scholarly journals An mHealth Assistive System “MyLung” to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research (Preprint)

2018 ◽  
Author(s):  
Riad Alharbey ◽  
Samir Chatterjee
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Behavioral Intention ◽  
Self Efficacy ◽  
Care Management ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Awareness Level

BACKGROUND Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients’ lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. OBJECTIVE The objective of this study is to design an innovative mobile health (mHealth) app system called “MyLung” that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. METHODS The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients’ behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). RESULTS The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as “meta-inferences” in this study. CONCLUSIONS We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease.

scholarly journals Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil

2019 ◽  
Vol 4 (6) ◽  
pp. e001921
Author(s):  
Max Oscar Bachmann ◽  
Eric D Bateman ◽  
Rafael Stelmach ◽  
Alvaro A Cruz ◽  
Matheus Pacheco de Andrade ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Link Type ◽  
To Receive

IntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates.ResultsAsthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms.ConclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.Trial registrationNCT02786030 (https://clinicaltrials.gov/).

scholarly journals Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne-Kathrin Rausch Osthoff ◽  
Swantje Beyer ◽  
David Gisi ◽  
Spencer Rezek ◽  
Ariane Schwank ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Intervention Group ◽  
Rehabilitation Program ◽  
Control Group ◽  
Chronic Obstructive ◽  
Long Term Effects ◽  
Obstructive Pulmonary Disease

Abstract Background Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. Methods A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. Results Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. Conclusions In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

Effects of Pharmacist-Conducted Medication Reconciliation at Discharge on 30-Day Readmission Rates of Patients With Chronic Obstructive Pulmonary Disease

2019 ◽  
pp. 089719001986724
Author(s):  
Divita Singh ◽  
Germin Fahim ◽  
Hoytin Lee Ghin ◽  
Scott Mathis
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Medication Errors ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Purpose: To analyze effect of pharmacist-conducted medication reconciliation on 30-day readmission rates in chronic obstructive pulmonary disease (COPD) and identify common medication errors among patient with readmissions. Methods: Pharmacists were educated on discharge medication reconciliation for patients with COPD. A retrospective chart review was conducted on patients who underwent pharmacist-conducted discharge medication reconciliation to determine 30-day readmissions. Medication errors analyzed included medication omissions and dose or frequency errors. Previously collected internal research without pharmacist-conducted medication reconciliation served as the control. Results: There were 65 patients in the control group and 50 in the intervention group. About 25% of patients in the control group and 26% of patients in the intervention group had any cause readmissions within 30 days of discharge ( P = .87). Both the control and the intervention group had similar COPD-related readmissions of 12.3% and 12.6%, respectively. Medication dose or frequency errors consisted of 68.9% and 46.7% of total errors in the control and the intervention groups, respectively. Long-acting muscarinic antagonist (LAMA) or long-acting beta 2-agonist (LABA) were the most common drug classes to be incorrectly dosed or omitted at discharge. In the intervention group, 30 errors were identified. Due to inability to coordinate discharges, pharmacists intervened on 13 errors, 7 of which were accepted by the prescriber. Conclusion: Pharmacist-conducted medication reconciliation at discharge did not affect 30-day readmission rates of patients with COPD. Confounding factors included a small sample size, passive pharmacist education, and discharge issues. The most common medication errors at discharge were dosing or frequency errors of LABAs or LAMAs.

scholarly journals MyLung: A mHealth Assistive System to Empower Patients with COPD (Preprint)

2020 ◽  
Author(s):  
Abc Xyz
Keyword(s):  
Behavioral Intention ◽  
Self Efficacy ◽  
Care Management ◽  
Intervention Group ◽  
Self Care ◽  
Control Group ◽  
Systems Research ◽  
Significant Difference ◽  
The Impact ◽  
Awareness Level

BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is one of those progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. The breathlessness has negative implications on patients’ lives that lead to physical and psychological limitations. The physical limitations impede daily life activities that are essential for patients with COPD. Psychological limitations are manifested in anxiety that results from the emotional response to breathlessness. Because patients with COPD are always overwhelmed by anxiety and depression, they are less motivated to engage in self-care and education intervention. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. OBJECTIVE The objective of this study is to design an innovative mHealth app system called “MyLung” that provides a complete solution to increase self-awareness and to promote better self-care management. This IT artifact includes three integrative modules that are novel: education, risk reduction, and monitoring. METHODS The utility and effectiveness of the assistive mobile-based technology are evaluated using mixed methods approach. The study combines quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients’ behavioral intention to change their lifestyle. Thirty patients were assigned in two groups (intervention group and control group). The results from the quantitative analysis introduced several follow-up interviews using a qualitative study RESULTS The results of the quantitative study provide significant evidence that the design of MyLung leads to change in awareness level, self-efficacy and behavioral intention for patients with COPD. T- tests reveal significant difference before and after using mobile based app for awareness level (M = 3.28 versus 4.56, t(10) = 6.062, p < 0.001), self-efficacy (M = 3.11 versus 5.56, t(10) = 2.96, p = 0.014) and behavioral intention (M = 2.91versus 4.55, t(10) = 3.212, p = 0.009). In the same vein, independent sample t-tests reveal significant difference between groups in awareness level (M = 4.56 versus 3.31, t(19) = 4.80, p < 0.001) and self- efficacy (M = 5.56 versus 3.66, t(19) = 2.8, p < 0.012). Integrating findings from quantitative and qualitative strands introduces inferences that describe the impact of the design in a comprehensive view. These inferences are referred in this study as “meta-inferences”. CONCLUSIONS The objective of this research is to empower patients with COPD with assistive mobile-based technology that helps increase awareness levels and to engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD, and to improve access to relevant information. Meta-inferences that are emerged from the research outputs contribute to chronic management information systems research by helping us gain more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease.

