Literature Reviews

October 2012

Pulmonary rehabilitation

Title: Short term and long term effects of pulmonary rehabilitation on physical activity in COPD.
Authors: Egan C, Deering BM, Blake C, Fullen BM, McCormack NM, Spruit MA, Costello RW.
Source: Respir Med. 2012 Oct 11. pii: S0954-6111(12)00312-5. doi: 10.1016/j.rmed.2012.08.016. [Epub ahead of print].
Summary: The hypothesis of this study was that pulmonary rehabilitation would lead to a sustained increase in standard outcome measures and in daily physical activity. Egan et al. show that while pulmonary rehabilitation increased exercise capacity this was not transmitted into increased daily physical activity. Hence, alternative methods to alter/affect behavioural change need to be addressed.

Title: Effectiveness, Attendance, and Completion of an Integrated, System-Wide Pulmonary Rehabilitation Service for COPD: Prospective Observational Study.
Authors: Hogg L, Garrod R, Thornton H, McDonnell L, Bellas H, White P.
Source: COPD. 2012 Aug;9(5):546-54. doi: 10.3109/15412555.2012.707258.
Summary: In this integrated PR service we report on effectiveness, attendance, and completion of twice weekly rolling recruitment and once weekly cohort recruitment programmes in two hospital and five community PR sites. PR is effective for COPD in real-world practice achieving results comparable to trials. Low rates of attendance and completion of PR were not explained by demographic characteristics, disease severity, psychological morbidity and source of referral despite the large number of participants.

Title: Pulmonary rehabilitation in chronic obstructive pulmonary disease: predictors of program completion and success.
Authors: Selzler AM, Simmonds L, Rodgers WM, Wong EY, Stickland MK.
Source: COPD. 2012 Aug;9(5):538-45. doi: 10.3109/15412555.2012.705365.
Summary: This study examined which patient characteristics are predictive of PR drop-out and non-response. Pulmonary function data did not predict drop-out or non-response to PR. These findings indicate that perceived impairment (i.e., health status) is more likely to influence completion of rehabilitation than actual pulmonary impairment and that demographic and standard clinical data do not adequately predict patient drop-out and non-response to rehabilitation.


Title: Nutritional targets to enhance exercise performance in chronic obstructive pulmonary disease.
Authors: van de Bool C, Steiner MC, Schols AM.
Source: Curr Opin Clin Nutr Metab Care. 2012 Nov;15(6):553-60. doi: 10.1097/MCO.0b013e328358bdeb.
Summary: This review presents current knowledge regarding the rationale and efficacy of nutrition as an ergogenic aid to enhance the effects of exercise and training in COPD.

Palliative care

Title: Oxygen is Nonbeneficial for Most Patients Who Are Near Death.
Authors: Campbell ML, Yarandi H, Dove-Medows E.
Source: J Pain Symptom Manage. 2012 Aug 23. [Epub ahead of print].
Summary: Clinicians prescribe and administer oxygen in response to reports of dyspnea, in the face of dropping oxygen saturation, as a "routine" comfort intervention, or to support anxious family members. Objective of the current double-blind, repeated-measure observation was to determine the benefit of administering oxygen to patients who are near death. The authors showed that repeated-measure analysis of variance revealed no differences in Respiratory Distress Observation Scale under changing gas and flow conditions and concluded that the routine application of oxygen to patients who are near death is not supported. The n-of-1 trial of oxygen in clinical practice is appropriate in the face of hypoxemic respiratory distress.

Title: "You get old, you get breathless, and you die": Chronic obstructive pulmonary disease in Barnsley, UK.
Authors: Small N, Gardiner C, Barnes S, Gott M, Halpin D, Payne S, Seamark D.
Source: Health Place. 2012 Aug 10. [Epub ahead of print].
Summary: Small et al. reported patients, family members and health professionals' experiences of Chronic Obstructive Pulmonary Disease (COPD) in Barnsley, northern England. A widespread belief that having "bad lungs" is part of normal ageing shapes everyday experience in this former mining town. Encouraging uptake of care, promoting smoking cessation, and developing care planning would be enhanced by engaging with the significance of place in the social narrative of health evident in this town.

