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Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment.
Jacobsen, PA, van 't Hul, AJ, Djamin, RS, Antons, JC, de Man, M, Weinreich, UM, Spruit, MA, Janssen, DJA
Respiratory research. 2021;(1):147
Abstract
INTRODUCTION Patients with COPD are vulnerable to workforce detachment. Better knowledge of features associated with paid work loss might be of help to design and select appropriate interventions. METHOD This cross-sectional study aimed to explore the presence of treatable traits in COPD patients without paid work. Patients with COPD below 65 years at first referral to a hospital-based patient clinic were included. Using binary logistic regression analysis, the relationship between paid work and the following characteristics was explored: low daily physical activity, exercise, active smoking, Medical Research Council dyspnea scale (MRC), poor nutritional status, exacerbations, and fatigue (checklist individual strength (CIS)). Variables were adjusted for age, sex, forced expiratory volume in 1 s (FEV 1), and education level. RESULTS In total, 191 patients (47.3%) were without paid work. The following treatable traits were related to not being in paid work: < 5000 steps/day (OR 2.36, 95% CI (1.52-3.68)), MRC ≥ 3 (OR 1.78, 95%CI (1.14-2.77)), CIS ≥ 36 points (OR 1.78, 95% CI (1.10-2.87)), six-minute walk distance (6MWD) < 70% of predicted (OR 2.62, 95% CI (1.69-4.06)), and ≥ 2 exacerbations per year (OR 1.80, 95% CI (1.12-2.92)). Significant differences were also seen in age (OR 1.06, 95% CI (1.02-1.10) per year), FEV 1% predicted (OR 0.98, 95% CI (0.97-1.00) per % predicted increase), and medium/high education level (OR 0.62, 95% CI (0.41-0.93)). When adjusting for all variables the only treatable trait that remained significant was 6MWD. CONCLUSION Patients without paid work are more likely to have treatable traits with 6MWD revealing the most significant association.
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Seasonal variations in objectively assessed physical activity among people with COPD in two Nordic countries and Australia: a cross-sectional study.
Hoaas, H, Zanaboni, P, Hjalmarsen, A, Morseth, B, Dinesen, B, Burge, AT, Cox, NS, Holland, AE
International journal of chronic obstructive pulmonary disease. 2019;:1219-1228
Abstract
Purpose: Seasons and weather conditions might influence participation in physical activity and contribute to differences between countries. This study aimed at investigating whether there were differences in physical activity levels between Norwegian, Danish and Australian people with chronic obstructive pulmonary disease (COPD), and establishing if any variations in physical activity were attributable to seasons. Patients and methods: A cross-sectional study where study subjects were people with COPD who participated in two separate clinical trials: the iTrain study (Norway, Denmark, and Australia) and the HomeBase study (Australia). Physical activity was objectively assessed with an activity monitor; variables were total energy expenditure, number of daily steps, awake sedentary time, light, and moderate-to-vigorous intensity physical activity. Differences in physical activity between countries and seasons were compared, with adjustment for disease severity. Results: In total, 168 participants were included from Norway (N=38), Denmark (N=36) and Australia (N=94). After controlling for disease severity, time spent in awake sedentary time was greater in Danish participants compared to the other countries (median 784 minutes/day [660-952] vs 775 minutes/day [626-877] for Norwegians vs 703 minutes/day [613-802] for Australians, P=0.013), whilst time spent in moderate to vigorous physical activity was lower (median 21 minutes/day [4-73] vs 30 minutes/day [7-93] for Norwegians vs 48 minutes/day [19-98] for Australians, P=0.024). Participants walked more during summer (median 3502 [1253-5407] steps/day) than in spring (median 2698 [1613-5207] steps/day), winter (median 2373 [1145-4206] steps/day) and autumn (median 1603 [738-4040] steps/day), regardless of geography. The median difference between summer and other seasons exceeded the minimal clinically important difference of 600 steps/day. However, the differences were not statistically significant (P=0.101). Conclusion: After controlling for disease severity, Danish participants spent more time in an awake sedentary state and less time in moderate to vigorous physical activity than their counterparts in Norway and Australia. People with COPD increased their physical activity in summer compared to other seasons. Weather conditions and seasonal variations may influence outcomes in clinical trials and health registries measuring physical activity over time, irrespective of the interventions delivered, and should be taken into account when interpreting results.
