Home About us Contact
|
Home About us Contact | ||
|
|
||
Severe COPD (severe + copd)
Selected AbstractsImpact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studiesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2009J. M. Rodriguez Gonzalez-Moro Summary Aims:, The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. Methods:, Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. Results:, In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91,30.25) vs. 21.4 (CI 95%: 20.8,21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. Conclusions:, COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters. [source] Study of peripheral muscle strength and severity indexes in individuals with chronic obstructive pulmonary diseasePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2010Diego Marmorato Marino Abstract Background and Purpose.,Individuals with chronic obstructive pulmonary disease (COPD) present reduced peripheral muscle strength, which leads to impaired mobility and increased mortality risk. However, it is not clear whether there is any relationship between muscle strength, muscle mass and the body mass index, airflow obstruction, dyspnea, exercise performance (BODE) index scale, which is considered to be the best predictor of survival for individuals with COPD. The BODE Index is a multidimensional system that measures body composition (B), airway obstruction (O), dyspnea perception (D) and the ability to exercise (E), and rates the severity of the major changes found in individuals with COPD. The objective of this study was to verify any relationship between the BODE Index, muscle mass and maximum muscle strengths of the upper limb (UL) and lower limb (LL) in subjects with moderate to very severe COPD.,Methods.,Twenty-six individuals with moderate to very severe COPD were evaluated by body composition (body mass index and muscle mass), BODE Index, handgrip strength (HS) and one repetition maximum (1RM) test of the UL and LL.,Results.,There was a positive correlation (Pearson, p < 0.05) of peripheral muscle strength, evaluated by HS and 1RM (pectoral and triceps, round muscles and dorsal section, quadriceps), to muscle mass (0.74, 0.57, 0.74 and 0.62, respectively) and the distance walked in the six-minute walking test (0.52, 0.50, 0.46 and 0.58, respectively), but no correlation of muscle strength was found to forced expiratory volume in one second to dyspnea or the BODE Index.,Conclusion.,In accordance with the results of this study, peripheral muscle strength as measured y HS and 1RM is not related to the severity indexes for COPD, unlike UL and LL muscle strength. Therefore, UL and LL measurements now have an additional importance in COPD evaluation. Copyright © 2010 John Wiley & Sons, Ltd. [source] Does the addition of non-invasive ventilation during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease augment patient outcome in exercise tolerance?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2010A literature review Abstract Background.,Non-invasive ventilation (NIV) during exercise in patients with chronic obstructive pulmonary disease (COPD) has been shown to increase exercise time and intensity. Feasibly then, NIV during pulmonary rehabilitation will enhance post-rehabilitation training effects. The purpose of this review is to systematically consider and critique the literature concerning the effects of NIV, when used during an exercise programme in COPD patients on exercise tolerance.,Method.,An electronic literature search was completed and the reference lists of the articles that fitted the following inclusion criteria were screened. Studies that used any mode of NIV during an exercise programme with a primary outcome measure focusing on exercise tolerance and were written after the year 2000 to reflect current practice. Studies that were not written in English or had been included in previous literature reviews were excluded. The studies were then critically appraised and assigned a level of evidence based upon Scottish Intercollegiate Guidelines Network.,Results.,Twenty-eight articles were screened, of which six fitted the inclusion criteria. The methodological quality ranged from level 1, to 1+. All but one study by Bianchi et al. (2002) demonstrated a statistically significant improvement in exercise tolerance with the addition of some form of NIV during pulmonary rehabilitation. The benefits may be greater in patients with more severe airway obstruction as determined by Forced Expiration Volume (FEV), (%pred).,Conclusion.,This review would suggest that