)

    Musarrat Hasan

    2014-06-01

    Conclusion: In conclusion, we suggest that all patients scheduled for myomectomy have prior CDMRS to evaluate the degree of vascularity and to assess if they have an appropriate response to misoprostol administered rectally, so that there is minimal or no blood loss during surgery. This preoperative assessment will decrease physician apprehension, with less intraoperative blood loss and morbidity.

  7. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    Science.gov (United States)

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  8. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    Science.gov (United States)

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  9. Empowering patients with COPD using Tele-homecare technology.

    Science.gov (United States)

    Huniche, Lotte; Dinesen, Birthe; Grann, Ove; Toft, Egon; Nielsen, Carl

    2010-01-01

    This paper discusses how a tele-rehabilitation program using home tele-monitoring may empower patients with chronic obstructive pulmonary disease (COPD). The paper is based on preliminary findings from an ongoing research and innovation project, called "Tele-homecare, chronic patients and the integrated healthcare system" (the TELEKAT project) that employs triple interventions related to patients, professionals, and the organization of care. The ways COPD patients make use of home tele-monitoring in the TELEKAT project points to the relevance of a concept of empowerment rooted in ideologies of social action, and focusing on the improvement of both personal and social conditions at the intersection of individual, organizational and community development.

  10. Attitudes of COPD patients towards tele-rehabilitation

    DEFF Research Database (Denmark)

    Dinesen, Birthe; Huniche, Lotte; Toft, Egon

    2013-01-01

    The aim of this paper is to describe patients’ attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients’ behavior when performing tele-rehabilitation activities in home...... the intervention group, 22 COPD patients were selected for qualitative interviews and participant observation in their homes. The theoretical framework for this study is based on learning theory and the “communities of practice” approach inspired by Etienne Wenger. COPD patients exhibit four types of attitudes...... about their tele-rehabilitation: indifference, learning as part of situations in everyday life, feeling of security and motivation for performing physical training. The patients express the view that they circulate between these attitudes depending on their physical and emotional state as they perform...

  11. Validity and underrecording of diagnosis of COPD in the Danish National Patient Registry

    DEFF Research Database (Denmark)

    Thomsen, Reimar W; Lange, Peter; Hellquist, Birthe;

    2011-01-01

    , and for 1546 patients with a discharge diagnosis of either pneumonia or respiratory failure but no COPD diagnosis. Presence of COPD was assessed based on medical history, clinical symptoms and findings, and spirometry results. RESULTS: The overall positive predictive value for COPD was 92% (95% confidence...

  12. Inhaled corticosteroids can reduce osteoporosis in female patients with COPD

    Directory of Open Access Journals (Sweden)

    Liu SF

    2016-07-01

    Full Text Available Shih-Feng Liu,1–3 Ho-Chang Kuo,1,2,4 Guan-Heng Liu,5 Shu-Chen Ho,4 Huang-Chih Chang,1,3 Hung-Tu Huang,6 Yu-Mu Chen,1 Kuo-Tung Huang,1,3 Kuan-Yi Chen,2 Wen-Feng Fang,1–3 Meng-Chih Lin1–3 1Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 2Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, 3Chang Gung University College of Medicine, 4Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, 5Li-Chih Valuable School, 6Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China Background: Whether the use of inhaled corticosteroids (ICSs in patients with COPD can protect from osteoporosis remains undetermined. The aim of this study is to assess the incidence of osteoporosis in patients with COPD with ICS use and without.Patients and methods: This is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI database between 1996 and 2011 (International Classification of Diseases, Ninth Revision – Clinical Modification [ICD-9-CM] 491, 492, 496. The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service claims submitted to TNHI. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X before the index date. These enrolled patients were followed up till 2011, and the incidence of osteoporosis was determined. The Cox proportional hazards regression model was also used to estimate hazard ratios (HRs for incidences of lung cancer.Results: Totally, 10,723 patients with COPD, including ICS users (n=812 and nonusers (n=9,911, were enrolled. The incidence rate of osteoporosis per 100

  13. Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality

    DEFF Research Database (Denmark)

    Williams, M. C.; Murchison, J. T.; Edwards, L. D.;

    2014-01-01

    , functional capacity and outcomes in patients with COPD. Methods Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and nonsmokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE......) study. Results CACS was measured in 942 subjects: 672 with COPD (mean age+/-SD, 63+/-7 years; FEV1 49+/-16% predicted), 199 smokers with normal spirometry (54+/-9 years; FEV1 110+/-12% predicted) and 71 nonsmokers (55+/-9 years; FEV1 114+/-14% predicted). CACS was higher in patients with COPD than...

  14. Electronic Nose To Detect Patients with COPD From Exhaled Breath

    Science.gov (United States)

    Velásquez, Adriana; Durán, Cristhian M.; Gualdron, Oscar; Rodríguez, Juan C.; Manjarres, Leonardo

    2009-05-01

    To date, there is no effective tool analysis and detection of COPD syndrome, (Chronic Obstructive Pulmonary Disease) which is linked to smoking and, less frequently to toxic substances such as, the wood smoke or other particles produced by noxious gases. According to the World Health Organization (WHO) estimates of this disease show it affects more than 52 million people and kills more than 2.7 million human beings each year. In order to solve the problem, a low-cost Electronic Nose (EN) was developed at the University of Pamplona (N. S) Colombia, for this specific purpose and was applied to a sample group of patients with COPD as well as to others who were healthy. From the exhalation breath samples of these patients, the results were as expected; an appropriate classification of the patients with the disease, as well as from the healthy group was obtained.

  15. Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD

    Science.gov (United States)

    Ouellette, Daniel R; Lavoie, Kim L

    2017-01-01

    COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes. PMID:28243081

  16. Influence of COPD Assessment Text (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of COPD patients

    Science.gov (United States)

    Liu, Jing; Meng, Guangju; Ma, Yi; Zhang, Xia; Chen, Dongmei; Chen, Mengting

    2015-01-01

    The study aimed to evaluate the influence of the COPD Assessment Test (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of patients with chronic obstructive pulmonary disease (COPD). Forty-five patients with COPD admitted from Nov. 2012 to Nov. 2013 were treated with combined bronchodilators and inhaled corticosteroids. Thirty-five patients admitted from Nov. 2012 to Nov. 2013 and classified as a study group received rehabilitation education guidance on the basis of the treatment of the control group to compare the quality-of-life-scale score, dyspnea index score, and motor function of the two groups of patients after 48 weeks of treatment. After treatment, the CAT score of both groups of patients was significantly lowered. After 48 weeks of treatment, the respiratory function of both groups was significantly improved, but the Medical Research Council (MRC) scale for the study group after treatment was significantly lower than that for the control group. After 48 weeks of rehabilitation exercises, the 6-minute walk test (6MWT) for patients with COPD was significantly prolonged, but the test results were significantly higher for the study group after treatment than for the control group. After receiving CAT rehabilitation education, COPD patients had significantly improved life quality and significantly enhanced exercise tolerance. The treatment mode may be gradually introduced in future clinic and nursing work.

  17. Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy

    Directory of Open Access Journals (Sweden)

    Martin M

    2017-01-01

    expiratory volume in 1 second [FEV1] decline was addressed with the Cochran–Armitage trend test. Regression models were used to investigate possible relationships between CT body composition indices and comorbidities.Results: From the entire ECLIPSE cohort, we identified 585 subjects with valid CT images at L2–L3 to assess body composition. CSA of VAT was increased (P<0.0001 and MT attenuation was reduced (indicating more muscle fat accumulation in patients with COPD (P<0.002. Pro­gressively increasing CSA of VAT was not associated with adverse clinical outcomes. The probability of exhibiting low 6MWD and accelerated FEV1 decline increased with progressively decreasing MT attenuation and CSA of MT. In COPD, the probability of having diabetes (P=0.024 and gastroesophageal reflux (P=0.0048 at baseline increased in parallel with VAT accumulation, while the predicted MT attenuation increased the probability of cardiovascular comorbidities (P=0.042. Body composition parameters did not correlate with coronary artery scores or with survival.Conclusion: Ectopic fat accumulation is increased in COPD, and this was associated with relevant clinical outcomes and comorbidities. Keywords: metabolic syndrome, obesity, abdominal adiposity, muscle

  18. Evaluation of a Telehealthcare Intervention for Patients with COPD

    DEFF Research Database (Denmark)

    Lilholt, Pernille Heyckendorff

    The healthcare system is facing challenges regarding the treatment of chronic obstructive pulmonary disease (COPD), which necessitating alternative ways to treat these patients. Telehealthcare could be this alternative. A range of studies have been conducted to evaluate the effectiveness of teleh......The healthcare system is facing challenges regarding the treatment of chronic obstructive pulmonary disease (COPD), which necessitating alternative ways to treat these patients. Telehealthcare could be this alternative. A range of studies have been conducted to evaluate the effectiveness...... telehealthcare. The overall aim of this dissertation was to evaluate the TeleCare North trial’s intervention. The PhD thesis focused more specifically on I) developing a trial protocol for the Danish, cluster-randomized, large-scale trial, TeleCare North; II) evaluating the trial’s telehealthcare system, Telekit...

  19. Flow characteristics in the airways of a COPD patient with a saber-sheath trachea

    Science.gov (United States)

    Jin, Dohyun; Choi, Haecheon; Lee, Changhyun; Choi, Jiwoong; Kim, Kwanggi

    2016-11-01

    The chronic obstructive pulmonary disease (COPD) is a lung disease characterized by the irreversible airflow limitation caused by the damaged small airways and air sacs. Although COPD is not a disease of the trachea, many patients with COPD have saber-sheath tracheas. The effects of this morphological change in the trachea geometry on airflow are investigated in the present study. An unstructured finite volume method is used for the simulations during tidal breathing in normal and COPD airways, respectively. During inspiration, local large pressure drop is observed in the saber-sheath region of the COPD patient. During expiration, vortical structures are observed at the right main bronchus of the COPD airway, while the flow in the normal airway remains nearly laminar. High wall shear stress exists at convex regions of both airways during inspiration and expiration. However, due to the morphological changes in the COPD airway, relatively higher wall shear stress is observed in the patient airways.

  20. The effect of rehabilitation on health-care utilisation in COPD patients in Copenhagen

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Rusch, Ea; Andersen, Per Kragh;

    2014-01-01

    INTRODUCTION: The Integrated Rehabilitation Programme for Chronic Conditions project (SIKS) implemented rehabilitation programmes for people with four chronic conditions in the local area within the Municipality of Copenhagen. OBJECTIVES: The objective of this study was to evaluate the impact...... of rehabilitation on health-care utilisation in chronic obstructive pulmonary disease (COPD) patients as a subgroup of SIKS. METHODS: For the analyses, data from Danish National Registers' were obtained. The following outcomes were analysed: (i) COPD hospital admissions, (ii) COPD bed days, (iii) COPD outpatient...... visits, (iv) COPD emergency room visits, (v) general practitioner visits, (vi) specialist visits, and (vii) COPD specific medication. The rehabilitation group consisted of 118 patients who completed the programme. The control group consisted of 236 COPD patients in Copenhagen who did not undergo...

  1. Nasal highflow improves ventilation in patients with COPD

    Directory of Open Access Journals (Sweden)

    Bräunlich J

    2016-05-01

    Full Text Available Jens Bräunlich,* Marcus Köhler,* Hubert WirtzDepartment of Respiratory Medicine, University of Leipzig, Leipzig, Germany *These authors contributed equally to this workBackground: Nasal highflow (NHF provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD.Materials and methods: This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2. Mean airway pressure was measured in the nasopharyngeal space (19 patients. To evaluate breathing volumes, we used a polysomnographic device (18 patients. All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed.Results: NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min. Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF.Conclusion: NHF

  2. Hypoxemia in patients with COPD: cause, effects, and disease progression.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-02-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation\\/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.

  3. Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

    Directory of Open Access Journals (Sweden)

    Schmidt Jan

    2009-09-01

    Full Text Available Abstract Background Decompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and/or waiting time is still under debate. Methods Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD and Child-Turcotte-Pugh (CTP scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores. Results In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of ≥9 and a MELD score of ≥14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091. Conclusion The long term prediction of mortality or removal from waiting list in patients awaiting liver

  4. Domain-specific cognitive impairment in patients with COPD and control subjects

    Science.gov (United States)

    Cleutjens, Fiona AHM; Franssen, Frits ME; Spruit, Martijn A; Vanfleteren, Lowie EGW; Gijsen, Candy; Dijkstra, Jeanette B; Ponds, Rudolf WHM; Wouters, Emiel FM; Janssen, Daisy JA

    2017-01-01

    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. PMID:28031706

  5. Safety of indacaterol in the treatment of patients with COPD

    Directory of Open Access Journals (Sweden)

    Donohue JF

    2011-09-01

    Full Text Available James F Donohue1, Dave Singh2, Oliver Kornmann3, David Lawrence4, Cheryl Lassen4, Benjamin Kramer5 1University of North Carolina, Chapel Hill, NC, USA; 2University of Manchester, Medicines Evaluation Unit, Manchester, UK; 3IKF Pneumologie GmbH and Co KG, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany; 4Novartis Horsham Research Centre, Horsham, UK; 5Novartis Pharmaceuticals Inc, East Hanover, New Jersey, USA Purpose: Pooled data were analyzed to evaluate the safety and tolerability of indacaterol, a once-daily inhaled long-acting ß2-agonist for chronic obstructive pulmonary disease (COPD. Patients and methods: Data were pooled from clinical studies of 3–12 months’ duration in patients with moderate-to-severe COPD receiving double-blind indacaterol 75 µg (n = 449, 150 µg (n = 2611, 300 µg (n = 1157, or 600 µg once daily (n = 547; formoterol 12 µg twice daily (n = 556; salmeterol 50 µg twice daily (n = 895; placebo (n = 2012; or tiotropium 18 µg once daily, given open label or blinded (n = 1214. Outcomes were adverse events, serious adverse events and deaths, plasma potassium, blood glucose, and QTc interval and vital signs. Results: The commonest adverse events with indacaterol were COPD worsening, nasopharyngitis, and headache; most cases were mild or moderate and incidence was generally similar to placebo and other active treatments. The risk of acute respiratory serious adverse events (leading to hospitalization, intubation, or death was not significantly increased with any of the active treatments compared with placebo. COPD exacerbation rates (analyzed in the intent-to-treat population were significantly reduced with all active treatments versus placebo. Hazard ratios versus placebo for major cardiovascular adverse events were <1 for all indacaterol doses. Notable values for vital signs and measures of systemic ß2-adrenoceptor activity were rare with indacaterol. The number of deaths adjusted per patient

  6. Characteristics of reversible and nonreversible COPD and asthma and COPD overlap syndrome patients: an analysis of salbutamol Easyhaler data.

    Science.gov (United States)

    Müller, Veronika; Gálffy, Gabriella; Orosz, Márta; Kováts, Zsuzsanna; Odler, Balázs; Selroos, Olof; Tamási, Lilla

    2016-01-01

    The choice of inhaler device for bronchodilator reversibility is crucial since suboptimal inhalation technique may influence the result. On the other hand, bronchodilator response also varies from time to time and may depend on patient characteristics. In this study, patients with airway obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio salbutamol dry powder inhaler (Buventol Easyhaler, Orion Pharma Ltd, Espoo, Finland). Demographic data and patients' perceptions of Easyhaler compared with β2-agonist pressurized metered dose inhalers (pMDIs) were analyzed. American Thoracic Society/European Respiratory Society guideline defined reversibility was found in 21 out of 63 COPD patients and in two out of 12 ACOS patients. Airway obstruction was more severe in COPD patients as compared with controls (mean FEV1 and FEV1% predicted both Psalbutamol was significantly lower in COPD patients compared with asthma controls (Psalbutamol dry powder inhaler. Nonreversible patients with COPD were characterized by higher weight and body mass index, and a higher FEV1/FVC ratio. Most patients preferred Easyhaler compared with a pMDI.

  7. An elevated breathing reserve index at the lactate threshold is a predictor of mortality in patients with cystic fibrosis awaiting lung transplantation.

    Science.gov (United States)

    Tantisira, Kelan G; Systrom, David M; Ginns, Leo C

    2002-06-15

    The proportion of cystic fibrosis (CF) patients dying while on the lung transplant wait list remains high; identification of such patients remains difficult. The breathing reserve index (BRI = minute ventilation/maximal voluntary ventilation) at the lactate threshold (LT) is a predictor of a pulmonary mechanical limit to incremental exercise. We hypothesized that an elevated BRI at the LT in patients with CF awaiting lung transplantation would be a predictor of wait list mortality. Forty-five consecutive patients with CF completed cardiopulmonary exercise testing as part of their pretransplant assessment. We evaluated BRI at LT, baseline demographic characteristics, pulmonary function, and other exercise parameters via Cox proportional hazards modeling. Fifteen patients died while awaiting transplant. Twenty one were transplanted, and nine still awaited transplantation. Relative risks from the multivariate model included (95% confidence interval in parentheses) BRI at LT, 17.52 (2.45-123.97); resting Pa(CO(2)), 1.29 (1.10-1.49); resting Pa(O(2)), 0.97 (0.90-1.05); and forced expiratory volume at one second as a percent of predicted, 1.19 (1.05-1.34). BRI at LT not only provided the highest point estimate of risk for wait list mortality but also identified a physiologically significant threshold value (0.70 or more) for those at risk. This measurement may allow improved timing of listing for transplantation, including consideration for living donor transplantation.

  8. Coherent efforts in relation to COPD patients with special emphasis on the quality and technological solutions

    DEFF Research Database (Denmark)

    Bagger, Bettan; Vestergaard*, Kitt; Andresen, Mette

    2014-01-01

    with respect to COPD patients. National Board of Health has produced series of recommendations to ensure quality based among others on The Chronic Care Model. But how do COPD patients and health professionals define quality themselves in daily life? University College Zealand and COPD Competence Center......, Hospital Naestved investigate COPD patients’ and health professionals’ perspectives with respect to their assessments of quality in clinical pathways and daily life focusing on clinical pathways, interdisciplinary sharing of knowledge and use of technology. Identification of parameters will be important...... insights in developing new ways of interconnections between key players in strengthening quality and consistency of patient care in pathways between sectors for the COPD patient. Aims: - To explore parameters for quality focusing on clinical pathways, competencies and daily life with respect to COPD...

  9. Economic and health consequences of COPD patients and their spouses in Denmark-1998-2010

    DEFF Research Database (Denmark)

    Løkke, Anders; Hilberg, Ole; Kjellberg, Jakob

    2014-01-01

    OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of morbidity and mortality worldwide, but longitudinal studies of the economic consequences of COPD are scarce. This study evaluated the economic consequences of COPD patients in Denmark and their spouses...... for age, gender and residence. Direct and indirect costs, including frequency of primary and secondary sector contacts and procedures, medication, unemployment benefits and social transfer payments were extracted from national databases for patients, spouses and controls. RESULTS: COPD patients...... on the economic consequences of COPD patients in Denmark and their spouses as well as displaying the serious health consequences for the individual spouse and society. Second, data shows substantial impact of COPD on income level and health expenses regardless of age and gender. It could be speculated that early...

  10. Development of the ProPal-COPD tool to identify patients with COPD for proactive palliative care

    Directory of Open Access Journals (Sweden)

    Duenk RG

    2017-07-01

    Full Text Available RG Duenk,1 C Verhagen,1 EM Bronkhorst,2 RS Djamin,3 GJ Bosman,4 E Lammers,5 PNR Dekhuijzen,6 KCP Vissers,1 Y Engels,1,* Y Heijdra6,* 1Department of Anesthesiology, Pain and Palliative Medicine, 2Department of Health Evidence, Radboud University Medical Center, Nijmegen, 3Department of Respiratory Medicine, Amphia Hospital, Breda, 4Department of Respiratory Medicine, Slingeland Hospital, Doetinchem, 5Department of Respiratory Medicine, Gelre Hospitals, Zutphen, 6Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands *These authors contributed equally to this work Background: Our objective was to develop a tool to identify patients with COPD for proactive palliative care. Since palliative care needs increase during the disease course of COPD, the prediction of mortality within 1 year, measured during hospitalizations for acute exacerbation COPD (AECOPD, was used as a proxy for the need of proactive palliative care.Patients and methods: Patients were recruited from three general hospitals in the Netherlands in 2014. Data of 11 potential predictors, a priori selected based on literature, were collected during hospitalization for AECOPD. After 1 year, the medical files were explored for the date of death. An optimal prediction model was assessed by Lasso logistic regression, with 20-fold cross-validation for optimal shrinkage. Missing data were handled using complete case analysis.Results: Of 174 patients, 155 patients were included; of those 30 (19.4% died within 1 year. The optimal prediction model was internally validated and had good discriminating power (AUC =0.82, 95% CI 0.81–0.82. This model relied on the following seven predictors: the surprise question, Medical Research Council dyspnea questionnaire (MRC dyspnea, Clinical COPD Questionnaire (CCQ, FEV1% of predicted value, body mass index, previous hospitalizations for AECOPD and specific comorbidities. To ensure minimal miss out of patients in need

  11. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD.

    Science.gov (United States)

    Caram, Laura Miranda de Oliveira; Ferrari, Renata; Naves, Cristiane Roberta; Coelho, Liana Sousa; Vale, Simone Alves do; Tanni, Suzana Erico; Godoy, Irma

    2016-01-01

    To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.

  12. Increased risk of community-acquired pneumonia in COPD patients with comorbid cardiovascular disease

    Science.gov (United States)

    Lin, Sheng-Hao; Perng, Diahn-Warng; Chen, Ching-Pei; Chai, Woei-Horng; Yeh, Chin-Shui; Kor, Chew-Teng; Cheng, Shih-Lung; Chen, Jeremy JW; Lin, Ching-Hsiung

    2016-01-01

    Background and objective COPD patients with community-acquired pneumonia (CAP) have worse clinical outcomes, as compared to those without COPD. Cardiovascular disease (CVD) is a common comorbidity for COPD patients. Whether COPD with comorbid CVD will increase the risk of CAP is not well investigated. The incidence and factors associated with CAP in COPD patients with and without CVD were analyzed. Methods The medical records of patients with newly diagnosed COPD between 2007 and 2010 were reviewed. The patients’ characteristics, medical history of CVD, occurrence of CAP, and type of medication were recorded. Kaplan–Meier curves were used to assess the differences in cumulative incidence of CAP. Cox’s proportional hazards regression model was used to determine the adjusted hazard ratios with 95% confidence intervals in relation to factors associated with CAP in COPD patients with and without CVD. Results Among 2,440 patients, 475 patients (19.5%) developed CAP during the follow-up period. COPD patients who developed CAP were significantly older, had lower forced expiratory volume in 1 second, frequent severe exacerbation and comorbid CVD, as well as received inhaled corticosteroid (ICS)-containing therapy than those without CAP. The cumulative incidence of CAP was higher in COPD patients with CVD compared to those without CVD. Patients who received ICS-containing therapy had significantly increased risk of developing CAP compared to those who did not. Conclusion For patients with COPD, comorbid CVD is an independent risk factor for developing CAP. ICS-containing therapy may increase the risk of CAP among COPD patients. PMID:27980402

  13. Dynamic hyperinflation during activities of daily living in COPD patients.

    Science.gov (United States)

    Silva, Cláudia S; Nogueira, Fabiana R; Porto, Elias F; Gazzotti, Mariana R; Nascimento, Oliver A; Camelier, Aquiles; Jardim, José R

    2015-08-01

    The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of these ADLs.

  14. Epidemiology and clinical impact of major comorbidities in patients with COPD

    Directory of Open Access Journals (Sweden)

    Smith MC

    2014-08-01

    Full Text Available Miranda Caroline Smith,1 Jeremy P Wrobel2 1Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia; 2Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia Abstract: Comorbidities are frequent in chronic obstructive pulmonary disease (COPD and significantly impact on patients' quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD. Keywords: cardiovascular disease, prevalence, mortality, chronic bronchitis, emphysema

  15. A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot Study

    Directory of Open Access Journals (Sweden)

    Patrícia Forestieri

    Full Text Available Abstract Objective: The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods: Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1 Control Group (n=11 - conventional protocol; and 2 Intervention Group (n=7 - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results: Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P =0.08 and P =0.001 for the control and intervention groups, respectively. Intergroup comparison revealed a greater increase in the intervention group compared to the control (P <0.001. Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P =0.22 and P <0.01, respectively. Intergroup comparison showed a significant increase in the intervention group compared to the control (P <0.01. Conclusion: Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support.

  16. A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot Study

    Science.gov (United States)

    Forestieri, Patrícia; Guizilini, Solange; Peres, Monique; Bublitz, Caroline; Bolzan, Douglas W.; Rocco, Isadora S.; Santos, Vinícius B.; Moreira, Rita Simone L.; Breda, João R.; de Almeida, Dirceu R.; Carvalho, Antonio Carlos de C.; Arena, Ross; Gomes, Walter J.

    2016-01-01

    Objective The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P=0.08 and P=0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P<0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P=0.22 and P<0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P<0.01). Conclusion Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support. PMID:27982348

  17. Theophylline-ranitidine interaction in elderly COPD patients.

    Science.gov (United States)

    Cukier, A; Vargas, F S; Santos, S R; Donzella, H; Terra-Filho, M; Teixeira, L R; Light, R W

    1995-08-01

    Most controlled studies in humans indicate that ranitidine does not alter theophylline metabolism, even at high doses. However, there have been several case reports published recently which demonstrate the development of theophylline toxicity mostly in older patients receiving stable oral doses of this drug when ranitidine was administered simultaneously. We studied eleven elderly (mean age, 69.0 +/- 6.2 years) patients with chronic obstructive pulmonary disease (COPD). During one week the patients took slow-release theophylline, 200 mg every 12 h, followed by one week intake of the same dose of theophylline plus ranitidine tablets, 150 mg every 12 h. At the end of each period, blood samples were obtained 0, 1, 2, 3, 4, 5, 6, 7, 8 and 12 h after the morning dose for the determination of serum theophylline levels. The peak theophylline concentration (Tmax) was achieved after 4.1 +/- 0.9 h while the patients were taking theophylline, and after 2.9 +/- 1.4 h with the combined regimen. This difference was statistically significant (P ranitidine cannot be ascribed to slower theophylline metabolism in the geriatric patients with COPD who is also given ranitidine.

  18. Whole-Body versus Local DXA-Scan for the Diagnosis of Osteoporosis in COPD Patients

    OpenAIRE

    Lidwien Graat-Verboom; Spruit, Martijn A; van den Borne, Ben E. E. M.; Smeenk, Frank W J M; Wouters, Emiel F. M.

    2010-01-01

    Background. Osteoporosis is an extrapulmonary effect of chronic obstructive pulmonary disease (COPD). Diagnosis of osteoporosis is based on BMD measured by DXA-scan. The best location for BMD measurement in COPD has not been determined. Aim of this study was to assess whole-body BMD and BMD of the hip and lumbar spine (local DXA) in COPD patients and compare the prevalence of osteoporosis at these locations. Methods. Whole body as well as local DXA-scan were made in 168 COPD patients entering...

  19. Reduced HDAC2 in skeletal muscle of COPD patients

    National Research Council Canada - National Science Library

    Masako To; Elisabeth B Swallow; Kenich Akashi; Kosuke Haruki; S Amanda Natanek; Michael I Polkey; Kazuhiro Ito; Peter J Barnes

    2017-01-01

    Background Skeletal muscle weakness in chronic obstructive pulmonary disease (COPD) is an important predictor of poor prognosis, but the molecular mechanisms of muscle weakness in COPD have not been fully elucidated...

  20. Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study

    OpenAIRE

    Strang, Susann; Ekberg-Jansson, Ann; Henoch, Ingela

    2014-01-01

    Objectives: Anxiety often arises in conjunction with dyspnoea in patients with severe COPD. Considering the provoking symptomatology and the high mortality rate for COPD, it is reasonable to believe that these conditions trigger death-related and existential anxiety. Although anxiety causes considerable distress and reduces quality of life, people's experience of anxiety has been studied relatively little. The aim of this study was to explore severely ill COPD patients’ experience of anxiety ...

  1. Influence of heart failure on resting lung volumes in patients with COPD

    Science.gov (United States)

    de Souza, Aline Soares; Sperandio, Priscila Abreu; Mazzuco, Adriana; Alencar, Maria Clara; Arbex, Flávio Ferlin; de Oliveira, Mayron Faria; O'Donnell, Denis Eunan; Neder, José Alberto

    2016-01-01

    ABSTRACT Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil. PMID:27832235

  2. Influence of heart failure on resting lung volumes in patients with COPD

    Directory of Open Access Journals (Sweden)

    Aline Soares de Souza

    Full Text Available ABSTRACT Objective: To evaluate the influence of chronic heart failure (CHF on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female with COPD+CHF and 32 (28 males/4 females with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC, and TLC-were lower in the former group (p < 0.05. There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05. Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05. Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction. However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil.

  3. Are patients with COPD treated with NIV in accordance with national guidelines?

    DEFF Research Database (Denmark)

    Titlestad, Ingrid Louise; Olsen, Fanny; Sandqvist, Hanna M

    2014-01-01

    whether NIV is used appropriately, we conducted an audit of COPD patients admitted to a university hospital in Denmark. Material and methods: Data from medical records were retrieved for two cohorts in 2010: 1) all patients admitted to the Medical Emergency Ward with the diagnosis of COPD, and 2) all...

  4. Survival of chronic hypercapnic COPD patients is predicted by smoking habits, comorbidity, and hypoxemia.

    NARCIS (Netherlands)

    Nizet, T.; Elshout, F.J.J. van den; Heijdra, Y.F.; Ven, M.J.T. van de; Mulder, P.G.H.; Folgering, H.T.M.

    2005-01-01

    STUDY OBJECTIVES: Chronic hypercapnia in patients with COPD has been associated with a poor prognosis. We hypothesized that, within this group of chronic hypercapnic COPD patients, factors that could mediate this hypercapnia, such as decreased maximum inspiratory mouth pressure (P(I(max))), decrease

  5. Health behaviors and their correlates among participants in the Continuing to Confront COPD International Patient Survey

    NARCIS (Netherlands)

    Muellerova, Hana; Landis, Sarah H.; Aisanov, Zaurbek; Davis, Kourtney J.; Ichinose, Masakazu; Mannino, David M.; Maskell, Joe; Menezes, Ana M.; van der Molen, Thys; Oh, Yeon-Mok; Tabberer, Maggie; Han, MeiLan K.

    2016-01-01

    BACKGROUND AND AIMS: We used data from the Continuing to Confront COPD International Patient Survey to test the hypothesis that patients with COPD who report less engagement with their disease management are also more likely to report greater impact of the disease. METHODS: This was a population-bas

  6. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD)

    DEFF Research Database (Denmark)

    Hallin, Runa; Gudmundsson, Gunnar; Suppli Ulrik, Charlotte

    2007-01-01

    Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality...

  7. Effects of inhaled corticosteroids with different lung deposition on exhaled hydrogen peroxide in stable COPD patients.

    NARCIS (Netherlands)

    Beurden, W.J.C van; Harff, G.A.; Dekhuijzen, P.N.R.; Poel-Smet, S.M. van der; Smeenk, F.W.

    2003-01-01

    BACKGROUND: The effects of inhaled corticosteroids (ICS) on markers of oxidative stress in patients with stable COPD are unclear. OBJECTIVES: The aim was to investigate the effect of ICS on exhaled H(2)O(2) in stable COPD patients and to compare ICS with different lung deposition. METHODS: Forty-one

  8. A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients

    NARCIS (Netherlands)

    Altenburg, Wytske A.; de Greef, Mathieu H. G.; ten Hacken, Nick H. T.; Wempe, Johan B.

    2012-01-01

    Purpose: Pulmonary rehabilitation (PR) has positive effects on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD). However, not all COPD patients benefit from PR to the same extent. We investigated whether there is a patient profile, which is associated with the improvement in enduran

  9. Chest wall volumes during inspiratory loaded breathing in COPD patients.

    Science.gov (United States)

    Coutinho Myrrha, Mariana Alves; Vieira, Danielle Soares Rocha; Moraes, Karoline Simões; Lage, Susan Martins; Parreira, Verônica Franco; Britto, Raquel Rodrigues

    2013-08-01

    Chest wall volumes and breathing patterns of 13 male COPD patients were evaluated at rest and during inspiratory loaded breathing (ILB). The sternocleidomastoid (SMM) and abdominal muscle activity was also evaluated. The main compartment responsible for the tidal volume at rest and during ILB was the abdomen. During ILB patients exhibited, in addition to increases in the ratio of inspiratory time to total time of the respiratory cycle and minute ventilation, increases (p<0.05) in the chest wall tidal volume by an increase in abdomen tidal volume as a result of improvement of end chest wall inspiratory volume without changing on end chest wall expiratory volume. The SMM and abdominal muscle activity increased 63.84% and 1.94% during ILB. Overall, to overcome the load imposed by ILB, COPD patients improve the tidal volume by changing the inspiratory chest wall volume without modifying the predominant mobility of the abdomen at rest and without affecting the end chest wall expiratory volume. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Incidence and relative risk for developing cancer among patients with COPD: a nationwide cohort study in Taiwan

    Science.gov (United States)

    Ho, Chung-Han; Chen, Yi-Chen; Wang, Jhi-Joung; Liao, Kuang-Ming

    2017-01-01

    Objectives This observational study aimed to examine the incidence of malignant diseases, including specific cancer types, after the diagnosis of chronic obstructive pulmonary disease (COPD) in Taiwanese patients. Setting Taiwan's National Health Insurance Research Database. Participants The definition of a patient with COPD was a patient with a discharge diagnosis of COPD or at least 3 ambulatory visits for COPD. The index date was the date of the first COPD diagnosis. Patients with a history of malignancy disorders before the index date were excluded. After matching age and gender, 13 289 patients with COPD and 26 578 control participants without COPD were retrieved and analysed. They were followed from the index date to malignancy diagnosis, death or the end of study follow-up (31 December 2011), whichever came first. Primary outcome measures Patients were diagnosed with cancer (n=1681, 4.2%; 973 (7.3%) for patients with COPD and 728 (2.7%) for patients without COPD). The risk of 7 major cancer types, including lung, liver, colorectal, breast, prostate, stomach and oesophagus, between patients with COPD and patients without COPD was also estimated. Results The mean age of all study participants was 57.9±13.5 years. The average length of follow-up to cancer incidence was 3.9 years for patients with COPD and 5.0 years for patients without COPD (prisk of developing cancer is higher in patients with COPD compared with patients without COPD. Cancer screening is warranted in patients with COPD. PMID:28279996

  11. Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial

    DEFF Research Database (Denmark)

    Jacobsen, Anna Svarre; Laursen, Lars C; Østergaard, Birte

    2013-01-01

    Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable...... phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional...... hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge....

  12. EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Brøndum, Eva; Martinez, Gerd;

    2008-01-01

    BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five-dimension que......BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five...... scale. At completion of the programme, statistical significant improvements were seen for ESWT 157.3s; ptotal score -2.8units; p....1%). CONCLUSIONS: In COPD patients receiving rehabilitation, responsiveness of EQ-5D utility was poor. One explanation might be a "ceiling effect" of this instrument....

  13. Physician-Patient Concordance in Pharmacological Management of Patients with COPD.

    Science.gov (United States)

    Small, Mark; Higgins, Victoria; Lees, Adam; Johns, Nicola; Mastrangelo, Anthony; Nazareth, Tara; Turner, Stuart J

    2015-01-01

    A retrospective analysis of a cross-sectional, multicenter survey was conducted in United States (US) medical practices to evaluate the concordance between patients with COPD and their physicians on disease-specific characteristics. Associations between patient and disease-related characteristics with monotherapy, dual therapy, or triple therapy prescribed as COPD maintenance regimens were also examined. Eligible physicians completed patient record forms (PRFs) for up to 6 consecutive patients with COPD. Patients for whom a PRF was completed were invited to complete a patient self-completion (PSC) survey consisting of questions similar to those on the PRF, as well as several validated measures to assess the impact of COPD on patients' lives. A total of 469 patients completed a PSC that was matched with the PRF completed by their physician, forming the sample for the concordance analysis. Moderate agreement (kappa (κ) = 0.41-0.60) was observed for 79% of measures, with the lowest concordance rating corresponding to hemoptysis (κ = 0.22). There were few differences in demographic or clinical characteristics between patients prescribed monotherapy and dual therapy. Triple therapy rather than monotherapy or dual therapy was more often prescribed for patients with greater frequency of symptoms, negative impact of COPD on daily life and interpersonal relationships, and respiratory impairment based on the most recent FEV1. Diverse factors influence US physicians' perceptions of disease and treatment choices, including patient symptoms, quality of life, and disease impact. Our results highlight that concordance between physicians and patients regarding symptoms and physical function may contribute to optimal management of COPD.

  14. Safety and Tolerability of Nebulized Amoxicillin-Clavulanic Acid in Patients with COPD (STONAC 1 and STONAC 2)

    NARCIS (Netherlands)

    Nijdam, L.C.; Assink, M.D.M.; Kuijvenhoven, J.C.; Saegher, de M.E.A.; Valk, van der P.D.L.P.M.; Palen, van der J.; Brusse-Keizer, M.G.J.; Movig, K.L.L.

    2016-01-01

    The safety and tolerability of nebulized amoxicillin clavulanic acid were determined in patients with stable COPD and during severe exacerbations of COPD. Nine stable COPD patients received doses ranging from 50:10 mg up to 300:60 mg amoxicillin clavulanic acid and eight patients hospitalised for a

  15. Determinants of smoking cessation in COPD patients treated in the outpatient setting

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra S; Thomsen, Reimar W; Johnsen, Søren P

    2016-01-01

    BACKGROUND: The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. METHODS: In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical and sociode......BACKGROUND: The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. METHODS: In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical...... and sociodemographic determinants of smoking cessation in 3,233 patients with COPD who smoked on outpatient contact during 2008 to 2012. Using multivariate Cox regression, we calculated hazard ratios (HRs) of quitting. RESULTS: Within 1 and 5 years from first outpatient contact, the probability of quitting was 19...... Medical Research Council (MRC) dyspnea scale score reinforce that young and socioeconomically disadvantaged patients have more difficulties achieving...

  16. Activity of Matrix Metalloproteinase in Airway Epithelial Cells of COPD Patients

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    To examine the mRNA expression of matrix metalloproteinase 9 (MMP-9) and the gelatinase activity of its inhibitor, tissue inhibitor of matrix metalloproteinase 1 (TIMP-1) in the primary epithelial cells of patients with COPD, airway epithelial cells were taken from 15 COPD patients and cultured in vitro. The patients were divided into three groups, COPD group, normal smoking control group and non-smoking control group, with 5 subjects in each group, on basis of the smoking history and lung function. The semi-qualitative RT-PCR was employed to determine the mRNA levels of MMP 9 and TIMP-1 and SDS PAGE was used for the determination of the gelatinase activity of MMP-9 and TIMP-1. Our result showed that the mRNA of MMP-9 and TIMP-1 in epithelial cells of the non-smoking subjects was at a low level The mRNA of MMP 9 and TIMP-1 in COPD patients and smokers was significantly higher than that in non-smokers (P<0.05). No significant difference was found in the levels of MMP-9 and TIMP-1 in epithelial cells between the COPD patients and smokers. The MMP-9/TIMP-1 ratios in COPD patients and smokers were significantly lower than that of non-smokers (P<0.05). The gelatinase activity in the epithelial cells of both COPD patients and normal smokers was increased (P<0.05), but no difference existed in the gelatinase activity in the epithelial cells between COPD patients and normal smokers. It is concluded that the transcription of MMP-9 and TIMP-1 and the gelatinase activity of MMP-9 and MMP-2 in the epithelial cells in COPD patients were increased, which resulted in an imbalance of MMP-9/TIMP-1, thereby causing pulmonary fibrosis. These factors play important roles in the pathogenesis of COPD.

  17. Comparison of pulmonary function in patients with COPD, asthma-COPD overlap syndrome, and asthma with airflow limitation

    Directory of Open Access Journals (Sweden)

    Kitaguchi Y

    2016-05-01

    Full Text Available Yoshiaki Kitaguchi, Masanori Yasuo, Masayuki Hanaoka First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan Background: This study was conducted in order to investigate the differences in the respiratory physiology of patients with chronic obstructive pulmonary disease (COPD, asthma-COPD overlap syndrome (ACOS, and asthma with airflow limitation (asthma FL+. Methods: The medical records for a series of all stable patients with persistent airflow limitation due to COPD, ACOS, or asthma were retrospectively reviewed and divided into the COPD group (n=118, the ACOS group (n=32, and the asthma FL+ group (n=27. All the patients underwent chest high-resolution computed tomography (HRCT and pulmonary function tests, including respiratory impedance. Results: The low attenuation area score on chest HRCT was significantly higher in the COPD group than in the ACOS group (9.52±0.76 vs 5.09±1.16, P<0.01. The prevalence of bronchial wall thickening on chest HRCT was significantly higher in the asthma FL+ group than in the COPD group (55.6% vs 25.0%, P<0.01. In pulmonary function, forced expiratory volume in 1 second (FEV1 and peak expiratory flow rate were significantly higher in the asthma FL+ group than in the ACOS group (76.28%±2.54% predicted vs 63.43%±3.22% predicted, P<0.05 and 74.40%±3.16% predicted vs 61.08%±3.54% predicted, P<0.05, respectively. Although residual volume was significantly lower in the asthma FL+ group than in the COPD group (112.05%±4.34% predicted vs 137.38%±3.43% predicted, P<0.01 and the ACOS group (112.05%±4.34% predicted vs148.46%±6.25% predicted, P<0.01, there were no significant differences in functional residual capacity or total lung capacity. The increase in FEV1 in response to short-acting ß2-agonists was significantly greater in the ACOS group than in the COPD group (229±29 mL vs 72±10 mL, P<0.01 and the asthma FL+ group (229±29 mL vs 153±21 mL, P<0.05. Regarding

  18. Patient Views on Three Key Service Areas within Hospital COPD Care

    Science.gov (United States)

    Roberts, C. Michael; Seiger, Anil; Ingham, Jane

    2009-01-01

    Objective: The views of patients with Chronic Obstructive Pulmonary Disease (COPD) about three key services (non-invasive ventilation [NIV], early discharge schemes and rehabilitation) were sought in order to inform recommendations for the delivery of optimum care within a national programme of hospital COPD service development. Design: Four focus…

  19. Optimizing identification and management of COPD patients - reviewing the role of the community pharmacist

    NARCIS (Netherlands)

    van der Molen, Thys; van Boven, Job F M; Maguire, Terence; Goyal, Pankaj; Altman, Pablo

    2017-01-01

    AIM: To propose key steps for community pharmacist integration into a patient care pathway for COPD management. METHODS: A literature search was conducted to identify publications focusing on the role of the community pharmacist in identification and management of COPD. RESULTS: The literature searc

  20. Self-management and early detection of exacerbations in patients with COPD

    NARCIS (Netherlands)

    Trappenburg, J.C.A.

    2011-01-01

    Exacerbations of COPD are a major global importance. They have a profound negative effect on patients, resulting in poor health status; they accelerate the progression of the disease; and account for a large proportion the increasing healthcare spending on COPD. Yet, controversies remain over the de

  1. Determinants of activation for self-management in patients with COPD

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Bos-Touwen, I. D.; de Man, Janneke; Lammers, J. W J; Schuurmans, M. J.; Trappenburg, J. C A

    2016-01-01

    BACKGROUND: COPD self-management is a complex behavior influenced by many factors. Despite scientific evidence that better disease outcomes can be achieved by enhancing self-management, many COPD patients do not respond to self-management interventions. To move toward more effective self-management

  2. Determinants of activation for self-management in patients with COPD

    NARCIS (Netherlands)

    Korpershoek, Yvonne J.G.; Bos-Touwen, I.D.; Man-van Ginkel, J.M. de; Lammers, J.-W.J.; Schuurmans, Marieke J.; Trappenburg, J.C.A.

    2016-01-01

    Background: COPD self-management is a complex behavior influenced by many factors. Despite scientific evidence that better disease outcomes can be achieved by enhancing self-management, many COPD patients do not respond to self-management interventions. To move toward more effective self-management

  3. A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo

    DEFF Research Database (Denmark)

    Soriano, JB; Sin, DD; Zhang, X

    2007-01-01

    Background: There is controversy about whether therapy with inhaled corticosteroids (ICSs) modifies the natural history of COPD, characterized by an accelerated decline in FEV1. Methods: The Inhaled Steroids Effect Evaluation in COPD (ISEEC) study is a pooled study of patient-level data from seven...

  4. Determinants of poor 6-min walking distance in patients with COPD: the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Spruit, Martijn A; Watkins, Michael L; Edwards, Lisa D

    2010-01-01

    for Epidemiologic Studies of Depression Scale; COPD-specific St Georges Respiratory Questionnaire; modified Medical Research Council (mMRC) dyspnea scale as part of the baseline assessment of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. RESULTS: Patients...

  5. A pooled analysis of FEV1, decline in COPD patients randomized to inhaled corticosteroids or placebo

    NARCIS (Netherlands)

    Soriano, Joan B.; Sin, Don D.; Zhang, Xuekui; Camp, Pat G.; Anderson, Julie A.; Anthonisen, Nick R.; Buist, A. Sonia; Burge, P. Sherwood; Calverley, Peter M.; Connett, John E.; Petersson, Stefan; Postma, Dirkje S.; Szafranski, Wojciech; Vestbo, Jorgen

    2007-01-01

    Background: There is controversy about whether therapy with inhaled corticosteroids (ICSs) modifies the natural history of COPD, characterized by an accelerated decline in FEV1. Methods: The Inhaled Steroids Effect Evaluation in COPD (ISEEC) study is a pooled study of patient-level data from seven l

  6. A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo

    DEFF Research Database (Denmark)

    Soriano, JB; Sin, DD; Zhang, X

    2007-01-01

    Background: There is controversy about whether therapy with inhaled corticosteroids (ICSs) modifies the natural history of COPD, characterized by an accelerated decline in FEV1. Methods: The Inhaled Steroids Effect Evaluation in COPD (ISEEC) study is a pooled study of patient-level data from seve...

  7. Aging-related systemic manifestations in COPD patients and cigarette smokers.

    Directory of Open Access Journals (Sweden)

    Laurent Boyer

    Full Text Available Chronic obstructive pulmonary disease (COPD is often associated with age-related systemic abnormalities that adversely affect the prognosis. Whether these manifestations are linked to the lung alterations or are independent complications of smoking remains unclear.To look for aging-related systemic manifestations and telomere shortening in COPD patients and smokers with minor lung destruction responsible for a decline in the diffusing capacity for carbon monoxide (DLCO corrected for alveolar volume (KCO.Cross-sectional study in 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD.Compared to control smokers, patients with COPD had higher aortic pulse-wave velocity (PWV, lower bone mineral density (BMD and appendicular skeletal muscle mass index (ASMMI, and shorter telomere length (TL. Insulin resistance (HOMA-IR and glomerular filtration rate (GFR were similar between control smokers and COPD patients. Smokers did not differ from nonsmokers for any of these parameters. However, smokers with normal spirometry but low KCO had lower ASMMI values compared to those with normal KCO. Moreover, female smokers with low KCO, had lower BMD and shorter TL compared to those with normal KCO.Aging-related abnormalities in patients with COPD are also found in smokers with minor lung dysfunction manifesting as a KCO decrease. Decreased KCO might be useful, particularly among women, for identifying smokers at high risk for aging-related systemic manifestations and telomere shortening.

