Literature Reviews

November 2011

Exercise training and pulmonary rehabilitation

Title: Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD.
Authors: Probst VS, Kovelis D, Hernandes NA, Camillo CA, Cavalheri V, Pitta F.
Source: Respir Care. 2011 Nov;56(11):1799-807.

Summary: The aim of this study was to compare the effects of 2 exercise/training regimens (a high-intensity whole-body endurance-and-strength program, and a low-intensity calisthenics-and-breathing-exercises program) on physical activity in daily life, exercise capacity, muscle force, health-related quality of life, and functional status. Probst et al. concluded that neither training program significantly improved time spent active or energy expenditure in daily life. The training regimens similarly improved quality of life and functional status. Exercise capacity and muscle force significantly improved only in the high-intensity endurance-and-strength group.

Title: Attacking the disease spiral in chronic obstructive pulmonary disease: an update.
Authors: Polkey MI, Moxham J.
Source: Clin Med. 2011 Oct;11(5):461-4.

Summary: This is a narrative review on the role of pulmonary rehabilitation at the core of reversing the disease spiral in patients with COPD.

Title: Acupuncture as an Adjunct to Pulmonary Rehabilitation.
Authors: Deering BM, Fullen B, Egan C, McCormack N, Kelly E, Pender M, Costello RW.
Source: J Cardiopulm Rehabil Prev. 2011 Oct 5. [Epub ahead of print].

Summary: The hypothesis of this study was that acupuncture in conjunction with pulmonary rehabilitation would improve COPD outcome measures compared to pulmonary rehabilitation alone. The addition of acupuncture to PR did not add significant benefit in most of the outcomes measured.

Title: Perioperative rehabilitation approaches in those over 75 years with respiratory dysfunction from chronic obstructive pulmonary disease undergoing abdominal tumor surgery.
Authors: Kii Y, Mizuma M, Kawate N.
Source: Disabil Rehabil. 2011 Oct 6. [Epub ahead of print].

Summary: Kii et al. report two cases of perioperative rehabilitation for abdominal cancer patients aged 75 years and older with severe chronic obstructive pulmonary disease.

Title: Determinants of success.
Authors: Garrod R, Malerba M, Crisafulli E.
Source: Eur Respir J. 2011 Nov;38(5):1215-1218. Epub 2011 Jun 30.

Summary: This is a narrative review on determinants of success of pulmonary rehabilitation in patients with COPD. Although there are some data suggesting that some medical conditions frequently associated with COPD (osteoporosis, metabolic syndrome and heart diseases) may negatively influence rehabilitation outcomes, at present the evidence is contradictory.

Complexity of COPD

Title: Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
Authors: Lugtenberg M, Burgers JS, Clancy C, Westert GP, Schneider EC.
Source: PLoS One. 2011;6(10):e25987. Epub 2011 Oct 20.

Summary: Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. This study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions.

Title: Annual Change in Pulmonary Function and Clinical Phenotype in Chronic Obstructive Pulmonary Disease.
Authors: Nishimura M, Makita H, Nagai K, Konno S, Nasuhara Y, Hasegawa M, Shimizu K, Betsuyaku T, Ito YM, Fuke S, Igarashi T, Akiyama Y, Ogura S; for the Hokkaido COPD Cohort Study Investigators.
Source: Am J Respir Crit Care Med. 2011 Oct 20. [Epub ahead of print].

Summary: This study aimed to examine the inter-subject variability in a 5-year observational cohort study, particularly focusing on emphysema severity. Emphysema severity is independently associated with a rapid annual decline in FEV1 in COPD. Sustainers as well as Rapid decliners warrant specific attention in clinical practice.

Skeletal muscle function and exercise tolerance

Title: Preserved muscle metaboreflex in chronic obstructive pulmonary disease.
Authors: Sherman MF, Road JD, McKenzie DC, Sheel AW.
Source: Appl Physiol Nutr Metab. 2011 Oct 25. [Epub ahead of print].