scholarly journals The Effects of Safflower Yellow on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized, Controlled Clinical Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
Xiao-jin Li ◽  
Yan Kang ◽  
Ru-rong Wang ◽  
Xue-lian Liao ◽  
Xiao-feng Ou ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Stay ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Average Length ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled

Objectives. To evaluate the efficacy of safflower yellow in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. In a prospective, randomized, controlled trial, 127 patients who met the inclusion criteria were enrolled and were randomly divided into two groups. The control group included 64 patients treated according to the global strategy for diagnosis, management, and prevention of COPD (www.goldcopd.org, updated 2011). The intervention group included 63 patients who received intravenous infusions of safflower yellow (100 mg of safflower yellow dissolved in 250 ml 0.9% saline) once daily for 14 consecutive days in addition to standard diagnosis and treatment. The difference in the average length of the hospital stay between the two groups of patients was determined. The follow-up period was 28 days; the differences in symptoms, clinical indicators, and 28-day mortality in the two groups were compared. Statistical analysis was conducted using SPSS 22.0 software to determine whether there were statistically significant differences (P <0.05) between groups. Results. There were no statistically significant differences between the intervention group and the control group in changes in secondary indicators. There were no statistically significant differences in the 28-day mortality or in the survival curves of the two groups (P=0.496 and P=0.075, respectively). Safflower yellow treatment of AECOPD may relieve the patient’s clinical symptoms, such as dyspnoea, shorten the average length of hospital stay (P=0.006, respectively), and decrease the duration of mechanical ventilation. Conclusion. Safflower yellow in the treatment of AECOPD has a degree of clinical value. This trial is registered under the identifier ChiCTR-IPR-17014176.

scholarly journals Evaluation and Exploration on the Effect of the Management of Chronic Obstructive Pulmonary Disease in Rural Areas through an Internet-Based Network Consulting Room

2018 ◽  
Vol 27 (3) ◽  
pp. 222-226
Author(s):  
Yan Yan ◽  
Li Liu ◽  
Jing Zeng ◽  
Liang Zhang
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Rural Areas ◽  
Close Contact ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Objective: This study aims to improve the management quality of chronic obstructive pulmonary disease (COPD) in rural areas. Methods: Two hundred forty discharged COPD patients were divided into an intervention group and a control group. In the intervention group, 120 patients established contact with doctors through the network consulting room, i.e., the doctor’s mobile platform, and were managed through video, voice, and text by the doctors, kept close contact with the doctors after discharge (education, consultation), and received electronic prescriptions, and drugs were sent to the patients’ door by online retailers. The patients in the control group were managed in the traditional manner. One year later, the predicted forced expiratory volume in 1 s (FEV1)%, FEV1/forced vital capacity (FVC), and CAT scores and the number of rehospitalized patients were compared between these 2 groups. Results: After 1 year of follow-up, the predicted FEV1% and the FEV1/FVC ratio were significantly higher in the intervention group than in the control group (p < 0.05). CAT scores were lower for patients in the intervention group than for those in the control group after 1 year of follow-up (p < 0.05). After 1 year of follow-up, 22 (18.33%) patients were rehospitalized in the intervention group and 58 (48.33%) patients were rehospitalized in the control group (p < 0.05). Conclusion: Doctors can improve the quality of life of patients with COPD and reduce the number of rehospitalizations through use of the network consulting room.

Cost-effectiveness of a telemonitoring program (telEPOC program) in frequently admitted chronic obstructive pulmonary disease patients

2021 ◽  
pp. 1357633X2110372
Author(s):  
Cristóbal Esteban ◽  
Ane Antón ◽  
Javier Moraza ◽  
Milagros Iriberri ◽  
Mateo Larrauri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cost Effectiveness ◽  
Pulmonary Disease ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
Cost Effectiveness Ratio ◽  
Obstructive Pulmonary Disease ◽  
The Cost ◽  
Quality Adjusted Life

