Use of self-efficacy and dyspnea perceptions to predict functional performance in people with COPD.

This correlational and comparative study explored whether self-reports of self-efficacy and dyspnea perceptions predict the perceived level of functional performance in adults who have chronic obstructive pulmonary disease (COPD). The convenience sample included 97 Caucasian men (52) and women (45). Participants had to have a forced expiratory volume in 1 second (FEV1) of less than 70% predicted, and a FEV1/forced vital capacity (FVC) of less than 70%. Participants were recruited from pulmonary function laboratories and from better breather support groups in a Midwestern state. Three standardized, self-report instruments, COPD Self-Efficacy Scale (CSES), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and Functional Performance Inventory (FPI) were used to measure the participants' self-report of their perceptions of self-efficacy, dyspnea, and functional performance. Dyspnea predicted 38.1% of the variance in functional performance, with self-efficacy contributing an additional 6.5% to the variance in the total sample. Self-efficacy predicted 36.5% of the variance in functional performance in men, with dyspnea contributing an additional 7.2% to the variance. However, in women, only dyspnea was a significant predictor of functional performance, at 48.5% when both dyspnea and self-efficacy were entered as independent variables. To improve patients' perceptions of functional performance, nurses can use methods such as breathing techniques and upper- and lower-body exercises that increase optimal management of dyspnea. Nurses may increase the self-efficacy of managing dyspnea by helping patients master breathing techniques and exercise through coaching and providing vicarious experiences through patient support groups or pulmonary rehabilitation programs.     

Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD

OBJECTIVE: To determine the impact of an 8-wk program of comprehensive pulmonary rehabilitation on depression, anxiety, dyspnea, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). DESIGN: We studied 24 patients with severe COPD randomized either to pulmonary rehabilitation (PR), (n = 10; FEV1 30 +/- 9%) or control (C; n = 14; FEV1 34 +/- 11%). The PR program included disease education, energy conservation techniques, relaxation, and exercise including 20-min arm elevation with dumbbells and 20-min leg exercise sessions three times a week for 8 wks. At baseline and after completion of the program, all patients were evaluated using the Beck Depression Inventory, State Trait Anxiety Inventory (STAI), Modified Medical Research Council Scale (MRC), and St. George's Respiratory Questionnaire (SGRQ). RESULTS: After PR, there was a significant improvement in the severity of depression (P < 0.01), a decrease in symptoms (P < 0.05), an increase in daily living activities (P < 0.05), and a decrease in the total score of the SGRO (P < 0.01). Dyspnea measured by the MRC scale was significantly better in the PR group (P < 0.01). CONCLUSIONS: The present study shows that in patients with severe COPD, pulmonary rehabilitation induces important changes on depression and anxiety independent of changes in dyspnea and health-related quality-of-life.     

异丙托溴铵吸入剂与布地奈德混悬液联合治疗慢阻肺的效果观察

目的:探讨异丙托溴铵吸入剂联合布地奈德混悬液治疗慢阻肺(COPD)的临床效果。方法:研究对象为本院在2019年1月至2020年1月收治的50例COPD患者,根据治疗方法的差异将其分为单一组(n=25,予以异丙托溴铵吸入剂治疗)与联合组(n=25,在单一组基础上联合布地奈德混悬液治疗)。以两组治疗前肺功能、慢阻肺自我评估测试(CAT)、呼吸困难评分(MRC)改善情况为临床疗效评价指标。结果:联合组治疗后的峰值呼气流速(PEF)、第1秒用力呼气容积(FEV1)、1秒钟用力呼气容积占用力肺活量%(FEV1/FVC)水平高于单一组,而CAT评分、MRC评分均低于单一组(P<0.05)。结论:采用异丙托溴铵吸入剂联合布地奈德混悬液治疗COPD的效果更为显著,不仅能有效改善患者呼吸困难症状,还能改善肺通气功能,预后效果良好。     

