Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial

Objective

To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity (PA) compared with standard medical care in patients with moderate chronic obstructive pulmonary disease (COPD).

Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up

Objective: Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial.

Design: Parallel-group controlled pragmatic pilot trial.

Subjects: There was a total of 83 patients with COPD (mean age 70?±?8 years with a forced expiratory volume in first second percent predicted of 60?±?17%). The intervention group (n?=?43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n?=?40) received usual care alone.

Main outcome measures: The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months.

Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR]?=?4.4, P?<?.001), increased conceptual knowledge in five domains (OR = 2.6–4.2, all P?<?.05), and altered disease management strategies (e.g., increased PA) (OR ≥ 2.7 P?<?.05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P?=?.044). Knowledge of PA was correlated with level of PA (ρ?=?.425–.512, P?<?.05) as well as to the use of PA as a strategy to manage their disease (χ²?=?11.2–32.9, P?<?.05).

Conclusion: Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial.

• Key points

• Even though self-management strategies are an important part of chronic obstructive pulmonary disease (COPD) management, access to support for such strategies are limited for a large part of the COPD-population.

• Promoting self-management through the COPD Web might increase short-term levels of physical activity, promote conceptual knowledge and alter disease management strategies.

• The primary care COPD population in this study experienced limited impact of the disease in daily life, limited exertional dyspnea, and high generic quality-of-life, but vastly reduced levels of physical activity.

• A future large scale study should include strategies to encourage greater exposures to the COPD Web, including an extended analysis of factors associated with using or not using the tool over time and its impact on outcome measures, objective measures of conceptual knowledge, and physical activity, and it should include a large enough sample size to enable sub-group analyses and strategies to enhance recruitment.

     

步行锻炼对COPD患者肺功能和生存质量的影响

目的 :探讨步行锻炼对慢性阻塞性肺疾病 (chronicobstructiveplumonarydisease,COPD)患者肺功能和生存质量的影响。方法 :28例轻、中度COPD患者每天进行30min以上的匀速步行锻炼 ,持续2个月 ,锻炼前后分别测试肺功能指标 (FVC、FEV1、%FVC、?V1、FEV1/FVC % )和评估生存质量。结果 :COPD患者锻炼后肺功能指标无明显差异 (P均>0.05) ,但生存质量评分明显优于锻炼前 (P均>0.05)。结论 :生存质量指标评估肺康复更敏感。     

呼吸运动康复路径在COPD患者中的应用护理研究

目的探讨呼吸运动康复路径在COPD患者中的应用护理效果。方法选取本院2016年5—8月收治的45例COPD患者为观察组,在常规护理的基础上实施呼吸、运动康复路径,选取本院2016年1—4月收治的40例COPD患者为对照组,给予常规护理。比较2组护理3个月后的肺功能、6 min步行距离和生活质量的变化。结果观察组护理3个月后的FVE1、FVE1/FVC、FVE1%高于对照组(P0.05);观察组护理3个月后的6 min步行距离大于对照组(P0.05);观察组护理3个月的影响、症状、活动能力等呼吸生活质量评分低于对照组(P0.05)。结论呼吸运动康复路径能够提高COPD患者的肺功能和运动能力,改善患者的生活质量。     

呼吸操训练对慢性阻塞性肺疾病患者预后的影响研究

目的 观察呼吸操训练对慢性阻塞性肺疾病(COPD)患者肺功能、生活质量及急性发作次数的影响.方法 干预组及对照组各30例,观察时间为1年.对照组采用常规护理方法,观察组在此基础上进行呼吸功能训练护理干预,两组均在出院前和出院后1年检测肺功能和生活质量,同时通过电话、复诊、上门随访等方法随访1年,记录患者病情变化情况.结果 经1年干预后,干预组患者的肺功能、生活质量、急性加重及再次住院的频率与干预前、对照组比较有明显改善,差异具有统计学意义(P<0.05).结论 呼吸操训练能改善COPD患者肺功能,延缓肺功能进一步恶化,提高患者的生活质量,改善预后,值得临床推广.

