Abstracts Pubmed Abril 2015
1. Chron Respir Dis. 2015 Apr 20.
Dynamic hyperinflation during activities of daily living in COPD patients.
Silva CS, Nogueira FR, Porto EF, Gazzotti MR, Nascimento OA, Camelier A, Jardim JR.
The objective of this study was to investigate whether some activities of daily living (ADLs) usually
related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are
associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation
techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8
years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots,
walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting
on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients
were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4L (50% ± 12.4);
FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction
in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters
carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230
mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a
shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and
with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after
performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of
these ADLs.
2. Eur Respir J. 2015 Apr 16.
Antagonistic implications of sarcopenia and abdominal obesity on physical performance in
COPD.
van de Bool C, Rutten EP, Franssen FM, Wouters EF, Schols AM.
Decreased physical performance due to loss of muscle mass (i.e. sarcopenia) is prevalent in ageing
and appears more pronounced in chronic disease. A comprehensive profile of the sarcopenic
phenotype in chronic obstructive pulmonary disease (COPD) is not yet available. The aim of the
present study was to characterise prevalence, functional implications and predictive value of
sarcopenia with or without abdominal obesity in Dutch COPD patients eligible for pulmonary
rehabilitation. 505 COPD patients (aged 37-87 years; 57% male) underwent assessment of lung
function, body composition and physical functioning, before entering pulmonary rehabilitation.
Sarcopenia was assessed by appendicular skeletal muscle index (ASMI) and abdominal obesity by
android/gynoid percentage fat mass (A/G%FM) using dual energy X-ray absorptiometry (DEXA). 86.5%
of patients were sarcopenic and showed lower physical functioning, while coexistent abdominal obesity
(78.0%) resulted in higher physical functioning. Implications on endurance were less pronounced in
women. The predictive value for physical functioning was higher for the "three-compartment" model
(ASMI, bone mineral content and A/G%FM) than the "two-compartment" model (fat-free mass index
and fat mass index) or "one-compartment" model (body mass index). In patients eligible for pulmonary
rehabilitation, sarcopenia is highly prevalent in all BMI-categories and associated with impaired
strength, and in men also with decreased endurance. Abdominal obesity seems to have protective
effects on physical functioning. ASMI is a better predictor for physical functioning than FFMI.
3. Am J Respir Crit Care Med. 2015 Apr 15.
Exercise limitation in chronic obstructive pulmonary disease. The
o'donnell threshold.
Casaburi R, Rennard SI.
4. Biomed Res Int. 2015. Epub 2015 Mar 19.
Cardiopulmonary Response to Exercise in COPD and Overweight Patients: Relationship
between Unloaded Cycling and Maximal Oxygen Uptake Profiles.
Ba A, Brégeon F, Delliaux S, Cissé F, Samb A, Jammes Y.
Cardiopulmonary response to unloaded cycling may be related to higher workloads. This was assessed
in male subjects: 18 healthy sedentary subjects (controls), 14 hypoxemic patients with chronic
obstructive pulmonary disease (COPD), and 31 overweight individuals (twelve were hypoxemic). They
underwent an incremental exercise up to the maximal oxygen uptake (VO2max), preceded by a 2 min
unloaded cycling period. Oxygen uptake (VO2), heart rate (HR), minute ventilation (VE), and
respiratory frequency (fR) were averaged every 10 s. At the end of unloaded cycling period, HR
increase was significantly accentuated in COPD and hypoxemic overweight subjects (resp., +14 ± 2
and +13 ± 1.5 min(-1), compared to +7.5 ± 1.5 min(-1) in normoxemic overweight subjects and +8 ±
1.8 min(-1) in controls). The fR increase was accentuated in all overweight subjects (hypoxemic: +4.5 ±
0.8; normoxemic: +3.9 ± 0.7 min(-1)) compared to controls (+2.5 ± 0.8 min(-1)) and COPDs (+2.0 ±
0.7 min(-1)). The plateau VE increase during unloaded cycling was positively correlated with VE values
measured at the ventilatory threshold and VO2max. Measurement of ventilation during unloaded
cycling may serve to predict the ventilatory performance of COPD patients and overweight subjects
during an exercise rehabilitation program.
