Malnutrition According to GLIM Criteria Is Associated with Mortality and Hospitalizations in Rehabilitation Patients with Stable Chronic Obstructive Pulmonary Disease

Malnutrition has a negative impact on patients with chronic pulmonary obstructive disease (COPD). The purpose of this study was to assess the prevalence of malnutrition, defined by the Global Leadership Initiative for Malnutrition (GLIM), in stable COPD patients referred to pulmonary rehabilitation, and to explore potential associations of malnutrition according to GLIM, and its components, with increased risk of mortality and hospitalizations in 2 years. In a post-hoc analysis of a prospective cohort of 200 rehabilitation patients with stable COPD, main outcome variables were hospital admissions, length of stay, and mortality during a 2-year follow-up. Covariates were malnutrition according to GLIM and its phenotypic criteria: unintentional weight loss, low body mass index (BMI), and low fat-free mass (FFM). Univariate and multivariate analysis were performed using logistic and proportional hazard Cox regression. Malnutrition according to GLIM showed 45% prevalence and was associated with increased mortality risk. Low age-related BMI and FFM were independently associated with mortality, which persisted after adjustment for age and lung function. Malnutrition and low BMI were also associated with increased risk of hospitalization. Malnutrition according to GLIM criteria was highly prevalent in rehabilitation patients with COPD and was associated with nearly 3 times greater mortality and hospitalization risk.     

肺康复训练对慢性阻塞性肺疾病患者的影响

目的分析慢性阻塞性肺疾病治疗中肺康复训练的应用价值。方法选取2017年3月—2019年6月本院收治的82例慢阻肺患者进行研究,随机分为常规组及研究组,每组均为41例。检测、记录两组患者的肺功能指标变化、呼吸困难程度以及急性加重情况并分别进行比较。结果研究组干预后FVC、FEV1以及FEV1/FVC三项指标水平均明显高于常规组,研究组干预后呼吸困难及急性加重的改善情况均远优于常规组,P<0.05,差异均具有统计学意义。结论康复训练可有效改善患者的急性加重及呼吸困难情况,并有效提高治疗效果。     

Effects of Sarcopenia on Ventilatory Behavior and the Multidimensional Nature of Dyspnea in Patients With Chronic Obstructive Pulmonary Disease

ObjectivesThis study tested the hypothesis that sarcopenia, a common extrapulmonary feature of chronic obstructive pulmonary disease (COPD), can affect ventilatory behavior, and worsen the multidimensional nature of dyspnea in patients with COPD.DesignCross-sectional survey study.Settingand Participants: Stable outpatients with COPD encountered in general practice and respiratory clinic.MethodSarcopenia was diagnosed according to an appendicular skeletal muscle mass index based on measurements of electrical impedance and handgrip strength. Exertional dyspnea was tested using a 3-minute Step Test and a 6-minute Walk Test. The dimensions of dyspnea were assessed by a multidimensional dyspnea profile.ResultsOf 60 stable patients with COPD, 16 met the criteria for sarcopenia. During the 3-minute Step Test, minute ventilation as a proportion of exercise time, tidal volume as a proportion of inspiratory capacity, the change in inspiratory capacity, and ventilation as a proportion of maximal voluntary ventilation did not differ between patients with and without sarcopenia. Patients with sarcopenia exhibited lower evolution of tidal volume, higher evolution of respiratory frequency versus ventilation and breathing discomfort on the 3-minute Step Test, as well as increased physical breathing effort on the 6-minute Walk Test, compared with those without sarcopenia. In a multivariable model adjusted using inverse probability weighting, sarcopenia was independently associated with breathing discomfort during the 3-minute Step Test and physical breathing effort during the 6-minute Walk Test.Conclusions and ImplicationsSarcopenia may be associated with shallow breathing and diverse sensory and affective components of exertional dyspnea in patients with COPD. The study indicates that improvement of the rapid breathing pattern may offer unique ways to alleviate dyspnea in older patients with COPD and sarcopenia.     

