Literature Reviews

January 2011

We hereby send you the monthly literature update of January 2011. 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.

Functional testing and exercise testing

Title: In search of parsimony: reliability and validity of the Functional Performance Inventory-Short Form.
Authors: Leidy NK, Knebel A.
Source: Int J Chron Obstruct Pulmon Dis. 2010 Nov 25;5:415-23.

Summary: The purpose of this study was to create a shorter version of the Functional Performance Inventory while preserving the integrity and psychometric properties of the original. Results suggest the shorter version of the Functional Performance Inventory is a viable alternative to the Functional Performance Inventory for situations in which a shorter instrument is desired. Further assessment of the instrument's performance properties in new samples of patients with COPD is warranted.

Title: Reproducibility of 6-minute walking test in patients with COPD.
Authors: Hernandes NA, Wouters EF, Meijer K, Annegarn J, Pitta F, Spruit MA.
Source: Eur Respir J. 2010 Dec 22. [Epub ahead of print].

Summary: This study aimed to investigate the reproducibility of two 6-min walking tests performed in subsequent days in a large and representative sample of 1514 patients with COPD and to quantify the learning effect between the two tests, as well as its determinants. The 6MWT was statistically reproducible. However, the vast majority of patients improved significantly in the second test by an average learning effect of 27m.

Title: 6-Minute Walk Test in Idiopathic Pulmonary Fibrosis: Test Validation and Minimal Clinically Important Difference.
Authors: du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, Lancaster L, Noble PW, Sahn SA, Szwarcberg J, Thomeer M, Valeyre D, King Jr TE.
Source: Am J Respir Crit Care Med. 2010 Dec 3. [Epub ahead of print].

Summary: Du Bois et al. aimed to assess the reliability, validity, and responsiveness of the 6MWT and estimate the minimal clinically important difference (MCID) in patients with IPF. The 6MWT is a reliable, valid, and responsive measure of disease status and a valid endpoint for clinical trials in IPF. The estimated MCID was 24-45 meters.

Title: Significance of changes in endurance shuttle walking performance.
Authors: Pepin V, Laviolette L, Brouillard C, Sewell L, Singh SJ, Revill SM, Lacasse Y, Maltais F.
Source: Thorax. 2010 Dec 8. [Epub ahead of print].

Summary: The minimal important difference (MID) for the endurance shuttle walk test remains unknown in COPD, therefore limiting its interpretability. A change in endurance shuttle walking performance of 45 to 85 s (or 60 to 115 m) after bronchodilation is likely to be perceived by patients. This MID value may be specific to the intervention from which it was derived.

Title: Osteoporosis in patients referred for lung transplantation.
Authors: Jastrzebski D, Lutogniewska W, Ochman M, Margas A, Kowalski K, Wyrwol J, Ksiazek B, Wojarski J, Zeglen S, Ziora D, Kozielski J.
Source: Eur J Med Res. 2010 Nov 4;15 Suppl 2:68-71.

Summary: The purpose of study is to determine the prevalence of osteoporosis with the regard to risk factors for osteoporosis in patients awaiting lung transplantation. Osteoporosis is very common in patients referred for lung transplantation, especially among COPD candidates. Therefore, early diagnosis and prevention of osteoporosis in lung transplant candidates should receive high priority.


Title: An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses.
Authors: Bailey CD, Wagland R, Dabbour R, Caress A, Smith J, Molassiotis A.
Source: BMC Pulm Med. 2010 Dec 9;10(1):63. [Epub ahead of print].

Summary: An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation. The authors concluded that more research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, the authors state that pharmacological treatments do not completely manage breathlessness and have an added burden of side effects.

Respiratory and skeletal muscles

Title: Respiratory Muscle Dysfunction in COPD: From Cell to Muscles.
Authors: Klimathianaki M, Vaporidi K, Georgopoulos D.
Source: Curr Drug Targets. 2011 Jan 3. [Epub ahead of print].

Summary: Respiratory muscle dysfunction is a cardinal feature of acute and chronic respiratory failure in COPD. Klimathianaki et al. summarize the current evidence.

Title: Cardiovascular and Musculoskeletal Co-morbidities in Patients with Alpha 1 Antitrypsin Deficiency.
Authors: Duckers JM, Shale DJ, Stockley RA, Gale NS, Evans BA, Cockcroft JR, Bolton CE.
Source: Respir Res. 2010 Dec 7;11(1):173. [Epub ahead of print].

Summary: Duckers et al. hypothesised that systemic consequences are evident in a further group of subjects with COPD due to Alpha-1 Antitrypsin Deficiency (A1ATD), yet are currently under-recognised. These authors concluded that patients with A1ATD related COPD have increased aortic stiffness suggesting increased risk of cardiovascular disease and evidence of occult musculoskeletal changes, all likely to contribute hugely to overall morbidity and mortality.


