Literature Reviews

May 2011

Exercise training and pulmonary rehabilitation

Title: Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass.
Authors: Napolis LM, Dal Corso S, Neder JA, Malaguti C, Gimenes AC, Nery LE.
Source: Clinics (Sao Paulo). 2011;66(3):401-6.

Summary: Napolis et al. investigated the effects of high-frequency neuromuscular electrical stimulation in 30 COPD patients with better-preserved peripheral muscle function using a prospective and cross-over study. High-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD.

Title: Exercise testing and training in chronic lung disease and pulmonary arterial hypertension.
Author: Arena R.
Source: Prog Cardiovasc Dis. 2011 May-Jun;53(6):454-63.

Summary: Emerging data indicate that exercise training is likewise beneficial in patients with interstitial lung disease and pulmonary arterial hypertension. This review summarizes the evidence supporting the value of exercise testing and training and provides recommendations for clinical practice.

Title: Exercise and its impact on dyspnea.
Authors: Sheel AW, Foster GE, Romer LM.
Source: Curr Opin Pharmacol. 2011 Apr 27. [Epub ahead of print].

Summary: In this review, the current mechanistic model of exertional dyspnea is summarized and new research demonstrating how treatment strategies improve dyspnea by reducing central ventilatory drive, improving dynamic ventilatory mechanics, and improving respiratory muscle function is highlighted. Lastly, Sheel et al. review the effects of healthy aging and recent evidence for a male-female difference with respect to exertional-related dyspnea.

Title: Does Pulmonary Rehabilitation address Cardiovascular Risk Factors in Patients with COPD?
Authors: Gale NS, Duckers JM, Enright S, Cockcroft JR, Shale DJ, Bolton CE.
Source: BMC Pulm Med. 2011 Apr 21;11(1):20. [Epub ahead of print].

Summary: Patients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. Gale et al. hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors. Cardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD.

Title: Dyspnea perception in COPD: Association between anxiety, dyspnea-related fear and dyspnea in a pulmonary rehabilitation program.
Authors: Janssens T, De Peuter S, Stans L, Verleden G, Troosters T, Decramer M, Van den Bergh O.
Source: Chest. 2011 Apr 14. [Epub ahead of print].

Summary: In this naturalistic outcome study, Janssens et al. investigated effects of baseline anxiety and dyspnea-related fear on perceived dyspnea and other outcomes of a well-established pulmonary rehabilitation program for COPD. Results indicate a mediating effect of dyspnea-related fear on the association between anxiety and exercise-related dyspnea. Exercise in pulmonary rehabilitation in persons with higher baseline dyspnea-related fear may act as a correction of excessive symptom reports through exposure to dyspneic situations.

Title: Effect of pulmonary rehabilitation on peripheral muscle fiber remodelling in COPD patients with GOLD stages II to IV.
Authors: Vogiatzis I, Terzis G, Stratakos G, Cherouveim E, Athanasopoulos D, Spetsioti S, Nasis I, Manta P, Roussos C, Zakynthinos S.
Source: Chest. 2011 Apr 14. [Epub ahead of print].

Summary: In most patients with COPD, rehabilitative exercise training partially reverses the morphological and structural abnormalities of peripheral muscle fibers. Whether the degree of improvement in muscle fiber morphology and typology with exercise training varies depending on disease severity remains, however, unknown. Functional capacity, morphologic and typologic adaptations to rehabilitation in peripheral muscle fibers were similar across GOLD stages II to IV. Pulmonary rehabilitation should be implemented in patients at all COPD stages.

Skeletal muscles

Title: Effects of Salmeterol on Skeletal Muscle Cells: Metabolic and Pro-Apoptotic Features.
Authors: Duranti G, La Rosa P, Dimauro I, Wannenes F, Bonini S, Sabatini S, Parisi P, Caporossi D.
Source: Med Sci Sports Exerc. 2011 May 4. [Epub ahead of print].

Summary: Duranti et al. evaluated the effects of Salmeterol on both proliferative and differentiated rat L6C5 and mouse C2C12 skeletal muscle cell lines. These results demonstrate that short-term supra-therapeutic Salmeterol exposure increased oxidative metabolic pathways on skeletal muscle cells, whereas prolonged treatment inhibits cell growth and exerts either a cytostatic, or pro-apoptotic effect in a time and dose-dependent way.

Title: Cigarette smoke-induced skeletal muscle atrophy is associated with up-regulation of USP-19 via p38 and ERK MAPKs.
Authors: Liu Q, Xu WG, Luo Y, Han FF, Yao XH, Yang TY, Zhang Y, Pi WF, Guo XJ.
Source: J Cell Biochem. 2011 Apr 18. doi: 10.1002/jcb.23151. [Epub ahead of print].

