Literature Reviews

June 2012


Title: Prevalence, risk factors, activity limitation and health care utilization of an obese, population-based sample with chronic obstructive pulmonary disease.
Authors: Vozoris N, O'Donnell DE.
Source: Can Respir J. 2012 May;19(3):e18-24.
Summary: This study aimed to estimate the prevalence and determine the risk factors and health associations among individuals with combined chronic obstructive pulmonary disease and obesity. The prevalence of obesity was higher in COPD, and exceeded that of the larger non-COPD group throughout the 13-year observation period. The presence of obesity in COPD was associated with significantly higher risk of severe activity limitation and increased health care utilization. The combination of obesity and COPD has major implications for health care delivery that has not been previously appreciated.

Title: Meeting the mental health needs of people with chronic obstructive pulmonary disease: a qualitative study.
Authors: Ellison L, Gask L, Bakerly ND, Roberts J.
Source: Chronic Illn. 2012 Jun 1. [Epub ahead of print].
Summary: This study aimed to understand the mental health needs of people living with chronic obstructive pulmonary disease: what they were experiencing, what they wanted (or did not want) which might be described as 'felt need', what they had accessed or received ('expressed need') and how, from their perspective, their emotional needs might be more effectively met by health care services. Ellison et al. concluded that innovative research and clinical care should be aimed towards development of skills, strategies and systems required to engage sensitively and negotiate needs for care, in a patient-centred manner, with people who do not necessarily see the need to ask for emotional support.

Authors: Villeneuve S, Pépin V, Rahayel S, Bertrand JA, Delorimier M, Rizk A, Desjardins C, Parenteau S, Beaucage F, Joncas S, Monchi O, Gagnon JF.
Source: Chest. 2012 Jun 7. [Epub ahead of print].
Summary: Villeneuve et al. aimed to determine the frequency and subtypes of MCI in COPD patients and to assess the validity of two cognitive screening tests, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA), in detecting MCI in COPD. In this preliminary study, a substantial proportion of COPD patients were found to have MCI, a known risk factor for dementia. Longitudinal follow-up on these patients is needed to determine the risk of developing more severe cognitive and functional impairments. Moreover, the MoCA is superior to the MMSE in detecting MCI in COPD patients.

Title: Brain Structure and Function in Chronic Obstructive Pulmonary Disease. A Multi-Modal Cranial Magnetic Resonance Imaging Study.
Authors: Dodd JW, Chung AW, van den Broek MD, Barrick TR, Charlton RA, Jones PW.
Source: Am J Respir Crit Care Med. 2012 Jun 7. [Epub ahead of print].
Summary: Dodd et al. hypothesized that COPD patients would have reduced white matter integrity and that functional communication between grey matter resting state networks (RSN) would be significantly different to controls. In addition they tested whether observed differences related to disease severity, cerebrovascular co-morbidity and cognitive dysfunction. In stable non-hypoxemic COPD there is reduced white matter integrity throughout the brain and widespread disturbance in functional activation of grey matter, which may contribute to cognitive dysfunction. White matter microstructural integrity but not grey matter functional activation is independent of smoking and cerebrovascular co-morbidity. The mechanisms remain unclear, but may include cerebral small vessel disease due to COPD.

Title: Cognitive dysfunction in patients with chronic obstructive pulmonary disease - A systematic review.
Authors: Schou L, Ostergaard B, Rasmussen LS, Rydahl-Hansen S, Phanareth K.
Source: Respir Med. 2012 May 11. [Epub ahead of print].
Summary: The aim of this study was to determine the occurrence and severity of cognitive dysfunction in COPD patients, and to assess the association between severity of COPD and the level of cognitive function. Cognitive impairment can be detected in severe COPD patients, but the clinical relevance of the cognitive dysfunction is not yet known. Future studies should concentrate on the consequences of cognitive dysfunction for daily living in these patients, and solutions involving a high degree of self-care might require special support.

Title: Comorbidity and sex-related differences in mortality in oxygen-dependent chronic obstructive pulmonary disease.
Authors: Ekström MP, Jogréus C, Ström KE.
Source: PLoS One. 2012;7(4):e35806. Epub 2012 Apr 26.
Summary: The present study evaluates differences in comorbidity between men and women, and tests the hypothesis that comorbidity contributes to sex-related differences in mortality in oxygen-dependent COPD. Comorbidity is different in men and women, but does not explain the sex-related difference in mortality in oxygen-dependent COPD.

