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Introduction: eHealth platforms can be used as a tool to promote physical activity (PA) in patients with COPD. When developing such platforms, a bottom-up approach is needed to ensure that patients’ and healthcare professionals’ (HCP) needs and expectations are addressed. Aim: To assess patients’ and HCP’ perspectives on the ideal eHealth platform (web application - app - for HCP + mobile app for patients) for PA promotion in patients with COPD. Methods: One focus group with 5 patients (68±8 yrs, FEV1 44±21pp) and 6 individual interviews with HCP (physicians and physiotherapist, 39±10 yrs) were conducted using a semi-structured interview guide. Interviews were recorded and transcripts were analysed using the Grounded Theory approach. Results: Participants considered an eHealth platform to promote patients' PA valuable. Both groups suggested that PA should be individualised according to patients’ characteristics. The main features for a mobile app included: shared goal setting, PA progress graphs, motivational messages and goal badges, notifications, a bi-directional communication system to support patients and information on breathing exercises. Both groups highlighted the importance of measuring steps, PA duration, SpO2, and dyspnoea on exertion. For the web app, the HCP highlighted the importance of a notification system to signal PA changes or non-compliance (e.g., colour scheme), as well as tabs for PA goal setting and monitoring. HCP recommended this platform for patients with stable or mild disease and/or those attending pulmonary rehabilitation. Conclusion: Findings provide guidance to the design of future eHealth platforms for PA promotion in COPD. published

Background: COPD is a heterogeneous disease. Better understanding of its trajectory, especially considering symptoms level, may help improving disease management. We described the evolution of functional status and impact of the disease in people with COPD according to symptoms level. Methods: People with COPD were assessed monthly for 6 months. Participants were grouped by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria in low (GOLD A & C) or high (GOLD B & D) symptom burden, based on the baseline values in the modified medical research council dyspnoea scale. Quadriceps muscle strength (QMS)–handheld dynamometry, 1-minute sit-to-stand test (1STS) and COPD assessment test (CAT) were collected. Differences within/between groups over time were explored with (non-)parametric mixed ANOVAs and Bonferroni-adjusted pairwise comparisons. Results: 87 people (85%♂, 68±9y, FEV1 51±20pp, 54% high symptoms) participated. People with low symptoms presented higher 1STS (p=0.01) and lower CAT (p

L'ITAB et Arvalis - Institut du végétal ont rassemblé les informations disponibles sur le comportement de différentes variétés de blé tendre d'hiver adaptées à une conduite en agriculture biologique. Chaque variété fait l’objet d’une fiche. Ces dernières contiennent des informations sur : 1 – l’identité de la variété (obtenteur, nombre d’années en test dans le réseau bio, classe technologique…) ; 2 – le comportement agronomique (précocité, alternativité, résistance au froid, résistance à la verse, hauteur, capacité à concurrencer les adventices, sensibilité aux maladies…) ; 3 – le potentiel de rendement et la teneur du grain en protéines ; 4 – les caractéristiques technologiques (poids spécifique, force boulangère, indice de Zélény, critères alvéographiques, comportement en panification…). Les variétés présentées sont : Activus, Adesso, Adriatic, Alessio, Alicantus, Angelus, Annie, Apexus, Attlass, Aurelius, Campesino, Cecilius, Centurion, Chevignon, Christoph, Descartes, Edelmann, Ehogold, Emilio, Emotion, Energo, Filon, Forcali, Gambetto, Geny, Ghayta, Graziaro, Gwastell, Gwenn, Hansel, Hanswin, Hendrix, Izalco CS, KWS Extase, Lennox, LG Absalon, LG Armstrong, Liskamm, Metropolis, Montalbano, Nogal, Numeric, Orloge, Poesie, Posmeda, Renan, RGT Forzano, RGT Montecarlo, RGT Venezio, Rubisko, Solehio, Sy Adoratio, Tengri, Togano, Ubicus, Valbona, Wendelin, Wital, Wiwa. A noter : sept nouvelles variétés font leur apparition dans ce référentiel en 2022 : Aurelius, Emotion, Gambetto, Gwenn, Hansel et Sy Adoration.