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A common misunderstanding in lung ultrasound: the comet tail artefact.
Yue Lee, FC, Jenssen, C, Dietrich, CF
Medical ultrasonography. 2018;(3):379-384
Abstract
The comet tail artefact is probably one of the most commonly and imprecisely used to describe vertical artefacts found in lung ultrasound. Two distinct artefacts are commonly observed: the lung comets and the B-lines. Both artefacts differ with regard to generation mechanism and clinical significance. This review explores the current understanding and use of these two artefacts in lung ultrasound and suggests how to avoid the pitfalls related to confusing comet tail artefacts with other vertical artefacts.
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Comparison of quantitative regional ventilation-weighted fourier decomposition MRI with dynamic fluorinated gas washout MRI and lung function testing in COPD patients.
Kaireit, TF, Gutberlet, M, Voskrebenzev, A, Freise, J, Welte, T, Hohlfeld, JM, Wacker, F, Vogel-Claussen, J
Journal of magnetic resonance imaging : JMRI. 2018;(6):1534-1541
Abstract
BACKGROUND Ventilation-weighted Fourier decomposition-MRI (FD-MRI) has matured as a reliable technique for quantitative measures of regional lung ventilation in recent years, but has yet not been validated in COPD patients. PURPOSE/HYPOTHESIS To compare regional fractional lung ventilation obtained by ventilation-weighted FD-MRI with dynamic fluorinated gas washout MRI (19 F-MRI) and lung function test parameters. STUDY TYPE Prospective study. POPULATION Twenty-seven patients with chronic obstructive pulmonary disease (COPD, median age 61 [54-67] years) were included. FIELD STRENGTH/SEQUENCE For FD-MRI and for 19 F-MRI a spoiled gradient echo sequence was used at 1.5T. ASSESSMENT FD-MRI coronal slices were acquired in free breathing. Dynamic 19 F-MRI was performed after inhalation of 25-30 L of a mixture of 79% fluorinated gas (C3 F8 ) and 21% oxygen via a closed face mask tubing using a dedicated coil tuned to 59.9 MHz. 19 F washout times in numbers of breaths (19 F-nbreaths ) as well as fractional ventilation maps for both methods (FD-FV, 19 F-FV) were calculated. Slices were matched using a landmark driven algorithm, and only corresponding slices with an overlap of >90% were coregistered for evaluation. STATISTICAL TESTS The obtained parameters were correlated with each other using Spearman's correlation coefficient (r). RESULTS FD-FV strongly correlated with 19 F-nbreaths on a global (r = -0.72, P < 0.0001) as well as on a lobar level and with lung function test parameters (FD-FV vs. FEV1, r = 0.76, P < 0.0001). There was a small systematic overestimation of FD-FV compared to 19 F-FV (mean difference -0.03 (95% confidence interval [CI]: -0.097; -0.045). DATA CONCLUSION Regional ventilation-weighted Fourier decomposition-MRI is a promising noninvasive, radiation-free tool for quantification of regional ventilation in COPD patients. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1534-1541.
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Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients.
Wang, K, Zeng, GQ, Li, R, Luo, YW, Wang, M, Hu, YH, Xu, WH, Zhou, LQ, Chen, RC, Chen, X
International journal of chronic obstructive pulmonary disease. 2017;:2655-2668
Abstract
BACKGROUND Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPImax [maximal inspiratory pressure] 5.20±0.89 cmH2O vs 1.32±0.91 cmH2O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05). CONCLUSION Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.
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Effect of endurance versus resistance training on quadriceps muscle dysfunction in COPD: a pilot study.