  8. Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD

    Directory of Open Access Journals (Sweden)

    Ouellette DR

    2017-02-01

    Full Text Available Daniel R Ouellette,1 Kim L Lavoie2 1Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA; 2Montreal Behavioral Medicine Center (MBMC, Research Center, Integrated University Health and Social Services Center – Sacred Heart Hospital of Montreal, Montreal, QC, Canada Abstract: COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes. Keywords: COPD, cognitive impairment, mood disorders, anxiety disorders, hypoxemia, pulmonary rehabilitation

  9. Influence of lung parenchymal destruction on the different indexes of the methacholine dose-response curve in COPD patients

    NARCIS (Netherlands)

    G.T. Verhoeven; A.F.M. Verbraak (Anton); S. Boere-van der Straat; H.C. Hoogsteden (Henk); J.M. Bogaard (Jan)

    2000-01-01

    textabstractSTUDY OBJECTIVES: The interpretation of nonspecific bronchial provocation dose-response curves in COPD is still a matter of debate. Bronchial hyperresponsiveness (BHR) in patients with COPD could be influenced by the destruction of the parenchyma and the

  10. Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997–2012)

    Science.gov (United States)

    de Miguel-Díez, Javier; López-de-Andrés, Ana; Jiménez-García, Rodrigo; Puente-Maestu, Luis; Jiménez-Trujillo, Isabel; Hernández-Barrera, Valentín

    2016-01-01

    Purpose The aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012). Methods A retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection). Results 1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD. Conclusions Incidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era. PMID:27846297

  11. Assessment of illness acceptance by patients with COPD and the prevalence of depression and anxiety in COPD

    Directory of Open Access Journals (Sweden)

    Uchmanowicz I

    2016-05-01

    Full Text Available Izabella Uchmanowicz,1 Beata Jankowska-Polanska,1 Urszula Motowidlo,2 Bartosz Uchmanowicz,1 Mariusz Chabowski3 1Department of Clinical Nursing, Faculty of Health Science, 2Department of Thoracic Surgery, 3Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Background: COPD is a civilization disease. It affects up to 8%–10% of population >30 years of age. Coexistence of depression occurs in 20%–40% of patients with COPD. Depression and anxiety reduce compliance and worsen prognosis. Objective: The aims of this study were to determine the degree of illness acceptance among patients with COPD, to examine the relation between disease acceptance and perceived anxiety and depression, and to verify which of the sociodemographic and clinical factors are associated with illness acceptance, anxiety, and depression. Materials and methods: The study included 102 patients with COPD (mean age 65.8 years, hospitalized due to exacerbations. Acceptance of Illness Scale and Hospital Anxiety and Depression Scale were used. For statistical analysis, Student’s t-test and Pearson’s r correlation coefficient were carried out. Results: The overall illness acceptance level was moderate with a tendency toward lack of acceptance (mean 20.6, standard deviation [SD] 7.62. The overall scores were 10.2 (SD 3.32 for anxiety and 10.8 (SD 4.14 for depression, which indicate borderline or high intensity of these symptoms. Acceptance of illness was negatively correlated with the intensity of depression symptoms (r=-0.46, P<0.05. Intensity of depression was significantly associated with intensity of smoking, duration of the disease, severity of dyspnea, and living in a rural area. Conclusion: Early identification and assessment of depression and anxiety symptoms allow health care providers to offer patients at risk of depression a special medical supervision. Rapid start of

  12. Does vitamin C or its combination with vitamin E improve radial artery endothelium-dependent vasodilatation in patients awaiting coronary artery bypass surgery?

    OpenAIRE

    Uzun, Alper; Yener, Umit; Cicek, Omer Faruk; Yalcinkaya, Adnan; Diken, Adem; Ozkan, Turgut; Ulas, Mahmut; Yener, Ozlem; Turkvatan, Aysel

    2013-01-01

    Background We evaluated the vasodilatory effects of two antioxidants, vitamins C (ascorbic acid) and E (α-tocopherol), on radial artery and endothelium-dependent responses in patients awaiting coronary artery bypass surgery. Methods The study was performed in three groups. The first group took 2 g of vitamin C orally (n = 31, vitamin C group), the second group took 2 g of vitamin C with 600 mg of vitamin E orally (n = 31, vitamins C + E group), and the third group took no medication (n = 31, ...

  13. Telaprevir-containing regimen for treatment of hepatitis C virus infection in patients with hepatocellular carcinoma awaiting liver transplantation: a case series

    Science.gov (United States)

    Torres, Harrys A; Kaseb, Ahmed; Mahale, Parag; Miller, Ethan; Frenette, Catherine

    2014-01-01

    In patients who undergo liver transplantation (LT), allograft failure secondary to hepatitis C virus (HCV) recurrence after LT accounts for two-thirds of graft failures and deaths. Achievement of sustained virologic response before LT eliminates the risk of HCV recurrence. Only a limited number of studies have evaluated the role of antiviral treatment before LT. No published data are available regarding the use of HCV protease inhibitors before LT. We report our experience using the combination of telaprevir, pegylated interferon alfa-2a (PegIFN alfa-2a), and ribavirin in three patients with HCV-associated hepatocellular carcinoma (HCC) awaiting LT. Two patients had not received, and one had had a partial response to HCV therapy (PegIFN alfa-2a plus ribavirin). All three patients had genotype 1b and were started on telaprevir and full doses of PegIFN alfa-2a and ribavirin. Treatment was planned to be continued until the day of LT or 48 weeks total, whichever came first. One patient still had detectable HCV RNA after 24 weeks of antivirals and was, therefore, excluded from further analysis. The other two patients had undetectable HCV RNA at the end of antiviral therapy. In one of these patients, HCV RNA remained undetectable after LT; the other patient experienced viral relapse. HCV therapy was tolerated by all patients; no patient required permanent discontinuation of therapy because of toxic effects. All three patients experienced hematologic toxic effects. Only one patient required treatment discontinuation, due to progression of HCC. The use of telaprevir-containing regimens appears to be safe in selected patients with HCV-associated HCC awaiting LT, but more studies are warranted to evaluate the safety and efficacy of this treatment combination to prevent post-LT viral recurrence. PMID:27508180

  14. Differences in walking pattern during 6-min walk test between patients with COPD and healthy subjects.

    Directory of Open Access Journals (Sweden)

    Janneke Annegarn

    Full Text Available BACKGROUND: To date, detailed analyses of walking patterns using accelerometers during the 6-min walk test (6MWT have not been performed in patients with chronic obstructive pulmonary disease (COPD. Therefore, it remains unclear whether and to what extent COPD patients have an altered walking pattern during the 6MWT compared to healthy elderly subjects. METHODOLOGY/PRINCIPAL FINDINGS: 79 COPD patients and 24 healthy elderly subjects performed the 6MWT wearing an accelerometer attached to the trunk. The accelerometer features (walking intensity, cadence, and walking variability and subject characteristics were assessed and compared between groups. Moreover, associations were sought with 6-min walk distance (6MWD using multiple ordinary least squares (OLS regression models. COPD patients walked with a significantly lower walking intensity, lower cadence and increased walking variability compared to healthy subjects. Walking intensity and height were the only two significant determinants of 6MWD in healthy subjects, explaining 85% of the variance in 6MWD. In COPD patients also age, cadence, walking variability measures and their interactions were included were significant determinants of 6MWD (total variance in 6MWD explained: 88%. CONCLUSIONS/SIGNIFICANCE: COPD patients have an altered walking pattern during 6MWT compared to healthy subjects. These differences in walking pattern partially explain the lower 6MWD in patients with COPD.

  15. Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients.

    Science.gov (United States)

    Karamanli, Harun; Ilik, Faik; Kayhan, Fatih; Pazarli, Ahmet Cemal

    2015-01-01

    A number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function. The present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year. In the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

  16. Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study

    Directory of Open Access Journals (Sweden)

    Saito H

    2015-10-01

    Full Text Available Hitoshi Saito,1,2 Koichiro Nomura,1,2,† Shinji Abe,1,2 Takashi Motegi,2,3 Takeo Ishii,2,3 Kumiko Hattori,2,3 Yuji Kusunoki,2,3 Akihiko Gemma,2 Kozui Kida2,3 1Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, 2Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan, 3Respiratory Care Clinic, Nippon Medical School †Koichiro Nomura passed away on July 30, 2014 Objective: Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD.Participants: Subjects included 87 patients either with COPD or at risk of COPD (symptomatic who underwent gastrectomy between December 2003 and October 2013 (group A, and 174 patients either with COPD or at risk of COPD, matched by age (±5 years, sex, and forced expiratory volume in 1 second (FEV1 as percentage of predicted (FEV1% predicted (±5% (group B.Methods: All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT, high-resolution chest computed tomography scans, and nutritional assessments.Results: The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00, and walked a significantly shorter distance in the 6MWT (P<0.05. Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV to total lung capacity (TLC as percentage of predicted (%RV/TLC alone was an independent and significant predictor of reduced distances in the 6MWT.Conclusion: We concluded

  17. Maximal exercise in obese patients with COPD: the role of fat free mass

    OpenAIRE

    Aiello, Marina; Teopompi, Elisabetta; Tzani, Panagiota; Ramponi, Sara; Gioia, Maria Rosaria; Marangio, Emilio; Chetta, Alfredo

    2014-01-01

    Background Obese patients (OB) with COPD may better tolerate exercise as compared to normal weight (NW) COPD patients, even if the reason for this is not yet fully understood. We investigated the interactions between obesity, lung hyperinflation, fat-free mass (FFM) and exercise capacity in COPD. Methods Forty-four patients (16 females; age 65 ± 8 yrs) were assessed by resting lung function and body composition and exercised on a cycle-ergometer to exhaustion. Results Twenty-two OB and 22 NW ...

  18. Treatment trends in patients with asthma–COPD overlap syndrome in a COPD cohort: findings from a real-world survey

    Directory of Open Access Journals (Sweden)

    Ding B

    2017-06-01

    Full Text Available Bo Ding,1 Mark Small2 1AstraZeneca Gothenburg, Mölndal, Sweden; 2Adelphi Real World, Bollington, Macclesfield, UK Background: Asthma and chronic obstructive pulmonary disease (COPD overlap syndrome (ACOS is an increasingly recognized phenotype. Few randomized clinical trials have been conducted in patients with ACOS; therefore, scientific evidence concerning ACOS is scarce and a therapeutic approach remains unclear. The aim of this study was to evaluate current treatment trends for patients with ACOS, identified as those with a dual definition of asthma and COPD, in a real-world COPD cohort.Methods: Data were analyzed from patients with asthma and COPD in the USA, France, Germany, Italy, Spain, and the UK who participated in the 2012 and 2013 Adelphi Respiratory Disease Specific Programmes (DSPs. Patients with ACOS were identified in the COPD population; these patients had a physician-confirmed, concomitant asthma diagnosis. Physicians completed a patient record form providing information on patient and disease characteristics including prescribed respiratory treatment. Pairwise comparisons were made between the ACOS, asthma, and COPD populations using χ2 tests.Results: In total, 9,042 patients with asthma-only, 7,119 patients with COPD-only, and 523 patients with ACOS (a dual diagnosis of asthma and COPD participated in the study. The most commonly prescribed regimens were inhaled corticosteroid/long-acting β2-agonist (ICS/LABA + long-acting muscarinic antagonist (LAMA; (ACOS 30%, asthma 1.4%, and COPD 32%, ICS/LABA (19%, 41.5%, and 17%, respectively, and LAMA (6%, 0.4%, and 19%, respectively; 18% of patients with ACOS were not prescribed an ICS. Patients with ACOS had a significantly higher incidence of gastroesophageal reflux disease, diabetes, and obesity and experienced more exacerbations in the past year than those with COPD or asthma.Conclusions: The majority of patients with ACOS, as defined in this research, were prescribed similar

  19. COPD exacerbation: anthropometric characteristics of patients and the frequency of hospital admissions

    Directory of Open Access Journals (Sweden)

    Gashynova K.Y.

    2014-11-01

    Full Text Available Exceptional importance of exacerbations for COPD course prognosing was reflected in the GOLD, 2011, where the number of exacerbations during the past year has been recognized as one of the main criteria of the future risks for patients. The aim of study was to determine the anthropometric indicators that increase the risk of re-hospitalization due to acute exacerbation of COPD. A retrospective analysis of medical records of inpatients who were hospitalized with COPD exacerbation to therapeutic department of CI "Dnipropetrovs’k sixth municipal clinical hospital" of Dnipropetrovsk regional council" during three years was done. It was established that neither sex, nor height, nor weight affect the rate of hospitalization due to COPD exacerbations. Older age is not a factor that increases the risk of hospitalization due to COPD exacerbation (despite the fact that the majority of hospitalized patients were elderly patients, 37% of them were persons of potentially working age. Severe exacerbation of COPD may occur in any patients with, even one year, experience of the disease. Among anthropometric indices, the most important predictor of re-hospitalization due to exacerbation of COPD is BMI<18.5, so its calculation is advisable in long-term observation of patients.

  20. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes

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    Fromer L

    2011-11-01

    Full Text Available Len FromerDepartment of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Current primary care patterns for chronic obstructive pulmonary disease (COPD focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.Keywords: chronic obstructive pulmonary disease, chronic care model, patient-centered medical home, self-management, interdisciplinary care team, coordination of care

  1. Circulating monocytes from healthy individuals and COPD patients

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    Piitulainen Eeva

    2003-09-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is characterized by incompletely reversible airflow obstruction associated with inflammation in which monocytes/macrophages are the predominant inflammatory cells. The only known genetic factor related to COPD is inherited PiZZ deficiency of α1-antitrypsin (AAT, an inhibitor of serine proteases. Methods We investigated the basal and LPS-stimulated release of pro-inflammatory molecules from blood monocytes isolated from age and gender matched healthy (n = 30 and COPD (n = 20 individuals with and without AAT deficiency. Results After 18 h of cell culture the basal release of MMP-9 was 2.5-fold, p Conclusions The basal and LPS-stimulated secretion of specific pro-inflammatory molecules from circulating monocytes differs between healthy and COPD subjects. These findings may be valuable for further studies on the mechanisms involved in recruitment and activation of inflammatory cells in COPD.

  2. Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients

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    Karamanli H

    2015-09-01

    Full Text Available Harun Karamanli,1 Faik Ilik,2 Fatih Kayhan,3 Ahmet Cemal Pazarli4 1Department of Pulmonology, 2Department of Neurology, ³Department of Psychiatry, Faculty of Medicine, Mevlana University, Konya, Turkey; 4Department of Pulmonology, Elbistan State Hospital, Elbistan, Turkey Background: A number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE and the Montreal Cognitive Assessment (MoCA, for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function. Methods: The present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: <26 points and MMSE (cutoff: ≤24 points scores were compared between these two groups.Results: The nonuser LTOTD-COPD group had a significantly lower MoCA score than that of the regular-user LTOTD-COPD group (19.38±2.99 vs 21.68±2.14, respectively as well as a significantly lower MMSE score. Moreover, the absence of supplemental oxygen therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014, and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year.Conclusion: In the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as

  3. Measurement properties of the Timed Up & Go test in patients with COPD.

    Science.gov (United States)

    Mesquita, Rafael; Wilke, Sarah; Smid, Dionne E; Janssen, Daisy Ja; Franssen, Frits Me; Probst, Vanessa S; Wouters, Emiel Fm; Muris, Jean Wm; Pitta, Fabio; Spruit, Martijn A

    2016-05-10

    We aimed to investigate the construct validity of the Timed Up & Go (TUG) test in chronic obstructive pulmonary disease (COPD), to identify characteristics related to an abnormal TUG time and to examine the responsiveness of the TUG to pulmonary rehabilitation (PR). TUG time was assessed before and after comprehensive PR in 500 COPD patients, and compared cross-sectionally in 100 non-COPD subjects. Physical health outcomes, mental health outcomes, symptom-related outcomes and multidimensional indices were assessed in COPD patients only. Good convergent and discriminant validity was demonstrated by fair-to-moderate correlation with physical health outcomes, symptom-related outcomes and multidimensional indices (r s = 0.18-0.70) and by little correlation with mental health outcomes (r s = 0.21-0.26). COPD patients had a worse TUG time than non-COPD subjects, demonstrating known-groups validity. A TUG time of 11.2 seconds had good sensitivity (0.75) and specificity (0.83) for identifying patients with a baseline 6-minute walk distance time improved after PR (p < 0.0001) and a change of 0.9-1.4 seconds was identified as clinically important. The TUG is valid and responsive in COPD. An abnormal result is indicative of poor health outcomes. This simple test provides valuable information and can be adopted in clinical and research settings. © The Author(s) 2016.

  4. Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD

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    Monique Tabak

    2012-01-01

    Full Text Available Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness, and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9% and 21 healthy controls (57.0 years participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm. Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( cpm versus  cpm, . COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3% were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels.

  5. Self-management in patients with COPD: theoretical context, content, outcomes, and integration into clinical care.

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    Kaptein, Ad A; Fischer, Maarten J; Scharloo, Margreet

    2014-01-01

    In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients' functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD.

  6. Effects of interval and continuous exercise training on autonomic cardiac function in COPD patients.

    Science.gov (United States)

    Rodríguez, Diego A; Arbillaga, Ane; Barberan-Garcia, Anael; Ramirez-Sarmiento, Alba; Torralba, Yolanda; Vilaró, Jordi; Gimeno-Santos, Elena; Gea, Joaquim; Orozco-Levi, Mauricio; Roca, Josep; Marco, Ester

    2016-01-01

    Both interval (IT) and continuous (CT) exercise training results in an improvement of aerobic capacity in patients with chronic obstructive pulmonary disease (COPD); however, their effects on cardiac autonomic function remains unclear. The aim of our study was to evaluate the effect of a supervised CT vs IT on autonomic cardiac function in COPD patients. COPD patients were divided into two different groups according to training modality (IT or CT). Autonomic cardiac dysfunction (ACD) was defined as a heart rate recovery lower than 12 bpm heart rate after the first minute of maximal exercise (HRR1 ) and an abnormal chronotropic response (CR) to exercise (exercise training improve heart rate recovery and CR in COPD patients. These benefits could help to individualize exercise training. © 2014 John Wiley & Sons Ltd.

  7. Are patients with COPD treated with NIV in accordance with national guidelines? An internal audit.

    Science.gov (United States)

    Titlestad, Ingrid L; Olsen, Fanny; Sandqvist, Hanna M; Pourbazargan, Melvin M; Fretheim, Håvard H; Lassen, Annmarie T; Vestbo, Jørgen

    2014-01-01

    Non-invasive ventilation (NIV) as an add-on modality to medical treatment has been recommended in national guidelines for patients acutely admitted with chronic obstructive pulmonary disorder (COPD) exacerbation and hypercapnic respiratory failure. To address concerns regarding whether NIV is used appropriately, we conducted an audit of COPD patients admitted to a university hospital in Denmark. Data from medical records were retrieved for two cohorts in 2010: 1) all patients admitted to the Medical Emergency Ward with the diagnosis of COPD, and 2) all patients receiving NIV regardless of their diagnosis at the Respiratory Ward. Demographic data and outcome of treatment were registered. Cohort 1 comprised 804 admissions fulfilling criteria for COPD at evaluation, and of the 804 admissions, NIV was initiated in 151 (18.7%) admissions. In 42 additional cases (5.2%), initial mild respiratory acidosis was registered at admission, fulfilling criteria for NIV treatment; and, in 36 cases, the clinical status was reported as improved or not reported at all; no deaths were observed. In cohort 2, 124 admissions were registered that comprised 110 admissions with COPD and 14 without a diagnosis of COPD (of which half had a 'not-to-intubate' order). The indication for NIV treatment was met in 92.7% of the COPD admissions. NIV was initiated in 18.8% of the COPD admissions, and in an additional 5.2%, NIV criteria were met without initiation. In 82.3% of the admissions receiving NIV, a COPD diagnosis and correct criteria for NIV treatment were met.

  8. Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD

    Science.gov (United States)

    He, Bai-Ting; Lu, Gan; Xiao, Si-Chang; Chen, Rui; Steier, Joerg; Moxham, John; Polkey, Michael I; Luo, Yuan-Ming

    2017-01-01

    Background The mechanisms underlying sleep-related hypoventilation in patients with coexisting COPD and obstructive sleep apnoea (OSA), an overlap syndrome, are incompletely understood. We compared neural respiratory drive expressed as diaphragm electromyogram (EMGdi) and ventilation during stage 2 sleep in patients with COPD alone and patients with overlap syndrome. Methods EMGdi and airflow were recorded during full polysomnography in 14 healthy subjects, 14 patients with OSA and 39 consecutive patients with COPD. The ratio of tidal volume to EMGdi was measured to indirectly assess upper airway resistance. Results Thirty-five patients with COPD, 12 healthy subjects and 14 patients with OSA completed the study. Of 35 patients with COPD, 19 had COPD alone (FEV1 38.5%±16.3%) whereas 16 had an overlap syndrome (FEV1 47.5±16.2%, AHI 20.5±14.1 events/hour). Ventilation (VE) was lower during stage 2 sleep than wakefulness in both patients with COPD alone (8.6±2.0 to 6.5±1.5 L/min, pCOPD alone (29.5±13.3% to 23.0±8.9% of maximal, pCOPD alone and healthy subjects but was significantly reduced in patients with OSA or overlap syndrome (pCOPD alone is due to reduction of neural respiratory drive, but in overlap syndrome it is due to increased upper airway resistance. PMID:27807016

  9. Relations between cardiopulmonary function during exercise and exercise tolerance in patients with COPD

    OpenAIRE

    Cuypers, Maarten; Vos, Tine

    2015-01-01

    Methods: In part 1, a cross-sectional study took place. Sixty COPD patients performed a spirometry and a cardiopulmonary exercise test (CPET). Predictors of exercise tolerance were examined. In part 2, a longitudinal observational study took place. Twelve COPD patients completed an exercise training intervention. A study on relations between changes in cardiopulmonary function and changes in exercise tolerance was performed. Results: Significant predictors of VO2peak are peak carbon d...

  10. Outcomes in COPD patients receiving tiotropium or salmeterol plus treatment with inhaled corticosteroids

    OpenAIRE

    Hodder, Richard; Kesten, Steven; Menjoge, Shailendra; Viel, Klaus

    2007-01-01

    Patients with COPD are frequently prescribed inhaled corticosteroids (ICS); however, it is unclear whether the treatment with ICS might modify responses to inhaled bronchodilators. Two 6-month, randomized, placebo-controlled, double-blind, double-dummy, parallel-group studies of tiotropium 18 μg once daily, compared with salmeterol, 50 μg bid, had been conducted in patients with moderate-to-severe COPD. Efficacy was assessed by spirometry, transition dyspnea index (TDI), St. George’s Respirat...

  11. Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD

    OpenAIRE

    Kim, Sae Ahm; Lee, Ji-Hyun; Kim, Eun-Kyung; Kim, Tae-Hyung; Kim, Woo Jin; Lee, Jin Hwa; Yoon, Ho Il; Baek, Seunghee; Lee, Jae Seung; Oh, Yeon-Mok; Lee, Sang-Do

    2015-01-01

    Background The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared w...

  12. Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients.

    Science.gov (United States)

    Iwakura, Masahiro; Okura, Kazuki; Shibata, Kazuyuki; Kawagoshi, Atsuyoshi; Sugawara, Keiyu; Takahashi, Hitomi; Shioya, Takanobu

    2016-01-01

    Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients. Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects' balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group. The COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (Pbalance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (Pbalance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical inactivity.

  13. Spirometry is underused in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Yu, Wai Cho; Fu, Sau Nga; Tai, Emily Lai-Bun; Yeung, Yiu Cheong; Kwong, Kwok Chu; Chang, Yui; Tam, Cheuk Ming; Yiu, Yuk Kwan

    2013-01-01

    Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in a district in Hong Kong. It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Of 126 patients who underwent spirometry, six (4.8%) did not have COPD. Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. The only independent factor predicting spirometry done ever was absence of old pulmonary tuberculosis and follow-up at respiratory specialist clinic. Age, sex, smoking status, comorbidities, duration of COPD, percentage predicted FEV1, body mass index, 6-minute walking distance, and Medical Research Council dyspnea score were not predictive. We conclude that spirometry is underused in general but especially by nonrespiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed.

  14. The effects of dynamic hyperinflation on CT emphysema measurements in patients with COPD

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    Alves, Giordano Rafael Tronco, E-mail: grtalves@gmail.com [Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro (Brazil); Marchiori, Edson [Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro (Brazil); Irion, Klaus Loureiro [Radiology Department, Liverpool Heart and Chest Hospital (United Kingdom); Teixeira, Paulo José Zimmerman [Pulmonology Department, Federal University of Health Sciences of Porto Alegre (Brazil); Berton, Danilo Cortozi [Pulmonology Department, Federal University of Rio Grande do Sul (Brazil); Rubin, Adalberto Sperb [Pulmonology Department, Federal University of Health Sciences of Porto Alegre (Brazil); Hochhegger, Bruno [Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro (Brazil)

    2014-12-15

    Objectives: Dynamic hyperinflation (DH) significantly affects dyspnea and intolerance to exercise in patients with chronic obstructive pulmonary disease (COPD). Quantitative computed tomography (QCT) of the chest is the modality of choice for quantification of the extent of anatomical lung damage in patients with COPD. The purpose of this article is to assess the effects of DH on QCT measurements. Methods: The study sample comprised patients with Global initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV COPD referred for chest CT. We examined differences in total lung volume (TLV), emphysema volume (EV), and emphysema index (EI) determined by QCT before and after DH induction by metronome-paced tachypnea (MPT). Initial (resting) and post-MPT CT examinations were performed with the same parameters. Results: Images from 66 CT scans (33 patients) were evaluated. EV and EI, but not TLV, increased significantly (p < 0.0001) after DH induction. Conclusion: QCT showed significant increases in EV and EI after MPT-induced DH in patients with GOLD stages III and IV COPD. For longitudinal assessment of patients with COPD using QCT, we recommend the application of a pre-examination rest period, as DH could mimic disease progression. QCT studies of the effects of DH-preventive therapy before exercise could expand our knowledge of effective measures to delay DH-related progression of COPD.

  15. Evaluation of Visual Evoked Potential (VEP) in Patients With Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Karthikkeyan, Kanmani; Padma, K; Rao, B Vishwanatha

    2015-01-01

    Chronic Obstructive Pulmonary Disease (COPD), a progressive and partially reversible disease, has drawn world-wide attention for its moderate prevalence rate and causing central and peripheral neuropathy. Considering its severity in causing visual pathway impairment, the present investigation was carried out to find out the functional integrity of the visual pathway through visual evoked potentials (VEP) and to determine the factors influencing the condition in COPD patients. A total of 30 COPD patients of both sexes, classified according to the severity of the disease based on spirometric indices, were subjected to VEP testing and series of wave forms were measured and compared with equal number of control subjects. The latency of N75 and P100 were prolonged (P VEP changes. Non-invasive procedure can possibly be utilized as a routine screening test for COPD patients for better medical care.

  16. Immune response to exercise in patients with COPD

    NARCIS (Netherlands)

    Helvoort, H.A.C. van

    2006-01-01

    Chronic Obstructive Pulmonary Disease (COPD) is increasingly being recognized as systemic rather than only a pulmonary disease. Increasing amounts of activated inflammatory cells, mediators and oxidative stress are not restricted to the local compartment- including airways, lung parenchyma, and pulm

  17. The feasibility of a home-based sedentary behaviour intervention for hospitalised chronic obstructive pulmonary disease (COPD patients: Sitting and ExacerbAtions Trial (COPD-SEAT

    Directory of Open Access Journals (Sweden)

    Mark Orme

    2015-10-01

    COPD-SEAT will be one of the first trials aimed at reducing sedentary behaviour at home in patients hospitalised for an acute exacerbation of COPD. This trial will provide valuable insight into the feasibility of implementing an at-home technology-based feedback intervention for reducing sedentary behaviour into patients existing care. Findings will inform a future large-scale trial acting as an adjuvant to pulmonary rehabilitation.

  18. Impaired function of regulatory T-cells in patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Tan, Dino B A; Fernandez, Sonia; Price, Patricia; French, Martyn A; Thompson, Philip J; Moodley, Yuben P

    2014-12-01

    Anti-inflammatory pathways affecting chronic obstructive pulmonary disease (COPD) are poorly understood. Regulatory T-cells (Tregs) are important negative regulators of T-cell activity and hence were investigated in COPD patients in this study. We hypothesised that functional defects in Tregs may promote increased inflammation contributing to the pathogenesis of COPD. Peripheral blood mononuclear cells (PBMC) were isolated from patients with stable COPD and age-matched non-smoking controls. Treg-mediated suppression of memory non-Treg (Foxp3(-)CD45RO(+)) CD4(+) T-cell activation was analysed by comparing PBMC responses to staphylococcal enterotoxin-B (SEB) pre- and post-depletion of Tregs (CD25(+)CD127(low)CD4(+) T-cells) by fluorescence-activated cell sorting (FACS). Activation of T-cells was assessed by HLA-DR expression. Levels of secreted cytokines were measured by ELISA. Depletion of Tregs increased SEB-induced activation of Foxp3(-)CD45RO(+) CD4(+) T-cells in samples from 15/15 healthy controls (demonstrating Treg-mediated suppression) and 9/14 COPD patients (Fisher's test, p=0.017). A screen of clinical data associated a failure of Treg-mediated suppression in the remaining five COPD patients with a higher body mass index (BMI) (33-38 kg/m(2)) compared to patients with unimpaired Treg function (20-32 kg/m(2)). In conclusion, we demonstrate impaired Treg-mediated suppression of CD4(+) T-cell activation in a subset of COPD patients, all of whom had high BMI. Obesity and/or perturbed homeostasis of Treg subsets may explain this defect and therefore contribute to increased inflammation observed in COPD.

  19. Differences in physical activity according to mMRC grade in patients with COPD

    Directory of Open Access Journals (Sweden)

    Hayata A

    2016-09-01

    Full Text Available Atsushi Hayata,1 Yoshiaki Minakata,2 Kazuto Matsunaga,3 Masanori Nakanishi,1 Nobuyuki Yamamoto1 1Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, 2Department of Respiratory Medicine, National Hospital Organization Wakayama Hospital, Wakayama, 3Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan Background: Physical activity (PA is impaired from the early stages of COPD, is associated with a worsening of disease prognosis, and causes COPD patients to restrict their daily activities in order to avoid breathlessness. The development of a simple tool to estimate physical activity level (PAL could be useful for the management of COPD. Objectives: We investigated the differences in PA according to the modified Medical Research Council (mMRC grade in patients with COPD. Methods: A cross-sectional study was performed on stable outpatients with COPD. PA was measured for 2 weeks using a triaxial accelerometer, and dyspnea grade was evaluated in all patients using the mMRC scale. Results: Ninety-eight patients were recruited. Significant differences in PA duration were observed at all intensities according to the mMRC grade. Despite treatment with controller medications, 59.2% of COPD patients had low PAL, which was <1.5 metabolic equivalents multiplied by hour per day. COPD patients with an mMRC grade ≥2, which was the most balanced cutoff point in the receiver operating characteristic curve, showed a higher reduction rate of PAL (80.0% at mMRC grade 2, 71.4% at mMRC grade 3, and 100% at mMRC grade 4. Conclusion: PA differed according to the mMRC grade, and mMRC grade ≥2 could predict a low PAL. Therefore, assessment of breathlessness by the mMRC questionnaire would be useful to stratify the risks of reduced PA in COPD. Keywords: accelerometer, questionnaire, dyspnea, METs

  20. Differences in physical activity according to mMRC grade in patients with COPD

    Science.gov (United States)

    Hayata, Atsushi; Minakata, Yoshiaki; Matsunaga, Kazuto; Nakanishi, Masanori; Yamamoto, Nobuyuki

    2016-01-01

    Background Physical activity (PA) is impaired from the early stages of COPD, is associated with a worsening of disease prognosis, and causes COPD patients to restrict their daily activities in order to avoid breathlessness. The development of a simple tool to estimate physical activity level (PAL) could be useful for the management of COPD. Objectives We investigated the differences in PA according to the modified Medical Research Council (mMRC) grade in patients with COPD. Methods A cross-sectional study was performed on stable outpatients with COPD. PA was measured for 2 weeks using a triaxial accelerometer, and dyspnea grade was evaluated in all patients using the mMRC scale. Results Ninety-eight patients were recruited. Significant differences in PA duration were observed at all intensities according to the mMRC grade. Despite treatment with controller medications, 59.2% of COPD patients had low PAL, which was metabolic equivalents multiplied by hour per day. COPD patients with an mMRC grade ≥2, which was the most balanced cutoff point in the receiver operating characteristic curve, showed a higher reduction rate of PAL (80.0% at mMRC grade 2, 71.4% at mMRC grade 3, and 100% at mMRC grade 4). Conclusion PA differed according to the mMRC grade, and mMRC grade ≥2 could predict a low PAL. Therefore, assessment of breathlessness by the mMRC questionnaire would be useful to stratify the risks of reduced PA in COPD. PMID:27695306

  1. The Evaluation of Osteoporosis in Male Patients with COPD - Original Investigation

    Directory of Open Access Journals (Sweden)

    Hale Karapolat

    2007-09-01

    Full Text Available Aim: Osteoporosis is an important complication in patients with chronic obstructive pulmonary disease (COPD. The aim of this study is to determine the bone mineral density (BMD and assess the relationship among bone mineral density, bone metabolism and the clinical data in patients with COPD. Patients and Method: 25 male COPD patients (mean age: 66±7.23 years and 29 healthy male controls (mean age: 63.68±8.04 years were enrolled into the study. COPD and control groups were assessed for hip (femoral neck and Ward’s triangle and lumbar BMD, biochemical (blood calcium, blood phosphate, 24-hour urine calcium, creatinin clearance, osteocalcin, deoxypyridinoline and hormonal [follicle-stimulating hormone (FSH, luteinising hormone (LH, free testosterone (sT, and parathyroid hormone (PTH] markers. Results: No significant difference was found in BMD and T scores of hip and lumbar areas between COPD and control groups (p>0.05. When compared to the control group, COPD patients had significantly lower free testosterone (p=0.008 and significantly higher osteocalcin (p=0.0016 and PTH (p=0.00 values. Pulmonary function test and duration of disease were not correlate with lumbar and hip BMD in COPD group (p>0.05. Conclusion: Although BMD did not differ in any groups, some hormonal and biochemical markers were different in patients with COPD. Because osteoporosis is considered as an important complication to cause fractures, it is important to identify the risk groups for osteoporosis and take preventive and therapeutical measures. (From the World of Osteoporosis 2007;13:70-4

  2. Improvement of cognitive function after a three-month pulmonary rehabilitation program for COPD patients.

    Science.gov (United States)

    Pereira, Eanes D B; Viana, Cinthya Sampaio; Taunay, Tauily C E; Sales, Penha U; Lima, Jose W O; Holanda, Marcelo A

    2011-08-01

    The objective of the study was to evaluate the effect of multidisciplinary pulmonary rehabilitation program on cognitive function in COPD patients, adjusting for potential confounders (gender, age, tobacco consumption, and educational level). In this prospective study, 34 COPD patients were submitted to neuropsychological testing before and after a 3-month pulmonary rehabilitation program. A control group with 18 healthy subjects of similar age, sex, and educational status was used to compare the cognitive function of COPD patients and healthy subjects at baseline. The association between the rehabilitation and change on th scores of cognitive variables, adjusted for each covariate, was estimated by means of linear random-intercept regression models. At baseline, the COPD patients had worse cognitive function with regard to verbal learning, memory, subjective organization, and verbal processing in comparison to the healthy volunteers. The improvement in cognitive performance by the COPD patients was evidenced even after adjusting for the sociodemographic factors that could potentially interfere on cognitive function. Male gender and age less than 65 years old were associated to higher scores in verbal learning and memory at baseline and after the rehabilitation program. The clinical approach to COPD-induced cognitive dysfunction should include participation in pulmonary rehabilitation programs. There were gender- and age-related differences in cognitive scores that persisted after rehabilitation.

  3. Telaprevir-containing regimen for treatment of hepatitis C virus infection in patients with hepatocellular carcinoma awaiting liver transplantation: a case series

    Directory of Open Access Journals (Sweden)

    Torres HA

    2014-07-01

    Full Text Available Harrys A Torres,1 Ahmed Kaseb,2 Parag Mahale,1 Ethan Miller,3 Catherine Frenette4 1Department of Infectious Diseases, Infection Control and Employee Health, 2Department of Gastrointestinal Medical Oncology, 3Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 4Department of Liver Transplantation, Weill Cornell Medical College, The Methodist Hospital, Houston, TX, USA Abstract: In patients who undergo liver transplantation (LT, allograft failure secondary to hepatitis C virus (HCV recurrence after LT accounts for two-thirds of graft failures and deaths. Achievement of sustained virologic response before LT eliminates the risk of HCV recurrence. Only a limited number of studies have evaluated the role of antiviral treatment before LT. No published data are available regarding the use of HCV protease inhibitors before LT. We report our experience using the combination of telaprevir, pegylated interferon alfa-2a (PegIFN alfa-2a, and ribavirin in three patients with HCV-associated hepatocellular carcinoma (HCC awaiting LT. Two patients had not received, and one had had a partial response to HCV therapy (PegIFN alfa-2a plus ribavirin. All three patients had genotype 1b and were started on telaprevir and full doses of PegIFN alfa-2a and ribavirin. Treatment was planned to be continued until the day of LT or 48 weeks total, whichever came first. One patient still had detectable HCV RNA after 24 weeks of antivirals and was, therefore, excluded from further analysis. The other two patients had undetectable HCV RNA at the end of antiviral therapy. In one of these patients, HCV RNA remained undetectable after LT; the other patient experienced viral relapse. HCV therapy was tolerated by all patients; no patient required permanent discontinuation of therapy because of toxic effects. All three patients experienced hematologic toxic effects. Only one patient required treatment

  4. Viral Profile of COPD Exacerbations According to Patients§

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    Dimopoulos, G; Tsiodras, S; Lerikou, M; Chranioti, Aik; Perros, E; Anagnostopoulou, U; Karakitsos, P; Armaganidis, A

    2015-01-01

    Background : To compare the differences between elderly and non-elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) due to viral infections. Methods : Patients with chronic obstructive pulmonary disease (COPD) exacerbation were recruited and classified as elderly (>65 years) and non-elderly (≤ 65 years). Sputum and oropharyngeal samples were assessed, PCR for respiratory viruses and cultures for common pathogens were performed. Results : 247 patients (median age: 69.3±9.5 years) were recruited and categorized into group A: non-elderly patients [n=81 (32.8%), median age 58±5.99] and group B: elderly patients [n=166 (67.2%), median age 74.8±4.8] years. In 133 (53.8%) patients a viral infection was identified and in 34 (13.8%) a bacterial pathogen was isolated from cultures. In 18 (7.3%) patients a double infection (bacterial+viral) was identified. In group B, the presence of cardiac failure (46.6% vs 28.3%, p<0.001), renal failure (10.5% vs 4%, p=0.03), bacterial co-infection (13.8% vs 7.4%, p=0.04), influenza vaccination rates (45.5% vs 215, p<0.001), and longer hospital stay (8.4±4.4 vs 7.5±3.2 days, p=0.02) were higher than group A. The overall rate of viral infections did not differ according to age. A trend to higher rates of infection with parainfluenza 3 [19 (20%) patients in group B vs3 (7.5%) patients in group A, p=0.04] was observed in older patients. Conclusion : No differences on the rate and type of viral infections were noted for elderly vs non elderly patients. However, they tended to have more bacterial co-infections that led to AECOPD and longer hospitalization stays compared to non-elderly patients. PMID:25741393

  5. Correlation of pulmonary functions of COPD patients to those of their first-degree children

    Institute of Scientific and Technical Information of China (English)

    卢冰冰; 何权瀛

    2003-01-01

    Objective To assess the risk factors correlating to the likelihood for airflow obstruction among first-degree children of chronic obstructive pulmonary disease (COPD) patients and whether familial aggregation of pulmonary function abnormality exists.Methods Fifty-nine smokers with COPD and 28 smokers without COPD as control and all their children available were recruited into the study. Their history was recorded and a binary logistic regression analysis was carried out to ascertain the effects of their relationship to a proband with COPD, when other potential risk factors were controlled. Results Children with COPD probands showed increased risk of FEV1 below the 70% predicted (OR=1.987) after accounting for the effects of smoking, sex and clinical symptoms. The lower the pulmonary function of the COPD proband, the higher the risk to their children for FEV1 below the 70% predicted. Conclusions Our finding demonstrates the presence of a household aggregation inclination of COPD and pulmonary function impairment. Genetic factors might act as the basis of the familial aggregation.

  6. Clinical Characteristics of Patients With Biomass Smoke-Associated COPD and Chronic Bronchitis, 2004-2014.

    Science.gov (United States)

    Pérez-Padilla, Rogelio; Ramirez-Venegas, Alejandra; Sansores-Martinez, Raul

    2014-05-06

    Individuals with chronic obstructive pulmonary disease (COPD) associated with biomass smoke inhalation tend to be women born in rural areas with lifelong exposure to open fires while cooking, but can also include persons with prenatal and childhood exposure. Compared with individuals with COPD due to tobacco smoking, individuals exposed to biomass smoke uncommonly have severe airflow obstruction, low diffusing capacity of the lung for carbon monoxide (DLCO) or emphysema in high-resolution computed tomography (HRCT) but cough, phlegm and airway thickening and air trapping are very common. Autopsies of patients with COPD from biomass smoke exposure show increased pulmonary artery small vessel intimal thickening which may explain pulmonary hypertension, in addition to emphysema and airway disease. Research on similarities and differences in lung damage produced by exposure to biomass fuel smoke while cooking vs. smoking tobacco may provide new insights on COPD. As a public health problem, COPD caused by inhalation of smoke from burning solid fuel is as relevant as COPD caused by smoking tobacco but mainly affects women and children from disadvantaged areas and countries and requires an organized effort for its control. Improved vented biomass stoves are currently the most feasible intervention, but even more efficient stoves are necessary to reduce the biomass smoke exposure and reduce incidence of COPD among this population.

  7. Exercise assessment and training in pulmonary rehabilitation for patients with COPD.

    Science.gov (United States)

    Singh, S; Harrison, S; Houchen, L; Wagg, K

    2011-09-01

    Chronic obstructive pulmonary disease (COPD) is a common condition with a growing impact on global health services. Patients with COPD frequently complain of dyspnoea and leg fatigue on exertion. Pulmonary rehabilitation (PR) is an established intervention for the management of patients with COPD. There is clear evidence for the benefit in this population. The purpose of this article is to describe the assessment process, exercise intervention and its anticipated benefits, in the context of a rehabilitation programme for individuals with COPD. This has been sub-divided into aerobic, skeletal muscle resistance and inspiratory muscle rationale, assessment and training. The evidence supporting the incorporation of aerobic and skeletal muscle resistance training in PR is well established. The benefit of including inspiratory muscle training (IMT) as an adjunct to PR is less clear.

  8. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

    Science.gov (United States)

    Yohannes, Abebaw Mengistu; Hann, Mark; Sibbald, Bonnie

    2011-07-01

    We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. Depression is common in patients with COPD. Untreated depression leads to poor compliance with medical treatment and increases health-care utilisation. We surveyed a random sample of GPs (n = 3956) in England using a postal questionnaire. The questionnaire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD. A total of 864 completed responses were received (22%). In the vignettes, a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD (95.4%) compared with patients with either severe osteoarthritis (88.3%) or depressive symptoms alone (86.3%). In each case, the vast majority of GPs reported that they would explore a diagnosis of depression using a clinical diagnostic tool. The preferred method of treatment, if offered, in all three cases was a combination of anti-depressant drugs and psychological therapy. GPs endorsed the importance of routinely screening for depression in patients who have COPD and acknowledged that depression impairs patient self-management of COPD.In conclusion, GPs in England were able to diagnose depression from the vignettes and plan appropriate treatment strategies in patients with chronic diseases. This should be complemented with thorough physical examination by GPs to rule out other factors such as the impact of physical illness. GPs believe depression interferes with patient self-management of COPD.

  9. Exploring the care needs of patients with advanced COPD: an overview of the literature.

    Science.gov (United States)

    Gardiner, Clare; Gott, Merryn; Payne, Sheila; Small, Neil; Barnes, Sarah; Halpin, David; Ruse, Charlotte; Seamark, David

    2010-02-01

    Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition worldwide and is associated with significant mortality. This paper gives an overview of the relevant literature regarding care needs in advanced COPD from the perspective of the patient or carer, and aims to explore the appropriateness of a palliative care approach in this group. Publications revealed that patients with COPD have a high symptom burden that impacts on quality of life and social functioning. Information provision in COPD is often lacking and the implications of diagnosis and prognosis are not routinely discussed. The impact on families and carers is considerable, many patients have significant care requirements which can affect family relationships. Although patients with COPD have regular contact with health services, access to specialist services and palliative care is poor. This paper highlights the need for increased provision for palliative care in COPD, alongside dedicated education and training for health professionals, and continued research to identify the most appropriate ways of delivering this care.

  10. Whole-Body versus Local DXA-Scan for the Diagnosis of Osteoporosis in COPD Patients

    Directory of Open Access Journals (Sweden)

    Lidwien Graat-Verboom

    2010-01-01

    Full Text Available Background. Osteoporosis is an extrapulmonary effect of chronic obstructive pulmonary disease (COPD. Diagnosis of osteoporosis is based on BMD measured by DXA-scan. The best location for BMD measurement in COPD has not been determined. Aim of this study was to assess whole-body BMD and BMD of the hip and lumbar spine (local DXA in COPD patients and compare the prevalence of osteoporosis at these locations. Methods. Whole body as well as local DXA-scan were made in 168 COPD patients entering pulmonary rehabilitation. Patient-relevant characteristics were assessed. Prevalence of osteoporosis was determined. Characteristics of patients without osteoporosis were compared to patients with osteoporosis on local DXA. Results. A higher prevalence of osteoporosis was found using local DXA compared to whole-body DXA (39% versus 21%. One quarter of patients without osteoporosis on whole body-DXA did have osteoporosis on local DXA. Significant differences in patient characteristics between patients without osteoporosis based on both DXA measurements and patients with osteoporosis based on local DXA only were found. Conclusions. DXA of the hip and lumbar spine should be made to assess bone mineral density in COPD patients. The lowest T-score of these locations should be used to diagnose osteoporosis.

  11. Self-care 3 months after COPD patient education: a qualitative descriptive analysis

    DEFF Research Database (Denmark)

    Mousing, Camilla Askov; Lomborg, Kirsten

    2012-01-01

    reported that their knowledge of COPD had increased, that they had acquired tools to handle their symptoms; and that the social aspect of patient education had motivated them to utilize their new habits and competencies into everyday life. As a side effect of the study it appeared that the research......Introduction: The literature indicates a conflict between the documented effect of chronic obstructive pulmonary disease (COPD) patient education and the patients' own experiences of the benefit in their everyday life. Aim: To explore from the patients' perspective how group patient education...... influinces their self-care three months after attending the program. Methods: In the period 2009-2010, eleven patients diagnosed with COPD completed an 8-week group education program in a Danish community health center. The patients were interviewed 3 months after completion of the program. Results: Patients...

  12. Clinical application value of impulse oscillometry in geriatric patients with COPD

    Science.gov (United States)

    Liu, Zhonghui; Lin, Lianjun; Liu, Xinmin

    2017-01-01

    Background The diagnosis and assessment of COPD rely mainly on the use of spirometry, which is an effort-dependent test and requires good patient cooperation. Impulse oscillometry (IOS) is a non-volitional method that requires less effort and cooperation and presents advantages for geriatric patients. However, the clinical application value of IOS in geriatric patients with COPD remains unclear. Aim The aim of this study was to investigate the clinical application value of IOS in geriatric patients with COPD. Subjects and methods A total of 234 subjects were retrospectively enrolled in this study, including 133 patients with COPD and 101 healthy volunteers. All the participants underwent IOS and spirometry examination. The data were collected and analyzed in the overall group, the geriatric group (aged ≥65 years), and the advanced elderly group (aged ≥80 years). Results 1) In COPD patients, a significant increase in respiratory impedance (Z5), resonant frequency (Fres), and respiratory resistance (R5, R20, R5–R20) and a decrease in respiratory reactance (X5) were observed in the overall group, the geriatric group, and the advanced elderly group compared with the healthy control subjects. 2) The IOS parameters correlated well with spirometry in COPD. In particular, R5–R20 showed the best correlation with forced expiratory volume in 1 second (FEV1) in the different age groups. 3) Fres and R5–R20 had the best diagnostic efficiency for COPD. The area under the curve (AUC) values for Fres, expressed by the receiver operating characteristic (ROC) curve, were 0.905, 0.909, and 0.914, for the different age groups, respectively. 4) The optimal cutoff values for Fres to diagnose airflow obstruction from ROC curves was 17.715 in the COPD patients. Its sensitivity and specificity were 0.789 and 0.931, respectively, and the cutoff values were similar in geriatric and advanced elderly patients. Conclusion IOS demonstrated good relevance compared with spirometry for

  13. Impact of lung function on exacerbations, health care utilization, and costs among patients with COPD

    Directory of Open Access Journals (Sweden)

    Ke X

    2016-07-01

    Full Text Available Xuehua Ke,1 Jessica Marvel,2 Tzy-Chyi Yu,2 Debra Wertz,1 Caroline Geremakis,1 Liya Wang,1 Judith J Stephenson,1 David M Mannino3 1HealthCore Inc., Wilmington, DE, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, 3University of Kentucky, Lexington, KY, USA Objective: To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV1 % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population.Methods: This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013. The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were abstracted from patients’ medical records. Patients were divided into two groups (low FEV1% predicted [<50%] and high FEV1% predicted [≥50%] based on the 2014 Global Initiative for Chronic Obstructive Lung Disease report. Health care resource utilization and costs were based on the prevalence and number of discrete encounters during the 12-month postindex follow-up period. Costs were adjusted to 2014 US dollars.Results: A total of 754 patients were included (n=297 low FEV1% predicted group, n=457 high FEV1% predicted group. COPD exacerbations were more prevalent in the low FEV1% predicted group compared with the high group during the 12-month pre- (52.5% vs 39.6% and postindex periods (49.8% vs 36.8%. Mean (standard deviation follow-up all-cause and COPD-related costs were $27,380 ($38,199 and $15,873 ($29,609 for patients in the low FEV1% predicted group, and $22,075 ($28,108 and $10,174 ($18,521 for patients in the high group. In the multivariable analyses, patients in the low FEV1% predicted group were more likely to have COPD

  14. Longer telomere length in COPD patients with α1-antitrypsin deficiency independent of lung function.

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    Aabida Saferali

    Full Text Available Oxidative stress is involved in the pathogenesis of airway obstruction in α1-antitrypsin deficient patients. This may result in a shortening of telomere length, resulting in cellular senescence. To test whether telomere length differs in α1-antitrypsin deficient patients compared with controls, we measured telomere length in DNA from peripheral blood cells of 217 α1-antitrypsin deficient patients and 217 control COPD patients. We also tested for differences in telomere length between DNA from blood and DNA from lung tissue in a subset of 51 controls. We found that telomere length in the blood was significantly longer in α1-antitrypsin deficient COPD patients compared with control COPD patients (p = 1×10(-29. Telomere length was not related to lung function in α1-antitrypsin deficient patients (p = 0.3122 or in COPD controls (p = 0.1430. Although mean telomere length was significantly shorter in the blood when compared with the lungs (p = 0.0078, telomere length was correlated between the two tissue types (p = 0.0122. Our results indicate that telomere length is better preserved in α1-antitrypsin deficient COPD patients than in non-deficient patients. In addition, measurement of telomere length in the blood may be a suitable surrogate for measurement in the lung.

