Literature Reviews

August 2013

Pulmonary rehabilitation / exercise training

Title: Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer.
Authors: Cavalheri V, Tahirah F, Nonoyama M, Jenkins S, Hill K.
Source: Cochrane Database Syst Rev. 2013 Jul 31;7:CD009955. [Epub ahead of print].
Summary: The primary aim of this study was to determine the effects of exercise training on exercise capacity in people following lung resection (with or without chemotherapy) for NSCLC. The evidence summarised in our review suggests that exercise training may potentially increase the exercise capacity of people following lung resection for NSCLC. The findings of our systematic review should be interpreted with caution due to disparities between the studies, methodological limitations, some significant risks of bias and small sample sizes. This systematic review emphasises the need for larger RCTs.

Title: High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy.
Authors: Stefanelli F, Meoli I, Cobuccio R, Curcio C, Amore D, Casazza D, Tracey M, Rocco G.
Source: Eur J Cardiothorac Surg. 2013 Jul 26. [Epub ahead of print].
Summary: In order to clarify the role of pulmonary rehabilitation, Stefanelli et al. have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy. Pulmonary rehabilitation was a valid preoperative strategy to improve physical performance in patients with both NSCLC and COPD and this advantage was also maintained after surgery.

Title: Measuring unsupported arm lifts as an outcome in pulmonary rehabilitation of chronic obstructive pulmonary disease patients.
Authors: Datta D, Zuwallack RL.
Source: Chron Respir Dis. 2013;10(3):159-63. doi: 10.1177/1479972313497371.
Summary: This study evaluated the potential utility of unsupported arm lifts testing as an outcome measurement for pulmonary rehabilitation. Using effect sizes, the degree of improvement appears to be between that of 6MWD and CRQ-SA. UAL may be a useful outcome assessment for pulmonary rehabilitation in COPD patients.

Title: Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients.
Authors: Croitoru A, Ioniţă D, Stroescu C, Pele I, Gologanu D, Dumitrescu A, Marinescu L, Anghelescu D, Alexandru M, Bogdan.
Source: Pneumologia. 2013 Mar-Jun;62(2):94-8, 101.
Summary: Croitoru et al. present the results of a 7-week outpatient rehabilitation program in terms of dyspnea, exercise tolerance and quality of life. The authors concluded that in Romanian COPD patients, the 7 week outpatient rehabilitation program was effective, leading to improvement of symptoms, exercise tolerance and quality of life.

Title: Chronic obstructive pulmonary disease patients' experience with pulmonary rehabilitation: A systematic review of qualitative research.
Authors: de Sousa Pinto JM, Martín-Nogueras AM, Morano MT, Macêdo TE, Arenillas JI, Troosters T.
Source: Chron Respir Dis. 2013;10(3):141-57. doi: 10.1177/1479972313493796.
Summary: The aim of this study was to give an in-depth consideration of the chronic obstructive pulmonary disease (COPD) patients' subjective view of the impact of pulmonary rehabilitation (PR) on their lives. The empowerment experienced by the patients in taking advantage of these opportunities leads to positive impacts over time. If they do not exploit these occasions, negative impacts arise in their life, which make the treatment assistance or follow-up more difficult. The COPD patients' feedback revealed that PR promotes a better 'way of life', well-being and important behavioural changes towards health promotion.

Title: Facilitating education in pulmonary rehabilitation using the living well with COPD programme for pulmonary rehabilitation: a process evaluation.
Authors: Cosgrove D, Macmahon J, Bourbeau J, Bradley JM, O Neill B.
Source: BMC Pulm Med. 2013 Aug 5;13(1):50. [Epub ahead of print].
Summary: he aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in pulmonary rehabilitation; and, 2) to conduct a process evaluation of the adapted programme. This rigorous process evaluation has demonstrated that the LWWCOPD programme for pulmonary rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based pulmonary rehabilitation. This programme is now available worldwide (

Title: Practical recommendations for exercise training in patients with COPD.
Authors: Gloeckl R, Marinov B, Pitta F.
Source: Eur Respir Rev. 2013 Jun 1;22(128):178-86. doi: 10.1183/09059180.00000513.
Summary: The aim of this article was to provide practical recommendations to healthcare professionals interested in offering a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease. The authors provide specific details on the rationale of why and especially how to implement exercise training in patients with COPD, including the prescription of training mode, intensity and duration, as well as suggestions of guidelines for training progression.