Iepsen, UW, Munch, GD, Rugbjerg, M, Rinnov, AR, Zacho, M, Mortensen, SP, Secher, NH, Ringbaek, T, Pedersen, BK, Hellsten, Y, et al
International journal of chronic obstructive pulmonary disease. 2016;:2659-2669
Abstract
INTRODUCTION Exercise is an important countermeasure to limb muscle dysfunction in COPD. The two major training modalities in COPD rehabilitation, endurance training (ET) and resistance training (RT), may both be efficient in improving muscle strength, exercise capacity, and health-related quality of life, but the effects on quadriceps muscle characteristics have not been thoroughly described. METHODS Thirty COPD patients (forced expiratory volume in 1 second: 56% of predicted, standard deviation [SD] 14) were randomized to 8 weeks of ET or RT. Vastus lateralis muscle biopsies were obtained before and after the training intervention to assess muscle morphology and metabolic and angiogenic factors. Symptom burden, exercise capacity (6-minute walking and cycle ergometer tests), and vascular function were also assessed. RESULTS Both training modalities improved symptom burden and exercise capacity with no difference between the two groups. The mean (SD) proportion of glycolytic type IIa muscle fibers was reduced after ET (from 48% [SD 11] to 42% [SD 10], P<0.05), whereas there was no significant change in muscle fiber distribution with RT. There was no effect of either training modality on muscle capillarization, angiogenic factors, or vascular function. After ET the muscle protein content of phosphofructokinase was reduced (P<0.05) and the citrate synthase content tended increase (P=0.08) but no change was observed after RT. CONCLUSION Although both ET and RT improve symptoms and exercise capacity, ET induces a more oxidative quadriceps muscle phenotype, counteracting muscle dysfunction in COPD.
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Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy: a randomised, non-inferiority trial.
Kosiński, S, Fryźlewicz, E, Wiłkojć, M, Ćmiel, A, Zieliński, M
Anaesthesiology intensive therapy. 2016;(5):280-287
Abstract
BACKGROUND Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. METHODS Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. RESULTS Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). CONCLUSIONS Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.
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Influence of different levels of immersion in water on the pulmonary function and respiratory muscle pressure in healthy individuals: observational study.
de Andrade, AD, Júnior, JC, Lins de Barros Melo, TL, Rattes Lima, CS, Brandão, DC, de Melo Barcelar, J
Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2014;(3):140-6
Abstract
BACKGROUND AND PURPOSE Immersion in water, with the head above the water line, causes acute physiological changes in the pulmonary and cardiovascular systems. The aim of this study was to evaluate the acute physiological responses to immersion on lung volumes and respiratory muscle strength at different depths. METHODS A cross-sectional study was conducted in 28 healthy individuals (21.75 ± 1.99 years; 13 men and 15 women). Anthropometric and spirometric data as well as respiratory muscle strength were evaluated. Evaluations were carried out on dry land (DL) and in a pool at three different levels of immersion: iliac crests (IC), xiphoid appendix of the sternum (XA) and clavicles (CL). The order of evaluation for spirometry and maximal inspiratory and expiratory pressures between DL and the different levels of immersion was randomized. The ANOVA test for repeated measures with post hoc Tukey was applied to compare the variables. RESULTS Vital capacity exhibited lower values at the CL level compared with DL, XA and IC (p < 0.01). The most significant change in forced expiratory volume in the first second (FEV(1)) occurred under immersion at CL and XA levels. No differences in maximal expiratory pressure were found in the comparisons between the different levels of immersion and DL (p = 0.19). There was nevertheless a decrease in maximum inspiratory pressure with immersion at the CL level (91 ± 23 cmH(2)O) compared with DL (105 ± 29 cmH(2)O), XA (99 ± 24 cmH(2)O) and IC (101 ± 25 cmH(2)O) values (p < 0.01). CONCLUSION The results suggest that immersion at the level of the clavicles and xiphoid appendix alters lung function and respiratory muscle strength when compared with the values measured out of the water and immersed at the IC level in healthy individuals, demonstrating the influence of hydrostatic pressure on the respiratory system.
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Longitudinal trends in health-related quality of life in adults with cystic fibrosis.
