scholarly journals Six Minute Walk Distance Is a Predictor of Survival in Patients with Chronic Obstructive Pulmonary Disease Undergoing Pulmonary Rehabilitation

2015 ◽  
Vol 22 (4) ◽  
pp. 225-229 ◽  
Author(s):  
Esther Dajczman ◽  
Rima Wardini ◽  
Goulnar Kasymjanova ◽  
David Préfontaine ◽  
Marc Alexander Baltzan ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Retrospective Chart Review ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Walk Distance ◽  
Obstructive Pulmonary Disease ◽  
Minimal Improvement ◽  
Severe Copd

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive and distressing disease with a trajectory that is often difficult to predict.OBJECTIVE: To determine whether initial 6 min walk distance (6MWD) or change in 6MWD following inpatient pulmonary rehabilitation (PR) predicted survival.METHODS: Patients referred for PR in 2010 were studied in a retrospective chart review. Measures of 6MWD before and following PR were recorded. Initial 6MWD was categorized as ≥250 m, 150 m to 249 m and ≤149 m. Government databases provided survival status up until December 2013 and survival analyses were performed. Initial 6MWD and a minimally important difference (MID) of ≥30 m were used for survival analysis.RESULTS: The cohort consisted of 237 patients (92 men, 145 women) with severe COPD. Mean (± SD) forced expiratory volume in 1 s (FEV1) was 0.75±0.36 L, with a mean FEV1/forced vital capacity (FVC) ratio of 0.57±0.16. Overall three-year survival was 58%. Mean survival for the study period as per predefined categories of 6MWD of ≥250 m, 150 m to 249 m and ≤149 m was 42.2, 37.0 and 27.8 months (P<0.001), respectively, with a three-year survival of 81%, 66% and 34% observed, respectively. Overall mean change in 6MWD was 62±57 m, and a minimal improvement of ≥30 m was observed in 72% of patients. In the lowest walking group, early mortality was significantly higher among those who did not achieve minimal improvement. Older age, male sex and shorter initial 6MWD were negative predictors of survival.CONCLUSION: In patients with severe COPD, initial 6MWD was predictive of survival. Overall survival at three years was only 58% and was especially poor (34%) in patients with low (<150 m) initial walk distance.

scholarly journals Smallest worthwhile effect of land-based and water-based pulmonary rehabilitation for COPD

2015 ◽  
Vol 1 (1) ◽  
pp. 00007-2015 ◽  
Author(s):  
Renae J. McNamara ◽  
Mark R. Elkins ◽  
Manuela L. Ferreira ◽  
Lissa M. Spencer ◽  
Robert D. Herbert
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Iterative Process ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Walk Distance ◽  
Obstructive Pulmonary Disease ◽  
Trade Off ◽  
Water Based

This study aimed to determine the smallest worthwhile effect of land-based and water-based pulmonary rehabilitation on 6-min walk distance among people with chronic obstructive pulmonary disease (COPD).Using a benefit–harm trade-off method, people with COPD who had completed two baseline 6-min walk tests at the commencement of outpatient pulmonary rehabilitation were presented with two scenarios: 8 weeks of land-based and 8 weeks of water-based pulmonary rehabilitation. Participants were guided through an iterative process allowing them to progressively refine their estimates of the smallest improvement due to each form of rehabilitation that would outweigh the associated costs, risks and inconvenience presented in the scenario.100 people with COPD participated (mean±sdage 72±9 years, forced expiratory volume in 1 s 54±16% predicted and baseline 6-min walk distance 377±101 m). For land-based pulmonary rehabilitation, the median smallest worthwhile effect was 20 m (95% CI 15–37 m). For water-based pulmonary rehabilitation, the median smallest worthwhile effect was 26 m (95% CI 15–33 m). These estimates did not differ significantly (p=0.10).People with COPD typically perceive that pulmonary rehabilitation would be worthwhile if it increased the 6-min walk distance by about 6%. The smallest worthwhile effects of land- and water-based pulmonary rehabilitation were similar.