Title: Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Lung Disease: US SURVEY AND REVIEW OF GUIDELINES AND CLINICAL PRACTICES.
Authors: Garvey C, Fullwood MD, Rigler J.
Source: J Cardiopulm Rehabil Prev. 2013 Jul 10. [Epub ahead of print].
Summary: This article describes the results of an informal, nonscientific survey of the American Association of Cardiovascular and Pulmonary Rehabilitation members exploring current pulmonary rehabilitation exercise prescription practices as a basis for discussion and reviews current national exercise recommendations for chronic obstructive pulmonary disease. Further, it describes areas of uncertainty regarding exercise prescription in pulmonary rehabilitation and suggests strategies for providing effective exercise training, given the diversity of guidelines, clinician preparedness, and patient complexity.


Title: Strategies used by respiratory nurses to stimulate self-management in patients with COPD.
Authors: Verbrugge R, de Boer F, Georges JJ.
Source: J Clin Nurs. 2013 Jul 3. doi: 10.1111/jocn.12048. [Epub ahead of print].
Summary: This study aimed to gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, to improve self-management of patients with chronic obstructive pulmonary disease. The main emphasis during the clinic session is directed at quitting smoking. Other self-management strategies such as providing information regarding nutrition and exercise, instilling confidence and becoming an equal discussion partner, gain less attention.

Title: Effects of a 6-Month Nurse-Led Self-Management Program on Comprehensive Pulmonary Rehabilitation for Patients with COPD Receiving Home Oxygen Therapy.
Authors: Moriyama M, Takeshita Y, Haruta Y, Hattori N, Ezenwaka CE.
Source: Rehabil Nurs. 2013 Aug 6. doi: 10.1002/rnj.119. [Epub ahead of print].
Summary: This study aimed to examine the effectiveness of a nurse-led 6-month comprehensive pulmonary rehabilitation program for stage IV chronic obstructive pulmonary disease patients receiving home oxygen therapy. The findings of this study that the program contributes to patients' learning of self-management skills and significantly improves dyspnea, social activity level, walking distance, and overall quality of life.

Title: he development and pilot testing of the self-management programme of activity, coping and education for chronic obstructive pulmonary disease (SPACE for COPD).
Authors: Apps LD, Mitchell KE, Harrison SL, Sewell L, Williams JE, Young HM, Steiner M, Morgan M, Singh SJ.
Source: Int J Chron Obstruct Pulmon Dis. 2013;8:317-27. doi: 10.2147/COPD.S40414. Epub 2013 Jul 9.
Summary: This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care.

Title: Mindfulness and Motivational Interviewing: Two candidate methods for promoting self-management.
Author: Benzo RP.
Source: Chron Respir Dis. 2013;10(3):175-82. doi: 10.1177/1479972313497372.
Summary: This manuscript describes two pilot qualitative studies carried out in patients with severe COPD aimed to engage the patient inner experience and promote self-management: a trial testing motivational interviewing (MI) as one style of helping patients with severe COPD make changes in their behavior and second a trial testing a mindfulness-based intervention. In the search for the "holy grail" for self-management programs that can promote a behavior change, mindfulness and MI seem promising for cultivating a way to live a life in which people are fully present and consciously agree with.


Title: The Acceptance of e-Health Solutions Among Patients with Chronic Respiratory Conditions.
Author: Duplaga M.
Source: Telemed J E Health. 2013 Jun 4. [Epub ahead of print].
Summary: The main objective of this study was to assess the acceptance of the use of e-health applications by patients suffering from bronchial asthma and other chronic respiratory conditions. Patients suffering from chronic respiratory conditions demonstrate higher levels of acceptance of e-health applications such as appointment booking, prescription renewal, and access to information (laboratory test results, educational resources) than of solutions directly related to medical care (communication with healthcare providers, disease monitoring).

Title: Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls.
Authors: Steventon A, Tunkel S, Blunt I, Bardsley M.
Source: BMJ. 2013 Aug 6;347:f4585. doi: 10.1136/bmj.f4585.
Summary: This study aimed to test the effect of a telephone health coaching service (Birmingham OwnHealth) on hospital use and associated costs in patients with heart failure, coronary heart disease, diabetes, or chronic obstructive pulmonary disease; and a history of inpatient or outpatient hospital use. The authors concluded that the Birmingham OwnHealth telephone health coaching intervention did not lead to the expected reductions in hospital admissions or secondary care costs over 12 months, and could have led to increases.

