Literature Reviews

April 2012


Title: How do dyspnoea scales compare with measurement of functional capacity in patients with COPD and at risk of COPD?
Authors: Boer LM, Asijee GM, van Schayck OC, Schermer TR.
Source: Prim Care Respir J. 2012 Mar 28. pii: pcrj-2012-02-0015. doi: 10.4104/pcrj.2012.00031. [Epub ahead of print].

Summary: This study aimed to examine whether the use of activity-based dyspnoea scales can substitute for actual functional capacity testing in 128 subjects (49% at risk of COPD, 24% GOLD stage I, 17% GOLD stage II, 9% GOLD stage III). Authors of COPD guidelines should consider stating more specifically that the MRC and similar scales measure (self-reported) activity-related dyspnoea but cannot replace objectively measured functional capacity.

Title: Differences in subjective and objective respiratory parameters in patients with chronic obstructive pulmonary disease with and without pain.
Authors: Bentsen SB, Rustøen T, Miaskowski C.
Source: Int J Chron Obstruct Pulmon Dis. 2012;7:137-43. Epub 2012 Feb 28.

Summary: The purpose of this study is to evaluate the differences in respiratory parameters between COPD patients who did and did not have pain. Comorbidity and breathlessness were risk factors for pain and the physical dimensions of breathlessness were associated with pain.


Title: Ambulatory oxygen improves the effectiveness of pulmonary rehabilitation in selected patients with chronic obstructive pulmonary disease.
Authors: Dyer F, Callaghan J, Cheema K, Bott J.
Source: Chron Respir Dis. 2012 Mar 27. [Epub ahead of print].

Summary: The effect of ambulatory oxygen use during pulmonary rehabilitation (PR) has not yet been clearly established, but many studies have shown benefit from oxygen acutely. Dyer et al. concluded that the use of ambulatory oxygen during a 6- to 7-week PR programme greatly improved endurance walking distance in patients who desaturated on exertion with a positive acute response to ambulatory oxygen at baseline.

Exercise training and rehabilitation

Title: Arm exercise training in chronic obstructive pulmonary disease: A randomised controlled trial.
Authors: McKeough ZJ, Bye PT, Alison JA.
Source: Chron Respir Dis. 2012 Mar 27. [Epub ahead of print].

Summary: The aim of this study was to compare the effects of arm endurance training, arm strength training, a combination of arm endurance and strength training, and no arm training on endurance arm exercise capacity. McKeough et al. concluded that the mode of training to be favoured to increase endurance arm exercise capacity is arm endurance training. However, combined arm endurance and strength training may also be very useful to reduce the symptoms during everyday arm tasks.

Title: Exercise Training After Lung Transplantation Improves Participation in Daily Activity: A Randomized Controlled Trial.
Authors: Langer D, Burtin C, Schepers L, Ivanova A, Verleden G, Decramer M, Troosters T, Gosselink R.
Source: Am J Transplant. 2012 Mar 5. doi: 10.1111/j.1600-6143.2012.04000.x. [Epub ahead of print].

Summary: Langer et al. investigated whether 3 months of supervised training, initiated immediately after hospital discharge, improve functional recovery and cardiovascular morbidity of patients up to 1 year after lung transplantation. Based on this study patients should be strongly encouraged to participate in an exercise training intervention after lung transplantation.

Title: Does body mass index influence the outcomes of a waking-based pulmonary rehabilitation programme in COPD?
Authors: Greening NJ, Evans RA, Williams JE, Green RH, Singh SJ, Steiner MC.
Source: Chron Respir Dis. 2012 Mar 13. [Epub ahead of print].

Summary: This study aimed to evaluate the effectiveness of a walking-based PR programme across the BMI range and the impact of BMI on exercise performance and health status. A walking-based PR programme was comparably effective across the BMI spectrum. Patients with COPD should be referred for standard PR, independent of BMI.


Title: Short-term outcomes in heart failure patients with chronic obstructive pulmonary disease in the community.
Authors: O'Kelly N, Robertson W, Smith J, Dexter J, Carroll-Hawkins C, Ghosh S.
Source: World J Cardiol. 2012 Mar 26;4(3):66-71.

Summary: This study aimed to establish the short term outcomes of heart failure (HF) patients in the community who have concurrent chronic obstructive pulmonary disease (COPD). COPD is a common comorbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF. It does not however appear to affect short-term mortality in ambulatory HF patients.

Title: Risk factors for osteoporosis in Caucasian patients with moderate chronic obstructive pulmonary disease: A case control study.
Authors: Graat-Verboom L, Smeenk FW, van den Borne BE, Spruit MA, Donkers-van Rossum AB, Aarts RP, Wouters EF.
Source: Bone. 2012 Mar 9. [Epub ahead of print].

Summary: The aim of this study was to compare COPD GOLD II patients (that is, patients with moderate COPD, stage II, according to the GOLD classification) with osteoporosis (cases) to COPD GOLD II patients without osteoporosis (controls) to identify risk factors for osteoporosis. Screening for osteoporosis should be performed even in moderate COPD patients, especially in those with a low BMI and/or a high RV%TLC.

Palliative care and family care giving

Title: The views of patients with severe chronic obstructive pulmonary disease on advance care planning: A qualitative study.
Authors: Macpherson A, Walshe C, O'Donnell V, Vyas A.
Source: Palliat Med. 2012 Mar 26. [Epub ahead of print].

Summary: This study aimed to explore the views of people with severe COPD about advance care planning. Further research should assess the effectiveness of this approach. Local coordination of who is responsible for information provision is needed, and greater involvement of patients with COPD in management decisions as they arise.

Title: Dyadic Coping Among Couples with COPD: A Pilot Study.
Authors: Meier C, Bodenmann G, Moergeli H, Peter-Wight M, Martin M, Buechi S, Jenewein J.
Source: J Clin Psychol Med Settings. 2012 Mar 20. [Epub ahead of print].

Summary: This study's objective was to compare the dyadic coping of couples in which one partner suffered from COPD with healthy couples of the same age. Meier et al. concluded that the dyadic coping of couples with COPD is unbalanced and more negative when compared to that of healthy couples. Interventions aimed at supporting COPD couples should seek to improve couples' dyadic coping in addition to individual coping strategies.

Title: Symptom Distress in Advanced Chronic Organ Failure: Disagreement among Patients and Family Caregivers.
Authors: Janssen DJ, Spruit MA, Wouters EF, Schols JM.
Source: J Palliat Med. 2012 Apr 4. [Epub ahead of print].

Summary: The aim of the present cross-sectional study was to examine agreement in severity of symptom distress, presence of symptom-related interventions, and satisfaction with medical treatment among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) and their family caregivers. Studies using proxy reporting reflect the views of proxies and do not accurately represent the patients' experience. For clinical care, it's important to pay attention to the perception from the patient as well as the perception from the family caregiver of symptom distress, presence of symptom-related interventions, and satisfaction with treatment.

Title: The unmet needs of people with end-stage chronic obstructive pulmonary disease: recommendations for change in Australia.
Authors: Crawford GB, Brooksbank MA, Brown M, Burgess TA, Young M.
Source: Intern Med J. 2012 Apr 4. doi: 10.1111/j.1445-5994.2012.02791.x. [Epub ahead of print].

Summary: This study aimed to explore the needs of people with end-stage COPD in South Australia and develop recommendations for a model of care. A flexible model of care is needed that assists people with COPD to navigate the health system. This should be patient-centred, and coordinated across primary, acute and community sectors.

Title: Dyspnea prevalence, trajectories, and measurement in critical care and at life's end.
Author: Campbell ML.
Source: Curr Opin Support Palliat Care. 2012 Mar 30. [Epub ahead of print].

Summary: Dyspnea is a multidimensional response to an asphyxial threat that heralds respiratory failure. A clinician's ability to treat dyspnea warrants understanding the prevalence, burden, trajectories, and measurement across chronic conditions and exacerbations. This review focuses on two contexts: the intensive care unit and the near death stage of illness.

Title: The Influence of Informal Caregivers on Adherence in COPD Patients.
Authors: Trivedi RB, Bryson CL, Udris E, Au DH.
Source: Ann Behav Med. 2012 Mar 16. [Epub ahead of print].

Summary: This study aims to evaluate the association between caregiver presence and adherence to medical recommendations among COPD patients. Caregivers, especially spouses, may improve adherence in COPD. Future interventions may target patients without caregivers to optimize COPD management.

Exercise testing

Title: On- and off-exercise kinetics of cardiac output in response to cycling and walking in COPD patients with GOLD Stages I-IV.
Authors: Vasilopoulou KM, Vogiatzis I, Nasis I, Spetsioti S, Cherouveim E, Koskolou M, Kortianou EA, Louvaris Z, Kaltsakas G, Koutsoukou A, Koulouris NG, Alchanatis M.
Source: Respir Physiol Neurobiol. 2012 Mar 29. [Epub ahead of print].

Summary: These authors aimed to study exercise-induced dynamic hyperinflation and intrathoracic pressure swings COPD. The more advanced the disease severity the more impaired is the hemodynamic response to constant-load exercise and the 6MWT, possibly reflecting greater cardiovascular impairment and/or greater physical deconditioning.

Title: Rollator Use Does Not Consistently Change the Metabolic Cost of Walking in People With Chronic Obstructive Pulmonary Disease.
Authors: Hill K, Dolmage TE, Woon LJ, Brooks D, Goldstein RS.
Source: Arch Phys Med Rehabil. 2012 Mar 29. [Epub ahead of print].

Summary: These authors aimed to (1) evaluate whether the use of a rollator changed metabolic cost during a controlled walking task, and (2) explore relationships between the difference in dyspnea and metabolic cost associated with rollator use. The mechanism responsible for the amelioration in dyspnea during rollator-assisted walking is multifactorial. A reduction in the metabolic cost of walking may play a part in some, but not all, patients.

Title: Association of body mass index with exercise cardiopulmonary responses in lung function-matched patients with chronic obstructive pulmonary disease.
Authors: Lan CC, Su CP, Chou LL, Yang MC, Lim CS, Wu YK.
Source: Heart Lung. 2012 Mar 14. [Epub ahead of print].

Summary: This study investigated the influence of body mass index (BMI) on exercise responses and quality of life in patients with COPD matched for values of forced expiratory volume in 1 second (FEV(1)). Underweight patients with COPD had lower respiratory muscle strength, impaired exercise capacity, earlier anaerobic metabolism, ineffective ventilation, and poorer quality of life.

Title: The Relationship Between Skeletal Muscle Oxygenation and Systemic Oxygen Uptake During Exercise in Patients With Chronic Obstructive Pulmonary Disease: A Preliminary Study.
Authors: Tabira K, Horie J, Fujii H, Aida T, Ito KI, Fukumoto T, Imagita H, Ishihara H.
Source: Respir Care. 2012 Mar 13. [Epub ahead of print].

Summary: The purpose of this study was to investigate the influence of skeletal muscle oxygenation on VO₂ during exercise in patients with COPD. VO₂ is highly influenced by oxygen utilization in exercising muscles, as well as by blood oxygenation levels and cardiac function. However, the impact of skeletal muscle utilization during exercise on VO₂peak varied greatly among the patients.

Integrated care

Title: An Official American Thoracic Society Workshop Report: The Integrated Care of the COPD Patient.
Authors: Nici L, Zuwallack R; on behalf of the American Thoracic Society Subcommittee on Integrated Care of the COPD Patient.
Source: Proc Am Thorac Soc. 2012 Mar;9(1):9-18.

Summary: This article summarizes the proceedings of a workshop, The Integrated Care of the COPD Patient, which was funded by the American Thoracic Society. This workshop included participants who were chosen because of their expertise in the area as well as their firsthand experience with disease management models. The summary describes the concepts of integrated care and chronic disease management, details specific components of disease management as they may apply to the patient with COPD, and provides several innovative examples of COPD disease management programs originating from different healthcare systems.