Patterns and Correlates of Sedentary Behaviour Accumulation and Physical Activity in People with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Abstract

Few studies have used 24-hour accelerometery to characterise posture and movement patterns in people with chronic obstructive pulmonary disease (COPD). This study aimed to quantify sedentary behaviour (SB), patterns of SB accumulation and physical activity (PA) in people with COPD, and to examine physiological and functional capacity correlates of total SB and patterns of SB accumulation. SB and PA were assessed continuously over seven days using thigh-worn accelerometery in people with COPD. Participants were regarded as “sedentary” if combined sitting/reclining time accounted for ≥70% of waking wear time. Differences in patterns of SB accumulation and PA were compared between “sedentary” and “non-sedentary” participants. Physiological and functional capacity correlates of SB were explored using univariate analysis. Sixty-nine people with COPD (mean (SD) age 74 (9) years, FEV1 55% (19) predicted) had sufficient wear data for analysis. Mean sedentary time was 643 (105) minutes/day (71% (11) of waking wear time), of which 374 (142) minutes/day were accumulated in prolonged bouts of ≥30?min. “Sedentary” participants had a more unfavourable pattern of SB accumulation and spent less time in PA of any intensity. Sedentary time, expressed as a proportion of waking wear time, was inversely correlated with light (r?=??0.97, p?<?.01) and moderate-to-vigorous intensity PA (r?=??0.55, p?<?.01) and exercise capacity (r?=??0.33, p?<?.01), but not with age, body mass index or lung function. People with COPD had high total SB and accumulated the majority of SB in prolonged bouts. High total SB was correlated with low physical activity and exercise tolerance.     

Effects of resistance training on respiratory function in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Purpose

Over the last decade, the potential use of resistance training (RT) for patients with chronic obstructive pulmonary disease (COPD) has gained increasing attention. Many COPD patients experience muscle dysfunction and reduced muscle mass, primarily as a result of chronic immobilization. These symptoms have been associated with reduced exercise tolerance and complaints of fatigue and dyspnea (even after minimal exertion). This paper presents findings from a systematic review that sought to: (1) present a meta-analysis of randomized controlled trials (RCT) investigating the effects of RT on respiratory function measures in patients with COPD and (2) investigate the existence of a dose–response relationship between intensity, duration and frequency of RT and assessed outcomes.

Methods

A systematic literature search of MEDLINE electronic database (January 1980 to December 2009) produced a body of research on the effects of RT with a control group in patients with COPD. Data analysis involved a random effects meta-analysis, in order to determine weighted mean differences with 95 confidence intervals (95% CI) for each endpoint. All data were analyzed with the software package Review Manager V 4.2.10 (of the Cochrane Collaboration); 14 RCTs were included in the meta-analysis.

Results

Findings demonstrated that RT did not substantially increase forced expiratory volume in 1 s. In addition, the weighted mean difference was 2.71% of predicted (95% CI, ?1.86 to 7.27; p?=?0.25) or by absolute 0.08 L (95% CI, ?0.03 to 0.19; p?=?0.14). It appeared that maximum minute ventilation increased by 3.77 L/min (95% CI, ?0.51 to 8.04; p?=?0.08).

Conclusions

Based on findings from the meta-analysis, RT produces a clinically and statistically significant effect on respiratory function (such as forced vital capacity) and is therefore recommended in the management of COPD.     

Handgrip Strength Seems Not to Be Affected by COPD Disease Progression: A Longitudinal Cohort Study