肺功能训练和营养支持对慢性阻塞性肺疾病患者的效果

目的 探讨肺功能训练和营养支持在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者稳定期护理中的效果.方法 选择2011年12月-2012年9月就诊于四川省自贡市第一人民医院的COPD患者42例,随机分为实验组22例和对照组20例.对照组予以常规护理和常规饮食,实验组在对照组基础上予以肺功能训练,并根据患者情况予以营养支持治疗.两组患者均予以8周治疗,采用改良的英国医学研究委员会呼吸困难指数（MMRC）评估患者呼吸困难程度,1秒用力呼气量（FEV1）/用力肺活量（FVC）评估患者气流受限程度,体质指数（BMI）评估患者营养状况,6 min步行试验（6 MWT）评估患者运动功能.结果 两组患者治疗前后MMRC评分、FEV1/FVC、BMI和6MWT比较差异均具有统计学意义（P＜0.05）.结论 肺功能训练合并营养支持治疗能够改善COPD患者营养状况,缓解患者呼吸困难及气流受阻程度,提高患者运动能力,有助于COPD患者的康复.     

Identifying adults at risk of COPD who need confirmatory spirometry in primary care: Do symptom-based questions help?

Objective To examine the usefulness of a symptom-based case-finding questionnaire (CFQ) and the Medical Research Council (MRC) dyspnea scale in identifying which individuals with known risk factors for chronic obstructive pulmonary disease (COPD) require targeted spirometry in primary care. Design Cross-sectional study. Setting Three community primary care practices in Ontario. Participants Men and women 40 years of age and older with a smoking history of 20 pack-years or more. Main outcome measures We administered a CFQ for the presence of cough, sputum, wheeze, dyspnea, and recurrent respiratory infections (possible range of scores from 0 to 5) and applied the MRC dyspnea scale to assess the severity of COPD (possible range of scores from 1 to 5). Spirometric measures of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were collected, with COPD defined as a postbronchodilator FEV1/FVC of less than 0.7 and FEV1 of less than 80% of the predicted value. Using spirometric data to confirm the diagnosis of COPD, likelihood ratios, pretest and posttest probabilities, and area under a receiver operating characteristic curve were calculated for the total CFQ and MRC scores. Results Scores for the CFQ and MRC dyspnea scale were available for 996 and 829 participants, respectively. The likelihood ratios for a total CFQ score of 3 or higher and an MRC dyspnea score of 4 or 5 were 1.82 (95% confidence interval [CI] 1.48 to 2.22) and 4.22 (95% CI 2.08 to 8.56), respectively. The likelihood ratios for a total CFQ score of 2 or less and an MRC dyspnea score of 1 were 0.75 (95% CI 0.66 to 0.85) and 0.50 (95% CI 0.39 to 0.65), respectively. Area under the receiver operating characteristic curve was 0.62 (95% CI 0.58 to 0.67; P < .001) for the total CFQ scores and 0.64 (95% CI 0.60 to 068; P < .001) for the MRC dyspnea scores. Conclusion In adults with known risk factors, the likelihood of having moderate to severe COPD is increased in those who report 3 or more common respiratory symptoms and marked functional limitation resulting from dyspnea. However, selecting individuals for spirometry based on symptoms alone will identify less than half of those with moderate to severe COPD.     

Physical activity as a mediator between dyspnea and fatigue in patients with chronic obstructive pulmonary disease.

A cross-sectional design was used to examine the mediating effect of physical activity between dyspnea and fatigue in patients with chronic obstructive pulmonary disease (COPD). Dyspnea was measured using a vertical visual analogue scale, fatigue using the Profile of Mood States-Fatigue subscale, and physical activity using the 6-minute-walk (6MW) test. A convenience sample of 17 male and 22 female patients with COPD provided data for analysis. The sample was characterized by relatively high forced expiratory volume in 1 second (FEV1) of predicted normal values, indicating mild lung impairment and high mean levels of fatigue and dyspnea. Controlling for age and FEV1, dyspnea, physical activity, and fatigue were significantly interrelated. Results of the regression analysis suggested the mediating function of physical activity between dyspnea and fatigue. Limitations and suggestions for practice and future research are presented.     