Title: Effect of early pulmonary rehabilitation on healthcare utilization and health status in patients hospitalized with acute exacerbations of COPD.
Authors: Ko FW, Dai DL, Ngai J, Tung A, Ng S, Lai K, Fong R, Lau H, Tam W, Hui DS.
Source: 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. Ko et al. 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.

Title: Oxygen supplementation facilitating successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease following trans-tibial amputation: a case report.
Authors: Sohal J, Arneja A, Sharma S.
Source: J Med Case Reports. 2010 Dec 22;4(1):410. [Epub ahead of print].

Summary: This case report illustrates that patients with significant severe COPD can be successfully fitted with limb prostheses and undergo rehabilitation using supplemental oxygen along with optimization of their underlying co-morbidities. Despite the paucity of published information in this area, prosthesis fitting and rehabilitation may be considered in patients who have undergone amputation and have severe COPD.

Title: Pulmonary rehabilitation: an underutilized resource in primary COPD care.
Authors: Garvey C, Fromer L, Saver DF, Yawn BP.
Source: Phys Sportsmed. 2010 Dec;38(4):54-60.

Summary: In this article, Garvey et al. discuss the important components of pulmonary rehabilitation, including exercise training, self-management education, and psychosocial and nutritional interventions, as based on the American Thoracic Society/European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Moreover, they also discuss the potential benefits of pulmonary rehabilitation, including reduction of respiratory symptoms, decreased disability, and increased participation in physical and social activities.

Complexity of COPD

Title: Addressing the Complexity of COPD.
Authors: Agusti A, Sobradillo P, Celli B.
Source: Am J Respir Crit Care Med. 2010 Dec 17. [Epub ahead of print].

Summary: Chronic obstructive pulmonary disease (COPD) is a complex disease at the clinical, cellular and molecular levels. However, its diagnosis, assessment and therapeutic management are based almost exclusively on the severity of airflow limitation. Recent theoretical, technological and analytical improvements provide tools capable of addressing the complexity of COPD. This review summarizes our current knowledge in this area and offers an insight into the elements needed to progress towards an integrated, multi-level view of COPD based upon the novel scientific strategy of systems biology and its potential clinical derivative, P4 medicine (Personalized, Predictive, Preventive and Participatory).

Title: Metabolic phenotype and adipose tissue inflammation in patients with chronic obstructive pulmonary disease.
Authors: Skyba P, Ukropec J, Pobeha P, Ukropcova B, Joppa P, Kurdiova T, Stroffekova K, Brusik M, Klimes I, Tkac I, Gasperikova D, Tkacova R.
Source: Mediators Inflamm. 2010;2010:173498. Epub 2010 Dec 21.

Summary: Skyba et al. investigated adipose tissue expressions of interleukin-6, tumor necrosis factor-alfa, CD68 (macrophage cell surface receptor), caspase-3, and Bax, and their relationships to the metabolic phenotype in nine cachectic, 12 normal-weight, 12 overweight, and 11 obese patients with COPD. The results of this study suggest that adipose tissue inflammation in obese COPD patients relates to insulin resistance. Cachectic patients remain insulin sensitive, with no adipose tissue upregulation of inflammatory or pro-apoptotic markers.

Title: Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes.
Authors: Garcia-Aymerich J, Gómez FP, Benet M, Farrero E, Basagaña X, Gayete A, Paré C, Freixa X, Ferrer J, Ferrer A, Roca J, Gáldiz JB, Sauleda J, Monsó E, Gea J, Barberà JA, Agustí A, Antó JM; on behalf of the PAC-COPD Study Group.
Source: Thorax. 2010 Dec 21. [Epub ahead of print].

Summary: It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes. Garcia-Aymerich et al. concluded that in patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: 'severe respiratory COPD', 'moderate respiratory COPD', and 'systemic COPD'.

Care giving burden and End-of-life communication

Title: Insights into chronic obstructive pulmonary disease patient attitudes on ventilatory support.
Authors: Chandramouli S, Molyneaux V, Angus RM, Calverley PM, Chakrabarti B.
Source: Curr Opin Pulm Med. 2010 Dec 16. [Epub ahead of print].

Summary: This review shows data regarding attitudes of COPD patients toward end-of-life in general and specifically concerning the area of ventilatory support. The authors conclude that physicians should consider the discussion of end-of-life issues preferably when patients are stable. Decision aids may prove to be a valuable adjunct in framing treatments such as mechanical ventilation.

Title: Personality features, caring burden and mental health of cohabitants of partners with chronic obstructive pulmonary disease or dementia.
Authors: Nordtug B, Krokstad S, Holen A.
Source: Aging Ment Health. 2010 Dec 6:1-9. [Epub ahead of print].