Title: Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases: a critical assessment of their methodological quality.
Authors: Kitsiou S, Paré G, Jaana M.
Source: J Med Internet Res. 2013 Jul 23;15(7):e150. doi: 10.2196/jmir.2770.
Summary: The primary aim of this critical review was to evaluate the methodology, quality, and reporting characteristics of prior reviews that have investigated the effects of home telemonitoring interventions in the context of chronic diseases. Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring.

Palliative care / family caregiving

Title: Palliative care for people with non-malignant lung disease: Summary of current evidence and future direction.
Authors: Boland J, Martin J, Wells AU, Ross JR.
Source: Palliat Med. 2013 Jul 9. [Epub ahead of print].
Summary: This article will focus on chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis as examples of life-limiting, non-curable and non-malignant lung diseases. As access to palliative care is poor for these patients, the barriers to referral need to be understood and reduced, which along with effective working between palliative care teams, with respiratory services backup, should optimise delivery of care in patients with life-limiting non-malignant lung disease.

Title: Experience of anxiety among patients with severe COPD - A qualitative, in-depth interview study.
Authors: Strang S, Ekberg-Jansson A, Henoch I.
Source: Palliat Support Care. 2013 Aug 6:1-8. [Epub ahead of print].
Summary: The aim of this study was to explore severely ill COPD patients' experience of anxiety and their strategies to alleviate anxiety. The majority of patients experienced anxiety, which limited their lives. Although the patients experienced both life anxiety and death anxiety, they were able to cope with the situation and find a defiant joy to some extent.

Title: Top 10 things palliative care clinicians wished everyone knew about palliative care.
Authors: Strand JJ, Kamdar MM, Carey EC.
Source: Mayo Clin Proc. 2013 Aug;88(8):859-65. doi: 10.1016/j.mayocp.2013.05.020.
Summary: This article discusses the changing role of modern palliative care, addresses common misconceptions, and presents an argument for early integration of palliative care in the treatment of patients dealing with serious illness.

Title: Caring for people with early and advanced chronic obstructive pulmonary disease: how do family carers cope?
Authors: Figueiredo D, Gabriel R, Jácome C, Marques A.
Source: J Clin Nurs. 2013 Aug 2. doi: 10.1111/jocn.12363. [Epub ahead of print].
Summary: This study aimed to examine the coping strategies of family carers of people with early and advanced chronic obstructive pulmonary disease and how those relate to their subjective health. This study provides a unique insight into family carer coping strategies at different stages of chronic obstructive pulmonary disease. Carers of people with early and advanced chronic obstructive pulmonary disease cope differently with their caring demands. Nevertheless, problem-focused coping strategies were perceived as the most helpful by both groups.


Title: Reproducibility of arterial stiffness and wave reflections in chronic obstructive pulmonary disease: The contribution of lung hyperinflation and a comparison of techniques.
Authors: Stone IS, John L, Petersen SE, Barnes NC.
Source: Respir Med. 2013 Aug 3. pii: S0954-6111(13)00220-5. doi: 10.1016/j.rmed.2013.06.008. [Epub ahead of print].
Summary: Stone and colleagues assessed the Vicorder reproducibility of carotid-femoral pulse wave velocity and Augmentation index in COPD, compared it to the SphygmoCor, and assessed the contribution of lung hyperinflation to measurement variability. In COPD, measurement of carotid-femoral pulse wave velocity is highly reproducible, not affected by lung hyperinflation and suitable as a surrogate endpoint in research studies.

Title: Examining cerebral metabolic abnormalities in chronic obstructive pulmonary disease (COPD) patients by localized proton magnetic resonance spectroscopy (MRS).
Authors: Karakas E, Yildizhan M, Karakas O, Boyaci FN, Cullu N, Cece H, Yildiz S, Sak ZH.
Source: Clin Ter. 2013 May-Jun;164(3):e179-82. doi: 10.7417/CT.2013.1565.
Summary: This study was planned based on the hypothesis that cerebral metabolism is impaired in chronic obstructive pulmonary disease (COPD) by using localized in vivo proton magnetic resonance spectroscopy. Materials and Methods. The findings of this study through the use of MRS confirmed that most patients with symptomatic COPD have cerebral metabolic abnormalities.

Title: Comorbidities and Health Status in Individuals With and Without COPD in Five Latin American Cities: The PLATINO Study.
Authors: López Varela MV, Montes de Oca M, Halbert R, Muiño A, Tálamo C, Pérez-Padilla R, Jardim JR, Valdivia G, Pertuzé J, Menezes AM; en representación del Equipo PLATINO.
Source: Arch Bronconeumol. 2013 Jul 12. pii: S0300-2896(13)00151-8. doi: 10.1016/j.arbres.2013.05.003. [Epub ahead of print].
Summary: In the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status.

Title: Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method : Cardio-ankle vascular index (CAVI).
Authors: Aykan AC, Gökdeniz T, Boyacı F, Gül I, Hatem E, Kalaycıoğlu E, Turan T, Bektaş H, Cilingir MB, Aykan DA, Ayyıldız F, Altun S.
Source: Herz. 2013 Aug 3. [Epub ahead of print].
Summary: The aim of the present study was to evaluate whether there is an association between the spirometric severity of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, with arterial stiffness as assessed by CAVI. In this study, Aykan et al. have shown that increased arterial stiffness assessed by CAVI is associated with the spirometric severity of COPD.

Title: The development and validation of the Anxiety Inventory for Respiratory disease (AIR).
Authors: Willgoss TG, Goldbart J, Fatoye F, Yohannes AM.
Source: Chest. 2013 Aug 1. doi: 10.1378/chest.13-0168. [Epub ahead of print].
Summary: There is a need for a disease-specific non-somatic anxiety scale to screen and measure anxiety in patients with COPD. The AIR is a short, user-friendly, reliable and valid scale for measuring and screening anxiety in patients with COPD.

Title: Chronic Obstructive Pulmonary Disease and Cerebral Microbleeds: The Rotterdam Study.
Authors: Lahousse L, Vernooij MW, Darweesh SK, Akoudad S, Loth DW, Joos GF, Hofman A, Stricker BH, Ikram MA, Brusselle GG.
Source: Am J Respir Crit Care Med. 2013 Jul 25. [Epub ahead of print].
Summary: This study aimed to examine whether COPD relates to the development and location of cerebral microbleeds, a novel marker of cerebral small-vessel disease. The findings of this study are compatible with an increased risk of COPD on the development of cerebral microbleeds in deep or infratentorial locations.

Balance / functional testing / exercise testing

Title: Functional Balance in Older Adults With COPD.
Authors: Jácome C, Cruz J, Gabriel R, Figueiredo D, Marques A.
Source: J Aging Phys Act. 2013 Jul 30. [Epub ahead of print].
Summary: This study assessed functional balance among older adults at all COPD grades and explored balance impairment predictors. Functional balance impairment is present at early COPD, although more evident at advanced grades. These findings highlight the importance of balance assessment in older patients at all COPD grades.

Title: A symptom-limited incremental step test (IST) determines maximum physiological responses in patients with chronic obstructive pulmonary disease.
Authors: Dal Corso S, de Camargo AA, Izbicki M, Malaguti C, Nery LE.
Source: Respir Med. 2013 Jul 14. pii: S0954-6111(13)00225-4. doi: 10.1016/j.rmed.2013.06.013. [Epub ahead of print].
Summary: This study aimed to compare maximal physiological responses between an IST and cardiopulmonary exercise testing (CPET), to test the reproducibility of the IST on different days, and to provide a predict equation to estimate VO2 from the IST in patients with COPD. A symptom-limited incremental step test, externally paced, elicits maximal cardiopulmonary and metabolic responses, and is well tolerated and reproducible in patients with COPD.

Title: The 6-minute pegboard and ring test is correlated with upper extremity activity of daily living in chronic obstructive pulmonary disease.
Authors: Takeda K, Kawasaki Y, Yoshida K, Nishida Y, Harada T, Yamaguchi K, Ito S, Hashimoto K, Matsumoto S, Yamasaki A, Igishi T, Shimizu E.
Source: Int J Chron Obstruct Pulmon Dis. 2013;8:347-51. doi: 10.2147/COPD.S45081. Epub 2013 Jul 23.
Summary: The purpose of this study was to characterize the 6PBRT and evaluate its relationship with upper-extremity activities of daily living (ADLs) in COPD patients. The The 6-minute pegboard may be a predictive test to maintain and improve upper-extremity ADL during pulmonary rehabilitation in patients with COPD.

Title: Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: an experimental crossover study.
Authors: Beekman E, Mesters I, Hendriks EJ, Klaassen MP, Gosselink R, van Schayck OC, de Bie RA.
Source: This study aimed to assess the 6-min walk distance on a 10m course versus a 30m course. This study shows that the impact of course length on the 6MWD and on the use of reference equations in patients with COPD is substantial and clinically relevant (based on the most conservative published minimum clinically important difference). Therefore, existing reference equations established for a 6MWT conducted over a 30m (or longer) course cannot be applied to predict the distance achieved on the 6MWT on a 10m course, which is frequently used in primary care physiotherapy practices for patients with COPD.

Physical activity

Title: Improving physical activity in patients with COPD with urban walking circuits.
Authors: Pleguezuelos E, Pérez ME, Guirao L, Samitier B, Ortega P, Vila X, Solans M, Riera A, Moreno E, Merí A, Miravitlles M.
Source: Respir Med. 2013 Jul 23. pii: S0954-6111(13)00261-8. doi: 10.1016/j.rmed.2013.07.008. [Epub ahead of print].
Summary: Pleguezuelos et al. analyzed the effects of the implementation of urban walking circuits on levels of physical activity and exercise capacity of patients with severe and very severe COPD after a rehabilitation program. The authors concluded that urban circuits are an easy, inexpensive strategy, which demonstrated to be useful to stimulate physical activity in our population of severe and very severe COPD patients and resulted in increased exercise capacity even 9 months after completion of a rehabilitation program.


Title: Differences between physician and patient in the perception of symptoms and their severity in COPD.
Authors: Miravitlles M, Ferrer J, Baró E, Lleonart M, Galera J.
Source: Respir Med. 2013 Jul 24. pii: S0954-6111(13)00231-X. doi: 10.1016/j.rmed.2013.06.019. [Epub ahead of print].
Summary: This study analysed the degree of concordance between the patients and their pulmonologists in the perception of the severity of symptoms. The degree of physician-patient concordance was greater in patients with more severe COPD. The patients and their pulmonologists identified the same three main symptoms of COPD but showed low concordance when assessing the impact of the symptoms of the illness.

Title: Narratives of breathlessness in chronic obstructive pulmonary disease.
Authors: Kvangarsnes M, Torheim H, Hole T, Ohlund LS.
Source: J Clin Nurs. 2013 Jul 27. doi: 10.1111/jocn.12033. [Epub ahead of print].
Summary: This study aimed to explore patient perceptions of chronic obstructive pulmonary disease exacerbation and the patients' experiences of their relations with health personnel during care and treatment. This study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.

Title: 'It is not going to change his life but it has picked him up': a qualitative study of perspectives on long term oxygen therapy for people with chronic obstructive pulmonary disease.
Authors: Goldbart J, Yohannes AM, Woolrych R, Caton S.
Source: Health Qual Life Outcomes. 2013 Jul 25;11(1):124. [Epub ahead of print].
Summary: The aim of the study was to explore the views and experiences of COPD patients, their carers and the healthcare professionals who deliver these services, on the long-term use of oxygen therapy. LTOT has some beneficial effects in improving daily activities and social interaction of patients with COPD but also some limitations. Increased support and monitoring by healthcare professionals would address some concerns, as would better information for patients, carers and the general public.

Lower-limb muscle

Title: MuRF-1 and Atrogin-1 Protein Expression and Quadriceps Fiber Size and Muscle Mass in Stable Patients with COPD.
Authors: Natanek SA, Riddoch-Contreras J, Marsh GS, Hopkinson NS, Moxham J, Man WD, Kemp PR, Polkey MI.
Source: COPD. 2013 Jul 11. [Epub ahead of print].
Summary: Small clinical studies suggest MuRF-1 and atrogin-1 expression in the quadriceps muscle is also increased in stable patients with Chronic Obstructive Pulmonary Disease compared to controls. However, it remains unclear whether these ligases have a role in maintaining a muscle-wasted state in COPD patients. Chronic upregulation of ubiquitin ligases was not evident in the quadriceps muscle of stable COPD patients with a low muscle mass. This does not exclude the possibility of transient increases in ubiquitin ligases during acute catabolic episodes.

Title: Intensity of daily physical activity is associated with central hemodynamic and leg muscle oxygen availability in COPD.
Authors: Louvaris Z, Kortianou EA, Spetsioti S, Vasilopoulou M, Nasis I, Asimakos A, Zakynthinos SG, Vogiatzis I.
Source: J Appl Physiol. 2013 Jul 11. [Epub ahead of print].
Summary: There is limited evidence as to whether central hemodynamic, oxygen transport and peripheral muscle oxygenation capacities also contribute to reduced daily physical activity. In COPD, besides ventilatory limitations and peripheral muscle weakness, intensity of daily physical activity is associated with both central hemodynamic and peripheral muscle oxygenation capacities regulating the adequacy of matching peripheral muscle oxygen availability by systemic oxygen transport.