  15. Longer telomere length in COPD patients with α1-antitrypsin deficiency independent of lung function.

    Science.gov (United States)

    Saferali, Aabida; Lee, Jee; Sin, Don D; Rouhani, Farshid N; Brantly, Mark L; Sandford, Andrew J

    2014-01-01

    Oxidative stress is involved in the pathogenesis of airway obstruction in α1-antitrypsin deficient patients. This may result in a shortening of telomere length, resulting in cellular senescence. To test whether telomere length differs in α1-antitrypsin deficient patients compared with controls, we measured telomere length in DNA from peripheral blood cells of 217 α1-antitrypsin deficient patients and 217 control COPD patients. We also tested for differences in telomere length between DNA from blood and DNA from lung tissue in a subset of 51 controls. We found that telomere length in the blood was significantly longer in α1-antitrypsin deficient COPD patients compared with control COPD patients (p = 1×10(-29)). Telomere length was not related to lung function in α1-antitrypsin deficient patients (p = 0.3122) or in COPD controls (p = 0.1430). Although mean telomere length was significantly shorter in the blood when compared with the lungs (p = 0.0078), telomere length was correlated between the two tissue types (p = 0.0122). Our results indicate that telomere length is better preserved in α1-antitrypsin deficient COPD patients than in non-deficient patients. In addition, measurement of telomere length in the blood may be a suitable surrogate for measurement in the lung.

  16. Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Matsuura, Yukiko, E-mail: matsuyuki_future@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Kawata, Naoko, E-mail: chumito_03@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Yanagawa, Noriyuki, E-mail: yanagawa@ho.chiba-u.ac.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sugiura, Toshihiko, E-mail: sugiura@js3.so-net.ne.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sakurai, Yoriko, E-mail: yoliri@nifty.com [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sato, Misuzu, E-mail: mis_misuzu@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Iesato, Ken, E-mail: iesato_k@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Terada, Jiro, E-mail: jirotera@chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sakao, Seiichiro, E-mail: sakao@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tada, Yuji, E-mail: ytada@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tanabe, Nobuhiro, E-mail: ntanabe@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Suzuki, Yoichi, E-mail: ysuzuki@faculty.chiba-u.jp [Department of public Health, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tatsumi, Koichiro, E-mail: tatsumi@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan)

    2013-10-01

    Objectives: Structural and functional changes in pulmonary vessels are prevalent at the initial stages of chronic obstructive pulmonary disease (COPD). These vascular alterations can be assessed using cross-sectional area (CSA) of small pulmonary vessels. However, neither in non-COPD smokers nor in COPD patients it has been defined whether the structural changes of pulmonary vessels detected by paired inspiratory and expiratory CT scans are associated with emphysematous changes. We quantified the CSA and low attenuation area (LAA) and evaluated the changes in these parameters in the inspiratory and expiratory phases. Materials and methods: Fifty consecutive non-COPD smokers and COPD patients were subjected to multi detector-row CT and the percentage of vessels with a CSA less than 5 mm{sup 2} as well as the percentage LAA for total lung area (%CSA < 5, %LAA, respectively) were calculated. Results: The %CSA < 5 correlated negatively with %LAA. The %CSA < 5 was lower in COPD patients with emphysema as compared with non-COPD smokers and COPD patients with or without mild emphysema. In addition, the %CSA < 5 was lower in the no/mild emphysema subgroup as compared with non-COPD smokers. The respiratory phase change of %CSA < 5 in COPD patients was greater than that in non-COPD smokers. Conclusion: The percentage of small pulmonary vessels decreased as emphysematous changes increase, and this decrease was observed even in patients with no/mild emphysema. Furthermore, respiratory phase changes in CSA were higher in COPD patients than in non-COPD smokers.

  17. Evaluation of psychological and physiological predictors of fatigue in patients with COPD

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    Bidgood Penelope L

    2009-10-01

    Full Text Available Abstract Background Fatigue in COPD impairs functional status; however there are few studies examining mechanistic pathways of this symptom. The aims of this study are to compare fatigue between COPD patients and healthy age-matched subjects, and to identify predictors of fatigue in COPD. Methods Seventy four COPD patients, mean age 69.9 (49-87 yrs, mean (SD % predicted FEV1 46.5 (20.0 % and FEV1/FVC ratio 0.45 (0.13 and 35 healthy subjects, mean age 67.1 (50-84 yrs completed the Multidimensional Fatigue Inventory (MFI 20. Patients' assessment included Depression (HADS, lung function, BMI, muscle strength, incremental shuttle walk test (ISWT, exercise oxygen saturation (SpO2, Borg breathlessness (CR-10 and exertion (RPE. Serum level of Interleukin 6 (IL-6 was recorded. Differences in MFI 20 between groups were examined and predictors of fatigue identified using logistic regression. Results Significant differences (p 2 (R2 = .62; of Physical Fatigue: depression, % predicted FEV1, ISWT and age (R2 = .57; Reduced Activity: % predicted FEV1, BMI and depression (R2 = .36; Reduced Motivation: RPE, depression and end SpO2 (R2 = .37 and Mental Fatigue: depression and end SpO2 (R2 = .38. Conclusion All dimensions of fatigue were higher in COPD than healthy aged subjects. Predictive factors differ according to the dimension of fatigue under investigation. COPD-RF is a multi component symptom requiring further consideration.

  18. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective

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    Tselebis A

    2016-02-01

    Full Text Available Athanasios Tselebis,1 Argyro Pachi,1 Ioannis Ilias,2 Epaminondas Kosmas,3 Dionisios Bratis,1 Georgios Moussas,1 Nikolaos Tzanakis4,5 1Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece; 2Endocrinology Department, “Elena Venizelou” Hospital, Athens, Greece; 3Pulmonary Department, “Metropolitan” General Hospital, Athens, Greece; 4Department of Thoracic Medicine, 5Social Medicine, Laboratory of Epidemiology, University of Crete Medical School, Heraklion, Greece Abstract: Chronic obstructive pulmonary disease (COPD is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms. Worldwide, the incidence of COPD presents a disturbing continuous increase. Anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative. Pharmacological treatment based on selective serotonin reuptake inhibitors has almost replaced tricyclic antidepressants. The main psychological intervention is cognitive behavioral therapy. Of particular interest are pulmonary rehabilitation programs, which can reduce anxiety and depressive symptoms in these patients. Although the literature on treating anxiety and depression in patients with COPD is limited, we believe that it points to the implementation of personalized strategies to address their psychopathological comorbidities. Keywords: COPD, anxiety, depression, pharmacological treatment, psychotherapy

  19. Upregulation of pro-inflammatory cytokines in the intercostal muscles of COPD patients.

    Science.gov (United States)

    Casadevall, C; Coronell, C; Ramírez-Sarmiento, A L; Martínez-Llorens, J; Barreiro, E; Orozco-Levi, M; Gea, J

    2007-10-01

    Muscle dysfunction is a characteristic feature of chronic obstructive pulmonary disease (COPD). Recent studies suggest that cytokines may operate as local regulators of both muscle function and regeneration. The aim of the present study was to characterise the expression of different cytokines in the external intercostal muscle of COPD. Muscle biopsies were obtained from 25 stable COPD patients and eight healthy controls. Local tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta, -6 and -10 expressions (real-time PCR and ELISA), sarcolemmal damage (immunohistochemistry), and the transcript levels of CD18 were assessed. Muscle TNF-alpha and IL-6 transcripts were significantly higher in COPD patients compared with controls, and IL-1beta and sarcolemmal damage showed a strong tendency in the same direction. Similar results were observed at protein level. The CD18 panleukocyte marker was similar in COPD and controls. Respiratory muscle function was impaired in COPD patients and it correlated to both the severity of lung function impairment and TNF-alpha muscle expression. Chronic obstructive pulmonary disease is associated with the upregulation of pro-inflammatory cytokines in the intercostal muscles. This phenomenon might be involved in respiratory muscle dysfunction.

  20. COPD in HIV-Infected Patients: CD4 Cell Count Highly Correlated

    Science.gov (United States)

    Guillouet-de-Salvador, Francine; Valerio, Laure; Puglièse, Pascal; Naqvi, Alissa; Durant, Jacques; Demonchy, Elisa; Perbost, Isabelle; Cua, Eric; Marquette, Charles-Hugo; Roger, Pierre-Marie

    2017-01-01

    Background COPD is a frequent and significant cause of respiratory morbidity in HIV-infected patients despite the control of HIV. We aimed to analyze the factors correlated with COPD in this population to evaluate the existence of specific indicators of vulnerability in this population. Methods and Findings 623 HIV-infected outpatients were enrolled during one year. This population was characterised by a dedicated questionnaire and electronic patient records. COPD screening was performed according to recommended spirometric criteria. The prevalence of COPD was 9.0%. Age and smoking were independently correlated with COPD (OR, 1.61 per 10 years increase, P = 0.007; OR, 1.28 per 10 pack-year increase, P = 0.003, respectively). Body mass index (BMI) and CD4 cell-count were independently and negatively correlated with COPD (OR, 0.78, P tobacco-smoking and respiratory complaints with a particular concern toward patients with a profound CD4 cell count defect. PMID:28056048

  1. Hospital-based pulmonary rehabilitation in patients with COPD in Sweden--a national survey.

    Science.gov (United States)

    Wadell, K; Janaudis Ferreira, T; Arne, M; Lisspers, K; Ställberg, B; Emtner, M

    2013-08-01

    Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with chronic obstructive pulmonary disease, COPD. However, the availability of PR programs varies between and within different countries. The aim of this study was to investigate the availability and content of hospital-based PR programs in patients with COPD in Sweden. A cross-sectional descriptive design was applied using a web-based questionnaire which was sent out to all hospitals in Sweden. The questionnaire consisted of 32 questions that concerned availability and content of PR in patients with COPD during 2011. Seventy out of 71 hospitals responded the electronic survey. Forty-six (66%) hospitals offered PR for patients with COPD. Around 75% of the hospitals in southern and middle parts of Sweden and 33% of the hospitals in the northern part offered PR. Thirty-four percent of the patients declined participation. A total number of 1355 patients participated in PR which represents 0.2% of the COPD population in Sweden. All hospitals had exercise training as major component and 76% offered an educational program. Not even half a percent of the patients with COPD in Sweden took part in a hospital-based PR program during 2011. There was a considerable geographic discrepancy in availability over the country. To enable a greater part of the increasing number of patients with COPD to take part in this evidence-based treatment, there is a need of evaluating other settings of PR programs; in primary care, at home and/or over the internet.

  2. A comparison of the assessment of quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary rehabilitation

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Martinez, Gerd; Lange, Peter

    2012-01-01

    The aim of this study was to compare the COPD specific health-related quality of life (HR-QoL) instruments, the St George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and COPD Clinical Questionnaire (CCQ), in terms of feasibility and correlations in COPD patients participating ...... in pulmonary rehabilitation (PR)....

  3. Initiation of triple therapy maintenance treatment among patients with COPD in the US

    Directory of Open Access Journals (Sweden)

    Simeone JC

    2016-12-01

    Full Text Available Jason C Simeone,1 Rakesh Luthra,2 Shuchita Kaila,2 Xiaoyun Pan,1 Tarun D Bhagnani,1 Jieruo Liu,1 Teresa K Wilcox1 1Real-World Evidence, Evidera, Waltham, MA, 2HEOR Value Demonstration Team, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD recommends triple therapy (long-acting muscarinic receptor antagonists, long-acting beta-2 agonists, and inhaled corticosteroids for patients with only the most severe COPD. Data on the proportion of COPD patients on triple therapy and their characteristics are sparse and dated. Objective 1 of this study was to estimate the proportion of all, and all treated, COPD patients receiving triple therapy. Objective 2 was to characterize those on triple therapy and assess the concordance of triple therapy use with GOLD guidelines. Patients and methods: This retrospective study used claims from the IMS PharMetrics Plus database from 2009 to 2013. Cohort 1 was selected to assess Objective 1 only; descriptive analyses were conducted in Cohort 2 to answer Objective 2. A validated claims-based algorithm and severity and frequency of exacerbations were used as proxies for COPD severity. Results: Of all 199,678 patients with COPD in Cohort 1, 7.5% received triple therapy after diagnosis, and 25.5% of all treated patients received triple therapy. In Cohort 2, 30,493 COPD patients (mean age =64.7 years who initiated triple therapy were identified. Using the claims-based algorithm, 34.5% of Cohort 2 patients were classified as having mild disease (GOLD 1, 40.8% moderate (GOLD 2, 22.5% severe (GOLD 3, and 2.3% very severe (GOLD 4. Using exacerbation severity and frequency, 60.6% of patients were classified as GOLD 1/2 and 39.4% as GOLD 3/4. Conclusion: In this large US claims database study, one-quarter of all treated COPD patients received triple therapy. Although triple therapy is recommended for the most severe COPD patients

  4. Platelet–lymphocyte ratios: a potential marker for pulmonary tuberculosis diagnosis in COPD patients

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    Chen G

    2016-11-01

    Full Text Available Guozhong Chen, Chunling Wu, Zhiying Luo, Yiming Teng, Suping Mao Department of Respiratory Medicine, Yiwu Central Hospital, Yiwu, Zhejiang Province, People’s Republic of China Background: In recent decades, morbidity and mortality have been found to be significantly increased in patients with chronic obstructive pulmonary disease (COPD complicated with pulmonary tuberculosis (PTB. Platelet–lymphocyte ratio (PLR is an indicator for inflammatory diseases. This study aims to investigate whether PLR could act as a potential marker for patients with COPD complicated with PTB.Methods: In this retrospective study, laboratory characteristics of 87 COPD patients complicated with PTB (determined by Mycobacterium tuberculosis positive culture from sputum or bronchial lavage fluid and 83 COPD patients (as the control group, determined by M. tuberculosis culture negativity from sputum or bronchial lavage fluid were investigated. Data obtained on the day of admission were analyzed.Results: PLR >216.82 was identified as the optimal cutoff value for discriminating COPD patients with PTB (sensitivity 92.4%, specificity 84.5%, positive-predictive value 91.6%, negative-predictive value 86.2%, and area under the curve [AUC] was 0.87 from patients with COPD alone. The AUC of PLR was significantly greater than that of neutrophil–lymphocyte count ratio (AUC, 0.74; 95% confidence interval, 0.67–0.81; P<0.01.Conclusion: PLR could be developed as a valuable maker for identifying tuberculosis infection in COPD patients. Keywords: platelet to lymphocyte ratio, pulmonary tuberculosis, chronic obstructive pulmonary disease

  5. Neutral sphingomyelinase-2, acid sphingomyelinase, and ceramide levels in COPD patients compared to controls

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    Lea SR

    2016-09-01

    Full Text Available Simon R Lea,1,* Hannah J Metcalfe,1,* Jonathan Plumb,1 Christian Beerli,2 Chris Poll,3 Dave Singh,1 Katharine H Abbott-Banner3 1Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK; 2Novartis Pharma AG, Postfach, Basel, Switzerland; 3Respiratory Diseases, Novartis Institute for Biomedical Research, Horsham, West Sussex, UK *These authors contributed equally to this work Background: Increased pulmonary ceramide levels are suggested to play a causative role in lung diseases including COPD. Neutral sphingomyelinase-2 (nSMase-2 and acid SMase (aSMase, which hydrolyze sphingomyelin to produce ceramide, are activated by a range of cellular stresses, including inflammatory cytokines and pathogens, but notably cigarette smoke appears to only activate nSMase-2. Our primary objective was to investigate nSMase-2 and aSMase protein localization and quantification in lung tissue from nonsmokers (NS, smokers (S, and COPD patients. In addition, various ceramide species (C16, C18, and C20 were measured in alveolar macrophages from COPD patients versus controls. Materials and methods: Patients undergoing surgical resection for suspected or confirmed lung cancer were recruited, and nSMase-2 and aSMase protein was investigated in different areas of lung tissue (small airways, alveolar walls, subepithelium, and alveolar macrophages by immunohistochemistry. Ceramide species were measured in alveolar macrophages from COPD patients and controls by mass spectrometry. Results: nSMase-2 and aSMase were detected in the majority of small airways. There was a significant increase in nSMase-2 immunoreactivity in alveolar macrophages from COPD patients (54% compared with NS (31.7% (P<0.05, and in aSMase immunoreactivity in COPD (68.2% and S (69.5% alveolar macrophages compared with NS (52.4% (P

  6. Living with chronic obstructive pulmonary disease (COPD): part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status.

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    Odencrants, Sigrid; Ehnfors, Margareta; Grobe, Susan J

    2007-03-01

    This study is the second part of a project with the main purpose of obtaining a deeper understanding of the consequences of living with chronic obstructive pulmonary disease (COPD) concerning meal-related situations and an impaired nutritional status. COPD is a slowly progressive lung disease that results in several complications, including malnutrition. Nutritional status is an important part of COPD treatment, and there are criteria recommended for nutritional assessment and interventions among patients with COPD. Despite this, patients with extreme malnutrition and unnoticed weight loss are reported. The aim of the study was to investigate how Registered Nurses (RNs) in primary care describe nutritional assessment practices and interventions in COPD patients with impaired nutritional status. An interview approach using semistructured questions and case vignettes was chosen. The sample included 19 RNs working specifically with COPD patients. Data from interviews were analysed using qualitative content analysis, and nine categories corresponding to the aim were identified. The RNs reported that their assessment of nutritional status was based largely on intuition. Assessment also included detection of the patients' current beliefs and being sensible about information provision - When and How. Interventions were supportive eating interventions, practical and cognitive participation, and making patients aware of the illness trajectory. An overall category that influenced nursing was respecting patients' feelings of shame and guilt about a self-inflicted disease. It seems that RNs use intuition because of a lack of knowledge of systematic methods of nutritional assessment. The findings also indicate that the RNs attempted to build a relationship of trust with the patients rather than provide early information on sensitive topics (e.g. nutritional information). The study reports areas of nursing care for COPD patients that must be improved in the future.

  7. The correlation between lung sound distribution and pulmonary function in COPD patients.

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    Masamichi Mineshita

    Full Text Available BACKGROUND: Regional lung sound intensity in chronic obstructive pulmonary disease (COPD patients is influenced by the severity and distribution of emphysema, obstructed peripheral airways, and altered ribcage and diaphragm configurations and movements due to hyperinflation. Changes in the lung sound distribution accompanied by pulmonary function improvements in COPD patients were observed after bronchodilator inhalation. We investigated the association of lung sound distribution with pulmonary functions, and the effects of emphysematous lesions on this association. These studies were designed to acquire the basic knowledge necessary for the application of lung sound analysis in the physiological evaluation of COPD patients. METHODS: Pulmonary function tests and the percentage of upper- and lower-lung sound intensity (quantitative lung data [QLD] were evaluated in 47 stable male COPD patients (54 - 82 years of age. In 39 patients, computed tomography taken within 6 months of the study was available and analyzed. RESULTS: The ratio of lower QLD to upper QLD showed significant positive correlations with FEV1 %predicted (%FEV1; ρ=0.45, p40%, n=20 and were stronger in less emphysematous patients (n=19, %FEV1; ρ=0.64, p<0.005, %MEF50; ρ=0.71, p<0.001. CONCLUSIONS: In COPD patients, the ratio of lower- to upper-lung sound intensities decreased according to the severity of obstructive changes, although emphysematous lesions considerably affected lung sound distribution.

  8. Surfactant Protein B Intron 4 Variation in German Patients with COPD and Acute Respiratory Failure

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    Carola Seifart

    2002-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a major health problem. Genetic factors that contribute to the disease have been postulated. The pulmonary surfactant protein B (SP-B, which is essential for normal lung function, is considered as a candidate gene for COPD in this case-control study. We studied the SP-B intron 4 size variants in 346 individuals. This group consisted of 118 patients with chronic bronchitis or COPD, including 24 patients with acute respiratory failure (ARF in COPD, 118 matched controls without pulmonary disease and 110 healthy individuals (population control. The frequency of intron 4 variants was similar in either control group (10.9%, 14.4% respectively, with a small increase in the COPD group (18.6%. This increase was due to a high increase of intron 4 variants in the ARF subgroup (37.5%, p = 0.003, OR 4.9, 95% CI: 1.76–13.6. The data indicate that SP-B intron 4 variants may associate with increased risk of ARF in COPD and may be used as a marker of susceptibility in this disease subgroup.

  9. The reasons for triple therapy in stable COPD patients in Japanese clinical practice

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    Miyazaki M

    2015-06-01

    Full Text Available Masaki Miyazaki,1 Hidetoshi Nakamura,1,2 Saeko Takahashi,1 Shotaro Chubachi,1 Mamoru Sasaki,1 Mizuha Haraguchi,1 Hideki Terai,1 Makoto Ishii,1 Koichi Fukunaga,1 Sadatomo Tasaka,1 Kenzo Soejima,1 Koichiro Asano,3 Tomoko Betsuyaku1 On behalf of the Keio COPD Comorbidity Research (K-CCR group 1Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 2Department of Respiratory Medicine, Saitama Medical University, Saitama, 3Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan Background: Triple combination therapy involving long-acting muscarinic antagonists long-acting β2 agonists, and inhaled corticosteroids has recently become an option for maintenance treatment of COPD. Some add-on clinical trials have reported the benefits of these combinations. However, the process to step up to triple therapy varies for individual cases.Methods: Keio University and affiliated hospitals conducted an observational COPD cohort study, recruiting patients diagnosed as having COPD by pulmonary physicians and those referred for investigation of possible COPD. Their prescription history and clinical course were retrospectively analyzed based on the physicians’ medical records and patient questionnaires. This study was registered with UMIN (UMIN000003470, April 10, 2010.Results: A total of 95 of the 445 COPD patients (21% were treated with inhaled corticosteroids/long-acting β2 agonists/long-acting muscarinic antagonists as maintenance therapy, including 12 in COPD Grade I, 31 in Grade II, 38 in Grade III, and 14 in Grade IV, based on the Global Initiative for Chronic Obstructive Lung Disease spirometric grading. For more than half of the patients on triple therapy, the treatment had been intensified due to unsatisfactory improvement of symptoms, and 32% were treated with triple therapy due to comorbid asthma. In contrast, there were COPD patients whose therapy was

  10. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

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    Ming-Shian Lin

    Full Text Available AIM: Chronic obstructive pulmonary disease (COPD is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD and the associated risk factors for patients with COPD. METHODS: This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI was used to detect PAD (ABI<0.90. RESULTS: The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118 and 10% in the elderly participants (≥65 years of age, n = 309. The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4% and hypertension (79.4% vs. 45.8% than those without asymptomatic PAD (p<0.05. There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR: 6.89, p<0.005, followed by old age (OR: 4.80, hypertension (OR: 3.39 and smoking burden (pack-years, OR: 1.02. CONCLUSIONS: The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  11. The view of pulmonologists on palliative care for patients with COPD: a survey study

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    Duenk, RG; Verhagen, C; Dekhuijzen, PNR; Vissers, KCP; Engels, Y; Heijdra, Y

    2017-01-01

    Introduction Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results The 256 respondents (31.8%) covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2%) indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%), communication between pulmonologist and general practitioner (77%), and identification of the palliative phase (75.8%), while the latter was considered the most important aspect for improvement (67.6%). Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%), while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT). In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%). Conclusion To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification criteria. Furthermore, pulmonologists should improve their skills of palliative care, and the members of the SPCT should be better informed about the management of COPD to improve care during hospitalization. Communication between pulmonologist and general practitioner should be emphasized in training to improve

  12. Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients

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    Iwakura, Masahiro; Okura, Kazuki; Shibata, Kazuyuki; Kawagoshi, Atsuyoshi; Sugawara, Keiyu; Takahashi, Hitomi; Shioya, Takanobu

    2016-01-01

    Background Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients. Materials and methods Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects’ balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group. Results The COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (P<0.001), five-times sit-to-stand times (P=0.002), daily steps (P=0.003), and MV-PA (P=0.022) compared to the controls; the exception was the standing balance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (P<0.001) and between OLST times and MV-PA (P=0.014) in the COPD group after adjusting for possible confounding factors. Conclusion Impairments in balance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical inactivity. PMID:27445470

  13. Factors associated with exacerbation in mild-to-moderate COPD patients

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    Kim JK

    2016-06-01

    Full Text Available Joo Kyung Kim,1 Soo Haeng Lee,1 Bho Hyeon Lee,1 Chang Youl Lee,2 Do Jin Kim,3 Kyung Hoon Min,4 Sung Kyoung Kim,5 Kwang Ha Yoo,6 Ki-Suck Jung,1 Yong Il Hwang1 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 3Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea Introduction: COPD exacerbation negatively impacts the patient’s quality of life and lung function, increases mortality, and increases socioeconomic costs. In a real-world setting, the majority of patients with COPD have mild-to-moderate airflow limitation. Therefore, it is important to evaluate COPD exacerbation in patients with mild-to-moderate airflow limitation, although most studies have focused on the patients with moderate or severe COPD. The objective of this study was to evaluate factors associated with COPD exacerbation in patients with mild-to-moderate airflow limitation. Methods: Patients registered in the Korean COPD Subtype Study cohort were recruited from 37 tertiary referral hospitals in Korea. We obtained their clinical data including demographic characteristics, past medical history, and comorbidities from medical records. Patients were required to visit the hospital to document their COPD status using self

  14. Correlation between serum albumin, prealbumin and ventilator dependence in patients with COPD

    Institute of Scientific and Technical Information of China (English)

    Shu-Miao Wu; Dan-Dan Chen

    2016-01-01

    Objective:To investigate the correlation between the serum albumin, prealbumin and ventilator dependence in patients with COPD.Methods: Serum albumin and prealbumin of 44 COPD patients using breathing machine>48 h were tested at admission, 1 week, 2 weeks treatment. According to the existence of ventilator dependence, divided the patients into the ventilator dependence group and the ventilator independence group, compare the albumin, prealbumin average of two groups, evaluate the correlation between the serum albumin, prealbumin and ventilator dependence in patients with COPD.Results: Albumin levels reduced in both groups after 1 week treatment, but there was no statistically significant difference. Albumin levels reduced in both groups after 2 weeks treatment, but more significantly in the ventilator dependence group, the difference had statistical significance. Prealbumin levels in the ventilator independence group after 1 week treatment didn’t reduced, but reduced in the ventilator dependence group, the difference was statistically significant. Prealbumin levels reduced in both groups after 2 weeks treatment, but more significant in the ventilator dependence group, the difference had statistical significance.Conclusion:Serum albumin and prealbumin levels were correlation with the ventilator dependence in patients with COPD. But prealbumin can more sensitively and more early predict the ventilator dependence in patients with COPD suffered from malnutrition.

  15. Indacaterol therapy in patients with COPD not receiving other maintenance treatment.

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    Decramer, Marc; Rossi, Andrea; Lawrence, David; McBryan, Danny

    2012-12-01

    Recent findings of rapid lung function decline in younger patients with moderate COPD severity suggest the need for effective early treatment. To evaluate the effectiveness of indacaterol as maintenance therapy in COPD patients not receiving other maintenance treatments. Pooled data from three randomised, placebo-controlled studies provided a population of patients with moderate-to-severe COPD not receiving maintenance treatment at baseline and who received once-daily, double-blind treatment with indacaterol 150 μg, indacaterol 300 μg or placebo. Data from an open-label tiotropium treatment arm in one study were available for comparison. Efficacy evaluations included trough FEV₁, dyspnoea (transition dyspnoea index, TDI) and health status (St George's Respiratory Questionnaire, SGRQ) at 6 months and risk of COPD exacerbations. The maintenance-naïve population comprised 232 (indacaterol 150 μg), 220 (indacaterol 300 μg) and 325 (placebo) patients, plus 156 (tiotropium) (30% of overall study population). Patients treated with indacaterol 150 and 300 μg had statistically significant improvements relative to placebo (p Indacaterol, given to patients with moderate-to-severe COPD not receiving other maintenance treatments, provided effective bronchodilation with significant, clinically relevant improvements in dyspnoea and health status compared with placebo. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Satellite cells senescence in limb muscle of severe patients with COPD.

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    Marie-Eve Thériault

    Full Text Available RATIONALE: The maintenance of peripheral muscle mass may be compromised in chronic obstructive pulmonary disease (COPD due to premature cellular senescence and exhaustion of the regenerative potential of the muscles. METHODS: Vastus lateralis biopsies were obtained from patients with COPD (n = 16 and healthy subjects (n = 7. Satellite cell number and the proportion of central nuclei, as a marker of muscle regenerative events, were assessed on cryosections. Telomere lengths, used as a marker of cellular senescence, were determined using Southern blot analyses. RESULTS: Central nuclei proportion was significantly higher in patients with COPD with a preserved muscle mass compared to controls and patients with COPD with muscle atrophy (p<0.001. In COPD, maximal telomere length was significantly decreased compared to controls (p<0.05. Similarly, minimal telomere length was significantly reduced in GOLD III-IV patients with muscle atrophy compared to controls (p<0.005. Minimal, mean and maximum telomere lengths correlated with mid-thigh muscle cross-sectional area (MTCSA (R = 0.523, p = 0.005; R = 0.435, p = 0.019 and R = 0.491, p = 0.009, respectively. CONCLUSIONS: Evidence of increased regenerative events was seen in GOLD III-IV patients with preserved muscle mass. Shortening of telomeres in GOLD III-IV patients with muscle atrophy is consistent with an increased number of senescent satellite cells and an exhausted muscle regenerative capacity, compromising the maintenance of muscle mass in these individuals.

  17. Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study.

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    Strang, Susann; Ekberg-Jansson, Ann; Henoch, Ingela

    2014-12-01

    Anxiety often arises in conjunction with dyspnoea in patients with severe COPD. Considering the provoking symptomatology and the high mortality rate for COPD, it is reasonable to believe that these conditions trigger death-related and existential anxiety. Although anxiety causes considerable distress and reduces quality of life, people's experience of anxiety has been studied relatively little. The aim of this study was to explore severely ill COPD patients' experience of anxiety and their strategies to alleviate anxiety. This qualitative, in-depth interview study explored perceptions of anxiety and the alleviation strategies that are adopted. Interviews were analyzed using a thematic content analysis approach, involving interpretive coding and identification of themes. People suffering from COPD (stage III or IV) were recruited from a pulmonary outpatient clinic in the west of Sweden. Purposive sampling was used, and thirty-one (31) patients were included. Most of the patients had experienced anxiety associated with COPD. Analyses revealed three major themes, death anxiety, life anxiety, and counterweights to anxiety. Death anxiety included fear of suffocation, awareness of death, fear of dying and separation anxiety. Life anxiety included fear of living and fear of the future. Counterweights to anxiety concerned coping with suffocation, avoiding strategy, and a sense of joy that defied their vulnerable situation. The majority of patients experienced anxiety, which limited their lives. Although the patients experienced both life anxiety and death anxiety, they were able to cope with the situation and find a defiant joy to some extent.

  18. Effects of Heliox in Stable COPD Patients at Rest and during Exercise

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    Matteo Pecchiari

    2012-01-01

    Full Text Available Heliox has been administered to stable chronic obstructive pulmonary disease (COPD patients at rest and during exercise on the assumption that this low density mixture would have reduced work of breathing, dynamic hyperinflation, and, consequently, dyspnea sensation. Contrary to these expectations, beneficial effects of heliox in these patients at rest have been reported only sporadically, and the majority of the studies performed until now suggests that heliox is not a therapeutic option in spontaneously breathing resting COPD patients. On the other hand, when it is administered to COPD patients exercising at a constant work rate, heliox systematically decreases dyspnea sensation, and, often but not always, increases exercise tolerance. For these reasons, heliox has been evaluated as a non pharmacological tool to power rehabilitation programs. The conflicting results provided by the published trials probably point at a substantial heterogeneity of the COPD patients population in terms of respiratory mechanics and gas exchange. Therefore, further studies, aimed to the identification of mechanisms conditioning the response of exercising COPD patients to heliox, are warranted, before heliox administration, which is costly and cumbersome, can be routinely used in rehabilitation programs.

  19. Experiences of COPD patients with existing smoking cessation programs and their preferences for improvement - a qualitative analysis

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    Aumann, I.; Tedja, L.; Graf von der Schulenburg, Johann-Matthias

    2016-01-01

    BACKGROUND: Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). For current smokers who are diagnosed with COPD, their first treatment option is to stop smoking. Motivation is necessary for long-term smoking cessation; therefore, when designing smoking cessation programs, the patients' needs and preferences should be considered. We focused on COPD patients' experiences with existing smoking cessation programs and evaluated their preferences for the improvement of ...

  20. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD).

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    Hallin, Runa; Gudmundsson, Gunnar; Suppli Ulrik, Charlotte; Nieminen, Markku M; Gislason, Thorarinn; Lindberg, Eva; Brøndum, Eva; Aine, Tiina; Bakke, Per; Janson, Christer

    2007-09-01

    Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality in this patient group. In a multicentre study conducted at four university hospitals (Reykjavik, Uppsala, Tampere and Copenhagen) hospitalised patients with COPD were investigated. Patient height, weight and lung function was recorded. Health status was assessed with St. George's Hospital Respiratory Questionnaire. After 2 years, mortality data was obtained from the national registers in each country. Of the 261 patients in the study 19% where underweight (BMI <20), 41% were of normal weight (BMI 20-25), 26% were overweight (BMI 25-30) and 14% were obese. FEV(1) was lowest in the underweight and highest in the overweight group (p=0.001) whereas the prevalence of diabetes and cardio-vascular co-morbidity went the opposite direction. Of the 261 patients 49 (19%) had died within 2 years. The lowest mortality was found among the overweight patients, whereas underweight was related to increased overall mortality. The association between underweight in COPD-patients, and mortality remained significant after adjusting for possible confounders such as FEV(1) (hazard risk ratio (95% CI) 2.6 (1.3-5.2)). We conclude that COPD patients that are underweight at admission to hospital have a higher risk of dying within the next 2 years. Further studies are needed in order to show whether identifying and treating weight loss and depletion of fat-free mass (FFM) is a way forward in improving the prognosis for hospitalised COPD patients.

  1. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

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    Sun KS

    2015-07-01

    Full Text Available Kuo-Shao Sun,1,2* Ming-Shian Lin,1,2* Yi-Jen Chen,1,2 Yih-Yuan Chen,3 Solomon Chih-Cheng Chen,4 Wei Chen1,5,6 1Division of Pulmonary and Critical Care Medicine, 2Department of Respiratory Care, Chang Gung University of Science and Technology, 3Department of Internal Medicine, 4Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 5College of Nursing, Dayeh University, Changhua, 6Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, Republic of China *These authors contributed equally to this work Objective: Symptomatic peripheral arterial disease (PAD is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD. However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. Methods: This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years who volunteered to perform ankle-brachial index (ABI and 6-minute walk test (6MWT consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90. All patients were free of PAD symptoms at enrollment. Results: Of the 200 COPD patients, 17 (8.5% were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159. The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r2=-0.667, P<0.001, followed by oxygen-cost diagram (r2=0.582, P<0.001 and forced expiratory volume in 1 second (r2=0.532, P<0.001. In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05. However, body mass index, baseline heart rate, and

  2. Physiological responses to Tai Chi in stable patients with COPD.

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    Qiu, Zhi-Hui; Guo, Hong-Xi; Lu, Gan; Zhang, Ning; He, Bai-Ting; Zhou, Lian; Luo, Y M; Polkey, M I

    2016-01-15

    We compared the physiological work, judged by oxygen uptake, esophageal pressure swing and diaphragm electromyography, elicited by Tai Chi compared with that elicited by constant rate treadmill walking at 60% of maximal load in eleven patients with COPD (Mean FEV1 61% predicted, FEV1/FVC 47%). Dynamic hyperinflation was assessed by inspiratory capacity and twitch quadriceps tension (TwQ) elicited by supramaximal magnetic stimulation of the femoral nerve was also measured before and after both exercises. The EMGdi and esophageal pressure at the end of exercise were similar for both treadmill exercise and Tai Chi (0.109±0.047 mV vs 0.118±0.061 mV for EMGdi and 22.3±7.1 cmH2O vs 21.9±8.1 cmH2O for esophageal pressure). Moreover the mean values of oxygen uptake during Tai Chi and treadmill exercise did not differ significantly: 11.3 ml/kg/min (51.1% of maximal oxygen uptake derived from incremental exercise) and 13.4 ml/kg/min (52.5%) respectively, p>0.05. Respiratory rate during Tai Chi was significantly lower than that during treadmill exercise. Both Tai Chi and treadmill exercise elicited a fall in IC at end exercise, indicating dynamic hyperinflation, but this was statistically significant only after treadmill exercise. TwQ decreased significantly after Tai Chi but not after treadmill. We conclude that Tai Chi constitutes a physiologically similar stimulus to treadmill exercise and may therefore be an acceptable modality for pulmonary rehabilitation which may be culturally more acceptable in some parts of the world.

  3. Serotonin and corticosterone rhythms in mice exposed to cigarette smoke and in patients with COPD: implication for COPD-associated neuropathogenesis.

    Directory of Open Access Journals (Sweden)

    Isaac K Sundar

    Full Text Available The circadian timing system controls daily rhythms of physiology and behavior, and disruption of clock function can trigger stressful life events. Daily exposure to cigarette smoke (CS can lead to alteration in diverse biological and physiological processes. Smoking is associated with mood disorders, including depression and anxiety. Patients with chronic obstructive pulmonary disease (COPD have abnormal circadian rhythms, reflected by daily changes in respiratory symptoms and lung function. Corticosterone (CORT is an adrenal steroid that plays a considerable role in stress and anti-inflammatory responses. Serotonin (5-hydroxytryptamine; 5HT is a neurohormone, which plays a role in sleep/wake regulation and affective disorders. Secretion of stress hormones (CORT and 5HT is under the control of the circadian clock in the suprachiasmatic nucleus. Since smoking is a contributing factor in the development of COPD, we hypothesize that CS can affect circadian rhythms of CORT and 5HT secretion leading to sleep and mood disorders in smokers and patients with COPD. We measured the daily rhythms of plasma CORT and 5HT in mice following acute (3 d, sub-chronic (10 d or chronic (6 mo CS exposure and in plasma from non-smokers, smokers and patients with COPD. Acute and chronic CS exposure affected both the timing (peak phase and amplitude of the daily rhythm of plasma CORT and 5HT in mice. Acute CS appeared to have subtle time-dependent effects on CORT levels but more pronounced effects on 5HT. As compared with CORT, plasma 5HT was slightly elevated in smokers but was reduced in patients with COPD. Thus, the effects of CS on plasma 5HT were consistent between mice and patients with COPD. Together, these data reveal a significant impact of CS exposure on rhythms of stress hormone secretion and subsequent detrimental effects on cognitive function, depression-like behavior, mood/anxiety and sleep quality in smokers and patients with COPD.

  4. Indacaterol add-on therapy improves lung function, exercise capacity and life quality of COPD patients.

    Science.gov (United States)

    Mroz, R M; Minarowski, L; Chyczewska, E

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is a progressive, inflammatory condition, involving airways and lung parenchyma. The disease leads to airflow limitation, and pulmonary hyperinflation, resulting in dyspnea, decreased exercise tolerance, and impaired quality of life. COPD pharmacotherapy guidelines are based on a combination of long-acting beta2-agonists (LABA), long-acting antimuscarinic agents (LAMA) and methyloxantins. Recently, indacaterol, ultralong acting beta2-agonist, has been introduced. The aim of our study was to assess the impact of indacaterol add-on therapy on lung function, exercise tolerance and quality of life of COPD patients. Thirty four COPD patients, receiving stable bronchodilator therapy were randomly allocated into two arms of add-on treatment (1:1 - indacaterol:placebo) for 3 months. Indacaterol replaced LABA in all patients receiving LABA. Spirometry, lung volumes, DLCO, St George's Respiratory Questionnaire (SGRQ) and 6 min Walk Distance (6MWD) were performed before and after therapy. We found that in the indacaterol group FEV1 did not changed significantly. However, there were significant improvements in ERV, 6MWD, and 6MWD-related dyspnea score. We also found that the degree of desaturation before and after 6MWD, and fatigue levels significantly improved in the indacaterol group. The patients' quality of life also changed favorably in the indacaterol treatment arm. We conclude that the add-on therapy with indacaterol exerts positive effects in COPD patients.

  5. Using PICO Methodology to Answer Questions About Smoking in COPD Patients.

    Science.gov (United States)

    Jiménez Ruiz, Carlos A; Buljubasich, Daniel; Riesco Miranda, Juan Antonio; Acuña Izcaray, Agustín; de Granda Orive, José Ignacio; Chatkin, José Miguel; Zabert, Gustavo; Guerreros Benavides, Alfredo; Paez Espinel, Nelson; Noé, Valeri; Sánchez-Angarita, Efraín; Núñez-Sánchez, Ingrid; Sansores, Raúl H; Casas, Alejandro; Palomar Lever, Andrés; Alfageme Michavila, Inmaculada

    2017-05-27

    The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (i)moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (ii)high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (iii)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (iv)high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index.

    Science.gov (United States)

    Almagro, Pedro; Soriano, Joan B; Cabrera, Francisco J; Boixeda, Ramon; Alonso-Ortiz, M Belen; Barreiro, Bienvenido; Diez-Manglano, Jesus; Murio, Cristina; Heredia, Josep L

    2014-05-01

    No valid tools exist for evaluating the prognosis in the short and medium term after hospital discharge of patients with COPD. Our hypothesis was that a new index based on the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index can accurately predict mortality, hospital readmission, and their combination for the period from 3 months to 1 year after discharge in patients hospitalized for COPD. A multicenter study of patients hospitalized for COPD exacerbations was used to develop the CODEX index, and a different patient cohort was used for validation. Comorbidity was measured using the age-adjusted Charlson index, whereas dyspnea, obstruction, and severe exacerbations were calculated according to BODEX (BMI, airfl ow obstruction, dyspnea, and previous severe exacerbations) thresholds. Information about mortality and readmissions for COPD or other causes was collected at 3 and 12 months after hospital discharge. Two sets of 606 and 377 patients were included in the development and validation cohorts, respectively. The CODEX index was associated with mortality at 3 months ( P CODEX C statistics were superior to those of the BODEX, DOSE (dyspnea, airfl ow obstruction, smoking status, and exacerbation frequency), and updated ADO (age, dyspnea, and airfl ow obstruction) indexes. The CODEX index was a useful predictor of survival and readmission at both 3 months and 1 year after hospital discharge for a COPD exacerbation, with a prognostic capacity superior to other previously published indexes.

  7. Illness perceptions and coping determine quality of life in COPD patients

    Directory of Open Access Journals (Sweden)

    Tiemensma J

    2016-08-01

    Full Text Available Jitske Tiemensma,1 Erin Gaab,2 Maarten Voorhaar,3,4 Guus Asijee,3,5 Adrian A Kaptein6 1Psychological Sciences, 2Health Sciences Research Institute, University of California, Merced, CA, USA; 3Department of Family Medicine, Maastricht University, Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht, the Netherlands; 4Boehringer Ingelheim, Alkmaar, the Netherlands; 5Boehringer Ingelheim, Amsterdam, the Netherlands; 6Department of Medical Psychology, Leiden University Medical Centre, Leiden, the Netherlands Background: A key goal of chronic obstructive pulmonary disease (COPD care is to improve patients’ quality of life (QoL. For outcomes such as QoL, illness perceptions and coping are important determinants.Aim: The primary aim was to assess the associations between illness perceptions, coping and QoL in COPD patients. A secondary aim was to compare illness perceptions and coping of patients with reference values derived from the literature.Patients and methods: A total of 100 patients were included in the study. Patients were asked to complete the Brief Illness Perception Questionnaire (B-IPQ, the Utrecht Proactive Coping Competence scale (UPCC, and a QoL item. Correlations and linear regression models were used to analyze the data. Student’s t-tests were used to compare patients with COPD with reference values derived from the literature.Results: Patients with better understanding of COPD utilized more proactive coping strategies (P=0.04. A more intense emotional response to COPD was related to less proactive coping (P=0.02. Patients who reported using more proactive coping techniques also reported to have a better QoL (P<0.01. Illness perceptions were also related to QoL: more positive illness perceptions were related to a better QoL (all P<0.05. Patients with COPD reported more negative illness perceptions than people with a common cold or patients with asthma (all P<0.01, but reported similar

  8. Deposition of insoluble elastin by pulmonary fibroblasts from patients with COPD is increased by treatment with versican siRNA

    Science.gov (United States)

    Wu, Lian; Zhang, Jing; Qu, Jie Ming; Bai, Chun-xue; Merrilees, Mervyn J

    2017-01-01

    A reduced content of alveolar elastic fibers is a key feature of COPD lung. Despite continued elastogenic potential by alveolar fibroblasts in the lung affected by COPD, repair of elastic fibers does not take place, which is due to increased levels of the chondroitin sulfate proteoglycan versican that inhibits the assembly of tropoelastin into fibers. In this study, primary pulmonary fibroblast cell lines from COPD and non-COPD patients were treated with a small interfering RNA (siRNA) against versican to determine if knockdown of versican could restore the deposition of insoluble elastin. Versican siRNA treatment reduced versican expression and secretion by pulmonary fibroblasts from both COPD and non-COPD patients (P<0.01) and significantly increased deposition of insoluble elastin in the COPD cell cultures (P<0.05). The treatment, however, did not significantly affect production of soluble elastin (tropoelastin) in either the COPD or non-COPD cell cultures, supporting a role for versican in inhibiting assembly but not synthesis of tropoelastin. These results suggest that removal or knockdown of versican may be a possible therapeutic strategy for increasing deposition of insoluble elastin and stimulating repair of elastic fibers in COPD lung. PMID:28138236

  9. Initiation of triple therapy maintenance treatment among patients with COPD in the US

    Science.gov (United States)

    Simeone, Jason C; Luthra, Rakesh; Kaila, Shuchita; Pan, Xiaoyun; Bhagnani, Tarun D; Liu, Jieruo; Wilcox, Teresa K

    2017-01-01

    Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple therapy (long-acting muscarinic receptor antagonists, long-acting beta-2 agonists, and inhaled corticosteroids) for patients with only the most severe COPD. Data on the proportion of COPD patients on triple therapy and their characteristics are sparse and dated. Objective 1 of this study was to estimate the proportion of all, and all treated, COPD patients receiving triple therapy. Objective 2 was to characterize those on triple therapy and assess the concordance of triple therapy use with GOLD guidelines. Patients and methods This retrospective study used claims from the IMS PharMetrics Plus database from 2009 to 2013. Cohort 1 was selected to assess Objective 1 only; descriptive analyses were conducted in Cohort 2 to answer Objective 2. A validated claims-based algorithm and severity and frequency of exacerbations were used as proxies for COPD severity. Results Of all 199,678 patients with COPD in Cohort 1, 7.5% received triple therapy after diagnosis, and 25.5% of all treated patients received triple therapy. In Cohort 2, 30,493 COPD patients (mean age =64.7 years) who initiated triple therapy were identified. Using the claims-based algorithm, 34.5% of Cohort 2 patients were classified as having mild disease (GOLD 1), 40.8% moderate (GOLD 2), 22.5% severe (GOLD 3), and 2.3% very severe (GOLD 4). Using exacerbation severity and frequency, 60.6% of patients were classified as GOLD 1/2 and 39.4% as GOLD 3/4. Conclusion In this large US claims database study, one-quarter of all treated COPD patients received triple therapy. Although triple therapy is recommended for the most severe COPD patients, spirometry is infrequently assessed, and a majority of the patients who receive triple therapy may have only mild/moderate disease. Any potential overprescribing of triple therapy may lead to unnecessary costs to the patient and health care system. PMID:28053518

  10. Changes of Number and Function of Late Endothelial Progenitor Cells in Peripheral Blood of COPD Patients Combined with Pulmonary Hypertension.

