Fatigue,anxiety and depression levels,activities of daily living of patients with chronic obstructive pulmonary disease

The aim of this cross‐sectional study was to determine the fatigue, anxiety and depression levels, activities of daily living of patients with chronic obstructive pulmonary disease (n = 255). It was found that there was significant difference between Visual Analogue Scale for Fatigue (VAS‐F) point averages and gender, education levels, marital status and economical status of patient with chronic obstructive pulmonary disease. Among the participants in this study, 36.5% had an anxiety disorder whereas 69.0% exhibited depression. In the study, it was determined that 85.5% of those were independent in their Katz's Index of Activities of Daily Living (ADLs) and 49.4% of those were independent in their Lawton and Brody's Index of Instrumental Activities of Daily Living (IADLs). This study has shown that VAS‐F, the Hospital Anxiety and Depression Scale, ADL and IADL instruments that measure the various aspects of health‐related quality of living can contribute considerably to a more diversified understanding of the patients' situation with chronic obstructive pulmonary disease.     

Fatigue in chronic illness: the experience of individuals with chronic obstructive pulmonary disease and with asthma

Although fatigue has been identified as a major problem for individuals with chronic obstructive pulmonary disease and with asthma, no research was found in which the symptom was directly studied in persons with these conditions. From studies carried out on various patient populations, it appears that fatigue has some specificity to disease state. Thus, it is important to describe the experience of fatigue within patient populations. To expand theoretical understanding of fatigue, qualitative research methods need to be applied. The purpose of this study therefore was to describe and compare the fatigue experiences of persons with chronic obstructive pulmonary disease (n=17) and with asthma (n=19). Data were obtained by use of a semi-structured questionnaire and were content analysed for categories and themes. There were many similarities between the fatigue experiences of the two groups. Fatigue is inextricably linked to laboured breathing. Although it interferes with their ability to carry out meaningful activities, the majority of individuals with chronic obstructive pulmonary disease or asthma cope well with it. The informants identified two types of coping strategies they use to manage their situation, which may be categorized as: problem-focused, including energy conservation, utilization and restoration; and emotion-focused, including being positive, accepting the physical limitations, distracting and normalizing.     

MSCT诊断慢性阻塞性肺疾病合并慢性肺源性心脏病

目的 比较不同严重程度慢性阻塞性肺疾病（COPD）及COPD合并慢性肺源性心脏病患者右心室功能,评价MSCT诊断COPD合并慢性肺源性心脏病的价值。方法 对53例COPD患者（轻中度组13例、重度组22例及合并慢性肺源性心脏病组18例）和36名健康志愿者（对照组）行肺功能和MSCT检查。记录肺功能和右心室功能参数。比较各组右心室功能差异,分析COPD患者肺功能与右心室功能的相关性。分别绘制右心室每搏输出量（SV）、射血分数（EF）的ROC曲线,评价MSCT在COPD合并慢性肺源性心脏病中的诊断价值。以预试验确定的右心室SV<48 ml或EF<40%作为诊断慢性肺源性心脏病的标准,计算诊断敏感度和特异度。结果 4组间右心室舒张末容积（EDV）、EDV/体质量指数（BMI）、SV、SV/BMI及EF差异有统计学意义（P均<0.05）,而收缩末容积（ESV）及ESV/BMI差异无统计学意义（P均>0.05）。COPD患者右心室SV/BMI、EF与第1秒用力呼气容积（FEV1）（r=0.321、0.296,P=0.019、0.031）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）（r=0.305、0.280,P=0.026、0.043）及FEV1占预计值百分比（FEV1%_pred;r=0.457、0.351,P=0.001、0.001）均呈正相关。分别绘制右心室EF、SV ROC曲线,AUC分别为0.973、0.930（P均<0.001）,MSCT诊断慢性肺源性心脏病的敏感度分别为77.77%、77.77%,特异度分别为98.59%、88.63%。结论 COPD患者在未达到慢性肺源性心脏病诊断标准前右心室功能已出现减退,且其肺功能与右心室功能呈正相关。MSCT能早期发现COPD患者右心室功能不全,且对于诊断慢性肺源性心脏病具有重要价值。     

护理干预对老年慢性阻塞性肺疾病患者用氧效果影响

目的探讨护理干预对老年慢性阻塞性肺疾病患者用氧治疗效果。方法选取本院呼吸科收治慢性阻塞性肺疾病(COPD)老年患者125例,根据护理方法不同分为观察组和对照组,给予相应护理后比较2组患者满意度,同时分析影响护理干预的相关影响因素。结果观察组患者护理满意程度高于对照组;病程、合并症、不良情绪、机械损伤4项为影响护理干预老年慢性阻塞性肺病患者用氧效果的相关风险因素。结论老年慢性阻塞性肺疾病采取护理干预后能提高用氧治疗效果,改善患者治疗期间生存质量,同时应根据患者情况对认知和依从性进行纠正。     

Pharmacoepidemiologic study of acute exacerbations of COPD: challenges and opportunities

Evaluation of: Rothberg MB, Pekow PS, Lahti M, Brody O, Skiest DJ, Lindenauer PK. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 303(20), 2035–2042 (2010).