Introduction: Persistent respiratory symptoms at rest and during exertion (e.g., dyspnea, fatigue) play a role on the low physical activity (PA) levels found in people with chronic obstructive pulmonary disease (COPD), but other factors may also be involved. Environmental factors have been shown to impact PA levels in other patient populations, but evidence regarding people with COPD is still scarce. Investigations have been focused mostly on outdoor factors, such as air pollution or population density, disregarding the patients’ perception of their surroundings, both indoor and outdoor milieus. Objectives: This study explored the relationship between self-reported indoor and outdoor physical environmental opportunities for PA and actual PA levels in patients with COPD. Methods: Patients with COPD completed the Physical Activity Neighbourhood Environment Survey (PANES; total score 0-6, higher scores indicating a more supportive PA environment; 11 subscales: Residential Density, Land Use Mix, Access to Transportation, Infrastructure for Pedestrians, Infrastructure for Bicycles, Recreation Facilities, Street Connectivity, Security – Crimes, Security – Traffic, Security – Pedestrians, Aesthetics) and questions regarding their indoor and outdoor home environment (car ownership; having a dog, corridor, elevator, stairs and/or exercise equipment). An accelerometer was used for 7 days to assess daily PA: steps (steps/day); time in moderate and vigorous PA (MVPA; min/day); total PA (TPA; light PA+MVPA; min/day). Mann-Whitney-U and Spearman’s correlations (r) tests were conducted. Results: Ninety-four patients [78 males (83%), 67 ± 8 years, 48 ± 19 FEV1% predicted] participated in this study. PANES total score (n = 75) was 3 [1;4] (median [Q1;Q3]). Forty-three patients had a dog (13 walked it regularly); 63 had stairs, 12 had an elevator, 71 had a corridor, 45 had exercise equipment (stationary bicycle, n = 21) and 84 owned a car. Participants performed 4,428 [2,761;6,886] steps/ day, 19 [9;41] min/day of MVPA and 144 [103;208] min/day of TPA. Patients walking the dog presented a significantly higher daily step count (4,895 [2,644;7,780] vs. 4,422 [2,850;6,775] steps/day, p = 0.01) and time in TPA (154 [100;256] vs. 144 [103;177] min/day, p =.03) than those not walking the dog. No other significant differences were observed in the indoor and outdoor home environment (p > 0.05). No significant correlations were found between any of the PANES subscales and the different PA outcomes (-0.210 ≤ r ≤ 0.181, p > 0.05). Conclusions: A minimal influence of neighbourhood environmental factors on PA levels of patients with COPD was found in this observational study. Findings support previous research, as walking the dog impacted patients’ daily step counts. Longitudinal research is needed to more definitely evaluate potential environmental opportunities to promote PA in people with COPD. published

Ce document synthétise les principales caractéristiques de plus de 70 variétés de blé tendre adaptées à une conduite en agriculture biologique : caractéristiques physiologiques (précocité, alternativité, hauteur, résistance au froid, résistance à la verse…), résistances faces aux agresseurs (pouvoir couvrant, résistance à la fusariose, à la rouille, à l’oïdium, à la septoriose…), valeurs technologiques (poids spécifique, indice de Zélény, force boulangère…). Il offre également un comparatif des principales variétés, en fonction de leur rendement et leur teneur en protéines, pour chaque grande région géographique (centre, nord-est, ouest, sud). Cette synthèse a été réalisée grâce à une collaboration entre le CTPS-GEVES, Arvalis-Institut du Végétal, l'ITAB, en lien avec le réseau des Chambres d’agriculture.

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients’ perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8-to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data. © ERS 2019.

Building on the core syllabus for postgraduate training in respiratory physiotherapy, published in 2014, the European Respiratory Society (ERS) respiratory physiotherapy task force has developed a harmonised and structured postgraduate curriculum for respiratory physiotherapy training. The curriculum outlines the knowledge, skills and attitudes which must be mastered by a respiratory physiotherapist working with adult or paediatric patients, together with guidance for minimal clinical exposures, and forms of learning and assessment. This article presents the rationale, methodology and content of the ERS respiratory physiotherapy curriculum. The full curriculum can be found in the supplementary material.

Carlos A Camillo,1,2 Daniel Langer,1,2 Christian R Osadnik,1,3–5 Lisa Pancini,2 Heleen Demeyer,1,2 Chris Burtin,1,6 Rik Gosselink,1,2 Marc Decramer,2 Wim Janssens,2 Thierry Troosters1,2 1KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; 2University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium; 3Monash University, Department of Physiotherapy, Melbourne, VIC, Australia; 4Institute for Breathing and Sleep, Melbourne, VIC, Australia; 5Monash Health, Monash Lung and Sleep, Melbourne, VIC, Australia; 6Hasselt University, Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium Abstract: The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi≥350 m and Δ6MWD≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD 30 m after PR are associated with worse 5-year survival in patients with COPD. Keywords: pulmonary disease, chronic obstructive, exercise training, mortality, 6-minute walk test, minimally important difference