Title: Comorbidities and Risk of Mortality in Patients with COPD.
Authors: Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto-Plata V, Zulueta J, Cabrera C, Zagaceta J, Hunninghake G, Celli B; The BODE Collaborative Group.
Source: Am J Respir Crit Care Med. 2012 May 3. [Epub ahead of print].
Summary: Divo et al. calculated mortality risk using Cox proportional hazard, and developed a graphic representation of the prevalence and strength of association to mortality in the form of a "comorbidome". A COPD comorbidity index (COTE) was constructed based on the comorbidities that increase mortality risk using a multivariate analysis. Comorbidities are frequent in COPD and 12 of them negatively influence survival. A simple disease specific comorbidities index (COTE) helps assess mortality risk in patients with COPD.


Title: Twenty years of telemedicine in chronic disease management - an evidence synthesis.
Author: Wootton R.
Source: J Telemed Telecare. 2012;18(4):211-20.
Summary: A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). The evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory.

Title: Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients.
Authors: Dinesen B, Haesum LK, Soerensen N, Nielsen C, Grann O, Hejlesen O, Toft E, Ehlers L.
Source: J Telemed Telecare. 2012;18(4):221-5. Epub 2012 May 31.
Summary: Dinesen et al. studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Future work requires large-scale studies of prolonged home monitoring with more extended follow-up.

Physical activity

Title: How many steps are enough to avoid severe physical inactivity in patients with chronic obstructive pulmonary disease?
Authors: Depew ZS, Novotny PJ, Benzo RP.
Source: Respirology. 2012 Jun 5. doi: 10.1111/j.1440-1843.2012.02207.x. [Epub ahead of print].
Summary: Depew et al. aimed to determine the number of daily steps associated with severe physical inactivity (physical activity level <1.40) in this population. They found that a daily step value <4,580 is associated with severe physical inactivity.

Title: Physical inactivity and risk of hospitalisation for chronic obstructive pulmonary disease.
Authors: Seidel D, Cheung A, Suh ES, Raste Y, Atakhorrami M, Spruit MA.
Source: Int J Tuberc Lung Dis. 2012 Jun 5. [Epub ahead of print].
Summary: The association between physical activity and risk of hospitalisation for chronic obstructive pulmonary disease (COPD) is not yet clear. Seidel et al. conducted a systematic review of the literature to fill this gap in knowledge.

Nutritional or pharmaceutical modulation

Title: Ghrelin treatment of cachectic patients with chronic obstructive pulmonary disease: a multicenter, randomized, double-blind, placebo-controlled trial.
Authors: Miki K, Maekura R, Nagaya N, Nakazato M, Kimura H, Murakami S, Ohnishi S, Hiraga T, Miki M, Kitada S, Yoshimura K, Tateishi Y, Arimura Y, Matsumoto N, Yoshikawa M, Yamahara K, Kangawa K.
Source: PLoS One. 2012;7(5):e35708. Epub 2012 May 1.
Summary: The efficacy and safety of adding ghrelin to pulmonary rehabilitation (PR) in cachectic COPD patients were investigated. In cachectic COPD patients, with the safety profile, ghrelin administration provided improvements in symptoms and respiratory strength, despite the lack of a significant between-group difference in 6-MWD.

Title: Prospects for the development of effective pharmacotherapy targeted at the skeletal muscles in chronic obstructive pulmonary disease: a translational review.
Authors: Steiner MC, Roubenoff R, Tal-Singer R, Polkey MI.
Source: Thorax. 2012 May 5. [Epub ahead of print].
Summary: In this article, Steiner et al. outline the steps the academic and pharmaceutical communities need to undertake for such therapeutic advances to be realised.

Exercise training

Title: Exercise prescription for hospitalized people with chronic obstructive pulmonary disease and comorbidities: a synthesis of systematic reviews.
Authors: Reid WD, Yamabayashi C, Goodridge D, Chung F, Hunt MA, Marciniuk DD, Brooks D, Chen YW, Hoens AM, Camp PG.
Source: Int J Chron Obstruct Pulmon Dis. 2012;7:297-320. Epub 2012 May 14.
Summary: The current research aimed to synthesize the relevant literature on the benefits of exercise for people with multimorbidities who experience an AECOPD, and ask: What are the parameters and outcomes of exercise in AECOPD and in conditions that are common comorbidities as reported by systematic reviews (SRs)? This synthesis showed evidence of significant benefits from exercise training in AECOPD, COPD, and conditions that are common comorbidities. A broader approach to exercise and activity prescription in pulmonary rehabilitation may induce therapeutic benefits to ameliorate clinical sequelae associated with AECOPD and comorbidities such as the inclusion of BT and functional training.

