Nutritional Status of Patients with Chronic Obstructive Pulmonary Disease in Relation to their Physical Performance

Nutritional abnormalities and physical inactivity are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to determine the association between nutritional status/body composition and physical performance in patients with COPD.

A cross-sectional observational study was conducted in outpatients with clinically stable, moderate to very severe COPD. In the assessment of nutritional status, we used dual energy X-ray absorptiometry, anthropometry, serum biomarkers, and the Mini-Nutritional Assessment (MNA) questionnaire. Physical performance was measured by the 6-minute walk distance (6MWD), 4-metre gait speed (4MGS), and physical activity. Univariate and multivariate analyses were performed.

In 111 patients (mean age 68 years, 69% men), the mean 6MWD was 376 ± 119 m, 4MGS 0.9 ± 0.2 m/s, and the average daily step count 8,059 ± 4,757. Patients with low exercise capacity (6MWD ≤ 350 m) had a significantly lower lean mass index (LMI) (p < 0.01), fat-free mass index (FFMI) (p < 0.01), bone mineral content (p < 0.01), bone mineral density (p < 0.01), T-score (p < 0.05), MNA score (p < 0.01), and serum albumin and prealbumin levels (p < 0.05). Patients with low physical activity (daily step count ≤ median) had lower LMI, FFMI, MNA score, serum prealbumin (for all comparisons p < 0.05) and vitamin D levels (p < 0.01). However, none of the nutritional variables showed an independent association with low physical performance in the multivariate models. In conclusion, patients with low physical performance have deficient nutritional status, but we could not demonstrate an independent relationship between nutritional parameters and physical performance.     

Physical Activity Patterns in Patients in Different Stages of Chronic Obstructive Pulmonary Disease

It has previously been suggested that exercise capacity is decreased in COPD and that it is associated with degree of disease. The reduced exercise capacity may plausibly be due to low levels of physical activity in this patient group. The aim of the present study was to assess exercise capacity and physical activity in different stages of COPD and to examine the associations between exercise capacity, pulmonary function and degree of physical activity. A total of 44 COPD patients and 17 healthy subjects participated in the study. Exercise capacity was assessed using the 6-minute walking test and physical activity was assessed using an accelerometer worn all waking hours during 7 days. Mean exercise capacity was significantly lower in COPD patients compared with healthy subjects. Mean physical activity level and time spent at least moderately active were significantly lower in patients with moderate and severe COPD compared with healthy subjects while no differences in time spent sedentary were observed between the study groups. Pulmonary function, mean physical activity level and time spent at least moderately physically active were significantly associated with exercise capacity in the patients. We conclude that patients with moderate and severe COPD are less physically active compared with healthy subjects. Furthermore, mean physical activity level and physical activity of at least moderate intensity are positively associated with exercise capacity in COPD, while time spent sedentary is not, which stresses an important role of physical activity on exercise capacity in these patients.     

Physical and Psychological Correlates of Functioning in Patients with Chronic Obstructive Pulmonary Disease

We studied the contribution of coping and illness perceptions to outcome in patients with chronic obstructive pulmonary disease (COPD). In a longitudinal study, 64 patients completed the Medical Outcomes Study Instrument and the Illness Perception Questionnaire. Data on coping and severity of illness (spirometry) were also collected. Regression analyses showed that first-time illness perceptions and coping significantly contributed to the prediction of social functioning, mental health, health perceptions, total functioning score, and prediction of visits to the outpatient clinic and prescribed medication 1 year later. These results have important implications for the medical management of patients with COPD.     