    Science.gov (United States)

    Liu, Pei; Zhang, Hongmei; Liu, Jianxin; Sheng, Chunfeng; Zhang, Linlin; Zeng, Yanjun

    2016-06-01

    Objective The objective of this study was to investigate the changes of number and function of late endothelial progenitor cells (EPCs) in peripheral blood of chronic obstructive pulmonary disease (COPD) patients combined with pulmonary hypertension. Subjects and Methods The study enrolled 120 cases including 40 non-COPD and pulmonary arterial hypertension (PAH) patients (non-COPD group), 40 COPD non-PAH patients (COPD group), and 40 COPD patients combined with PAH (COPD + PAH group). Peripheral blood mononuclear cells were separated by density gradient centrifugation, cultured for 21 days, and then identified as late endothelial progenitor cells. The cell colonies were counted. MTT assay, modified Boyden chamber assay, and human fibronectin plates were used to measure the proliferation, migration, and adhesion functions of the late endothelial progenitor cells, respectively. Results Compared with non-COPD and COPD groups, the number of peripheral blood late EPCs in COPD + PAH group was significantly reduced, and the proliferation, adhesion, and migration capacities were significantly lowered; the differences were statistically significant (p number and function of late EPCs decreased with the increase of pulmonary artery pressure (p number of late EPCs in COPD patients combined with pulmonary hypertension was reduced, which implies the impaired cell functions. The changes of number and function were negatively correlated with the severity of pulmonary hypertension.

  11. An official American Thoracic Society workshop report: the Integrated Care of The COPD Patient.

    Science.gov (United States)

    Nici, Linda; ZuWallack, Richard

    2012-03-01

    The optimal care of the patient with chronic obstructive pulmonary disease (COPD) requires an individualized, patient-centered approach that recognizes and treats all aspects of the disease, addresses the systemic effects and comorbidities, and integrates medical care among healthcare professionals and across healthcare sectors. In many ways the integration of medical care for COPD is still in its infancy, and its implementation will undoubtedly represent a paradigm shift in our thinking. This article summarizes the proceedings of a workshop, The Integrated Care of the COPD Patient, which was funded by the American Thoracic Society. This workshop included participants who were chosen because of their expertise in the area as well as their firsthand experience with disease management models. Our summary describes the concepts of integrated care and chronic disease management, details specific components of disease management as they may apply to the patient with COPD, and provides several innovative examples of COPD disease management programs originating from different healthcare systems. It became clear from the discussions and review of the literature that more high-quality research in this area is vital. It is our hope that the information presented here provides a "call to arms" in this regard.

  12. Identification of Clinical Phenotypes Using Cluster Analyses in COPD Patients with Multiple Comorbidities

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    Pierre-Régis Burgel

    2014-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is characterized by persistent airflow limitation, the severity of which is assessed using forced expiratory volume in 1 sec (FEV1, % predicted. Cohort studies have confirmed that COPD patients with similar levels of airflow limitation showed marked heterogeneity in clinical manifestations and outcomes. Chronic coexisting diseases, also called comorbidities, are highly prevalent in COPD patients and likely contribute to this heterogeneity. In recent years, investigators have used innovative statistical methods (e.g., cluster analyses to examine the hypothesis that subgroups of COPD patients sharing clinically relevant characteristics (phenotypes can be identified. The objectives of the present paper are to review recent studies that have used cluster analyses for defining phenotypes in observational cohorts of COPD patients. Strengths and weaknesses of these statistical approaches are briefly described. Description of the phenotypes that were reasonably reproducible across studies and received prospective validation in at least one study is provided, with a special focus on differences in age and comorbidities (including cardiovascular diseases. Finally, gaps in current knowledge are described, leading to proposals for future studies.

  13. Mechanisms of bacterial resistance to antibiotics in infections of COPD patients.

    Science.gov (United States)

    Kyd, Jennelle M; McGrath, John; Krishnamurthy, Ajay

    2011-04-01

    A key characteristic of airway inflammation in chronic obstructive pulmonary disease (COPD) is the persistent presence of bacteria in the lower airways. The most commonly isolated bacteria in the lower respiratory tract of COPD patients are nontypeable Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae, with growing evidence of the significance of Pseudomonas aeruginosa infections in severe COPD disease. This review focuses on the antibiotic resistant mechanisms associated with the gram-negative bacteria H. influenzae and M. catarrhalis and comparison with P. aeruginosa infection because of the recent evidence of its significance in patients with severe COPD disease. These mechanisms of resistance to β-lactams in H. influenzae and M. catarrhalis are mostly associated with serine β-lactamases of class A type, whereas P. aeruginosa strains exhibit a much broader repertoire with class A-D type mechanisms. Other mechanisms of antibiotic resistance include membrane permeability, efflux pump systems and mutations in antimicrobial targets. Antimicrobial resistance within biofilm matrices appears to be different to the mechanisms observed when the bacteria are in the planktonic state. P. aeruginosa exhibits a more numerous and diverse range of antimicrobial resistance mechanisms in comparison to M. catarrhalis and H. influenzae. The recognition that P. aeruginosa is associated with exacerbations in patients with more severe COPD and that turnover in infecting strains is detected (unlike in cystic fibrosis patients), then further investigation is required to better understand the contribution of antimicrobial resistance and other virulence mechanisms to poor clinical outcomes to improve therapeutic approaches.

  14. HLA polymorphisms as incidence factor in the progression to end-stage renal disease in Brazilian patients awaiting kidney transplant.

    Science.gov (United States)

    Crispim, J C; Mendes-Júnior, C T; Wastowski, I J; Palomino, G Martelli; Saber, L T; Rassi, D M; Donadi, E A

    2008-06-01

    Chronic renal failure (CRF) leads in the majority of instances to end-stage renal disease (ESRD) requiring renal replacement therapy. Age, gender, genetics, race, hypertension, and smoking among others are factors associated with ESRD. Our interest was to evaluate the possible associations of class I and II HLA antigens with ESRD renal disease independent of other factors, among patients with CRF, having various diagnoses in the Brazilian population of the São Paulo state. So 21 HLA-A, 31 HLA-B, and 13 HLA-DR were detected in 105 patients who were compared with 160 healthy controls of both sexes who were not related to the patients evaluated until 2005. We calculated allelic frequencies, haplotypes frequencies, etiological fractions (EF), preventive fractions, and relative risks (RR). We compared demographic data of patients and controls. The antigens positively associated with ESRD were: HLA-A78 (RR = 30.31 and EF = 0.96) and HLA-DR11 (RR = 18.87 and EF = 0.65). The antigens HLAB14 (RR = 29.90 and EF = 0.75) was present at a significantly lower frequency among patients compared with controls. In contrast, no haplotype frequency showed statically significant associations. Further molecular studies may clarify types and subtypes of alleles involved with ESRD progression.

  15. Mortality in COPD patients discharged from hospital: the role of treatment and co-morbidity

    DEFF Research Database (Denmark)

    Gudmundsson, G; Gislason, T; Lindberg, E

    2006-01-01

    with diabetes had an increased mortality rate [HR = 2.25 (1.28-3.95)]. Other risk factors were advanced age, low FEV1 and lower health status. Patients treated with inhaled corticosteroids and/or long-acting beta-2-agonists had a lower risk of death than patients using neither of these types of treatment....... CONCLUSION: Mortality was high after COPD admission, with older age, decreased lung function, lower health status and diabetes the most important risk factors. Treatment with inhaled corticosteroids and long-acting bronchodilators may be associated with lower mortality in patients with COPD....

  16. Exercise-induced skeletal muscle deoxygenation in O-supplemented COPD patients

    DEFF Research Database (Denmark)

    Vogiatzis, I; Athanasopoulos, D; Stratakos, G

    2009-01-01

    hemoglobin to total hemoglobin and reflects the relative contributions of tissue O2 delivery and tissue O2 utilization. Oxygen was supplemented to all patients in order to maintain arterial O2 saturation normal (> 95%). The StO2 decreased during symptom-limited exercise, reaching the nadir at peak WR...... subjects (19.0 +/- 5.2 and 15.6 +/- 2.5 s, respectively). In O2-supplemented COPD patients, peripheral muscle oxygenation for a given work load is similar to that in healthy subjects, thus suggesting that skeletal muscle O2 consumption becomes normal for a given O2 delivery in COPD patients...

  17. Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

    OpenAIRE

    Drivenes, Elin; Østrem, Anders; Melbye, Hasse

    2014-01-01

    Background A combination of inhaled corticosteroid and long-acting beta2 agonist (ICS/LABA) is used frequently to treat chronic obstructive pulmonary disease (COPD) patients. The aim of the study was to determine whether prescribing ICS/LABA to COPD patients in primary care in 2009/10 was within the GOLD guidelines and whether and to what degree patient characteristics were associated with prescription of these drugs by GPs. Methods This was a cross-sectional study in seven Norwegian GP pract...

  18. All Danish first-time COPD hospitalisations 2002-2008: incidence, outcome, patients, and care.

    Science.gov (United States)

    Lykkegaard, Jesper; Søndergaard, Jens; Kragstrup, Jakob; Rømhild Davidsen, Jesper; Knudsen, Thomas; Andersen, Morten

    2012-04-01

    This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients. Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed. During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased. Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. COPD, Body Mass, Fat Free Body Mass and prognosis in Patients from a Random Population Sample

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Prescott, E; Almdal, Thomas Peter;

    2006-01-01

    RATIONALE: Low body mass index (BMI) is a marker of poor prognosis in chronic obstructive pulmonary disease (COPD). In the general population, the harmful effect of low BMI is due to the deleterious effects of a low fat-free mass index (FFMI; fat-free mass/weight(2)). OBJECTIVES: We explored...... distribution of low FFMI and its association with prognosis in a population-based cohort of patients with COPD. METHODS: We used data on 1,898 patients with COPD identified in a population-based epidemiologic study in Copenhagen. FFM was measured using bioelectrical impedance analysis. Patients were followed...... 10th percentile of the general population. BMI and FFMI were significant predictors of mortality, independent of relevant covariates. Being in the lowest 10th percentile of the general population for FFMI was associated with a hazard ratio of 1.5 (95% confidence interval, 1.2-1.8) for overall...

  20. Effect of N-acetylcysteine in COPD patients with different microsomal epoxide hydrolase genotypes

    Directory of Open Access Journals (Sweden)

    Zhang JQ

    2015-05-01

    Full Text Available Jian-Qing Zhang,1 Jia-Qiang Zhang,1 Hua Liu,2 Zhi-Huan Zhao,1 Li-Zhou Fang,1 Ling Liu,1 Wei-Ping Fu,1 Jing-Kui Shu,1 Jia-Gang Feng,1 Lu-Ming Dai1 1Department of Respiratory Critical Care Medicine, 2Department of Clinical Laboratory, First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China Background: The role of the antioxidant N-acetylcysteine (NAC in the treatment of chronic obstructive pulmonary disease (COPD has not been clarified as yet. In early studies, we found that the proportion of smokers with COPD having extremely slow/slow microsomal epoxide hydrolase (EPHX1 enzyme activity is significantly higher than that in healthy smokers. The purpose of this study was to evaluate whether different EPHX1 enzyme activity is related to differential therapeutic effects of treatment with NAC in COPD.Methods: A total of 219 patients with COPD were randomly allocated to an extremely slow/slow EPHX1 enzyme activity group (n=157 or a fast/normal EPHX1 enzyme activity group (n=62 according to their EPHX1 enzyme activity. Both groups were treated with NAC 600 mg twice daily for one year. The main study parameters, including forced expiratory volume in one second (FEV1, St George’s Respiratory Questionnaire (SGRQ, and yearly exacerbation rate, were measured at baseline and at 6-month intervals for one year.Results: Both FEV1 and SGRQ symptom scores were improved after treatment with NAC in the slow activity group when compared with the fast activity group. Further, changes in FEV1 and SGRQ symptom score in patients with mild-to-moderate COPD were more significant than those in patients with severe-to-very severe COPD. The yearly exacerbation rates were reduced in both groups, but the reduction in the slow activity group was significantly lower than in the fast activity group.Conclusion: NAC treatment in COPD patients with extremely slow/slow EPHX1 enzyme activity improves FEV1 and the SGRQ symptom score, especially

  1. STUDY OF ECG AND ECHOCARDIOGRAPHIC FINDINGS IN COPD PATIENTS IN A TERTIARY CARE CENTRE

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    Ramakrishna

    2016-03-01

    Full Text Available COPD is a major cause of death worldwide. Early identification of the complications, particularly pulmonary hypertension and right ventricular dysfunction can prevent or delay long-term complications. AIM OF THE STUDY To study ECG and Echocardiographic profile among COPD patients and study their importance in the management of COPD. MATERIALS AND METHODS We have studied 103 (N=103 patients diagnosed as COPD in our tertiary care centre. We categorized them into mild (FEV1/FVC80% predicted, Moderate (FEV1/FVC1 was seen in 4.44%. Atrial ectopics were seen in 18.55% and ventricular ectopics were seen in 3.09%. Right axis deviation was seen in 5.55% and no ECG changes in 39.17%. Echocardiogram showed consistent abnormal findings in 94%. Pulmonary arterial hypertension was seen in 94.84%, RV hypertrophy was seen in 26.82%. Cardiac arrhythmias and cardiac failure were seen in 8.24% each. ECG and Echocardiography can identify early pulmonary hypertension and right ventricular dysfunction. Proper institution of therapy can prevent long-term complications of severe pulmonary hypertension and right heart failure and can prolong the life and improve quality of life among COPD patients.

  2. Blood Pressure Profile and Hypertensive Organ Damage in COPD Patients and Matched Controls. The RETAPOC Study.

    Directory of Open Access Journals (Sweden)

    Rafael Golpe

    Full Text Available Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases.Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed.classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05. There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01 and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001.Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.

  3. Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients.

    NARCIS (Netherlands)

    Rodríguez, E.; Ferrer, J.; Zock, J.P.; Serra, I.; Antó, J.M.; Batlle, J. de; Kromhout, H.; Vermeulen, R.; Donaire-Gonzalez, D.; Benet, M.; Balcells, E.; Monso, E.; Gayete, A.; Garcia-Aymerich, J.

    2014-01-01

    Background: Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients. Methods: We s

  4. Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients

    NARCIS (Netherlands)

    Rodríguez, Esther; Ferrer, Jaume; Zock, Jan Paul; Serra, Ignasi; Antó, Josep M.; De Batlle, Jordi; Kromhout, Hans; Vermeulen, Roel; Donaire-González, David; Benet, Marta; Balcells, Eva; Monsó, Eduard; Gayete, Àngel; Garcia-Aymerich, Judith; Guerra, Stefano; Gea, Joaquim; Orozco-Levi, Mauricio; Vollmer, Ivan; Barberà, Joan Albert; Gómez, Federico P.; Paré, Carles; Roca, Josep; Rodriguez-Roisin, Robert; Agustí, Àlvar; Freixa, Xavier; Rodriguez, Diego A.; Gimeno, Elena; Portillo, Karina; Andreu, Jordi; Pallissa, Esther; Casan, Pere; Güell, Rosa; Giménez, Ana; Marín, Alicia; Morera, Josep; Farrero, Eva; Escarrabill, Joan; Ferrer, Antoni; Sauleda, Jaume; Togores, Bernat; Gáldiz, Juan Bautista; López, Lorena; Belda, José

    2014-01-01

    BACKGROUND: Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients.\

  5. Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device

    NARCIS (Netherlands)

    Dekhuijzen, P.N.R.; Batsiou, M.; Bjermer, L.; Bosnic-Anticevich, S.; Chrystyn, H.; Papi, A.; Rodriguez-Roisin, R.; Fletcher, M.; Wood, L.; Cifra, A.; Soriano, J.B.; Price, D.B.

    2016-01-01

    BACKGROUND AND AIMS: Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device. MET

  6. Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients

    NARCIS (Netherlands)

    Rodríguez, Esther; Ferrer, Jaume; Zock, Jan Paul; Serra, Ignasi; Antó, Josep M.; De Batlle, Jordi; Kromhout, Hans; Vermeulen, Roel; Donaire-González, David; Benet, Marta; Balcells, Eva; Monsó, Eduard; Gayete, Àngel; Garcia-Aymerich, Judith; Guerra, Stefano; Gea, Joaquim; Orozco-Levi, Mauricio; Vollmer, Ivan; Barberà, Joan Albert; Gómez, Federico P.; Paré, Carles; Roca, Josep; Rodriguez-Roisin, Robert; Agustí, Àlvar; Freixa, Xavier; Rodriguez, Diego A.; Gimeno, Elena; Portillo, Karina; Andreu, Jordi; Pallissa, Esther; Casan, Pere; Güell, Rosa; Giménez, Ana; Marín, Alicia; Morera, Josep; Farrero, Eva; Escarrabill, Joan; Ferrer, Antoni; Sauleda, Jaume; Togores, Bernat; Gáldiz, Juan Bautista; López, Lorena; Belda, José

    2014-01-01

    BACKGROUND: Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients.\

  7. Klotho gene polymorphism -395 Gpatients with chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Ioannis Sotiriou, MD

    2010-01-01

    Full Text Available SUMMARY. Background: The function of the Klotho gene, originally identified by insertional mutagenesis in mice, is to suppress multiple aging phenotypes. It has been shown that a mutant Klotho gene is associated with pulmonary emphysema in mice. The aims of this study were to detect Klotho gene polymorphisms (-395G>A SNP and to identify their possible relationships with clinical findings in patients with chronic obstructive pulmonary disease (COPD. Methods: In 167 patients with COPD -395G>A SNP of the Klotho gene was genotyped by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP coupled with sequencing. The possible relationship was explored of -395G>A SNP with clinical findings such as lung function parameters, staging according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD, and body mass index (BMI. Results: Of the 167patients with COPD, 99 (59.3% presented the wild type -395G allele, 62 (37.1% were heterozygotes (–395GA allele, and 6 (3.6% presented the non-wild type–395A allele. In these COPD patients there was an association between Klotho genotypes and BMI (p=0.025. No association was found between Klotho gene polymorphism and disease severity, assessed by spirometry, arterial blood gases and GOLD stage. Conclusion: Klotho -395G>A polymorphisms are detected in patients with COPD and are associated with BMI, but not with various parameters of disease severity. This may suggest a possible metabolic pathway in the implication of Klotho deficient gene in the pathophysiology of emphysema in COPD patients. Pneumon 2010, 23(4:348-354.

  8. COPD patients' medical care and support in Greece during financial crisis

    Directory of Open Access Journals (Sweden)

    Mitonas G

    2016-11-01

    Full Text Available George Mitonas,1 Alexia Juvana,2 Zoe Daniil,3 Chryssa Hatzoglou,4 Konstantinos Gourgoulianis3 1Diavata Health Center, Gennimatas General Hospital, 2Papageorgiou General Hospital, Thessaloniki, 3Pulmonary Medicine Department, University Hospital of Larissa, 4Physiology Department, Medical School, University of Thessaly, Larissa, Greece Background: The need to follow a multidisciplinary strategy in chronic obstructive ­pulmonary disease (COPD management and rehabilitation in community settings in Greece raises significant questions, given the severe austerity measures being imposed at present. The aim of this study was to investigate the clinical profile of patients with COPD along with the care provided in rural community settings in Greece.Methods: Two primary health care centers and 200 newly diagnosed patients over a 12-month period were involved in the study. A self-assessment questionnaire, including questions about smoking habits, the presence of comorbidities and chronic respiratory symptoms, as well as the COPD Assessment Test were used. Spirometry was performed with a dry spirometer. Obstructive spirometry was defined as forced expiratory volume in 1 second/forced vital capacity ratio <0.7, according to Global Initiative for Chronic Obstructive Lung Disease guidelines.Results: Males comprised 70% of the sample, with cough and sputum being the prominent signs. Regarding COPD staging, 68.5% were classified in stages I/II. Arterial hypertension and coronary heart disease were the most common comorbidities. Current smokers accounted for 88.5%, while 88% were heavy drinkers. A general practitioner made the diagnosis in 68.5% of the cases, among which offspring and spouses provided home care in 38% and 8% of the cases, respectively, while an informal caregiver other than a relative was reported in 34% of the cases. No caregiver (self-care was reported in 20% of the cases. All patients of stage III and IV had a COPD Assessment Test score >10

  9. The effects of extrafine beclometasone/formoterol (BDP/F) on lung function, dyspnea, hyperinflation, and airway geometry in COPD patients: novel insight using functional respiratory imaging

    OpenAIRE

    De Backer, Jan; Vos, Wim; Vinchurkar, Samir; van Holsbeke, Cedric; Poli, Gianluigi; Claes, Rita; Salgado,Rodrigo; De Backer, Wilfried

    2015-01-01

    Background: The efficacy of inhaled corticosteroids (ICS) in moderately severe COPD patients remains unclear. At the same time, the use of extrafine particles in COPD patients is a topic of ongoing research. Objectives: This study assessed the effect of ICS in steroid-naive mild COPD patients and the effect of reducing the ICS dose in more severe COPD patients previously using ICS when switching to an extrafine particle BDP/F formulation (Foster using Modulite technology, Chiesi Pharm...

  10. Patients' use of self-monitored readings for managing everyday life with COPD

    DEFF Research Database (Denmark)

    Huniche, Lotte; Dinesen, Birthe; Nielsen, Carl;

    2013-01-01

    OBJECTIVE: Effects of self-monitoring depend on how patients engage with readings and how this engagement is used for managing chronic disease. This article reports on a study of how chronic obstructive pulmonary disease (COPD) patients made use of readings during 16 weeks of self-monitoring. PAT...

  11. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis

    NARCIS (Netherlands)

    F.J.B. Lötters (Freek); B. van Tol; G. Kwakkel (Gert); R.A.A.M. Gosselink (Rik)

    2002-01-01

    textabstractThe purpose of this meta-analysis is to review studies investigating the efficacy of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients and to find out whether patient characteristics influence the efficacy of IMT. A systematic li

  12. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD

    NARCIS (Netherlands)

    Wijkstra, PJ; Lacasse, Y; Guyatt, GH; Casanova, C; Gay, PC; Jones, JM; Goldstein, RS

    2003-01-01

    Study objectives: The potential benefits of noninvasive positive pressure ventilation (NIPPV) for patients with COPD remains inconclusive, as most studies have included only a small number of patients. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) that compared noctur

  13. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Vervoort, S. C J M; Nijssen, L. I T; Trappenburg, J. C A; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management

  14. Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD

    DEFF Research Database (Denmark)

    Ringbaek, Thomas J.; Lavesen, Marie; Lange, Peter

    2016-01-01

    BACKGROUND: A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). OBJECTIVE: To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. METHODS: A total of 115 patients pa...

  15. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Vervoort, S. C J M; Nijssen, L. I T; Trappenburg, J. C A; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related

  16. Health-related quality of life in COPD patients with chronic respiratory failure

    NARCIS (Netherlands)

    Duiverman, M. L.; Wempe, J. B.; Bladder, G.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2008-01-01

    The Maugeri Respiratory Failure (MRF-28) and Severe Respiratory Insufficiency (SRI) questionnaires were recently developed to assess health-related quality of life (HRQoL) in patients with chronic respiratory failure, although not exclusively in chronic obstructive pulmonary disease (COPD) patients.

  17. Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?

    Directory of Open Access Journals (Sweden)

    Maria Enedina Aquino Scuarcialupi

    2014-04-01

    Full Text Available OBJECTIVE: To investigate the modulatory effects that dynamic hyperinflation (DH, defined as a reduction in inspiratory capacity (IC, has on exercise tolerance after bronchodilator in patients with COPD. METHODS: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET. On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometry and submaximal CPET at constant speed up to the limit of tolerance (Tlim. The patients who showed ΔIC(peak-rest 0.05. In addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60%] vs. 10% [3-53%]; p > 0.05. CONCLUSIONS: Improvement in TLim was associated with an increase in IC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise.

  18. Illness perceptions and treatment beliefs in pulmonary rehabilitation for patients with COPD

    NARCIS (Netherlands)

    Fischer, Maarten Jan

    2011-01-01

    In spite of the well-demonstrated benefits for patients, 20-40% of the patients with COPD who are referred to a pulmonary rehabilitation programme do not complete treatment. The aim of this thesis was to investigate the association of illness perceptions and treatment beliefs with treatment adherenc

  19. Imbalances of Th17 and Treg cells and their respective cytokines in COPD patients by disease stage.

    Science.gov (United States)

    Li, Xiang-Nan; Pan, Xue; Qiu, Dong

    2014-01-01

    The typical balance between Th17 and Treg T cell subsets is altered in various autoimmune diseases. Here, inflammatory markers in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) (n=32) and stable COPD (n=36) were compared with smokers with normal lung function (n=40, control group). Flow cytometry was used to detect proportions of Th17 and Treg cells in the peripheral blood. ELISA of induced sputum samples was used to detect IL-17 (secreted by Th17 cells) and TGF-β1 (secreted by Treg cells) concentrations. The proportion of Th17 cells in peripheral blood and secreted IL-17 and TGF-β1 levels in sputum were significantly higher in acute exacerbation of COPD patients than in stable COPD and control groups (P Treg cells was lower than in stable COPD but higher than in controls. Th17 proportions were negatively correlated with Treg proportions in both acute exacerbation and stable COPD patients, and positively correlated with IL-17 levels (P Treg proportion and TGF-β1 levels (P Treg cells. Acute exacerbation of COPD is shifted toward a pro-inflammatory response, while stable COPD is shifted toward an anti-inflammatory response. This finding may provide a new direction for future clinical treatment of COPD by seeking to repair the disrupted balance in T cells.

  20. Factors contributing to quality of life in COPD patients in South Korea

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    Kwon HY

    2016-01-01

    Full Text Available Hye-Young Kwon,1,2 Eugene Kim2 1Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; 2Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, South Korea Objectives: Chronic obstructive pulmonary disease (COPD is a chronic lung disease, and the burden of COPD is expected to increase in the rapidly aging nation of South Korea. This study aims to examine the factors contributing to health-related quality of life (HRQOL in COPD patients.Patients and methods: This study was based on 6-year-data obtained from the Korean National Health and Nutrition Examination Survey 2007–2012. COPD was diagnosed in 2,734 survey participants and the severity was graded according to the criteria set by the Global Initiative for Chronic Obstructive Lung Disease. The EuroQol-5D (EQ-5D index was used to assess the quality of life.Results: The EQ-5D index scores for COPD patients and the general population were 0.915±0.003 and 0.943±0.001, respectively. Males, younger people, and patients with higher education attainment and income levels had a higher utility score. In addition, the adjusted EQ-5D index scores for severity level IV significantly decreased by 0.100 (P=0.041, compared to the severity group I scores. No significant differences were found in stage II and III patients. Comorbidities (excluding cancer and hypertension appeared to negatively influence HRQOL among COPD patients. In particular, depression (EQ-5D index score =-0.089, P=0.0003 and osteoporosis (EQ-5D index score= -0.062, P=0.0039 had a significant influence, while smoking status did not appear to influence patient HRQOL.Conclusion: In this study, we found that the higher the severity of COPD, the lower the quality of life. In particular, patients with depression and osteoporosis had a relatively low utility score. Therefore, these comorbidities should be carefully monitored in order to improve quality

  1. Gender Differences in Mortality and Clinical Expressions of Patients with COPD: The TORCH Experience

    DEFF Research Database (Denmark)

    Celli, Bartolome; Vestbo, Jörgen; Jenkins, Christine R;

    2010-01-01

    RATIONALE: There is limited knowledge regarding gender differences and outcomes in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES: Determine gender differences in survival, causes of death and patient-centered outcomes in the 3 year TORCH study. METHODS: 1,481 women and 4......,631 men with COPD were enrolled in TORCH, a trial comparing salmeterol 50 mug plus fluticasone propionate 500 mug bid (SFC) and each component individually. Causes of death were determined by an endpoint committee. Gender differences in survival were explored using a Cox's proportional hazards model...

  2. Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD - a review.

    Science.gov (United States)

    Nyberg, André; Carvalho, João; Bui, Kim-Ly; Saey, Didier; Maltais, François

    Even though chronic obstructive pulmonary disease (COPD) is primarily a disease of the respiratory system, limb muscle dysfunction characterized by muscle weakness, reduced muscle endurance and higher muscle fatigability, is a common secondary consequence and a major systemic manifestation of the disease. Muscle dysfunction is especially relevant in COPD because it is related to important clinical outcomes such as mortality, quality of life and exercise intolerance, independently of lung function impairment. Thus, improving muscle function is considered an important therapeutic goal in COPD management. Pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based and comprehensive approach used to promote better self-management of the disease, minimize symptom burden, optimize functional status, and increase participation in activities of daily life. Exercise training, including cardiovascular and muscle exercises, is the cornerstone of PR and is considered the best available strategy to improve exercise tolerance and muscle function among patients with COPD. This paper addresses the various components of exercise training within PR used to improve limb muscle function in COPD, providing clinicians and health-care professionals with an overview and description of these various exercise modalities and of their effects on limb muscle function. Guidance and recommendations to help design optimal limb muscle training regimens for these patients are also presented. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  3. The effects of ELTGOL on mucociliary clearance in patients with COPD

    Directory of Open Access Journals (Sweden)

    Jocimar. A. Martins

    2006-12-01

    Full Text Available Excessive tracheobronchial secretion is a common complication of chronic obstruction pulmonary disease (COPD and its presence is associated with lower survival, greater hospitalization and death. Slow expiration with the glottis open in a lateral posture (ELTGOL is a chest physiotherapy procedure for the removal of lung secretions. Studies which have assessed ELTGOL through pulmonary scintigraphy were not found [1]. The aim this study was to evaluate the effects of ELTGOL on the mucociliary clearance in patients with COPD. Twelve patients with COPD aged 45 to 75 years were studied. After inhaling 20 mCi of 99mTc-DTPA [2], six posterior static scintigraphy images were taken in intervals of 0, 20, 40, 60, 80 and 120 minutes (figure 1.

  4. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD

    DEFF Research Database (Denmark)

    Mäkelä, Mika J; Backer, Vibeke; Hedegaard, Morten

    2013-01-01

    are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs......Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age......, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD...

  5. The effect of conjugated linoleic acid supplementation on the nutritional status of COPD patients.

    Science.gov (United States)

    Ghobadi, Hassan; Matin, Somaieh; Nemati, Ali; Naghizadeh-Baghi, Abbas

    2016-01-01

    COPD patients are susceptible to anorexia, reduction of caloric intake, weight loss, and malnutrition. One of the possible mechanisms is the increase of inflammatory markers such as interleukin 1β (IL1β), is highly correlated with anorexia. Considering the anti-inflammatory role of conjugated linoleic acid (CLA), this study aimed to investigate the effect of CLA supplementation on the nutritional status of COPD patients. In a double-blind clinical trial, 93 COPD patients who volunteered to participate in the study and who filled out a written consent form, were randomly assigned to control or supplementation groups. The patients in the supplementation group received 3.2 g of CLA on a daily basis for 6 weeks, while those in the control group received placebo on a daily basis for 6 weeks. For IL1β assessment, the patients' anthropometric indices and appetite score were checked and their blood samples were collected both before and after the treatment. Moreover, in order to investigate the changes in the caloric intake trend during the study, their dietary intake levels were assessed using 24-hour dietary recall, 3 days a week at the onset, in the 4th week, and at the end of the study. Eventually, 90 patients completed the study. The results demonstrated a significant increase in appetite score (P=0.001), average caloric intake (P=0.01), and macronutrient intake (Pnutritional status of patients suffering from COPD through adjusting the serum level of IL1β.

  6. Increased risk of community-acquired pneumonia in COPD patients with comorbid cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Lin SH

    2016-12-01

    Full Text Available Sheng-Hao Lin,1,2 Diahn-Warng Perng,3,4 Ching-Pei Chen,5,6 Woei-Horng Chai,1 Chin-Shui Yeh,1 Chew-Teng Kor,7 Shih-Lung Cheng,8,9 Jeremy JW Chen,2,* Ching-Hsiung Lin1,10,11,* 1Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 2Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 3Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 4School of Medicine, National Yang-Ming University, Taipei, 5Department of Internal Medicine, Division of Cardiology, Changhua Christian Hospital, 6Department of Beauty Science and Graduate Institute of Beauty Science Technology, Chien-Kuo Technology University, 7Department of Internal Medicine, Internal Medicine Research Center, Changhua Christian Hospital, Changhua, 8Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 9Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan, 10Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, 11School of Medicine, Chung Shan Medical University, Taichung, Taiwan *These authors contributed equally to this work Background and objective: COPD patients with community-acquired pneumonia (CAP have worse clinical outcomes, as compared to those without COPD. Cardiovascular disease (CVD is a common comorbidity for COPD patients. Whether COPD with comorbid CVD will increase the risk of CAP is not well investigated. The incidence and factors associated with CAP in COPD patients with and without CVD were analyzed. Methods: The medical records of patients with newly diagnosed COPD between 2007 and 2010 were reviewed. The patients’ characteristics, medical history of CVD, occurrence of CAP, and type of medication were recorded. Kaplan–Meier curves were used to assess the differences in cumulative incidence of CAP. Cox’s proportional hazards regression model was used to determine the

  7. Genome-wide association study of smoking behaviours in patients with COPD.

    Science.gov (United States)

    Siedlinski, Mateusz; Cho, Michael H; Bakke, Per; Gulsvik, Amund; Lomas, David A; Anderson, Wayne; Kong, Xiangyang; Rennard, Stephen I; Beaty, Terri H; Hokanson, John E; Crapo, James D; Silverman, Edwin K

    2011-10-01

    Background Cigarette smoking is a major risk factor for chronic obstructive pulmonary disease (COPD) and COPD severity. Previous genome-wide association studies (GWAS) have identified numerous single nucleotide polymorphisms (SNPs) associated with the number of cigarettes smoked per day (CPD) and a dopamine beta-hydroxylase (DBH) locus associated with smoking cessation in multiple populations. Objective To identify SNPs associated with lifetime average and current CPD, age at smoking initiation, and smoking cessation in patients with COPD. Methods GWAS were conducted in four independent cohorts encompassing 3441 ever-smoking patients with COPD (Global Initiative for Obstructive Lung Disease stage II or higher). Untyped SNPs were imputed using the HapMap (phase II) panel. Results from all cohorts were meta-analysed. Results Several SNPs near the HLA region on chromosome 6p21 and in an intergenic region on chromosome 2q21 showed associations with age at smoking initiation, both with the lowest p=2×10(-7). No SNPs were associated with lifetime average CPD, current CPD or smoking cessation with p<10(-6). Nominally significant associations with candidate SNPs within cholinergic receptors, nicotinic, alpha 3/5 (CHRNA3/CHRNA5; eg, p=0.00011 for SNP rs1051730) and cytochrome P450, family 2, subfamily A, polypeptide 6 (CYP2A6; eg, p=2.78×10(-5) for a non-synonymous SNP rs1801272) regions were observed for lifetime average CPD, however only CYP2A6 showed evidence of significant association with current CPD. A candidate SNP (rs3025343) in DBH was significantly (p=0.015) associated with smoking cessation. Conclusion The authors identified two candidate regions associated with age at smoking initiation in patients with COPD. Associations of CHRNA3/CHRNA5 and CYP2A6 loci with CPD and DBH with smoking cessation are also likely of importance in the smoking behaviours of patients with COPD.

  8. Effect of carbocisteine on patients with COPD: a systematic review and meta-analysis

    Science.gov (United States)

    Zeng, Zheng; Yang, Dan; Huang, Xiaoling; Xiao, Zhenliang

    2017-01-01

    Background COPD is the fourth leading cause of death in the world. It is a common, progressive, treatable and preventable disease. The exacerbation of COPD is associated with the peripheral muscle force, forced expiratory volume in 1 second (FEV1), the quality of life and mortality. Many studies indicated that the mucoactive medicines could reduce the exacerbations of COPD. This study summarized the efficacy of carbocisteine as a treatment for COPD. Methods We searched the randomized controlled trials (RCTs) following electronic bibliographic databases: MedLine, Embase, Cochrane Library and Web of Science. We additionally searched gray literature database: OpenSIGLE. We also additionally searched the clinical trial registers: ClinicalTrials.gov register and International Clinical Trials Registry Platform Search Portal. We used RCTs to assess the efficacy of the treatments. We included studies of adults (older than 18 years) with COPD. We excluded studies that were published as protocol or written in non-English language (Number 42016047078). Findings Our findings included data from four studies involving 1,357 patients. There was a decrease in the risk of the rate of total number of exacerbations with carbocisteine compared with placebo (−0.43; 95% confidence interval [CI] −0.57, −0.29, P<0.01). Carbocisteine could also improve the quality of life (−6.29; 95% CI −9.30, −3.27) and reduce the number of patients with at least one exacerbation (0.86; 95% CI 0.78, 0.95) compared with placebo. There was no significant difference in the FEV1 and adverse effects and the rate of hospitalization. Interpretation Long-term use of carbocisteine (500 mg TID) may be associated with lower exacerbation rates, the smaller number of patients with at least one exacerbation and higher quality of life of patients with COPD. PMID:28814855

  9. Effect of carbocisteine on patients with COPD: a systematic review and meta-analysis.

    Science.gov (United States)

    Zeng, Zheng; Yang, Dan; Huang, Xiaoling; Xiao, Zhenliang

    2017-01-01

    COPD is the fourth leading cause of death in the world. It is a common, progressive, treatable and preventable disease. The exacerbation of COPD is associated with the peripheral muscle force, forced expiratory volume in 1 second (FEV1), the quality of life and mortality. Many studies indicated that the mucoactive medicines could reduce the exacerbations of COPD. This study summarized the efficacy of carbocisteine as a treatment for COPD. We searched the randomized controlled trials (RCTs) following electronic bibliographic databases: MedLine, Embase, Cochrane Library and Web of Science. We additionally searched gray literature database: OpenSIGLE. We also additionally searched the clinical trial registers: ClinicalTrials.gov register and International Clinical Trials Registry Platform Search Portal. We used RCTs to assess the efficacy of the treatments. We included studies of adults (older than 18 years) with COPD. We excluded studies that were published as protocol or written in non-English language (Number 42016047078). Our findings included data from four studies involving 1,357 patients. There was a decrease in the risk of the rate of total number of exacerbations with carbocisteine compared with placebo (-0.43; 95% confidence interval [CI] -0.57, -0.29, P<0.01). Carbocisteine could also improve the quality of life (-6.29; 95% CI -9.30, -3.27) and reduce the number of patients with at least one exacerbation (0.86; 95% CI 0.78, 0.95) compared with placebo. There was no significant difference in the FEV1 and adverse effects and the rate of hospitalization. Long-term use of carbocisteine (500 mg TID) may be associated with lower exacerbation rates, the smaller number of patients with at least one exacerbation and higher quality of life of patients with COPD.

  10. Airway inflammation in Japanese COPD patients compared with smoking and nonsmoking controls

    Directory of Open Access Journals (Sweden)

    Ishikawa N

    2015-01-01

    Full Text Available Nobuhisa Ishikawa,1 Noboru Hattori,2 Nobuoki Kohno,2 Akihiro Kobayashi,3 Tomoyuki Hayamizu,4 Malcolm Johnson5 1Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan; 2Department of Molecular and Internal Medicine, Hiroshima University, Hiroshima, Japan; 3Biomedical Data Science Department, 4Medical Affairs Respiratory Department, GlaxoSmithKline Shibuya-ku, Tokyo, Japan; 5Respiratory Global Franchise, GlaxoSmithKline, Uxbridge, UK Purpose: To assess the importance of inflammation in chronic obstructive pulmonary disease (COPD by measuring airway and systemic inflammatory biomarkers in Japanese patients with the disease and relevant control groups.Patients and methods: This was the first study of its type in Japanese COPD patients. It was a non-treatment study in which 100 participants were enrolled into one of three groups: nonsmoking controls, current or ex-smoking controls, and COPD patients. All participants underwent standard lung function assessments and provided sputum and blood samples from which the numbers of inflammatory cells and concentrations of biomarkers were measured, using standard procedures.Results: The overall trends observed in levels of inflammatory cells and biomarkers in sputum and blood in COPD were consistent with previous reports in Western studies. Increasing levels of neutrophils, interleukin 8 (IL-8, surfactant protein D (SP-D, and Krebs von den Lungen 6 (KL-6 in sputum and clara cell 16 (CC-16, high-sensitivity C-reactive protein (hs-CRP, and KL-6 in serum and plasma fibrinogen were seen in the Japanese COPD patients compared with the non-COPD control participants. In sputum, significant correlations were seen between total cell count and matrix metalloproteinase 9 (MMP-9; P<0.001, neutrophils and MMP-9 (P<0.001, macrophages and KL-6 (P<0.01, total cell count and IL-8 (P<0.05, neutrophils and IL-8 (P<0.05, and macrophages and MMP-9 (P<0.05. Significant correlations were also

  11. Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD

    Directory of Open Access Journals (Sweden)

    Rhee CK

    2015-08-01

    Full Text Available Chin Kook Rhee,1 Jin Woo Kim,2 Yong Il Hwang,3 Jin Hwa Lee,4 Ki-Suck Jung,3 Myung Goo Lee,5 Kwang Ha Yoo,6 Sang Haak Lee,7 Kyeong-Cheol Shin,8 Hyoung Kyu Yoon9 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, 3Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 8Regional Center for Respiratory Disease, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Background and objective: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines, either a modified Medical Research Council (mMRC dyspnea score of ≥2 or a chronic obstructive pulmonary disease (COPD assessment test (CAT score of ≥10 is considered to represent COPD patients who are

  12. Relationship between balance and physical activity measured by an activity monitor in elderly COPD patients

    Directory of Open Access Journals (Sweden)

    Iwakura M

    2016-07-01

    Full Text Available Masahiro Iwakura,1,2 Kazuki Okura,2 Kazuyuki Shibata,1,2 Atsuyoshi Kawagoshi,2 Keiyu Sugawara,2 Hitomi Takahashi,2 Takanobu Shioya1 1Department of Rehabilitation, Akita City Hospital, 2Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan Background: Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients. Materials and methods: Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted and 13 age-matched healthy control subjects (mean age, 72±6 years participated in the study. We assessed all 35 subjects’ balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST] and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]. Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group. Results: The COPD patients exhibited significant reductions in OLST times (P=0.033, Short Physical Performance Battery scores (P=0.013, 4 m gait speed (P<0.001, five-times sit-to-stand times (P=0.002, daily steps (P=0.003, and MV-PA (P=0.022 compared to the controls; the exception was the standing balance test scores. The correlation and multivariate regression analyses revealed significant independent associations between OLST times and daily steps (P<0.001 and between OLST times and MV-PA (P=0.014 in the COPD group after adjusting for

  13. Mental disorders and quality of life in COPD patients and their spouses

    Directory of Open Access Journals (Sweden)

    Kerstin Kühl

    2008-12-01

    Full Text Available Kerstin Kühl1, Wolfgang Schürmann2, Winfried Rief11Philipps University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D – 35032 Marburg, Germany; 2Private pulmonary practice, Bahnhofstraße 30, D – 35037 Marburg, GermanyAbstract: In the current study, the prevalence of the most common psychological disorders in COPD patients and their spouses was assessed cross-sectionally. The influence of COPD patients’ and their spouses’ psychopathology on patient health-related quality of life was also examined. The following measurements were employed: Forced expiratory volume in 1 second expressed in percentage predicted (FEV1%, Shuttle-Walking-Test (SWT, International Diagnostic Checklists for ICD-10 (IDCL, questionnaires on generic and disease-specific health-related quality of life (St. George’s Respiratory Questionnaire (SGRQ, European Quality of Life Questionnaire (EuroQol, a modified version of a Disability-Index (CDI, and a screening questionnaire for a broad range of psychological problems and symptoms of psychopathology (Symptom-Checklist-90-R (SCL-90-R. One hundred and forty-three stable COPD outpatients with a severity grade between 2 and 4 (according to the GOLD criteria as well as 105 spouses took part in the study. The prevalence of anxiety and depression diagnoses was increased both in COPD patients and their spouses. In contrast, substance-related disorders were explicitly more frequent in COPD patients. Multiple linear regression analyses indicated that depression (SCL-90-R, walking distance (SWT, somatization (SCL-90-R, male gender, FEV1%, and heart disease were independent predictors of COPD patients’ health-related quality of life. After including anxiousness of the spouses in the regression, medical variables (FEV1% and heart disease no longer explained disability, thus highlighting the relevance of spouses’ well-being. The results underline the importance of depression

  14. Efficacy of Vasadi Syrup and Shwasaghna Dhuma in the patients of COPD (Shwasa Roga).

    Science.gov (United States)

    Sharma, Praveen Kumar; Johri, Sharad; Mehra, B L

    2010-01-01

    Chronic Obstructive Pulmonary Disease (COPD) threatens as emerging public health crisis. The two major drivers for this are the ageing of the world's population and the impressive, if deplorable, success of the multinational tobacco companies at forcing open world markets. One of the most striking aspect of COPD is that it is heterogenous. There are many different presentations with differing intensities of symptoms and even differing responses to the medication. Sorting out, what accounts for this phenomenon and how treatments can be best individualised, is of concern to both basic and clinical scientists. COPD is a leading cause of morbidity and mortality worldwide and results in a substantial economic and social burden to society. It is the sixth most common cause of death worldwide and expected to rise to third position by 2020. Several national and international agencies like WHO, GOLD, ATS, ERS etc. are working in a direction of finding some solution of this wicked problem. In Ayurvedic texts Shwasa Roga has been described having symptomatology close to COPD. A study was carried out in P.G.Deptt. of Kayachikitsa in R.G.G.P.G.Ayu.College Paprola, H. P. where the role and efficacy of two Ayurvedic formulations -Vasadi Syrup and Shwasaghna Dhuma was evaluated on 30 patients of COPD selected on the basis of fixed inclusion and exclusion criteria in two different groups. In both the groups drugs provided significant results based on subjective symptomatological criteria and objective spirometric criteria.

  15. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy

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    Corhay JL

    2013-12-01

    Full Text Available Jean-Louis Corhay, Delphine Nguyen Dang, Hélène Van Cauwenberge, Renaud Louis Department of Pneumology, Centre Hospitalier Universitaire du Sart-Tilman Liège, Liège, Belgium Abstract: Chronic obstructive pulmonary disease (COPD is an obstructive and progressive airway disease associated with an important reduction in daily physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life (HRQoL. Nowadays, pulmonary rehabilitation (PR plays an essential role in the management of symptomatic patients with COPD, by breaking the vicious circle of dyspnea–decreased activity–deconditioning–isolation. Indeed the main benefits of comprehensive PR programs for patients with COPD include a decrease in symptoms (dyspnea and fatigue, improvements in exercise tolerance and HRQoL, reduction of health care utilization (particularly bed-days, as well as an increase in physical activity. Several randomized studies and meta-analyses greatly established the benefits of PR, which additionally, is recommended in a number of influential guidelines. This review aimed to highlight the impact of PR on COPD patients, focusing on the clinical usefulness of PR, which provides patients a good support for change. Keywords: chronic obstructive pulmonary disease, exercise training, physical activity, quality of life

  16. Population pharmacodynamic modeling and simulation of the respiratory effect of acetazolamide in decompensated COPD patients.

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    Nicholas Heming

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD patients may develop metabolic alkalosis during weaning from mechanical ventilation. Acetazolamide is one of the treatments used to reverse metabolic alkalosis. METHODS: 619 time-respiratory (minute ventilation, tidal volume and respiratory rate and 207 time-PaCO2 observations were obtained from 68 invasively ventilated COPD patients. We modeled respiratory responses to acetazolamide in mechanically ventilated COPD patients and then simulated the effect of increased amounts of the drug. RESULTS: The effect of acetazolamide on minute ventilation and PaCO2 levels was analyzed using a nonlinear mixed effect model. The effect of different ventilatory modes was assessed on the model. Only slightly increased minute ventilation without decreased PaCO2 levels were observed in response to 250 to 500 mg of acetazolamide administered twice daily. Simulations indicated that higher acetazolamide dosage (>1000 mg daily was required to significantly increase minute ventilation (P0.75 L min(-1 in 60% of the population. The model also predicts that 45% of patients would have a decrease of PaCO2>5 mmHg with doses of 1000 mg per day. CONCLUSIONS: Simulations suggest that COPD patients might benefit from the respiratory stimulant effect after the administration of higher doses of acetazolamide.