稳定期慢性阻塞性肺疾病和肺心病患者营养状况分析

目的 通过对稳定期COPD和肺心病患营养状况的分析，为开展有针对性的饮食干预治疗提供参考依据。方法 采用24h膳食回忆法，并进行营养测量、生化检验和肺通气功能检查，及其与营养指标的相关性分析。结果 88名患热能和蛋白质、脂肪等营养素的摄入明显不足；碳水化合物摄入偏高。21．59％体重偏低。营养及生化指标均与肺通气功能存在不同程度的正相关。纬论 热能和多种营养素的摄入不足是导致营养不良的重要原因之一。     

Longitudinal Changes in Health Status Using the Chronic Respiratory Disease Questionnaire and Pulmonary Function in Patients with Stable Chronic Obstructive Pulmonary Disease

Long-term changes in health status have been less evaluated in patients with chronic obstructive pulmonary disease (COPD), in comparison to the changes in forced expiratory volume in 1 s (FEV1). Accordingly, we examined the clinical course of health status as well as pulmonary function in COPD patients, and investigated the relationship between the change in health status and the change in pulmonary function in a 3-year longitudinal study involving 224 patients with COPD. Health status using the Chronic Respiratory Disease Questionnaire (CRQ) and pulmonary function were measured at baseline and every six months over three years. We used the random effects model for the slopes to estimate the longitudinal changes. A total of 147 patients completed the 3-year study. The dyspnoea, fatigue, and emotional function domains of the CRQ declined slowly but significantly over 3 years (p = 0.001, 0.003, and 0.004, respectively) with a mean decline rate of 0.08/year. This means that it would take about 6 years to reach the minimal important change of 0.5 on the CRQ. The mean decline in post-bronchodilator FEV1 was 60 ml/year. None of the changes in any of the domains of the CRQ were significantly correlated with the changes in pulmonary function. We have found that, in comparison to the decline in pulmonary function, health status evaluated by the CRQ declined significantly but very slowly in three of four domains over three years in patients with COPD. Furthermore, we have demonstrated that there was no significant relationship between the change in health status and the change in pulmonary function.     

Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria

EWGSOP2 criteria for sarcopenia recommends the use of either handgrip strength (GS) or 5-times repeated chair stand test (RCS) as a muscle strength measure. We aim to compare the impact of different muscle strength definitions on sarcopenia prevalence and predictive validity for 2-year outcomes, using the EWGSOP2 clinical algorithm. We studied 200 community-dwelling older adults, comparing sarcopenia prevalence using three muscle strength definitions: 1) maximum GS (Asian Working Group cutoffs); 2) RCS-1 (standard cutoff >15s); and 3) RCS-2 (ROC-derived cutoff >12.5s). Two-year outcomes include: 1) Incident frailty (modified Fried criteria); 2) Physical performance [Short Physical Performance Battery (SPPB) score <10]; and 3) Quality of life [EuroQol-5 dimension (EQ-5D) <25th percentile]. We performed logistic regression on 2-year outcomes adjusted for age, gender, cognition and mood. Prevalence of confirmed sarcopenia was 14.5%, 4% and 9% for GS, RCS-1 and RCS-2 respectively. For 2-year outcomes (N=183), RCS-2 predicted incident frailty (OR: 5.7, 95% CI 1.4–22.8, p=0.013), low SPPB (OR: 4.4, 95% CI 1.4–13.1, p=0.009), and trended towards predicting low QOL (OR: 2.1, 95% CI 0.9–4.9, p=0.095). In contrast, GS and RCS-1 did not predict frailty nor low QOL, but predicted low SPPB only (GS: OR 3.8, 95% CI 1.3–10.6, p=0.01; RCS-1: OR: 8.8, 95% CI 2.2–35.0, p=0.002). Sarcopenia prevalence varies with muscle strength definitions, with GS being significantly higher vis-á-vis RCS definitions. Our results also support the use of population-specific over standard cutoffs for RCS to obtain intermediate estimates of sarcopenia prevalence and the best predictive validity for two-year outcomes.     