Exercise-induced oxygen desaturation (EID) is associated with increased risk of mortality in chronic obstructive pulmonary disease (COPD). Several screening tests have been proposed to predict EID, including FEV1, DLCO and baseline-SpO2. We 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 addition, we studied the prevalence and characteristics of patients exhibited EID to SpO2nadir ≤88%.402 non-hypoxemic COPD patients performed 6MWT. Sensitivity and specificity of baseline SpO2 ≤95% as a cut-off to predict EID and determinants of EID were investigated.158 patients (39%) exhibited EID. The sensitivity of baseline-SpO2 ≤95% to predict EID was 81.0%, specificity 49.2%, positive and negative predictive values were 50.8% and 80.0%, respectively. In a multivariate model, DLCO

Symptoms during physical activity and physical inactivity are hallmarks of chronic obstructive pulmonary disease (COPD). Our aim was to evaluate the validity and usability of six activity monitors in patients with COPD against the doubly labelled water (DLW) indirect calorimetry method. 80 COPD patients (mean±SD age 68±6 years and forced expiratory volume in 1 s 57±19% predicted) recruited in four centres each wore simultaneously three or four out of six commercially available monitors validated in chronic conditions for 14 consecutive days. A priori validity criteria were defined. These included the ability to explain total energy expenditure (TEE) variance through multiple regression analysis, using TEE as the dependent variable with total body water (TBW) plus several physical activity monitor outputs as independent variables; and correlation with activity energy expenditure (AEE) measured by DLW. The Actigraph GT3X (Actigraph LLC, Pensacola, FL, USA), and DynaPort MoveMonitor (McRoberts BV, The Hague, the Netherlands) best explained the majority of the TEE variance not explained by TBW (53% and 70%, respectively) and showed the most significant correlations with AEE (r=0.71, p

Comprehensive pulmonary rehabilitation is an important component in the clinical management of people with chronic obstructive pulmonary disease (COPD). Although supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation, there are many other components that should be considered to manage the impairments and symptom burden, as well as the psychosocial and lifestyle changes imposed by COPD. These include approaches designed to: 1) facilitate smoking cessation; 2) optimise pharmacotherapy; 3) assist with early identification and treatment of acute exacerbations; 4) manage acute dyspnoea; 5) increase physical activity; 6) improve body composition; 7) promote mental health; 8) facilitate advance care planning; and 9) establish social support networks. This article will describe these approaches, which may be incorporated within pulmonary rehabilitation, to optimise effective chronic disease self-management. © ERS 2013.

Reduced physical activity is an important feature of Chronic Obstructive Pulmonary Disease (COPD). Various activity monitors are available but their validity is poorly established. The aim was to evaluate the validity of six monitors in patients with COPD. We hypothesized triaxial monitors to be more valid compared to uniaxial monitors. Thirty-nine patients (age 68±7years, FEV1 54±18%predicted) performed a one-hour standardized activity protocol. Patients wore 6 monitors (Kenz Lifecorder (Kenz), Actiwatch, RT3, Actigraph GT3X (Actigraph), Dynaport MiniMod (MiniMod), and SenseWear Armband (SenseWear)) as well as a portable metabolic system (Oxycon Mobile). Validity was evaluated by correlation analysis between indirect calorimetry (VO2) and the monitor outputs: Metabolic Equivalent of Task [METs] (SenseWear, MiniMod), activity counts (Actiwatch), vector magnitude units (Actigraph, RT3) and arbitrary units (Kenz) over the whole protocol and slow versus fast walking. Minute-by-minute correlations were highest for the MiniMod (r = 0.82), Actigraph (r = 0.79), SenseWear (r = 0.73) and RT3 (r = 0.73). Over the whole protocol, the mean correlations were best for the SenseWear (r = 0.76), Kenz (r = 0.52), Actigraph (r = 0.49) and MiniMod (r = 0.45). The MiniMod (r = 0.94) and Actigraph (r = 0.88) performed better in detecting different walking speeds. The Dynaport MiniMod, Actigraph GT3X and SenseWear Armband (all triaxial monitors) are the most valid monitors during standardized physical activities. The Dynaport MiniMod and Actigraph GT3X discriminate best between different walking speeds. © 2012 Van Remoortel et al.