  17. N-acetylcysteine in patients with COPD exacerbations associated with increased sputum.

    Science.gov (United States)

    Ayfer Aytemur, Zeynep; Baysak, Aysegul; Ozdemir, Ozer; Köse, Timur; Sayiner, Abdullah

    2015-04-01

    N-acetylcysteine (NAC) has been shown not to alter the clinical outcome in chronic obstructive pulmonary disease (COPD) exacerbations. However, NAC may improve symptoms through its mucolytic effect in the subgroup of patients with increased sputum production. The aims of this study were to determine whether NAC improves symptoms and pulmonary function in patients with COPD exacerbation and increased sputum production. This was a placebo-controlled study, where patients with severe COPD and increased sputum production, who were hospitalized for an exacerbation, were included. They were randomized to receive either NAC 200 mg tid or placebo in addition to the usual treatment. Forty-two patients were included and were equally distributed to NAC and placebo groups. The symptoms, namely, ease of sputum production and dyspnea at rest and on exertion significantly improved in both groups; but there was no difference in improvement between NAC and placebo groups (p = 0.96, 0.62, 0.31, respectively). Similarly, forced expiratory volume-one second (FEV1) and PaO2 levels improved significantly in NAC (964 ± 599-1239 ± 543 ml, p NAC does not have any beneficial effect on clinical outcomes in patients with severe COPD exacerbation associated with increased and/or viscous mucus production.

  18. Maximal respiratory static pressures in patients with different stages of COPD severity

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    Ricci Alberto

    2008-01-01

    Full Text Available Abstract Background In this study, we analyzed maximal inspiratory pressure (MIP and maximal expiratory pressure (MEP values in a stable COPD population compared with normal subjects. We evaluated the possible correlation between functional maximal respiratory static pressures and functional and anthropometric parameters at different stages of COPD. Furthermore, we considered the possible correlation between airway obstruction and MIP and MEP values. Subject and methods 110 patients with stable COPD and 21 age-matched healthy subjects were enrolled in this study. Patients were subdivided according to GOLD guidelines: 31 mild, 39 moderate and 28 severe. Results Both MIP and MEP were lower in patients with severe airway impairment than in normal subjects. Moreover, we found a correlation between respiratory muscle function and some functional and anthropometric parameters: FEV1 (forced expiratory volume in one second, FVC (forced vital capacity, PEF (peak expiratory flow, TLC (total lung capacity and height. MIP and MEP values were lower in patients with severe impairment than in patients with a slight reduction of FEV1. Conclusion The measurement of MIP and MEP indicates the state of respiratory muscles, thus providing clinicians with a further and helpful tool in monitoring the evolution of COPD.

  19. Body composition in severe refractory asthma: comparison with COPD patients and healthy smokers.

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    Markos Minas

    Full Text Available BACKGROUND: Body composition is an important parameter for patients with chronic obstructive pulmonary disease (COPD whereas the association between asthma and obesity is not fully understood. The impact of severe refractory asthma (SRA on fat free mass (FFM has not been investigated. METHODOLOGY AND PRINCIPAL FINDINGS: 213 subjects (70 healthy smokers, 71 COPD patients and 72 asthma patients without significant comorbidities were included in the study. In all patients, body composition assessment (using bioelectrical impendance analysis, skinfold and anthropometric measurements and spirometry were performed. Differences in fat free mass index (FFMI between groups were assessed and determinants of FFMI in asthma were evaluated. Patients with SRA had lower values of FFMI compared to patients with mild-to-moderate asthma [18.0(17.3-18.3-19.5(18.4-21.5, p<0.001], despite the fact that they were more obese. The levels of FFMI in SRA were lower than those of GOLD stage I-III COPD and comparable to those of stage IV COPD patients [18.0(17.3-18.3-18.8(17.8-20.1, p = ns]. These differences were present even after proper adjustments for sex, age, smoking status, daily dose of inhaled corticosteroids (ICS and daily use of oral corticosteroids (OCS. In multivariate analysis, independent predictors of FFMI in asthmatic patients were age, use of OCS and the presence of SRA, but not smoking, sex or cumulative dose of ICS used. CONCLUSIONS AND SIGNIFICANCE: SRA is related to the presence of low FFMI that is comparable to that of GOLD stage IV COPD. The impact of this observation on asthma mechanisms and outcomes should be further investigated in large prospective studies.

  20. Relationship between oxygen consumption kinetics and BODE Index in COPD patients

    Directory of Open Access Journals (Sweden)

    Borghi-Silva A

    2012-10-01

    Full Text Available Audrey Borghi-Silva,1 Thomas Beltrame,1,2 Michel Silva Reis,1 Luciana Maria Malosá Sampaio,3 Aparecida Maria Catai,1 Ross Arena,4 Dirceu Costa31Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, SP, Brazil; 2Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada; 3Rehabilitation Sciences Master’s Program, Universidade Nove de Julho, Sao Paulo, SP, Brazil; 4Division of Physical Therapy, Department of Orthopedics, Division of Cardiology, Department of Internal Medicine, and Latin American and Iberian Institute, University of New Mexico, Albuquerque, NM, USABackground and objective: Patients with chronic obstructive pulmonary disease (COPD present with reduced exercise capacity due to impaired oxygen consumption (VO2, caused primarily by pulmonary dysfunction and deleterious peripheral adaptations. Assuming that COPD patients present with slower VO2 and heart rate (HR on-kinetics, we hypothesized that this finding is related to disease severity as measured by the BODE Index. In this context, the present study intends to evaluate the relationship between VO2 uptake on-kinetics during high-intensity exercise and the BODE Index in patients with COPD.Methods: Twenty males with moderate-to-severe stable COPD and 13 healthy control subjects matched by age and sex were evaluated. COPD patients were screened by the BODE Index and then underwent an incremental cardiopulmonary exercise test and a constant speed treadmill session at 70% of maximal intensity for 6 minutes. The onset of the exercise (first 360 seconds response for O2 uptake and HR was modeled according to a monoexponential fit.Results: Oxygen consumption and HR on-kinetics were slower in the COPD group compared with controls. Additionally, VO2 on-kinetic parameters revealed a strong positive correlation (r = 0.77, P < 0.05 with BODE scores and a moderate negative correlation with

  1. COHERENT EFFORT FOR COPD PATIENTS  WITH A SPECIAL FOCUS ON WELFARE TECHNOLOGY

    DEFF Research Database (Denmark)

    Vestergaard*, Kitt; Bagger, Bettan; Jensen, Lars Heegaard

    2014-01-01

    is given by health professionals whom they have feel safe with and related to. Some expressed that they did not feel familiar with technology and therefore do not expect to use it in their daily life. Others felt that the new experiences with technological aid would make them feel more secure in daily life......Background: Welfare technology is considered to be cost effective, promoting consistent quality in health care (1, 2), including the care pathways for individuals with Chronic Obstructive Pulmonary Disease (COPD). Welfare technology has been found to ensure more freedom and responsibility for ones...... own illness leading to prevention of hospitalizations (3, 4). Technologies therefore are assumed to enhance the quality and consistency of treatment programs for patients with COPD. Prior to implementation of welfare technology in the Region of Zealand, Denmark, University College Zealand and COPD...

  2. Poster COHERENT EFFORT FOR COPD PATIENTS  WITH A SPECIAL FOCUS ON WELFARE TECHNOLOGY

    DEFF Research Database (Denmark)

    Vestergaard*, Kitt; Bagger, Bettan; Bech, Lone

    2014-01-01

    is given by health professionals whom they have feel safe with and related to. Some expressed that they did not feel familiar with technology and therefore do not expect to use it in their daily life. Others felt that the new experiences with technological aid would make them feel more secure in daily life......Background: Welfare technology is considered to be cost effective, promoting consistent quality in health care (1, 2), including the care pathways for individuals with Chronic Obstructive Pulmonary Disease (COPD). Welfare technology has been found to ensure more freedom and responsibility for ones...... own illness leading to prevention of hospitalizations (3, 4). Technologies therefore are assumed to enhance the quality and consistency of treatment programs for patients with COPD. Prior to implementation of welfare technology in the Region of Zealand, Denmark, University College Zealand and COPD...

  3. Influence of lung parenchymal destruction on the different indexes of the methacholine dose-response curve in COPD patients

    NARCIS (Netherlands)

    G.T. Verhoeven; A.F.M. Verbraak (Anton); S. Boere-van der Straat; H.C. Hoogsteden (Henk); J.M. Bogaard (Jan)

    2000-01-01

    textabstractSTUDY OBJECTIVES: The interpretation of nonspecific bronchial provocation dose-response curves in COPD is still a matter of debate. Bronchial hyperresponsiveness (BHR) in patients with COPD could be influenced by the destruction of the parenchyma and the aug

  4. Sinonasal inflammation in COPD

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Konge, Lars; Thomsen, Sf

    2013-01-01

    In this review we demonstrate that patients with chronic obstructive pulmonary disease (COPD) frequently report sinonasal symptoms. Furthermore, we present evidence that smoking on its own can cause nasal disease, and that in COPD patients, nasal inflammation mimics that of the bronchi. All...... this evidence suggests that COPD related sinonasal disease does exist and that smoking on its own rather than systemic inflammation triggers the condition. However, COPD related sinonasal disease remains to be characterized in terms of symptoms and endoscopic findings. In addition, more studies are needed...... to quantify the negative impact of sinonasal symptoms on the quality of life in COPD patients....

  5. A Qualitative Content Analysis of Spirituality and Religiosity amongst Greek COPD Patients

    Directory of Open Access Journals (Sweden)

    Efthymios Tzounis

    2016-03-01

    Full Text Available Chronic Obstructive Pulmonary Disease (COPD is a chronic and common disease throughout the world. Spiritual/religious beliefs are often central to patients with serious illnesses and could serve as a resource for coping with such illnesses. A qualitative methodology was chosen in order to gain a thorough understanding of 75 (male n = 69, 92%, female n = 6, 8% Greek COPD patients’ perceptions of spirituality and religiosity and explore the importance of practicing their beliefs while 25 patients refused to participate in the study. The fewer female participant patients in the study are related to the lower percentage of women suffering from COPD in Greece, which can be further linked to the low smoking habit of women. A total of four patients (5.3% stated that they had no religious or spiritual understanding of their life; 41 (54.7% reported a religious belief; eight (10.7% told of a spiritual belief; and 22 (29.3% of the participants reported both a religious and a spiritual belief. Faith in the will of God seems to be a particularly strong feature of patients’ beliefs. Praying and church attendance were more likely to confirm the importance of practicing their beliefs in their daily lives but COPD seems to prevent patients from regular churchgoing. Religion and spirituality were found to be helpful while patients did not seem to have unrealistic expectations from God when dealing with illness. When asked, participants defined spirituality as “happiness”, “love”, “our God”, “the spirit”, and as an act of altruism. Adopting a more holistic perspective for COPD patients in the clinical setting, spirituality and religiosity can offer suggestions for interventions related to their health issues.

  6. Helping COPD patients change health behavior in order to improve their quality of life

    Directory of Open Access Journals (Sweden)

    Almagro P

    2013-07-01

    Full Text Available Pere Almagro, Alejandra CastroAcute Geriatric Care Unity, Internal Medicine Department, University Hospital Mútua de Terrassa, Barcelona, SpainAbstract: Chronic obstructive pulmonary disease (COPD is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence – essential to optimizing disease control – several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations

  7. Dynamic hyperinflation is associated with a poor cardiovascular response to exercise in COPD patients

    Directory of Open Access Journals (Sweden)

    Tzani Panagiota

    2011-11-01

    Full Text Available Abstract Background Pulmonary hyperinflation has the potential for significant adverse effects on cardiovascular function in COPD. The aim of this study was to investigate the relationship between dynamic hyperinflation and cardiovascular response to maximal exercise in COPD patients. Methods We studied 48 patients (16F; age 68 yrs ± 8; BMI 26 ± 4 with COPD. All patients performed spirometry, plethysmography, lung diffusion capacity for carbon monoxide (TLco measurement, and symptom-limited cardiopulmonary exercise test (CPET. The end-expiratory lung volume (EELV was evaluated during the CPET. Cardiovascular response was assessed by change during exercise in oxygen pulse (ΔO2Pulse and double product, i.e. the product of systolic blood pressure and heart rate (DP reserve, and by the oxygen uptake efficiency slope (OUES, i.e. the relation between oxygen uptake and ventilation. Results Patients with a peak exercise EELV (%TLC ≥ 75% had a significantly lower resting FEV1/VC, FEF50/FIF50 ratio and IC/TLC ratio, when compared to patients with a peak exercise EELV (%TLC 2Pulse (r = - 0.476, p = 0.001, OUES (r = - 0.452, p = 0.001 and DP reserve (r = - 0.425, p = 0.004. Furthermore, according to the ROC curve method, ΔO2Pulse and DP reserve cut-off points which maximized sensitivity and specificity, with respect to a EELV (% TLC value ≥ 75% as a threshold value, were ≤ 5.5 mL/bpm (0.640 sensitivity and 0.696 specificity and ≤ 10,000 Hg · bpm (0.720 sensitivity and 0.783 specificity, respectively. Conclusion The present study shows that COPD patients with dynamic hyperinflation have a poor cardiovascular response to exercise. This finding supports the view that in COPD patients, dynamic hyperinflation may affect exercise performance not only by affecting ventilation, but also cardiac function.

  8. Early COPD patients with lung hyperinflation associated with poorer lung function but better bronchodilator responsiveness

    Directory of Open Access Journals (Sweden)

    Chen C

    2016-10-01

    Full Text Available Chunlan Chen,* Wenhua Jian,* Yi Gao, Yanqing Xie, Yan Song, Jinping Zheng State Key Laboratory of Respiratory Disease, China National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: It is unknown whether aggressive medication strategies should be used for early COPD with or without lung hyperinflation. We aimed to explore the characteristics and bronchodilator responsiveness of early COPD patients (stages I and II with/without lung hyperinflation.Methods: Four hundred and six patients with COPD who performed both lung volume and bronchodilation tests were retrospectively analyzed. Residual volume to total lung capacity >120% of predicted values indicated lung hyperinflation. The characteristics and bronchodilator responsiveness were compared between the patients with and without lung hyperinflation across all stages of COPD.Results: The percentages of patients with lung hyperinflation were 72.7% in the entire cohort, 19.4% in stage I, 68.5% in stage II, 95.3% in stage III, and 100.0% in stage IV. The patients with lung hyperinflation exhibited poorer lung function but better bronchodilator responsiveness of both forced expiratory volume in 1 second and forced vital capacity than those without lung hyperinflation during early COPD (t=2.21–5.70, P=0.000–0.029, especially in stage I, while age, body mass index, smoking status, smoking history, and disease duration were similar between the two subgroups in the same stages. From stages I to IV of subgroups with lung hyperinflation, stage I patients had the best bronchodilator responsiveness. Use of bronchodilator responsiveness of forced vital capacity to detect the presence of lung hyperinflation in COPD patients showed relatively high sensitivities (69.5%–75.3% and specificities (70.3%

  9. The Validity and Precision of the Leicester Cough Questionnaire in COPD Patients with Chronic Cough

    NARCIS (Netherlands)

    Berkhof, Farida F.; Boom, Lisenka N.; ten Hertog, Nynke E.; Uil, Steven M.; Kerstjens, Huib A. M.; van den Berg, Jan W. K.

    2012-01-01

    Background: A validated instrument to assess the effects of chronic cough on health status in patients with chronic obstructive pulmonary disease (COPD) is currently not available. The Leicester Cough Questionnaire (LCQ) is a cough-specific health status questionnaire which is originally validated f

  10. Time-related feedback messages for changing activity behaviour of patients with COPD

    NARCIS (Netherlands)

    Tabak, Monique; Akker, op den Harm; Hermens, H.J.

    2013-01-01

    Background: The promotion of physical activity in daily life is an important aspect in the treatment of COPD patients [1]. We developed a telemedicine application – the Activity Coach – that aims to increase activity levels and to balance activities over the day. Activity levels are measured using a

  11. Perception of fatigue and quality of life in patients with COPD

    NARCIS (Netherlands)

    Breslin, E; van der Schans, C; Breukink, S; Meek, P; Mercer, K; Volz, W; Louie, S

    1998-01-01

    Introduction: Although dyspnea is considered the primary activity-limiting symptom in patients with COPD, other symptoms, such as fatigue, are frequently reported, The purpose of this study was to determine the relationship between fatigue and pulmonary function, exercise tolerance, depression, and

  12. The Validity and Precision of the Leicester Cough Questionnaire in COPD Patients with Chronic Cough

    NARCIS (Netherlands)

    Berkhof, Farida F.; Boom, Lisenka N.; ten Hertog, Nynke E.; Uil, Steven M.; Kerstjens, Huib A. M.; van den Berg, Jan W. K.

    2012-01-01

    Background: A validated instrument to assess the effects of chronic cough on health status in patients with chronic obstructive pulmonary disease (COPD) is currently not available. The Leicester Cough Questionnaire (LCQ) is a cough-specific health status questionnaire which is originally validated f

  13. Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

    DEFF Research Database (Denmark)

    Titlestad, Ingrid L; Lassen, Annmarie T; Vestbo, Jørgen

    2013-01-01

    Implementation of noninvasive ventilation (NIV) as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomiz...

  14. Indacaterol vs tiotropium in COPD patients classified as GOLD A and B

    NARCIS (Netherlands)

    Mahler, Donald A.; Kerstjens, Huib A. M.; Donohue, James F.; Buhl, Roland; Lawrence, David; Altman, Pablo

    Introduction: According to current GOLD strategy, patients with COPD classified as groups A and B may be treated with inhaled bronchodilators, either long-acting beta(2)-agonist (LABA) or long-acting muscarinic antagonist (LAMA). However, there is little guidance on which class of agent is preferred

  15. Stepwise withdrawal of inhaled corticosteroids in COPD patients receiving dual bronchodilation

    DEFF Research Database (Denmark)

    Magnussen, Helgo; Watz, Henrik; Kirsten, Anne

    2014-01-01

    Long-acting bronchodilators in combination with inhaled corticosteroids (ICS) are recommended to decrease the risk of recurrent exacerbations in patients with Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3-4 chronic obstructive pulmonary disease (COPD). There is increasing...

  16. A systematic review of the effects of bronchodilators on exercise capacity in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Wijkstra, PJ; Ten Hacken, NHT; Koeter, GH; Postma, DS; Kerstjens, HAM

    2002-01-01

    One of the major goals of bronchodilator therapy in patients with COPD is to decrease airflow limitation in the airways and, as a consequence, improve dyspnea and exercise tolerance. The focus of this systematic review is to assess the effects of treatment with beta-agonists, anticholinergics, and t

  17. Effects of formoterol (Oxis (R) Turbuhaler (R)) and ipratropium on exercise capacity in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Van de Velde, [No Value; Meysman, M; Vincken, W; Wollmer, P; Hansson, L; Kerstjens, HAM; Qvint, U; Pauwels, RA

    2002-01-01

    Although long-acting inhaled beta(2)-agonists improve various outcome measures in COPD, no double-blind study has yet shown a significant effect of these drugs on exercise capacity. In a randomized, double-blind, placebo-controlled, crossover study, patients received formoterol (4.5,9, or 18 mug b.i

  18. Temazepam 10mg does not affect breathing and gas exchange in patients with severe normocapnic COPD.

    NARCIS (Netherlands)

    Stege, G.; Heijdra, Y.F.; Elshout, F.J.J. van den; Ven, M.J.T. van de; Bruijn, P.J. de; Sorge, A.A. van; Dekhuijzen, P.N.R.; Vos, P.J.E.

    2010-01-01

    BACKGROUND: Benzodiazepines can improve sleep quality, but are also thought to cause respiratory depression in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the effects of temazepam on indices of circadian respiratory function, dyspnea, sleep

  19. The Validity and Precision of the Leicester Cough Questionnaire in COPD Patients with Chronic Cough

    NARCIS (Netherlands)

    Berkhof, Farida F.; Boom, Lisenka N.; ten Hertog, Nynke E.; Uil, Steven M.; Kerstjens, Huib A. M.; van den Berg, Jan W. K.

    2012-01-01

    Background: A validated instrument to assess the effects of chronic cough on health status in patients with chronic obstructive pulmonary disease (COPD) is currently not available. The Leicester Cough Questionnaire (LCQ) is a cough-specific health status questionnaire which is originally validated

  20. The Canadian Optimal Therapy of COPD Trial: Design, Organization and Patient Recruitment

    Directory of Open Access Journals (Sweden)

    Shawn D Aaron

    2004-01-01

    Full Text Available BACKGROUND: There are no published studies that have assessed whether adding long-acting beta 2-agonist bronchodilators and/or inhaled steroids to chronic therapy with tiotropium would provide additional clinical benefit to patients with moderate to severe chronic obstructive pulmonary disease (COPD.

  1. High-intensity knee extensor training restores skeletal muscle function in COPD patients.

    Science.gov (United States)

    Brønstad, Eivind; Rognmo, Oivind; Tjonna, Arnt Erik; Dedichen, Hans Henrich; Kirkeby-Garstad, Idar; Håberg, Asta K; Bjørk Ingul, Charlotte; Wisløff, Ulrik; Steinshamn, Sigurd

    2012-11-01

    Improving reduced skeletal muscle function is important for optimising exercise tolerance and quality of life in chronic obstructive pulmonary disease (COPD) patients. By applying high-intensity training to a small muscle group, we hypothesised a normalisation of muscle function. Seven patients with COPD performed 6 weeks (3 days·week(-1)) of high-intensity interval aerobic knee extensor exercise training. Five age-matched healthy individuals served as a reference group. Muscle oxygen uptake and mitochondrial respiration of the vastus lateralis muscle were measured before and after the 6-week training programme. Initial peak work and maximal mitochondrial respiration were reduced in COPD patients and improved significantly after the training programme. Peak power and maximal mitochondrial respiration in vastus lateralis muscle increased to the level of the control subjects and were mainly mediated via improved complex I respiration. Furthermore, when normalised to citrate synthase activity, no difference in maximal respiration was found either after the intervention or compared to controls, suggesting normal functioning mitochondrial complexes. The present study shows that high-intensity training of a restricted muscle group is highly effective in restoring skeletal muscle function in COPD patients.

  2. Effect of PaO2 and social circumstances on outcomes in out-patient treatment of COPD exacerbations.

    Science.gov (United States)

    Khalid, S; Elliott, A C; Pilling, A; Wolstenholme, R J

    2007-01-01

    The current British Thoracic Society guidelines on COPD recommend that patients with COPD exacerbations should be admitted to hospital if they either have partial pressure of arterial oxygen of PaO2 PaO2 or those living in adverse social circumstances compared to other groups of patients. The number of patients dying in this period was too small to analyse with adequate power. This study indicates that such patients can be safely managed at home in the context of well established COPD services.

  3. Deposition of insoluble elastin by pulmonary fibroblasts from patients with COPD is increased by treatment with versican siRNA

    Directory of Open Access Journals (Sweden)

    Wu L

    2017-01-01

    Full Text Available Lian Wu,1,2 Jing Zhang,3 Jie Ming Qu,4 Chun-xue Bai,3 Mervyn J Merrilees5 1Department of Community and Health Services, Unitec, 2Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand; 3Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 4Department of Pulmonary Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 5Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand Abstract: A reduced content of alveolar elastic fibers is a key feature of COPD lung. Despite continued elastogenic potential by alveolar fibroblasts in the lung affected by COPD, repair of elastic fibers does not take place, which is due to increased levels of the chondroitin sulfate proteoglycan versican that inhibits the assembly of tropoelastin into fibers. In this study, primary pulmonary fibroblast cell lines from COPD and non-COPD patients were treated with a small interfering RNA (siRNA against versican to determine if knockdown of versican could restore the deposition of insoluble elastin. Versican siRNA treatment reduced versican expression and secretion by pulmonary fibroblasts from both COPD and non-COPD patients (P<0.01 and significantly increased deposition of insoluble elastin in the COPD cell cultures (P<0.05. The treatment, however, did not significantly affect production of soluble elastin (tropoelastin in either the COPD or non-COPD cell cultures, supporting a role for versican in inhibiting assembly but not synthesis of tropoelastin. These results suggest that removal or knockdown of versican may be a possible therapeutic strategy for increasing deposition of insoluble elastin and stimulating repair of elastic fibers in COPD lung. Keywords: pulmonary fibroblasts, COPD, elastin, versican

  4. The view of pulmonologists on palliative care for patients with COPD: a survey study

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    Duenk RG

    2017-01-01

    Full Text Available RG Duenk,1 C Verhagen,1 PNR Dekhuijzen,2 KCP Vissers,1 Y Engels,1,* Y Heijdra2,* 1Department of Anesthesiology, Pain and Palliative Medicine, 2Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands *These authors contributed equally to this work Introduction: Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective: Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods: A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results: The 256 respondents (31.8% covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2% indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%, communication between pulmonologist and general practitioner (77%, and identification of the palliative phase (75.8%, while the latter was considered the most important aspect for improvement (67.6%. Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%, while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT. In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%. Conclusion: To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification

  5. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China.

    Science.gov (United States)

    Dong, Xiao-Yan; Wang, Lan; Tao, Yan-Xia; Suo, Xiu-Li; Li, Yue-Chuan; Liu, Fang; Zhao, Yue; Zhang, Qing

    2017-01-01

    Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients' quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR), which has been developed and validated in its English version, is needed for patients with COPD in China. A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women), who met the inclusion and exclusion criteria, were enrolled in the study. Test-retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach's α. Content validity was examined using the Content Validity Index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). Besides, convergent validity and construct validity were also examined. The AIR-C (AIR-Chinese version) scale had high test-retest reliability (intraclass correlation coefficient =0.904) and internal consistency (Cronbach's α=0.914); the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89-1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, Panxiety and panic symptoms in the AIR-C scale had the best fit according to Confirmatory Factor Analysis (CFA). The AIR-C scale had a good reliability and validity for patients with COPD and can be used as a user-friendly and valid tool for measuring anxiety symptoms among patients with COPD in China.

  6. Tidal breathing patterns derived from structured light plethysmography in COPD patients compared with healthy subjects

    Directory of Open Access Journals (Sweden)

    Motamedi-Fakhr S

    2016-12-01

    Full Text Available Shayan Motamedi-Fakhr,1 Rachel C Wilson,1 Richard Iles2 1PneumaCare Ltd, Ely, UK; 2Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Purpose: Differences in tidal breathing patterns have been reported between patients with chronic obstructive pulmonary disease (COPD and healthy individuals using traditional measurement techniques. This feasibility study examined whether structured light plethysmography (SLP – a noncontact, light-based technique – could also detect differences in tidal breathing patterns between patients with COPD and healthy subjects. Patients and methods: A 5 min period of tidal (quiet breathing was recorded in each patient with COPD (n=31 and each healthy subject (n=31, matched for age, body mass index, and sex. For every participant, the median and interquartile range (IQR; denoting within-subject variability of 12 tidal breathing parameters were calculated. Individual data were then combined by cohort and summarized by its median and IQR. Results: After correction for multiple comparisons, inspiratory time (median tI and its variability (IQR of tI were lower in patients with COPD (p<0.001 and p<0.01, respectively as were ratios derived from tI (tI/tE and tI/tTot, both p<0.01 and their variability (p<0.01 and p<0.05, respectively. IE50SLP (the ratio of inspiratory to expiratory flow at 50% tidal volume calculated from the SLP signal was higher (p<0.001 in COPD while SLP-derived time to reach peak tidal expiratory flow over expiratory time (median tPTEFSLP/tE was shorter (p<0.01 and considerably less variable (p<0.001. Thoraco–abdominal asynchrony was increased (p<0.05 in COPD. Conclusion: These early observations suggest that, like traditional techniques, SLP is able to detect different breathing patterns in COPD patients compared with subjects with no respiratory disease. This provides support for further investigation into the potential uses of SLP in assessing clinical conditions and interventions

  7. Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia

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    Søgaard M

    2016-03-01

    Full Text Available Mette Søgaard,1 Morten Madsen,1 Anders Løkke,2 Ole Hilberg,2 Henrik Toft Sørensen,1 Reimar W Thomsen1 1Department of Clinical Epidemiology, 2Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark Background: Pneumonia may be a major contributor to hospitalizations for chronic obstructive pulmonary disease (COPD exacerbation and influence their outcomes.Methods: We examined hospitalization rates, health resource utilization, 30-day mortality, and risk of subsequent hospitalizations for COPD exacerbations with and without pneumonia in Denmark during 2006–2012.Results: We identified 179,759 hospitalizations for COPD exacerbations, including 52,520 first-time hospitalizations (29.2%. Pneumonia was frequent in first-time exacerbations (36.1%, but declined in successive exacerbations to 25.6% by the seventh or greater exacerbation. Pneumonic COPD exacerbations increased 20% from 0.92 per 1,000 population in 2006 to 1.10 per 1,000 population in 2012. Nonpneumonic exacerbations decreased by 6% from 1.74 per 1,000 population to 1.63 per 1,000 population during the same period. A number of markers of health resource utilization were more prevalent in pneumonic exacerbations than in nonpneumonic exacerbations: length of stay (median 7 vs 4 days, intensive care unit admission (7.7% vs 12.5%, and several acute procedures. Thirty-day mortality was 12.1% in first-time pneumonic COPD exacerbations versus 8.3% in first-time nonpneumonic cases (adjusted HR [aHR] 1.20, 95% confidence interval [CI] 1.17–1.24. Pneumonia also predicted increased mortality associated with a second exacerbation (aHR 1.14, 95% CI 1.11–1.18, and up to a seventh or greater exacerbation (aHR 1.10, 95% CI 1.07–1.13. In contrast, the aHR of a subsequent exacerbation was 8%–13% lower for patients with pneumonic exacerbations.Conclusions: Pneumonia is frequent among patients hospitalized for COPD exacerbations and is associated with increased health care

  8. COPD Medicine

    Science.gov (United States)

    ... Education & Training Home Treatment & Programs Medications COPD Medications COPD Medications Make an Appointment Ask a Question Refer ... control the symptoms of chronic obstructive pulmonary disease (COPD). Most people with COPD take long-acting medicine ...

  9. Combined nutritional support in patients with chronic obstructive pulmonary disease (COPD), under mechanical ventilation (MV).

    Science.gov (United States)

    Grigorakos, Leonidas; Sotiriou, Evangelia; Markou, Nikolaos; Stratouli, Stamatina; Boutzouka, Eleni; Philntisis, George; Baltopoulos, George

    2009-01-01

    The importance of nutrition is clearly established in the management of the critically ill patient: malnutrition contributes to immune incompetence, poor wound healing, increased postoperative complication and prolonged hospital stay. The interaction between nutritional status, nutritional supply and respiratory function is important in the management of the Chronic Obstructive pulmonary Disease (COPD) patients under mechanical ventilation (MV). In the present study was analyzed the benefits of combined nutritional support in patients with COPD under MV. One hundred ninety two (192) patients with COPD were admitted to our Intensive Care Unit (ICU), due to severe respiratory failure of whom 163 (84.9%) patients were under MV. In 18 (11.04%) patients after the 10th day under MV and due to severe malnutrition (serum albumin nutrition (EN) of 1800 Kcals and parenteral nutrition (PN) of 2000 Kcals, at high concentration in lipids from central venous catheter. Seven (38.89%) patients on the 4th day, after combined nutrition, had a positive balance of nitrogen and normal level of the nutritional indices, 4 (22.22%) were on normal level on the 5th day, 3 (16.67%) on the 6th day, 1 (5.56%) on the 7th day after combined nutrition. We had no complications from the combination of EN and PN. Conclusively, of these 18 patients that were given both EN and PN, 15 (83.33%) were weaned from MV and continued the combined nutritional support for 3 days, while 3 (16.67%) died during the combination of EN and PN, without having achieved a normal level of the indices of nutrition and without a positive balance of nitrogen. In this study was found that: 1. patients with COPD under MV rapidly developed malnutrition, 2. the combination EN and PN without complications contribute to the weaning from MV, 3. positive nitrogen balance and normal increases of nutrition are achieved after the 4th day of combined nutrition and 4. Early addition of EN and PN in patients with COPD under MV, probably

  10. Efficacy and safety of indacaterol and tiotropium in COPD patients according to dyspnoea severity.

    Science.gov (United States)

    Mahler, Donald A; Buhl, Roland; Lawrence, David; McBryan, Danny

    2013-06-01

    Guidelines for chronic obstructive pulmonary disease (COPD) recommend that treatment choices be based partly on symptoms. A post-hoc analysis of pooled data from clinical studies compared the efficacy and safety of once-daily inhaled bronchodilators indacaterol (150 and 300 μg) and open-label tiotropium (18 μg) according to baseline dyspnoea severity on the modified Medical Research Council (mMRC) scale in patients with COPD (mMRC scores indacaterol (both doses) improved 24-h post-dose ('trough') forced expiratory volume in 1 s (FEV1), transition dyspnoea index (TDI) and St George's Respiratory Questionnaire (SGRQ) total scores at week 26 and reduced the risk of COPD exacerbations vs placebo; and open-label tiotropium improved trough FEV1 and TDI total score vs placebo at week 26. In patients with more dyspnoea: indacaterol (both doses) improved trough FEV1, TDI and SGRQ total scores at week 26; indacaterol 300 μg was the only treatment to improve the TDI total score by more than the minimum clinically important difference (≥1 point) vs placebo; and open-label tiotropium improved trough FEV1, TDI total score at week 26 and decreased the risk of COPD exacerbations vs placebo. In both subgroups, all treatments were well tolerated. In patients with less dyspnoea, all treatments had similar effects. Indacaterol 300 μg may be a useful treatment option for patients with COPD who experience more severe breathlessness. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Lee, Haejung; Kim, Sungmin; Lim, Yeonjung; Gwon, Hyejin; Kim, Yunseong; Ahn, Jong-Joon; Park, Hye-Kyung

    2013-01-01

    The purpose of this study was to identify the relationship between nutritional status and the severity of the disease in patients with COPD in South Korea. This study used pretest data from a larger intervention study. Data were collected from March to October 2010, and 251 patients diagnosed with COPD from five hospitals in South Korea were included in the analysis. All participants were interviewed face-to-face. Actual dietary intake was measured by a 24-h dietary recall, and the body mass index (BMI), obstruction of the airway (FEV1% predicted), degree of dyspnea (modified Medical Research Council: MMRC), and exercise capacity (6min walking distance: 6MWD) (BODE) index was calculated to estimate the severity of the condition. Lower BODE index scores indicate lower risk of mortality. The data were analyzed by descriptive statistics, a χ(2) test, t-tests, analysis of variance (ANOVA), Pearson correlation, and hierarchical multiple regression using SPSS 18.0. The mean age of the participants was 66.83 years and 92.4% of the participants were men. The mean total energy intake was 1431.65kcal, and the mean BODE index score was 2.89. Total energy intake significantly explained additional variance in BODE, BMI, the severity of the perceived dyspnea, and the length of 6min walk after controlling for age, duration after diagnosed with COPD, and physical activities. The findings of this study emphasized the importance of calorie intake in the disease severity among COPD patients. Further research on the effects of nutritional intervention on the health outcomes of patients with COPD is warranted. Copyright © 2013. Published by Elsevier Ireland Ltd.

  12. Patients' and their family members' experiences of participation in care following an acute exacerbation in COPD

    DEFF Research Database (Denmark)

    Andersen, Ingrid Charlotte; Thomsen, Thora Grothe; Bruun, Poul

    2017-01-01

    recovering from an exacerbation, the challenges associated with an unpredictable health condition dominate everyday life for patients and can involve their family members. Proper patient and family participation in care during discharge and follow-up can help patients to improve self-management. However......AIM AND OBJECTIVES: To explore the experiences of patients with chronic obstructive pulmonary disease (COPD) and their family members relating to both participation in care during hospitalization for an acute exacerbation in COPD, and to the subsequent day-to-day care at home. BACKGROUND: When...... and increased uncertainty. While patients mostly demonstrated a reactive approach to care, family members strived to be more proactive. In hospital, preparing for discharge included an effort to find a balance between powerlessness and influence during interactions with healthcare professionals. At home...

  13. Improving inhaler use in COPD and the role of patient preference

    Directory of Open Access Journals (Sweden)

    E. D. Bateman

    2005-12-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a difficult disease to manage, but recent research focusing on its pathophysiology has provided direction for the development of new treatments and improved management strategies. COPD differs substantially from asthma, both in its pathophysiology and its treatment. Unlike asthma, COPD cannot be fully controlled or "reversed"; it is progressive and responses to anti-inflammatory drugs, including corticosteroids, have been disappointing, suggesting the presence of a unique, persistent form of inflammation. The current main emphasis in the treatment of COPD is therefore to minimise airflow obstruction using regular bronchodilator therapy. Apparently small improvements in traditional measures of airflow obstruction, such as functional residual capacity, may produce significant improvements in other measures, resulting in clinical benefit. Ensuring efficient delivery of bronchodilators is vital to treatment success but has received little attention in guidelines to date. Inhaler technique, adherence rates and levels of satisfaction with therapy are all far from ideal. Improvements in these areas require more detailed consideration of the interactions between the patient, the healthcare provider and the inhaler device, and an examination of how inhaler choices are currently made by both healthcare provider and patient.

  14. Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance

    Directory of Open Access Journals (Sweden)

    D. E. O'Donnell

    2006-12-01

    Full Text Available The physiological hallmark of chronic obstructive pulmonary disease (COPD is expiratory flow limitation. However, it is the resultant air trapping and associated increases in lung volume (hyperinflation that provide a mechanistic link between the physiological impairment and the characteristic symptoms of COPD, such as dyspnoea (breathlessness, exercise intolerance and reduced health-related quality of life (HRQoL. During exercise, the negative consequences of hyperinflation are particularly apparent. Delayed lung emptying and increased end-expiratory lung volume are aggravated, and tidal volume cannot rise to meet the increased ventilatory demands. Dyspnoea intensity rises abruptly to intolerable levels, and further increases in ventilation can only be achieved by rapid breathing. This rebounds to cause greater hyperinflation in a vicious cycle. As a result, patients with COPD often prematurely stop or avoid activity, leading to deconditioning, increased dyspnoea, worsening of disease and, ultimately, reduced HRQoL. The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend long-acting bronchodilators as first-line maintenance treatment in COPD. Once-daily tiotropium 18 µg, a long-acting anticholinergic agent with 24-h efficacy, has been consistently shown to relieve dyspnoea and improve exercise tolerance and health status. These improvements may allow patients with chronic obstructive pulmonary disease to increase their daily activities, thereby reversing the cycle of chronic inactivity and muscle deconditioning.

  15. [Smoking cessation in patients with COPD: the status of routine care in Germany].

    Science.gov (United States)

    Mühlig, S

    2008-10-01

    Almost every second heavy-smoker (> 20 Cig./day) develops a COPD after long-term tobacco use. Cigarette smoking is not only the leading cause of COPD, but also the most important predictor for an unfavourable prognosis. Inversely, quitting smoking can enhance the disease course as well as the lung function of patients suffering from COPD more effectively than any other treatment. Currently, a wide range of evidence-based psychological and pharmacological smoking cessation treatments exists including disease-specific therapy approaches. However, professional smoking cessation treatments are used only rarely in health-care routine. This fact is due to persisting deficits in the German health-care system: With the exception of pharmacological therapy approaches and some telephone or online counselling programmes, smoking cessation treatments are not generally available. In the future, one should keep a sharp eye on the permanent motivation of COPD patients to quit smoking totally and to establish disease-specific smoking cessation programmes in routine care.

  16. Correlation of cardiopulmonary exercise testing parameters with quality of life in stable COPD patients.

    Science.gov (United States)

    Mirdamadi, Mahsa; Rahimi, Besharat; Safavi, Enayat; Abtahi, Hamidreza; Peiman, Soheil

    2016-08-01

    The precise head to head relationships between Cardio-pulmonary exercise testing (CPET) parameters and patients' daily symptoms/activities and the disease social/emotional impact are less well defined. In this study, the correlation of COPD daily symptoms and quality of life [assessed by St. George's Respiratory Questionnaire (SGRQ)] and COPD severity index (BODE-index) with CPET parameters were investigated. Symptom-limited CPET was performed in 37 consecutive COPD (GOLD I-III) subjects during non-exacerbation phase. The SGRQ was also completed by each patient. SGRQ-score correlated negatively with FEV1 (r=-0.49, Pmax) (r=-0.44, Ptest, Peak-V'O2, %WR-max, HR-Reserve and Breathing reserve were higher (P=0.04, VO2/∆WR (r=-0.64, PVO2/∆WR and BODE-index suggests that along with COPD progression, regardless of negative past history, other comorbidities such as cardiac/musculoskeletal problems should be sought.

  17. Effect of carbocisteine on patients with COPD: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Zeng Z

    2017-08-01

    Full Text Available Zheng Zeng,1 Dan Yang,2 Xiaoling Huang,3 Zhenliang Xiao4 1Respiratory Medicine, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China; 2Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, 4Respiratory Medicine, Southwest Medical University, Chengdu Military General Hospital, Chengdu, Sichuan, People’s Republic of China Background: COPD is the fourth leading cause of death in the world. It is a common, progressive, treatable and preventable disease. The exacerbation of COPD is associated with the peripheral muscle force, forced expiratory volume in 1 second (FEV1, the quality of life and mortality. Many studies indicated that the mucoactive medicines could reduce the exacerbations of COPD. This study summarized the efficacy of carbocisteine as a treatment for COPD. Methods: We searched the randomized controlled trials (RCTs following electronic bibliographic databases: MedLine, Embase, Cochrane Library and Web of Science. We additionally searched gray literature database: OpenSIGLE. We also additionally searched the clinical trial registers: ClinicalTrials.gov register and International Clinical Trials Registry Platform Search Portal. We used RCTs to assess the efficacy of the treatments. We included studies of adults (older than 18 years with COPD. We excluded studies that were published as protocol or written in non-English language (Number 42016047078. Findings: Our findings included data from four studies involving 1,357 patients. There was a decrease in the risk of the rate of total number of exacerbations with carbocisteine compared with placebo (-0.43; 95% confidence interval [CI] -0.57, -0.29, P<0.01. Carbocisteine could also improve the quality of life (-6.29; 95% CI -9.30, -3.27 and reduce the number of patients with at least one exacerbation (0

  18. Increased brachial intima-media thickness is associated with circulating levels of asymmetric dimethylarginine in patients with COPD

    Science.gov (United States)

    Urban, Matthias Helmut; Eickhoff, Philipp; Funk, Georg-Christian; Burghuber, Otto Chris; Wolzt, Michael; Valipour, Arschang

    2017-01-01

    Background Chronic obstructive pulmonary disease (COPD) is associated with an increased cardiovascular risk. However, the mechanisms for this association are yet unclear. The aim of this study was to investigate the relationship between brachial intima-media thickness (B-IMT), an independent predictor of cardiovascular risk, systemic inflammation, and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, in patients with COPD and respective controls. Methods The study sample consisted of 60 patients with stable COPD, free from overt cardiovascular disorders, as well as 20 smoking and 20 nonsmoking controls. Ultrasound assessment of B-IMT, spirometry, venous blood sampling for quantification of inflammatory markers and ADMA levels were carried out, and individual cardiovascular risk was calculated via the Framingham risk score. Results Patients with COPD showed significantly higher B-IMT compared to smoking (P=0.007) and nonsmoking controls (P=0.033). COPD patients with elevated B-IMT had a twofold increased calculated 10-year risk for cardiovascular events compared to those below the recommended cutoff (P=0.002). B-IMT was significantly associated with systemic inflammation (interleukin-6 [IL-6]; r=0.365, P=0.006) and ADMA (r=0.331, P=0.013) in COPD. Multivariate linear regression revealed male sex and ADMA as independent predictors of B-IMT in this study sample. Conclusion B-IMT is significantly increased in patients with COPD and is associated with systemic inflammation and ADMA levels.

  19. Evaluation of body composition in COPD patients using multifrequency bioelectrical impedance analysis

    Science.gov (United States)

    de Blasio, Francesca; de Blasio, Francesco; Miracco Berlingieri, Giulia; Bianco, Andrea; La Greca, Marta; Franssen, Frits M E; Scalfi, Luca

    2016-01-01

    Background Multifrequency bioelectrical impedance analysis (MF-BIA) is a technique that measures body impedance (Z) at different frequencies (5, 10, 50, 100, and 250 kHz). Body composition may be estimated using empirical equations, which include BIA variables or, alternatively, raw BIA data may provide direct information on water distribution and muscle quality. Objectives To compare raw MF-BIA data between COPD patients and controls and to study their relationship with respiratory and functional parameters in COPD patients. Methods MF-BIA was performed (Human Im-Touch analyzer) in 212 COPD patients and 115 age- and BMI-matched controls. Fat-free mass (FFM) and fat mass were estimated from BIA data, and low- to high-frequency (5 kHz/250 kHz) impedance ratio was calculated. Physical fitness, lung function and respiratory muscle strength were also assessed in COPD patients. Results After adjusting for age, weight, and body mass index, FFM and the 5/250 impedance ratio were lower in COPD patients (P<0.001) and were negatively affected by disease severity. In both male and female patients, the 5/250 impedance ratio was significantly correlated mainly with age (r=−0.316 and r=−0.346, respectively). Patients with a 5/250 impedance ratio below median value had lower handgrip strength (P<0.001), 6-minute walk distance (P<0.005), respiratory muscle strength (P<0.005), forced expiratory volume in 1 second (P<0.05) and vital capacity (P<0.005). Finally, the 5/250 impedance ratio was reduced (P<0.05) in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) III and IV (compared to those with GOLD I and II) or a BODE index between 6 and 10 points (compared to those with BODE index between 1 and 5 points). Conclusion MF-BIA may be a useful tool for assessing body composition and nutritional status in COPD patients. In particular, the impedance ratio could give valuable information on cellular integrity and muscle quality.

  20. Lack of additional effect of adjunct of assisted ventilation to pulmonary rehabilitation in mild COPD patients.

    Science.gov (United States)

    Bianchi, L; Foglio, K; Porta, R; Baiardi, R; Vitacca, M; Ambrosino, N

    2002-05-01

    Different modalities of assisted ventilation improve breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effects of the addition of assisted ventilation during exercise training on the outcome of a structured pulmonary rehabilitation programme (PRP) in COPD patients. Thirty-three male patients with stable COPD (mean (SD) forced expiratory volume in 1 s (FEV1) 44 (16) % pred), without chronic ventilatory failure, undergoing a 6-week multidisciplinary outpatient PRP including exercise training, were randomised to training during either mask proportional assist ventilation (PAV: 18 patients) or spontaneous breathing (SB: 15 patients). Assessment included exercise tolerance, dyspnoea, leg fatigue, and health-related quality of life (HRQL). Five out of 18 patients (28%) in the PAV group dropped out due to lack of compliance with the equipment. Both groups showed significant post-PRP improvements in exercise tolerance (peak work rate difference: 20 (95% Cl 2.4-37.6) and 14 (3.8% CI to 24.2) W in PAV and SB group, respectively), dyspnoea and leg fatigue, but not in HRQL, without any significant difference between groups. It is concluded that with the modality and in the patients assessed in this study assisted ventilation during training sessions included in a multidisciplinary PRP was not well tolerated by all patients and gave no additional physiological benefit in comparison with exercise training alone.

  1. Inflammatory and immunological profiles in patients with COPD: relationship with FEV 1 reversibility

    Science.gov (United States)

    Queiroz, Cleriston Farias; Lemos, Antonio Carlos Moreira; Bastos, Maria de Lourdes Santana; Neves, Margarida Célia Lima Costa; Camelier, Aquiles Assunção; Carvalho, Natália Barbosa; de Carvalho, Edgar Marcelino

    2016-01-01

    ABSTRACT Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls). Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL) group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL) group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%). The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01), and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05). However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5) were higher in patients than in controls (p < 0.001) but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile. PMID:27832230

  2. Inflammatory and immunological profiles in patients with COPD: relationship with FEV 1 reversibility

    Directory of Open Access Journals (Sweden)

    Cleriston Farias Queiroz

    Full Text Available ABSTRACT Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls. Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%. The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01, and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05. However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5 were higher in patients than in controls (p < 0.001 but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile.