慢性阻塞性肺疾病患者家庭氧疗和呼吸操康复治疗的效果观察

慢性阻塞性肺疾病（COPD）是一种严重危害人们健康的慢性进行性加重的呼吸道疾病。目前，常规治疗效果不能令人满意。美国夜间氧疗试验组（NOTT）和英国医学研究会（BMRC）的研究表明，长期家庭氧疗（LTDOT）能改善生治质量，延长生存时间。以色列weiner等的研究显示，通过持续呼吸肌训练（SEMT），COPD患者呼吸肌强度及耐力得到改善，呼吸困难减轻。本院报告30例同步接受LTDOT和SEMT康复治疗的COPD缓解期患者，观察其改善肺功能及活动耐力的临床疗效。     

COPD稳定期患者疾病严重程度与生命质量的相关性研究

目的研究慢性阻塞性肺疾病稳定期患者疾病严重程度与生命质量的相关性。方法对79例慢性阻塞性肺疾病稳定期患者进行综合评估,根据严重程度分为A、B、C和D组,与对照组（18例）分别进行36条目健康测量简表（SF-36）评分,比较组间生命质量各维度的差别。结果A组患者在SF-36量表各维度得分与对照组比较,差异无统计学意义（P〉0．05）。B、C和D组患者生命质量较对照组下降,D组下降维度最多且得分最低。结论COPD患者的生活质量较差,随着COPD患者疾病严重程度增加其生命质量下降。     

Association of Prefrailty and Frailty With All-Cause Mortality,Acute Exacerbation,and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis

ObjectiveTo evaluate the impact of prefrailty and frailty on all-cause mortality, acute exacerbation, and all-cause hospitalization in patients with chronic obstructive pulmonary disease (COPD).DesignMeta-analysis.Setting and ParticipantsTwo authors independently searched PubMed, Web of Science, and Embase databases until December 27, 2022,to identify studies that reported the predictive value of prefrailty and frailty in COPD patients.MeasurementsAll-cause mortality, acute exacerbation, and all-cause hospitalization.ResultsTen studies reporting on 11 articles enrolling 13,203 patients with COPD were included. The prevalence of frailty ranged from 6.0% to 51%. When compared with nonfrailty, the pooled adjusted hazard ratio (HR) of all-cause mortality was 1.48 (95% CI 0.92-2.40) for prefrailty and 2.64 (95% CI 1.74-4.02) for frailty, respectively. The pooled adjusted odds ratio (OR) of all-cause hospitalization was 1.35 (95% CI 1.05-1.74) for prefrailty and 1.65 (95% CI 1.05-2.61) for frailty. In addition, frailty significantly predicted all acute exacerbation (OR 2.20, 95% CI 1.26-3.81) but not moderate to severe acute exacerbation (OR 1.42, 95% CI 0.94-2.17) in patients with stable COPD. However, the pooled results of all-cause hospitalization were not reliable in leave-1-out sensitivity analyses.Conclusions and ImplicationsFrailty significantly predicts all-cause mortality in patients with COPD, even after adjustment for common confounding factors. Assessment of frail status in COPD patients may improve secondary prevention and allow early intervention. However, future studies are warranted to validate the impact of frailty defined by a standardized definition of frailty on acute exacerbation and all-cause hospitalization.     

社区康复治疗对慢性阻塞性肺病患者肺功能及生活质量影响的研究

目的探索适合慢性阻塞性肺病(COPD)患者的社区康复途径及服务模式,为今后在社区内广泛开展慢性阻塞性肺病患者的康复护理提供临床参考依据。方法收集2013年1月至2013年10月期间在我院住院的慢性阻塞性肺病患者136例,依据出院顺序单双序列随机分成实验组和对照组各68例,实验组患者出院后给予个性化社区康复治疗,对照组则指导医嘱服药和常规定期随访,两组患者在门诊复诊时进行肺功能检测、耐力检测及憋气试验,对比两组患者干预后肺功能指标的差异。生存质量评分采用《慢性阻塞性肺病患者生命质量评分表》进行评价。结果行个性化社区护理的实验组患者,其用力肺活量和1秒率均显著高于对照组,6分钟步行距离和憋气时间较对照组患者均显著延长(P<0.05)。实验组患者总体生活质量、躯体感觉、生理功能、心理功能均显著优于对照组(P<0.05),而社会活动则无显著差异(P>0.05)。结论社区康复模式有助于社区护理的规范化,提高护理质量,改善患者的健康水平和生活质量,有助于推动我国社区护理事业的发展。     