家庭康复训练对慢性阻塞性肺疾病患者的影响

目的通过考察家庭康复训练对慢性阻塞性肺疾病(COPD)患者的影响,以探讨家庭康复锻炼的方法和效果。方法组织在1998-01/2002-12吉林军医学院附属中心医院接受治疗的COPD患者进行为期12周的以步行为主要锻炼内容的家庭康复训练。训练强度以往复运动实验(SWT)为准。测量记录肺功能、运动能力和呼吸困难等内容。结果训练12周后,康复训练组的FVC(%预期值),FEV(%预期值)和FEV1/FVC比率明显高于对照组(t=1.851～2.892,P<0.05);康复组患者SWT与对照组相比有明显改善(t=2.137～2.938,P<0.05);康复组患者的运动时间和距离明显高于对照组(t=2.892～2.912,P<0.01),心率和呼吸困难程度明显低于对照组(t=2.268～2.938,P<0.05)。结论简单的家庭康复训练,在COPD患者中取得了很好的训练效果,患者的运动能力和呼吸困难程度得到改善。     

医疗体操对慢性阻塞性肺疾患患者康复的影响

目的 观察医疗体操对慢性阻塞性肺疾患(chr0nic 0bstructive pulm0nay disease,COPD)患者呼吸功能康复的影响。方法 以集中办训练班的形式组织26例COPD患者接受为期3个月的医疗体操锻炼，锻炼前后分别评定呼吸功能、运动能力和心理健康水平。结果 锻炼结束后，患者的用力肺活量(f0rced vital capacity,FVC、第1秒用力呼气容积(f0rced expirat0ry v0lume in 0ne sec0nd,FEV1)、FVC占预计值百分比(FVC％)、FEVl／FVC及6分钟步行试验(6-minute walking distance,6MD)均明显高于锻炼前水平(P＜0．01)，抑郁和焦虑评分明显下降(P＜0．01)。结论 医疗体操可明显改善COPD患者的呼吸功能和运动能力，减轻患者的抑郁和焦虑程度。     

The Effect of Thoracic Joint Mobilization and Self-stretching Exercise on Pulmonary Functions of Patients with Chronic Neck Pain

[Purpose] The objective of this study was to determine the effect of thoracic joint mobilization and self-stretching exercise on the pulmonary functions of patients with chronic neck pain. [Subjects] The present study was performed with 34 patients with chronic neck pain featuring thoracic kyphosis; we divided them into a thoracic joint mobilization group (TJMG, n = 11), self-stretching exercise group (SSEG, n = 11), and thoracic joint mobilization and self-stretching exercise group (TJMSSEG, n = 12). [Methods] Treatments and exercise were conducted three times a week for six weeks in TJMG, SSEG, and TJMSSEG; the subjects’ pulmonary functions in terms of forced vital capacity (FVC), forced expiratory volume at one second (FEV1), and peak expiratory flow (PEF) were measured using CardioTouch equipment. [Results] Comparisons of the individuals within each of the TJMG, SSEG, and TJMSSEG showed that all of FVC, FEV1, and PEF increased significantly; Comparisons within each of the showed that FVC, FEV1, and PEF increased significantly. Among the study groups, FVC was significantly higher in TJMSSEG than in TJMG after six weeks; FEV1 was significantly higher in TJMSSEG than in TJMG and SSEG after four and six weeks; and PEF was significantly higher in TJMSSEG than in TJMG and SSEG after six weeks. [Conclusion] The study results indicate that thoracic joint mobilization and self-stretching exercise are effective interventions for increasing FVC, FEV1, and PEF among pulmonary functions.Key words: Thoracic joint mobilization, Self-stretching exercise, Pulmonary function     

肺功能检查在社区医院慢性阻塞性肺疾病诊断中的临床应用

目的探讨肺功能检查在社区医院的应用价值。方法选择进行肺功能检查的635例具有吸烟史及(或)环境职业污染接触史及(或)咳嗽、咳痰或呼吸困难史者作为研究对象,并选择76例健康者进行对照,测定第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、用力肺活量(FVC)和第1秒用力呼吸容积/用力肺活量(FEV1/FVC)等指标。结果社区医院初诊中慢阻肺误诊率为22.92%,漏诊率22.09%;轻度、中度、重度和极重度慢阻肺患者的FEV1%和FEV1/FVC均明显低于健康人。结论肺功能检查在社区医院慢阻肺的诊断中具有较高的临床应用价值。     