5. Phys Ther. 2015 Apr 9.
Efficacy of a Novel Method for Inspiratory Muscle Training in People With Chronic Obstructive
Pulmonary Disease.
Langer D, Charususin N, Jácome C, Hoffman M, McConnell A, Decramer M, Gosselink R.
BACKGROUND: Most inspiratory muscle training (IMT) interventions in patients with COPD have been
implemented as fully supervised daily training for 30 minutes with controlled training loads using
mechanical threshold loading (MTL) devices. Recently, an electronic tapered flow resistive loading
(TFRL) device was introduced that has a different loading profile and stores training data during IMT
sessions. OBJECTIVE: We aimed to compare the efficacy of a brief, largely unsupervised IMT protocol,
conducted using either traditional MTL or TFRL on inspiratory muscle function in patients with COPD.
DESIGN: Twenty clinically stable patients with inspiratory muscle weakness, participating in a
pulmonary rehabilitation program, were randomly allocated to perform eight weeks of either MTL- or
TFRL-IMT. METHODS: Patients performed two daily home-based IMT sessions of 30 breaths (3-5
minutes per session) at the highest tolerable intensity, supported by twice weekly supervised sessions.
Compliance, progression of training intensity, increases in maximal inspiratory mouth pressure (Pi,max)
and endurance capacity of inspiratory muscles (T,lim) were evaluated. RESULTS: More than 90% of
IMT sessions were completed in both groups. The TFRL group tolerated higher loads during the final
three weeks of the IMT program (all p<0.05) with similar effort scores on a Borg CR-10 scale, and
achieved larger improvements in Pi,max (p=0.02), and T,lim (p=0.02) than the MTL-group.
LIMITATION: Absence of a study arm involving a sham-IMT intervention. CONCLUSION: The short
and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups
and is an alternative to traditional IMT protocols in this population. Patients in the TFRL-group tolerated
higher training loads and achieved larger improvements in inspiratory muscle function than patients in
the MTL group.
6. J Cardiopulm Rehabil Prev. 2015 Apr 7.
Effectiveness of Repeated Courses of Pulmonary Rehabilitation on Functional Exercise
Capacity in Patients With COPD.
Atabaki A, Fine J, Haggerty M, Marolda C, Wakefield D, Yu A, ZuWallack R.
PURPOSE: To determine whether an as-needed repeated pulmonary rehabilitation (PR) intervention
produces a clinically important improvement in exercise capacity. METHODS: The study included a
retrospective analysis of characteristics and 6-minute walk distance (6MWD) of patients with chronic
obstructive pulmonary disease (COPD) who completed PR at 2 centers. Data were abstracted from all
patients with COPD completing 2 courses of rehabilitation and those of randomly sampled patients
completing only 1 course of PR. RESULTS: We identified 37 repeaters and selected 69 nonrepeaters
for analysis. No significant differences between the 2 groups with regard to age, FEV1 percent
predicted, gender, initial 6MWD, improvement in 6MWD, and the percentage of patients achieving the
minimal important difference (MID) of ≥ 35 m were observed with the completion of the first
rehabilitation. The time between the first and second PR interventions was a mean of 45 ± 24 months.
Repeating patients had a decrease of 90 ± 76 m in 6MWD at the beginning of the second rehabilitation
course compared with the end of the first intervention (P= .001). Twenty-four (65%) of repeating
patients achieved the MID in 6MWD at the end of the second course of PR. Those who achieved the
MID in 6MWD during the second course of rehabilitation also tended to have attained greater
improvement in this outcome during the first course (P= .07). CONCLUSION: Two-thirds of patients
with COPD undergoing repeat PR experienced significant improvement in exercise capacity. Offering
PR to patients with COPD on an as-needed basis appears to be beneficial even after a prolonged
period of time between the interventions.
7. Rev Port Pneumol (2006). 2015 Jan-Feb;21(1):11-5.
The overall impact of COPD (CAT) and BODE index on COPD male patients:correlation?