  3. Quadriceps and respiratory muscle fatigue following high-intensity cycling in COPD patients.

    Directory of Open Access Journals (Sweden)

    Damien Bachasson

    Full Text Available Exercise intolerance in COPD seems to combine abnormal ventilatory mechanics, impaired O2 transport and skeletal muscle dysfunction. However their relative contribution and their influence on symptoms reported by patients remain to be clarified. In order to clarify the complex interaction between ventilatory and neuromuscular exercise limiting factors and symptoms, we evaluated respiratory muscles and quadriceps contractile fatigue, dynamic hyperinflation and symptoms induced by exhaustive high-intensity cycling in COPD patients. Fifteen gold II-III COPD patients (age = 67 ± 6 yr; BMI = 26.6 ± 4.2 kg.m(-2 performed constant-load cycling test at 80% of their peak workload until exhaustion (9.3 ± 2.4 min. Before exercise and at exhaustion, potentiated twitch quadriceps strength (Q(tw, transdiaphragmatic (P(di,tw and gastric (P(ga,tw pressures were evoked by femoral nerve, cervical and thoracic magnetic stimulation, respectively. Changes in operational lung volumes during exercise were assessed via repetitive inspiratory capacity (IC measurements. Dyspnoea and leg discomfort were measured on visual analog scale. At exhaustion, Q(tw (-33 ± 15%, >15% reduction observed in all patients but two and Pdi,tw (-20 ± 15%, >15% reduction in 6 patients were significantly reduced (P15% reduction in 3 patients. Percentage reduction in Q(tw correlated with the percentage reduction in P(di,tw (r = 0.66; P<0.05. Percentage reductions in P(di,tw and P(ga,tw negatively correlated with the reduction in IC at exhaustion (r = -0.56 and r = -0.62, respectively; P<0.05. Neither dyspnea nor leg discomfort correlated with the amount of muscle fatigue. In conclusion, high-intensity exercise induces quadriceps, diaphragm and less frequently abdominal contractile fatigue in this group of COPD patients. In addition, the rise in end-expiratory lung volume and diaphragm flattening associated with dynamic hyperinflation in COPD might limit the development of abdominal and

  4. Plasminogen activator inhibitor-1 is elevated in patients with COPD independent of metabolic and cardiovascular function

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    Waschki B

    2017-03-01

    Full Text Available Benjamin Waschki,1–3 Henrik Watz,2,3 Olaf Holz,4,5 Helgo Magnussen,2,3 Beata Olejnicka,6 Tobias Welte,5,7 Klaus F Rabe,1,3 Sabina Janciauskiene5,7 1Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany; 2Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany; 3Airway Research Center North (ARCN, German Center for Lung Research (DZL, Grosshansdorf, Germany; 4Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany; 5Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH, German Center for Lung Research (DZL, Hannover, Germany; 6Department of Medicine, Trelleborg Hospital, Trelleborg, Sweden; 7Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany Introduction: Plasminogen activator inhibitor-1 (PAI-1, a major inhibitor of fibrinolysis, is associated with thrombosis, obesity, insulin resistance, dyslipidemia, and premature aging, which all are coexisting conditions of chronic obstructive pulmonary disease (COPD. The role of PAI-1 in COPD with respect to metabolic and cardiovascular functions is unclear. Methods: In this study, which was nested within a prospective cohort study, the serum levels of PAI-1 were cross-sectionally measured in 74 stable COPD patients (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stages I–IV and 18 controls without lung disease. In addition, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, waist circumference, blood pressure, smoking status, high-sensitive C-reactive protein (hs-CRP, adiponectin, ankle–brachial index, N-terminal pro-B-type natriuretic peptide, and history of comorbidities were also determined. Results: The serum levels of PAI-1 were significantly higher in COPD patients than in controls, independent of a broad spectrum of possible confounders including metabolic and cardiovascular dysfunction. A multivariate regression analysis revealed

  5. Phlebotomy for rapid weaning and extubation in COPD patient with secondary polycythemia and respiratory failure

    Directory of Open Access Journals (Sweden)

    Tripathy Swagata

    2010-01-01

    Full Text Available The increased incidence of ventilator-associated complications in patients with chronic obstructive pulmonary disease (COPD necessitates rapid weaning and extubation. The presence of secondary polycythemia in this subgroup increases the incidence of stroke and myocardial infarction due to hyperviscosity and tissue hypoxia. We present a 58-year-old male patient of COPD with secondary polycythemia (hematocrit 64% who had possible hyperviscosity-related complications leading to cardiac arrest after a minor surgical procedure. The patient developed ventilator dependence after recovery. Phlebotomy was done to remove 10% of total blood volume. Symptomatic improvement was dramatic. Improvement in weaning indices like rapid shallow breathing index and PaO 2 /PAO 2 was observed facilitating rapid weaning and early extubation. Monitored, acute phlebotomy is safe and cost-effective. It decreases blood volume and viscosity, increases cardiac output and improves exercise tolerance in patients.

  6. Persistent systemic inflammation and symptoms of depression among patients with COPD in the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Janssen, D. J. A.; Mullerova, H.; Agusti, A.

    2014-01-01

    follow-up between COPD patients with persistent systemic inflammation (PSI) and never inflamed patients (NI) in the ECLIPSE cohort. Methods: The ECLIPSE study included 2164 COPD patients. Parameters assessed at baseline and at 36 months follow-up included: demographics, clinical characteristics.......98). At 36 months follow-up, CES-D scores were comparable in PSI and NI patients (12.2 (9.3) vs. 10.5 (9.0) points, p = 0.08) as were their temporal changes (0.5 (8.3) vs. 1.3 (7.9) points, p = 0.30). Conclusion: The ECLIPSE study does not support a strong relationship between PSI and symptoms of depression...

  7. Increased difference between slow and forced vital capacity is associated with reduced exercise tolerance in COPD patients

    OpenAIRE

    Yuan, Wei; He, Xin; Xu, Qiu-Fen; Wang, Hao-Yan; Casaburi, Richard

    2014-01-01

    Background A higher slow vital capacity (VC) compared with forced vital capacity (FVC) indicates small airway collapse and air trapping. We hypothesized that a larger difference between VC and FVC (VC-FVC) would predict impaired exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Methods Pulmonary function and incremental cardiopulmonary exercise responses were assessed in 97 COPD patients. Patients were then divided into two groups: one in which VC > FVC (n = 77)...

  8. Relation between clinical and anthropometric data and systemic inflammation in patients with COPD

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    Pertseva Т.А.

    2015-11-01

    Full Text Available Recently, much attention is devoted to systemic inflammation in patients with chronic obstructive pulmonary disease (COPD. The aim of our study was to determine the relationship between clinical and anthropometric data with systemic inflammation in stable COPD patients. According to the study CRP levels were raised in 44% of patients (7.9 [7,1-10,9. Serum CRP was significantly higher in stable COPD patients than in control subjects (p=0.04. CRP correlated well with the pack/years index(p = 0,032 and disease duration (p=0,01. It wasn’t established link between CRP levels and height, weight, stage, disease category. CRP level affected the frequency of exacerbations (r=0,50; p=0,01. Patients with high CRP level had significantly more exacerbations in the past year (p=0.01. Patients who received any type of therapy for a long period of time had lower CRP levels, than patients who did not reseive any therapy.

  9. Mortality in COPD patients discharged from hospital: the role of treatment and co-morbidity

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    Nieminen Markku M

    2006-08-01

    Full Text Available Abstract Background The aim of this study was to analyse mortality and associated risk factors, with special emphasis on health status, medications and co-morbidity, in patients with chronic obstructive pulmonary disease (COPD that had been hospitalized for acute exacerbation. Methods This prospective study included 416 patients from each of the five Nordic countries that were followed for 24 months. The St. George's Respiratory Questionnaire (SGRQ was administered. Information on treatment and co-morbidity was obtained. Results During the follow-up 122 (29.3% of the 416 patients died. Patients with diabetes had an increased mortality rate [HR = 2.25 (1.28–3.95]. Other risk factors were advanced age, low FEV1 and lower health status. Patients treated with inhaled corticosteroids and/or long-acting beta-2-agonists had a lower risk of death than patients using neither of these types of treatment. Conclusion Mortality was high after COPD admission, with older age, decreased lung function, lower health status and diabetes the most important risk factors. Treatment with inhaled corticosteroids and long-acting bronchodilators may be associated with lower mortality in patients with COPD.

  10. The use of healthcare resources in the last 3 years of life in patients with COPD and lung cancer in Denmark

    DEFF Research Database (Denmark)

    Husted, Marie Gade; Kriegbaum, Margit; Kirkegaard, Nicolai

    2014-01-01

    OBJECTIVE: The aim was to describe the use of healthcare resources during the last 3 years of life in patients who died from chronic obstructive pulmonary disease (COPD) or lung cancer (LC), including patients with LC and COPD. METHODS: Using data from Danish health registers, we identified 6648...... of health resources. CONCLUSIONS: The high use of health resources together with the underuse of economic reimbursement in patients with terminal COPD suggest that more focus should be given to these patients. The need for NIV might be an indicator of poor prognosis and reflect an intensified need...... individuals who, in 2010, died from COPD (n=3013) and LC (n=3635), including 775 from LC and COPD. RESULTS: Patients with COPD and LC had a high use of services in the last 3 years of life, but the trajectory for COPD was different from that of LC. Fifty-five per cent of subjects with LC received...

  11. The Most Common Detected Bacteria in Sputum of Patients with the Acute Exacerbation of COPD

    OpenAIRE

    Cukic, Vesna

    2013-01-01

    Introduction: Acute exacerbation of COPD (AECOPD) may be triggered by infection with bacteria or viruses or by environmental pollutants; the cause of about one-third of exacerbations cannot be identified. Objective: To determine the most common bacteria in sputum culture of patients with AECOPD hospitalized in Intensive care unit of Clinic for pulmonary disease and TB “Podhrastovi” in the 2012. Material and methods: This is a retrospective analysis of sputum bacterial cultures of patients wit...

  12. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    OpenAIRE

    Korpershoek, Y. J. G.; Vervoort, S.C.J.M.; Nijssen, L. I T; Trappenburg, J.C.A.; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. Methods: A qualitative study using semi-structured in-d...

  13. A gender difference in circulating neutrophils in malnourished patients with COPD

    Directory of Open Access Journals (Sweden)

    Sven Larsson

    2011-01-01

    Full Text Available Sven Larsson1, Anita Nordenson1, Pernilla Glader1, Shigemi Yoshihara2, Anders Lindén1, Frode Slinde31Department of Internal Medicine/Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; 2Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan; 3Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SwedenBackground: Circulating markers of inflammation in chronic obstructive pulmonary disease (COPD may correlate to disease progression and extrapulmonary complications such as malnourishment. However, surprisingly little is known about gender-related differences for circulating inflammatory markers in COPD.Purpose: To characterize differences in circulating markers of inflammation in malnourished female and male patients with COPD.Subjects: Thirty female and 11 male patients with a clinical diagnosis of COPD and malnourishment were examined. A group of control subjects without evidence of COPD was recruited for comparison of some variables.Methods: Blood samples were drawn, and the following parameters were studied: leukocytes and differential counts, C-reactive protein (CRP, tumor necrosis factor-α, interleukin (IL-6 and IL-8, myeloperoxidase (MPO, neutrophil elastase (NE, intracellular adhesion molecule-1, vascular endothelial adhesion molecule-1, and E-selectin.Results: The mean neutrophil concentration was significantly (P = 0.019 higher in female (4.5 × 109/L than in male patients with COPD (3.5 × 109/L and significantly higher than in female control subjects (3.1 × 109/L (P , 0.01, n = 85. The mean CRP values were considerably higher in female (4.9 mg/mL than in male patients with COPD (1.5 mg/mL, but the difference was not statistically significant (P = 0.20. The mean concentrations of IL-6 and IL-8 tended to be higher in female than in male patients with COPD, but these differences did not reach statistical

  14. Efficacy of a self-management plan in exacerbations for patients with advanced COPD

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    Sánchez-Nieto JM

    2016-08-01

    Full Text Available Juan Miguel Sánchez-Nieto,1,2 Rubén Andújar-Espinosa,3 Roberto Bernabeu-Mora,1,2 Chunshao Hu,1 Beatriz Gálvez-Martínez,1 Andrés Carrillo-Alcaraz,1 Carlos Federico Álvarez-Miranda,3 Olga Meca-Birlanga,1 Eva Abad-Corpa4 1Division of Pneumology, Hospital Morales Meseguer, 2University of Murcia, 3Division of Pneumology, Hospital Arrixaca, Murcia, 4Department of Professional Development Unit, Murcia, Spain Background: Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.Methods: Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.Results: After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04 and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40

  15. Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels: a pilot study

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    Donohue JF

    2014-07-01

    Full Text Available James F Donohue,1 Nancy Herje,2 Glenn Crater,2 Kathleen Rickard2 1Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 2Aerocrine, Inc., Morrisville, NC, USA Objective: To characterize fractional exhaled nitric oxide (FeNO levels that may be indicative of Th2-mediated airway inflammation in patients with chronic obstructive pulmonary disease (COPD. Methods: This single-visit, outpatient study was conducted in 200 patients aged 40 years and older with COPD. All patients underwent spirometry and FeNO testing. COPD severity was classified according to the Global initiative for chronic Obstructive Lung Disease (GOLD 2010 guidelines. Results: Patients who participated in the study had a mean age of 63.9±11.3 years and a mean smoking history of 46±29 pack years. Patients had a mean forced expiratory volume in 1 second % predicted of 53.9%±22.1%. The percentage of patients classified with COPD severity Stage I, II, III, and IV was 13%, 40%, 39%, and 8%, respectively. In addition, according to current procedural terminology codes, 32% of patients were classified as mixed COPD/asthma, 26% as COPD/emphysema, and 42% as all other codes. The mean FeNO level for all patients was 15.3±17.2 parts per billion (ppb. Overall, 89% of patients had a FeNO <25 ppb, 8% had a FeNO 25–50 ppb, and 3% had a FeNO >50 ppb. The percentages of patients with FeNO in the intermediate or high ranges of FeNO were greatest among patients with mixed COPD/asthma (intermediate, 11.5%; high, 6.6% compared with COPD/emphysema (intermediate, 8%; high, 0 and all other codes (intermediate, 6.3%; high, 1.3%. Conclusion: Increases in FeNO were identified in a subset of patients with COPD, particularly in those previously diagnosed with both COPD and asthma. Since FeNO is useful for identifying patients with airway inflammation who will have a beneficial response to treatment with an inhaled corticosteroid, these data may have important

  16. Gender differences in the T-cell profiles of the airways in COPD patients associated with clinical phenotypes

    Science.gov (United States)

    Forsslund, Helena; Yang, Mingxing; Mikko, Mikael; Karimi, Reza; Nyrén, Sven; Engvall, Benita; Grunewald, Johan; Merikallio, Heta; Kaarteenaho, Riitta; Wahlström, Jan; Wheelock, Åsa M; Sköld, C Magnus

    2017-01-01

    T lymphocytes are believed to play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). How T cells are recruited to the lungs and contribute to the inflammatory process is largely unknown. COPD is a heterogeneous disease, and discriminating disease phenotypes based on distinct molecular and cellular pathways may provide new approaches for individualized diagnosis and therapies. Bronchoalveolar lavage (BAL) and blood samples were obtained from 40 never-smokers, 40 smokers with normal lung function, and 38 COPD patients. T-cell chemokine receptor expression was analyzed with flow cytometry, and soluble BAL cytokines and chemokines were measured using a cytokine multiplex assay. Correlations with gender and clinical characteristics including lung imaging were investigated using multivariate modeling. Th1/Tc1- and Th2/Tc2-associated soluble analytes and T-cell chemokine receptors were analyzed as cumulative Th1/Tc1 and Th2/Tc2 immune responses. A higher expression of chemokine receptor CCR5 on CD8+ T cells in BAL and higher percentage of CXCR3+CD8+ T cells in blood was found in female smokers with COPD compared to those without COPD. CCR5 expression on CD4+ and CD8+ T cells was lower in BAL from male smokers with COPD compared to those without COPD. Among female smokers with COPD, Th1/Tc1 immune response was linked to BAL macrophage numbers and goblet cell density, and Th2/Tc2 response was associated with the measures of emphysema on high-resolution computed tomography. The highly gender-dependent T-cell profile in COPD indicates different links between cellular events and clinical manifestations in females compared to males. Our findings may reveal mechanisms of importance for the difference in clinical course in female COPD patients compared to males. PMID:28053515

  17. Trends in COPD mortality and in-patient admissions in men & women: evidence of convergence.

    LENUS (Irish Health Repository)

    O'Farrell, A

    2011-09-01

    Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality. Although more prevalent in men, it is anticipated that, due to the convergence in smoking rates, the prevalence rate in women will surpass that of men. There were 14,519 deaths attributable to COPD in the period 2000-2009. Although deaths decreased for both sexes, reduction in deaths was significantly higher among men (test for trend, p<0.01 for men vs. p=0.06 for women). Smoking rates decreased for both sexes from 1980-2009 with the percentage reduction in smoking significantly greater in men (11.5% vs. 7.0%, p<0.001). There has been a convergence in COPD deaths and COPD hospital in-patient discharges for men and women that mirrors the trend in the convergence of male and female smoking rates. This study provides evidence of the need for effective smoking cessation programmes that are targeted at women as well as men.

  18. All Danish first-time COPD hospitalisations 2002-2008: Incidence, outcome, patients, and care

    DEFF Research Database (Denmark)

    Lykkegaard, Jesper; Søndergaard, Jens; Kragstrup, Jakob

    2012-01-01

    .01-1.34) and the one-year mortality increased OR 1.12 (95% CI1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient...... clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased. CONCLUSION: Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD...... the total rate of COPD hospitalisations decreased from 460 to 410 per 100 000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI1...

  19. Impact of current cough on health-related quality of life in patients with COPD

    Science.gov (United States)

    Deslee, Gaëtan; Burgel, Pierre-Régis; Escamilla, Roger; Chanez, Pascal; Court-Fortune, Isabelle; Nesme-Meyer, Pascale; Brinchault-Rabin, Graziella; Perez, Thierry; Jebrak, Gilles; Caillaud, Denis; Paillasseur, Jean-Louis; Roche, Nicolas

    2016-01-01

    Background Cough and sputum production are frequent in chronic obstructive pulmonary disease (COPD). The objective of this study was to examine the relationship between cough and sputum production and health-related quality of life in COPD. Methods A cross-sectional study was conducted in the French Initiatives COPD cohort and assessed cough and sputum production within the past 7 days using the cough and sputum assessment questionnaire (CASA-Q), health-related quality of life, spirometry, smoking status, dyspnea, exacerbations, anxiety and depression, and comorbidities. Results One hundred and seventy-eight stable COPD patients were included (age, 62 [56–69] years, 128 male, forced expiratory volume in 1 second [FEV1]: 57 [37–72] % predicted) (median [Q1–Q3]). In univariate analyses, health-related quality of life (Saint George’s respiratory questionnaire total score) was associated with each CASA-Q domain and with chronic bronchitis, exacerbations, dyspnea, FEV1, depression, and anxiety. All four domains introduced separately were independently associated with health-related quality of life. When introduced together in multivariate analyses, only the cough impact domain remained independently associated with health-related quality of life (R2=0.60). With chronic bronchitis (standard definition) instead of the CASA-Q, the R2 was lower (R2=0.54). Conclusion This study provides evidence that current cough in the previous 7 days is an important determinant of health-related quality of life impairment in stable COPD patients. PMID:27695305

  20. Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation.

    Science.gov (United States)

    Santos, Salud; Marin, Alicia; Serra-Batlles, Joan; de la Rosa, David; Solanes, Ingrid; Pomares, Xavier; López-Sánchez, Marta; Muñoz-Esquerre, Mariana; Miravitlles, Marc

    2016-01-01

    Exacerbations of COPD represent an important medical and health care problem. Certain susceptible patients suffer recurrent exacerbations and as a consequence have a poorer prognosis. The effects of bronchial infection, either acute or chronic, and of the inflammation characteristic of the disease itself raise the question of the possible role of antibiotics and anti-inflammatory agents in modulating the course of the disease. However, clinical guidelines base their recommendations on clinical trials that usually exclude more severe patients and patients with more comorbidities, and thus often fail to reflect the reality of clinicians attending more severe patients. In order to discuss aspects of clinical practice of relevance to pulmonologists in the treatment and prevention of recurrent exacerbations in patients with severe COPD, a panel discussion was organized involving expert pulmonologists who devote most of their professional activity to day hospital care. This article summarizes the scientific evidence currently available and the debate generated in relation to the following aspects: bacterial and viral infections, chronic bronchial infection and its treatment with cyclic oral or inhaled antibiotics, inflammatory mechanisms and their treatment, and the role of computerized tomography as a diagnostic tool in patients with severe COPD and frequent exacerbations.

  1. Long-Term Oxygen Therapy in COPD: Factors Affecting and Ways of Improving Patient Compliance

    Directory of Open Access Journals (Sweden)

    Stamatis Katsenos

    2011-01-01

    Full Text Available Long-term oxygen therapy (LTOT is the cornerstone mode of treatment in patients with severe chronic obstructive pulmonary disease (COPD associated with resting hypoxaemia. When appropriately prescribed and correctly used, LTOT has clearly been shown to improve survival in hypoxemic COPD patients. Adherence to LTOT ranges from 45% to 70% and utilization for more than 15 hours per day is widely accepted as efficacious. Although several studies have addressed the level of patients' adherence to LTOT, few have suggested or evaluated interventions that conduce to compliance enhancement. The lack of sufficient data regarding COPD patients following oxygen prescription is an enormous void that must be duly confronted to augment clinical effectiveness and cost containment for the long term use. The present review article highlights factors influencing the compliance of patients using LTOT and emphasizes novel strategies and interventions that may prove to be of significant benefit given the remarkably little current research appraising this issue. Therefore, additional research should be promptly performed to verify the efficacy of newly designed approaches in improving the outcomes of patients receiving LTOT.

  2. Ventricular performance during exercise in patients with chronic obstructive pulmonary disease (COPD)

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Iwao; Akashiba, Tsuneto; Horie, Takashi (Nihon Univ., Tokyo (Japan). School of Medicine)

    1992-01-01

    We assessed ventricular performance during exercise in 16 chronic obstructive pulmonary disease (COPD) patients and 8 normal control subjects by means of radionuclide equilibrium angiography using technetium-99m as a tracer. Supine exercise on a bicycle ergometer was performed until symptom-limited exhaustion. Data were accumulated for 300 heart beats at rest and 150 heart beats during exercise. We used the standard voxel count method to calculate the ventricular volumes. Age, FEV{sub 1.0}%, %VC, PaO{sub 2} and PaCO{sub 2} of the COPD patients were 63{+-}8 yr, 46{+-}11%, 69{+-}18%, 68{+-}11 Torr and 44{+-}7 Torr (mean{+-}SD), respectively. Systolic dysfunction of both the left and right ventricles was well confirmed in the present study. In 12 patients who also underwent hemodynamic studies, resting total pulmonary vascular resistance index (TPVRI) and mean pulmonary artery pressure (P-barpa) significantly correlated with right ventricular end-systolic volume index (RVESVI) obtained by RI angiography; {gamma}=0.769 (p<0.01) and {gamma}=0.631 (p<0.05), respectively. A significant relationship was also observed between left ventricular dysfunction and the degree of hypercapnia. In response to exercise testing, 10 of 16 patients exhibited insufficient augmentation of stroke volume, and both left and right end-diastolic volumes decreased in half of 10 patients. It is suggested that cardiac function may be disturbed by mechanical factors such as pulmonary hyperinflation in COPD patients. (author).

  3. [Effect of lung volume reduction surgery (LVRS) on nutritional status in patients with COPD].

    Science.gov (United States)

    Kobayashi, Atsushi; Yoshikawa, Masanori; Kushibe, Keiji; Takenaka, Hideaki; Hukuoka, Atsuhiko; Tamaki, Shinji; Kimura, Hiroshi

    2003-12-01

    The beneficial effects of lung volume reduction surgery (LVRS) on patients with severe chronic obstructive pulmonary disease (COPD) on pulmonary function and exercise performance has been established. However, the impact on nutritional status and prognosis has not been demonstrated. In the present study, we investigated the changes in nutritional status in COPD patients undergoing bilateral thoracoscopic LVRS and also analyzed the relationship between nutritional status and postoperative complications and prognosis. After LVRS, body weight, fat-free mass (FFM) and caloric intake were significantly increased. Increase in FFM correlated significantly with improvement in exercise performance. In underweight patients before LVRS, the incidence of post-operative complications was significantly higher than in normal-weight patients, and a patient who was moderately-to-severely underweight (% ideal body weight nutritional status after LVRS contributes to improvement in exercise performance, and that preoperative nutritional status has a significant impact on postoperative morbidity and mortality. From our data, we concluded that preoperative nutritional assessment is an important part of the preoperative evaluation of LVRS, and that LVRS provides nutritional benefits for underweight patients with severe COPD.

  4. Identification of COPD patients' health status using an intelligent system in the CHRONIOUS wearable platform.

    Science.gov (United States)

    Bellos, Christos C; Papadopoulos, Athanasios; Rosso, Roberto; Fotiadis, Dimitrios I

    2014-05-01

    The CHRONIOUS system offers an integrated platform aiming at the effective management and real-time assessment of the health status of the patient suffering from chronic obstructive pulmonary disease (COPD). An intelligent system is developed for the analysis and the real-time evaluation of patient's condition. A hybrid classifier has been implemented on a personal digital assistant, combining a support vector machine, a random forest, and a rule-based system to provide a more advanced categorization scheme for the early and in real-time characterization of a COPD episode. This is followed by a severity estimation algorithm which classifies the identified pathological situation in different levels and triggers an alerting mechanism to provide an informative and instructive message/advice to the patient and the clinical supervisor. The system has been validated using data collected from 30 patients that have been annotated by experts indicating 1) the severity level of the current patient's health status, and 2) the COPD disease level of the recruited patients according to the GOLD guidelines. The achieved characterization accuracy has been found 94%.

  5. Oral iodinated activated charcoal improves lung function in patients with COPD.

    Science.gov (United States)

    Skogvall, Staffan; Erjefält, Jonas S; Olin, Anders I; Ankerst, Jaro; Bjermer, Leif

    2014-06-01

    The effect of 8 weeks treatment with oral iodinated activated charcoal (IAC) on lung function of patients with moderate chronic obstructive pulmonary disease (COPD) was examined in a double blind randomized placebo controlled parallel group study with 40 patients. In the IAC group, patients showed a statistically significant improvement of FEV1 baseline by 130 ml compared to placebo, corresponding to 8.2% improvement (p = 0.031*). Correlation statistics revealed that the improvement of FEV1 baseline was significantly correlated both to FEV1 post-bronchodilator (p = 0.0020**) and FEV1 post-exercise (0.033*) values. This demonstrates that the improved baseline lung function by IAC did not inhibit a further beta2-adrenoceptor relaxation, and thus that patients did not reach a limit for maximal improvement of the lung function after IAC treatment. Eight patients in the IAC group developed abnormal thyroid hormone levels transiently during the treatment. This side effect was not correlated to improvement of lung function (p = 0.82). No serious adverse effects directly related to the treatment were recorded. In summary, this study demonstrates that iodinated activated charcoal surprisingly and significantly improved lung function of patients with moderate COPD. The underlying mechanism of action is unclear, but is likely to be different from the drugs used today. The immediate conclusion is that further studies are now justified in order to determine clinical efficacy of IAC in COPD and explore possible mechanisms of action.

  6. Lung and kidney: a dangerous liaison? A population-based cohort study in COPD patients in Italy

    Science.gov (United States)

    Fedeli, Ugo; De Giorgi, Alfredo; Gennaro, Nicola; Ferroni, Eliana; Gallerani, Massimo; Mikhailidis, Dimitri P; Manfredini, Roberto; Fabbian, Fabio

    2017-01-01

    Background COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD) is frequently diagnosed in older people living in Western societies and could impact COPD patients’ mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD. Methods A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI) were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression. Results Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up). After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30–1.42) independently from comorbidities summarized by the CCI was a significant risk factor for mortality. Conclusion In spite of limitations due to the use of claims data, long-term survival of COPD patients was heavily affected by the presence of CKD and other comorbidities. PMID:28184156

  7. Beyond FEV1 in COPD: a review of patient-reported outcomes and their measurement

    Directory of Open Access Journals (Sweden)

    Jones P

    2012-10-01

    Full Text Available Paul Jones,1 Marc Miravitlles,2 Thys van der Molen,3 Karoly Kulich41Division of Clinical Science, University of London, London, UK; 2Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Ciber de Enfermedades Respiratorias, Barcelona, Spain; 3Department of Primary Care, University Medical Centre Groningen, Groningen, The Netherlands; 4Novartis Pharma AG, Basel, SwitzerlandAbstract: Patients with chronic obstructive pulmonary disease (COPD present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV1. However, the evidence suggests that FEV1 is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new

  8. Gait speed as a measure of functional status in COPD patients

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    Karpman C

    2014-11-01

    Full Text Available Craig Karpman, Roberto Benzo Mindful Breathing Laboratory, Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA Abstract: Chronic obstructive pulmonary disease (COPD is a disease associated with dyspnea, fatigue, and exercise intolerance. The degree of functional debility and level of exercise capacity greatly influences quality of life and mortality in patients with COPD, and the measures of exercise capacity are to be an integral part of patient assessment but often not feasible in routine daily practice, resulting in likely suboptimal care. There is a need for simple ways to identify functional decline in the clinical setting in order to guide resources to preventive interventions or proper care, including palliative care. Gait speed, or measuring how long it takes for a patient to walk a short distance, takes very little time and space, and can serve as a candidate measure of physical function in COPD. Gait speed has been shown to be an indicator of disability, health care utilization, and survival in older adults. It is a simple, reliable, and feasible measure to perform in the clinic and has been promoted as the next vital sign, providing insight into patients' functional capacity. Gait speed is mainly determined by exercise capacity but reflects global well-being as it captures many of the multisystemic effects of disease severity in COPD rather than pulmonary impairment alone. It is an excellent screening measure for exercise capacity and frailty; in COPD, the usual gait speed (4-m course with rolling start has been very accurate in identifying clinically relevant benchmarks of the 6-minute walk test, poor (<350 m and very poor (<200 m 6-minute walk test distances. A specific cut-off point of 0.8 m⋅s-1 had a positive predictive value of 69% and negative predictive value of 98% in predicting very poor exercise capacity. The increasing evidence on gait speed is promising as a simple test that can inform the

  9. HOLD study (Home care Obstructive Lung Disease): natural history of patients with advanced COPD.

    Science.gov (United States)

    Gainza Miranda, Daniel; Sanz Peces, Eva María; Alonso Babarro, Alberto; Prados Sánchez, Maria Concepción; Varela Cerdeira, María

    2016-03-22

    Chronic obstructive pulmonary disease (COPD) is the fourth cause of death in western countries. Its final stage has clearly been forgotten by medical research in recent years. There exists consensus regarding the need to integrate palliative care in assisting these patients, but the difficulty in establishing a prognosis for the disease, establishing limits for life support measures, the lack of information about the disease's natural course and ignorance as to the most effective health-care structure for these patients' palliative treatment may be responsible for their late inclusion or non-inclusion in specific programmes. The main purpose of this work is to find out the natural background of patients with stage IV COPD and the main prognostic factors that influence these patients' survival. Prospective observational study of a home patient cohort with stage IV COPD sent from Neumology consultations and Palliative Care Unit in La Paz Hospital in Madrid and Primary Care Health Centres in the area to the palliative care home support team. The goal is to study socio-demographic variables, prognosis, nutritional status, use of health resources, perceived quality of life, functionality, main symptomatology, use and effectiveness of opioids, adherence to treatment, prognostic information regarding the disease, information given by professionals, advance directives, social backup requirements and overburden level of the main caregiver. The HOLD study is a project aimed at finding out the prognostic factors and evolution of the disease COPD in its most advanced stage. The final goal is to improve the health and quality of life, in a personalised, integral way up to end of life and explore and foster communication with patients, as well as their participation and collaboration in decision-taking. The HOLD study can help us better understand what these patients' real palliative and care needs are, in order to more efficiently organise their treatment at end of life.

  10. Identifying patients at risk of late recovery (≥ 8 days) from acute exacerbation of chronic bronchitis and COPD

    National Research Council Canada - National Science Library

    Anzueto, Antonio; Miravitlles, Marc; Ewig, Santiago; Legnani, Delfino; Heldner, Stephanie; Stauch, Kathrin

    2012-01-01

    ...) in patients with acute exacerbations of chronic bronchitis/COPD (AECB/AECOPD). An international, observational, non-interventional study in outpatients with AECB/AECOPD who received treatment for their exacerbation with the antibiotic moxifloxacin...

  11. Nocturnal noninvasive positive pressure ventilation in stable COPD : A systematic review and individual patient data meta-analysis

    NARCIS (Netherlands)

    Struik, F. M.; Lacasse, Y.; Goldstein, R. S.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2014-01-01

    Introduction: The effects of nocturnal noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) remain controversial. Methods: The Cochrane Airways group Register of Trials, MEDLINE, EMBASE and CINAHL were searched up to August 2012. Indi

  12. Reproducibility and responsiveness of a noninvasive EMG technique of the respiratory muscles in COPD patients and in healthy subjects

    NARCIS (Netherlands)

    Duiverman, ML; van Eykern, LA; Vennik, PW; Koeter, GH; Maarsingh, EJW; Wijkstra, PJ

    2004-01-01

    In the present study, we assessed the reproducibility and responsiveness of transcutaneous electromyography (EMG) of the respiratory muscles in patients with chronic obstructive pulmonary disease ( COPD) and healthy subjects during breathing against an inspiratory load. In seven healthy subjects and

  13. Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

    Science.gov (United States)

    Altinoz, Hilal; Adiguzel, Nalan; Salturk, Cuneyt; Gungor, Gokay; Mocin, Ozlem; Berk Takir, Huriye; Kargin, Feyza; Balci, Merih; Dikensoy, Oner; Karakurt, Zuhal

    2016-01-01

    Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m2, and the second group consisted of subjects with BMI >30 kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m2, while 80 subjects had BMI >30 kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival. PMID:27578969

  14. Low bone mineral density in COPD patients with osteoporosis is related to low daily physical activity and high COPD assessment test scores

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    Liu WT

    2015-09-01

    Full Text Available Wen-Te Liu,1,2,* Han-Pin Kuo,3,* Tien-Hua Liao,4 Ling-Ling Chiang,1 Li-Fei Chen,3 Min-Fang Hsu,5 Hsiao-Chi Chuang,1 Kang-Yun Lee,2,6 Chien-Da Huang,3 Shu-Chuan Ho11School of Respiratory Therapy, College of Medicine, Taipei Medical University, 2Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, 3Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 4Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, 5Department of Healthcare Administration, Asia University, Wufeng, Taichung, 6Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workAbstract: COPD patients have an increased prevalence of osteoporosis (OP compared with healthy people. Physical inactivity in COPD patients is a crucial risk factor for OP; the COPD assessment test (CAT is the newest assessment tool for the health status and daily activities of COPD patients. This study investigated the relationship among daily physical activity (DPA, CAT scores, and bone mineral density (BMD in COPD patients with or without OP. This study included 30 participants. Ambulatory DPA was measured using actigraphy and oxygen saturation by using a pulse oximeter. BMD was measured using dual-energy X-ray absorptiometry. OP was defined as a T-score (standard deviations from a young, sex-specific reference mean BMD less than or equal to -2.5 SD for the lumbar spine, total hip, and femoral neck. We quantified oxygen desaturation during DPA by using a desaturation index and recorded all DPA, except during sleep. COPD patients with OP had lower DPA and higher CAT scores than those of patients without OP. DPA was significantly positively correlated with (lumbar spine, total hip, and femoral neck BMD (r=0.399, 0.602, 0.438, respectively

  15. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China

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    Dong X

    2016-12-01

    Full Text Available Xiao-Yan Dong,1,* Lan Wang,1,* Yan-Xia Tao,1 Xiu-li Suo,2 Yue-Chuan Li,2 Fang Liu,1 Yue Zhao,1 Qing Zhang1 1School of Nursing, Tianjin Medical University, 2Department of Respiratory Care, Tianjin Chest Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work Background: Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients’ quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR, which has been developed and validated in its English version, is needed for patients with COPD in China.Methods: A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women, who met the inclusion and exclusion criteria, were enrolled in the study. Test–retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach’s α. Content validity was examined using the Content Validity Index (CVI, scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave. Besides, convergent validity and construct validity were also examined.Results: The AIR-C (AIR-Chinese version scale had high test–retest reliability (intraclass correlation coefficient =0.904 and internal consistency (Cronbach’s α=0.914; the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89–1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, P<0.01, and there were

  16. The impact of SHS exposure on health status and exacerbations among patients with COPD

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    Mark D Eisner

    2009-05-01

    hospital-based care for COPD, which was a composite endpoint of either ED visits or hospitalizations for COPD (HR 1.52; 95% CI 1.06 to 2.18 and HR 1.40; 95% CI 0.94 to 2.10, respectively. In conclusion, SHS was associated with poorer health status and a greater risk of COPD exacerbation. COPD patients may comprise a vulnerable population for the health effects of SHS.Keywords: chronic obstructive pulmonary disease, chronic bronchitis, pulmonary emphysema, tobacco smoke pollution

  17. Detection of acute deterioration in health status visit among COPD patients by monitoring COPD assessment test score

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    Pothirat C

    2015-02-01

    Full Text Available Chaicharn Pothirat, Warawut Chaiwong, Atikun Limsukon, Athavudh Deesomchok, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Theerakorn Theerakittikul, Nittaya PhetsukDivision of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: The Chronic Obstructive Pulmonary Disease Assessment Test (CAT could play a role in detecting acute deterioration in health status during monitoring visits in routine clinical practice.Objective: To evaluate the discriminative property of a change in CAT score from a stable baseline visit for detecting acute deterioration in health status visits of chronic obstructive pulmonary disease (COPD patients.Methods: The CAT questionnaire was administered to stable COPD patients routinely attending the chest clinic of Chiang Mai University Hospital who were monitored using the CAT score every 1–3 months for 15 months. Acute deterioration in health status was defined as worsening or exacerbation. CAT scores at baseline, and subsequent visits with acute deterioration in health status were analyzed using the t-test. The receiver operating characteristic curve was performed to evaluate the discriminative property of change in CAT score for detecting acute deterioration during a health status visit.Results: A total of 354 follow-up visits were made by 140 patients, aged 71.1±8.4 years, with a forced expiratory volume in 1 second of 47.49%±18.2% predicted, who were monitored for 15 months. The mean CAT score change between stable baseline visits, by patients’ and physicians’ global assessments, were 0.05 (95% confidence interval [CI], -0.37–0.46 and 0.18 (95% CI, -0.23–0.60, respectively. At worsening visits, as assessed by patients, there was significant increase in CAT score (6.07; 95% CI, 4.95–7.19. There were also significant increases in CAT scores at visits with mild and moderate exacerbation (5.51 [95% CI, 4.39–6

  18. Barriers and enablers of physical activity engagement for patients with COPD in primary care

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    Kosteli MC

    2017-03-01

    Full Text Available Maria-Christina Kosteli,1 Nicola R Heneghan,1 Carolyn Roskell,1 Sarah E Williams,1 Peymane Adab,2 Andrew P Dickens,2 Alexandra Enocson,2 David A Fitzmaurice,2 Kate Jolly,2 Rachel Jordan,2 Sheila Greenfield,2 Jennifer Cumming1 1School of Sport, Exercise and Rehabilitation Sciences, 2Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK Background: Given that physical activity (PA has a positive impact on COPD symptoms and prognosis, this study examined the factors that both encourage and limit participation in PA for individuals with COPD in a primary care setting from the perspective of social cognitive theory.Methods: A purposive sample of 26 individuals with a range of COPD severity (age range: 50–89 years; males =15 were recruited from primary care to participate in one of four focus groups. Thematic analysis was undertaken to identify key concepts related to their self-efficacy beliefs.Results: Several barriers and enablers closely related to self-efficacy beliefs and symptom severity were identified. The main barriers were health related (fatigue, mobility problems, breathing issues caused by the weather, psychological (embarrassment, fear, frustration/disappointment, attitudinal (feeling in control of their condition, PA perception, older age perception, and motivational. The main enabling factors were related to motivation (autonomous or controlled, attitudes, self-regulation, and performance accomplishments.Clinical implications: When designing interventions for individuals with COPD, it is important to understand the patient-specific social cognitive influences on PA participation. This information can then inform individually tailored management planning. Keywords: COPD, social cognitive theory, self-efficacy, barriers, enablers, primary care

  19. Highly absorptive curcumin reduces serum atherosclerotic low-density lipoprotein levels in patients with mild COPD

    Science.gov (United States)

    Funamoto, Masafumi; Sunagawa, Yoichi; Katanasaka, Yasufumi; Miyazaki, Yusuke; Imaizumi, Atsushi; Kakeya, Hideaki; Yamakage, Hajime; Satoh-Asahara, Noriko; Komiyama, Maki; Wada, Hiromichi; Hasegawa, Koji; Morimoto, Tatsuya

    2016-01-01

    Purpose COPD is mainly caused by tobacco smoking and is associated with a high frequency of coronary artery disease. There is growing recognition that the inflammation in COPD is not only confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs, including blood vessels. α1-antitrypsin–low-density lipoprotein (AT-LDL) complex is an oxidatively modified LDL that accelerates atherosclerosis. Curcumin, one of the best-investigated natural products, is a powerful antioxidant. However, the effects of curcumin on AT-LDL remain unknown. We hypothesized that Theracurmin®, a highly absorptive curcumin with improved bioavailability using a drug delivery system, ameliorates the inflammatory status in subjects with mild COPD. Patients and methods This is a randomized, double-blind, parallel-group study. Subjects with stages I–II COPD according to the Japanese Respiratory Society criteria were randomly assigned to receive 90 mg Theracurmin® or placebo twice a day for 24 weeks, and changes in inflammatory parameters were evaluated. Results There were no differences between the Theracurmin® and placebo groups in terms of age, male/female ratio, or body mass index in 39 evaluable subjects. The percent changes in blood pressure and hemoglobin A1c and LDL-cholesterol, triglyceride, or high-density lipoprotein-cholesterol levels after treatment were similar for the two groups. However, the percent change in the AT-LDL level was significantly (P=0.020) lower in the Theracurmin® group compared with the placebo group. Conclusion Theracurmin® reduced levels of atherosclerotic AT-LDL, which may lead to the prevention of future cardiovascular events in mild COPD subjects. PMID:27616885

  20. Psychometric properties of the Physical Activity Scale for the Elderly in Chinese patients with COPD

    Science.gov (United States)

    Tao, Yan-xia; Wang, Lan; Dong, Xiao-yan; Zheng, Hong; Zheng, Ya-shu; Tang, Xing-yue; Zhao, Yue; Zhang, Qing

    2017-01-01

    Background For patients with COPD, physical activity (PA) is recommended as the core component of pulmonary rehabilitation, but there is lack of a validated questionnaire for assessing the PA effectively. Aim To evaluate the reliability and validity of the Chinese version of Physical Activity Scale for the Elderly (PASE-C) in patients with COPD. Methods A cross-sectional study was conducted with 167 outpatients aged 60 years or older with COPD. Test−retest reliability and internal consistency were calculated by intraclass correlation coefficient (ICC) and Cronbach’s coefficient α, respectively. Validity was evaluated by correlation with the International Physical Activity Questionnaire-Short (IPAQ-S), data of pedometer, Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), grip strength, and disease characteristics. Results The PASE-C had an excellent seven-day test−retest reliability (ICC=0.98) and an acceptable internal consistency (Cronbach’s α=0.71). The content validity was supported by an item-content validity index, a scale-content validity index/universal agreement, and a scale-content validity index/average value of 0.70–1, 0.70, and 0.93, respectively. Concurrent validity was tested by correlation with IPAQ-S (r=0.651). Criterion validity was confirmed by correlation with the walking steps (r=0.611) and energy expenditure (r=0.493). For construct validity, PASE-C had correlations with SES6 (r=0.396), HADS for depression (r=−0.234), seven subscales of SF-36 (r=0.182–0.525), grip strength (r=0.341), and disease characteristics including the duration of COPD (r=−0.215), modified British Medical Research Council scale (r=−0.354), forced expiratory volume in one second as percentage of predicted (r=0.307), and Global Initiative for Chronic Obstructive Lung Disease grade (r=−0.264), with a good construct validity (all P

  1. Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

    Science.gov (United States)

    2014-01-01

    Background Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better

  2. Influence of emphysema distribution on pulmonary function parameters in COPD patients

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    Helder Novais e Bastos

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the impact that the distribution of emphysema has on clinical and functional severity in patients with COPD. METHODS: The distribution of the emphysema was analyzed in COPD patients, who were classified according to a 5-point visual classification system of lung CT findings. We assessed the influence of emphysema distribution type on the clinical and functional presentation of COPD. We also evaluated hypoxemia after the six-minute walk test (6MWT and determined the six-minute walk distance (6MWD. RESULTS: Eighty-six patients were included. The mean age was 65.2 ± 12.2 years, 91.9% were male, and all but one were smokers (mean smoking history, 62.7 ± 38.4 pack-years. The emphysema distribution was categorized as obviously upper lung-predominant (type 1, in 36.0% of the patients; slightly upper lung-predominant (type 2, in 25.6%; homogeneous between the upper and lower lung (type 3, in 16.3%; and slightly lower lung-predominant (type 4, in 22.1%. Type 2 emphysema distribution was associated with lower FEV1, FVC, FEV1/FVC ratio, and DLCO. In comparison with the type 1 patients, the type 4 patients were more likely to have an FEV1 < 65% of the predicted value (OR = 6.91, 95% CI: 1.43-33.45; p = 0.016, a 6MWD < 350 m (OR = 6.36, 95% CI: 1.26-32.18; p = 0.025, and post-6MWT hypoxemia (OR = 32.66, 95% CI: 3.26-326.84; p = 0.003. The type 3 patients had a higher RV/TLC ratio, although the difference was not significant. CONCLUSIONS: The severity of COPD appears to be greater in type 4 patients, and type 3 patients tend to have greater hyperinflation. The distribution of emphysema could have a major impact on functional parameters and should be considered in the evaluation of COPD patients.

  3. COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

    Directory of Open Access Journals (Sweden)

    da Silva SMD

    2016-03-01

    Full Text Available Silvia Maria Doria da Silva, Ilma Aparecida Paschoal, Eduardo Mello De Capitani, Marcos Mello Moreira, Luciana Campanatti Palhares, Mônica Corso PereiraPneumology Service, Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP, Campinas, São Paulo, BrazilBackground: Computed tomography (CT phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2, Slope of phase 2 (Slp2, and Slope of phase 3 (Slp3 of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath.Objective: To investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables.Subjects and methods: Sixty-five patients with COPD Gold III–IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk test [6MWT], and VC. The presence and profusion of tomography findings were evaluated, and later, the patients were identified as having emphysema (EMP or airway disease (AWD phenotype. EMP and AWD groups were compared; tomography findings scores were evaluated versus spirometric, 6MWT, and VC variables.Results: Bronchiectasis was found in 33.8% and peribronchial thickening in 69.2% of the 65 patients. Structural findings of airways had no significant correlation with spirometric variables. Air trapping and EMP were strongly correlated with VC variables, but in opposite directions. There was some overlap between the EMP and AWD

  4. Correlation between frequency of hospitalization of patients with severe copd and severity indices

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    Eleni Gaki

    2011-01-01

    Full Text Available SUMMARY.Backgrou nd: Several parameters have been proposed as riskfactors for hospitalization of patients with chronic obstructivepulmonary disease (COPD. Objectives: The aim of this studywas to investigate the association between changes in parametersexpressing various different aspects of disease severity and thefrequency of hospitalization of patients with severe COPD withoutco-morbidities. Population and methods: Of 117 patients withsevere COPD recruited for prospective study, 74 completed 2-yearmonitoring and were classified into 2 groups according to their frequencyof hospitalization: Group A (n=39 ≤2 hospitalizations/year,Group B >2 hospitalizations/year (n=35. Parameters measured atbaseline and 2 years included: FEV1 % pred, FEV1/FVC ratio, ratio ofinspiratory capacity (IC to total lung capacity (TLC(IC/TLC, bodymass index (BMI, fat free mass index (FFMI, 6 minute walk distance(6MWD, the Borg dyspnoea scale before and after 6MWD, dyspnoeaaccording to the Medical Research Council (MRC scale, pH and8-isoprostane in exhaled breath condensate (EBC, serum levels ofC-reactive protein (CRP and fibrinogen, arterial blood gases, theBMI, airflow obstruction, dyspnoea, and exercise capacity (BODEindex and quality of life. Results: The patients with more frequenthospitalizations showed greater change in the baseline study variablesafter 2 years. The specific differences were loss of muscle mass,deterioration of airway obstruction, decrease in exercise capacity,increase in airways and systemic inflammation and impairment inquality of life. The most significant changes found to be associatedwith hospitalization frequency using a regression model were inCRP, 6MWD, fibrinogen, 8-isoprostane and BODE. Co nclusions:In this selected cohort of patients with severe COPD, increased hospitalizationfrequency was associated with changes in parametersexpressing deterioration in exercise capacity and in systemic andairways inflammation. Pneumon 2011, 24(2:164-170.