American translation, modification, and validation of the St. George's Respiratory Questionnaire

BACKGROUND: The St. George's Respiratory Questionnaire (SGRQ) is a 50-item health status survey specific for chronic obstructive pulmonary disease (COPD) and other respiratory diseases that is available in British English but not American English. The SGRQ's symptom-reporting component requires a 1-year reporting period, which may be too long for reliable and accurate patient recall. OBJECTIVES: The objectives of the present study were to translate the SGRQ from British to American English, modify the reporting period of the symptom-reporting component from 1 year to 1 month, and assess the reliability, validity, and sensitivity to change of this translated modified version in a sample of patients with COPD. METHODS: Based on input from American patients with COPD and health professionals, the SGRQ was translated into American English (SGRQ-A) and then translated back to British English. For SGRQ-A reliability and validity studies, patients were asked to report symptoms experienced over 1 year (reporting period in the original SGRQ) and 1 month (modification made to SGRQ-A). We evaluated 102 patients with COPD (50% female; mean age, 68 years; mean forced expiratory volume in 1 second [FEV1], 1.01 L) at an administrative session before and after completion of a pulmonary rehabilitation program. The SGRQ-A, Chronic Respiratory Disease Questionnaire (CRQ), 36-Item Short Form Health Survey (SF-36), 6-minute walk (6MW), Medical Research Council (MRC) Dyspnea scale, and pulmonary function tests (FEV1 and % predicted FEV1) were used in the assessment battery. RESULTS: The SGRQ-A showed good agreement with the original SGRQ when translated back to British English. Internal reliability (Cronbach alpha) was > 0.70 for all SGRQ-A components except the 1-year symptom-reporting component. Test-retest intraclass correlations were 0.795 to 0.900. Construct validity was strengthened when all SGRQ-A components (except 1-year symptoms and most 1-month symptoms) correlated (P < or = 0.01) with the MRC Dyspnea scale, 6MW, all SF-36 concept scores, and 80% of CRQ domains (r = 0.30-0.72). Discriminate validity was demonstrated when all components of the SGRQ-A with the modified 1-month symptom-reporting period were shown to discriminate better between disease-severity groups (based on patient self-reports of disease severity) than did pulmonary function tests and the 6MW. Responsiveness of the SGRQ-A to change in health status was demonstrated when scores on the Symptoms-1 month and Total-1 month components detected significant improvements in patients' health status (P = 0.02 and P = 0.04, respectively). CONCLUSION: The SGRQ-A with a modified 1-month symptom-reporting period demonstrated reliability and validity in this sample of patients with COPD. Key words: chronic obstructive pulmonary disease, St. George's Respiratory Questionnaire, American translation, reliability, validity, symptom recall.     

持续功法锻炼模式在慢性阻塞性肺疾病稳定期患者肺康复中的应用效果

目的探讨持续功法锻炼模式在慢性阻塞性肺疾病(COPD)稳定期患者肺康复中的应用效果,为COPD中医干预提供依据。方法选取2019年6—12月医院呼吸内科门诊及住院病房收治的COPD稳定期患者共156例,按照组间基本特征具有可比性的原则分为观察组和对照组,每组78例。对照组采取常规护理联合中医六字诀疗法,观察组在对照组基础上实施持续功法锻炼模式,比较两组患者肺功能指标,改良呼吸困难指数,COPD患者自我症状评估测试以及呼吸锻炼依从性情况。结果干预后,观察组FEV1、FVC、FEV1/FVC、呼气峰值流速肺功能指标均优于对照组(P<0.05);观察组mMRC评分、CAT评分明显高于对照组(P<0.05);观察组呼吸锻炼依从良好率优于对照组(P<0.05)。结论持续功法锻炼模式运用于COPD稳定期患者,可有效提升患者呼吸锻炼依从性,缓解呼吸困难,提升CAT评分相关症状,改善肺功能相关指标。     