Guideline recommendations for the treatment of acute exacerbations of chronic obstructive pulmonary disease are derived from randomized clinical trials; they usually have a small sample size and are unrepresentative of patient populations. By contrast, observation data represent real-world patient population with large sample sizes and greater generalizability; however, appropriate methodologies are needed to analyze the data and make sound inference. This article reviews the study by Rothberg et al., summarizes the key findings, and extends the discussion to the challenges and opportunities of pharmacoepidemiologic studies in acute exacerbations of chronic obstructive pulmonary disease.     

The relationship between fear of movement,pain and fatigue severity,dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease

Purpose: Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess levels of kinesiophobia among stable COPD patients and evaluate the relationship between kinesiophobia and pain and fatigue severity, dyspnea level, and comorbidities in this patient group.

Material and Methods: Thirty-one patients with moderate/severe COPD and thirty-one age- and sex-matched healthy controls participated in the study. All participants were assessed using Visual Analog Scale for pain severity, Fatigue Severity Scale, modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia.

Results: Ninety-three percent of the patients with COPD had a high degree of kinesiophobia (Tampa Scale of Kinesiophobia score >37). The modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia scores of patients with COPD was significantly higher than those of healthy subjects (p?<?0.001). Tampa Scale of Kinesiophobia score was significantly associated with modified Medical Research Council Dyspnea Scale score (r?=?0.676, p?<?0.001), Charlson Comorbidity Index score (r?=?0.746, p?<?0.001) and fatigue severity level (r?=?0.524, p?=?0.005).

Conclusion: Most moderate/severe COPD patients express fear of movement. Kinesiophobia is strongly associated with dyspnea perception, fatigue severity, multisystemic comorbidities in COPD. Further studies are needed to determine the effects of kinesiophobia on the success of pulmonary rehabilitation.

• Implications for rehabilitation

• Most of moderate-to-severe chronic obstructive pulmonary disease patients have fear of movement.

• Increase fear of movement in moderate–severe chronic obstructive pulmonary disease is associated with increased dyspnea perception and fatigue severity and multisystemic comorbidities.

     

Multiple symptoms in patients with chronic obstructive pulmonary disease in Norway

This paper examines the prevalence of multiple symptoms and the relationships between future expectations and multiple symptoms in a cross‐sectional study of 100 patients with chronic obstructive pulmonary disease. A questionnaire was used to examine the patients’ symptoms of breathlessness, anxiety, depression, sleeplessness, fatigue, and pain, and their outlook for the future. All patients reported breathlessness, 64% anxiety, 69% depression, 28% sleeplessness, 72% fatigue, and 45% pain. Those with anxiety reported significant depression (P < 0.001), and those with fatigue reported significant depression (P = 0.004). Patients who reported pain also reported significant sleeplessness (P = 0.022). A negative outlook for the future was reported by 42% of patients who also reported significantly more anxiety, depression, sleeplessness, fatigue, and pain (P ≤ 0.049). Multiple symptoms are common in chronic obstructive pulmonary disease, and patients with a pessimistic view of the future reported more symptoms. Those with multiple symptoms and a negative outlook toward the future may benefit from interventions to help them achieve a more positive outlook for the future, which may relieve symptom burden.     

Hot sand baths (psammotherapy): A systematic review

IntroductionPsammotherapy is a traditional practice in which hot sand baths are employed for therapeutic purposes. This systematic review aims to investigate the potential efficacy of psammotherapy in the treatment of any disease.MethodsMedline via PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar were searched for articles describing studies on the efficacy of psammotherapy in patients with different health conditions. Articles were screened by the two author independently and, in case of disagreements, items were discussed until consensus was reached. All relevant clinical outcomes (symptom and pain relief, modifications in any functional and laboratory parameter, changes in drug consumption, variations of quality of life) were extracted from included studies.ResultsAfter article screening and selection, three studies were included in the review. One study involved patients with chronic obstructive pulmonary disease, while in the other two studies patients with rheumatoid arthritis were recruited. Included trials indicate that psammotherapy might be useful for the management of studied diseases.DiscussionBased on available data, no conclusions can be driven on the clinical efficacy of psammotherapy. However, very limited evidence suggests that hot sand baths might be useful in improving symptoms and functionality of patients with some rheumatic and respiratory chronic illnesses. Further studies are encouraged to better assess the clinical efficacy of hot sand baths.     