scholarly journals The Burden of Illness in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease in Canada

2012 ◽  
Vol 19 (5) ◽  
pp. 319-324 ◽  
Author(s):  
M Reza Maleki-Yazdi ◽  
Suzanne M Kelly ◽  
Sy S Lam ◽  
Mihaela Marin ◽  
Martin Barbeau ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Burden Of Illness ◽  
Patient Survey ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative ◽  
One Year ◽  
Severe Copd

INTRODUCTION: No recent Canadian studies with physician- and spirometry-confirmed diagnosis of chronic obstructive pulmonary disease (COPD) that assessed the burden of COPD have been published.OBJECTIVE: To assess the costs associated with maintenance therapy and treatment for acute exacerbations of COPD (AECOPD) over a one-year period.METHODS: Respirologists, internists and family practitioners from across Canada enrolled patients with an established diagnosis of moderate to severe COPD (Global initiative for chonic Obstructive Lung Disease stages 2 and 3) confirmed by postbronchodilator spirometry. Patient information and health care resources related to COPD maintenance and physician-documented AECOPD over the previous year were obtained by chart review and patient survey.RESULTS: A total of 285 patients (59.3% male; mean age 70.4 years; mean pack years smoked 45.6; mean duration of COPD 8.2 years; mean postbronchodilator forced expiratory volume in 1 s 58.0% predicted) were enrolled at 23 sites across Canada. The average annual COPD-related cost per patient was $4,147. Across all 285 patients, maintenance costs were $2,475 per patient, of which medications accounted for 71%. AECOPD treatment costs were $1,673 per patient, of which hospitalizations accounted for 82%. Ninety-eight patients (34%) experienced a total of 157 AECOPD. Treatment of these AECOPD included medications and outpatient care, 19 emergency room visits and 40 hospitalizations (mean length of stay 8.9 days). The mean cost per AECOPD was $3,036.DISCUSSION: The current costs associated with moderate and severe COPD are considerable and will increase in the future. Appropriate use of medications and strategies to prevent hospitalizations for AECOPD may reduce COPD-related costs because these were the major cost drivers.

scholarly journals Impact of feedback on physical activity levels of individuals with chronic obstructive pulmonary disease during pulmonary rehabilitation

2014 ◽  
Vol 11 (4) ◽  
pp. 191-198 ◽  
Author(s):  
Joana Cruz ◽  
Dina Brooks ◽  
Alda Marques
Keyword(s):  
Physical Activity ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Activity Monitors ◽  
Standing Time ◽  
The Impact

This study aimed at investigating whether providing feedback on physical activity (PA) levels to patients with chronic obstructive pulmonary disease (COPD) is feasible and enhances daily PA during pulmonary rehabilitation (PR). Patients with COPD participated in a 12-week PR program. Daily PA was measured using activity monitors on weeks 1, 7, and 12, and feedback was given in the following weeks on the number of steps, time spent in sedentary, light, and moderate-to-vigorous intensity activities, and time spent standing, sitting, and lying. Compliance with PA monitoring was collected. Two focus groups were conducted to obtain patients’ perspectives on the use of activity monitors and on the feedback given. Differences in PA data were also assessed. Sixteen patients (65.63 ± 10.57 years; forced expiratory volume in one second (FEV1) 70.31 ± 22.74% predicted) completed the study. From those, only eleven participants used the activity monitors during all monitoring days. Participants identified several problems regarding the use of activity monitors and monitoring duration. Daily steps (  p = 0.026) and standing time (  p = 0.030) were improved from week 1 to week 7; however, the former declined from week 7 to week 12. Findings suggest that using feedback to improve PA during PR is feasible and results in improved daily steps and standing time on week 7. The subsequent decline suggests that additional strategies may be needed to stimulate/maintain PA improvements. Further research with more robust designs is needed to investigate the impact of feedback on patients’ daily PA.