Summary: The objective of this study was to measure the magnitude of the muscle metaboreflex in people with COPD. Sherman et al. observed a preserved muscle metaboreflex in mild-to-severe COPD, suggesting the metaboreflex is not a contributing factor to the development of exercise intolerance in this population.

Title: Glucose and pyruvate metabolism in severe chronic obstructive pulmonary disease.
Authors: Kao CC, Hsu JW, Bandi V, Hanania NA, Kheradmand F, Jahoor F.
Source: J Appl Physiol. 2011 Oct 20. [Epub ahead of print].

Summary: The objective of this study was to determine differences in the rates of glucose production and clearance, the rate of glycolysis (pyruvate production), and oxidative and non-oxidative pyruvate disposal in subjects with severe COPD compared to healthy controls. In subjects with severe COPD, there are alterations in glucose metabolism, leading to increased glucose production and faster glucose metabolism by glycolysis and oxidation compared to controls. However, no difference in glucose conversion to lactate via pyruvate reduction is observed.

Title: Comparing Peak And Sub-Maximal Cardiorespiratory Responses During Field Walking Tests With Incremental Cycle Ergometry In COPD.
Authors: Hill K, Dolmage TE, Woon L, Coutts D, Goldstein R, Brooks D.
Source: Respirology. 2011 Oct 18. doi: 10.1111/j.1440-1843.2011.02089.x. [Epub ahead of print].

Summary: Hill et al. sought to compare peak and sub-maximal cardiorespiratory responses to the six-minute walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) with a ramp cycle ergometry test (CET) in patients with COPD. In COPD, field walking tests elicited a similar peak rate of oxygen uptake and heart rate as a CET, demonstrating that both self- and externally-paced walking tests progress to high intensities.

Title: Effects of oxygen on exertional dyspnoea and exercise performance in patients with chronic obstructive pulmonary disease.
Authors: Miki K, Maekura R, Hiraga T, Kitada S, Miki M, Yoshimura K, Tateishi Y.
Source: Respirology. 2011 Oct 18. doi: 10.1111/j.1440-1843.2011.02086.x. [Epub ahead of print].

Summary: Exercise responses under hyperoxic conditions in patients with COPD were investigated in a single-blind, randomized trial. Regardless of whether they were breathing compressed air or 24% O(2) , these patients did not develop ventilatory compensation in response to exertional acidosis and stopped exercising when a similar pH was reached.

Title: Probabilistic multi-shape segmentation of knee extensor and flexor muscles.
Authors: Andrews S, Hamarneh G, Yazdanpanah A, HajGhanbari B, Reid WD.
Source: Med Image Comput Comput Assist Interv. 2011;14(Pt 3):651-8.

Summary: Andrews et al. present a fully automatic segmentation method that overcomes the inherent difficulties of this problem to accurately segment the different muscles.

Title: Downregulation of the serum response factor/miR-1 axis in the quadriceps of patients with COPD.
Authors: Lewis A, Riddoch-Contreras J, Natanek SA, Donaldson A, Man WD, Moxham J, Hopkinson NS, Polkey MI, Kemp PR.
Source: Thorax. 2011 Oct 13. [Epub ahead of print].

Summary: Lewis et al. studied muscle-specific microRNAs and serum response factor (SRF) in patients with COPD. Down regulation of the activity of the MRTF-SRF axis and the expression of muscle-specific microRNAs, particularly miR-1, may contribute to COPD-associated skeletal muscle dysfunction.

Title: [Muscle catabolism in patients with chronic obstructive pulmonary disease.] [Article in Spanish]
Authors: Montenegro Alvarez de Tejera P, Cabanes-Mariscal MA, Gutierrez-Ortega C, Medina Font J, Villa-Corbaton MC, Gómez de Terreros J.
Source: Rev Clin Esp. 2011 Oct 11. [Epub ahead of print].

Summary: Montenegro Alvarez de Tejera et al. have examined the excretion of pseudouridine in patients with different stages of COPDs evolution. The urinary excretion of pseudouridine is increased in chronic bronchitis and COPD and is related to disease stage. Its excretion is independent of age and gender.

Title: Airflow limitation or static hyperinflation: which is more closely related to dyspnea with activities of daily living in patients with COPD?
Authors: Nishimura K, Yasui M, Nishimura T, Oga T.
Source: Respir Res. 2011 Oct 11;12(1):135. [Epub ahead of print].

Summary: Purpose of this study was to evaluate the correlation between breathlessness during daily activities and airflow limitation or static hyperinflation in COPD. Both static hyperinflation and airflow limitation contributed greatly to dyspnea in COPD patients.

Title: Development of the i-BODE: Validation of the incremental shuttle walking test within the BODE index.
Authors: Williams JE, Green RH, Warrington V, Steiner MC, Morgan MD, Singh SJ.
Source: Respir Med. 2011 Oct 4. [Epub ahead of print].

Summary: The objective of the study was to evaluate the incorporation of the ISWT within the BODE index (named the i-BODE) to predict mortality in COPD. Williams et al. found the i-BODE index to be an independent predictor of mortality in COPD, even when other strong predictors such as age and pack years are adjusted for. The ISWT can be successfully substituted for the 6MWT as an alternative measure of exercise capacity within the BODE index.

Physical activity assessment

Title: Objective physical activity assessment in patients with chronic organ failure: a validation study of a new single-unit activity monitor.
Authors: Annegarn J, Spruit MA, Uszko-Lencer NH, Vanbelle S, Savelberg HH, Schols AM, Wouters EF, Meijer K.
Source: Arch Phys Med Rehabil. 2011 Nov;92(11):1852-1857.e1.

Summary: This study aimed to validate a new activity monitor (CAM) in patients with COPD or CHF during 1 hour of unconstrained activity assessment. Annegarn et al. concluded that the CAM is a promising single-sensor unobtrusive tool for providing accurate data on the type and duration of daily activities in the home environment of patients with chronic organ failure.

Title: Validation of the StepWatch device for measurement of free-living ambulatory activity in patients with chronic obstructive pulmonary disease.
Authors: Nguyen HQ, Burr RL, Gill DP, Coleman K.
Source: J Nurs Meas. 2011;19(2):76-90.

Summary: This study examined the validity of the StepWatch activity monitor and the optimal number of monitoring days in patients with COPD. This study provides preliminary evidence to support the validity of the StepWatch device for measuring free-living ambulatory physical activity in COPD.

End-of-life communication and palliative care

Title: Predicting changes in preferences for life-sustaining treatment among patients with advanced chronic organ failure.
Authors: Janssen DJ, Spruit MA, Schols JM, Cox B, Nawrot TS, Curtis JR, Wouters EF.
Source: Chest. 2011 Oct 20. [Epub ahead of print].

Summary: The objectives were to investigate one-year stability of preferences regarding cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV) for outpatients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) or chronic renal failure (CRF) and to identify predictors of changes in preferences. More than a third of the outpatients with advanced COPD, CHF or CRF change their preferences regarding CPR and/or MV at least once during one year. Regular re-evaluation of advance care planning is necessary, in particular when patients experience a change in health status, mobility, symptoms of anxiety or depression, or marital status.

Title: Advance Care Planning in COPD.
Authors: Patel K, Janssen DJ, Curtis JR.
Source: Respirology. 2011 Oct 18. doi: 10.1111/j.1440-1843.2011.02087.x. [Epub ahead of print].

Summary: This is a narrative review of recent trends in advance care planning and end-of-life care for patients with COPD Advance care planning

Title: The lived experience of breathlessness and its implications for care: a qualitative comparison in cancer, COPD, heart failure and MND.
Authors: Gysels MH, Higginson IJ.
Source: BMC Palliat Care. 2011 Oct 17;10(1):15. [Epub ahead of print].

Summary: This paper compares the experience of breathlessness in cancer, COPD, heart failure and MND, four conditions sharing heavy symptom burdens, poor prognoses, high breathlessness rates and palliative care needs. Integrated palliative care is needed, that makes use of all appropriate therapeutic options, collaborative efforts from health, social care professionals, patients and caregivers, and therapies that acknowledge the dynamic interrelation of the body, mind and spirit.