Literature Reviews

October 2013

Pulmonary rehabilitation

Title: An official american thoracic society/european respiratory society statement: key concepts and advances in pulmonary rehabilitation.
Authors: Spruit MA, Singh SJ, Garvey C, Zuwallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF; ATS/ERS Task Force on Pulmonary Rehabilitation.
Source: Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64. doi: 10.1164/rccm.201309-1634ST.
Summary: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

Title: Adherence to a Maintenance Exercise Program 1 Year After Pulmonary Rehabilitation: WHAT ARE THE PREDICTORS OF DROP-OUT?
Authors: Heerema-Poelman A, Stuive I, Wempe JB.
Source: J Cardiopulm Rehabil Prev. 2013 Sep 11. [Epub ahead of print].
Summary: This study aimed to evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence. Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program.


Title: Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial.
Authors: Pinnock H, Hanley J, McCloughan L, Todd A, Krishan A, Lewis S, Stoddart A, van der Pol M, Macnee W, Sheikh A, Pagliari C, McKinstry B.
Source: BMJ. 2013 Oct 17;347:f6070. doi: 10.1136/bmj.f6070.
Summary: Pinnock and colleagues aimed to test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care. In participants with a history of admission for exacerbations of COPD, telemonitoring was not effective in postponing admissions and did not improve quality of life. The positive effect of telemonitoring seen in previous trials could be due to enhancement of the underpinning clinical service rather than the telemonitoring communication.

Title: Clinical validation of the CHRONIOUS wearable system in patients with chronic disease.
Authors: Bellos C, Papadopoulos A, Rosso R, Fotiadis DI.
Source: Conf Proc IEEE Eng Med Biol Soc. 2013 Jul;2013:7084-7. doi: 10.1109/EMBC.2013.6611190.
Summary: The CHRONIOUS system has been proven to be a well-validated real-time patient monitoring and supervision platform, providing a useful tool for the clinician and the patient that would contribute to the more effective management of chronic diseases.

Skeletal muscles

Title: Fiber type atrophy, oxidative stress and oxidative fiber reduction are the attributes of different phenotypes in chronic obstructive pulmonary disease patients.
Authors: Gouzi F, Abdellaoui A, Molinari N, Pinot E, Ayoub B, Laoudj-Chenivesse D, Cristol JP, Mercier J, Hayot M, Prefaut CG.
Source: J Appl Physiol (1985). 2013 Oct 17. [Epub ahead of print].
Summary: Gouzi and collegaues tested whether the fiber CSA and the type I fiber reductions were the attributes of different phenotypes of the disease, using unsupervised clustering method and post-hoc validation. These authors identified and validated two phenotypes of COPD patients showing different muscle histo-morphology and level of oxidative stress. Thus, this study demonstrates that the muscle heterogeneity is the translation of different phenotypes of the disease.

Care dependency

Title: Care dependency in patients with chronic obstructive pulmonary disease and heart failure - a secondary data analysis of German prevalence studies.
Authors: Köberich S, Lohrmann C, Dassen T.
Source: Scand J Caring Sci. 2013 Oct 17. doi: 10.1111/scs.12091. [Epub ahead of print].
Summary: The aim of this study was to compare the degree of care dependency between hospitalised patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD). The authors concluded that patients with CHF or COPD did not differ in levels of care dependency. Both patient populations are restricted in engaging in activities potentially associated with physical condition and possibly influenced by perceived dyspnoea. Furthermore, comorbidities like incontinence and cognitive impairment seem to play an important role regarding the degree of care dependency.

Chronic/integrated care

Title: High-quality chronic care delivery improves experiences of chronically ill patients receiving care.
Authors: Cramm JM, Nieboer AP.
Source: Int J Qual Health Care. 2013 Oct 11. [Epub ahead of print].
Summary: This study aimed to investigate whether high-quality chronic care delivery improved the experiences of patients. This research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time.