Udenafil Improves Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study

Abstract

Pulmonary hypertension (PH) is a serious complication of chronic obstructive pulmonary disease (COPD), and there is no effective pharmacological treatment for COPD-associated PH. We evaluated the effect of udenafil, a phosphodiesterase-5 (PDE-5) inhibitor, on the exercise capacity of patients with severe COPD. Patients with severe and very severe COPD (forced expiratory volume in one second (FEV₁) <50% of predicted) received udenafil (50 mg daily) for 8 weeks. A 6-min walk test (6MWT), lung function test, Doppler echocardiography, and Saint George's Respiratory Questionnaire (SGRQ) were completed before and after therapy. The primary outcome was a change in the 6-min walk distance (6MWD). Thirty-eight patients were screened for eligibility, and 23 completed the study. After 8 weeks of udenafil treatment, the mean 6MWD increased from 315 to 348 m (p = 0.02), and median PASP decreased from 36 to 30 mmHg (p = 0.02). There were no changes in the SGRQ score, Borg dyspnea score, or pulmonary function parameters. The PDE-5 inhibitor udenafil improved exercise capacity and decreased pulmonary artery pressure in patients with severe COPD. However, due to the small sample size, uncontrolled design and high dropout rate, the efficacy of udenafil in severe COPD needs to be confirmed in a large-scale randomized controlled study. This study was registered at ClinicalTrials.gov (number: NCT01364181).     

The Relationship between Self-Efficacy,Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses

Abstract

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted r?=?0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted r?=?0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted r?=?0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest.     

Dietary Patterns and Chronic Obstructive Pulmonary Disease: A Meta-analysis

Investigation of the relationship between dietary patterns and some chronic noncommunicable diseases has become appealing in nutritional epidemiology. Some studies have reported potential associations between dietary patterns and the risk of chronic obstructive pulmonary disease; however, the results remain conflicting. Thus, we conducted this meta-analysis to pool the results of studies to clarify the associations between dietary patterns and the risk of chronic obstructive pulmonary disease. A literature search of MEDLINE and EBSCO databases was performed to identify relevant studies published from January 1990 up to June 2015. A total of 13 studies met the inclusion criteria and were included in this meta-analysis. The highest category of healthy/prudent dietary patterns when compared with the lowest category was apparently associated with a decreased risk (OR = 0.55; CI: 0.46, 0.66; P < 0.0001). An increase in the risk of chronic obstructive pulmonary disease was shown for the highest compared with the lowest categories of “unhealthy/western-style” dietary patterns (OR = 2.12; CI: 1.64, 2.74; P < (0.0001). The results of this meta-analysis indicate that different dietary pattern may be associated with the risk of chronic obstructive pulmonary disease.     

Paraoxonase 1 Activity in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Paraoxonase 1 (PON1) is an antioxidative enzyme manly associated with high density lipoproteins (HDL) in the peripheral blood. The aim of this study was to determine the PON1 paraoxonase and arylesterase activities in patients with chronic obstructive pulmonary disease (COPD). We also aimed to determine the concentration of reduced thiol groups as a marker of protein oxidation. Materials and methods: The study included 105 patients with stable COPD and 44 healthy controls. PON1 activities and thiols concentration were assayed in sera by spectrophotometry. Results: PON1 basal (POX) and salt-stimulated paraoxonase activity (POX1) as well as arylesterase activity (ARE) were significantly reduced in COPD patients. In addition, concentration of reduced thiol groups was significantly decreased in COPD group. PON1 activities were similar in patients with different disease severity (GOLD stages). However, a significant reduction in POX, POX1 and ARE was observed already in GOLD II stage when compared to controls. POX and POX1 showed modest while ARE yielded very good power for discrimination between healthy subjects and COPD patients. Univariate and multivariate logistic regression analysis indicated that ARE is a good COPD predictor. Conclusion: Reduction of PON1 activity observed in COPD patients could be partly caused by oxidative environment. Lower concentrations of reduced thiol groups in COPD patients suggest that a decrease in PON1 activity could reflect oxidative changes of enzyme free cysteine residues. Furthermore, decreased PON1 arylesterase activity might indicate a down-regulation of PON1 concentration. Our results suggest that ARE could be considered as potential biomarker for COPD diagnosis.     

Pulmonary Embolism in Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study

Background: To evaluate the incidence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) in Taiwan. Methods: This was a retrospective population-based cohort study using data retrieved from Taiwan's National Health Insurance Research Database (2000 to 2008), which contains 99% of Taiwanese healthcare data. The evaluations included 355,878 COPD patients and 355,878 non-COPD patients for comparison. Results: The incidence of PE in the COPD cohort was 12.31 per 10,000 person-years (1.37/10,000 persons/y), which was approximately 4-times higher than in the comparison cohort (0.35/10,000 persons/y). In the COPD cohort, risk of PE was higher in the young age group (20-59 y, HR 4.64, 95% CI 3.06-7.03) than in other age groups. Risk of PE was higher in patients with COPD combined with hypertension, coronary artery disease, and cancer, or those with previous operation (HR 4.16, 4.75, 4.56, and 4.50 respectively) than in those with COPD and no comorbidity. Conclusions: The overall incidence of PE is lower in Taiwan than in western countries. However, the prevalence of PE in COPD patients is higher than in non-COPD patients and increases with age. It is crucial to incorporate PE into the differential diagnosis of COPD exacerbation for clinical physicians.     