Title: Caring for the older person with chronic obstructive pulmonary disease.
Authors: Fried TR, Vaz Fragoso CA, Rabow MW.
Source: JAMA. 2012 Sep 26;308(12):1254-63.
Summary: The authors describe a case of COPD in an 81-year-old man hospitalized with severe dyspnea and respiratory failure which highlights both the challenges in managing COPD in the elderly and the limitations in applying guidelines to geriatric patients. The authors conclude that meeting the many needs of older patients with COPD and their families requires that clinicians supplement guideline-recommended care with treatment decision making that takes into account older persons' comorbid conditions, recognizes the trade-offs engendered by the increased risk of adverse events, focuses on symptom relief and function, and prepares patients and their loved ones for further declines in the patient's health and their end-of-life care.

Title: A Home-Based Exercise Program to Improve Function, Fatigue, and Sleep Quality in Patients With Stage IV Lung and Colorectal Cancer: A Randomized Controlled Trial.
Authors: Cheville AL, Kollasch J, Vandenberg J, Shen T, Grothey A, Gamble G, Basford JR.
Source: J Pain Symptom Manage. 2012 Sep 24. pii: S0885-3924(12)00328-4. doi: 10.1016/j.jpainsymman.2012.05.006. [Epub ahead of print].
Summary: Objective of the present study was to conduct a trial of a home-based exercise intervention that can be integrated into established delivery and reimbursement structures. Sixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The authors included that a home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer.

Title: The Evidence Base for Oxygen for Chronic Refractory Breathlessness: Issues, Gaps, and a Future Work Plan.
Authors: Johnson MJ, Abernethy AP, Currow DC.
Source: J Pain Symptom Manage. 2012 Sep 24. pii: S0885-3924(12)00327-2. doi: 10.1016/j.jpainsymman.2012.03.017. [Epub ahead of print].
Summary: Breathlessness or "shortness of breath," medically termed dyspnea, is a common and distressing symptom featuring strongly in advanced lung, cardiac, and neuromuscular diseases; its prevalence and intensity increase as death approaches. This article presents current understanding of the use of oxygen for treating refractory breathlessness in advanced disease. The objective is to highlight what is still unknown, set a research agenda to resolve these questions, and highlight methodological issues for consideration in planned studies.

Title: Life-Sustaining Treatment Preferences: Matches and Mismatches Between Patients' Preferences and Clinicians' Perceptions.
Authors: Downey L, Au DH, Curtis JR, Engelberg RA.
Source: J Pain Symptom Manage. 2012 Sep 24. pii: S0885-3924(12)00363-6. doi: 10.1016/j.jpainsymman.2012.07.002. [Epub ahead of print].
Summary: Objective of this observational study was to investigate preferences of 196 male veterans with COPD for life-sustaining therapies, clinicians' accuracy in understanding those preferences, and predictors of patient preference and clinician error. The authors concluded that clinicians erred more often about patients' wishes when patients did not want treatment than when they wanted it. Treatment decisions based on clinicians' perceptions could result in costly and unwanted treatments. End-of-life care could benefit from increased clinician-patient discussion about end-of-life care, particularly if discussions included patient education about risks of treatment and allowed clinicians to form and maintain accurate impressions of patients' preferences.

Title: The End-of-Life Experience for a Cohort of Patients with Pulmonary Arterial Hypertension.
Authors: Grinnan DC, Swetz KM, Pinson J, Fairman P, Lyckholm LJ, Smith T.
Source: J Palliat Med. 2012 Oct;15(10):1065-70.
Summary: In this investigation, the authors surveyed surrogates of recent decedents with Pulmonary Arterial Hypertension (PAH) to better understand the end-of-life experience of patients with PAH. The authors concluded that patients with PAH usually died from their disease, often in the hospital setting with a high symptom burden. Further study will be needed to confirm the findings from this study and to better understand the forces leading to the trends uncovered in this investigation.