噻托溴铵联合沙美特罗/丙酸氟替卡松对慢性阻塞性肺疾病稳定期患者的疗效

目的 通过检测肺功能和慢性阻塞性肺疾病(COPD)评估测试(CAT)评分观察联合吸入噻托溴铵和沙美特罗/丙酸氟替卡松对COPD稳定期中重度患者的疗效.方法 采用随机、双盲的方法将48例COPD患者分为联合治疗组和对照组,联合治疗组给予噻托溴铵和沙美特罗/丙酸氟替卡松治疗,对照组给予沙美特罗/丙酸氟替卡松治疗.分别对两组患者治疗前后的CAT评分、肺功能的检测进行比较.结果 两组CAT评分治疗后均较治疗前明显下降,而联合治疗组下降较对照组更明显,差异有统计学意义(t=2.689,P＜0.05);治疗后两组肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气量占预计值的百分比(FEV1％)]均有不同程度的改善,联合治疗组肺功能指标优于对照组,差异均有统计学意义(t值分别为2.894、4.366、3.156,P＜0.05).2组患者治疗前后CAT评分与FEV1％呈明显负相关(Spearman 相关系数rs分别为-0.694、-0.631、-0.618、-0.745,P＜0.05).结论 联合吸入噻托溴铵和沙美特罗/丙酸氟替卡松治疗COPD稳定期中重度患者不仅能够改善肺功能,而且能提高患者运动耐力和改善患者生活质量,具有较好的治疗效果.     

多索茶碱联合噻托溴铵粉治疗慢性阻塞性肺疾病的效果

目的对多索茶碱与噻托溴铵粉联合治疗慢性阻塞性肺疾病患者的效果进行详细的探讨。方法选取102例2017年2月—2019年6月在本院治疗的慢性阻塞性肺疾病患者,随机分为对照组和观察组,各51例,给对照组患者给予多索茶碱治疗,给观察组患者给予多索茶碱联合噻托溴铵粉治疗,观察并比较两组患者的治疗效果以及肺功能的改善情况。结果观察组治疗效果(92.16%)优于对照组(62.75%),差异具有统计学意义(P<0.05);治疗前,观察组患者各项肺功能指标与对照组差异无统计学意义(P>0.05),经过不同的治疗后,观察组与对照组各项肺功能指标与治疗前相比较均有所改善,差异有统计学意义(P<0.05);观察组肺功能各项指标均优于对照组,差异具有统计学意义(P<0.05)。结论临床上治疗慢性阻塞性肺疾病患者时,将多索茶碱与噻托溴铵粉治联合起来使用,对改善患者肺功能及促进患者病情的恢复起到了积极的促进作用,效果显著。     

稳定期慢性阻塞性肺疾病患者呼出气一氧化氮测定及其临床意义

目的观察稳定期慢性阻塞性肺疾病(COPD)患者呼出气一氧化氮(FENO)水平,探讨其与患者肺功能及炎性指标的相关性。方法纳入76例稳定期COPD患者为COPD组, 63例健康体检者为对照组。比较两组的年龄、性别、吸烟指数、BMI、 hs-CRP、 EOS%和N%、肺功能及FENO水平。结果两组的吸烟指数、 FEV1%、 hs-CRP、 EOS%、 N%、 FENO水平比较均有统计学差异(P <0.05);两组的年龄、性别、 BMI比较无统计学差异(P>0.05)。相关分析显示, COPD组的FENO水平与EOS%呈正相关(P <0.05),与年龄、吸烟指数、 BMI、 FEV1%、 N%、 hs-CRP无相关性(P>0.05)。多元线性回归分析显示,EOS%、 hs-CRP是COPD患者FENO水平的影响因素。结论稳定期COPD患者的FENO水平较高,且与外周血嗜酸性粒细胞增多相关,可反映患者的气道炎症水平。     

膈肌起搏器在慢性阻塞性肺疾病呼吸机依赖患者脱机中的应用临床疗效观察

目的:探讨慢性阻塞性肺疾病(COPD)呼吸机依赖患者膈肌起搏器的应用及疗效。方法:把2018年6月~2019年6月本院呼吸内科收治的COPD使用呼吸机并发生依赖的清醒患者60例作为研究对象,男27例,女33例;患者年龄60~75岁,平均(66.3±1.2)岁,随机分为观察组(运用常规治疗及护理并增加使用膈肌起搏器)和对照组(运用常规治疗及护理),每组30例,对两组脱机成功率和脱机时间进行比较。结果:观察组患者脱机情况明显优于对照组,观察组与对照组2周脱机成功率分别为83.3%和46.7%,脱机时间分别为(7.56±1.45),(9.42±1.28)d,差异均有统计学意义(P<0.05)。结论:COPD呼吸机依赖患者准备脱机前,给予膈肌起搏器治疗,可明显提高脱机成功率及缩短呼吸机使用时间。     

不吸烟和吸烟的慢性支气管炎人群慢性阻塞性肺疾病患病率和临床特征的研究

目的：观察不吸烟和吸烟的慢性支气管炎人群中慢性阻塞性肺（COPD）的患病率和临床特征。方法;1992年筛选出2395例慢性支气管炎患者,不吸烟组952例,吸烟组1443例,经问卷、查体、肺功能测量调查COPD患病情况。结果：（1）不吸烟组COPD患病率低于吸烟组（37．7％和43．1％,P＝0．009）,两组均随年龄和咳嗽年限升高,吸烟组患病率随年龄升高幅度大于不吸烟组。（2）控制性别等因素后,吸烟组肺功能随年龄下降的速度大于不吸烟组。（3）Logistic回归分析：慢性支气管炎患者是否患者COPD与年龄、低体质指数、呼吸道症状与体征有关系,吸烟组与年龄和性别关系更为密切,而不吸烟组与临床症状和体征更为密切。结论：不是所有慢性支气管炎患者都患有COPD,吸烟、年龄大、病程长是COPD易患因素,吸烟可以加速病情进展,呼吸症状和体征有助于鉴别是否已患有COPD。控制吸烟和早期治疗慢性支气管炎对COPD的预防具有重要的意义。     

Cost-Utility Analysis of Telemonitoring Interventions for Patients with Chronic Obstructive Pulmonary Disease (COPD) in Germany

Background

Chronic obstructive pulmonary disease (COPD) poses major challenges for health care systems. Previous studies suggest that telemonitoring could be effective in preventing hospitalisations and hence reduce costs.

Objective

The aim was to evaluate whether telemonitoring interventions for COPD are cost-effective from the perspective of German statutory sickness funds.

Methods

A cost-utility analysis was conducted using a combination of a Markov model and a decision tree. Telemonitoring as add-on to standard treatment was compared with standard treatment alone. The model consisted of four transition stages to account for COPD severity, and a terminal stage for death. Within each cycle, the frequency of exacerbations as well as outcomes for 2015 costs and quality adjusted life years (QALYs) for each stage were calculated. Values for input parameters were taken from the literature. Deterministic and probabilistic sensitivity analyses were conducted.

Results

In the base case, telemonitoring led to an increase in incremental costs (€866 per patient) but also in incremental QALYs (0.05 per patient). The incremental cost-effectiveness ratio (ICER) was thus €17,410 per QALY gained. A deterministic sensitivity analysis showed that hospitalisation rate and costs for telemonitoring equipment greatly affected results. The probabilistic ICER averaged €34,432 per QALY (95 % confidence interval 12,161–56,703).

Conclusion

We provide evidence that telemonitoring may be cost-effective in Germany from a payer’s point of view. This holds even after deterministic and probabilistic sensitivity analyses.

     

Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD)

Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients’ eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation’s National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = ?0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients benefit from web-based self-management support resources.