Title: Integrated disease management interventions for patients with chronic obstructive pulmonary disease.
Authors: Kruis AL, Smidt N, Assendelft WJ, Gussekloo J, Boland MR, Rutten-van Mölken M, Chavannes NH.
Source: Cochrane Database Syst Rev. 2013 Oct 10;10:CD009437. [Epub ahead of print].
Summary: This systematic review aimed to evaluate the effects of integrated disease management (IDM) programs or interventions in people with COPD on health-related QoL, exercise tolerance and number of exacerbations. In these COPD participants, IDM not only improved disease-specific QoL and exercise capacity, but also reduced hospital admissions and hospital days per person.

Title: Integrated interdisciplinary care for patients with chronic obstructive pulmonary disease reduces emergency department visits, admissions and costs: A quality assurance study.
Authors: Dajczman E, Robitaille C, Ernst P, Hirsch AM, Wolkove N, Small D, Bianco J, Stern H, Palayew M.
Source: Can Respir J. 2013 Sep-Oct;20(5):351-6.
Summary: This study aimed to investigate whether health care utilization could be reduced by a newly developed integrated, interdisciplinary initiative that included a COPD nurse navigator who educates patients and families, transitions patients through various points of care and integrates services. The present quality assurance study indicated that the implementation of an integrated interdisciplinary program for the care of patients with COPD can improve patient outcomes despite the tendency of COPD to worsen over time.

Exercise testing

Title: Exercise-induced oxygen desaturation (EID) in COPD patients without resting hypoxemia.
Authors: Andrianopoulos V, Franssen FM, Peeters JP, Ubachs TJ, Bukari H, Groenen M, Burtin C, Vogiatzis I, Wouters EF, Spruit MA.
Source: Respir Physiol Neurobiol. 2013 Oct 9. pii: S1569-9048(13)00328-5. doi: 10.1016/j.resp.2013.10.002. [Epub ahead of print].
Summary: This study aimed to validate a proposed cut-off of baseline-SpO2 ≤95% as simple screening procedure to predict EID during six-minute walk test (6MWT). In a multivariate model, DLCO <50%, FEV1 <45%, PaO2 <10kPa, baseline-SpO2 <95%, and female sex were the strongest determinants of EID. Baseline oxygen saturation solely is inaccurate to predict EID. A combination of clinical characteristics (DLCO, FEV1, PaO2, baseline-SpO2, sex) increases the odds for EID in COPD.

Title: Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease.
Authors: Schoos MM, Dalsgaard M, Kjærgaard J, Moesby D, Jensen SG, Steffensen I, Iversen KK.
Source: BMC Cardiovasc Disord. 2013 Oct 12;13(1):84. [Epub ahead of print].
Summary: Schoos and collegaues evaluated echocardiographic predictors of mortality and six minutes walking distance (6MWD), a marker for quality of life and mortality in COPD. Among subjects with moderate to severe COPD and normal LVEF, GLS independently predicted all-cause mortality. Exercise tolerance correlated with standard lung function parameters only in univariate models; in subsequent models including echocardiographic parameters, longer 6MWD correlated independently with milder TR, better DLCO SB, younger age and lower BMI.

Title: Exercise Endurance in Chronic Obstructive Pulmonary Disease Patients at an Altitude of 2640 meters Breathing Air and Oxygen (FIO2 28% and 35%): A Randomized Crossover Trial.
Authors: Maldonado D, González-García M, Barrero M, Jaramillo C, Casas A.
Source: COPD. 2013 Oct 10. [Epub ahead of print].
Summary: At Bogota's altitude (2640 m), the lower barometric pressure (560 mmHg) causes severe hypoxemia in COPD patients, limiting their exercise capacity. The aim was to compare the effects of breathing oxygen on exercise tolerance. Oxygen administration for COPD patients in Bogotá significantly increased ET by decreased respiratory load, improved cardiovascular performance and oxygen transport. The higher increases of the PaO2 and SaO2 with 35% FIO2 did not represent a significant advantage in the ET. This finding has important logistic and economic implications for oxygen use in rehabilitation programs of COPD patients at the altitude of Bogotá and similar altitudes.