NIV may allow an increased exercise intensity and duration during pulmonary rehabilitation in patients with moderate to very severe COPD, (according to the American Thoracic Society guidelines), resulting in a greater training effect and a prolonged exercise capacity. Further research looking at long-term follow-up is recommended. Copyright © 2009 John Wiley & Sons, Ltd. [source] Serum progastrin-releasing peptide levels followed by whole-body positron emission tomography detects early recurrence of small-cell lung cancerRESPIROLOGY, Issue 1 2007Hiroyuki YAMAGUCHI Abstract: A 65-year-old male smoker with severe COPD was diagnosed with limited-stage small-cell lung cancer. After receiving cisplatin/irinotecan, serum progastrin-releasing peptide (ProGRP) levels decreased to within the reference values and the lesions were markedly reduced in size. A whole-body 18F-fluorodeoxyglucose PET (FDG-PET) scan confirmed complete remission. During follow up, serum ProGRP levels increased, and a whole-body FDG-PET scan detected recurrence at the hilar lymph node that had been negative on CT. Complete remission was again achieved with second-line chemotherapy (cisplatin/etoposide) and local irradiation to the hilar lymph node. Monitoring serum ProGRP levels, followed by whole-body FDG-PET when indicated, may improve the clinical management of patients with small-cell lung cancer after initial complete remission. [source] Frequent hospital readmissions for acute exacerbation of COPD and their associated factorsRESPIROLOGY, Issue 2 2006Zhenying CAO Objective: The factors that determine frequent hospital readmissions for acute exacerbations of COPD (AECOPD) are poorly understood. The aim of this study was to ascertain rates of re-hospitalizations for AECOPD patients and evaluate factors associated with frequent readmissions for acute exacerbations. Methods: We conducted a cross-sectional survey of 186 patients with moderate to severe COPD with one or more admissions for acute exacerbations to two large general hospitals. Frequency of previous readmissions for AECOPD in the past year, and clinical characteristics, including depression and spirometry were ascertained in the stable state both before discharge and at 1-month post discharge. Results: Among them, 67% had one or more previous readmission, 46% had two or more, 9% had 10,20 readmissions in the 1-year period prior to current admission. There was a high prevalence of current or ex-heavy smokers, underweight patients, depression and consumption of psychotropic drugs, and low prevalence of caregiver support, pulmonary rehabilitation and influenza and pneumcoccal vaccination. Univariate analysis showed that male sex, duration >5 years, FEV1 < 50% predicted, use of psychotropic drugs, receipt of pulmonary rehabilitation and vaccination were significantly associated with frequent past readmissions. Multivariate analysis revealed that disease duration >5 years (odds ratio (OR) = 2.32; 95% confidence interval (CI): 1.09,4.92), FEV1 < 50% predicted (OR = 2.60; 95% CI: 1.18,5.74), use of psychotropic drugs (OR = 13.47; 95% CI: 1.48,122.92) and vaccination status (OR = 3.27; 95% CI: 1.12,9.57) were independently associated with frequent readmissions for AECOPD. Conclusion: Frequent past readmission for AECOPD was associated with disease severity and psychosocial distress and increased use of vaccinations. [source] Physical training and testing in patients with chronic obstructive pulmonary diseaseTHE CLINICAL RESPIRATORY JOURNAL, Issue 1 2007Ragnheiður Harpa Arnardóttir Abstract Introduction:, The effects of different training modes need to be investigated further in patients with chronic obstructive pulmonary disease (COPD). Both advanced laboratory tests and field tests are used in patients with COPD to evaluate effects of interventions such as pulmonary rehabilitation. Aims:, The overall aims of the studies were to investigate the effects of different training modalities on exercise capacity and on health-related quality of life (HRQoL) in patients with moderate or severe COPD and, further, to explore two of the physical field tests used in pulmonary rehabilitation, the 12-min walk test and the incremental shuttle walking test (ISWT). Materials and Methods:, Patients with moderate or severe COPD were included. In study I (n = 57), the 12-min walk test was performed three times within 1 week. Exercise-induced hypoxemia (EIH) was assessed by pulse oximeter and was defined as SpO2 < 90%. In study II (n = 93), performance on ISWT was compared to performance on two different cycle tests. In study III (n = 42), the effects of two different combination training programmes were compared when training twice a week for 8 weeks. One programme was mainly based on endurance training (group A), and the other was based on resistance training and on callisthenics (group B). In study IV (n = 60), endurance training with interval resistance was compared to endurance training with continuous resistance. Results:, In study I, the 12-min walking distance (12MWD) did not increase on retesting in patients with EIH, but increased significantly on retesting in the non-EIH patients. In study II, the ISWT was as good a predictor of peak exercise capacity (W peak) as peak oxygen uptake (VO2 peak) was. In study III, W peak and 12MWD increased in group A but not in group B. HRQoL, anxiety and depression were unchanged in both groups. Ratings of perceived exertion at rest were significantly lower in group A than in group B after training and during 12 months of follow-up. Twelve months post training, 12MWD was back to baseline in group A, but was significantly shorter than at baseline in group B. Patients with moderate and severe COPD responded to training in the same way. In study IV, both interval and continuous endurance training increased W peak, VO2 peak, peak exhaled carbon dioxide (VCO2 peak) and 12MWD. Likewise, HRQoL, dyspnoea during activities of daily life, anxiety and depression improved similarly in both groups. At a fixed, sub-maximal workload (isotime), the interval training reduced oxygen cost and ventilatory demand significantly more than the continuous training did. Conclusions:, EIH affects the retest effects on 12MWD. W peak can be predicted from an ISWT similarly well as from VO2 peak. A short training programme can improve W peak and 12MWD when based mainly on endurance training. Both patients with moderate and severe COPD respond to training in the same way. A short endurance training intervention can possibly delay decline in 12MWD for 1 year. Both interval and continuous endurance training improves physical performance and HRQoL. Interval training lowers the energy cost of sub-maximal work more than continuous training does. [source] Cellular and molecular mechanisms in chronic obstructive pulmonary disease: an overviewCLINICAL & EXPERIMENTAL ALLERGY, Issue 8 2004A. Di Stefano Summary In the last decade, the analysis of bronchial biopsies and lung parenchyma obtained from chronic obstructive pulmonary disease (COPD) patients compared with those from smokers with normal lung function and non-smokers has provided new insights on the role of the different inflammatory and structural cells, their signalling pathways and mediators, contributing to a better knowledge of the pathogenesis of COPD. This review summarizes and discusses the lung pathology of COPD patients with emphasis on inflammatory cell phenotypes that predominate in different clinical conditions. In bronchial biopsies, a cascade of events takes place during progression from mild-to-severe disease. T lymphocytes, particularly CD8+ cells and macrophages are the prevalent inflammatory cells in the lung of healthy smokers and patients with mild COPD, while total and activated neutrophils predominate in severe COPD. The number of CD4+, CD8+ cells and macrophages expressing nuclear factor-kappa B (NF-,B), STAT-4 and IFN-, proteins as well as endothelial adhesion molecule-1 in endothelium is increased in mild/moderate disease. In contrast, activated neutrophils (MPO+ cells) and increased nitrotyrosine immunoreactivity develops in severe COPD. In bronchial biopsies obtained during COPD exacerbations, some studies have shown an increased T cell and granulocyte infiltration. Regular treatment with high doses of inhaled glucocorticoids does not significantly change the number of inflammatory cells in bronchial biopsies from patients with moderate COPD. The profile in lung parenchyma is similar to bronchial biopsies. ,Healthy' smokers and mild/moderate diseased patients show increased T lymphocyte infiltration in the peripheral airways. Pulmonary emphysema is associated with a general increase of inflammatory cells in the alveolar septa. The molecular mechanisms driving the lymphocyte and neutrophilic prevalence in mild and severe disease, respectively, needs to be extensively studied. Up-regulation of pro-inflammatory transcription factors NF-,B and STAT-4 in mild, activated epithelial and endothelial cells in the more severe disease may contribute to this differential prevalence of infiltrating cells. [source] | ||||||||||