Summary: It is still unclear whether USP-19 is involved in muscle atrophy induced by COPD. Rats exposed to chronic cigarette smoke and L6 myotubes incubated with cigarette smoke extract (CSE) were studied here. Liu et al. conclude that USP-19 is associated with muscle atrophy in response to cigarette smoke and is a potential therapeutic target. CSE promotes myotube wasting in culture partly by inhibiting myogenic differentiation and acts via p38 and ERK MAPK to stimulate expression of USP-19 in vitro.

Title: Resting energy expenditure and protein turnover are increased in patients with severe chronic obstructive pulmonary disease.
Authors: Kao CC, Hsu JW, Bandi V, Hanania NA, Kheradmand F, Jahoor F.
Source: Metabolism. 2011 May 5. [Epub ahead of print].

Summary: The objective of this study was to determine first whether resting energy expenditure was increased in patients with COPD and, second, whether this was associated with increased protein turnover and/or systemic inflammation. Kao et al. concluded that increased rates of protein turnover are associated with increased resting energy expenditure and loss of fat-free mass in COPD.

Title: Relationship Between Peripheral Muscle Structure and Function in Patients With Chronic Obstructive Pulmonary Disease With Different Nutritional Status.
Authors: Malaguti C, Napolis LM, Villaça D, Neder JA, Nery LE, Corso SD.
Source: J Strength Cond Res. 2011 Apr 11. [Epub ahead of print].

Summary: The purpose of this study was to investigate the relationships between peripheral muscle structure (mass) and function (strength, endurance, and maximal aerobic capacity) in patients with chronic obstructive pulmonary disease (COPD) with different nutritional states. The main practical application of this study is to point out a crucial role for the strategies able to ameliorate cardiorespiratory and muscular fitness in patients with COPD, even in those patients with preserved muscle mass.

Patient-reported outcomes and daily symptoms

Title: Prevalence and characteristics of pain in patients with chronic obstructive pulmonary disease compared to the norwegian general population.
Authors: Bentsen SB, Rustøen T, Miaskowski C.
Source: J Pain. 2011 May;12(5):539-45.

Summary: The purpose of this study was to evaluate the prevalence and characteristics of pain in patients with COPD compared to a sample from the Norwegian general population. Compared to the general population, pain is more common in patients with COPD and ranges from moderate to severe in its intensity.

Title: Chronic Obstructive Pulmonary Disease Patient Well-Being and Its Relationship with Clinical and Patient-Reported Outcomes: A Real-Life Observational Study.
Authors: Braido F, Baiardini I, Balestracci S, Menoni S, Balbi F, Ferraioli G, Bocchibianchi S, Canonica GW.
Source: Respiration. 2011 May 4. [Epub ahead of print].

Summary: The objective of this study was to evaluate the psychological well-being and its determining factors in a real-life COPD population and to evaluate if patients with a different well-being differ in illness perception, health status and alexithymia. Braido et al. concluded that in order to minimize the disease-negative effects on patients' lives, assessment of well-being and its determining factors, as well as planning specific behavioural, educational and therapeutic interventions seem to be relevant and useful.

Title: Symptoms of dysphagia in patients with COPD.
Authors: Chaves RD, Carvalho CR, Cukier A, Stelmach R, Andrade CR.
Source: J Bras Pneumol. 2011 Apr;37(2):176-183.

Summary: The objective of this study was to identify symptoms of dysphagia in individuals with COPD, based on their responses on a self-perception questionnaire. Chaves et al. show that the individuals with COPD presented with symptoms of dysphagia that were associated with the pharyngeal and esophageal phases of swallowing, as well as with the mechanism of airway protection, a history of pneumonia, and nutritional symptoms.

Title: The prevalence of urinary incontinence among women and men with chronic obstructive pulmonary disease in Sweden.
Authors: Hrisanfow E, Hägglund D.
Source: J Clin Nurs. 2011 Apr 28. doi: 10.1111/j.1365-2702.2010.03660.x. [Epub ahead of print].

Summary: The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with COPD in primary health care. The authors conclude that incontinence content should be included in care plans for patients living with COPD.

Title: Symptoms, Comorbidities, and Health Care in Advanced Chronic Obstructive Pulmonary Disease or Chronic Heart Failure.
Authors: Janssen DJ, Spruit MA, Uszko-Lencer NH, Schols JM, Wouters EF.
Source: J Palliat Med. 2011 Apr 21. [Epub ahead of print].

Summary: Objective of the present cross-sectional observational study was to assess severity of symptoms, presence of comorbidities, and current provision of health care in outpatients with advanced COPD or CHF. Janssen et al. conclude that patients with advanced COPD or CHF experience comorbidities and suffer from multiple symptoms, which are often under treated. Further development and implementation of palliative care programs, consisting of regular assessment of the patients' comorbidities and symptoms as well as the provision of patient-tailored interventions is needed.