Abstract：

Objective To observe breathing exercises for patients with COPD on pulmonary function, quality of life and the number of acute attacks.Methods Sixty patients with COPD were randomly divided into intervention group (n=30) and control group (n=30) for 1-year observation period. Traditional care was applied in control group,and breathing exercises nursing intervention was added to intervention group.In both groups, the patients' pulmonary function and quality of life were measured before and after discharge for 1 year.The progress of patients' conditions were recorded by telephone, return visit, follow-up visits for 1 year.Results After intervention by 1 year, in intervention group the patients' lung function, quality of life and the number of exacerbation and readmission were significant improved as compared to control group and before intervention, the difference was statistically significant (P<0.05).Conclusions The breathing exercises can improve pulmonary function, delay further deterioration of lung function, improve quality of life of patients and the prognosis, it is worthy of promotion.     

三种超声方法监测膈肌活动对慢性阻塞性肺患者病情的判定

目的：探究M型超声法,B超直接法和B超间接法对慢阻肺患者病情判定的意义。 方法：以FEV1占预计值％=50为分界线,选取高风险COPD患者40例（高风险组与低风险COPD患者40例（低风险组）。记录两组患者的基本信息,肺功能,血气以及三种超声以及X线下膈肌的移动度的数据。利用单因素和多因素分析筛选影响慢阻肺患者病情严重程度的指标,分析三种超声的测量结果和X线下测量的相关性。采用ROC分析方法,评价3种超声测量方法预测COPD严重程度的价值。 结果：M型超声移动度、B超直接法移动度、B超间接法移动度,X线下的移动度是高风险COPD患者的独立影响因素。M型超声移动度,B超直接法移动度,B超间接超移动度与X线移动度呈显著正相关（r1=0.738,r2=0.667,r3=0.634,P<0.05）。M型和X线联合诊断的诊断COPD的AUC最大,为 0.781。Ｂ超间接法移动度AUC最小,为0.610。 结论：M型超声移动度,B超直接法和B超间接法均可以用于COPD病情判定,M超和X线联合诊断的效果更佳。     

The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking

The principal aim of the present study was to examine the validity of the Computer Science and Applications (CSA) activity monitor during level walking in coronary artery disease (CAD) patients. As a secondary aim, we evaluated the usefulness of two previously published energy expenditure (EE) prediction equations. Thirty-four subjects (29 men and five women), all with diagnosed CAD, volunteered to participate. Oxygen uptake (VO2) was measured by indirect calorimetry during walking on a motorized treadmill at three different speeds (3.2, 4.8 and 6.4 km h-1). Physical activity was measured simultaneously using the CSA activity monitor, secured directly to the skin on the lower back (i.e. lumbar vertebrae 4-5) with an elastic belt. The mean (+/- SD) activity counts were 1208 +/- 429, 3258 +/- 753 and 5351 +/- 876 counts min-1, at the three speeds, respectively (P < 0.001). Activity counts were significantly correlated to speed (r = 0.92; P < 0.001), VO2 (ml kg-1 min-1; r = 0.87; P < 0.001) and EE (kcal min-1; r = 0.85, P < 0.001). A stepwise linear regression analysis showed that activity counts and body weight together explained 75% of the variation in EE. Predicted EE from previously published equations differed significantly when used in this group of CAD patients. In conclusion, the CSA activity monitor is a valid instrument for assessing the intensity of physical activity during treadmill walking in CAD patients. Energy expenditure can be predicted from body weight and activity counts.     

慢性阻塞性肺病急性期病人对呼吸机依赖的原因及对策(附22例报告)

目的 :探讨慢性阻塞性肺病 (COPD)急性期患者对机械通气产生依赖的原因 ,以及相应的治疗方法。方法 :对 3年来收入我院ICU 36例行机械通气的COPD急性期病人进行回顾性研究。结果 :在 36例COPD急性期病人中 ,2 2例出现了对呼吸机的依赖 ,发生率约 6 1% ,最后 16例成功撤机 ,占 73% ,6例因严重并发症死亡 ,占 2 7%。感染、营养不良及呼吸机应用不当是造成对呼吸机依赖的主要原因。 14例出现营养不良或加重 ,列居所有并发症之首。结论 :加强感染控制 ,合理的营养支持 ,减少呼吸肌做功 ,以及减少并发症的发生是治疗的关键。     

慢性阻塞性肺疾病患者自我护理能力及其影响因素研究

目的 了解COPD患者的自我护理能力及影响因素。方法 采用自我护理能力量表（ESCA）测定102例COPD患者的自我护理能力,应用SPSS10.0处理所有数据资料。结果 COPD患者的自我护理能力得分均值为（93．24±14．03）;多元回归分析提示,影响COPD患者自我护理能力的因素为抑郁、焦虑、夜间症状和家庭关系。结论 在设计和实施护理干预措施时,应重视COPD患者的抑郁、焦虑、夜间症状和家庭关系。     

Individualizing the selection of long-acting bronchodilator therapy for patients with COPD: considerations in primary care

Chronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care settings. COPD remains the third leading cause of death in the United States and carries a significant burden to both patients and the healthcare system. COPD is a chronic, progressive, irreversible lung disease associated with high morbidity and mortality. Proper assessment and diagnosis requires spirometry which is currently underutilized in primary care. Management is focused on adequate symptom control, improving quality of breathing and quality of life, and preventing exacerbations and hospitalizations. However, many patients are not receiving long-acting bronchodilator maintenance therapy as recommended in current clinical guidelines. Even when patients receive appropriate therapy, real-world issues such as a patient’s health literacy, physical and cognitive limitations, and therapy nonadherence limit the effectiveness of prescribed inhaled medications. Primary care providers are well situated to ensure that prescribed therapies and long-term management goals are matched to the individual needs of patients with COPD.     

COPD患者住院医疗费用变动情况及其相关因素分析

目的：分析1997～2006年COPD住院患者医疗费用构成和变动情况。方法：回顾性分析北京市某＂三甲＂医院1997～2006年959例COPD住院患者的总费用和构成情况。分析10年间医疗费用变动情况及其影响因素。结果：自1997年起,例均住院费用和检查费逐年上升,1999年和2004年达峰值,2003年后治疗费有上升趋势,护理费用变化不明显,近年药费增长趋势有所下降。结论：在控制医疗费用增长的过程中检查费和治疗费的作用不容忽视,应完善医疗相关制度和缩短住院日。     

循证护理在COPD病人机械通气联合振动雾化吸入中应用效果观察

目的:探讨循证护理在慢性阻塞性肺病(COPD)病人机械通气联合振动雾化吸入中的应用效果。方法:选取2008年1月~2010年6月于本院进行治疗的40例行机械通气联合振动雾化治疗的COPD病人为研究对象,将其随机分为对照组(常规护理模式组)20例和观察组(循证护理模式组)20例,后将两组病人的总有效率、通气时间、总住院时间、并发症发生率、病人满意率及护理前及护理后3 d,7 d的B russels评分、A-PACHEⅡ评分及GCS评分进行研究及比较。结果:观察组病人治疗总有效率、病人满意率高于对照组,通气时间、总住院时间短于对照组,并发症发生率低于对照组,护理后3 d,7 d的B russels评分、APACHEⅡ评分及GCS评分均优于对照组(P<0.05),均有显著性差异。结论:循证护理在COPD病人机械通气联合振动雾化中的护理效果好,广受病人欢迎,值得推广应用。     

多索茶碱在慢性阻塞性肺疾病患者中的应用

目的:探讨多索茶碱在慢性阻塞性肺疾病患者中的应用效果。方法:对60例慢性阻塞性肺疾病患者给予多索茶碱治疗,同时对所得数据进行统计学处理和分析。结果:60例慢性阻塞性肺疾病患者治疗后肺功能改善情况与治疗前比较差异有统计学意义(P<0.05);经积极治疗后总有效率为95.0%。结论:多索茶碱治疗慢性阻塞性肺疾病疗效确切,对改善患者肺功能及生活质量具有重要的临床意义。     