Title: Episodic and Continuous Breathlessness: A New Categorization of Breathlessness.
Authors: Simon ST, Higginson IJ, Benalia H, Gysels M, Murtagh FE, Spicer J, Bausewein C.
Source: J Pain Symptom Manage. 2012 Sep 24. pii: S0885-3924(12)00356-9. doi: 10.1016/j.jpainsymman.2012.06.008. [Epub ahead of print].
Summary: Objective of this qualitative study using in-depth interviews with patients suffering from four life-limiting and advanced diseases (chronic heart failure, chronic obstructive pulmonary disease, lung cancer, and motor neuron disease) was to explore patients' experiences and descriptions of breathlessness to categorize breathlessness. The authors concluded that participants categorize their breathlessness by time and triggers. The categorization needs further verification, similar to that already established in pain, and can be used as a new evidence-based categorization to advance our understanding of this under-researched, yet high impact, symptom to optimize management.

Title: Analysis of longitudinal changes in dyspnea of patients with chronic obstructive pulmonary disease: an observational study.
Authors: Oga T, Tsukino M, Hajiro T, Ikeda A, Nishimura K.
Source: Respir Res. 2012 Sep 25;13(1):85. [Epub ahead of print].
Summary: The present observational study explored the longitudinal change in dyspnea in patients with COPD. The authors concluded that dyspnea worsened over time in patients with COPD. However, as different dyspnea measurements showed different evaluative characteristics, it is important to follow dyspnea using appropriate measurements. Progressive dyspnea was related not only to progressive airflow limitation, but also to various factors such as worsening of diffusing capacity or psychological status. Changes in peak dyspnea at the end of exercise may evaluate different aspects from other dyspnea measurements.

Daily functioning

Title: Impact of Peak Oxygen Uptake and Muscular Fitness on the Performance of Activities of Daily Living in Patients With Chronic Obstructive Pulmonary Disease.
Authors: Kato DJ, Rodgers W, Stickland M, Haennel RG.
Source: J Cardiopulm Rehabil Prev. 2012 Sep 24. [Epub ahead of print].
Summary: The purpose of this study was to examine the relationships between selected parameters of physical fitness and performance of ADL in COPD patients. A convenience sample of 23 COPD patients was studied at the conclusion of an exercise rehabilitation program. The authors suggested that development of lower body strength may be more important in optimizing ADL performance in COPD patients.

Title: Conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease.
Authors: Lindqvist G, Heikkilä K, Albin B, Hjelm K.
Source: Prim Health Care Res Dev. 2012 Oct 2:1-11. [Epub ahead of print].
Summary: This study aimed to describe conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease (COPD) in different stages of the disease. The men felt that daily life was burdened, restricted and the partner relationship was affected, even if the disease had not reached the final stage. The COPD forced them gradually into a caregiving role, and their daily life changed. They become more of a caregiver than a spouse. The men experienced lack of knowledge and support, and they felt that health professionals and municipality did not care about them.


Title: Prediction of the Clinical Course of COPD using the new GOLD Classification A Study of the General Population.
Authors: Lange P, Marott JL, Vestbo J, Olsen KR, Ingebrigtsen TS, Dahl M, Nordestgaard BG.
Source: Am J Respir Crit Care Med. 2012 Sep 20. [Epub ahead of print].
Summary: The new Global initiative for obstructive lung disease (GOLD) stratification of COPD into categories A, B, C and D is based on symptoms, level of lung function, and history of exacerbations. Objective of the present study was to investigate the abilities of this stratification to predict clinical course of COPD. The authors concluded that the new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, has a significantly poorer survival than group C, in spite of a higher level of forced expiratory volume in the first second of expiration (FEV1). This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.


Title: Are Depressive Symptoms Related to Physical Inactivity in Chronic Obstructive Pulmonary Disease?
Authors: Venkata A, Dedios A, Zuwallack R, Lahiri B.
Source: J Cardiopulm Rehabil Prev. 2012 Sep 24. [Epub ahead of print].
Summary: In this pilot study, the authors evaluated the relationship between depressive symptoms and activity in clinically stable COPD. Sixteen patients with high depression scores (DEPR) and 20 with low depression scores (non-DEPR), were studied. Physical activity was measured over 7 consecutive days, using the SenseWear armband. The authors did not demonstrate a relationship between depressive symptoms and directly measured physical activity level in patients with COPD.