The effect of non‐pharmacological staged interventions on fatigue and dyspnoea in patients with chronic obstructive pulmonary disease: A randomized controlled trial

The aim of this study was to examine the effect of non‐pharmacological staged interventions on fatigue and dyspnoea in patients with chronic obstructive pulmonary disease. A randomized controlled trial was conducted with 64 patients in a tertiary hospital in China from 2010 to 2011. Patients were randomly assigned to the control group (n = 32), who received routine care, and the intervention group (n = 32), who received additional non‐pharmacological staged interventions. The Multidimensional Fatigue Inventory and the five‐grade Medical Research Council dyspnoea scale were used to collect data at baseline and after 6 weeks. Compared with the control group, patients in the intervention group had significantly lower scores on general fatigue (P < 0.001), physical fatigue (P < 0.001), reduced activity (P < 0.001) and reduced motivation (P = 0.03) and had better relief of dyspnoea (P = 0.02). Our study showed that non‐pharmacological staged interventions were effective in relieving fatigue and dyspnoea in patients with chronic obstructive pulmonary disease.     

Living with chronic obstructive pulmonary disease: insiders' perspectives

AIM: This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives. BACKGROUND: Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives. Previous qualitative studies on chronic obstructive pulmonary disease have tended to focus on specific problems associated with the disease, such as fatigue and social isolation. METHOD: A hermeneutic phenomenological study was carried out with 10 older adults who participated in a local hospital's case management or pulmonary rehabilitation programme. Data were collected by interviews in 2003. FINDINGS: Three major themes were identified: Knowing What Works, Hanging On...Barely, and Losing Control-Gaining Control. The changes associated with chronic obstructive pulmonary disease were described as increasingly challenging and even threatening to participants' current lifestyles. The impact of dyspnoea was great and invaded almost every aspect of their lives. Participants identified the most effective methods to resolve shortness of breath. CONCLUSION: People with severe chronic obstructive pulmonary disease have had extensive experience of managing their disease and are familiar with techniques that have helped them integrate the illness and symptoms into their lives. Nurses can synthesize patient knowledge with nursing knowledge to assist patients with severe chronic obstructive pulmonary disease to achieve their maximum quality of life.     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

胸部CT评估慢性阻塞性肺疾病患者竖脊肌萎缩及脂肪浸润程度北大核心CSCD

目的观察胸部CT评估慢性阻塞性肺疾病(COPD)患者竖脊肌(ESM)萎缩及脂肪浸润程度的价值。方法纳入113例接受胸部CT平扫及肺功能检查的稳定期COPD男性患者(COPD组)及40名健康男性(对照组);比较组间及COPD组内不同慢性阻塞性肺疾病全球倡议(GOLD)分级患者一般资料、肺功能检查结果及ESM CT参数,并行相关性分析,观察COPD患者ESM萎缩及脂肪浸润特征。结果组间肺活量(VC)、用力VC(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC、残气量(RV)、RV/肺总量(TLC)、一氧化碳弥散量(DLco)、ESM总横截面积(CSA)、肌肉密度、放射性密度比(RDR)、CSA指数、ESM局部体积、面积密度乘积及肺气肿区域占总肺容积百分比(LAA%)差异均有统计学意义(P均<0.05)。COPD组内各GOLD分级COPD患者体质量、体质量指数(BMI)、深吸气量(IC)、VC、FVC、FEV_(1)、FEV_(1)/FVC、TLC、RV/TLC、DLco、ESM总CSA、CSA指数、ESM局部体积、面积密度乘积及LAA%差异均有统计学意义(P均<0.05)。COPD患者ESM局部体积与FEV_(1)呈中度相关(r=0.52,P<0.001)。结论胸部CT可定量评估COPD患者ESM萎缩及脂肪浸润程度;ESM局部体积为最佳评估指标。     

The elevated CXCL5 levels in circulation are associated with lung function decline in COPD patients and cigarette smoking-induced mouse model of COPD

Abstract

Introduction: C-X-C motif chemokine 5 is primarily chemotactic for neutrophils and previously shown to increase in the bronchoalveolar lavage fluid of patients with chronic obstructive pulmonary disease. However, whether C-X-C motif chemokine 5 levels correlate with lung function decline in patients or mouse model of chronic obstructive pulmonary disease was not clear.

Methods: The mouse model was induced by cigarette smoke exposure. Plasma/serum and bronchoalveolar lavage fluid were obtained from patients and mouse model of chronic obstructive pulmonary disease; C-X-C motif chemokine 5 levels were assessed and correlated with lung functions and granulocyte-colony stimulating factor levels, respectively.

Results: The C-X-C motif chemokine 5 levels increased and correlated to granulocyte-colony stimulating factor levels in both plasma/serum and bronchoalveolar lavage fluid obtained from patients and mouse model of chronic obstructive pulmonary disease. Circulating levels of C-X-C motif chemokine 5 correlated to lung functions decline in patients and mouse model.