Title: Helplessness, self blame and faith may impact on self management in COPD: a qualitative study.
Authors: Sheridan N, Kenealy T, Salmon E, Rea H, Raphael D, Schmidt-Busby J.
Source: Prim Care Respir J. 2011 Apr 21. pii: pcrj-2011-02-0015. doi: 10.4104/pcrj.2011.00035. [Epub ahead of print].

Summary: This study aimed to explore how patients with COPD experience helplessness using in-depth interviews with 29 COPD patients. Sheridan et al. conclude that clinicians seeking to support patients to include longer term strategies in their self management will need to coach patients to experiences of short-term success, and be aware of the ways that patients experience and interpret their helplessness. Clinicians need to address self blame, and recognise patients' priorities of faith and family.

Palliative care

Title: Update on the role of palliative oxygen.
Authors: Davidson PM, Johnson MJ.
Source: Curr Opin Support Palliat Care. 2011 Jun;5(2):87-91.

Summary: This paper reviews the efficacy and appropriateness of palliative oxygen therapy. Davidson et al. conclude that the routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified.

Functional status and physical activity

Title: Functional status measurement in COPD: a review of available methods and their feasibility in primary care.
Authors: Kocks JW, Asijee GM, Tsiligianni IG, Kerstjens HA, van der Molen T.
Source: Prim Care Respir J. 2011 Apr 26. pii: pcrj-2010-12-0145-R1. doi: 10.4104/pcrj.2011.00031. [Epub ahead of print].

Summary: This review aims to categorise systematically the available tools based on their construct (i.e. what the tool intends to measure) and to rate the tools for use in the primary care setting. Kocks et al. conclude that in primary care, the 6-minute walking distance test is the most reliable semi-laboratory functional capacity test, but is not very practical. The pedometer is the best functional performance field test.

Title: Physical Activity and its Relationship with the State of Health of Stable Copd Patients.
Authors: Marín Royo M, Pellicer Císcar C, González Villaescusa C, Bueso Fabra MJ, Aguar Benito C, Andreu Rodríguez AL, Herrejón Silvestre A, Soler Cataluna JJ; en representación del grupo EPOC de la Sociedad Valenciana de Neumología (SVN).
Source: Arch Bronconeumol. 2011 Apr 21. [Epub ahead of print].

Summary: The aim was to study the daily physical activity in the lives of stable COPD patients, outside the setting of a pulmonary rehabilitation program. Stable COPD patients perform low levels of physical activity. Lower physical activity is associated with poorer health and with more severe disease.

Title: The Importance of Movement for People Living With Chronic Obstructive Pulmonary Disease.
Authors: Williams V, Bruton A, Ellis-Hill C, McPherson K.
Source: Qual Health Res. 2011 Apr 21. [Epub ahead of print].

Summary: Williams et al. employed a grounded theory study with 18 participants with COPD to explore their dimensions of activity. To conclude, the stagnation-movement theory explains the experience of activity within its environmental context, and how this experience might be affected on physical, social, and psychological levels.

Title: Determinants of Frequency, Duration, and Continuity of Home Walking in Patients with COPD.
Authors: Donesky D, Janson SL, Nguyen HQ, Neuhaus J, Neilands TB, Carrieri-Kohlman V.
Source: Geriatr Nurs. 2011 Apr 16. [Epub ahead of print].

Summary: The purpose of this study was to identify determinants of frequency (days per week), duration (minutes per session), and continuity (persistence over 1 year) of home walking in 103 patients with COPD who participated in a dyspnea self-management program. Participants walked more frequently if they were exercising before they entered the study, had less depressive symptoms, and were living with friends or family. Duration of walks was influenced by supervised exercise training; living with spouse, friends, or family; and physical conditioning. Participants who walked most consistently over the course of the year had more supervised exercise sessions as part of the dyspnea self-management program, exercised regularly before entering the program, and perceived a gain in social support over the year.

Respiratory muscles

Title: Effects of loading on upper airway and respiratory pump muscle motoneurons.
Authors: Hill K, Eastwood P.
Source: Respir Physiol Neurobiol. 2011 Apr 12. [Epub ahead of print].

Summary: This paper describes the respiratory pump and upper airway motoneuron responses to the imposition of acute loads including processes of pre-activation, respiratory reflexes, potentiation and fatigue. It also considers changes suggestive of adaptation to chronic loading either from specific respiratory muscle training programs or as part of disease processes such as chronic obstructive pulmonary disease or obstructive sleep apnoea.

Body composition

Title: A practical guide to bioelectrical impedance analysis using the example of chronic obstructive pulmonary disease.
Authors: Walter-Kroker A, Kroker A, Mattiucci-Guehlke M, Glaab T.
Source: Nutr J. 2011 Apr 21;10(1):35. [Epub ahead of print].

Summary: The purpose of this article is to provide some guidance on the use of BIA/BIVA with special attention to practical considerations.