Title: Anxiety and depression following pulmonary rehabilitation.
Authors: Bentsen SB, Wentzel-Larsen T, Henriksen AH, Rokne B, Wahl AK.
Source: Scand J Caring Sci. 2012 Aug 28. doi: 10.1111/j.1471-6712.2012.01064.x. [Epub ahead of print]
Summary: The aim of this study was to evaluate changes and predictive factors of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) before and up to 3 months after pulmonary rehabilitation (PR). The authors concluded that a tendency of less anxiety and depression during the PR programme was found, but the changes were not significant. Higher level of self-efficacy and better exercise capacity are suggested to relieve anxiety and depression.

Title: Anxiety Disorders in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review.
Authors: Willgoss TG, Yohannes AM.
Source: Respir Care. 2012 Aug 16. [Epub ahead of print].
Summary: There is a growing interest in the role of co-morbid anxiety in patients with chronic obstructive pulmonary disease (COPD). The present study reviews studies which report the prevalence of clinical anxiety and specific anxiety disorders in patients with COPD. Of 410 studies identified, ten met the inclusion criteria for review. The authors concluded that there is a high prevalence of clinical anxiety in patients with COPD. Social phobia and specific phobia appear to be particularly prevalent, yet they have received little attention within existing literature. Further research into effective management and screening for clinical anxiety disorders is warranted.

Title: Lower Health Literacy is Associated with Poorer Health Status and Outcomes in Chronic Obstructive Pulmonary Disease.
Authors: Omachi TA, Sarkar U, Yelin EH, Blanc PD, Katz PP.
Source: J Gen Intern Med. 2012 Aug 14. [Epub ahead of print].
Summary: The present study examines the associations between health literacy and both outcomes and health status in COPD. The authors concluded that independent of socioeconomic status, poor health literacy is associated with greater COPD severity, greater COPD helplessness, worse respiratory-specific HRQoL, and higher odds of COPD-related emergency health-care utilization. These results underscore that COPD patients with poor health literacy may be at particular risk for poor health-related outcomes.

Title: Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore.
Authors: Feng L, Lim ML, Collinson S, Ng TP.
Source: COPD. 2012 Aug 21. [Epub ahead of print].
Summary: The present study analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.


Title: Examining fatigue in COPD: development, validity and reliability of a modified version of FACIT-F scale.
Authors: Al-Shair K, Muellerova H, Yorke J, Rennard SI, Wouters EF, Hanania NA, Sharafkhaneh A, Vestbo J.
Source: Health Qual Life Outcomes. 2012 Aug 23;10(1):100. [Epub ahead of print].
Summary: In the present study 2107 COPD patients from the ECLIPSE cohort completed the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) scale. The authors used well-structured classic method, the principal components analysis (PCA) and Rasch analysis for structurally examining the 13-item FACIT-F. The authors concluded that the original and modified FACIT-F are valid and reliable scales in COPD. The modified version is shorter and measures not only total fatigue but also its sub-components in COPD.

Title: Breathing exercises for chronic obstructive pulmonary disease.
Authors: Holland AE, Hill CJ, Jones AY, McDonald CF.
Source: Cochrane Database Syst Rev. 2012 Oct 17;10:CD008250. doi: 10.1002/14651858.CD008250.pub2.
Summary: Holland et al. aimed to determine whether breathing exercises in people with COPD have beneficial effects on dyspnoea, exercise capacity and health-related quality of life compared to no breathing exercises in people with COPD; and to determine whether there are any adverse effects of breathing exercises in people with COPD. Breathing exercises over four to 15 weeks improve functional exercise capacity in people with COPD compared to no intervention; however, there are no consistent effects on dyspnoea or health-related quality of life. Outcomes were similar across all the breathing exercises examined. Treatment effects for patient-reported outcomes may have been overestimated owing to lack of blinding. Breathing exercises may be useful to improve exercise tolerance in selected individuals with COPD who are unable to undertake exercise training; however, these data do not suggest a widespread role for breathing exercises in the comprehensive management of people with COPD.