The assessment of physical activity in healthy populations and in those with chronic diseases is challenging. The aim of this systematic review was to identify whether available activity monitors (AM) have been appropriately validated for use in assessing physical activity in these groups. Following a systematic literature search we found 134 papers meeting the inclusion criteria; 40 conducted in a field setting (validation against doubly labelled water), 86 in a laboratory setting (validation against a metabolic cart, metabolic chamber) and 8 in a field and laboratory setting. Correlation coefficients between AM outcomes and energy expenditure (EE) by the criterion method (doubly labelled water and metabolic cart/chamber) and percentage mean differences between EE estimation from the monitor and EE measurement by the criterion method were extracted. Random-effects meta-analyses were performed to pool the results across studies where possible. Types of devices were compared using meta-regression analyses. Most validation studies had been performed in healthy adults (n = 118), with few carried out in patients with chronic diseases (n = 16). For total EE, correlation coefficients were statistically significantly lower in uniaxial compared to multisensor devices. For active EE, correlations were slightly but not significantly lower in uniaxial compared to triaxial and multisensor devices. Uniaxial devices tended to underestimate TEE (-12.07 (95%CI; -18.28 to -5.85) %) compared to triaxial (-6.85 (95%CI; -18.20 to 4.49) %, p = 0.37) and were statistically significantly less accurate than multisensor devices (-3.64 (95%CI; -8.97 to 1.70) %, p

Na+ and K+ are the major extra- and intracellular cations, respectively. We have thus studied the role of these ions on human basophil histamine release by modifying their transmembrane gradients or by increasing membrane ion fluxes using ionophores. 1) When external Na+ (reduced to 4 mM) was replaced by the nonpermeating Na+ substitute N-methyl-D-glucamine, the release of histamine was enhanced in 2 mM Ca2+ (from 37.5 +/- 8.0% in 140 mM Na+ to 68.5 +/- 9.1% in low Na+) and became possible in the presence of low Ca2+ (at 1 microM Ca2+: from 0.6 +/- 0.7% in 140 mM Na+ to 36.2 +/- 8.0% in low Na+); moreover, in low Na+, the release of histamine became partly independent on Ca2+ influx. 2) Increasing the Na+ influx with the cation channel-forming gramicidin D inhibited the release of histamine by 33.2 +/- 13.6% (n = 6) in an external Na(+)-dependent manner. 3) Decreasing K+ efflux using K+ channel blockers (4-aminopyridine, quinine, sparteine) inhibited histamine release in a dose-response manner. 4) The K+ ionophore valinomycin, which increases K+ efflux, slightly enhanced IgE-mediated histamine release when used alone, whereas it potentiated the release of histamine from leukocytes previously treated with 4-aminopyridine by 57.0 +/- 18.6% (n = 7). 5) Decreasing K+ efflux by increasing external K+ inhibited IgE-mediated release in a similar manner as Na+ did. The inhibitory effects of Na+ and high K+ were not additive, thus suggesting that both cations inhibited the release by a common mechanism. In conclusion 1) our data evidence that histamine release from human basophils is inhibited by Na+ influx and potentiated by K+ efflux; 2) they suggest that K+ channels are present on the basophil membrane and that Na+ and K+ fluxes act on histamine release most probably via modulation of membrane potential.

The role of IgG4 antibodies in allergic disorders is suspected. Yet, their presence on human basophil membrane has not been demonstrated and the mechanism of the degranulation induced by anti-IgG4 antibodies remains unclear. As previously reported, we observed that monoclonal anti-IgG4 (10 to 100 micrograms/ml) induced histamine release in the presence of D2O from leukocytes of normal and atopic subjects. The release was accompanied by a decrease of the number of toluidine blue-positive basophils (TB+). Histamine release and TB+ decrease were also observed with lower concentrations of anti-IgG4 (1 to 100 pg/ml). Since basophil activation assessed by TB+ decrease was more sensitive than histamine release, we thus used the former method to further study the mechanisms of the anti-IgG4- vs anti-IgE-induced basophil activation. Basophil activation by anti-IgG4 at 1 to 100 pg/ml, but not by anti-IgG4 at 10 to 100 micrograms/ml or anti-IgE, required the presence of polymorphonuclear cells. Furthermore, anti-IgG4-stimulated purified eosinophils, but not neutrophils, released basophil-activating factors identified as cationic proteins from eosinophils. Thus, the human basophil can be activated by anti-IgG4 via two different mechanisms according to the antibody concentration. At high concentrations (10 to 100 micrograms/ml) basophil activation does not require the presence of polymorphonuclear cells whereas at lower concentrations (1 to 100 pg/ml) the presence of eosinophils is necessary. We propose that in the latter concentration range, basophil activation is a two-step process: 1) release by anti-IgG4 of eosinophil cationic proteins that 2) will, in turn, activate human basophils. This study lends support to the role of IgG4 and eosinophils in anaphylactic reactions.