Literature Reviews

April 2011

We hereby send you the monthly literature update of April 2011. Part of the "Summaries" below are directly quoted from the abstract. We hope that these summaries are serviceable to you and your colleagues. Please keep in mind that we will not be able to provide you with a complete overview of all relevant articles published each month; and please read the full text of the below-mentioned articles for more details on methodology and results.

Sally J. Singh, chair
Martijn A. Spruit, secretary

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Palliative care and end-of-life communication

Title: Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease.
Authors: Ek K, Sahlberg-Blom E, Andershed B, Ternestedt BM.
Source: J Adv Nurs. 2011 Mar 6. doi: 10.1111/j.1365-2648.2010.05604.x. [Epub ahead of print].

Summary: This paper is a report of a qualitative study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone. The authors concluded that COPD is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.

Title: Understanding mechanisms and documenting plausibility of palliative interventions for dyspnea.
Author: Mahler DA.
Source: Curr Opin Support Palliat Care. 2011 Mar 22. [Epub ahead of print]

Summary: Purpose of this study was to review the mechanisms for the perception of dyspnea and to consider the plausibility of interventions that palliate dyspnea after optimal treatment of the underlying disease. The author concluded that targets for palliating dyspnea in patients with advanced disease include sensory receptors within the lung/chest wall and the central nervous system. The opioid system plays an important role in palliating dyspnea. Both endogenous and exogenous opioids modulate breathlessness.

Quality of life and health status

Title: Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity.
Authors: Albuquerque SC, Carvalho ER, Lopes RS, Marques HS, Macêdo DS, Pereira ED, Hyphantis TN, Carvalho AF.
Source: Qual Life Res. 2011 Mar 15. [Epub ahead of print]

Summary: Purpose of the study was to assess COPD patients' defensive profile compared with healthy participants and to test whether specific ego defense mechanisms are associated with health-related quality of life (HRQoL) and self-reported dyspnoea severity. The authors concluded that COPD patients exhibit a relatively immature and neurotic defensive profile. Clinicians and consultation-liaison psychiatrists should consider the patients' underlying personality structure, especially somatization tendencies, since it is independently associated with HRQoL and dyspnoea severity.

Title: Health-related quality of life in patients with severe COPD hospitalized for exacerbations - comparing EQ-5D, SF-12 and SGRQ.
Authors: Menn P, Weber N, Holle R.
Source: Health Qual Life Outcomes. 2010 Apr 15;8:39.

Summary: The aim of this study was to measure HrQoL during acute exacerbations of COPD using generic and disease-specific instruments, and to assess completeness, proportion with best or worst health state, sensitivity to change and discriminative ability for each instrument. The authors concluded that acute exacerbations seriously impair health status and quality of life. The EQ-5D is generally suitable to measure HrQoL in exacerbations of severe COPD. The main issue with the SF-12 is the high proportion of missing values in a self-assessed setting. Properties of the SGRQ were satisfactory. However, it is not suitable for cost-utility analyses in health-economic evaluations.

Title: Impaired health status and care dependency in patients with advanced COPD or chronic heart failure.
Authors: Janssen DJ, Franssen FM, Wouters EF, Schols JM, Spruit MA.
Source: Qual Life Res. 2011 Mar 27. [Epub ahead of print].

Summary: Aims of this cross-sectional study were to assess health status and care dependency in patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to identify correlates of an impaired health status. Patients with advanced COPD or CHF have an impaired health status and may be confronted with care dependency. Physical and psychological symptoms, care dependency and number of drugs were correlated with impaired health status. The authors concluded that clinical care should regularly assess symptom burden and care dependency to identify patients with advanced COPD or CHF at risk for an impaired health status.

Title: Is the EQ-5D responsive to recovery from a moderate COPD exacerbation?
Authors: Goossens LM, Nivens MC, Sachs P, Monz BU, Rutten-van Mölken MP.
Source: Respir Med. 2011 Mar 23. [Epub ahead of print].

Summary: This manuscript aimed to assess the ability of the EQ-5D to detect the recovery from moderate COPD exacerbations. Goossens et al. conclude that the EQ-5D is responsive to the recovery from a moderate COPD exacerbation.