Title: Internet-Based Dyspnea Self-Management Support for Patients With Chronic Obstructive Pulmonary Disease.
Authors: Nguyen HQ, Donesky D, Reinke LF, Wolpin S, Chyall L, Benditt JO, Paul SM, Carrieri-Kohlman V.
Source: J Pain Symptom Manage. 2012 Oct 13. pii: S0885-3924(12)00373-9. doi: 10.1016/j.jpainsymman.2012.06.015. [Epub ahead of print].
Summary: The purpose of this study was to test the efficacy of two 12-month dyspnea self-management programs (DSMPs), Internet-based (eDSMP) and face-to-face (fDSMP), compared with a general health education (GHE) control on the primary outcome of dyspnea with activities. The DSMPs did not significantly reduce dyspnea with activities compared with attention control. However, the high participant satisfaction with the DSMPs combined with positive changes in other outcomes, including self-efficacy for managing dyspnea and exercise behavior, highlight the need for additional testing of individually tailored technology-enabled interventions to optimize patient engagement and improve clinically relevant outcomes.

Title: Dyspnea severity, changes in dyspnea status and mortality in the general population: the Vlagtwedde/Vlaardingen study.
Authors: Figarska SM, Boezen HM, Vonk JM.
Source: Eur J Epidemiol. 2012 Oct 7. [Epub ahead of print].
Summary: Dyspnea is a predictor of mortality. The effects of dyspnea severity and changes in dyspnea status on all-cause and cause-specific mortality remain unclear. These results show that dyspnea is associated with mortality in a severity-dependent manner. Furthermore this study is the first showing that dyspnea remission normalizes mortality risk. Having or developing dyspnea is a risk factor for mortality.

Health status

Title: Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study.
Authors: Wilke S, Janssen DJ , Wouters EF, Schols JM, Franssen FM, Spruit MA.
Source: Health Qual Life Outcomes. 2012 Aug 21;10(1):98. [Epub ahead of print].
Summary: The aim of this study was to determine whether and to what extent a disease-specific health status questionnaire (Saint George's Respiratory Questionnaire, SGRQ) correlates with generic health status questionnaires (EuroQol-5-Dimensions, EQ-5D; Assessment of Quality of Life instrument, AQoL; Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36) at four different time points in patients with advanced COPD; and to determine the correlation between the changes in these questionnaires during one-year follow-up. Wilke et al. concluded that at four, eight and 12 months after baseline, SGRQ total scores and EQ-5D index scores, AQoL total scores and SF-36 PCS scores were moderately to strongly correlated, while SGRQ total scores were weakly correlated with SF-36 MCS scores. The correlations between changes over time were weak or even absent. Disease-specific health status questionnaires and generic health status questionnaires should be used together to gain complete insight in health status and changes in health status over time in patients with advanced COPD.

Title: Decline of Health Status Sub-Domains by Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Survey.
Authors: Verhage T, Boer L, Molema J, Heijdra Y, Dekhuijzen R, Vercoulen JH.
Source: Respiration. 2012 Aug 22. [Epub ahead of print]
Summary: Objectives were confirmation of the negative health status (HS) effect of exacerbations by using a highly differentiated instrument, and to evaluate which aspects of HS are affected most. The authors concluded that exacerbation frequency and HS show weak correlations after a year, but most of these disappear after correction for prior HS levels. In such exacerbations, aggravated HS probably takes much longer to manifest itself.

Title: Evaluation of Quality of Life instruments for use in COPD care and research: A systematic review.
Authors: Weldam SW, Schuurmans MJ, Liu R, Lammers JW.
Source: Int J Nurs Stud. 2012 Aug 23. [Epub ahead of print].
Summary: The objective of this review was to comprehensively evaluate content and psychometric properties of available QoL instruments used in COPD care and research.

Despite the comprehensive overview the authors could not uniformly recommend the best instrument to evaluate QoL in COPD patients. However, they could recommend the disease specific instruments CRQ, CAT, SGRQ, or LCOPD. In addition to the best evidence synthesis, the decision to use one instrument over another, will be driven by study purpose and research questions in combination with the domains of the instrument.