Title: Validation of the i-BODE Index as a Predictor of hospitalization and Mortality in Patients with COPD Participating in Pulmonary Rehabilitation.
Authors: Moberg M, Vestbo J, Martinez G, Williams JE, Ladelund S, Lange P, Ringbaek T.
Source: COPD. 2013 Oct 10. [Epub ahead of print].
Summary: The aim of this study was to examine the value of the i-BODE index to predict hospital admission and to confirm its usefulness to predict mortality in a Danish population. The i-BODE index is a significant predictor of hospital admission and thus health care utilization, and also mortality.

Title: Physical activity and longitudinal change in 6-min walk distance in COPD patients.
Authors: Frisk B, Espehaug B, Hardie JA, Strand LI, Moe-Nilssen R, Eagan TM, Bakke PS, Thorsen E.
Source: Respir Med. 2013 Sep 13. pii: S0954-6111(13)00369-7. doi: 10.1016/j.rmed.2013.09.004. [Epub ahead of print].
Summary: This study aimed to examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function. Patients in GOLD stage II maintained their functional capacity assessed by 6MWD over 3 years, while it was significantly reduced for patients in GOLD stages III and IV. Level of physical activity and FEV1 were predictors for longitudinal change in functional capacity.

Cognitive behavioral strategies

Title: Evidence for cognitive-behavioral strategies improving dyspnea and related distress in COPD.
Authors: Norweg A, Collins EG.
Source: Int J Chron Obstruct Pulmon Dis. 2013;8:439-451. Epub 2013 Sep 25.
Summary: Norweg and colleagues reviewed 23 COPD studies to examine the evidence for the effectiveness of cognitive-behavioral strategies for relieving dyspnea in COPD. While evidence is increasing, additional randomized controlled trials are needed to evaluate the effectiveness of psychosocial and self-management interventions in relieving dyspnea, in order to make them more available to patients and to endorse them in official COPD, dyspnea, and pulmonary rehabilitation practice guidelines. By relieving dyspnea and related anxiety, such interventions may promote adherence to exercise programs and adaptive lifestyle change.

Virtual game systems

Title: Using a virtual game system to innovate pulmonary rehabilitation: Safety, adherence and enjoyment in severe chronic obstructive pulmonary disease.
Authors: Wardini R, Dajczman E, Yang N, Baltzan M, Préfontaine D, Stathatos M, Marciano H, Watson S, Wolkove N.
Source: Can Respir J. 2013 Sep-Oct;20(5):357-61.
Summary: The present pilot study tested the use of a virtual game system (VGS) for exercise training in patients with moderate to very severe chronic obstructive pulmonary disease undergoing pulmonary rehabilitation (PR). Safety, feasibility, enjoyment and adherence were assessed. Moderate exercise using a VGS was safe, feasible and enjoyed as an adjunct to inpatient PR. This modality may encourage patients to maintain physical activity after PR.

Activity counseling

Title: Effect of 'activity monitor-based' counseling on physical activity and health-related outcomes in patients with chronic diseases: A systematic review and meta-analysis.
Authors: Vaes AW, Cheung A, Atakhorrami M, Groenen MT, Amft O, Franssen FM, Wouters EF, Spruit MA.
Source: Ann Med. 2013 Sep;45(5-6):397-412. doi: 10.3109/07853890.2013.810891. Epub 2013 Jul 3.
Summary: This review evaluated the effects of activity monitor-based counseling on physical activity (PA) and generic and disease-specific health-related outcomes in adults with diabetes mellitus type II (DMII), chronic obstructive pulmonary disease (COPD), or chronic heart failure (CHF). Activity monitor-based counseling had a beneficial effect on PA, HbA1c, systolic blood pressure, and BMI in patients with DMII. Data in patients with COPD and CHF are limited or non-existing, respectively.