Conclusions: Granulocyte-colony stimulating factor might coordinate with C-X-C motif chemokine 5 in the pathogenesis of neutrophilic inflammation in chronic obstructive pulmonary disease. Circulating C-X-C motif chemokine 5 might serve as a potential blood-based biomarker to add additional modest predictive value on the preliminary screening and diagnosis of chronic obstructive pulmonary disease.

• Key messages

• Circulating C-X-C motif chemokine 5 might serve as a potential blood-based biomarker to add additional modest predictive value on the preliminary screening and diagnosis of COPD.

• Granulocyte-colony stimulating factor might coordinate with C-X-C motif chemokine 5 in the pathogenesis of neutrophilic inflammation in chronic obstructive pulmonary disease.

     

评估急性发作期慢性阻塞性肺病患者营养状况、肺功能的临床价值

目的评估急性发作期慢性阻塞性肺病患者的营养状况与肺功能、动脉血气指标变化的关系,以预测慢性阻塞性肺病急性发作期患者的病程及预后。方法收集2008年3月至2009年3月因COPD急性加重(AECOPD)入住中日联谊医院呼吸内科53例患者,并除外肝、肾、消化道疾病及结核、恶性肿瘤、甲状腺功能亢进等消耗性疾病。依据轻度:FEV1/FVC70%、FEV1≥80%预计值,有或无慢性咳嗽、咳痰症状;极重度:FEV1/FVC70%、FEV130%预计值,或FEV150%预计值,并伴有慢性呼吸衰竭或右心衰竭临床表现,将慢性阻塞性肺病分为轻度及极重度两组,对比分析其营养、免疫、肺功能、血气及住院情况。结果实际体重占理想体重的百分比(%IBW)、一秒用力呼气量(FEV1)及FEV1和用力肺活量(FVC)百分比、动脉血二氧化碳分压(PCO2)、住院天数两组之间有显著性差异(P0.05)。结论慢性阻塞性肺病患者的营养状况与肺功能改变,动脉血二氧化碳分压和住院天数具有重要相关性。     

Factors influencing self-management in chronic obstructive pulmonary disease: an integrative review

BackgroundChronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g. personal) and external (e.g. health service) factors.ObjectivesThis paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research.DesignIntegrative review.Data sourcesMedline, Embase, PubMed, CINAHL, Google Scholar.Review methodsIntegrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care.FindingsSelf-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management.ConclusionsChronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.     

护士健康指导下的肺康复对老年慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的探讨门诊护士健康指导下的肺康复对老年慢性阻塞性肺疾病(COPD)患者运动耐力、生活质量及肺功能的影响。方法对54 例门诊COPD稳定期老年患者实施健康指导下的康复锻炼3 个月,分别在干预前后对患者进行呼吸困难及疲劳程度评定(采用Borg 评分)、肺功能测定、6 min 步行距离评定和生活质量评分。结果干预后,患者呼吸困难及疲劳程度有所改善,6 min 步行距离明显增加(P<0.01);生活质量各维度评分明显提高(P<0.01);肺功能未见明显改善(P>0.05)。结论门诊护士健康指导下的肺康复能提高COPD稳定期老年患者运动耐力和生活质量。     

Effect of chronic hydroxychloroquine use on COVID-19 risk in patients with rheumatoid arthritis and systemic lupus erythematosus: a multicenter retrospective cohort

ObjectiveHydroxychloroquine (HCQ) has been used during the coronavirus disease 2019 (COVID-19) pandemic because of its reported anti-viral activity. This study examined the association of chronic HCQ use with the incidence and complications of COVID-19.MethodsThis retrospective cohort study included adults with rheumatoid arthritis and/or systemic lupus erythematosus who visited rheumatology clinics in three tertiary hospitals in Riyadh, Saudi Arabia between January 2019 and December 2020. Patients were categorized into two groups based on HCQ use. Data were obtained from the electronic health record and by interviews with patients. The primary study objective was the incidence of COVID-19 and its complications from March 2020 to February 2021.ResultsAlmost 11% of the study cohort was positive for COVID-19, and the incidence of COVID-19 was similar between HCQ users (11.11%) and nonusers (10.86%). Disease complication rates were similar in the study arms, and they mainly included fever, dry cough, fatigue, and breathing difficulty.ConclusionsThis study revealed no significant association between chronic HCQ use and the incidence of COVID-19, and disease complications were similar in the study arms.     

慢性肾脏病合并风湿病的治疗

风湿病可以累及多个器官和系统,其中肾脏是最常受累的器官之一。常见风湿病包括系统性红斑狼疮、 类风湿关节炎、系统性硬化症、抗中性粒细胞胞浆抗体(ANCA)相关血管炎、原发性干燥综合征以及痛风均可以合并 慢性肾脏病。本文就慢性肾脏病合并上述风湿病的治疗进展作一综述。