Cognitive functioning

Title: The effect of hypoxia on cognitive performance in patients with chronic obstructive pulmonary disease.
Authors: Martin SE, Bradley JM, Buick JB, Crossan A, Stuartelborn J.
Source: Respir Physiol Neurobiol. 2011 Mar 10. [Epub ahead of print].

Summary: The aim of this study was to determine the effect of hypoxia on cognitive performance in patients with COPD when PaO2 was decreased below 6.6 kPa. The authors concluded that no short term deterioration in visual search, mental flexibility or visuospatial constructional ability was detected when PaO2 was decreased to below 6.6 kPa. The results show that short term exposure to hypoxia had no adverse effect on cognitive function.

Problematic activities of daily life

Title: Problematic Activities of Daily Life are Weakly Associated With Clinical Characteristics in COPD.
Authors: Annegarn J, Meijer K, Passos VL, Stute K, Wiechert J, Savelberg HH, Schols AM, Wouters EF, Spruit MA; on behalf of the Ciro+ Rehabilitation Network.
Source: J Am Med Dir Assoc. 2011 Feb 15. [Epub ahead of print].

Summary: This retrospective chart review aimed to identify the most prevalent self-reported problematic ADLs in COPD patients, determine performance and satisfaction scores of these problematic ADLs, and explore the association between 13 clinical determinants and 4 problematic ADL domains. Annegarn et al. conclude that the lack of a strong association between problematic ADLs and clinical determinants emphasizes the need for individualized assessment of these ADLs to allow tailored intervention.

Title: Functional Disability and Associated Chronic Conditions among Geriatric Populations in a Rural Community of India.
Authors: Chakrabarty D, Mandal PK, Manna N, Mallik S, Ghosh P, Chatterjee C, Sardar JC, Sau M, Sinha Roy AK.
Source: Ghana Med J. 2010 Dec;44(4):150-4.

Summary: This study aimed to find out the prevalence of different chronic diseases and disability among the geriatric population in a rural community of India and to determine the association between chronic diseases and disability of the geriatric population. Association between different risk factors and disability was found with age, sex, anaemia, COPD, scabies, hypertrophy of prostate, ischaemic heart disease, osteoporosis, osteoarthritis and acid peptic disorder were the risk factors of disability.

Title: Level of daily physical activity in individuals with COPD compared with healthy controls.
Authors: Vorrink SN, Kort HS, Troosters T, Lammers JW.
Source: Respir Res. 2011 Mar 22;12(1):33. [Epub ahead of print].

Summary: This literature review aimed to present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The focus was on the extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the severity of the disease has an additional influence on DPA. It appears that patients with COPD have a significantly reduced duration, intensity, and counts of DPA when compared to healthy control subjects. The intensity of DPA seems to be less affected by COPD than duration and counts. Judging from the results, it seems that severity of COPD is not strongly correlated with level of DPA.

Title: Task-related oxygen uptake during domestic activities of daily life in patients with COPD and healthy elderly subjects.
Authors: Vaes AW, Wouters EF, Franssen FM, Uszko-Lencer NH, Stakenborg KH, Westra M, Meijer K, Schols AM, Janssen PP, Spruit MA.
Source: Chest. 2011 Mar 17. [Epub ahead of print].

Summary: Task-related oxygen uptake and symptom perception during ADLs have been studied rarely in COPD. It therefore remains unknown whether and to what extent differences may exist in task-related oxygen uptake and symptom perception during ADLs in COPD patients after stratification for gender, GOLD stage, MRC dyspnea grade or score on BODE index. Vaes et al. concluded that COPD patients experience a relatively high metabolic load and symptom perception during the performance of ADLs that is not the same as seen in their healthy peers, particularly in patients with GOLD stage IV, MRC dyspnea grade 5 or BODE score of ≥6 points.

Title: Brief, Valid Measures of Dyspnea and Related Functional Limitations in Chronic Obstructive Pulmonary Disease (COPD).
Authors: Yount SE, Choi SW, Victorson D, Ruo B, Cella D, Anton S, Hamilton A.
Source: Value Health. 2011 Mar-Apr;14(2):307-15.

Summary: This study examined the psychometric performance of two item-response theory-based (IRT) measures of dyspnea and related functional limitations (FLs) in patients with COPD and simulated computerized adaptive testing (CAT) of the banks to determine the number of questions required to achieve high precision. The Functional Assessment of Chronic Illness Therapy-Dyspnea short forms and banks provide options for brief, psychometrically sound measures of dyspnea and/or FLs in COPD.

Title: The importance of clinical management problems in older people with COPD and asthma: do patients and physicians agree?
Authors: McDonald VM, Higgins I, Simpson JL, Gibson PG.
Source: Prim Care Respir J. 2011 Mar 29. pii: pcrj-2009-12-0100-R3. doi: 10.4104/pcrj.2011.00025. [Epub ahead of print].

Summary: COPD and asthma in older people are complex conditions associated with multiple clinical problems. The relative importance of these problems to both patients and physicians and the level of agreement between them is largely unknown. In asthma and COPD, patients and their physicians agree about the importance of managing activity limitation, dyspnoea, and airway inflammation. Other areas of management had little concordance or were viewed as less important. Self-management skills were not rated as important by patients and this may hinder successful management.

Title: Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease.
Authors: Rocco CC, Sampaio LM, Stirbulov R, Corrêa JC.
Source: Clinics (Sao Paulo). 2011;66(1):125-9.

Summary: The purpose was to assess functional (balance L-L and A-P displacement, sit-to-stand test (SST) and Tinetti scale - balance and gait) and neurophysiological aspects (patellar and Achilles reflex and strength) relating these responses to the BODE Index in patients with COPD. The individuals with COPD had functional and neurophysiological alterations in comparison with the control group. The BODE Index was correlated with the Tinetti scale and the SST. Both are functional tests, easy to administer, low cost and feasible, especially the SST.

Symptoms of fatigue

Title: Fatigue in COPD: Prevalence and effect on outcomes in pulmonary rehabilitation.
Authors: Baltzan MA, Scott AS, Wolkove N, Bailes S, Bernard S, Bourbeau J, Maltais F.
Source: Chron Respir Dis. 2011 Mar 23. [Epub ahead of print].

Summary: Baltzan et al. sought to estimate the prevalence of high fatigue in this population and to determine whether individuals with high fatigue had a different response to pulmonary rehabilitation. This study suggests that high levels of fatigue is a common feature in patients with COPD. They have a lower exercise capacity and a lower health status. However, they benefit from pulmonary rehabilitation.

Exercise performance

Title: Physiologic responses during the six minute walk test in obese and non-obese COPD patients.
Authors: Bautista J, Ehsan M, Normandin E, Zuwallack R, Lahiri B.
Source: Respir Med. 2011 Mar 15. [Epub ahead of print].

Summary: Bautista et al. compared physiologic responses during a 6 min walk test in 10 obese and 10 non-obese COPD patients matched by gender, age, and spirometric severity category. Although 6 min walk distance is shorter in obese COPD patients, their physiologic responses are similar to those of non-obese patients.

Title: Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression.
Authors: Márquez-Martín E, Ramos PC, López-Campos JL, Del Pilar Serrano Gotarredona M, Herrero SN, Aguilar RT, Cortes EB, Ruiz FO.
Source: Int J Chron Obstruct Pulmon Dis. 2011;6:105-12. Epub 2011 Jan 26.

Summary: This study attempted to explore the possible relationship between the extent of emphysema, as assessed by high-resolution computed tomography (HRCT), and COPD severity. We also included some study variables involving exercise tolerance evaluation and peripheral muscle strength (PMS) measurement. Compared with subjects with a non-emphysematous phenotype, subjects with an emphysematous phenotype has a different profile in terms of BMI, lung function, PMS, and exercise capacity.

Title: Physiological Correlates of Endurance Time Variability during Constant-Workrate Cycling Exercise in Patients with COPD.
Authors: Vivodtzev I, Gagnon P, Pepin V, Saey D, Laviolette L, Brouillard C, Maltais F.
Source: PLoS One. 2011 Feb 28;6(2):e17007.

Summary: Vivodtzev et al. investigated pulmonary and physiological variables that may contribute to these variations in T(end). T(end) was independently related to the aerobic fitness and to tolerance to leg fatigue at the end of exercise. A large fraction of the variability in T(end) was not explained by the physiological parameters assessed in the present study. Individualization of exercise intensity during CET should help in reducing variations in T(end) among patients with COPD.