scholarly journals Meal Induced Oxygen Desaturation and Dyspnea in Chronic Obstructive Pulmonary Disease

1998 ◽  
Vol 5 (5) ◽  
pp. 361-365 ◽  
Author(s):  
Norman Wolkove ◽  
Li Yi Fu ◽  
Ashok Purohit ◽  
Antoinette Colacone ◽  
Harvey Kreisman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Arterial Oxygen Saturation ◽  
Care Facility ◽  
Forced Expiratory Volume ◽  
Oxygen Desaturation ◽  
Arterial Oxygen ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severe Copd

OBJECTIVE: To study arterial oxygen saturation (SpO2) obtained by pulse oximetry and dyspnea during active eating (AE) and passive eating (PE) in patients with severe chronic obstructive pulmonary disease (COPD).DESIGN: Patients were studied on two consecutive days with AE and PE, which occurred in random order. SpO2was recorded for 20 mins before and during eating, and dyspnea was recorded by the patient using a 10 cm visual analogue scale before and upon completion of eating.SETTING: Subjects were in-patients at an intermediate care facility who were hospitalized for pulmonary rehabilitation or for convalescence after an exacerbation of COPD.POPULATION STUDIED: Thirty-five patients with severe COPD (forced expiratory volume in 1 s [FEV1] less than 50% predicted, FEV1to forced vital capacity ratio less than 65%) were studied. Mean age was 70.5±7.1 years.MAIN RESULTS: Mean SpO2decreased significantly (P<0.05) from 91.7±3.4% to 90.1±4.0% during AE, and 91.7±3.2% to 90.8±3.6% during PE. Mean lowest SpO2was lower and percentage of time with SpO2less than 90% was greater during eating compared with corresponding control periods during both AE and PE. Dyspnea increased significantly (P<0.05) from 1.4±1.2 to 3.3±2.3 cm during AE, and from 1.5±1.5 to 2.4±2.2 cm during PE. The increase in dyspnea was significantly greater during AE than PE.CONCLUSIONS: Eating is an activity that can adversely affect SpO2and increase dyspnea in patients with severe COPD. Oxygen desaturation and particularly increased dyspnea may at least in part relate to the recruitment of upper extremity muscles during eating.

scholarly journals Diaphragmatic Excursion is Correlated With the Improvement in Exercise Tolerance After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease

2021 ◽  
Author(s):  
Masashi Shiraishi ◽  
Yuji Higashimoto ◽  
Ryuji Sugiya ◽  
Hiroki Mizusawa ◽  
Yu Takeda ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Roc Curve ◽  
Pulmonary Rehabilitation ◽  
Exercise Tolerance ◽  
Maximum Level ◽  
Quadriceps Muscle ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background: In patients with chronic obstructive pulmonary disease (COPD), the maximum level of diaphragm excursion (DEmax) is correlated with dynamic lung hyperinflation and exercise tolerance. This study aims to clarify the utility of DEmax to predict the improvement in exercise tolerance after pulmonary rehabilitation (PR) in patients with COPD.Methods: This was a prospective cohort study. Sixty-two patients with stable COPD participated in an outpatient PR programme from April 2018 to February 2021, and 50 completed the programme. Six-minute walk distance (6MWD) was used to evaluate exercise tolerance, and ultrasonography was used to measure DEmax. Responders to PR in exercise capacity were defined as patients with an increase >30 m in 6MWD. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of DEmax to predict responses to PR.Results: Baseline levels of forced expiratory volume in one second (%FEV1), 6MWD, maximum inspiratory pressure (PImax), DEmax and quadriceps muscle strength (QMS) were significantly higher, and peak dyspnoea of modified Borg (mBorg) scale was lower in responders (n = 30) than in non-responders (n = 20) to PR (p < 0.01). In multivariate analysis, DEmax was significantly correlated with an increase of >30 m in 6MWD. The area under the ROC curve of DEmax to predict responders was 0.915, with a sensitivity of 83% and a specificity of 95% at a cut-off point of 44.9 mm of DEmax.Conclusion: DEmax well predicted the improvement in exercise tolerance after PR in patients with COPD.