Abstract

Skeletal muscle dysfunction, functional exercise capacity impairment and reduced physical activity are characteristic features in patients with chronic obstructive pulmonary disease (COPD). Assessments addressing muscle strength of the upper limb, such as measurement of handgrip strength (HGS), are rarely performed and reported. We aimed to analyze the course of HGS and possible predictors of changes in HGS over time in COPD. Yearly assessments of various disease markers were performed for a follow-up of up to seven years in a cohort of COPD patients to assess the longitudinal disease process. Data of 194 patients with at least one follow-up measurement were analyzed. HGS decreased significantly by B = ?0.86 (95% CI ?1.09/?0.62, p?<?0.001) over time. The multivariate mixed effects model showed an independent association between greater annual declines in HGS and lower numbers of steps per day by B?=?0.11 (95% CI 0.03/0.18, p?=?0.006) and an enhanced change in COPD Assessment Test scores by B = ?0.01 (95% CI ?0.01/?0.00, p?=?0.034). No evidence for an independent association between annual decline in HGS and FEV₁% pred. by B = ?0.01 (95% CI ?0.03/0.01, p?=?0.297) was shown. Patients who died during follow-up did not exhibit greater declines in HGS compared to survivors (p?=?0.884). Although HGS significantly decreased over time, no pathophysiological link with COPD disease progression could be demonstrated. Previous cross-sectional associations between HGS and mortality could not be confirmed in this longitudinal setting. Our data suggests that repeated monitoring of HGS in clinical settings seems not to be helpful to predict COPD specific disease progression.     

Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis

A large body of evidence exists indicating that autonomic imbalance is characteristic of heart failure, with several parameters of autonomic function associated with adverse clinical outcomes. The aim of this systematic review and meta-analysis was to investigate the effects of exercise training on parameters of autonomic function in patients with heart failure and where possible quantify the size of the effect. We conducted database searches (PubMed, EMBASE and Cochrane Trials Register to 31 March 2017) for exercise-based rehabilitation trials in heart failure; using search terms, exercise training, autonomic function, heart rate recovery, heart rate variability and muscle sympathetic nerve activity. Pooled data indicated a statistically significant increase in heart rate recovery at 1 min (HRR₁) in exercise compared to control groups_, mean difference 5.90 bpm (95%CI 5.12, 6.69; p?<?0.00001). Pooled data also indicated that exercise training improved the short-term heart rate variability (HRV) parameters of root mean square of successive differences between normal heart beats (RMSSD (ms)) [mean difference 10.44 (95%CI 0.60, 20.28, p?=?0.04)] and high-frequency normalised units (HF_nu) [mean difference 7.72 (95%CI 3.32, 12.12, p?=?0.0006), which are predominantly reflective of parasympathetic activity. Analyses also indicated a statistically significant decrease in muscle sympathetic nerve activity (MSNA) bursts/minute (mean difference ??11.09 (95%CI ??16.18, ??6.00; p?<?0.0001) and MSNA bursts/100 heart beats (mean difference ??15.44 (95%CI ??20.95, ?9.92; p?<?0.00001) in exercise groups compared to controls. With improvements in HRR, HRV and MSNA, exercise training appears to facilitate an improvement in parasympathetic tone and reduction in sympathetic activity.     

The Relationship between Particulate Matter (PM10) and Hospitalizations and Mortality Of Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Abstract

Background: Numerous studies have reported variable associations between ambient particulate matter (PM) and chronic obstructive pulmonary disease (COPD) hospitalizations and mortality. Objective: To conduct a systematic study assessing the associations between hospitalizations and mortality from COPD and ambient PM₁₀ (particulate matter with aerodynamic diameters ≤ 10 μm, PM₁₀). Methods: Systematic searches were conducted in 6 common electronic databases. A meta-analysis was performed to estimate the odds ratio (OR) to evaluate the relationship between PM₁₀ and COPD hospitalizations and mortality. Publication bias and heterogeneity of samples were tested by Begg funnel plot and Egger test, respectively. Study findings were analyzed using random-effect model and fixed-effect model. Results: The search yielded 31 studies suitable for the meta-analysis during the period from Jan 1, 2000 to Oct 31, 2011. A 10μg/m³ increase in PM₁₀ was associated with a 2.7% (95%CI = 1.9%-3.6%) increase in COPD hospitalizations with an OR of 1.027 (95%CI: 1.019–1.036), and a 1.1% (95%CI: 0.8%–1.4%) increase in COPD mortality with an OR of 1.011 (95%CI: 1.008–1.014). Conclusions: Ambient PM₁₀ is associated with increased COPD hospitalizations and mortality. Further research is needed to elucidate whether this association is causal and to clarify its mechanisms.     

