Effectiveness of Smartphone Devices in Promoting Physical Activity and Exercise in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review

The objectives of this systematic review were to analyse existing evidence on the efficacy of smartphone devices in promoting physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) and to identify the validity and precision of their measurements. A systematic review was undertaken across nine electronic databases: WOS Core Collection, PubMed, CINAHL, AMED, Academic Search Complete, Cochrane Central Register of Controlled Trials, SciELO, LILACS and ScienceDirect. Randomized and non-randomized controlled clinical trials were identified. To obtain additional eligible articles, the reference lists of the selected studies were also checked. Eligibility criteria and risk of bias were assessed by two independent authors. A total of eight articles met eligibility criteria. The studies were focused on promoting PA (n = 5) and the precision of device measurements (n = 3). The effectiveness of smartphones in increasing PA level (steps/day) at short and long term is very limited. Mobile-based exercise programs reported improvements in exercise capacity (i.e. incremental Shuttle-Walk-Test) at short and long term (18.3% and 21%, respectively). The precision of device measurements was good-to-excellent (r = 0.69–0.99); however, these data should be interpreted with caution due to methodological limitations of studies. The effectiveness of smartphone devices in promoting PA levels in patients with COPD is scarce. Further high-quality studies are needed to evaluate the effectiveness of smartphone devices in promoting PA levels. Registration number: CRD42016050048.     

Exercise Capacity and Activities of Daily Living are Related in Patients With Chronic Obstructive Pulmonary Disease

IntroductionThe knowledge of the relationship between exercise capacity and activities of daily living (ADLs) is important to minimize the negative outcomes in ADLs resulting from reduced exercise capacity in patients with chronic obstructive pulmonary disease (COPD). There is a limited study about the association between exercise capacity and ADLs in patients with COPD. This study aimed to investigate the relationship between maximal exercise capacity and ADLs in patients with GOLD stage II–III COPD.MethodsTwenty-seven clinically stable GOLD stage II–III COPD patients were included (mean age = 58.59 ± 9.63 years and mean FEV₁ = 50.6 ± 13.7%) in this cross-sectional study. Maximal and submaximal exercise capacity were evaluated using an incremental shuttle walk test (ISWT) and 6-min walk test (6MWT), respectively. Activities of daily living were assessed using Glittre-ADL test.ResultsThe ISWT distance was significantly correlated with Glittre-ADL test time (r = −0.517, p = 0.006). There was also a negative correlation between 6MWT distance and Glittre-ADL test time (r = −0.506, p = 0.007).ConclusionA moderate relationship was found between maximal exercise capacity and general activities of daily living performance. The reduction in exercise capacity increases the negative influences in ADLs and strengthens our beliefs that exercise interventions in pulmonary rehabilitation could influence activities of daily living positively.     

乙酰半胱氨酸对稳定期慢性阻塞性肺疾病患者急性加重率及生活质量的影响研究

目的观察乙酰半胱氨酸对稳定期慢性阻塞性肺疾病(COPD)患者急性加重率及生活质量的影响。方法选择2012年4月—2013年8月在鄂尔多斯市中心医院门诊就诊的稳定期COPD患者86例,随机分为治疗组43例和对照组43例。对照组给予常规治疗,治疗组在常规治疗的基础上加用乙酰半胱氨酸。观察两组患者肺功能指标、急性加重情况,并采用中文版COPD评估测试(CAT)问卷评价其生活质量。结果两组患者治疗前及治疗后6、12个月第一秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)比较,差异均无统计学意义(P0.05)。治疗前,两组患者中文版CAT问卷总分比较,差异无统计学意义(P0.05);治疗后6、12个月,治疗组患者中文版CAT问卷总分低于对照组,差异均有统计学意义(P0.05)。治疗前及治疗6个月后,两组患者急性加重率比较,差异均无统计学意义(P0.05);治疗12个月后,治疗组急性加重率低于对照组,差异有统计学意义(P0.05)。结论长期口服乙酰半胱氨酸可减少COPD患者急性加重率,改善其生活质量。     

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.     

早期护理干预对慢性阻塞性肺疾病患者的效果分析

目的探讨早期护理干预对慢性阻塞性肺疾病（COPD）患者的影响。方法根据患者的个体化差异,在进行抗感染、畅通呼吸道、化痰、解痉等综合处理的基础上有针对性地制订实施平稳期的护理干预（COPD健康宣教、呼吸功能锻炼、全身运动的耐力锻炼、长期氧疗、营养支持、情志护理等）。结果患者咳嗽、咳痰、气短症状均较前减轻,急性发作次数减少;生活质量提高,患者满意度高。结论早期护理干预能改善症状,提高生活质量,有利于整体护理质量的提高。     

Effect of High/Low Dose N-Acetylcysteine on Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, charcterised by persistent airflow limitation, mucus hypersecretion, oxidative stress and airway inflammation. N-acetylcysteine (NAC) have anti-oxidant and anti-inflammatory properties, which have been shown an uncertain benefit in COPD patients. Method: Systematic searches were conducted in Cochrane, Medline and Embase electronic databases. A meta-analysis was performed to evaluate the different effect between high and low-dose NAC treatment on COPD exacerbation. Results: This review yielded 11 studies. The methodological quality of included studies were scored using the Jadad score, with a scale of 1 to 5 (score of 5 being the highest). Data showed high-dose NAC can reduce both the total number of exacerbations (RR = 0.59, 0.47 to 0.74, 95%CI, p < 0.001) and the proportion of patients with at least one exacerbation (RR = 0.76, 0.59 to 0.98, 95%CI, p = 0.03). In the low-dose group, subgroup with jadad ≤ 3 showed a significant decrease (RR = 0.69, 0.61 to 0.77, 95%CI, p < 0.001) in the proportion of patients with exacerbation, the other subgroup with Jadad score > 3 showed no significant decrease (RR = 0.98, 0.90 to 1.06, 95%CI, p = 0.59). And low-dose NAC showed no benifit in the total number of exacerbations (RR = 0.97, 0.68 to 1.37, 95%CI, p = 0.85). Neither high nor low-dose NAC treatment showed benifit in forced expiratory volume in one second(FEV₁)(WMD = 1.08, ?9.97 to 12.13, 95%CI, p = 0.85). Conclusion: Long-term high-dose NAC treatment may lead to a lower rate of exacerbations. But the effect of low-dose NAC treatment remains uncertain. Further researches are needed to confirm this outcome and to clarify its mechanisms.     

Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Background

Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.

Methods

Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.

Results

In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score ≥6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).

Conclusions

Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.     

Diagnostic Value of Computed Tomography in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Abstract

Introduction: Computed tomography (CT) has been approved for diagnosing chronic obstructive pulmonary disease (COPD). The diagnostic accuracy, however, has never been examined in a systematic review. Therefore, we conducted a meta-analysis to evaluate the accuracy of CT in diagnosing COPD. Methods: Articles reporting diagnostic accuracy of CT for COPD were searched from seven electronic databases and hand searching. Two reviewers independently extracted data and assessed methodological quality. Sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (LR+ and LR–, respectively), and diagnostic odds ratios (DOR) were pooled using a bivariate model. The diagnostic performance of overall test also was assessed using the visual power of the ROC plot to present the bivariate model. Potential between-study heterogeneity was explored using subgroup analyses. Results: Data were extracted from 8 studies that met the inclusion criteria. All summary measures were grossly heterogeneous and therefore would not be appropriately summarized. These studies were further stratified by type of imaging technique and test index. The summary estimates of CT for COPD were as follows: SEN, 0.83(95% CI, 0.73-0.89); SPE, 0.87(95% CI, 0.70-0.95); LR+, 6.2(95% CI, 2.5-15.5); LR–, 0.20(95% CI, 0.12-0.34); and DOR, 31(95% CI, 8-116). The five summary estimates of CT on the lung density were 0.80 (95% CI, 0.74-0.84), 0.77(95% CI, 0.58-0.89), 3.5(95% CI, 1.8-6.9), 0.26(95% CI, 0.20-0.34) and 13(95% CI, 6-32), respectively. Conclusions: The current meta-analyses suggest that quantitative measures of CT may be useful to diagnose COPD. Developed CT technology may improve the accuracy of diagnosis. Further studies assessed diagnostic performance of CT are needed.     

