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CME/MOC

Literature Reviews

March 2011

Advance care planning and palliative care

Title: Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities.
Author: Heffner JE.
Source: Curr Opin Pulm Med. 2011 Mar;17(2):103-9.

Summary: Experts in palliative care have increasingly recognized the global epidemic of COPD, its astonishing rise in prevalence, and its profound impact on patients' quality of life and functional capacity. Heffner highlights recent advances in identifying barriers to advance care planning and opportunities for providing more effective and timely palliative care.

Title: Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?
Authors: Johnson KS, Tulsky JA, Hays JC, Arnold RM, Olsen MK, Lindquist JH, Steinhauser KE.
Source: J Gen Intern Med. 2011 Feb 19. [Epub ahead of print].

Summary: Objective of this cross-sectional cohort study was to examine the association of spiritual history and current spiritual well-being with symptoms of anxiety and depression in patients with advanced illness (1/3 were diagnosed with cancer, 1/3 COPD, and 1/3 CHF). The authors concluded that current spiritual well-being and past negative religious experiences were associated with symptoms of anxiety and depression.

Title: Advance care planning for patients with COPD: Past, present and future.
Authors: Janssen DJ, Engelberg RA, Wouters EF, Curtis JR.
Source: Patient Educ Couns. 2011 Feb 11. [Epub ahead of print]

Summary: Objective of this narrative review was to discuss the importance, current status and directions for improvement of advance care planning and communication about end-of-life care for patients with COPD. The authors concluded that advance care planning can improve outcomes for patients and their relatives. Recent studies provide directions for how to facilitate advance care planning for patients with COPD.

Symptoms

Title: Prevalence of depressive symptoms in Japanese male patients with chronic obstructive pulmonary disease.
Authors: Hayashi Y, Senjyu H, Iguchi A, Iwai S, Kanada R, Honda S, Ozawa H.
Source: Psychiatry Clin Neurosci. 2011 Feb;65(1):82-8. doi: 10.1111/j.1440-1819.2010.02171.x.

Summary: The objective of this study was to utilize commonly applied tools, the Hospital Anxiety and Depression Scale - Depression subscale (HADS-D) and the Center for Epidemiological Studies Depression Scale (CES-D), to screen for depressive symptoms in patients with stable chronic obstructive pulmonary disease (COPD). The authors concluded that the prevalence of depressive symptoms differed when assessed with CES-D and HADS-D.

Title: The effect of breathing exercises on the fatigue levels of patients with chronic obstructive pulmonary disease.
Authors: Zakerimoghadam M, Tavasoli K, Nejad AK, Khoshkesht S.
Source: Acta Med Indones. 2011 Jan;43(1):29-33.

Summary: This study aimed to assess the effect of breathing exercises on fatigue level of the patients with COPD. Zakerimoghadam et al. conclude that respiratory exercise is effective in reducing the fatigue in the patients with COPD.

Body composition and co-morbidities

Title: COPD, Bone Metabolism, and Osteoporosis.
Authors: Lehouck A, Boonen S, Decramer M, Janssens W.
Source: Chest. 2011 Mar;139(3):648-57.

Summary: Lehouck et al. review COPD and osteoporosis,as they are strongly associated because of common risk factors such as age, smoking, and inactivity.

Title: Prevalence and Associated Factors of Osteoporosis Among Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.
Authors: Silva DR, Coelho AC, Dumke A, Valentini JD, de Nunes JN, Stefani CL, Mendes LF, Knorst MM.
Source: Respir Care. 2011 Feb 21. [Epub ahead of print].

Summary: The objectives of this study were to estimate the prevalence of osteoporosis in a sample of COPD outpatients, and to investigate the correlation among T-score and several factors suggested to be associated with osteoporosis. Silva et al. identified a high prevalence of osteoporosis and osteopenia in outpatients with COPD.

Rehabilitation and exercise training

Title: Ambulatory Rehabilitation Improves Exercise Capacity in Patients With Pulmonary Hypertension.
Authors: Fox BD, Kassirer M, Weiss I, Raviv Y, Peled N, Shitrit D and Kramer MR.
Source: Journal of Cardiac Failure, March 2011, Pages 196-200.

Summary: The present study aimed to evaluate outpatient pulmonary rehabilitation for patients with pulmonary arterial hypertension. Fox et al. conclude ambulatory rehabilitation is a safe and efficacious treatment for patients with pulmonary hypertension already on medical therapy.

Title: [Pulmonary Rehabilitation Before and After Lung Transplantation.][Article in German]
Authors: Kenn K, Sczepanski B.
Source: Pneumologie. 2011 Feb 22. [Epub ahead of print].

Summary: Kenn et al. present the importance, aims and specific features of rehabilitation prior to and following lung transplantation. Finally the therapeutic concept will be discussed with regard to the economic burden and the limited resources in lung transplantation.