缓解期慢性阻塞性肺病患者氧疗的观察及护理

目的：通过对慢性阻塞性肺病（COPD）患者为期四年的随访，了解长期家庭氧疗对其生命质量和生存时间的影响，并对此提出护理措施。方法：COPD患者分为长期氧疗组和非氧疗组，定期进行血常规、血气分析和肺功能检测，并对两组患者四年中的住院率、病死率进行比较。结果：氧疗组PO2水平显著高于非氧疗组；其血红蛋白、红细胞压积显著低于非氧疗组，且氧疗组的这两项指标与氧疗前相比得到了一定程度的逆转；肺功能下降程度两组无明显差异；氧疗组在四年中的住院率和病死率均显著低于非氧疗组。结论：长期氧疗可显著降低COPD患者住院次数和远期病死率，提高其生命质量，是COPD惠者缓解期康复治疗的重要手段。     

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     

COPD患者社区护理需求调查分析与对策

目的：通过COPD患者对社区护理的需求分析,为COPD患者制定有效的社区护理措施,提高患者生活质量。方法：采用百行设计的向,卷,对管辖范围的396例COPD患者选择社区康复护理相关问题进行人户调查。结果：回收有效问卷394份,对社区护理需求包括心理祷求、用、药指导、戒烟、实际困难、家庭氧疗、运动指导、饮食指导等,分别为93．90％,91．87％,56．34％,89．84％,89．84％,81．97％。81．417％。结论,COPD患者社区护理有较高需求,社区卫生服务机构研究制定社区护理对策,把COPD纳入社区健康专案管理,可实施规范、有效的社区护理干预,提高患者生活质量。     

多元化健康教育对COPD患者长期家庭氧疗依从性的应用研究

目的:探讨多元化健康教育对慢性阻塞性肺疾病(COPD)患者长期家庭氧疗依从性的影响.方法:将102例COPD缓解期患者随机分成对照组和观察组各51例,对照组采用常规健康教育方法,观察组采用多元化健康教育方法,在常规健康教育的基础上,通过发放氧疗知识手册、氧疗日志和工艺品式的用氧安全标识,定期家庭随访等多种形式反复强化.结果:实施1、6 个月后,观察组氧疗依从性明显高于对照组(P＜0.01).结论:对家庭氧疗患者实施多元化健康教育能显著提高患者的依从性,达到治疗目的.     

家庭肺康复联合移动医疗应用程序在稳定期COPD患者中的应用效果研究

【】目的：探讨家庭肺康复联合移动医疗应用程序对慢性阻塞性肺疾病(COPD)患者肺康复的效果。方法：便利抽样法选取2016年5月至2017年8月在上海同济大学附属同济医院门诊就诊的91名稳定期COPD患者为研究对象,按随机数字表法分为对照组(43人)和试验组(48人)。对照组给予常规家庭肺康复训练,试验组给予常规家庭肺康复训练和COPD管家应用程序进行干预。评价两组患者出院时、出院后3个月的肺功能、6 min步行试验距离和生活质量。结果：出院后3个月,试验组患者的肺功能与对照组相比无统计学差异(P > 0.05);6 min步行距离和生活质量评分均优于对照组(P < 0.05)。结论：家庭肺康复联合COPD管家应用程序有助于提高COPD患者的身体活动能力,改善其生活质量,值得在COPD患者中推广应用。     

慢性阻塞性肺疾病患者焦虑状况调查及护理干预

目的:探讨慢性阻塞性肺疾病(COPD)患者的焦虑状况及护理干预方法。方法:将60例COPD患者采用随机配对的方法分为观察组和对照组各30例,观察组给予个性化听-唱结合的音乐护理干预,对照组给予常规护理,比较两组患者护理前后焦虑状况、生命体征及住院时间、住院费用。结果:护理干预前两组患者焦虑状况、生命体征比较差异无统计学意义(P>0.05),护理干预后两组患者焦虑状况、生命体征及住院时间、住院费用比较差异均有统计学意义(P<0.05,P<0.01)。结论:个性化听-唱结合的音乐护理干预对COPD患者具有减轻焦虑程度、改善和稳定生命体征、缩短住院时间,减少住院费用的作用,方法简便易行,值得临床借鉴。