Physical activity and sedentary behaviour: applying lessons to chronic obstructive pulmonary disease

In health and disease, the benefits of regular participation in moderate to vigorous intensity physical activity are well documented. However, individuals with chronic conditions, such as those with chronic obstructive pulmonary disease (COPD), typically do very little activity at a moderate or vigorous intensity. Much of their day is instead spent in sedentary behaviour, such as sitting or reclining, which requires very little energy expenditure. This high level of time spent in sedentary behaviour can have serious health consequences, including increased risk of diabetes, cardiovascular disease and premature mortality. There is emerging evidence to suggest that participation in light intensity physical activities (e.g. standing or slow walking) may have benefits for cardio‐metabolic health. Given the low aerobic capacity of individuals with moderate to severe COPD, increasing light intensity activity (through reducing sedentary time) may be a feasible additional strategy to improve health in this population, alongside traditional recommendations to increase the time spent in moderate to vigorous intensity physical activity. This review provides an overview of physical activity and sedentary behaviour, with a particular emphasis on these behaviours for people with COPD. It provides suggestions for the measurement of these behaviours within the clinical setting, as well as for interventions that may be effective at increasing physical activity and reducing sedentary behaviour in this population.     

无创通气在慢性阻塞性肺疾病患者撤机中的应用

目的：探讨无创通气应用于慢性阻塞性肺疾病（COPD）患者有创机械通气撤机中的作用。方法：62例cOPD合并呼吸衰竭应用有创通气后撤机拔管的患者，分为治疗组32例，对照组30例，治疗组在常规药物治疗基础上应用无创通气，对照组应用常规治疗（药物治疗＋吸氧）。观察两组的血气分析指标、再插管率、住院天数及住院病死率等。结果：治疗组给予无创通气后与对照组比较动脉血气PaO2明显上升（P〈0．05），PaCO2下降明显（P〈0．05），两组再插管率为9%和30％（P〈0．05），住院天数为（32±10）d和（38±15）d（P〈0．05），住院病死率为6．2％和23．3％（P〈0．05）。结论：撤机拔管后立即开始应用无创通气的患者再插管率下降，住院天数减少及病死率下降。     

胸腔镜手术对慢性阻塞性肺病伴肺大疱患者的治疗研究

目的探讨胸腔镜手术对慢性阻塞性肺病（COPD）伴肺大疱的治疗效果。方法 2007年10月—2010年6月我科收治的52例COPD伴肺大疱患者行胸腔镜下肺大疱切除术,其中伴气胸者10例;若胸腔内粘连尚可分离、肺大疱呈局限性非均质性分布,予完全胸腔镜下肺大疱切除;若胸腔镜探查发现胸腔内广泛粘连、肺大疱太多或弥漫分布以及麻醉难以实现单肺通气,则采用胸腔镜加小切口肺大疱切除术;并对手术前后患者的肺功能进行对比分析。结果术后随访44例3～36个月,患者胸闷伴轻度呼吸困难等症状明显改善,术前气胸者无气胸复发;术后3、6个月肺功能均较术前明显改善（P〈0.05）。结论胸腔镜手术治疗COPD伴肺大疱疗效明显。手术指征、手术方法、围术期的策略以及管理对治疗效果起决定作用。     

Chronic Obstructive Pulmonary Disease and SocioEconomic Status: a Systematic Review