Prevalence of Physical Disability in Patients with Chronic Obstructive Pulmonary Disease and Associated Risk Factors

Abstract

Introduction: To analyze the prevalence of disability among patients with COPD as compared to people without this lung disease and to identify sociodemographic and health factors associated with these physical limitations. Methods: We performed a cross-sectional study based on data taken from the European Health Interview Survey for Spain (EHISS) 2009. The survey included adults aged 40 to 79 years (n = 13624). We identified patients with COPD using a direct question from the survey. The main study variable was disability, including basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility disability (MD). Independent variables analyzed included socio-demographic characteristics, self-perceived health status, presence of mental disease and co-morbid chronic conditions and lifestyles. Results: The overall prevalence of self-reported COPD was 7.2%. The total prevalence of ADL, IADL and MD was higher among men suffering COPD than among the population without this disease (16.39% vs. 4.91%; 27.70% vs. 12.45%; 48.94% vs. 17.46% respectively). These significant differences were also observed among women with equivalent figures of: 23.25% vs. 8.71%; 31.03% vs. 10.53%; 64.83% vs. 34.08%. Being older, having a self-perceived health status of “fair/poor/very poor” and suffering from mental disease (anxiety and/or depression) were factors associated with a higher probability of reporting any disability in both men and women suffering from COPD. Conclusions: Higher rates of disability were seen among COPD patients compared to the general population. Among COPD patients older age, depression, anxiety and worse self-rated health were associated with higher disability.     

Impaired Sleep Reduces Quality of Life in Chronic Obstructive Pulmonary Disease

Disturbed sleep is reportedly common in chronic obstructive pulmonary disease (COPD), but the impact of quality of sleep on health-related quality of life (HRQL) has not been previously investigated in these individuals. The purpose of this study was to assess the impact of quality of sleep on HRQL in patients with COPD. In 30 clinically stable patients with moderate to very severe COPD, we evaluated subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and HRQL using the Saint George’s Respiratory Questionnaire. Additionally, lung function was assessed by spirometry, severity of dyspnea by the Modified Medical Research Council scale, and functional exercise capacity by the Six-Minute Walk Test. Twenty-one (70%) patients showed poor quality of sleep (PSQI > 5). HRQL was significantly correlated with quality of sleep (P = 0.02), post-bronchodilator FEV1 (P = 0.04), and severity of dyspnea (P < 0.01). Multiple regression analysis showed that quality of sleep was the best predictor of quality of life in our subjects. Our data suggest that quality of sleep is major determinant of HRQL in COPD. Increased efforts to diagnose and treat sleep problems, including measures to improve factors that adversely affect sleep should receive great attention in the daily management of these patients.     

Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis

Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I² = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.     

Recovery Following Acute Exacerbations of Chronic Obstructive Pulmonary Disease – A Review

Acute exacerbations are associated with disease progression, hospital admission and death in people with chronic obstructive pulmonary disease (COPD). The detrimental outcomes associated with acute exacerbations highlights a need to understand the time course of recovery following acute exacerbation of COPD (AECOPD) so that effective and timely interventions can be provided. The aim of this narrative review was to describe the natural recovery in physiology, symptoms and function following AECOPD. Substantial recovery of lung function and airway inflammation occurs in the first week after onset of an AECOPD, whilst systemic inflammatory markers may take up to two weeks to recover. Symptoms generally improve over the first 14 days, however marked variation is evident between studies and individuals. There are limited data regarding the time course of recovery for functional capacity, quality of life and strength. In a small number of patients (<10%) recovery of lung function and symptoms has not occurred by three months. Features of patients at risk of a prolonged recovery following AECOPD include older age, more severe lung disease, presence of chronic bronchitis, lower body mass index and more chronic dyspnoea. Exacerbation features associated with prolonged recovery are symptoms of the common cold at exacerbation onset, evidence of viral infection, more severe dyspnoea during the exacerbation and persistent systemic inflammation. In clinical practice efforts should be made to recognise prolonged recovery, which puts patients at risk of poor outcomes, and to address the consequences of AECOPD including physical inactivity and skeletal muscle weakness. Whether delivery of specific interventions at distinct time points in the recovery process can enhance recovery remains to be determined.     

日常生活受限的老年患者营养状况的调查

目的:调查日常生活活动能力下降的老年患者的营养状况。方法:使用简易营养评价简表(MNA-SF)评估我院干部病房住院老年患者的营养状况,并按照日常生活自理能力程度分为4组进行分析。结果:共53例患者纳入研究,23(43.40%)例患者发生营养不良,且4组随着日常生活自理能力下降,MNA-SF评分(营养不良发生率)分别为13.00±1.30(4.76%),10.13±1.64(62.50%),9.40±2.50(60.00%),7.36±3.15(76.57%)(P<0.05)。简易营养评价简表评分和白蛋白、前白蛋白、血红蛋白具有良好的相关性。结论:老年患者随着日常生活自理能力的下降,其营养不良发生率逐渐增加,MNA-SF可以用于这类人群营养不良的筛查。     

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.