Chronic obstructive pulmonary disease is a typical disease among chronic and respiratory diseases. The costs associated with chronic disease care are rising dramatically, and this makes it necessary to redesign care processes, including new tools which allow the health system to be more sustainable without compromising on the quality of the care, compared to that currently provided. One approach may be to use information and communication technologies. In this context, we explored the cost-effectiveness of applying a telemonitoring system to a cohort of chronic obstructive pulmonary disease patients with frequent readmissions (the telEPOC programme). We conducted an intervention study with a control group. The inclusion criteria used were having chronic obstructive pulmonary disease (forced expiratory volume in the first second/forced vital capacity  < 70%) and having been hospitalised for exacerbation at least twice in the last year or three times in the last 2 years. We estimated the costs incurred by patients in each group and calculated the quality-adjusted life years and incremental cost-effectiveness ratio. Overall, 77 patients were included in the control group and 86 in the intervention group. The raw cost-effectiveness analysis showed that the cost of the telEPOC intervention was significantly lower than that of usual care, while there were no significant differences between the groups in effectiveness. The incremental cost-effectiveness ratio for the intervention was €175,719.71 per quality-adjusted life-year gained. There were no differences between the intervention group (telemonitoring) and the control group (standard care) from the cost-effectiveness point of view. On the other hand, the intervention programme (telEPOC) was less expensive than routine clinical practice.

scholarly journals The effect of pursed lip breathing exercise against decrease of breathing levels in chronic obstruction pulmonary disease

2019 ◽  
Vol 6 (11) ◽  
pp. 4695
Author(s):  
Honesty Diana Morika ◽  
Indah Komala Sari ◽  
Rhona Sandra ◽  
Eliza Arman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pharmacological Treatment ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Obstructive ◽  
P Value ◽  
Shortness Of Breath ◽  
Breathing Exercise ◽  
Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease that is a problem throughout the world where its prevalence, morbidity and mortality are increasing every year. The high number of COPD visits is due to persistent and progressive shortness of breath complaints. Existing pharmacological therapies for COPD have not shown improvement in the long-term decline in pulmonary function that is a hallmark of COPD. It is very necessary for companion therapy that is non-pharmacological treatment is expected to be able to complete pharmacological treatment in reducing shortness of breath of COPD patients with pursed-lip breathing exercise.Methods: This study uses a quassy experiment design with two group pretest and posttes design approaches. This study was in obstructive pulmonary disease patients in the lung hospital in West Sumatra with an intervention group of 16 and a control of 16 respondents. Data analysis using univariate and bivariate using independent t-test statistics.Results: The results showed the average decrease in shortness of breath in the control group without pretest 3.19 and posttest 2.56 in the pretest pursed lip breathing exercise intervention group 3.19 and posttest performed 1.69. Test statistic p-value 0.026.Conclusions: There is an effect of pursed lip breathing exercise on reducing the level of shortness of breath in patients with chronic obstructive pulmonary disease.

scholarly journals The effect of Pursed Lips Breathing Exercises on the Oxygen Saturation Levels of Patients with Chronic Obstructive Pulmonary Disease in Persahabatan Hospital, Jakarta

2021 ◽  
pp. 35-64
Author(s):  
. Sumedi ◽  
Koshy Philip ◽  
Muhammad Hafizurrachman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Oxygen Saturation ◽  
Pulmonary Disease ◽  
Intervention Group ◽  
Lung Ventilation ◽  
Control Group ◽  
Chronic Obstructive ◽  
Breathing Exercise ◽  
Obstructive Pulmonary Disease ◽  
Breathing Exercises

Patients with chronic obstructive pulmonary disease can face increased resistance of airflow, air trapping, and lung hyperinflation. This condition can also cause decreased lung ventilation functions. Using a pursed lips breathing exercise can strengthen respiratory muscles that can improve oxygen saturation by maintaining airflow to bronchus and its branches and alveolus which then can prevent collapse in bronchiolus. The purpose of the study was to identify the effect of pursed lips breathing exercises on the oxygen saturation levels in patients with chronic obstructive lung disease in Persahabatan hospital, Jakarta. The design was quasi experimental, with a control group pre-post test design. A random sampling technique was used in the study. The exercise was provided to the intervention group for six days. The findings showed that the lung ventilation function is significantly different between preand post-intervention for both groups (p=0.00). Further, the average lung ventilation function in the intervention group is significantly different from that of the control group after intervention (p=0.012). In addition, while there is a significant relationship between subject age and the increase of the lung ventilation score (p=0.001), there was no relationship between height and the increase of oxygen saturation (p=0.091) and no significant relationship between sex and the increase of oxygen saturation (p=0.346). Based on these findings, the pursed lips breathing exercise is recommended to patients with chronic obstructive lung disease in order to improve the level of oxygen saturation.   Keywords: Oxygen saturation, Pursed lips breathing exercise, Chronic Obstructive Pulmonary Disease.

Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 29 (2) ◽  
pp. 864-872
Author(s):  
Fernanda Borowsky da Rosa ◽  
Adriane Schmidt Pasqualoto ◽  
Catriona M. Steele ◽  
Renata Mancopes
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Oral Cavity ◽  
Pulmonary Disease ◽  
Thermal Sensation ◽  
Sensory Function ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Age Related ◽  
Copd Patients

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years ( SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years ( SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups (“≤ 65 years” and “> 65 years”) within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications ( p < .001) and xerostomia ( p = .003) in the COPD cohort. Oral cavity thermal sensation ( p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group ( p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.

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