Antiplatelet Treatment Reduces All-Cause Mortality in COPD Patients: A Systematic Review and Meta-Analysis

Previous studies clearly showed that patients with chronic obstructive pulmonary disease (COPD) are at high risk for cardiovascular events. Platelet activation is significantly heightened in these patients, probably because of a chronic inflammatory status. Nevertheless, it is unclear whether antiplatelet treatment may contribute to reduce all-cause mortality in COPD patients. To clarify this issue, we performed a systematic review and meta-analysis including patients with COPD (outpatients or admitted to hospital for acute exacerbation). The primary endpoint was all-cause mortality. We considered studies stratifying the study population according the administration or not of antiplatelet therapy and reporting its relationship with the primary endpoint. Overall, 5 studies including 11117 COPD patients were considered (of those 3069 patients were with acute exacerbation of COPD). IHD was present in 33% of COPD patients [95%CI 31%–35%). Antiplatelet therapy administration was common (47%, 95%CI 46%–48%), ranging from 26% to 61%. Of note, IHD was considered as confounding factor at multivariable analysis in all studies. All-cause mortality was significantly lower in COPD patients receiving antiplatelet treatment (OR 0.81; 95%CI 0.75–0.88). The data was consistent both in outpatients and in those with acute exacerbation of COPD. The pooled studies analysis showed a very low heterogeneity (I² : 8%). Additional analyses (meta-regression) showed that antiplatelet therapy administration was effective independently (to potential confounding factors as IHD, cardiovascular drugs and cardiovascular risk factors. In conclusion, our meta-analysis suggested that antiplatelet therapy might significantly contribute to reduce all-cause mortality in COPD patients.     

Interdependence of physical inactivity,loss of muscle mass and low dietary intake: Extrapulmonary manifestations in older chronic obstructive pulmonary disease patients

Aim

Extrapulmonary manifestations, such as reductions in skeletal muscle and physical inactivity, are important clinical features of patients with chronic obstructive pulmonary disease (COPD), and might depend on the severity of COPD. As it is still unclear whether the relationship between muscle loss and physical inactivity is dominated by a disease‐specific relationship or caused by patient factors, including physiological aging, we aimed to investigate the pulmonary or extrapulmonary factors associated with physical inactivity among older COPD patients.

Methods

A total of 38 older male COPD patients (aged ≥65 years) were enrolled, and were evaluated cross‐sectionally. Skeletal muscle mass was measured using bioelectrical impedance, and physical activity and energy intake were recorded for 2 weeks using a pedometer and diary.

Results

Daily step counts were successfully evaluated in 28 participants (mean forced expiratory volume in 1 s [%predicted; %FEV₁]; 49.5%), and ranged widely. The mean step counts was 5166 steps/day, and found to have a significant relationship with dyspnea (r = ?0.46), diffusing capacity (r = 0.47), %FEV1 (r = 0.44), skeletal muscle index (r = 0.59) and total dietary intake (r = 0.47), but not with age (P = 0.14). A stepwise multivariate analysis showed that the skeletal muscle index (β = 0.50) and total dietary intake (β = 0.35) were significant determinants of the daily step count (R² = 0.46, p < 0.01).

Conclusions

Although various pulmonary factors are associated with daily physical activity, skeletal muscle mass and dietary intake are more closely correlated with physical activity in COPD patients. Because physical inactivity might be the strongest predictor of prognosis, the present results suggest that a comprehensive treatment strategy must be considered for older COPD patients to improve their extrapulmonary manifestations and pulmonary dysfunction. Geriatr Gerontol Int 2018; 18: 88–94 .     

Oxidative stress markers in blood in systemic sclerosis: A meta-analysis

Objectives: The purpose of this study is to clarify the relationship between systemic sclerosis (SSC) and oxidative stress markers in blood.

Methods: We conducted a systematic literature search of databases, including PubMed and Embase, for studies reporting circulating oxidative stress markers in patients with SSC and controls published from 1980 to December 2015. Standardized mean differences (SMDs) and 95% confidence intervals (95%CI) were calculated.