Title: Effectiveness of Paced Walking to Music at Home for Patients with COPD.
Authors: Ho CF, Maa SH, Shyu YI, Lai YT, Hung TC, Chen HC.
Source: COPD. 2012 May 29. [Epub ahead of print].
Summary: This paper investigated the effects of paced walking to music at home with an 80% VO(2) peak for patients with COPD. The paced walking to music at home program helps patients to achieve a higher-intensity exercise. It is easily incorporated into the care of COPD patients, providing them with a convenient, safe and enjoyable exercise.

Title: Early Rehabilitation Exercise Program for Inpatients During an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED TRIAL.
Authors: Tang CY, Blackstock FC, Clarence M, Taylor NF.
Source: J Cardiopulm Rehabil Prev. 2012 May;32(3):163-9.
Summary: This study aimed to determine whether an early rehabilitation program was safe and feasible for patients during an acute exacerbation of chronic obstructive pulmonary disease (COPD). There was preliminary evidence that it was safe and feasible to implement an exercise program for patients during an acute exacerbation of COPD. Additional studies with larger sample sizes are required to accurately evaluate program effectiveness.

Exercise performance and muscle function

Title: Effects of peripheral neuropathy (PNP) on exercise capacity and quality of life in patients with chronic obstructive pulmonary diseases.
Authors: Ulubay G, Ulasli SS, Bozbas SS, Ozdemirel T, Karatas M.
Source: Arch Med Sci. 2012 May 9;8(2):296-302.
Summary: This study aimed to identify whether PNP affects exercise performance and quality of life in COPD patients. The present study demonstrates the exercise limitation in COPD patients with PNP. Thus, presence of PNP has a poor effect on exercise capacity and quality of life in patients with COPD. Furthermore, treatment modalities for PNP can be recommended to these patients in order to improve exercise capacity and quality of life.

Title: Differences in Walking Pattern during 6-Min Walk Test between Patients with COPD and Healthy Subjects.
Authors: Annegarn J, Spruit MA, Savelberg HH, Willems PJ, van Bool C, Schols AM, Wouters EF, Meijer K.
Source: PLoS One. 2012;7(5):e37329. Epub 2012 May 18.
Summary: Annegarn et al. made a detailed analysis of walking patterns using accelerometers during the 6-min walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD). COPD patients have an altered walking pattern during 6MWT compared to healthy subjects. These differences in walking pattern partially explain the lower 6MWD in patients with COPD.

Title: Prevalence of limb muscle dysfunction (LMD) in patients with chronic obstructive pulmonary disease admitted to a pulmonary rehabilitation centre.
Authors: Carrai R, Scano G, Gigliotti F, Romagnoli I, Lanini B, Coli C, Grippo A.
Source: Clin Neurophysiol. 2012 May 20. [Epub ahead of print].
Summary: Carrai et al. attempted to quantify the prevalence of LMD and assess its impact on clinical outcomes in patients admitted to a rehabilitation programme. LMD might not be restricted to patients with severe airway obstruction and regardless of COPD stage, contributes to functional limitation of these patients.

Title: Relationship between body composition, peripheral muscle strength and functional exercise capacity in patients with severe chronic obstructive pulmonary disease.
Authors: Hillman CM, Heinecke EL, Hii JW, Cecins NM, Jenkins SC, Eastwood PR.
Source: Intern Med J. 2012 May;42(5):578-81. doi: 10.1111/j.1445-5994.2012.02771.x.
Summary: The influence of body composition and peripheral muscle strength on 6-minute walk distance was assessed by performing dual energy X-ray absorptiometry scanning, spirometry and dynamometry testing in 13 men and 13 women with severe chronic obstructive pulmonary disease. Multivariate modelling showed that 76% of the variance in 6-minute walk distance could be explained by an equation incorporating lung function, quadriceps strength and lean leg mass. These findings indicate an important role for lower limb strength measures in pulmonary rehabilitation training programmes.