scholarly journals The efficacy of adding budesonide/formoterol to ipratropium plus theophylline in managing severe chronic obstructive pulmonary disease: an open-label, randomized study in China

2019 ◽  
Vol 13 ◽  
pp. 175346661985350 ◽  
Author(s):  
Kewu Huang ◽  
Yanfei Guo ◽  
Jian Kang ◽  
Li An ◽  
Zeguang Zheng ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Randomized Study ◽  
Reduction Rate ◽  
Forced Expiratory Volume ◽  
Chinese Patients ◽  
Chronic Obstructive ◽  
Open Label ◽  
Obstructive Pulmonary Disease ◽  
Severe Copd

Background: Patients diagnosed with chronic obstructive pulmonary disease (COPD) in China are commonly prescribed ipratropium plus theophylline (I+T) therapy. Studies have shown that an inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination is also efficacious in reducing symptoms and exacerbations. This study evaluated the efficacy and tolerability of adding budesonide/formoterol (BUD/FORM) to I+T in Chinese patients with severe COPD. Methods: A randomized, parallel-group, open-label, multicenter phase IV study (Clinical Trials.gov identifier: NCT01415518) was conducted in China. Patients received either BUD/FORM (160/4.5 µg; two inhalations twice daily [bid] via Turbuhaler®) + I (20 µg per inhalation, two inhalations four times daily) + T (100 mg bid) or I+T alone for 12 weeks. The primary efficacy variable was change from baseline in predose forced expiratory volume in 1 s (FEV1). Results: A total of 584 patients were randomized equally between treatment groups. At the end of the study, the BUD/FORM plus I+T group displayed significant improvements in predose FEV1 versus the I+T group (between-group difference 6.9%; 95% confidence interval [CI]: 4.3, 9.6; p < 0.0001). Forced vital capacity, inspiratory capacity, peak expiratory flow and health-related quality of life (HRQoL) scores were significantly improved (all p < 0.0001) and exacerbation frequency was reduced (43.5% reduction; rate ratio 0.565, 95% CI 0.325, 0.981; p = 0.0425) with BUD/FORM plus I+T versus I+T alone. Conclusion: Patients with severe COPD in China treated with BUD/FORM plus I+T showed significant improvements in lung function and HRQoL and a reduction in exacerbations compared with I+T alone. Both treatments were well tolerated and no safety concerns were noted. The reviews of this paper are available via the supplemental material section.

Objectively Measured Steps/Day in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 13 (11) ◽  
pp. 1275-1283 ◽  
Author(s):  
Travis Saunders ◽  
Nerissa Campbell ◽  
Timothy Jason ◽  
Gail Dechman ◽  
Paul Hernandez ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Meta Analysis ◽  
Airflow Obstruction ◽  
Forced Expiratory Volume ◽  
Activity Level ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Objectively Measured

Background:Although individual studies have reported on the number of steps/day taken by individuals with chronic obstructive pulmonary disease (COPD), this evidence has not been systematically reviewed or synthesized.Methods:MEDLINE and PsycINFO were searched for studies reporting objectively-measured steps/day and percent predicted forced expiratory volume in 1 second (FEV1%) in patients with COPD. Meta-analyses were used to estimate steps/day across studies, while metaregression was used to estimate between-study variance based on clinical and demographic factors (year and location of study, activity monitor brand, number of days wearing the monitor, whether participants were about to enter pulmonary rehabilitation, 6-minute walk distance (6MWD), FEV1%, age, and sex).Results:38 studies including 2621 participants met inclusion criteria. The pooled mean estimate was 4579 steps/day (95% CI:4310 to 5208) for individuals with COPD. Only 6MWD, FEV1% and whether patients were about to undergo pulmonary rehabilitation explained a significant portion of the variance (P < 0.1) in univariate meta-regression. In a multivariate model including the above risk factors, only FEV1% was associated with steps/day after adjustment for other covariates.Conclusions:These results indicate that patients with COPD achieve extremely low levels of physical activity as assessed by steps/day, and that severity of airflow obstruction is associated with activity level.