Ladeira I, Gomes T, Castro A, Ribeiro C, Guimarães M, Taveira N.
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) will be the 5th leading cause of
disability (DALYs) and the 4th leading cause of death by 2030. Measuring the real impact of COPD
using CAT ("COPD Assessment Test") can complement BODE index, an indicator of mortality. AIMS:
To assess correlation between CAT and BODE index in COPD patients. MATERIALS AND METHODS:
A retrospective study was conducted in a population of patients with COPD in a Respiratory
Rehabilitation program. We analyzed demographic variables, variables in respiratory function - 6min
walking test (6MWT), post-BD forced expiratory volume in 1st second (FEV1%); dyspnea by mMRC
scale; BODE Index and CAT. RESULTS: The study included 50 patients - GOLD stage I (7), II (25), III
(14) and IV (4), 48 men; mean age 62.6 years (±9.5), average BMI 25.8kg/m(2) (±4.8) and FEV1 57.1%
(±19.6); 6MWT of 443.3m (±61.6); 46% patients in classes 2 and 3 of mMRC scale; 84% were class 2
in BODE Index. About 80% reported slight to medium impact in CAT. CAT score and impact were
correlated with BODE index score: R=0.475, p<0.01, and R=0.377, p=0.004, and BODE index class:
R=0.357, p=0.011, and R=0.326, p=0.021. CONCLUSION: As pre-existent data in the literature
(exacerbations and benefit of rehabilitation in COPD), the positive correlations found with BODE index
reinforce the discriminative validity of CAT as a complement in the evaluation of what the true impact of
COPD is on a patient's daily life.
8. Int J Chron Obstruct Pulmon Dis. 2015 Mar 23
Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in
chronic obstructive pulmonary disease patients.
do Nascimento ES, Sampaio LM, Peixoto-Souza FS, Dias FD, Gomes EL, Greiffo FR, Ligeiro de
Oliveira AP, Stirbulov R, Vieira RP, Costa D.
Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic
airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is
characterized by pulmonary and systemic inflammation. However, increases in the levels of
inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation
improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study
was to evaluate whether a home-based pulmonary rehabilitation (HBPR) program improves exercise
tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This
prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de
Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of healthrelated quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental
test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers
(interleukin [IL]-6 and IL-8). At the end of the evaluations, patients received a booklet containing the
physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25
patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant
increase in the walked distance and the maximal inspiratory pressure, improvements on two
components from the health-related quality-of-life questionnaire, and a decrease in plasma IL-8 levels
after the intervention. The HBPR is an important and viable alternative to pulmonary rehabilitation for
the treatment of patients with COPD; it improves exercise tolerance, inspiratory muscle strength, quality
of life, and systemic inflammation in COPD patients.
09. PLoS One. 2015 Apr
Cluster Analysis in Patients with GOLD 1 Chronic Obstructive Pulmonary Disease.
Gagnon P, Casaburi R, Saey D, Porszasz J, Provencher S, Milot J, Bourbeau J, O'Donnell DE, Maltais
F.
BACKGROUND: We hypothesized that heterogeneity exists within the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 1 spirometric category and that different subgroups could be
identified within this GOLD category. METHODS: Pre-randomization study participants from two clinical
trials were symptomatic/asymptomatic GOLD 1 chronic obstructive pulmonary disease (COPD) patients
and healthy controls. A hierarchical cluster analysis used pre-randomization demographics, symptom
scores, lung function, peak exercise response and daily physical activity levels to derive population
subgroups. RESULTS: Considerable heterogeneity existed for clinical variables among patients with
GOLD 1 COPD. All parameters, except forced expiratory volume in 1 second (FEV1)/forced vital
capacity (FVC), had considerable overlap between GOLD 1 COPD and controls. Three-clusters were
identified: cluster I (18 [15%] COPD patients; 105 [85%] controls); cluster II (45 [80%] COPD patients;
11 [20%] controls); and cluster III (22 [92%] COPD patients; 2 [8%] controls). Apart from reduced
diffusion capacity and lower baseline dyspnea index versus controls, cluster I COPD patients had
otherwise preserved lung volumes, exercise capacity and physical activity levels. Cluster II COPD
patients had a higher smoking history and greater hyperinflation versus cluster I COPD patients.