Abstract

Background. Along with age and sex, socioeconomic status is one of the most powerful determinants of health. We conducted a systematic review to examine the consistency and magnitude of the association between socioeconomic status and COPD health outcomes to determine the potential impact of SES disparity on the COPD population. Methods. Electronic databases to October 2011 were searched for studies of adults who had or were at risk for COPD that quantified an association between a measure of socioeconomic status and at least one COPD health outcome. Two authors independently reviewed studies, assessed study quality, and for eligible studies, extracted data. Results. Regardless of the population, socioeconomic status measure or COPD outcome examined, with few exceptions, consistent significant inverse associations between socioeconomic status and COPD outcomes were found. Most studies found that individuals of the lowest socioeconomic strata were at least twice as likely to have poor outcomes as those of the highest (range from no difference to 10-fold difference). Conclusions. Social and economic disadvantage appears to have a significant consistent impact on COPD mortality and morbidity. These findings point to the need for public health strategies and research to address socioeconomic status disparity in individuals with COPD.     

基因重组生长激素在COPD急性加重期的治疗

目的　研究基因重组生长激素 (r- h GH)在慢性阻塞性肺疾病 (COPD)急性加重期治疗中的临床应用价值。方法　 30例 COPD急性加重期患者随机分成生长激素组和对照组。两组均给予抗感染、氧疗及营养支持等。生长激素组在上述治疗基础上加用 r- h GH,每晚 1次皮下注射 ,连续应用 7～ 10日。观察各组的治疗疗程 ,治疗前后的血糖峰值及胰岛素的用量。结果　生长激素组平均疗程 9.9± 3.8日 ,少于对照组 (13.8± 4 .3日 ) (p<0 .0 5 ) ,两组治疗前后的血糖峰值及胰岛素用量无显著差异。结论　 r- h GH能够缩短 COPD急性加重期患者的治疗疗程     

老年AECOPD患者合并急性心肌梗死临床观察

目的 探讨老年慢性阻塞性肺病急性加重期（AECOPD）合并急性心肌梗死（AMI）的临床特点,以减少误诊及漏诊.方法对老年AECOPD合并AMI（A组）22例患者的临床表现、实验室检查、心电图进行回顾性分析,与同期收治的单纯老年AECOPD（B组）164例患者进行比较.结果 两组均有咳嗽、咳痰、气喘;A组突然出现胸闷、呼吸困难加重的发生率显著高于B组（100%比3.7%,P〈0.01）,多伴有冷汗（81.8%比0,P〈0.01）、晕厥（22.7%比0,P〈0.01）、消化道症状（36.4%比10.4%,P〈0.01）和低血压（18.2%比3.7%,P〈0.05）;A组动脉氧分压/氧浓度（PaO2/FiO2）显著低于B组（313.52±126.68比361.86±120.82,P〈0.05）.结论老年AECOPD患者突然出现胸闷和呼吸困难加重、冷汗、晕厥、低血压,应警惕合并AMI,追踪心电图及心肌酶谱动态变化有助诊断.     

噻托溴胺对慢性阻塞性肺疾病稳定期患者生存质量的评价

目的观察中度慢性阻塞性肺疾病(COPD)稳定期吸入噻托溴胺的临床疗效。方法将40例中度COPD(Ⅱ～Ⅲ级)稳定期患者随机分为2组,治疗组(噻托溴铵组)(n=20,思力华,Boehinger Ingelheim,18ug,1次/d,早晨给药)和对照组(n=20,按需使用短效抗胆碱能支气管扩张剂),整个观察期为1年,观察2组用药3个月、6个月和1年后肺功能的变化以及StGeorge′s呼吸问卷(SGRQ)等情况,通过6min步行试验(6MWT)观察运动耐力的变化以及随访3～12个月急性加重的例次及住院例次。结果用药3个月后治疗组FEV1、FVC、FEV1/FVC及FEV1占预计值(%)比对照组明显改善,2组比较差异有显著性(P0.05),治疗组运动耐力(6MWT)增加,SGRQ评分比较治疗组明显下降,随访3～12个月治疗组急性加重例次明显减少,与对照组比较差异有显著性(P0.05);治疗组用药后3个月、6个月和1年后肺功能比较无显著差异(P0.05)。结论吸入噻托溴胺可以改善稳定期(Ⅱ～Ⅲ级)COPD患者肺功能与运动耐力,减少急性加重的发作,改善生活质量,不良反应少,使用方便,值得临床广泛推广。