  5. Outcomes of a telemonitoring-based program (telEPOC) in frequently hospitalized COPD patients.

    Science.gov (United States)

    Esteban, Cristóbal; Moraza, Javier; Iriberri, Milagros; Aguirre, Urko; Goiria, Begoña; Quintana, José M; Aburto, Myriam; Capelastegui, Alberto

    2016-01-01

    The increasing prevalence of chronic diseases requires changes in health care delivery. In COPD, telemedicine appears to be a useful tool. Our objective was to evaluate the efficacy (in improving health care-resource use and clinical outcomes) of a telemonitoring-based program (telEPOC) in COPD patients with frequent hospitalizations. We conducted a nonrandomized observational study in an intervention cohort of 119 patients (Galdakao-Usansolo Hospital) and a control cohort of 78 patients (Cruces Hospital), followed up for 2 years (ClinicalTrials.gov identifier: NCT02528370). The inclusion criteria were two or more hospital admissions in the previous year or three or more admissions in the previous 2 years. The intervention group received telemonitoring plus education and controls usual care. Most participants were men (13% women), and the sample had a mean age of 70 years, forced expiratory volume in 1 second of 45%, Charlson comorbidity index score of 3.5, and BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index score of 4.1. In multivariate analysis, the intervention was independently related to lower rates of hospital admission (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.27-0.54; Ptelemonitoring and education was able to reduce the health care-resource use and stabilize the clinical condition of frequently admitted COPD patients.

  6. Effect of 6 Months of Balance Training During Pulmonary Rehabilitation in Patients With COPD.

    Science.gov (United States)

    Mkacher, Wajdi; Mekki, Marwa; Tabka, Zouhair; Trabelsi, Yassine

    2015-01-01

    Balance impairment is recognized as an important issue for patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the effect of balance training as part of pulmonary rehabilitation (PR) on balance in COPD patients. Patients were randomly assigned to an intervention or usual care group. The intervention group underwent balance training 3 times a week for 6 months in addition to the standard PR. The control group received 6 months of the standard PR program only. Balance was assessed by the Timed Up and Go (TUG), Tinetti, Berg Balance Scale (BBS), and the Unipodal Stance (UST) tests. Balance confidence was rated using the ABC scale. Exercise tolerance was determined using a 6-Minute Walk Test. Following the completion of PR, the intervention group showed improvement in all balance measures. Only TUG, ABC, and UST scores were improved in the usual care group (P Tinetti, BBS, and ABC scores (P score (P scores on balance tests in COPD patients.

  7. Methods for Assessing Expiratory Flow Limitation during Tidal Breathing in COPD Patients

    Directory of Open Access Journals (Sweden)

    Nickolaos G. Koulouris

    2012-01-01

    Full Text Available Patients with severe COPD often exhale along the same flow-volume curve during quite breathing as during forced expiratory vital capacity manoeuvre, and this has been taken as indicating expiratory flow limitation at rest (EFLT. Therefore, EFLT, namely, attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in GOLD III and IV stage in whom the latter symptoms are common. The existing up-to-date physiological methods for assessing expiratory flow limitation (EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure (NEP has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, non invasive, most practical, and accurate new technique.

  8. Gender Differences in Mortality and Clinical Expressions of Patients with COPD: The TORCH Experience

    DEFF Research Database (Denmark)

    Celli, Bartolome; Vestbo, Jörgen; Jenkins, Christine R;

    2010-01-01

    RATIONALE: There is limited knowledge regarding gender differences and outcomes in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES: Determine gender differences in survival, causes of death and patient-centered outcomes in the 3 year TORCH study. METHODS: 1,481 women and 4......,631 men with COPD were enrolled in TORCH, a trial comparing salmeterol 50 mug plus fluticasone propionate 500 mug bid (SFC) and each component individually. Causes of death were determined by an endpoint committee. Gender differences in survival were explored using a Cox's proportional hazards model...... SGRQ (51.3 vs. 48.7) and MRC score. During the study, 707 (15.3%) men and 168 (11.3%) women died. After adjusting for differences in baseline factors, the risk of dying was 16% higher in men than in women, however this was not statistically significant (hazard ratio 1.16 [95% CI 0.98, 1.39]). Causes...

  9. Resting energy expenditure and carbohydrate oxidation are higher in elderly patients with COPD: a case control study

    Directory of Open Access Journals (Sweden)

    Ramires Bruna

    2012-06-01

    Full Text Available Abstract Background Elderly patients with chronic obstructive pulmonary disease (COPD usually have a compromised nutritional status which is an independent predictor of morbidity and mortality. To know the Resting Energy Expenditure (REE and the substrate oxidation measurement is essential to prevent these complications. This study aimed to compare the REE, respiratory quotient (RQ and body composition between patients with and without COPD. Methods This case–control study assessed 20 patients with chronic obstructive pulmonary disease attending a pulmonary rehabilitation program. The group of subjects without COPD (control group consisted of 20 elderly patients attending a university gym, patients of a private service and a public healthy care. Consumption of oxygen (O2 and carbon dioxide (CO2 was determined by indirect calorimetry and used for calculating the resting energy expenditure and respiratory quotient. Body mass index (BMI and waist circumference (WC were also measured. Percentage of body fat (%BF, lean mass (kg and muscle mass (kg were determined by bioimpedance. The fat free mass index (FFMI and muscle mass index (MMI were then calculated. Results The COPD group had lower BMI than control (p = 0.02. However, WC, % BF, FFMI and MM-I did not differ between the groups. The COPD group had greater RQ (p = 0.01, REE (p = 0.009 and carbohydrate oxidation (p = 0.002. Conclusions Elderly patients with COPD had higher REE, RQ and carbohydrate oxidation than controls.

  10. Oxidative stress, redox signaling pathways, and autophagy in cachectic muscles of male patients with advanced COPD and lung cancer.

    Science.gov (United States)

    Puig-Vilanova, Ester; Rodriguez, Diego A; Lloreta, Josep; Ausin, Pilar; Pascual-Guardia, Sergio; Broquetas, Joan; Roca, Josep; Gea, Joaquim; Barreiro, Esther

    2015-02-01

    Muscle dysfunction and wasting are predictors of mortality in advanced COPD and malignancies. Redox imbalance and enhanced protein catabolism are underlying mechanisms in COPD. We hypothesized that the expression profile of several biological markers share similarities in patients with cachexia associated with either COPD or lung cancer (LC). In vastus lateralis of cachectic patients with either LC (n=10) or advanced COPD (n=16) and healthy controls (n=10), markers of redox balance, inflammation, proteolysis, autophagy, signaling pathways, mitochondrial function, muscle structure, and sarcomere damage were measured using laboratory and light and electron microscopy techniques. Systemic redox balance and inflammation were also determined. All subjects were clinically evaluated. Compared to controls, in both cachectic groups of patients, a similar expression profile of different biological markers was observed in their muscles: increased levels of muscle protein oxidation and ubiquitination (pmuscle structural abnormalities and sarcomere disruptions were significantly greater (pmuscles of both cachectic patient groups than in controls (pmuscles of cachectic COPD patients (pmuscle wasting and sarcomere disruption in patients with respiratory cachexia: LC and COPD.

  11. Characteristics of patients with COPD newly prescribed a long-acting bronchodilator: a retrospective cohort study

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    Wurst KE

    2014-09-01

    Full Text Available Keele E Wurst,1 Samantha St Laurent,1 Hana Mullerova,2 Kourtney J Davis3 1Worldwide Epidemiology, GlaxoSmithKline R&D, Research Triangle Park, NC, USA; 2Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK; 3Worldwide Epidemiology, GlaxoSmithKline R&D, Wavre, Belgium Introduction: This study aimed to characterize patients with chronic obstructive pulmonary disease (COPD newly prescribed a long-acting bronchodilator (LABD, and to assess changes in medication over 24 months. Methods: A cohort of patients with COPD aged ≥40 years newly prescribed an LABD between January 1, 2007 and December 31, 2009 were identified from the Truven Marketscan® Commercial Database (Truven Health Analytics, Ann Arbor, MI, USA and followed for 24 months. Inclusion criteria included no prior prescription for an LABD or inhaled corticosteroids for 12 months prior to the LABD index date (baseline. Patient characteristics were examined. As LABDs were mainly long-acting muscarinic antagonists (LAMAs, additions, switches, discontinuation, adherence to (medication possession ratio, and persistence (proportion of days covered with LAMA monotherapy were assessed for 24 months following the index date. Adherence and persistence with long-acting β2-agonists (LABAs were also assessed. Results: A cohort of 3,268 patients aged 40–65 years was identified (mean age 55.8 years, 48% male. LAMA monotherapy was prescribed to 93% of patients who received an LABD. During the 24-month follow-up, 16% of these patients added COPD medication, 10% switched to an inhaled corticosteroid-containing medication, and 25% discontinued after one LAMA prescription at baseline. Over 12 and 24 months, adherence to LAMA was 40% and 33%, respectively, and adherence to LABA was 29% and 24%, respectively. Over the same time periods, persistence with LAMA monotherapy was 19% and 15%, respectively, and persistence with LABA was 9% and 7%, respectively. Conclusion: Adherence to newly initiated LAMA

  12. Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients

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    Jeong SH

    2016-08-01

    Full Text Available Suk Hyeon Jeong,1,* Hyun Lee,1,* KC Carriere,2,3 Sun Hye Shin,1 Seong Mi Moon,1 Byeong-Ho Jeong,1 Won-Jung Koh,1 Hye Yun Park1 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 2Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada; 3Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea *These authors contributed equally to this work Background: Comorbidities have a serious impact on the frequent severe acute exacerbations (AEs in patients with COPD. Previous studies have used the Charlson comorbidity index to represent a conglomerate of comorbidities; however, the respective contribution of each coexisting disease to the frequent severe AEs remains unclear.Methods: A retrospective, observational study was performed in 77 COPD patients who experienced severe AE between January 2012 and December 2014 and had at least 1-year follow-up period from the date of admission for severe AE. We explored the incidence of frequent severe AEs (≥2 severe AEs during 1-year period in these patients and investigated COPD-related factors and comorbidities as potential risk factors of these exacerbations.Results: Out of 77 patients, 61 patients (79.2% had at least one comorbidity. During a 1-year follow-up period, 29 patients (37.7% experienced frequent severe AEs, approximately two-thirds (n=19 of which occurred within the first 90 days after admission. Compared with patients not experiencing frequent severe AEs, these patients were more likely to have poor lung function and receive home oxygen therapy and long-term oral steroids. In multiple logistic regression analysis, coexisting asthma (adjusted odds ratio [OR] =4.02, 95% confidence interval [CI] =1.30–12.46, P=0.016, home oxygen therapy (adjusted OR =9.39, 95% CI =1.60–55.30, P=0.013, and C-reactive protein

  13. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study

    OpenAIRE

    Korpershoek YJG; Vervoort SCJM; Nijssen LIT; Trappenburg JCA; Schuurmans MJ

    2016-01-01

    YJG Korpershoek,1,2 SCJM Vervoort,3 LIT Nijssen,2 JCA Trappenburg,2 MJ Schuurmans1,2 1Research Group Chronic Illnesses, Faculty of Health Care, University of Applied Sciences Utrecht, 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate...

  14. Cardiopulmonary response during whole-body vibration training in patients with severe COPD

    Science.gov (United States)

    Richter, Petra; Winterkamp, Sandra; Pfeifer, Michael; Nell, Christoph; Christle, Jeffrey W.; Kenn, Klaus

    2017-01-01

    Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE)/carbon dioxide production (V′CO2): 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236). Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min−1 to 1060±160 mL·min−1 with WBVT and 988±124 mL min−1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD. PMID:28326310

  15. Effects of beclomethasone/formoterol fixed combination on lung hyperinflation and dyspnea in COPD patients

    Directory of Open Access Journals (Sweden)

    Tzani P

    2011-10-01

    Full Text Available Panagiota Tzani1, Ernesto Crisafulli2, Gabriele Nicolini3, Marina Aiello1, Alfredo Chetta1, Enrico Maria Clini2, Dario Olivieri1 1Department of Clinical Sciences, University of Parma, Parma, Italy; 2Department of Oncology Haematology and Pulmonary Diseases, University of Modena and Ospedale Villa Pineta, Pavullo, Modena, Italy; 3Medical Affairs Department, Chiesi Farmaceutici SpA, Parma, Italy Background: Chronic obstructive pulmonary disease (COPD is a common disease characterized by airflow obstruction and lung hyperinflation leading to dyspnea and exercise capacity limitation. Objectives: The present study was designed to evaluate whether an extra-fine combination of beclomethasone and formoterol (BDP/F was effective in reducing air trapping in COPD patients with hyperinflation. Fluticasone salmeterol (FP/S combination treatment was the active control. Methods: COPD patients with forced expiratory volume in one second <65% and plethysmographic functional residual capacity ≥120% of predicted were randomized to a double-blind, double-dummy, 12-week, parallel group, treatment with either BDP/F 400/24 µg/day or FP/S 500/100 µg/day. Lung volumes were measured with full body plethysmography, and dyspnea was measured with transition dyspnea index. Results: Eighteen patients were evaluable for intention to treat. A significant reduction in air trapping and clinically meaningful improvement in transition dyspnea index total score was detected in the BDP/F group but not in the FP/S group. Functional residual capacity, residual volume (RV and total lung capacity significantly improved from baseline in the BDP/F group only. With regard to group comparison, a significantly greater reduction in RV was observed with BDP/F versus FP/S. Conclusion: BDP/F extra-fine combination is effective in reducing air trapping and dyspnea in COPD patients with lung hyperinflation. Keywords: small airways, chronic obstructive pulmonary disease, airflow obstruction 

  16. Effective smoking cessation interventions for COPD patients: a review of the evidence

    OpenAIRE

    Coronini-Cronberg, Sophie; Heffernan, Catherine; Robinson, Michael

    2011-01-01

    Objectives To review the effectiveness of smoking cessation interventions offered to chronic obstructive pulmonary disease (COPD) patients, and identify barriers to quitting experienced by them, so that a more effective service can be developed for this group. Design A rapid systematic literature review comprising computerized searches of electronic databases, hand searches and snowballing were used to identify both published and grey literature. Setting A review of studies undertaken in nort...

  17. Cardiopulmonary response during whole-body vibration training in patients with severe COPD

    Directory of Open Access Journals (Sweden)

    Rainer Gloeckl

    2017-03-01

    Full Text Available Several studies in patients with chronic obstructive pulmonary disease (COPD have shown that whole-body vibration training (WBVT has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE/carbon dioxide production (V′CO2: 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236. Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min−1 to 1060±160 mL·min−1 with WBVT and 988±124 mL min−1 without WBV (p=0.093. However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068, heart rate (109±13 bpm versus 110±15 bpm, p=0.513 or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279. Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD.

  18. Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD

    OpenAIRE

    Boixeda R; Almagro P; Díez-Manglano J; Cabrera FJ; Recio J; Martin-Garrido I; Soriano JB

    2015-01-01

    Ramon Boixeda,1 Pere Almagro,2,3 Jesús Díez-Manglano,4 Francisco Javier Cabrera,5 Jesús Recio,6 Isabel Martin-Garrido,7 Joan B Soriano8On behalf of the COPD and Pluripathological Patients Groups of the Spanish Internal Medicine Society 1Internal Medicine Department, Hospital de Mataró – CSDM, Universitat Autònoma de Barcelona, Mataró, Barcelona, Spain; 2Internal Medicine Department, Hospital Mútua de Terras...

  19. Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma

    Directory of Open Access Journals (Sweden)

    Kubo K

    2012-04-01

    Full Text Available Yoshiaki Kitaguchi1,*, Yoshimichi Komatsu1,*, Keisaku Fujimoto2, Masayuki Hanaoka1, Keishi Kubo1 1First Department of Internal Medicine, Shinshu University School of Medicine, 2Department of Biomedical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Japan *These authors contributed equally to this workBackground: Chronic obstructive pulmonary disease (COPD and asthma may overlap and converge in older people (overlap syndrome. It was hypothesized that patients with overlap syndrome may have different clinical characteristics such as sputum eosinophilia, and better responsiveness to treatment with inhaled corticosteroid (ICS.Methods: Sixty-three patients with stable COPD (forced expiratory volume in 1 second [FEV1] ≤80% underwent pulmonary function tests, including reversibility of airflow limitation, arterial blood gas analysis, analysis of inflammatory cells in induced sputum, and chest high-resolution computed tomography. The inclusion criteria for COPD patients with asthmatic symptoms included having asthmatic symptoms such as episodic breathlessness, wheezing, cough, and chest tightness worsening at night or in the early morning (COPD with asthma group. The clinical features of COPD patients with asthmatic symptoms were compared with those of COPD patients without asthmatic symptoms (COPD without asthma group.Results: The increases in FEV1 in response to treatment with ICS were significantly higher in the COPD with asthma group. The peripheral eosinophil counts and sputum eosinophil counts were significantly higher. The prevalence of patients with bronchial wall thickening on chest high-resolution computed tomography was significantly higher. A significant correlation was observed between the increases in FEV1 in response to treatment with ICS and sputum eosinophil counts, and between the increases in FEV1 in response to treatment with ICS and the grade of bronchial wall thickening. Receiver operating

  20. The effect of conjugated linoleic acid supplementation on the nutritional status of COPD patients

    Directory of Open Access Journals (Sweden)

    Ghobadi H

    2016-10-01

    Full Text Available Hassan Ghobadi,1 Somaieh Matin,2 Ali Nemati,3 Abbas Naghizadeh-baghi4 1Pulmonary Division, 2Internal Medicine Department, 3Biochemistry and Nutrition Department, 4Basic Sciences Department, Ardabil University of Medical Sciences, Ardabil, Iran Background: COPD patients are susceptible to anorexia, reduction of caloric intake, weight loss, and malnutrition. One of the possible mechanisms is the increase of inflammatory markers such as interleukin 1β (IL1β, is highly correlated with anorexia. Considering the anti-inflammatory role of conjugated linoleic acid (CLA, this study aimed to investigate the effect of CLA supplementation on the nutritional status of COPD patients.Patients and methods: In a double-blind clinical trial, 93 COPD patients who volunteered to participate in the study and who filled out a written consent form, were randomly assigned to control or supplementation groups. The patients in the supplementation group received 3.2 g of CLA on a daily basis for 6 weeks, while those in the control group received placebo on a daily basis for 6 weeks. For IL1β assessment, the patients’ anthropometric indices and appetite score were checked and their blood samples were collected both before and after the treatment. Moreover, in order to investigate the changes in the caloric intake trend during the study, their dietary intake levels were assessed using 24-hour dietary recall, 3 days a week at the onset, in the 4th week, and at the end of the study. Eventually, 90 patients completed the study.Results: The results demonstrated a significant increase in appetite score (P=0.001, average caloric intake (P=0.01, and macronutrient intake (P<0.05, while a significant decrease was observed in the serum level of IL1β among the patients of the supplementation group (P=0.008. Meanwhile, although the supplementation group’s body mass index was also higher on completion, compared to their own initial state as well as to that in the control

  1. Differences in Adherence and Non-Adherence Behaviour Patterns to Inhaler Devices Between COPD and Asthma Patients.

    Science.gov (United States)

    Plaza, Vicente; López-Viña, Antolín; Entrenas, Luis Manuel; Fernández-Rodríguez, Concepción; Melero, Carlos; Pérez-Llano, Luis; Gutiérrez-Pereyra, Fernando; Tarragona, Eduard; Palomino, Rosa; Cosio, Borja G

    2016-10-01

    Differences between COPD and asthma may also differentially affect adherence to inhaled drugs in each disease. We aimed to determine differences in behaviour patterns of adherence and non-adherence to inhaled therapy between patients with COPD and patients with asthma using the Test of Adherence to Inhalers (TAI) questionnaire. A total of 910 patients (55% with asthma, 45% with COPD) participated in a cross-sectional multicentre study. Data recorded included sociodemographics, education level, asthma or COPD history, TAI score, the Asthma Control Test (ACT), the COPD Assessment Test (CAT) and spirometry. Asthma patients were statistically significant less adherents, 140 (28%) vs. 201 (49%), and the pattern of non-adherence was more frequently erratic (66.8% vs. 47.8%) and deliberate (47.2% vs. 34.1%) than COPD patients; however unwitting non-adherence was more frequently observed in COPD group (31.2% vs. 22.8%). Moreover, taking together all sample studied, only being younger than 50 years of age (OR 1.88 [95% CI: 1.26-2.81]) and active working status (OR 1.45 [95% CI: 1.00-2.09]) were risk factors for non-adherence in the multivariate analysis, while having asthma remained in the limits of the significance (OR 1.44 [95%CI: 0.97-2.14]). Even though non-adherence to inhalers is more frequently observed in asthma than in COPD patients and exhibited a different non-adherence patterns, these differences are more likely to be related to sociodemographic characteristics. However, differences in non-adherence patterns should be considered when designing specific education programmes tailored to each disease.

  2. Home telemonitoring in COPD: a systematic review of methodologies and patients' adherence.

    Science.gov (United States)

    Cruz, Joana; Brooks, Dina; Marques, Alda

    2014-04-01

    This systematic review aimed to provide a comprehensive description of the methodologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease (COPD) and to explore patients' adherence and satisfaction with the use of telemonitoring systems. A literature search was performed from June to August and updated until December of 2012 on Medline, Embase, Web of Science and B-on databases using the following keywords: [tele(-)monitoring, tele(-)health, tele(-)homecare, tele(-)care, tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. References of all articles were also reviewed. Seventeen articles were included, 12 of them published from 2010 to the present. The methodologies were similar in the training provided to patients and in the data collection and transmission processes. However, differences in the type of technology used, telemonitoring duration and provision of prompts/feedback, were found. Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision. Nevertheless, they reported some difficulties in their use, which in some studies were related to lower compliance rates. Telemonitoring interventions are a relatively new field in COPD research. Findings suggest that these interventions, although promising, present some usability problems that need to be considered in future research. These adjustments are essential before the widespreading of telemonitoring. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial.

    Science.gov (United States)

    Ng, Bobby H P; Tsang, Hector W H; Jones, Alice Y M; So, C T; Mok, Thomas Y W

    2011-03-01

    The initial gain from a Pulmonary Rehabilitation Program (PRP) among patients with chronic obstructive pulmonary disease (COPD) begins to fade away 6 months after the completion of a rehabilitation program. One possible reason may be due to the poor compliance of the patients to the existing forms of home exercise program (e.g., walking, weight training activities, etc.). This study tested the efficacy of health qigong (HQG), a traditional Chinese exercise, as an adjunct home exercise program in optimizing the gains obtained from PRP until 6 months after discharge. This was a randomized controlled trial (RCT) on a mind-body exercise intervention. Eighty (80) patients with COPD receiving conventional PRP pulmonary rehabilitation program were randomized to the HQG intervention group (n = 40) and control group (n = 40). Assessments were undertaken by blinded assessors at baseline, discharge from training, and follow-up (FU) at 3 and 6 months. Primary outcomes involved functional capacity scales and secondary outcomes involved quality-of-life scales. Intention-to-treat analysis identified trends of improvement in all outcome measures in the HQG group, whereas lesser improvement and trends of deteriorations were identified in the control group. Ancillary analysis using a per-protocol method, however, identified significantly better improvements in functional capacity measures among the HQG at the 6-month FU. This RCT provided some evidence to support the positive effect of HQG as an adjunct home exercise for rehabilitation among people with COPD and to support further related research.

  4. Computed tomography assessment of airway dimensions with combined tiotropium and indacaterol therapy in COPD patients.

    Science.gov (United States)

    Hoshino, Makoto; Ohtawa, Junichi

    2014-04-01

    Combining a long-acting muscarinic antagonist with a long-acting β₂-agonist has been shown to be pharmacologically useful in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the effectiveness of the dual bronchodilator therapy on airway dimensions in COPD. Patients (n = 54) were randomly assigned to receive tiotropium (18 μg once daily), indacaterol (150 μg once daily) or tiotropium plus indacaterol for 16 weeks. Quantitative computed tomography (CT), pulmonary function and health status (St. George's Respiratory Questionnaire) were measured. Compared with tiotropium or indacaterol alone, combination therapy resulted in a significant decrease in percentage wall area (WA%) and wall thickness, corrected for body surface area, and an increase in luminal area (Ai/BSA). Concurrent treatment was superior to monotherapy in physiological indices, including forced vital capacity, forced expiratory volume in 1 s (FEV₁) and inspiratory capacity. The changes in WA% and Ai/BSA were significantly correlated with changes in FEV₁ (r = -0.44, P indacaterol is effective for COPD patients to promote reduction in airway wall thickness, bronchodilation, and improvements in lung function compared with a single inhaler. © 2014 The Authors. Respirology © 2014 Asian Pacific Society of Respirology.

  5. Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD.

    Science.gov (United States)

    Petrovic, Milos; Reiter, Michael; Zipko, Harald; Pohl, Wolfgang; Wanke, Theodor

    2012-01-01

    Dynamic hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD). Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT). The aim of the study was to analyze the effects of IMT on exercise capacity, dyspnea, and inspiratory fraction (IF) during exercise in patients with COPD. Daily inspiratory muscle strength and endurance training was performed for 8 weeks in 10 patients with COPD GOLD II and III. Ten patients with COPD II and III served as a control group. Maximal inspiratory pressure (Pimax) and endurance time during resistive breathing maneuvers (tlim) served as parameter for inspiratory muscle capacity. Before and after training, the patients performed an incremental symptom limited exercise test to maximum and a constant load test on a cycle ergometer at 75% of the peak work rate obtained in the pretraining incremental test. ET was defined as the duration of loaded pedaling. Following IMT, there was a statistically significant increase in inspiratory muscle performance of the Pimax from 7.75 ± 0.47 to 9.15 ± 0.73 kPa (P < 0.01) and of tlim from 348 ± 54 to 467 ± 58 seconds (P < 0.01). A significant increase in IF, indicating decreased dynamic hyperinflation, was observed during both exercise tests. Further, the ratio of breathing frequency to minute ventilation (bf/V'(E)) decreased significantly, indicating an improved breathing pattern. A significant decrease in perception of dyspnea was also measured. Peak work rate during the incremental cycle ergometer test remained constant, while ET during the constant load test increased significantly from 597.1 ± 80.8 seconds at baseline to 733.6 ± 74.3 seconds (P < 0.01). No significant changes during either exercise tests were measured in the control group. The present study found that in patients with COPD, IMT results in

  6. Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD

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    Petrovic M

    2012-11-01

    Full Text Available Milos Petrovic,1 Michael Reiter,2 Harald Zipko,3 Wolfgang Pohl,1 Theodor Wanke11Pulmonary Department and Karl Landsteiner Institute for Clinical and Experimental Pulmology, Hietzing Hospital, Vienna, Austria; 2Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria; 3FH Campus Vienna, University of Applied Sciences – Health Department, Vienna, AustriaAbstract: Dynamic hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD. Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT. The aim of the study was to analyze the effects of IMT on exercise capacity, dyspnea, and inspiratory fraction (IF during exercise in patients with COPD. Daily inspiratory muscle strength and endurance training was performed for 8 weeks in 10 patients with COPD GOLD II and III. Ten patients with COPD II and III served as a control group. Maximal inspiratory pressure (Pimax and endurance time during resistive breathing maneuvers (tlim served as parameter for inspiratory muscle capacity. Before and after training, the patients performed an incremental symptom limited exercise test to maximum and a constant load test on a cycle ergometer at 75% of the peak work rate obtained in the pretraining incremental test. ET was defined as the duration of loaded pedaling. Following IMT, there was a statistically significant increase in inspiratory muscle performance of the Pimax from 7.75 ± 0.47 to 9.15 ± 0.73 kPa (P < 0.01 and of tlim from 348 ± 54 to 467 ± 58 seconds (P < 0.01. A significant increase in IF, indicating decreased dynamic hyperinflation, was observed during both exercise tests. Further, the ratio of breathing frequency to minute ventilation (bf/V'E decreased significantly, indicating an improved breathing pattern. A significant decrease in

  7. ASSOCIATION OF BRONCHIECTASIS IN MODERATE TO SEVERE COPD PATIENTS ATTENDING KATURI MEDICAL COLLEGE HOSPITAL, GUNTUR FROM 2011 - 2013

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    Ramakrishna

    2015-03-01

    Full Text Available 50 patients of COPD having moderate to severe COPD were analysed with clinical, chest x - ray, CT scan, serum c reactive protein and albumin levels and microbiological study by sputum microscopy for culture and sensitivity and gram stain. Mean age of the patients was 63±7.87 years. Out of 50 Patients 45 were men ( 90% and the remaining were women ( 10%. Bronchiectasis was present in 30 patients ( 60%. H. influenza was the commonest organism isolated from sputum. Patients with bronchiectasis had significantly more exacerbations ( p=0.0001, severe airway obstruction ( p=0.037, higher crp levels ( p=0.0001 and low album In levels ( p=0.007. Nine patients ( 30% died in bronchiectasis group and only one patient ( 3.33% died in patients without bronchiectasis. Our study showed an elevated prevalence of bronchiectasis in patients with moderate to severe COPD and was associated with severe airway

  8. Influence of heart failure on resting lung volumes in patients with COPD.

    Science.gov (United States)

    Souza, Aline Soares de; Sperandio, Priscila Abreu; Mazzuco, Adriana; Alencar, Maria Clara; Arbex, Flávio Ferlin; Oliveira, Mayron Faria de; O'Donnell, Denis Eunan; Neder, José Alberto

    2016-01-01

    To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 - (end-inspiratory lung volume/TLC)]. This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p espirometria forçada e lenta e pletismografia de corpo inteiro. Os pacientes do grupo DPOC+ICC apresentaram maior VEF1, VEF1/CVF e VEF1/capacidade vital lenta; porém, todos os principais volumes "estáticos" - VR, capacidade residual funcional (CRF) e CPT - foram menores que aqueles do grupo DPOC (p < 0,05). A CRF diminuiu mais do que o VR, determinando assim menor volume de reserva expiratória no grupo DPOC+ICC que no grupo DPOC. Houve redução relativamente proporcional da CRF e da CPT nos dois grupos; logo, a CI também foi similar. Consequentemente, a fração inspiratória no grupo DPOC+ICC foi maior que no grupo DPOC (0,42 ± 0,10 vs. 0,36 ± 0,10; p < 0,05). Embora a razão volume corrente/CI fosse maior no grupo DPOC+ICC, a reserva inspiratória relativa foi notadamente similar entre os grupos (0,35 ± 0,09 vs. 0,44 ± 0,14; p < 0,05). Apesar dos efeitos restritivos da ICC, pacientes com DPOC+ICC apresentam elevações relativas dos limites inspiratórios (maior fração inspiratória). Entretanto, esses pacientes utilizam apenas parte desses limites, com o provável intuito de evitar reduções críticas da reserva inspiratória e maior trabalho elástico.

  9. Prescribing cycle training intensity from the six-minute walk test for patients with COPD

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    Luxton Nia

    2007-07-01

    Full Text Available Abstract Background Cycle training intensity for patients with chronic obstructive pulmonary disease (COPD is normally based on an incremental cycle test. Such tests are expensive and not readily available to clinicians. The six-minute walk test (6MWT has been proposed as an alternative to an incremental cycle test for this purpose, based on the findings of previous research that the peak oxygen consumption (VO2peak for the incremental cycle test and the 6MWT was equivalent in participants with COPD. A regression equation relating distance walked on the 6MWT and peak work rate (Wpeak on the incremental cycle test has been described. The aim of this study is to measure the physiological responses to constant load cycle exercise performed at an intensity of 60% Wpeak determined from the 6MWT in participants with stable COPD. Methods/Design This study is a prospective, repeated measures design. Thirty-five participants with stable COPD and mild to severe lung disease will be recruited from referrals to pulmonary rehabilitation. Subjects with co-morbidities limiting exercise performance will be excluded. Two 6MWTs will be performed. The better 6MWT will be used to calculate Wpeak for cycle exercise from a regression equation. After 30 minutes rest, subjects will perform ten minutes of constant-load cycle exercise at 60% of the calculated Wpeak. During all exercise, cardiorespiratory and metabolic data (Cosmed K4b2, dyspnoea and rate of perceived exertion (RPE will be recorded. The VO2 measured at the end of cycle exercise will be compared to VO2peak of the 6MWT (VO2bike/VO2walk. Pearson's correlation coefficient will be calculated for the relationship between VO2bike and VO2walk. A one-way analysis of variance (ANOVA, with Bonferroni correction, will be performed to determine whether the ratio of VO2bike/VO2walk is affected by disease severity. Discussion This novel study will measure the physiological responses to cycle exercise, in terms of VO2

  10. 沙丁胺醇雾化吸入治疗 COPD 患者的护理%Nursing care of COPD patients treated with inhalation of salbutamol

    Institute of Scientific and Technical Information of China (English)

    黄玉凤

    2013-01-01

    inhalation treatment nursing experience of 73 cases of COPD patients with salbutamol aerosol. In the course of treatment should pay attention to regulating the flow of oxygen; close observation and timely; adverse drug reaction; close observation of cough, asthma, sputum situation. The correct use of atomizer, atomization after the patients were encouraged to sputum discharge effectively.%采用沙丁胺醇雾化吸入治疗73例 COPD 患者的护理体会。在治疗过程中应注意调节氧气的流量;严密观察病情;及时发现药物的不良反应;密切观察咳嗽、气喘、咳痰情况。正确使用雾化吸入器,雾化结束后鼓励患者进行有效的排痰。

  11. POPE study: rationale and methodology of a study to phenotype patients with COPD in Central and Eastern Europe

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    Zbozinkova Z

    2016-03-01

    Full Text Available Zuzana Zbozinkova,1 Adam Barczyk,2 Ruzena Tkacova,3 Arschang Valipour,4 Neven Tudoric,5 Kirill Zykov,6 Attila Somfay,7 Marc Miravitlles,8 Vladimir Koblizek91Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; 2Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; 3Department of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia; 4Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Wien, Austria; 5School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia; 6Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia; 7Department of Pulmonology, University of Szeged, Deszk, Hungary; 8Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 9Department of Pneumology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech RepublicIntroduction: Chronic obstructive pulmonary disease (COPD constitutes a major health challenge in Central and Eastern European (CEE countries. However, clinical phenotypes, symptom load, and treatment habits of patients with COPD in CEE countries remain largely unknown. This paper provides a rationale for phenotyping COPD and describes the methodology of a large study in CEE.Methods/design: The POPE study is an international, multicenter, observational cross-sectional survey of patients with COPD in CEE. Participation in the study is offered to all consecutive outpatients with stable COPD in 84 centers across the CEE region if they fulfill the following criteria: age >40 years, smoking history ≥10 pack-years, a confirmed diagnosis of COPD with postbronchodilator FEV1/FVC ,0.7, and absence

  12. Is dynamometry able to infer the risk of muscle mass loss in patients with COPD?

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    Ramos D

    2015-07-01

    Full Text Available Dionei Ramos,1 Giovana Navarro Bertolini,1 Marceli Rocha Leite,1 Luiz Carlos Soares Carvalho Junior,1 Paula Roberta da Silva Pestana,1 Vanessa Ribeiro dos Santos,2 Ana Claudia de Souza Fortaleza,2 Fernanda Maria Machado Rodrigues,1 Ercy Mara Cipulo Ramos1 1Department of Physiotherapy, São Paulo State University, Presidente Prudente, Brazil; 2Department of Motricity Sciences, São Paulo State University, Rio Claro, Brazil Introduction: Sarcopenia is characterized by a progressive and generalized decrease of strength and muscle mass. Muscle mass loss is prevalent in patients with chronic obstructive pulmonary disease (COPD as a result of both the disease and aging. Some methods have been proposed to assess body composition (and therefore identify muscle mass loss in this population. Despite the high accuracy of some methods, they require sophisticated and costly equipment.Aim: The purpose of this study was to infer the occurrence of muscle mass loss measured by a sophisticated method (dual energy X-ray absorptiometry [DEXA] using a more simple and affordable equipment (dynamometer.Methods: Fifty-seven stable subjects with COPD were evaluated for anthropometric characteristics, lung function, functional exercise capacity, body composition, and peripheral muscle strength. A binary logistic regression model verified whether knee-extension strength (measured by dynamometry could infer muscle mass loss (from DEXA.Results: Patients with decreased knee-extension strength were 5.93 times more likely to have muscle mass loss, regardless of sex, disease stage, and functional exercise capacity (P=0.045.Conclusion: Knee-extension dynamometry was able to infer muscle mass loss in patients with COPD. Keywords: COPD, sarcopenia, peripheral muscle strength  

  13. Long-term efficacy of intensive cycle ergometer exercise training program for advanced COPD patients

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    Pothirat C

    2015-01-01

    Full Text Available Chaicharn Pothirat, Warawut Chaiwong, Nittaya Phetsuk, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Athavudh Deesomchok, Theerakorn Theerakittikul, Atikun Limsukon Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: Exercise training has been incorporated into the international guidelines for the treatment of chronic obstructive pulmonary disease (COPD. However, the long-term efficacy of the training program for patients with advanced COPD has never been evaluated in Thailand. Purpose: To determine the long-term efficacy of intensive cycle ergometer exercise program on various clinical parameters of patients with advanced COPD. Materials and methods: The patients with advanced COPD were separated into two groups: the intensive ergometer exercise program group and the control group. The clinical parameters of all the patients were assessed at baseline, every month for the first 3 months, and then every 3 months until they had completed the 24-month follow-up. Mann–Whitney U test was used to compare baseline mean differences between the groups. Repeated measure analysis was applied to determine the progress in all parameters during the entire follow-up period. Mean incase imputation method was applied to estimate the parameters of dropout cases. Results: A total of 41 patients were enrolled: 27 in the intensive ergometer exercise program group and 14 in the control group. The intensive cycle ergometer exercise program group showed statistically significant improvements in muscle strength (from month 1 till the end of the study, month 24, endurance time (from month 1 till the end of measurement, month 12 and clinically significant improvements in 6-minute walk distance (from month 2 until month 9, dyspnea severity by transitional dyspnea index (from month 1 till the end of the study, month 24, and quality of life (from month 1 till the end of

  14. Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD

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    Boixeda R

    2015-12-01

    Full Text Available Ramon Boixeda,1 Pere Almagro,2,3 Jesús Díez-Manglano,4 Francisco Javier Cabrera,5 Jesús Recio,6 Isabel Martin-Garrido,7 Joan B Soriano8On behalf of the COPD and Pluripathological Patients Groups of the Spanish Internal Medicine Society 1Internal Medicine Department, Hospital de Mataró – CSDM, Universitat Autònoma de Barcelona, Mataró, Barcelona, Spain; 2Internal Medicine Department, Hospital Mútua de Terrassa, Terrassa, 3Universitat de Barcelona, Barcelona, Spain; 4Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Zaragoza, Spain; 5Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; 6Internal Medicine Department, Hospital Vall d’Hebrón, Barcelona, Barcelona, Spain; 7Internal Medicine Department, Hospital Quirón San Camilo, Madrid, Madrid, Spain; 8Instituto de Investigación Hospital Universitario de la Princesa (IISP, Universidad Autónoma de Madrid, Cátedra UAM-Lindel, Madrid, Spain Objective: To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities.Patients and methods: The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded.Results: A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%. The isolation of Pseudomonas aeruginosa (30.7% was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV1 [P=0.005], and the BODEx index [P=0.009]; also with

  15. COPD is frequent in conditions of comorbidity in patients treated with various diseases in a university hospital

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    Akira Yamasaki

    2010-09-01

    Full Text Available Akira Yamasaki, Kiyoshi Hashimoto, Yasuyuki Hasegawa, Ryota Okazaki, Miki Yamamura, Tomoya Harada, Shizuka Ito, Soichiro Ishikawa, Hiroki Takami, Masanari Watanabe, Tadashi Igishi, Yuji Kawasaki, Eiji ShimizuDivision of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, JapanBackground: Chronic obstructive pulmonary disease (COPD is one of the leading causes of death and loss of disability-adjusted life-years. However, many COPD patients are not diagnosed because of underrecognition or underdiagnosis of this disease among many patients and physicians. One possible reason is underrecognition of spirometry. In this study, we examined the prevalence of airflow limitation and underlying disease in patients with airflow limitation.Methodology: From April 2006 to March 2008, patients who had spirometry performed were examined. The original disease of patients, pulmonary function tests, smoking status, and respiratory symptoms were surveyed from their medical records.Results: Of all patients who had spirometry performed, 15.8% showed airflow limitation (FEV1/FVC < 0.7. A variety of diseases were observed in patients with airflow limitation. Among all diseases, cardiovascular disease was the highest and gastrointestinal malignant disease had the second highest prevalence in patients with airflow limitation.Conclusion: COPD might be frequent in conditions of comorbidity in patients treated for various diseases. Attention should be paid to the possibility of co-existence of COPD and the influence of COPD on these patients.Keywords: airflow limitation, chronic obstructive pulmonary disease, comorbidity, spirometry, prevalence

  16. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients

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    Lim JU

    2017-08-01

    Full Text Available Jeong Uk Lim,1 Jae Ha Lee,2 Ju Sang Kim,3 Yong Il Hwang,4 Tae-Hyung Kim,5 Seong Yong Lim,6 Kwang Ha Yoo,7 Ki-Suck Jung,4 Young Kyoon Kim,8 Chin Kook Rhee8 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, College of Medicine, The Catholic University of Korea, 2Division of Pulmonology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, 3Division of Pulmonary Medicine, Department of Internal Medicine, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 5Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, 6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, 8Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Introduction: A low body mass index (BMI is associated with increased mortality and low health-related quality of life in patients with COPD. The Asia-Pacific classification of BMI has a lower cutoff for overweight and obese categories compared to the World Health Organization (WHO classification. The present study assessed patients with COPD among different BMI categories according to two BMI classification systems: WHO and Asia-Pacific. Patients and methods: Patients with COPD aged 40 years or older from the Korean COPD Subtype Study cohort were selected for evaluation

  17. Smoking, season, and detection of chlamydia pneumoniae DNA in clinically stable COPD patients

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    Goldsmith Charles H

    2002-07-01

    Full Text Available Abstract Background The prevalence and role of Chlamydia pneumoniae in chronic obstructive pulmonary disease (COPD remain unclear. Methods Peripheral blood mononuclear cells were obtained from 100 outpatients with smoking-related, clinically stable COPD, and induced sputum was obtained in 62 patients. Results Patients had mean age (standard deviation of 65.8 (10.7 years, mean forced expiratory volume in one second of 1.34 (0.61 L, and 61 (61.0% were male. C. pneumoniae nucleic acids were detected by nested polymerase chain reaction in 27 (27.0%. Current smoking (odds ratio {OR} = 2.6, 95% confidence interval {CI}: 1.1, 6.6, P = 0.04, season (November to April (OR = 3.6, 95% CI: 1.4, 9.2, P = 0.007, and chronic sputum production (OR = 6.4, 95% CI: 1.8, 23.2, P = 0.005 were associated with detection of C. pneumoniae DNA. Conclusions Prospective studies are needed to examine the role of C. pneumoniae nucleic acid detection in COPD disease symptoms and progression.

  18. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    Science.gov (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.

  19. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD?

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    Camiciottoli G

    2015-04-01

    Full Text Available Gianna Camiciottoli,1 Stefano Diciotti,2 Francesca Bigazzi,1 Simone Lombardo,3 Maurizio Bartolucci,4 Matteo Paoletti,1 Mario Mascalchi,3 Massimo Pistolesi1 1Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; 2Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi,” University of Bologna, Cesena, Italy; 3Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy; 4Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy Abstract: A substantial proportion of patients with chronic obstructive pulmonary disease (COPD develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory–expiratory low dose computed tomography (CT and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28 and in females (n=27. Women with a predominant conductive airway phenotype (n=10 showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001. Intrathoracic tracheal collapsibility was directly correlated with inspiratory–expiratory volume variation at CT and with forced expiratory volume (1 second, and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD

  20. Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD

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    Yilmaz Yelvar GD

    2016-06-01

    Full Text Available Gul Deniz Yilmaz Yelvar,1 Yasemin Çirak,2 Yasemin Parlak Demir,3 Murat Dalkilinç,1 Bülent Bozkurt4 1Department of Musculoskeletal Physiotherapy, 2Department of Cardiopulmonary Physiotherapy, 3Department of Neurological Rehabilitation, School of Physiotherapy and Rehabilitation, 4Department of Respiratory Medicine, Faculty of Medicine, Turgut Özal University, Ankara, Turkey Objective: The objective of this study was to investigate the immediate effect of manual therapy (MT on respiratory functions and inspiratory muscle strength in patients with COPD.Participants and methods: Thirty patients with severe COPD (eight females and 22 males; mean age 62.4±6.8 years referred to pulmonary physiotherapy were included in this study. The patients participated in a single session of MT to measure the short-term effects. The lung function was measured using a portable spirometer. An electronic pressure transducer was used to measure respiratory muscle strength. Heart rate, breathing frequency, and oxygen saturation were measured with a pulse oximeter. For fatigue and dyspnea perception, the modified Borg rating of perceived exertion scale was used. All measurements were taken before and immediately after the first MT session. The ease-of-breathing visual analog scale was used for rating patients’ symptoms subjectively during the MT session.Results: There was a significant improvement in the forced expiratory volume in the first second, forced vital capacity, and vital capacity values (P<0.05. The maximal inspiratory pressure and maximal expiratory pressure values increased significantly after MT, compared to the pre-MT session (P<0.05. There was a significant decrease in heart rate, respiratory rate (P<0.05, and dyspnea and fatigue perception (P<0.05.Conclusion: A single MT session immediately improved pulmonary function, inspiratory muscle strength, and oxygen saturation and reduced dyspnea, fatigue, and heart and respiratory rates in patients with

  1. The lungs need to be deflated: effects of glycopyrronium on lung hyperinflation in COPD patients.

    Science.gov (United States)

    Sanguinetti, Claudio M

    2014-04-01

    Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation caused by bronchial alterations, small airways disease and parenchymal destruction. In patients with COPD the structural and functional lung alterations can progress more or less rapidly from the initial small airways disease to an overt COPD where a severe expiratory flow limitation takes place. In these conditions, lung hyperinflation develops characterized by increase in functional residual capacity (FRC) and decrease in inspiratory capacity (IC). Thus, IC is an easy and reliable index to monitor lung hyperinflation and to assess the efficacy of bronchodilator drugs. When FRC increases, tidal volume (VT) is located in a more flatted upper part of the P -V curve of the respiratory system and respiratory muscles must sustain a greater elastic workload. Furthermore, due to inadequate time for expiration, there is a positive alveolar pressure at the end of expiration (PEEPi). This represents a further elastic workload for the inspiratory muscles. This impairment of ventilatory mechanics generates dyspnea that in most severely compromised patients occurs also for small efforts causing activity limitation and worst health-related quality of life (HRQoL). Due to these respiratory alterations, bronchodilators are the cornerstone of the long-term treatment of COPD in order to decrease airways resistances, lung hyperinflation and exacerbation rate, and improve patient's symptoms, exercise tolerance and health status. Long-acting antimuscarinic bronchodilators (LAMAs) have proven to be very useful in terms of lung deflation and exercise tolerance. Recently, new LAMAs with several positive characteristics have been introduced into clinical use among which glycopyrronium bromide has shown to be particularly effective. Glycopyrronium has a longer-lasting effect compared to other anticholinergic drugs, therefore it allows a single daily administration and facilitates the therapy of a

  2. The relationship between different diet quality indices and severity of airflow obstruction among COPD patients.

    Science.gov (United States)

    Yazdanpanah, Leila; Paknahad, Zamzam; Moosavi, Ali Javad; Maracy, Mohammad Reza; Zaker, Mohammad Masoud

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. Smoking is the number one cause of COPD; however, genetic, environmental and dietary factors contribute to the etiology of this disease. In this study, we assessed the association between three diet quality indices -the Healthy Eating Index-2005 (HEI-2005), the Healthy Eating Index-2010 (HEI-2010), and Mediterranean Diet Score (MED)- and the severity of disease in COPD patients. This cross-sectional study was performed at Rasul-e-Akram Hospital in Tehran on 121 COPD patients with the mean age of (SD) of 66.1(10.9) years. A pulmonary specialist diagnosed all participants based on a spirometry test. They were categorized into four groups (1, 2, 3, 4 stages of disease). Three diet quality indices, spirometry test and determination of disease severity were performed for all the participants. ANCOVA and Kruskal-Wallis test were used to assess the relationship between dietary quality indices and severity of the disease. The relationship between HEI-2010, HEI-2005, MED score, their components and lung function was assessed using a multiple linear regression analysis. All analyses were done using SPSS 18. Reduction of the Healthy Eating Index-2010 and MED score were observed along with the increase in disease severity, but they were not significant. The relationship between the three diet quality indices and lung function showed a significant association between MED score and Forced expiratory volume in one second (FEV1), The Forced Vital Capacity (FVC) (β=2.9, 95% CI (1.1, 4.8), p=0.002), (β=2.8, 95% CI (0.9, 4.8), p=0.007), respectively. Mediterranean dietary pattern and obtaining a better score on HEI-2010 diet were associated with a better lung function test.