Cluster III COPD patients had reduced physical activity versus controls and clusters I and II COPD
patients, and lower FEV1/FVC versus clusters I and II COPD patients. CONCLUSIONS: The results
emphasize heterogeneity within GOLD 1 COPD, supporting an individualized therapeutic approach to
patients.
10. Disabil Rehabil. 2015 Apr 17:1-10. [Epub ahead of print]
Evaluation of the effectiveness of a home-based inspiratory muscle training programme in
patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests.
Nikoletou D, Man WD, Mustfa N, Moore J, Rafferty G, Grant RL, Johnson L, Moxham J.
PURPOSE: To evaluate the effectiveness of a home-based inspiratory muscle training (IMT)
programme using multiple inspiratory muscle tests. METHOD: Sixty-eight patients (37 M) with moderate
to severe chronic obstructivepulmonary disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.;
FEV1/FVC 35.7[11.2]%) were randomised into an experimental or control group and trained with a
threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or <15% PImax,
respectively, for 7 weeks. Thirty-nine patients (23 M) completed the study. The following measures
were assessed pre- and post-IMT: PImax, sniff inspiratory nasal pressure (SNIP), diaphragm
contractility (Pdi,tw), incremental shuttle walk test (ISWT), respiratory muscle endurance (RME),
chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS)
and the SF-36. Between-group changes were assessed using one-way analysis of variance (ANOVA).
RESULTS: PImax and perception of well-being improved significantly post-IMT [p = 0.04 and <0.05 in
four domains, respectively]. This was not reflected in SNIP [p = 0.7], Pdi,tw [p = 0.8], RME [p = 0.9] or
ISWT [p = 0.5]. CONCLUSIONS: A seven-week, community-based IMT programme, with realistic use
of health-care resources, improves PImax and perception of well-being but a different design may be
required for improvement in other measures. Multiple tests provide a more comprehensive evaluation
of changes in muscle function post-IMT. Implications for Rehabilitation A seven-week, home-based
inspiratory muscle training programme improves maximal inspiratory pressure and perception of wellbeing in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm
contractility, respiratory muscle endurance and exercise capacity. Multiple tests are recommended for a
more comprehensive assessment of changes in muscle function following inspiratory muscle training
programmes. Therapists need to explore different community-based inspiratory muscle training
regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to
improvements in diaphragm contractility and exercise capacity.
11. Int J Chron Obstruct Pulmon Dis. 2015 Mar
Comparison of laboratory- and field-based exercise tests for COPD: a systematic review.
Fotheringham I, Meakin G, Punekar YS, Riley JH, Cockle SM, Singh SJ.
Exercise tests are often used to evaluate the functional status of patients with COPD. However, to the
best of our knowledge, a comprehensive systematic comparison of these tests has not been
performed. We systematically reviewed studies reporting the repeatability and/or reproducibility of
these tests, and studies comparing their sensitivity to therapeutic intervention. A systematic review
identified primary manuscripts in English reporting relevant data on the following exercise tests: 6minute walk test (6MWT) and 12-minute walk test, incremental and endurance shuttle walk tests (ISWT
and ESWT, respectively), incremental and endurance cycle ergometer tests, and incremental and
endurance treadmill tests. We identified 71 relevant studies. Good repeatability (for the 6MWT and
ESWT) and reproducibility (for the 6MWT, 12-minute walk test, ISWT, ESWT, and incremental cycle
ergometer test) were reported by most studies assessing these tests, providing patients were
familiarized with them beforehand.The 6MWT, ISWT, and particularly the ESWT were reported to be
sensitive to therapeutic intervention. Protocol variations (eg, track layout or supplemental oxygen use)
affected performance significantly in several studies. This review shows that while the validity of several
tests has been established, for others further study is required. Future work will assess the link
between these tests, physiological mechanisms, and patient-reported measures.