Palliative care

Title: Evolution of End-of-Life Care at United States Hospitals in the New Millennium.
Authors: Lin RY, Levine RJ, Scanlon BC.
Source: J Palliat Med. 2012 May;15(5):592-601.
Summary: Objectives of this study were to examine the characteristics of United States hospitalizations that result in hospice transfers including the clinical and demographic features, and to determine distinctive factors associated with discharges to hospice. The National Inpatient Sample(NIS) databases for 2000-2009 were queried for hospitalizations which resulted in transfers to hospice and expiration in the hospital. The authors concluded that hospital discharges to hospice have increased over the past ten years. Female gender, age, and chronic obstructive pulmonary disease were predictors of discharge to hospice, while congestive heart failure was inversely associated.

Title: Is hospitalisation for COPD an opportunity for advance care planning? A qualitative study.
Authors: Seamark D, Blake S, Seamark C, Hyland ME, Greaves C, Pinnuck M, Ward D, Hawkins A, Halpin D; The East Devon Respiratory Research Group.
Source: Prim Care Respir J. 2012 May 17. pii: pcrj-2012-01-0009-R1. doi: 10.4104/pcrj.2012.00032. [Epub ahead of print].
Summary: Aims of this qualitative study were to examine whether an admission to hospital for an exacerbation of COPD is an opportunity for ACP and to understand, from the patient perspective, the optimum circumstances for ACP. 16 patients who had a recent admission for an exacerbation of COPD and their carers were interviewed. Hospital admission and discharge was seen as chaotic and lacking in continuity. The authors concluded that the period of hospitalisation may not be an appropriate time to initiate ACP but may be a milestone that can lead to discussions.

Title: Differences between community professional and patient perceptions of chronic obstructive pulmonary disease treatment outcomes: a qualitative study.
Authors: Cooke M, Thackray S.
Source: J Clin Nurs. 2012 Jun;21(11-12):1524-33. doi: 10.1111/j.1365-2702.2012.04094.x.
Summary: This qualitative study aims to define, compare and order 'assessed needs and defined outcomes' of professional providers of chronic obstructive pulmonary disease services with patients' prioritized needs and defined outcomes' and relate these to service provision. The authors found that both professionals and patients agreed that access to equitably provided services included more respiratory rehabilitation; other priorities indicate key differences between professional's and patient's perceptions of financial support, the communication of health education and the need for better provision of palliative care at end of life.

Title: Patient journey: implications for improving and integrating care for older adults with chronic obstructive pulmonary disease.
Authors: Jackson K, Oelke ND, Besner J, Harrison A.
Source: Can J Aging. 2012 Jun;31(2):223-33.
Summary: In this qualitative study, Jackson et al. have summarized the experiences of four patients living with chronic obstructive pulmonary disease as they interacted with the health care system over a three-month period following hospital discharge. Three overarching themes - social support, system navigation, and access - emerged from the data. The authors concluded that attending to provider-patient and provider-provider communication, and to patient social support and self-care needs, could improve integration and care outcomes.

Title: What is Your Understanding of Your Illness? A Communication Tool to Explore Patients' Perspectives of Living with Advanced Illness.
Authors: Morris DA, Johnson KS, Ammarell N, Arnold RM, Tulsky JA, Steinhauser KE.
Source: J Gen Intern Med. 2012 May 26. [Epub ahead of print].
Summary: Morris et al. conducted a qualitative analysis of responses of patients with advanced cancer, congestive heart failure, or COPD to the question "what is your understanding of your illness?". Five major themes were identified: the diagnosis or describing the pathophysiology, illness history, prognosis, symptoms, and causality. Responses varied by diagnosis. Cancer patients' responses more often included specific diagnostic details and prognosis, while non-cancer patients referenced symptoms and causality. The authors concluded that patients' responses to the open-ended question can provide the clinician with important information and insight on how they view their illness in a non-acute setting. The identified themes can serve as a foundation for patient-centered communication strategies as we strive to build a mutual understanding of illness with patients.

Title: Systematic review of noncancer presentations with a median survival of 6 months or less.
Authors: Salpeter SR, Luo EJ, Malter DS, Stuart B.
Source: Am J Med. 2012 May;125(5):512.e1-6.
Summary: Purpose of this systematic review was to report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival. Data were extracted on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors.