Literature Reviews

February 2011

We hereby send you the monthly literature update of February 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.

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Title: Outpatient pulmonary rehabilitation - rehabilitation models and shortcomings in outpatient aftercare.
Authors: Korczak D, Huber B, Steinhauser G, Dietl M.
Source: GMS Health Technol Assess. 2010 Jul 29;6:Doc11.

Summary: The goal of this health technology assessment is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. Korczak et al. conclude that out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation.

Title: Tai chi Qigong improves lung functions and activity tolerance in COPD clients: A single blind, randomized controlled trial.
Authors: Chan AW, Lee A, Suen LK, Tam WW.
Source: Complement Ther Med. 2011 Feb;19(1):3-11. Epub 2011 Jan 17.

Summary: Chan et al. aimed to evaluate the effectiveness of a Tai chi Qigong program in enhancing respiratory functions and activity tolerance in clients with COPD. Tai chi Qigong was able to improve respiratory functions and activity tolerance level in COPD clients. The breathing and walking exercise helped maintain lung functions and slow down disease progression.

Title: Do patients with lung cancer benefit from physical exercise?
Andersen AH, Vinther A, Poulsen LL, Mellemgaard A.
Acta Oncol. 2011 Feb;50(2):307-13.

Summary: The aim of this study was to investigate, if a well-documented COPD rehabilitation protocol can improve physical fitness and quality of life (QoL) in patients with lung cancer. The authors concluded that patients with pulmonary cancer can achieve significant improvements in physical fitness after completion of the intervention program. No changes in pulmonary function and QoL were observed. In addition, they found that a large number of patients dropped out before intervention and that the patients, who succeeded, often discontinued training at home.

Title: Effects of pulmonary rehabilitation on quality of life in chronic obstructive pulmonary disease patients.
Moullec G, Laurin C, Lavoie KL, Ninot G.
Curr Opin Pulm Med. 2011 Jan 3. [Epub ahead of print].

Summary: This review describes the state of knowledge over the past year concerning health-related quality of life benefits after pulmonary rehabilitation and suggests avenues for future research.

Title: Effect of early pulmonary rehabilitation on healthcare utilization and health status in patients hospitalized with acute exacerbations of COPD.
Ko FW, Dai DL, Ngai J, Tung A, Ng S, Lai K, Fong R, Lau H, Tam W, Hui DS.
Respirology. 2010 Dec 30. doi: 10.1111/j.1440-1843.2010.01921.x. [Epub ahead of print].

Summary: This study assessed the effect of early rehabilitation programme following acute exacerbation of COPD over a period of 1 year. The authors found that an 8-week programme resulted in better health status of the subjects at 6 months but without reduction in healthcare utilization at 1 year. A program following acute exacerbation of COPD led to improvement in quality of life up to 6 months, but did not reduce healthcare utilization at 1 year.

Health Education

Title: An Educational Intervention for Providers to Promote Bone Health in High-Risk Older Patients.
Authors: Simone MJ, Roberts DH, Irish JT, Neeman N, Schulze JE, Lipsitz LA, Schwartzstein R, Aronson MD, Tan ZS.
J Am Geriatr Soc. 2011 Feb 2. doi: 10.1111/j.1532-5415.2010.03240.x. [Epub ahead of print].

Summary: This study aimed to design, implement, and assess an educational intervention for providers focused on osteoporosis screening and management in older patients with COPD or asthma who have been prescribed prolonged courses of oral or high-dose inhaled corticosteroids or both and are therefore at high risk for bone loss and fractures. Simone et al. conclude that an educational intervention improved adherence to osteoporosis management guidelines of academic pulmonary specialists. The results of this study provide evidence for the positive effect of a multimodal educational program in altering practice behaviors.

Title: Using self-efficacy theory to educate a patient with chronic obstructive pulmonary disease: A case study of 1-year follow-up.
Author: Kaşıkçı MK.
Int J Nurs Pract. 2011 Feb;17(1):1-8. doi: 10.1111/j.1440-172X.2010.01898.x.

Summary: This study aimed to explore the utility of structured education programme on strengthening self-efficacy in an older adult with chronic obstructive pulmonary disease (COPD) using a combined qualitative and quantitative approach. The authors concluded that by applying a self-efficacy theory, a planned education programme could be useful in improving both short-term and long-term self-efficacy in patients with COPD.

Nutrition and Energy Expenditure

Title: Energy and Protein Intake and Its Relationship with Pulmonary Function in Chronic Obstructive Pulmonary Disease (COPD) Patients.
Yazdanpanah L, Shidfar F, Moosavi AJ, Heidarnazhad H, Haghani H.
Acta Med Iran. 2010 Nov-Dec;48(6):374-9.

Summary: Assessment of energy and protein intake and its relationship with pulmonary function in 63 COPD patients was performed in this study. The study group included 63 COPD patients. The results of the study suggest that accurate evaluation of protein and energy intake and requirements should be included in the goals of medical treatment of COPD patients.

Title: Energy expenditure during daily activities as measured by two motion sensors in patients with COPD.
Cavalheri V, Donária L, Ferreira T, Finatti M, Camillo CA, Cipulo Ramos EM, Pitta F.
Respir Med. 2011 Jan 26. [Epub ahead of print].

Summary: The aim of this study was to determine which daily activities are more demanding to patients with COPD and to compare the accuracy of energy expenditure estimation given by the pedometer Digiwalker SW701 and the multisensor SenseWear Armband. Walking up/downstairs was the most energy-demanding daily activity for patients with COPD. Furthermore, during daily activities, the multisensor showed adequate overall estimation of energy expenditure, as opposed to the pedometer.

Respiratory and Skeletal Muscles

Title: Impact of inspiratory muscle training in patients with COPD: what is the evidence?
Gosselink R, De Vos J, van den Heuvel SP, Segers J, Decramer M, Kwakkel G.
Eur Respir J. 2011 Feb;37(2):416-25.

Summary: Gosselink et al. performed a meta-analysis including 32 randomised controlled trials on the effects of inspiratory muscle training (IMT) in COPD. IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspiratory muscle endurance training was shown to be less effective than respiratory muscle strength training.

Title: Respiratory and Skeletal Muscle Strength in Chronic Obstructive Pulmonary Disease.
Singer J, Yelin EH, Katz PP, Sanchez G, Iribarren C, Eisner MD, Blanc PD.
J Cardiopulm Rehabil Prev. 2011 Jan 13. [Epub ahead of print].

Summary: The authors sought to quantify the impact of respiratory muscle and lower extremity strength on exercise capacity and lower extremity function in patients with COPD. Their conclusion was that in COPD, reduced respiratory and lower extremity muscle strength are associated with decreased exercise and functional capacity.

Title: Peripheral muscle dysfunction and chronic obstructive pulmonary disease.
Breunung L, Roberts M.
Br J Hosp Med (Lond). 2011 Jan;72(1):17-21.

Summary: This review evaluates the evidence for the mechanisms that mediate these changes and the significance of the diminished muscle function in COPD.

Complexity of COPD

Title: Prognostic assessment in COPD: Health related quality of life and the BODE index.
Marin JM, Cote CG, Diaz O, Lisboa C, Casanova C, Lopez MV, Carrizo SJ, Pinto-Plata V, Dordelly LJ, Nekach H, Celli BR.
Respir Med. 2011 Jan 29. [Epub ahead of print].

Summary: The objective was to identify the relationship between BODE index and the SGRQ and to test the predictive value of both tools against survival in 1398 COPD patients. Marin et al. conclude that health status as measured by SGRQ worsens with disease severity evaluated by the BODE index. Both tools predict mortality and provide complimentary information in the evaluation of patients with COPD.

Title: COPD severity score as a predictor of failure in exacerbations of COPD. The ESFERA study.
Miravitlles M, Izquierdo I, Herrejón A, Torres JV, Baró E, Borja J; On behalf of the ESFERA investigators.
Respir Med. 2011 Jan 10. [Epub ahead of print].

Summary: This study evaluates the COPD severity score (COPDSS) as a predictor of clinical failure, together with other severity, activity and quality of life measurements, in patients with exacerbated COPD. The authors concluded that clinical failure after ambulatory treatment of exacerbation of COPD is frequent. Usual markers of severity (impaired lung function, active smoking and severe dyspnoea) are associated with failure; however, a short severity questionnaire (COPDSS) provides better predictive value than the usual variables.

Title: Determinants of elevated healthcare utilization in patients with COPD.
Simon-Tuval T, Scharf SM, Maimon N, Bernhard-Scharf BJ, Reuveni H, Tarasiuk A.
Respir Res. 2011 Jan 13;12(1):7. [Epub ahead of print]

Summary: Objective of this study was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. The authors concluded that comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

End-of-Life Communication and Palliative Care

Title: Comparing Three Life-Limiting Diseases: Does Diagnosis Matter or is Sick, Sick?
Steinhauser KE, Arnold RM, Olsen MK, Lindquist J, Hays J, Wood LL, Burton AM, Tulsky JA.
J Pain Symptom Manage. 2011 Jan 27. [Epub ahead of print].

Summary: The purpose of this study was to compare the functional capacity, emotional well-being, and quality of life of patients with cancer, congestive heart failure, and COPD to assess whether diagnosis distinguishes differences in patient experience, and compare patients with cancer and noncancer diagnoses. Comparing patients with advanced cancer, CHF, and COPD, illness experience was more similar than different. Patients living with life-limiting illnesses other than cancer may benefit from whole-person services often extended to cancer patients.