Summary: This cross-sectional study examined the interplay between personality, mental health and type of disease in explaining caring burden in home-dwelling cohabitants of partners with COPD or dementia. The authors conclude that differences in personality and illness explained both caring burden and mental health among caregivers. To mitigate the caring burden and mental health problems among home-dwelling caregivers, public health services need to take into account the personality and gender of the caregiver, and also the disease of the ill partner.

Title: The Association of Depression and Preferences for Life-Sustaining Treatments in Veterans with Chronic Obstructive Pulmonary Disease.
Authors: Reinke LF, Slatore CG, Udris EM, Moss BR, Johnson EA, Au DH.
Source: J Pain Symptom Manage. 2010 Dec 7. [Epub ahead of print].

Summary: This cross-sectional study assessed whether a history of depression or active depressive symptoms is associated with preferences for life-sustaining therapies among Veterans with COPD. Reinke et al. conclude that depressive history and active symptoms among Veterans with severe COPD were not associated with their decisions for life-sustaining treatments. Clinicians caring for patients with COPD should understand the importance of assessing and treating patients with depressive symptoms, yet recognize that depressive symptoms may not be predictive of a patient declining life-sustaining treatments.

Title: Advances in chronic obstructive pulmonary disease among older adults.
Authors: Blanchette CM, Berry SR, Lane SJ.
Source: Curr Opin Pulm Med. 2010 Dec 21. [Epub ahead of print].

Summary: This review summarizes recent research on COPD among older adults. Recent research on COPD and older adults addresses four key areas: diagnosis and screening, comorbidities, end-of-life care, and management. The authors conclude that more research on older adults and COPD suggest that aging is a determinant of the progression of disease and that management of this population requires different metrics and strategies.

Title: A theoretical decision model to help inform advance directive discussions for patients with COPD.
Authors: Hajizadeh N, Crothers K, Braithwaite RS.
Source: BMC Med Inform Decis Mak. 2010 Dec 20;10(1):75. [Epub ahead of print].

Summary: In order to begin to inform advance directives (AD) discussions between clinicians and COPD patients, the authors constructed a decision tree to estimate the impact of alternative AD decisions on both quality and quantity of life (quality adjusted life years, QALYs). The authors concluded that their model suggests that AD decisions are sensitive to patient preferences about long-term institutionalization and potential complications of therapy, particularly in patients with severe COPD. Future work will elicit actual patient preferences about complications of invasive mechanical ventilation, and incorporate our model into a clinical decision support to be used for actual COPD patients facing AD decisions.

Title: Presence of In-Home Caregiver and Health Outcomes of Older Adults with Chronic Obstructive Pulmonary Disease.
Authors: Wakabayashi R, Motegi T, Yamada K, Ishii T, Gemma A, Kida K.
Source: J Am Geriatr Soc. 2011 Jan 3. doi: 10.1111/j.1532-5415.2010.03222.x. [Epub ahead of print].

Summary: The authors aimed to determine whether the presence of in-home caregivers is associated with changes in the health outcomes of older adults with COPD. Participants with COPD living alone were higher functioning in terms of instrumental activities of daily life, but they had less exercise capacity and more-frequent emergency visits than participants in the in-home caregiver groups and no difference in hospitalizations.


Title: Telemonitoring in chronic obstructive airway disease and adult patients with cystic fibrosis.
Authors: Jarad NA, Sund ZM.
Source: J Telemed Telecare. 2010 Dec 16. [Epub ahead of print].

Summary: This study compared the use of telemonitoring in patients with chronic obstructive pulmonary disease (COPD) and adult patients with cystic fibrosis (CF). Patients used a personal data assistant (PDA) attached to a spirometer to score symptoms and to perform daily spirometry. When exacerbations were detected, patients were offered treatment according to a pre-designed protocol. When compared to a parallel period in the previous year, the number of hospitalisations for COPD exacerbations was reduced, whereas the number of intravenous antibiotics in CF patients did not differ. The authors concluded that adherence to telemonitoring was much greater for COPD than CF patients and the results appear to be more favourable for COPD patients than for CF patients.

Title: Using home telehealth to empower patients to monitor and manage long term conditions.
Authors: Paget T, Jones C, Davies M, Evered C, Lewis C.
Source: Nurs Times. 2010 Nov 16-22;106(45):17-9.

Summary: This article describes a pilot telehealth project in Swansea where patients with heart failure and COPD were provided with telehealth monitoring equipment. While early evaluation points to some potential economic benefits, supporting patient empowerment was a significant outcome.

Suzanne Lareau, RN, MS
Chair, Assembly on Pulmonary Rehabilitation