Results: Of the 1076 articles initially retrieved, 47 were included in our meta-analysis including 12 oxidative stress markers. The concentrations of nitric oxide (SMD?=?0.77; 95%CI: 0.18, 1.36; p?=?0.01), malondialdehyde (SMD?=1.63; 95%CI: 1.03, 2.24; p?=?0.000), asymmetric dimethylarginine (SMD?=?0.51; 95%CI: 0.12, 0.91; p?=?0.011), and ROOH (SMD?=?3.37; 95%CI: 0.28, 6.46; p?=?0.033) in the blood of patients with SSC were higher than those of the control group, whereas the concentrations of superoxide dismutase (SMD?=??1.11; 95%CI:??1.57, ?0.65; p?=?0.000) and vitamin C (SMD?=??1.12; 95%CI:??1.51,??0.73; p?=?0.000) were lower than in the control group.

Conclusions: The oxidative stress markers in blood for patients with SSC were aberrant, indicating the imbalanced states of oxidation and antioxidation in SSC.     

The relationship between exercise capacity and masked hypertension in sedentary patients with diabetes mellitus

Aim: Although exaggerated blood pressure responses (EBPR) to exercise have been related to future hypertension and masked hypertension (MHT), the relationship between exercise capacity and MHT remains unclear. A sedentary life style has been related to increased cardiovascular mortality, diabetes mellitus (DM), and hypertension. In this study, we aimed to examine the relationship between exercise capacity and MHT in sedentary patients with DM.

Methods: This study included 85 sedentary and normotensive patients with DM. Each patient’s daily physical activity level was assessed according to the INTERHEART study. All patients underwent an exercise treadmill test, and exercise duration and capacity were recorded. Blood pressure (BP) was recorded during all exercise stages and BP values ≥200/110?mmHg were accepted as EBPR. MHT was diagnosed in patients having an office BP <140/90?mmHg and a daytime ambulatory BP >135/85?mmHg. Patients were divided into two groups according to their ambulatory BP monitoring (MHT and normotensive group).

Results: The prevalence of MHT was 28.2%. Exercise duration and capacity were lower in the MHT group than in the normotensive group (p?p?=?0.03). According to a multivariate regression, exercise capacity (OR: 0.61, CI95%: 0.39–0.95, p?=?0.03), EBPR (OR: 9.45, CI95%: 1.72–16.90, p?=?0.01), and the duration of DM (OR: 0.84, CI95%: 0.71–0.96, p?=?0.03) were predictors of MHT.

Conclusion: Exercise capacity, EBPR, and the duration of DM were predictors of MHT in sedentary subjects with DM.     

Dropout from physical activity interventions in people living with HIV: a systematic review and meta-analysis

Physical activity (PA) interventions have been shown to improve the health of people living with HIV (PLWH), yet treatment dropout poses an important challenge. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in PA interventions in PLWH. Electronic databases were searched for records up to September 2016. Randomized control trials of PA interventions in PLWH reporting dropout rates were included. Random effects meta-analysis and meta-regression analyses were employed. In 36 studies involving 49 PA intervention arms, 1128 PLWH were included (mean age?=?41.6 years; 79.3% male; 39% White). The trim and fill adjusted treatment dropout rate was 29.3% (95% CI?=?24.5–34.7%). There was a significant lower dropout rate in resistance training interventions compared with aerobic (p?=?0.003) PA interventions, in studies utilizing supervised interventions throughout the study period (p?p?β?=?1.15, standard error (SE)?=?0.49, z?=?2.0, p?=?0.048), a lower body mass index(BMI) (β?=?0.14, SE?=?0.06, z?=?2.16, p?=?0.03), and a lower cardiorespiratory fitness (β?=?0.10, SE?=?0.04, z?=?2.7, p?=?0.006). The dropout from PA interventions is much higher in PLWH than in many other populations with chronic morbidities. Qualified professionals (i.e., exercise physiologists, physical educators, or physical therapists) should be incorporated as key care providers in the multidisciplinary care of HIV/AIDS and should prescribe supervised PA for PLWH in order to enhance adherence and reduce the burden of HIV/AIDS. Special attention should be given men, those with a higher BMI, and those with a lower cardiorespiratory fitness.     

Rehabilitation effects of land and water-based aerobic exercise on lung function,dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background:We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review''s purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs.Methods:Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000–December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331).Results:Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61–465.75).Conclusion:Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.     

Cardiac Autonomic Function and Cardiovascular Response to Exercise in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with impaired exercise tolerance, but it has not been established to what extent cardiac autonomic function impacts on exercise capacity. Objective: To evaluate whether there is an association between airflow limitation and cardiac autonomic function and whether cardiac autonomic function plays a role in exercise intolerance and daily physical activity (PA) in patients with COPD. Methods: Univariate and multivariate analyses were performed to evaluate the association between both 6-minute walking test (6MWT) and PA (steps per day) and pulmonary function, cardiac autonomic function (HR at rest, HRR and heart rate variability, HRV) in patients with COPD. Results: In 154 COPD patients (87 females, mean [SD]: age 62.5 [10.7] years, FEV₁%predicted (43.0 [19.2]%), mean HR at rest was elevated (86.4 [16.4] beats/min) and HRV was reduced (33.69 [28.96] ms) compared to published control data. There was a significant correlation between FEV₁ and HR at rest (r = -0.32, p < 0.001), between HR at rest and 6MWD (r = -0.26, p = 0.001) and between HR at rest and PA (r = -0.29, p = 0.010). No correlation was found between HRV and 6MWD (r = 0.089, p = 0.262) and PA (r = 0.075, p = 0.322). In multivariate analysis both HR and FEV₁ were independent predictors of exercise capacity in patients with COPD. Conclusions: In patients with COPD the degree of airflow limitation is associated with HR at rest. The degree of airflow limitation and cardiac autonomic function, as quantified by HR at rest, are independently associated with exercise capacity in patients with COPD.     

Association of the bradykinin receptors genes variants with hypertension: a case–control study and meta-analysis

Background: The present study was to investigate the role of bradykinin receptors genes polymorphisms on hypertension risk in Northern Han Chinese population. We also carried out a meta-analysis on Chinese to derive a more full assessment of this association. Methods and results: A total of 976 subjects from Northern Han Chinese and 7 studies with 1599 cases and 1425 controls were included in this case–control study and in the current meta-analysis, respectively. For the case–control study, we identified the genotypes of ?58T/C and 1098A/G polymorphism in BDKRB2 and BDKRB1 genes, respectively, by TaqMan PCR method. Overall, we found significant association between the ?58T/C polymorphism and the increased risk of hypertension in the allele comparison (p?=?0.01, OR?=?1.386, 95%CI [1.138–1.688]). Subgroup analysis by gender suggested that this obvious association could still be found in males, but not in females. For the 1098A/G polymorphism, no significant association was revealed in overall and subgroup analysis. For the meta-analysis involving the ?58T/C polymorphism, a significant association between this polymorphism and hypertension was observed in the whole group. In Chinese Han subgroup, we found significant association with hypertension in allele comparison(C vs. T: p?=?0.03, OR?=?1.28, 95%CI 1.03–1.59, p_{heterogeneity}?=?0.05). Conclusions: Our case–control study indicated that ?58T/C might be significantly associated with the increased risk of hypertension in Northern Han Chinese population, which was partially confirmed by our meta-analysis.     

Differences in Adherence and Non-Adherence Behaviour Patterns to Inhaler Devices Between COPD and Asthma Patients

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.     

Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis

Pulmonary rehabilitation (PR) is recommended as an effective treatment for patients with chronic obstructive pulmonary disease (COPD). Previous meta-analyses showed that PR improves exercise capacity and health-related quality of life (HRQOL). However, they did not evaluate the effect of PR on the sensation of dyspnea.We searched six databases in May 2019 for randomized controlled trials (RCTs) that examined PR, including supervised lower limb endurance training as a minimal essential component that was continued for 4–12 weeks, in patients with stable COPD, with changes from baseline dyspnea as a primary outcome. Secondary outcomes were changes in exercise capacity, HRQOL, activity of daily life (ADL), physical activity (PA), and adverse events. We calculated the pooled weighted mean difference (MD) using a random effects model. We identified 42 studies with 2150 participants. Compared with the control, PR improved dyspnea, as shown using the British Medical Research Council (MRC) questionnaire (MD, −0.64; 95% CI, −0.99 to −0.30; p = 0.0003), transitional dyspnea index (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001), modified Borg score during exercise (MD, −0.62; 95% CI, −1.10 to −0.14; p = 0.01), and Chronic Respiratory Questionnaire (CRQ) dyspnea score (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007). PR significantly increased exercise capacity measured by the 6 min walking distance time, peak workload, and peak VO₂. It improved HRQOL measured by the St. George's Respiratory Questionnaire and CRQ, but not on PA or ADL. These results indicated that PR programs including lower limb endurance training improve dyspnea, HRQOL, and exercise capacity in patients with stable COPD.     

Effects of Pulmonary Rehabilitation Including Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease after Stratification by the Degree of Static Hyperinflation

Background

Inspiratory muscle training (IMT) improves inspiratory muscle strength, exercise capacity and health status in patients with chronic obstructive pulmonary disease (COPD). However, there is no additional effect on top of comprehensive pulmonary rehabilitation (PR). It is unclear whether patients with different baseline degrees of static hyperinflation respond differentially to IMT as part of a PR program. Therefore, the aim was to study the effects of IMT as an add-on on PR after stratification for baseline degrees of static hyperinflation.

Methods

In this single center retrospective study data were extracted between June 2013 and October 2020 of COPD patients who participated in a comprehensive PR program including IMT. IMT was performed twice daily, one session consisted of 3 series of 10 breaths and training intensity was set initially at a load of approximately 50% of patients’ maximal static inspiratory mouth pressure (MIP). The primary outcome measure was MIP. Secondary outcomes were the distance achieved on the 6-min walk test (6MWD), endurance cycling exercise capacity at 75% of the peak work rate (CWRT) and disease-specific health status using the COPD assessment test.

Results

754 patients with COPD were screened for eligibility and 328 were excluded because of repeated PR programs, missing data or baseline residual volume (RV)?>?350%. In total, 426 COPD patients were categorized into RV categories 50–130% (n?=?84), 131–165% (n?=?86), 166–197% (n?=?86), 198–234% (n?=?85) and 235–349% (n?=?85). In the whole sample, MIP, endurance exercise capacity and health status improved significantly. The change in 6MWD was higher in the lowest baseline degree of static hyperinflation [+?39 (9–92) m] compared with the baseline highest degree of static hyperinflation [+?11 (??18–54) m] (p?<?0.05).

Conclusions

IMT as part of a PR program in patients with COPD with different baseline degrees improved MIP irrespective of the degree of static lung hyperinflation. Improvement in functional exercise capacity was significantly higher in the group with the lowest degree of static hyperinflation compared with the patients with the highest degree of static hyperinflation.

     

The Glittre-ADL Test Cut-Off Point to Discriminate Abnormal Functional Capacity in Patients with COPD

The study objective was to determine a cut-off point for the Glittre activities of daily living (ADL)test (TGlittre) to discriminate patients with normal and abnormal functional capacity. Fifty-nine patients with moderate to very severe COPD (45 males; 65 ± 8.84 years; BMI: 26 ± 4.78 kg/m²; FEV₁: 35.3 ± 13.4% pred) were evaluated for spirometry, TGlittre, 6-minute walk test (6 MWT), physical ADL, modified Medical Research Council scale (mMRC), BODE index, Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT). The receiver operating characteristic (ROC) curve was used to determine the cut-off point for TGlittre in order to discriminate patients with 6 MWT < 82% pred. The ROC curve indicated a cut-off point of 3.5 minutes for the TGlittre (sensitivity = 92%, specificity = 83%, and area under the ROC curve = 0.95 [95% CI: 0.89–0.99]). Patients with abnormal functional capacity had higher mMRC (median difference 1 point), CAT (mean difference: 4.5 points), SGRQ (mean difference: 12.1 points), and BODE (1.37 points) scores, longer time of physical activity <1.5 metabolic equivalent of task (mean difference: 47.9 minutes) and in sitting position (mean difference: 59.4 minutes) and smaller number of steps (mean difference: 1,549 minutes); p < 0.05 for all. In conclusion, the cut-off point of 3.5 minutes in the TGlittre is sensitive and specific to distinguish COPD patients with abnormal and normal functional capacity.     

Prevalence of asthma and chronic obstructive pulmonary disease in Aboriginal and non-Aboriginal populations: A systematic review and meta-analysis of epidemiological studies

BACKGROUND:

Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups.

OBJECTIVE:

To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations.

METHODS:

MEDLINE, EMBASE, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis.

RESULTS:

Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]).

CONCLUSIONS:

Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.