scholarly journals Identification of MMP-9 as a biomarker for detecting progression of chronic obstructive pulmonary disease

2015 ◽  
Vol 93 (6) ◽  
pp. 541-547 ◽  
Author(s):  
Marwa F. Abd El-Fatah ◽  
Mohamed A. Ghazy ◽  
Mohamed S. Mostafa ◽  
May M. El-Attar ◽  
Ahmed Osman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Fold Increase ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Mrna Levels ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Metalloproteinase 9 ◽  
Severe Copd

Chronic obstructive pulmonary disease (COPD) is a complex immunological disease with multiple pathological features that is primarily induced by smoking together with additional genetic risk factors. COPD is frequently underdiagnosed; forced expiratory volume in the first second (FEV1) is considered to be the main diagnostic measure for COPD, yet it is insufficiently sensitive to monitor disease progression. Biomarkers capable of monitoring COPD progression and severity are needed. In this report, we evaluated matrix metalloproteinase-9 (MMP-9) as an early marker for the detection and staging of COPD, by assessing the mRNA levels of MMP-9 in peripheral blood samples collected from 22 COPD patients, 6 asymptomatic smokers, and 5 healthy controls. Our results demonstrate that the mRNA levels of MMP-9 increased more than two-fold in severe COPD relative to non-COPD smokers or moderate COPD groups. Moreover, in the very severe COPD group, MMP-9 mRNA levels showed a 4-fold increase relative to the non-COPD smokers or the moderate COPD groups, while there was a mild increase (∼40%) when compared to the severe COPD group. Taken together, our results suggest that MMP-9 serves as a biomarker for the grade and severity of COPD.

scholarly journals Diaphragmatic excursion is correlated with the improvement in exercise tolerance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masashi Shiraishi ◽  
Yuji Higashimoto ◽  
Ryuji Sugiya ◽  
Hiroki Mizusawa ◽  
Yu Takeda ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Roc Curve ◽  
Pulmonary Rehabilitation ◽  
Exercise Tolerance ◽  
Maximum Level ◽  
Quadriceps Muscle ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background In patients with chronic obstructive pulmonary disease (COPD), the maximum level of diaphragm excursion (DEmax) is correlated with dynamic lung hyperinflation and exercise tolerance. This study aimed to elucidate the utility of DEmax to predict the improvement in exercise tolerance after pulmonary rehabilitation (PR) in patients with COPD. Methods This was a prospective cohort study. Of the 62 patients with stable COPD who participated in the outpatient PR programme from April 2018 to February 2021, 50 completed the programme. Six-minute walk distance (6MWD) was performed to evaluate exercise tolerance, and ultrasonography was performed to measure DEmax. Responders to PR in exercise capacity were defined as patients who demonstrated an increase of > 30 m in 6MWD. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of DEmax to predict responses to PR. Results Baseline levels of forced expiratory volume in 1 s, 6MWD, maximum inspiratory pressure, DEmax and quadriceps muscle strength were significantly higher, and peak dyspnoea of modified Borg (mBorg) scale score was lower in responders (n = 30) than in non-responders (n = 20) to PR (p < 0.01). In multivariate analysis, DEmax was significantly correlated with an increase of > 30 m in 6MWD. The area under the ROC curve of DEmax to predict responders was 0.915, with a sensitivity and specificity of 83% and 95%, respectively, at a cut-off value of 44.9 mm of DEmax. Conclusion DEmax could adequately predict the improvement in exercise tolerance after PR in patients with COPD.

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