Additional evidence for the affective dimension of dyspnea in patients with COPD

The primary purpose of this secondary analysis was to determine whether 103 participants with chronic obstructive pulmonary disease rated the affective dimension of dyspnea (dyspnea‐related anxiety and dyspnea‐related distress) separately from the sensory dimension (intensity) during baseline exercise testing conducted as part of a randomized clinical trial. A secondary purpose was to determine if dyspnea‐related anxiety and distress were rated distinctly different from other measurements of anxiety. At the end of a 6‐minute walk and an incremental treadmill test, participant ratings of the magnitude of dyspnea‐related anxiety and distress on the Modified Borg Scale were significantly different from their ratings of the intensity of dyspnea. Dyspnea‐related anxiety and distress also appeared to be concepts independent from measures of state anxiety, negative affect, and anxiety before a treadmill test. © 2009 Wiley Periodicals, Inc. Res Nurs Health 33:4–19, 2010     

医疗体操对缓解期COPD患者的康复疗效

目的探讨医疗体操对缓解期COPD患者肺功能、运动能力、免疫力及生活质量的影响。方法FEV1％＜69％的中、重度COPD缓解期患者20例,集中接受医疗体操锻炼,为期2个月。结果锻炼后患者的用力肺活量(FVC)、FVC占预计值％(FVC％)、第1秒用力呼气容积(FEV1)、FEV1占预计值％(FEV1％)及FEV1/FVC均明显提高;6MD步行距离从369.40±45.70m增加至413.50±101.27m;T细胞亚群检查CD3、CD4明显增加;生活质量从日常生活能力、社会活动能力、抑郁、焦虑和总均分进行统计,锻炼后均明显提高;FEV1、FEV1占预计值％与生活质量总均分的相关性均有统计学意义(相关系数为0.618,P=0.004和0.501,P=0.025);与6MD距离亦有相关性(相关系数为0.496,P=0.026和0.503,P=0.024)。结论①医疗体操能改善COPD缓解期患者的肺功能,提高患者的运动能力和生活质量;②医疗体操锻炼后T细胞亚群的改变可能与免疫功能状态改善有关;③FEV1、FEV1占预计值％与患者的生活质量及运动能力有相关性。     

慢性阻塞性肺疾病患者日常活动状况及相关因素分析

目的描述稳定期COPD患者的日常活动状况并分析其相关因素。方法在北京两所医院呼吸科门诊选取稳定期COPD患者94例,用PFSDQ-M评估其活动受限、活动后呼吸困难和疲乏情况。结果患者的日常活动为轻度到中度受限,活动后呼吸困难和疲乏程度为轻度到中度。活动受限、活动后呼吸困难和疲乏程度分别与6min步行距离、FEV1、FEV1/FVC、MMRC呼吸困难程度及BODE指数呈显著性相关(r=-0.27-0.60,P0.01)。MMRC呼吸困难评分可解释26%日常活动受限的变化。结论稳定期的COPD患者日常活动轻度受限,重度患者活动明显受限。呼吸困难是日常活动受限主要的影响因素。     

基于呼吸双相CT定量参数早期诊断慢性阻塞性肺疾病

  目的  探讨慢性阻塞性肺疾病（COPD）患者呼吸双相CT定量参数特点以及CT定量参数对COPD的早期诊断价值。  方法  回顾性选取2018年3月~2020年12月我院收治的COPD患者112例,对其进行呼吸双相CT扫描和肺功能检查,分别记录患者肺功能指标,包括用力肺活量（FVC）、第1秒用力呼气容积（FEV1%）和第1秒用力呼气容积与肺活量比值（FEV1/FVC）,采用FACT-Digital lungTM数据分析软件获取患者CT定量参数呼吸气相肺容积（LV）、平均肺密度（MLD）和肺气肿指数（EI）,并检验CT定量参数与肺功能指标的相关性。  结果  COPD患者的FVC为2.95±0.86 L,FEV1%为2.06±0.78 L,FEV1/FVC为（61.76± 11.93）%。COPD患者呼气相的LV小于吸气相,MLD和EI大于吸气相,差异有统计学意义（P < 0.05）。呼气相LV与FVC无相关性（P > 0.05）,LV与FEV1%和FEV1/FVC呈负相关关系（P < 0.05）,MLD与FVC、FEV1%和FEV1/FVC均呈正相关关系（P < 0.05）,EI与FVC、FEV1%和FEV1/FVC均呈负相关关系（P < 0.05）。吸气相LV与FVC呈正相关关系,与FEV1%和FEV1/FVC呈负相关关系（P < 0.05）,MLD与FVC呈负相关关系,与FEV1%和FEV1/FVC呈正相关关系（P < 0.05）,EI与FVC、FEV1%和FEV1/FVC均呈负相关关系（P < 0.05）。  结论  呼吸双相CT定向参数指标与肺功能指标有较好的相关性,对于COPD早期诊断有较好的指导价值。      