Title: Disability in COPD and its relationship to clinical and patient-reported outcomes.
Authors: Braido F, Baiardini I, Menoni S, Maria Bagnasco A, Balbi F, Bocchibianchi S, Balestracci S, Grazia Piroddi M, Walter Canonica G.
Source: Curr Med Res Opin. 2011 Mar 8. [Epub ahead of print].

Summary: This study aimed to assess the presence of disability in COPD patients and its relationships with disease severity, comorbidities, and patient-reported outcomes. Disability can be identified in each disease stage, with dyspnea serving as the most relevant inducing factor. Since disability substantially impacts patient perception of and experience with COPD, its presence must be taken into account during disease management.

Respiratory muscles

Title: Effect of helium breathing on intercostal and quadriceps muscle blood flow during exercise in COPD patients.
Authors: Vogiatzis I, Habazettl H, Aliverti A, Athanasopoulos D, Louvaris Z, Lomauro A, Wagner HE, Roussos C, Wagner PD, Zakynthinos SG.
Source: Am J Physiol Regul Integr Comp Physiol. 2011 Mar 16. [Epub ahead of print].

Summary: Whether blood flow redistribution from intercostal to locomotor muscles contributes to this improvement, currently remains unknown. Accordingly, the objective of this study was to investigate whether such redistribution plays a role in improving locomotor muscle oxygen delivery whilst breathing heliox at near-maximal [75% peak work rate (WR(peak))], maximal (100%WR(peak)) and supra-maximal (115%WR(peak)) exercise in COPD. Vogiatzis et al. concluded that since intercostal muscle blood flow did not decrease by heliox administration, blood flow redistribution from intercostal to locomotor muscles does not represent a likely mechanism of improvement in locomotor muscle oxygen delivery.

Health technology

Title: Effects of automated prompts for logging symptom and exercise data on mobile devices in patients with chronic obstructive pulmonary disease.
Authors: Wolpin S, Nguyen HQ, Donesky-Cuenco D, Carrieri-Kohlman V, Doorenbos A.
Source: Comput Inform Nurs. 2011 Feb;29(2 Suppl):TC3-8.

Summary: The purpose of this analysis was to conduct a summative evaluation of 7474 automated prompts sent to participants with chronic obstructive pulmonary disease (n=19). Factors associated with delayed response to the prompts included older age, limited computer skills, and reports of no exercise. We recommend that future investigators who are using mobile devices in their research pay careful attention to usability issues as well as strategies that might keep patients engaged and motivated.


Title: The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study.
Authors: Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, Falzon C, Garrod R, Lee C, Polkey MI, Jones PW, Man WD, Hopkinson NS.
Source: Thorax. 2011 Mar 12. [Epub ahead of print].

Summary: The introduction of the COPD Assessment Test (CAT) score as an outcome measure was prospectively studied by PR programmes across London. The CAT score is simple to implement as an outcome measure, it improves in response to PR and can distinguish categories of response.

Title: Pulmonary Rehabilitation in Non-small Cell Lung Cancer Patients After Completion of Treatment.
Authors: Glattki GP, Manika K, Sichletidis L, Alexe G, Brenke R, Spyratos D.
Source: Am J Clin Oncol. 2011 Mar 2. [Epub ahead of print].

Summary: The aim of this study was to investigate the utility of an inpatient multidisciplinary pulmonary rehabilitation (PR) program on pulmonary function and exercise capacity of patients with NSCLC after completion of their treatment. Patients with NSCLC who could accomplish PR program, after multidisciplinary treatment for the main disease, seem to benefit in terms of exercise capacity and pulmonary function. These benefits are independent of concurrent COPD and surgical treatment for lung cancer.

Title: The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD.
Authors: Von Leupoldt A, Taube K, Lehmann K, Fritzsche A, Magnussen H.
Source: Chest. 2011 Mar 31. [Epub ahead of print].

Summary: The present study examined the impact of anxiety and depression on functional performance, dyspnea and quality of life in patients with COPD at start and end of an outpatient pulmonary rehabilitation program. This study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and quality of life in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during PR.