Title: Rehabilitation in COPD patients admitted for exacerbation.
Authors: Clini E, Venturelli E, Crisafulli E.
Source: Pneumonol Alergol Pol. 2011;79(2):116-20.

Summary: This review updates the application of early pulmonary rehabilitation and main physical therapies both during hospital acute care and following discharge of COPD patients who have experienced exacerbation.

Title: Skeletal muscle effects of electrostimulation after COPD exacerbation: a pilot study.
Authors: Abdellaoui A, Préfaut C, Gouzi F, Couillard A, Coisy-Quivy M, Hugon G, Molinari N, Lafontaine T, Jonquet O, Laoudj-Chenivesse D, Hayot M.
Source: Eur Respir J. 2011 Feb 24. [Epub ahead of print].

Summary: Muscle dysfunction is a major problem in chronic obstructive pulmonary disease (COPD), particularly after exacerbations. Abdellaoui et al . studied whether neuromuscular electrostimulation (NMES) might be directly useful following an acute exacerbation and if such a therapy decreases muscular oxidative stress and/or alters muscle fibre distribution. This study shows that following COPD exacerbation, NMES is effective in counteracting muscle dysfunction and decreases muscle oxidative stress.

Title: Improvement of heart rate variability after exercise training and its predictors in COPD.
Authors: Camillo CA, Laburu VD, Gonçalves NS, Cavalheri V, Tomasi FP, Hernandes NA, Ramos D, Marquez Vanderlei LC, Cipulo Ramos EM, Probst VS, Pitta F.
Source: Respir Med. 2011 Feb 20. [Epub ahead of print].

Summary: Camillo et al. aimed to investigate changes in heart rate variability after two exercise training programs in patients with COPD and to investigate the determinants of these eventual changes. High-intensity exercise training improves heart rate variability at rest and during orthostatic stimulus in patients with COPD. Better baseline total HRV, muscle force and daily physical activity level are predictors of HRV improvements after the training program.

Title: Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease.
Author: Ige OM, Olarewaju RK, Lasebikan VO, Adeniyi YO.
Source: Indian J Chest Dis Allied Sci. 2010 Oct-Dec;52(4):197-201.

Summary: Ige et al. studied the feasibility of a rehabilitation programme for COPD patients. This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that benefits in physical ability and in health-related quality of life can be achieved. Importantly, the improvements were maintained at six months.

Title: Effects of pulmonary rehabilitation in bronchiectasis: A retrospective study.
Authors: Ong H, Lee A, Hill C, Holland A, Denehy L.
Source: Chron Respir Dis. 2011;8(1):21-30.

Summary: This study aimed to evaluate the effects of an out-patient pulmonary rehabilitation program in patients with a primary diagnosis of bronchiectasis and to compare them with a matched COPD group who completed the same pulmonary rehabilitation program. This study supports the inclusion of patients with bronchiectasis in existing pulmonary rehabilitation programs.

Oxygen use

Title: Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study.
Authors: Arnold E, Bruton A, Donovan-Hall M, Fenwick A, Dibb B, Walker E.
Source: BMC Pulm Med. 2011 Feb 11;11:9.

Summary: The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Arnold et al. conclude that increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this study.

Problematic activities of daily life

Title: Development and validation of the living with chronic obstructive pulmonary disease questionnaire.
Authors: McKenna SP, Meads DM, Doward LC, Twiss J, Pokrzywinski R, Revicki D, Hunter CJ, Glendenning GA.
Source: Qual Life Res. 2011 Feb 11. [Epub ahead of print]

Summary: The purpose of the study was to develop a patient-based patient-reported outcome measure for COPD that captures the overall everyday impact of living with COPD from the patient's perspective. The Living with COPD is a new measure examining the everyday impact of living with COPD. It demonstrates good scaling properties and may prove valuable in understanding treatment benefits.

Skeletal muscles

Title: Evidence that a higher ATP cost of muscular contraction contributes to the lower mechanical efficiency associated with COPD: preliminary findings.
Authors: Layec G, Haseler LJ, Hoff J, Richardson RS.
Source: Am J Physiol Regul Integr Comp Physiol. 2011 Feb 9. [Epub ahead of print].

Summary: Layec et al. used (31)P-magnetic resonance spectroscopy ((31)P-MRS) to examine the energy cost and skeletal muscle energetics in six patients with COPD during dynamic plantar flexion exercise in comparison to six well-matched healthy control subjects. The results reveal, for the first time that in a small subset of patients with COPD a higher ATP cost of muscle contraction may substantially contribute to the lower mechanical efficiency previously reported in this population. In addition, it appears that some patients with COPD have preserved mitochondrial function and normal energy supply in lower limb skeletal muscle.