呼吸训练对类风湿关节炎合并间质肺炎患者肺功能指标的影响分析

目的探讨呼吸训练对类风湿关节炎合并间质肺炎患者肺功能康复的影响。方法选择在本院就诊的391例类风湿关节炎患者,其中合并间质肺炎患者51例,将其随机分为观察组与对照组,观察组25例,对照组26例。所有患者均给予抗风湿药物进行基础治疗,同时对观察组进行3个月的呼吸功能锻炼,对照组不接受呼吸功能锻炼。两组进行临床体征评价、肺功能(FEV1%、MMEF、FEV1/FVC、PEF)评价及圣乔治呼吸疾病问卷(SGRQ)评分。结果观察组咳嗽、喘息、腹胀、乏力、厌食和合并感冒等症状明显少于对照组,FEV1%、MMEF、FEV1/FVC、PEF指标及SGRQ评分较对照组改善更明显,差异均具有统计学意义(均P0.05)。结论通过呼吸训练,能够有效降低类风湿关节炎合并间质肺炎患者的临床症状,明显改善肺功能,显著提高患者生活质量并改善其心态,值得临床应用和推广。     

不同有氧运动方式对健康人心肺适能影响的研究

目的:本研究旨在比较两种不同有氧锻炼方式对健康人心肺适能水平的影响。方法:将32名健康受试者随机分到跑步平台组和楼梯机组各16名,2组受试者分别进行跑步机及楼梯机有氧锻炼,每次30min,每天1次,共5d。结果:锻炼后,楼梯机组第1秒用力呼气容积(FEV1)、FEV1/FVC、最大通气量(MVV)、呼气峰流速(PEF)以及6min步行距离(6MWD)均较锻炼前明显提高(P<0.05),用力肺活量(forced vital capacity,FVC)比较差异无统计学意义;跑步平台组锻炼后FVC、FEV1、FEV1/FVC、6MWD、PEF较锻炼前明显提高(P<0.05),MVV变化差异无统计学意义。锻炼后,楼梯机组FEV1/FVC、MVV、6MWD、PEF提高幅度明显优于跑步平台组(P<0.05),但FVC、FEV1的提高幅度差异无统计学意义。结论:楼梯机锻炼和跑步平台锻炼对健康人的心肺适能水平都有显著影响,但楼梯机锻炼对健康人的MVV、FEV1/FVC、PEF及6MWD的提高幅度更大,即楼梯机锻炼在短时间内对健康人的心肺适能水平影响更显著。     

Relationship between symptoms and functional performance in COPD

We studied the relationships among functional performance and three symptoms--dyspnea, fatigue, and sleep difficulty--in a sample of 100 people with chronic obstructive pulmonary disease (COPD). All participants had an FEV(1) 60% or less of the predicted level for age, sex, and height. Consistent with the Theory of Unpleasant Symptoms, dyspnea correlated with both fatigue and sleep difficulty. Dyspnea and fatigue both had moderate negative correlations with functional performance, while sleep difficulty had a small nonsignificant negative correlation with functional performance. After controlling for age and oxygen use, dyspnea was the only symptom to predict variance in functional performance significantly. Of the three symptoms studied, only dyspnea was related to both the other symptoms and to functional performance. Focusing on dyspnea may be the best way to improve both symptom experience and functional performance in people with COPD.