  3. A validated disease specific prediction equation for resting metabolic rate in underweight patients with COPD

    Directory of Open Access Journals (Sweden)

    Anita Nordenson

    2010-09-01

    Full Text Available Anita Nordenson2, Anne Marie Grönberg1,2, Lena Hulthén1, Sven Larsson2, Frode Slinde11Department of Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; 2Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska Academy at University of Gothenburg, SwedenAbstract: Malnutrition is a serious condition in chronic obstructive pulmonary disease (COPD. Successful dietary intervention calls for calculations of resting metabolic rate (RMR. One disease-specific prediction equation for RMR exists based on mainly male patients. To construct a disease-specific equation for RMR based on measurements in underweight or weight-losing women and men with COPD, RMR was measured by indirect calorimetry in 30 women and 11 men with a diagnosis of COPD and body mass index <21 kg/m2. The following variables, possibly influencing RMR were measured: length, weight, middle upper arm circumference, triceps skinfold, body composition by dual energy x-ray absorptiometry and bioelectrical impedance, lung function, and markers of inflammation. Relations between RMR and measured variables were studied using univariate analysis according to Pearson. Gender and variables that were associated with RMR with a P value <0.15 were included in a forward multiple regression analysis. The best-fit multiple regression equation included only fat-free mass (FFM: RMR (kJ/day = 1856 + 76.0 FFM (kg. To conclude, FFM is the dominating factor influencing RMR. The developed equation can be used for prediction of RMR in underweight COPD patients.Keywords: pulmonary disease, chronic obstructive, basal metabolic rate, malnutrition, body composition

  4. Highly absorptive curcumin reduces serum atherosclerotic low-density lipoprotein levels in patients with mild COPD

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    Funamoto M

    2016-08-01

    Full Text Available Masafumi Funamoto,1,2 Yoichi Sunagawa,1–3 Yasufumi Katanasaka,1–3 Yusuke Miyazaki,1,2 Atsushi Imaizumi,4 Hideaki Kakeya,5 Hajime Yamakage,2 Noriko Satoh-Asahara,2 Maki Komiyama,2 Hiromichi Wada,2 Koji Hasegawa,2 Tatsuya Morimoto1–3 1Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, 2Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, 3Shizuoka General Hospital, Shizuoka, 4Theravalues Corporation, Kioicho, Tokyo, 5Department of System Chemotherapy and Molecular Sciences, Division of Bioinformatics and Chemical Genomics, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan Purpose: COPD is mainly caused by tobacco smoking and is associated with a high frequency of coronary artery disease. There is growing recognition that the inflammation in COPD is not only confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs, including blood vessels. α1-antitrypsin–low-density lipoprotein (AT-LDL complex is an oxidatively modified LDL that accelerates atherosclerosis. Curcumin, one of the best-investigated natural products, is a powerful antioxidant. However, the effects of curcumin on AT-LDL remain unknown. We hypothesized that Theracurmin®, a highly absorptive curcumin with improved bioavailability using a drug delivery system, ameliorates the inflammatory status in subjects with mild COPD.Patients and methods: This is a randomized, double-blind, parallel-group study. Subjects with stages I–II COPD according to the Japanese Respiratory Society criteria were randomly assigned to receive 90 mg Theracurmin® or placebo twice a day for 24 weeks, and changes in inflammatory parameters were evaluated.Results: There were no differences between the Theracurmin® and placebo groups in terms of age, male/female ratio, or body mass index in 39 evaluable subjects. The percent changes in blood pressure

  5. Air quality improvement during 2010 Asian games on blood coagulability in COPD patients.

    Science.gov (United States)

    Zhang, Zili; Wang, Jian; Guo, Meihua; Xiong, Mingmei; Zhou, Qipeng; Li, Defu; Shu, Jiaze; Lu, Wenju; Sun, Dejun

    2016-04-01

    Exposure to elevated levels of ambient air pollutants can lead to adverse cardiovascular effects. Perturbation of the coagulation balance is one of the potential mechanisms. However, evidence regarding the impact of improvement in air pollution on blood coagulability in COPD patients has never been reported. Coagulation processes are known to be of relevance for cardiovascular pathology; therefore, this study aimed to investigate the association of short-term air pollution exposure with blood marker (D-dimer) of coagulation. A 3-year (through the Asian game) cohort study based on the GIRD COPD Biobank Project was conducted in 36 COPD patients to estimate whether changes in measurements of D-dimer were associated with changes in pollutant concentration, comparing for 51 intervention days (November 1-December 21) in 2010 with the same calendar date of baseline years (2009 and 2011). Daily mean concentrations of air pollutants and meteorological variables were measured during the time. Daily PM10 decreased from 65.86 μg/m(3) during the baseline period to 62.63 μg/m(3) during the Asian Games period; daily NO2 decreased from 51.33 to 42.63 μg/m(3). SO2 and other weather variables did not differ substantially. We did not observe statistically significant improvements in D-dimer levels by 9.86% from a pre-Asian game mean of 917 ng/ml to a during-Asian game mean of 1007 ng/ml, platelet number by 11.66%, PH by -0.15%, PCO2 by -6.54%, and PO2 by -1.16%. In the post-Asian game period, when pollutant concentrations increased, most outcomes approximated pre-Asian game levels, and similar effects were also demonstrated in D-dimer, platelet number, and arterial blood gas. For D-dimer and platelet number, we observed statistically significant increases associated with increases in NO2 at lag 1-3 and SO2 at lag 2-4. For PH, PCO2, and PO2, any significant effect was not demonstrated. This study gives no support to the hypothesis that reduction in air pollution levels during the

  6. Sustained effects of integrated COPD management on health status and exercise capacity in primary care patients

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    2010-11-01

    Full Text Available Annemarije L Kruis1, Joan van Adrichem2, Magda R Erkelens2, Huub Scheepers3, Hans in ’t Veen4, Jean WM Muris5, Niels H Chavannes11Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Physiotherapy Center De Beweging, Rotterdam, 3Well-being Medical Center, Bocholtz-Simpelveld, 4Department of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, 5Department of General Practice, Maastricht University Medical Center, The NetherlandsBackground: Chronic obstructive pulmonary disease (COPD constitutes a growing health care problem worldwide. Integrated disease management (IDM of mild to moderate COPD patients has been demonstrated to improve exercise capacity and health status after one year, but long-term results are currently lacking in primary care.Methods: Long-term data from the Bocholtz study, a controlled clinical trial comparing the effects of IDM versus usual care on health status in 106 primary care COPD patients during 24 months of follow-up, were analyzed using the Clinical COPD Questionnaire (CCQ. In addition, the Kroonluchter IDM implementation program has treated 216 primary care patients with mild to moderate COPD since 2006. Longitudinal six-minute walking distance (6MWD results for patients reaching 24 months of follow-up were analyzed using paired-sample t-tests. In prespecified subgroup analyses, the differential effects of baseline CCQ score, Medical Research Council (MRC dyspnea score, and 6MWD were investigated.Results: In the Bocholtz study, subjects were of mean age 64 years, with an average postbronchodilator forced expiratory volume in one second (FEV1 of 63% predicted and an FEV1/forced vital capacity (FVC ratio of 0.56. No significant differences existed between groups at baseline. CCQ improved significantly and in a clinically relevant manner by 0.4 points over 24 months; effect sizes were doubled in patients with CCQ > 1 at baseline and tripled in patients with MRC dyspnea score

  7. The continuum of physiological impairment during treadmill walking in patients with mild-to-moderate COPD: patient characterization phase of a randomized clinical trial.

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    Denis E O'Donnell

    Full Text Available BACKGROUND: To have a better understanding of the mechanisms of exercise limitation in mild-to-moderate chronic obstructive pulmonary disease (COPD, we compared detailed respiratory physiology in patients with COPD and healthy age- and sex-matched controls. METHODS: Data were collected during the pre-treatment, patient characterization phase of a multicenter, randomized, double-blind, crossover study. Patients with COPD met Global Initiative for Chronic Obstructive Lung Disease (GOLD 1 or 2 spirometric criteria, were symptomatic, and had evidence of gas trapping during exercise. All participants completed pulmonary function and symptom-limited incremental treadmill exercise tests. RESULTS: Chronic activity-related dyspnea measured by Baseline Dyspnea Index was similarly increased in patients with GOLD 1 (n = 41 and 2 (n = 63 COPD compared with controls (n = 104. Plethysmographic lung volumes were increased and lung diffusing capacity was decreased in both GOLD groups. Peak oxygen uptake and work rate were reduced in both GOLD groups compared with controls (p<0.001. Submaximal ventilation, dyspnea, and leg discomfort ratings were higher for a given work rate in both GOLD groups compared with controls. Resting inspiratory capacity, peak ventilation, and tidal volume were reduced in patients with GOLD 2 COPD compared with patients with GOLD 1 COPD and controls (p<0.001. CONCLUSIONS: Lower exercise tolerance in patients with GOLD 1 and 2 COPD compared with controls was explained by greater mechanical abnormalities, greater ventilatory requirements, and increased subjective discomfort. Lower resting inspiratory capacity in patients with GOLD 2 COPD was associated with greater mechanical constraints and lower peak ventilation compared with patients with GOLD 1 COPD and controls. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01072396.

  8. Acute bronchodilator responsiveness and health outcomes in COPD patients in the UPLIFT trial

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    Decramer Marc

    2011-01-01

    Full Text Available Abstract Background Debate continues as to whether acute bronchodilator responsiveness (BDR predicts long-term outcomes in COPD. Furthermore, there is no consensus on a threshold for BDR. Methods At baseline and during the 4-year Understanding Potential Long-term Improvements in Function with Tiotropium (UPLIFT® trial, patients had spirometry performed before and after administration of ipratropium bromide 80 mcg and albuterol 400 mcg. Patients were split according to three BDR thresholds: ≥12% + ≥200 mL above baseline (criterion A, ≥15% above baseline (criterion B; and ≥10% absolute increase in percent predicted FEV1 values (criterion C. Several outcomes (pre-dose spirometry, exacerbations, St. George's Respiratory Questionnaire [SGRQ] total score were assessed according to presence or absence of BDR in the treatment groups. Results 5783 of 5993 randomized patients had evaluable pre- and post-bronchodilator spirometry at baseline. Mean age (SD was 64 (8 years, with 75% men, mean post-bronchodilator FEV1 1.33 ± 0.44 L (47.6 ± 12.7% predicted and 30% current smokers. At baseline, 52%, 66%, and 39% of patients had acute BDR using criterion A, B, and C, respectively. The presence of BDR was variable at follow-up visits. Statistically significant improvements in spirometry and health outcomes occurred with tiotropium regardless of the baseline BDR or criterion used. Conclusions A large proportion of COPD patients demonstrate significant acute BDR. BDR in these patients is variable over time and differs according to the criterion used. BDR status at baseline does not predict long-term response to tiotropium. Assessment of acute BDR should not be used as a decision-making tool when prescribing tiotropium to patients with COPD.

  9. Effect of a network system for providing proper inhalation technique by community pharmacists on clinical outcomes in COPD patients

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    Takemura M

    2013-05-01

    Full Text Available Masaya Takemura,1 Katsumi Mitsui,2 Masako Ido,2 Masataka Matsumoto,1 Misuzu Koyama,3 Daiki Inoue,1 Kazufumi Takamatsu,1 Ryo Itotani,1 Manabu Ishitoko,1 Shinko Suzuki,1 Kensaku Aihara,1 Minoru Sakuramoto,1 Hitoshi Kagioka,1 Motonari Fukui11Respiratory Disease Center, Kitano-Hospital, the Tazuke Kofukai Medical Research Institute, Osaka, Japan; 2Division of Pharmacy, Kitano-Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan; 3Kita-ku Pharmaceutical Association, Osaka, JapanIntroduction: Nonadherence to inhalation therapy is very common in patients with chronic obstructive pulmonary disease (COPD. Few data are available to support the role of community pharmacists in optimizing inhalation therapy in COPD patients. Since 2007, the Kitano Hospital and the Kita-ku Pharmaceutical Association have provided a network system for delivering correct inhalation techniques through certified community pharmacists. The effects of this network system on clinical outcomes in COPD patients were examined.Methods: A total of 88 consecutive outpatients with COPD at baseline and 82 of those 4 years later were recruited from the respiratory clinic of Kitano Hospital Medical Research Institute. Measurements included the frequency of COPD exacerbations, patients’ adherence to inhalation therapy using a five-point Likert scale questionnaire, and patients’ health status both prior to this system and 4 years later.Results: Usable information was obtained from 55 patients with COPD at baseline, and from 51 patients 4 years later. Compared with baseline values, a significant decrease was observed in the frequency of COPD exacerbations (1.5 ± 1.6 versus 0.8 ± 1.4 times/year, P = 0.017. Adherence to the inhalation regimen increased significantly (4.1 ± 0.7 versus 4.4 ± 0.8, P = 0.024, but health status was unchanged. At 4 years, of 51 COPD patients, 39 (76% patients who visited the certified pharmacies showed significantly higher medication adherence

  10. A unique protein profile of peripheral neutrophils from COPD patients does not reflect cytokine-induced protein profiles of neutrophils in vitro

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    Koenderman Leo

    2011-09-01

    Full Text Available Abstract Background Inflammation, both local and systemic, is a hallmark of chronic obstructive pulmonary disease (COPD. Inflammatory mediators such as TNFα and GM-CSF are secreted by lung epithelium, alveolar macrophages and other inflammatory cells and are thought to be important contributors in the pathogenesis of COPD. Indeed, neutrophils are activated by these cytokines and these cells are one of the major inflammatory cell types recruited to the pulmonary compartment of COPD patients. Furthermore, these inflammatory mediators are found in the peripheral blood of COPD patients and, therefore, we hypothesized that TNFα/GM-CSF-induced protein profiles can be found in peripheral neutrophils of COPD patients. Methods Using fluorescence 2-dimensional difference gel electrophoresis we investigated differentially regulated proteins in peripheral neutrophils from COPD patients and healthy age-matched control subjects. Furthermore, protein profiles from COPD patients were compared with those of neutrophils of healthy age-matched controls that were stimulated with TNFα and/or GM-CSF in vitro. Protein gels were compared using DeCyder 7.0 software. Results We identified 7 significantly regulated protein spots between peripheral neutrophils from COPD patients and age-matched healthy control subjects. Stimulation of peripheral neutrophils with TNFα, GM-CSF or TNFα + GM-CSF in vitro resulted in 13, 20 and 22 regulated protein spots, respectively. However, these cytokine-induced protein differences did not correspond with the protein differences found in neutrophils from COPD patients. Conclusion These results show that neutrophils from COPD patients have a unique protein profile compared to neutrophils from healthy age-matched controls. Furthermore, the neutrophil profiles of COPD patients do not reflect putative dominant signals induced by TNFα, GM-CSF or their combination. Our results indicate that systemic neutrophil responses in COPD patients

  11. Investigation of airways using MDCT for visual and quantitative assessment in COPD patients

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    Pierre-Yves Brillet

    2008-03-01

    Full Text Available Pierre-Yves Brillet1, Catalin I Fetita2, Amaury Saragaglia2, Anne-Laure Brun3, Catherine Beigelman-Aubry3, Françoise Prêteux2, Philippe A Grenier31Department of Radiology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Université Léonard de Vinci–Paris Nord, EA 2361, Bobigny, France; 2ARTEMIS Department, Institut National des Télécommunications, Université Paris V, Evry, France; 3Department of Radiology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, FranceAbstract: Multidetector computed tomography (MDCT acquisition during a single breath hold using thin collimation provides high resolution volumetric data set permitting multiplanar and three dimensional reconstruction of the proximal airways. In chronic obstructive pulmonary disease (COPD patients, this technique provides an accurate assessment of bronchial wall thickening, tracheobronchial deformation, outpouchings reflecting dilatation of the submucous glands, tracheobronchomalacia, and expiratory air trapping. New software developed to segment adequately the lumen and walls of the airways on MDCT scans allows quantitative assessment of the airway dimensions which has shown to be reliable in clinical practice. This technique can become important in longitudinal studies of the pathogenesis of COPD, and in the assessment of therapeutic interventions.Keywords: COPD – tracheobronchial tree, multidetector CT – airway remodeling, tracheobronchomalacia

  12. Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study

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    Fleehart S

    2014-12-01

    Full Text Available Sara Fleehart,1,* Vincent S Fan,2,3,* Huong Q Nguyen,4 Jungeun Lee,1 Ruth Kohen,3 Jerald R Herting,5 Gustavo Matute-Bello,2,3 Sandra G Adams,6,7 Genevieve Pagalilauan,3 Soo Borson3 1School of Nursing, University of Washington, Seattle, WA, USA; 2VAPuget Sound Health Care Center, Seattle, WA, USA; 3School of Medicine, University of Washington, Seattle, WA, USA; 4Reseach and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; 5Department of Sociology, University of Washington, Seattle, WA, USA; 6School of Medicine, University of Texas Health Science Center; 7South Texas Veterans Health Care System, San Antonio, TX, USA *These authors contributed equally to this paper Purpose: The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD. Patients and methods: We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9, which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment. Results: Of 202 participants, 121 (60% had depressive symptoms (PHQ ≥6; 51 (25% had a PHQ-9 ≥10, indicating a high likelihood of current major depression; and 22 (11% reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004; had worse dyspnea (P=0.009, depression (P<0.001, and anxiety (P=0.003; and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P<0.001 and more hospitalizations for COPD exacerbations (P=0.03 but had similar

  13. Outcome at three months of COPD patients with acute hypercapnic respiratory failure treated with NPPV in an Acute Medicine Ward

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    Fabrizio Vincenti

    2011-03-01

    Full Text Available Non invasive positive pressure ventilation (NPPV is increasingly used for patients with hypercapnic respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease (COPD. NPPV has been shown to improve arterial blood gas tensions and dyspnoea and to prevent the need for intubation in patients admitted to hospital with an exacerbation of COPD associated with respiratory acidosis. Although advantages of NPPV over conventional treatment have been convincingly documented in the short period, there are fewer data as to the outcomes following hospital discharge. We have undertaken a prospective descriptive study to obtain comprehensive data on the in hospital and 3 month outcomes of a cohort of 57 COPD patients treated with NPPV for acute hypercapnic respiratory failure as a first intervention in addition to usual medical care. Patients with a COPD exacerbation had better outcomes than patients with COPD complicated by other acute conditions. Pneumonia was specifically associated with a higher inhospital risk of death. In our series about one in four patients with an indicator of previous severe respiratory disease (past admission for acute respiratory failure, previous use of NPPV, long term oxygen therapy or home NPPV was dead at three months after discharge and almost one in two was dead or had been readmitted. On the contrary, patients without indicators of previous severe respiratory disease benefited from NPPV during an acute episode of respiratory failure and had a chance of approximately 80% of being alive and free from recurrence at three months.

  14. Association of plasma adiponectin levels with cellular hydration state measured using bioelectrical impedance analysis in patients with COPD

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    Yoshikawa T

    2012-08-01

    Full Text Available Takahiro Yoshikawa,1 Hiroshi Kanazawa21Department of Sports Medicine, Osaka City University Graduate School of Medicine, 2Department of Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, JapanBackground: It is widely recognized that chronic obstructive pulmonary disease (COPD includes a variety of extra pulmonary complications and comorbidities. Recently, adiponectin was shown to regulate cellular metabolism in humans. Cellular hydration state is affected by a variety of hormonal factors and regulates cellular metabolic state. Therefore, this study was designed to determine whether adiponectin is a possible factor involved in cellular hydration state in COPD.Methods: Thirty patients with COPD and 41 age-matched controls participated in the study. Plasma levels of total and high molecular weight (HMW adiponectin were measured and anthropometry and pulmonary function tests were conducted. Intracellular water (ICW, extracellular water (ECW, and ECW/ICW ratio, which are parameters of cellular hydration state, were measured using bioelectrical impedance analysis.Results: Higher levels of total and HMW adiponectin in plasma were found in patients with COPD compared with levels in controls. A significant inverse correlation was observed between body mass index and plasma levels of total and HMW adiponectin in the control group. However, this significant correlation was not observed in patients with COPD. The plasma levels of total and HMW adiponectin were also not significantly correlated with any pulmonary function parameters in patients with COPD. Regarding the state of cellular hydration, the plasma levels of total adiponectin were inversely correlated with the ECW/ICW ratio and positively with ICW values in patients with COPD. Moreover, closer correlations were found between these parameters and plasma HMW adiponectin levels.Conclusion: The results of the present study suggest a novel association of the plasma

  15. [Inhaled corticosteroids for COPD

    NARCIS (Netherlands)

    Dekhuijzen, P.N.R.

    2003-01-01

    Over 60% of patients with COPD are treated with inhaled corticosteroids (ICS), even though their use is still subject to debate. The inflammatory process in the lungs of patients with COPD is dominated by macrophages, CD8+ T-lymphocytes, neutrophilic granulocytes and mast cells, as well as an increa

  16. Teleconsultation with discharged elderly patients with severe COPD

    DEFF Research Database (Denmark)

    Sorknæs, Anne Dichmann; Hounsgaard, Lise; Olesen, Finn

    fieldwork, focusing on telecare consultations between specialist nurses and patients. Study findings show that patients and nurses alike consider technology-mediated nursing consultations as qualified care, enabling a close relationship between patient and nurse. Technological mediation of nursing practices...... changes the way nurses perform and it also changes their professional identity. The nurses amplify their audio-visual perceptions, communicative skills and by including the patient as their assistant. Correspondingly, their patients take on an active role in observation and measurement of their condition......Telemedicine is increasingly being introduced with the overall expectation that it can solve some of the basic challenges faced by the health system regarding a growing number of chronically ill patients with several service needs. This article focuses on Danish hospital staff nurses...

  17. Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

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    Titlestad IL

    2013-04-01

    Full Text Available Ingrid L Titlestad,1 Annmarie T Lassen,2 Jørgen Vestbo1,3 1Department of Respiratory Medicine, 2Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark; 3Respiratory Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK Abstract: Implementation of noninvasive ventilation (NIV as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomized controlled trials show lowered mortality rates in highly selected patients with acute exacerbation and respiratory failure, there are only few reports on long-term survival after receiving NIV. We present long-term all-cause mortality data from patients receiving NIV for the first time. Method: Data from medical records were retrospectively retrieved from all patients receiving NIV for the first time after being admitted acutely to an acute medical ward and further transfer to a respiratory ward with respiratory failure and a diagnosis of COPD in the period January 1, 2005 to December 31, 2007; patients were followed until January 2012. Demographic data collected included age, sex, diagnoses at discharge, and, when present, FEV1; a “not-to-intubate” order was also registered when listed. Results: In total, 253 patients (143 female, 110 male received NIV for the first time. The median age was 72 years (range 46–91 years. The 30-day mortality rate was 29.3%. The 5-year survival rate was 23.7%. Women showed a trend towards better survival than men (25.7% vs 19.2%, P = 0.25, and the trend was even more pronounced for patients with COPD. Conclusion: The mortality rate of patients receiving NIV is high, as expected in a real-life setting, but with a 5-year survival rate

  18. Tiotropium bromide in the routine care of GOLD stage II COPD patients: a pharmaeconomic evaluation

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    Orietta Zaniolo

    2011-06-01

    Full Text Available Background: a secondary pre-specified analysis of the UPLIFT cohort demonstrated that the inclusion of tiotropium bromide in the routine care of GOLD stage II (moderate chronic obstructive pulmonary disease (COPD patients is associated with stronger improvements of survival, quality of life, and exacerbation rate than those shown in the total cohort; in this subgroup, tiotropium furthermore induces a significant reduction in the rate of FEV1 decline.Objective: to adapt the Spiriva® model, originally built to evaluate cost-effectiveness of tiotropium inclusion in the general COPD population, to GOLD II patients.Methods: the Spiriva® model is a probabilistic Markov patient-level simulation developed over a lifetime horizon to compare outcomes associated with the inclusion of tiotropium in routine care (RC for COPD treatment with those obtained with RC alone. Patients are characterised by gender, age, height, smoking status and FEV1. Model structure and sources have been maintained unvaried, except for demographic characteristics, specific for GOLD II patients, as extrapolated from an Italian observational study, and tiotropium efficacy, based on the secondary analysis of GOLD II UPLIFT patients. As in the original model, only direct health care costs are considered.Results: patients treated with tiotropium on average (95% CI gain 0.70 (0.00/7.23 LYs or 0.77 (0.02/4.67 QALYs compared to RC. The incremental lifetime cost is € 3,520 (-6,391/26,686, meaning that the incremental cost required to gain a QALY (incremental cost-effectiveness ratio – ICER is equal to € 4,548. Sensitivity analysis shows that tiotropium has a 50% probability of being cost-effective for a willingness-to-pay (WTP around 4,600 €/QALY; 100% probability is achieved with a WTP of € 9,300.Conclusions: the adoption of a strategy based on the inclusion of tiotropium from the early COPD stages represents good value for money in Italy, as the ICER estimated for GOLD II

  19. Prevalence of blood eosinophilia in hospitalized patients with acute exacerbation of COPD.

    Science.gov (United States)

    Hasegawa, Kohei; Camargo, Carlos A

    2016-05-01

    In this cohort of 3084 patients hospitalized for acute exacerbation of COPD (AECOPD), we found that 17% had blood eosinophilia (≥300 cells/μL); the use of an alternative cut-off level (≥2%) demonstrated that 40% had elevated eosinophil count. Patients with eosinophilia had higher frequency of readmission for AECOPD during 1-year follow-up period. This is the first study to investigate the prevalence of eosinophilia among inpatients with AECOPD--the population with the highest morbidity and health-care utilization. © 2015 Asian Pacific Society of Respirology.

  20. Psychometric properties of the Physical Activity Scale for the Elderly in Chinese patients with COPD

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    Tao YX

    2016-12-01

    Full Text Available Yan-xia Tao,1,* Lan Wang,1,* Xiao-yan Dong,1 Hong Zheng,2 Ya-shu Zheng,2 Xing-yue Tang,1 Yue Zhao,1 Qing Zhang1 1School of Nursing, Tianjin Medical University, 2Department of Respiratory Care, Tianjin First Center Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work Background: For patients with COPD, physical activity (PA is recommended as the core component of pulmonary rehabilitation, but there is lack of a validated questionnaire for assessing the PA effectively. Aim: To evaluate the reliability and validity of the Chinese version of Physical Activity Scale for the Elderly (PASE-C in patients with COPD. Methods: A cross-sectional study was conducted with 167 outpatients aged 60 years or older with COPD. Test-retest reliability and internal consistency were calculated by intraclass correlation coefficient (ICC and Cronbach’s coefficient α, respectively. Validity was evaluated by correlation with the International Physical Activity Questionnaire-Short (IPAQ-S, data of pedometer, Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6, Hospital Anxiety and Depression Scale (HADS, Medical Outcomes Study 36-Item Short Form Health Survey (SF-36, grip strength, and disease characteristics. Results: The PASE-C had an excellent seven-day test-retest reliability (ICC=0.98 and an acceptable internal consistency (Cronbach’s α=0.71. The content validity was supported by an item-content validity index, a scale-content validity index/universal agreement, and a scale-content validity index/average value of 0.70-1, 0.70, and 0.93, respectively. Concurrent validity was tested by correlation with IPAQ-S (r=0.651. Criterion validity was confirmed by correlation with the walking steps (r=0.611 and energy expenditure (r=0.493. For construct validity, PASE-C had correlations with SES6 (r=0.396, HADS for depression (r=-0.234, seven subscales of SF-36 (r=0.182-0.525, grip strength (r=0.341, and disease

  1. Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

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    Thorpe O

    2014-01-01

    Full Text Available Olivia Thorpe, Saravana Kumar, Kylie JohnstonInternational Centre for Allied Health Evidence, The Samson Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA, AustraliaBackground: Chronic obstructive pulmonary disease (COPD is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD.Methods: This study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD.Results: A plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness environment-related (weather, transport, and finance, and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and "feeling better".Conclusion: This research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is

  2. Nutritional status, dietary energy intake and the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Hallin, Runa; Koivisto-Hursti, Ulla-Kaisa; Lindberg, Eva; Janson, Christer

    2006-03-01

    Loss of body weight, as a result of imbalance between increased energy demand and/or reduced dietary intake, is a common problem in patients with COPD. The aim of this investigation was to examine the relationship between nutritional intake, change in body weight and the risk of exacerbation in patients with COPD. The study comprised 41 patients who were hospitalised because of an exacerbation of COPD. The follow-up period was 12 months. Weight, height and lung function were measured at baseline. At the 12-month follow-up, weight change and current weight were assessed by an interview and nutritional intake was recorded in a food diary for 7 days. An acute exacerbation was defined as having been admitted to hospital and/or making an emergency visit to hospital, due to COPD during the follow-up period. At baseline, 24% of the patients were underweight (body mass index (BMI)25 kg/m2). Energy intake was lower than the calculated energy demand for all groups. During the follow-up period, 24 of the 41 patients had an exacerbation. A low BMI at inclusion and weight loss during the follow-up period were independent risk factors for having an exacerbation (P=0.003 and 0.006, respectively). We conclude that, in patients who are hospitalised because of COPD, underweight and weight loss during the follow-up period are related to a higher risk of having new exacerbations.

  3. A two-year evaluation of the 'real life' impact of COPD on patients in Germany: The DACCORD observational study.

    Science.gov (United States)

    Kardos, Peter; Vogelmeier, Claus; Worth, Heinrich; Buhl, Roland; Lossi, Nadine S; Mailänder, Claudia; Criée, Carl-Peter

    2017-03-01

    DACCORD is an observational, non-interventional study being conducted in German primary and secondary care centres. The study aims to describe the impact of disease (including exacerbations) and treatments over 2 years on 'real-life' patients with chronic obstructive pulmonary disease (COPD). Patients had a clinical and spirometry diagnosis of COPD, were aged ≥40 years and, on recruitment, were initiating or changing COPD maintenance medication. The only exclusion criteria were asthma and randomised clinical trial participation. Exacerbations data were collected every 3 months. COPD medication, COPD Assessment Test (CAT) and forced expiratory volume in 1 s (FEV1) were recorded at baseline and after 1 and 2 years. A total of 6122 patients were recruited, 3137 (51.2%) of whom completed the 2-year visit. The mean age of these patients was 65.6 years, 59% were male, 69% had mild or moderate airflow limitation, and their mean COPD Assessment Test (CAT) total score was 20.3. Overall, there was a trend towards decreasing COPD exacerbation rates over the 2-year follow-up period, with rates of 0.390 during Year 1 and 0.347 during Year 2. Rates were lower in patients with no exacerbation during the 6 months prior to entry (0.263 and 0.251 during Years 1 and 2, respectively), with 51.6% of patients having no exacerbation during the 6 months prior to entry and over the 2-year follow-up. Approximately 50% of the overall population experienced a clinically relevant improvement from baseline in CAT total score at Year 1 and 2. When assessed by treatment class (or classes), persistence to medication was high (77.8% in Year 1 and 71.4% in Year 2). Overall, the 2-year follow-up data from DACCORD suggest that for most patients with COPD exacerbations are a rare event. For the majority of patients, the focus should be on managing symptoms, and the impact that these symptoms have on their daily lives. Even for those patients who do exacerbate, although prevention of exacerbations is

  4. Evaluation of body composition in COPD patients using multifrequency bioelectrical impedance analysis

    Directory of Open Access Journals (Sweden)

    de Blasio F

    2016-09-01

    Full Text Available Francesca de Blasio,1 Francesco de Blasio,2,3 Giulia Miracco Berlingieri,2 Andrea Bianco,3,4 Marta La Greca,1 Frits M E Franssen,5 Luca Scalfi1 1Department of Public Health, Medical School, “Federico II” University of Naples, 2Respiratory Medicine and Pulmonary Rehabilitation Section, Clinic Center, Private Hospital, Naples, 3Department of Medicine and Health Sciences “V Tiberio”, University of Molise, Campobasso, 4Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy; 5Department of Research and Education, CIRO, Horn, the NetherlandsBackground: Multifrequency bioelectrical impedance analysis (MF-BIA is a technique that measures body impedance (Z at different frequencies (5, 10, 50, 100, and 250 kHz. Body composition may be estimated using empirical equations, which include BIA variables or, alternatively, raw BIA data may provide direct information on water distribution and muscle quality.Objectives: To compare raw MF-BIA data between COPD patients and controls and to study their relationship with respiratory and functional parameters in COPD patients.Methods: MF-BIA was performed (Human Im-Touch analyzer in 212 COPD patients and 115 age- and BMI-matched controls. Fat-free mass (FFM and fat mass were estimated from BIA data, and low- to high-frequency (5 kHz/250 kHz impedance ratio was calculated. Physical fitness, lung function and respiratory muscle strength were also assessed in COPD patients.Results: After adjusting for age, weight, and body mass index, FFM and the 5/250 impedance ratio were lower in COPD patients (P<0.001 and were negatively affected by disease severity. In both male and female patients, the 5/250 impedance ratio was significantly correlated mainly with age (r=−0.316 and r=−0.346, respectively. Patients with a 5/250 impedance ratio below median value had lower handgrip strength (P<0.001, 6-minute walk distance (P<0.005, respiratory muscle strength (P<0.005, forced

  5. Lung and kidney: a dangerous liaison? A population-based cohort study in COPD patients in Italy

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    Fedeli U

    2017-01-01

    Full Text Available Ugo Fedeli,1 Alfredo De Giorgi,2 Nicola Gennaro,1 Eliana Ferroni,1 Massimo Gallerani,3 Dimitri P Mikhailidis,4 Roberto Manfredini,2 Fabio Fabbian2 1Epidemiological Department, Veneto Region, 2Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, 3Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy; 4Department of Clinical Biochemistry (Vascular Disease Prevention Clinic, University College London Medical School, London, UK Background: COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD is frequently diagnosed in older people living in Western societies and could impact COPD patients’ mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD.Methods: A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM. Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression.Results: Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up. After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30–1.42 independently from comorbidities summarized by the CCI was a significant risk factor for mortality.Conclusion: In spite of limitations due to the use of claims data, long-term survival

  6. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Science.gov (United States)

    2011-01-01

    Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision

  7. Muscle training with repetitive magnetic stimulation of the quadriceps in severe COPD patients.

    Science.gov (United States)

    Bustamante, Víctor; López de Santa María, Elena; Gorostiza, Amaia; Jiménez, Unai; Gáldiz, Juan B

    2010-02-01

    Previous studies have used electrical neuromuscular stimulation as a physical training method in patients with severe COPD. We introduce the use of the more tolerable magnetic stimulation for the same purpose, investigating the effectiveness of an eight-week protocol. Eighteen patients with severe COPD were randomly assigned to a magnetic stimulation training protocol, n=10, FEV(1)=30% (SD: 7) or to parallel clinical monitoring, control group, n=8, FEV(1)=35% (SD: 8). During eight weeks, patients were stimulated for 15min on each quadriceps femoris, three times per week. Quadriceps muscle strength and endurance measurements, quality-of-life questionnaires (SF36, SGRQ) and a six-minute walking test were all carried out before and after the training period in the stimulated and control subjects. All patients completed the training with increasing intensity of stimulation, displaying a significant improvement in voluntary quadriceps strength (17.5% of the baseline value) and exercise capacity, with a mean increase of 23m in the six-minute walking test. The questionnaire scores showed greater increases in quality-of-life scores in the trained subjects compared to the controls, particularly in the physical function areas: mean increments in SF36 in "physical function": +26, "role limitations due to physical problems": +40 and "vitality": +17.5, while +13, -4 and +1, respectively in controls. Saint George's "Activity" score improved by 19.6 points, for 11.5 in controls. In COPD patients who are limited due to dyspnoea, magnetic neuromuscular stimulation of the quadriceps constitutes a feasible training method for the lower limbs, with positive effects on the muscle function, effort capacity and perception areas.

  8. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Directory of Open Access Journals (Sweden)

    Fenwick Angela

    2011-02-01

    Full Text Available Abstract Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge; were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development

  9. Teleconsultation with discharged elderly patients with severe COPD

    DEFF Research Database (Denmark)

    Sorknæs, Anne Dichmann; Hounsgaard, Lise; Olesen, Finn

    changes the way nurses perform and it also changes their professional identity. The nurses amplify their audio-visual perceptions, communicative skills and by including the patient as their assistant. Correspondingly, their patients take on an active role in observation and measurement of their condition...

  10. Training with inspiratory pressure support in patients with severe COPD.

    NARCIS (Netherlands)

    Hul, A. van 't; Gosselink, R.; Hollander, P.; Postmus, P.; Kwakkel, G.

    2006-01-01

    This study evaluates the effects of training with noninvasive ventilatory support in patients with chronic obstructive pulmonary disease in a randomised, controlled, observer-blinded trial. Twenty-nine patients with chronic obstructive pulmonary disease and with a ventilatory limited exercise

  11. Evaluation of the COPD Assessment Test and GOLD patient types: a cross-sectional analysis

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    Lopez-Campos JL

    2015-05-01

    Full Text Available Jose Luis Lopez-Campos,1,2,* Alberto Fernandez-Villar,3,* Carmen Calero-Acuña,1 Cristina Represas-Represas,3 Cecilia Lopez-Ramírez,1 Virginia Leiro Fernández,3 Juan Jose Soler-Cataluña,2,4 Ricard Casamor5 On behalf of the On-Sint study group 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS, Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES, Instituto de Salud Carlos III, Madrid, Spain; 3Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV, Complexo Hospitalario de Vigo, Vigo, Spain; 4Servicio de Neumología Hospital Arnau de Vilanova, Valencia, Spain; 5Departamento Médico de Novartis Farmacéutica, Barcelona, Spain *These authors contributed equally to this work Background: The COPD Assessment Test (CAT has been recently developed to quantify COPD impact in routine practice. However, no relationship with other measures in the Global Initiative for Obstructive Lung Disease (GOLD strategy has been evaluated. The present study aimed to evaluate the relationship of the CAT with other GOLD multidimensional axes, patient types, and the number of comorbidities.Methods: This was a cross-sectional analysis of the Clinical presentation, diagnosis, and course of chronic obstructive pulmonary disease (On-Sint study. The CAT score was administered to all participants at the inclusion visit. A GOLD 2011 strategy consisting of modified Medical Research Council scale (MRC scores was devised to study the relationship between the CAT, and GOLD 2011 axes and patient types. The relationship with comorbidities was assessed using the Charlson comorbidity index, grouped as zero, one to two, and three or more.Results: The CAT questionnaire was completed by 1,212 patients with COPD. The CAT maintained a relationship with all the three axes, with a ceiling effect for dyspnea and no distinction between mild and

  12. Comparison of two different levels of physical training in patients with moderate to severe COPD.

    Science.gov (United States)

    Bjørnshave, Bodil; Korsgaard, Jens

    2005-01-01

    Our objective was to compare the effect of a 4-week homebased low and middle intensity and frequency training program in patients with moderate to severe chronic obstructive pulmonary disease. From 124 patients hospitalized with chronic obstructive lung disease (COPD) in an 18-month period 65 fulfilled the inclusion criteria and were invited to participate. Only 31 (48%) accepted and among these only 20 patients (31% of invited) completed the 4-week study period. The walking time in seconds in a standardized treadmill walking test was unchanged after 4 weeks of low intensity training 60 minutes per week for two weekly training sessions. In contrast, the walking time in seconds increased 55% (p < 0.001) from 321 seconds to 499 seconds in 9 patients who completed 4 weeks of middle intensity training which comprised 2 1/2 hours of training per week for 5 weekly training sessions. There was no change in lung function over the 4 weeks but the combined score for physical quality of life (physical component summary) measured by SF-36 increased (p < 0.05) with both low intensity and middle intensity physical training. In conclusion, homebased physical training, which aims at improvements in patient performance and quality of life as part of pulmonary rehabilitation programs, is only accepted by about one-third of unselected patients with moderate to severe COPD. The minimum training time necessary to improve physical performance is 2-3 hours per week of middle intensity training.

  13. Comorbidities of COPD

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    Arnaud Cavaillès

    2013-12-01

    Full Text Available By 2020, chronic obstructive pulmonary disease (COPD will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately.

  14. Development of a program for tele-rehabilitation of COPD patients across sectors: co-innovation in a network

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    Birthe Dinesen

    2011-03-01

    Full Text Available Introduction: The aim of the Telekat project is to prevent re-admissions of patients with chronic obstructive pulmonary disease (COPD by developing a preventive programof tele-rehabilitation across sectors for COPD patients. The development of the program is based on a co-innovation process between COPD patients, relatives, healthcare professionals and representatives from private firms and universities. This paper discusses theobstacles that arise in the co-innovation process of developing an integrated technique for tele-rehabilitation of COPD patients.Theory: Network and innovation theory.Methods: The casestudy was applied. A triangulation of data collection techniques was used: documents, observations (123 hours, qualitative interviews (n=32 and action research.Findings: Obstacles were identified in the network context; these obstacles included the mindset of the healthcare professionals, inter-professionals relations, views of technology as a tool and competing visions for the goals of tele-rehabilitation.Conclusion: We have identified obstacles that emerge in the co-innovation process when developing a programme for tele-rehabilitation of COPD patients in an inter-organizational context. Action research has been carried out and can have helped to facilitate the co-innovation process.

  15. Safety and Tolerability of Nebulized Amoxicillin-Clavulanic Acid in Patients with COPD (STONAC 1 and STONAC 2).

    Science.gov (United States)

    Nijdam, L C; Assink, M D M; Kuijvenhoven, J C; de Saegher, M E A; van der Valk, P D L P M; van der Palen, J; Brusse-Keizer, M G J; Movig, K L L

    2016-08-01

    The safety and tolerability of nebulized amoxicillin clavulanic acid were determined in patients with stable COPD and during severe exacerbations of COPD. Nine stable COPD patients received doses ranging from 50:10 mg up to 300:60 mg amoxicillin clavulanic acid and eight patients hospitalised for a COPD exacerbation received fixed doses 200/40 mg twice daily. Safety was evaluated by spirometry before and after inhalation. Tolerability was evaluated by questionnaire. Plasma and expectorated sputum samples were assayed for amoxicillin content. Seventeen patients underwent in total 100 nebulizations with amoxicillin clavulanic acid. In this safety and tolerability study no clinically relevant deteriorations in FEV1 were observed. Nebulized amoxicillin clavulanic acid produces sputum concentrations well above the Minimal Inhibiting Concentration of 90% for potential pathogenic micro-organisms, with low concentrations in the central compartment (low systemic exposure). Based on spirometry and reported side effects, inhalation of nebulized amoxicillin clavulanic acid seems to be safe and well tolerated, both in stable patients with COPD as in those experiencing a severe exacerbation. Levels of amoxicillin were adequate.

  16. Development of a program for tele-rehabilitation of COPD patients across sectors: co-innovation in a network

    Directory of Open Access Journals (Sweden)

    Birthe Dinesen

    2011-03-01

    Full Text Available Introduction: The aim of the Telekat project is to prevent re-admissions of patients with chronic obstructive pulmonary disease (COPD by developing a preventive programof tele-rehabilitation across sectors for COPD patients. The development of the program is based on a co-innovation process between COPD patients, relatives, healthcare professionals and representatives from private firms and universities. This paper discusses theobstacles that arise in the co-innovation process of developing an integrated technique for tele-rehabilitation of COPD patients. Theory: Network and innovation theory. Methods: The casestudy was applied. A triangulation of data collection techniques was used: documents, observations (123 hours, qualitative interviews (n=32 and action research. Findings: Obstacles were identified in the network context; these obstacles included the mindset of the healthcare professionals, inter-professionals relations, views of technology as a tool and competing visions for the goals of tele-rehabilitation. Conclusion: We have identified obstacles that emerge in the co-innovation process when developing a programme for tele-rehabilitation of COPD patients in an inter-organizational context. Action research has been carried out and can have helped to facilitate the co-innovation process.

  17. Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation

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    Altinoz H

    2016-08-01

    Full Text Available Hilal Altinoz,1 Nalan Adiguzel,2 Cuneyt Salturk,2 Gokay Gungor,2 Ozlem Mocin,2 Huriye Berk Takir,2 Feyza Kargin,2 Merih Balci,2 Oner Dikensoy,1 Zuhal Karakurt2 1Pulmonary Division, Acibadem University School of Medicine, 2Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey Abstract: Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD, but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI. The first group consisted of subjects with BMI between 20 and 30 kg/m2, and the second group consisted of subjects with BMI >30 kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT, and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m2, while 80 subjects had BMI >30 kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67. Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such

  18. Mechanisms of improvement of respiratory failure in patients with COPD treated with NIV.

    Science.gov (United States)

    Nickol, Annabel H; Hart, Nicholas; Hopkinson, Nicholas S; Hamnegård, Carl-Hugo; Moxham, John; Simonds, Anita; Polkey, Michael I

    2008-01-01

    Noninvasive ventilation (NIV) improves gas-exchange and symptoms in selected chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure. We hypothesized NIV reverses respiratory failure by one or all of increased ventilatory response to carbon-dioxide, reduced respiratory muscle fatigue, or improved pulmonary mechanics. Nineteen stable COPD patients (forced expiratory volume in one second 35% predicted) were studied at baseline (DO), 5-8 days (D5) and 3 months (3M) after starting NIV. Ventilator use was 6.2 (3.7) hours per night at D5 and 3.4 (1.6) at 3M (p = 0.12). Mean (SD) daytime arterial carbon-dioxide tension (PaCO2) was reduced from 7.4 (1.2) kPa to 7.0 (1.1) kPa at D5 and 6.5 (1.1) kPa at 3M (p = 0.001). Total lung capacity decreased from 107 (28) % predicted to 103 (28) at D5 and 103 (27) % predicted at 3M (p = 0.035). At D5 there was an increase in the hypercapnic ventilatory response and some volitional measures of inspiratory and expiratory muscle strength, but not isolated diaphragmatic strength whether assessed by volitional or nonvolitional methods. These findings suggest decreased gas trapping and increased ventilatory sensitivity to CO2 are the principal mechanism underlying improvements in gas-exchange in patients with COPD following NIV. Changes in some volitional but not nonvolitional muscle strength measures may reflect improved patient effort.

  19. YouTube as a source of COPD patient education: A social media content analysis

    Science.gov (United States)

    Stellefson, Michael; Chaney, Beth; Ochipa, Kathleen; Chaney, Don; Haider, Zeerak; Hanik, Bruce; Chavarria, Enmanuel; Bernhardt, Jay M.

    2014-01-01

    Objective Conduct a social media content analysis of COPD patient education videos on YouTube. Methods A systematic search protocol was used to locate 223 videos. Two independent coders evaluated each video to determine topics covered, media source(s) of posted videos, information quality as measured by HONcode guidelines for posting trustworthy health information on the Internet, and viewer exposure/engagement metrics. Results Over half the videos (n=113, 50.7%) included information on medication management, with far fewer videos on smoking cessation (n=40, 17.9%). Most videos were posted by a health agency or organization (n=128, 57.4%), and the majority of videos were rated as high quality (n=154, 69.1%). HONcode adherence differed by media source (Fisher’s Exact Test=20.52, p=.01), with user-generated content (UGC) receiving the lowest quality scores. Overall level of user engagement as measured by number of “likes,” “favorites,” “dislikes,” and user comments was low (mdn range = 0–3, interquartile (IQR) range = 0–16) across all sources of media. Conclusion Study findings suggest that COPD education via YouTube has the potential to reach and inform patients, however, existing video content and quality varies significantly. Future interventions should help direct individuals with COPD to increase their engagement with high-quality patient education videos on YouTube that are posted by reputable health organizations and qualified medical professionals. Patients should be educated to avoid and/or critically view low-quality videos posted by individual YouTube users who are not health professionals. PMID:24659212