Dill, EJ, Dawson, R, Sellers, DE, Robinson, WM, Sawicki, GS
Chest. 2013;(3):981-989
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Abstract
BACKGROUND Health-related quality-of-life (HRQOL) measures have been used as patient-reported outcomes in clinical trials in cystic fibrosis (CF), but there are limited data on HRQOL changes over time in adults with CF. METHODS The Project on Adult Care in Cystic Fibrosis, a prospective, longitudinal panel study of 333 adults with CF at 10 CF centers in the United States, administered a disease-specific HRQOL measure, the Cystic Fibrosis Questionnaire-Revised (CFQ-R), seven times over 21 months. The CFQ-R assesses both physical and psychosocial domains of health. Growth curve regression models were developed for each CFQ-R domain, adjusting for demographic and clinical characteristics. RESULTS Between 205 and 303 adults completed surveys (response rate, 70%-93%). Mean age at baseline was 33 years (range, 19-64 years); mean FEV1 % predicted was 59.8% (SD, 22%). Over the 21 months of follow-up, lung function, frequency of pulmonary exacerbations, and nutritional indices were associated with physical CFQ-R domain scores. There were no significant population trends over time in the physical domain scores; however, there were population time trends in three psychosocial domains: treatment burden (+8.9 points/y), emotional functioning (+3.2 points/y), and social functioning (-2.4 points/y). Individual variation in both physical and psychosocial subscales was seen over 21 months. CONCLUSIONS In a longitudinal multicenter population of adults with CF, clinical variables such as FEV1, exacerbation frequency, and weight were correlated with related CFQ-R subscales. For the population as a whole, the physical domains of CFQ-R, such as respiratory symptoms, were stable. In contrast, population changes in several psychosocial domains of CFQ-R suggest that differentiating between the physical and the psychosocial trajectories in health among adults with CF is critical in evaluating patient-reported outcomes.
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Respiratory function and changes in lung epithelium biomarkers after a short-training intervention in chlorinated vs. ozone indoor pools.
Fernández-Luna, Á, Gallardo, L, Plaza-Carmona, M, García-Unanue, J, Sánchez-Sánchez, J, Felipe, JL, Burillo, P, Ara, I
PloS one. 2013;(7):e68447
Abstract
BACKGROUND Swimming in indoor pools treated with combined chemical treatments (e.g. ozone) may reduce direct exposure to disinfection byproducts and thus have less negative effects on respiratory function compared to chlorinated pools. The aim of this study is to analyze the effects of a short-term training intervention on respiratory function and lung epithelial damage in adults exercising in indoor swimming pool waters treated with different disinfection methods (chlorine vs. ozone with bromine). METHODS Lung permeability biomakers [surfactant protein D (SP-D) and Clara cell secretory protein (CC16) in plasma] and forced expiratory volumes and flow (FEV1, FVC and FEF25-75) were measured in 39 healthy adults. Thirteen participants swam during 20 sessions in a chlorinated pool (CP), 13 performed and equivolumic intervention in an ozone pool (OP) and 13 were included in a control group (CG) without exposition. RESULTS Median plasma CC16 levels increased in CP swimmers (4.27 ± 3.29 and 6.62 ± 5.51 µg/L, p=0.01, pre and post intervention respectively) while no significant changes in OP and CG participants were found. No significant changes in median plasma SP-D levels were found in any of the groups after the training period. FVC increased in OP (4.26 ± 0.86 and 4.43 ± 0.92 L, p<0.01) and CP swimmers (4.25 ± 0.86 and 4.35 ± 0.85 L, p<0.01). FEV1 only increased in OP swimmers (3.50 ± 0.65 and 3.59 ± 0.67, p=0.02) and FEF25-75 decreased in CP swimmers (3.70 ± 0.87 and 3.37 ± 0.67, p=0.02). CONCLUSION Despite lung function being similar in both groups, a higher lung permeability in CP compared to OP swimmers was found after a short-term swimming program. Combined chemical treatments for swimming pools such as ozone seem to have less impact on lung epithelial of swimmers compared to chlorinated treated pools.