Title: Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study.
Pinnock H, Kendall M, Murray SA, Worth A, Levack P, Porter M, Macnee W, Sheikh A.
BMJ. 2011 Jan 24;342:d142. doi: 10.1136/bmj.d142.

Summary: This qualitative study aimed to understand the perspectives of people with severe COPD as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD. The authors concluded that the policy focus on identifying a time point for transition to palliative care has little resonance for people with COPD or their clinicians and is counter productive if it distracts from early phased introduction of supportive care. Careful assessment of possible supportive and palliative care needs should be triggered at key disease milestones along a lifetime journey with COPD, in particular after hospital admission for an exacerbation.

Title: Patient-clinician communication about end-of-life care for Dutch and US patients with COPD.
Janssen DJ, Curtis JR, Au DH, Spruit MA, Downey L, Schols JM, Wouters EF, Engelberg RA.
Eur Respir J. 2011 Jan 13. [Epub ahead of print].

Summary: Objective of this study was to compare quality of patient-clinician communication about end-of-life care and endorsement of barriers and facilitators to this communication in the Netherlands and US. The authors concluded that Dutch patients reported lower quality of communication about end-of-life care. Quality of communication about end-of-life care needs to improve in the Netherlands and the US.

Title: Adherence to treatment guidelines and long-term survival in hospitalized patients with chronic obstructive pulmonary disease.
Sarc I, Jeric T, Ziherl K, Suskovic S, Kosnik M, Anker SD, Lainscak M.
J Eval Clin Pract. 2011 Jan 11. doi: 10.1111/j.1365-2753.2010.01617.x. [Epub ahead of print]

Summary: This retrospective study aimed to assess the implementation of COPD guidelines and potential association with long-term mortality in patients with COPD in Slovenia. The authors concluded that implementation of guideline-recommended therapy was not optimal, particularly in patients who died during follow-up. The high long-term mortality calls for careful risk assessment and appropriate adherence to treatment guidelines.


Title: Anemia in Chronic Obstructive Pulmonary Disease: A Systematic Review of the Prevalence, Quality of Life and Mortality.
Yohannes AM, Ershler WB.
Respir Care. 2011 Jan 27. [Epub ahead of print].

Summary: Yohannes and Ershler performed a systematic review and synthesis of the literature about the prevalence of comorbid anemia and its impact on quality of life, healthcare utilisation and mortality in patients with COPD. It is not clear the true prevalence of anemia in patients with COPD. There is a lack of consensus agreement regarding this haematological abnormalities and true frequency. Therefore, based on the findings from the existing literature, it indicates that much more work is necessary to establish the true prevalence of anemia in COPD. Robust and prospective clinical studies are needed to improve the management of COPD patients with comorbid anemia.

Exercise Testing and Functional Performance

Title: Too rapid increase and too much breathlessness are distinct indices of exertional dyspnea in COPD.
Delclaux C, Chevalier-Bidaud B, Essalhi M, Callens E, Graba S, Gillet-Juvin K, Valcke-Brossollet J, Mahut B.
Respir Physiol Neurobiol. 2011 Jan 21. [Epub ahead of print].

Summary: The aim of the study was to assess whether different indices of dyspnea can be obtained from cardiopulmonary exercise test and whether these indices correlate with distinct physiological parameters in COPD. Forty-two COPD patients underwent pulmonary function and incremental exercise tests. The authors concluded that baseline hyperinflation is associated with the perception of a too rapid increase in dyspnea on exercise in COPD.

Title: Fatigue and Functional Impairment in Early Stage Non-Small Cell Lung Cancer Survivors.
Hung R, Krebs P, Coups EJ, Feinstein MB, Park BJ, Burkhalter J, Ostroff JS.
J Pain Symptom Manage. 2011 Jan 7. [Epub ahead of print].

Summary: This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors. The authors concluded that fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue.


Title: Preventative tele-health supported services for early stage Chronic Obstructive Pulmonary Disease: a protocol for a pragmatic randomized controlled trial pilot.
Fitzsimmons DA, Thompson J, Hawley M, Mountain GA.
Trials. 2011 Jan 7;12(1):6. [Epub ahead of print].

Summary: This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life.Fitzsimmons et al. conclude that the tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future.

Title: Effects of Home Telemonitoring to Support Improved Care for Chronic Obstructive Pulmonary Diseases.
Sicotte C, Paré G, Morin S, Potvin J, Moreault MP.
Source: Telemed J E Health. 2011 Jan 9. [Epub ahead of print].

Summary: This study aimed to assess the impact of a home telemonitoring technology on patients with COPD in terms of care satisfaction, patient empowerment, improved quality of life, and utilization of hospital and home care. Sicotte et al. conclude that capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology.