Search

Hintergrund: Neben erheblichen körperlichen Einschränkungen leiden Menschen mit interstitiellen Lungenerkrankungen (ILD) häufig unter einer verminderten Lebensqualität und psychischen Begleitphänomenen. Ziel der Arbeit: Im klinischen Alltag wird psychischen Begleiterscheinungen interstitieller Lungenerkrankungen (z. B. Depressivität und Angstsymptomatik) häufig noch wenig Aufmerksamkeit geschenkt, obgleich die Forschung in diesem Bereich in den letzten 10 Jahren kontinuierlich zugenommen hat. Dieser Beitrag soll einen Überblick über die Häufigkeit, das Erscheinungsbild und die Zusammenhänge dieser psychischen Begleiterscheinungen mit dem Krankheitsgeschehen geben. Material und Methoden: Es wurde eine Literaturübersicht erstellt, indem relevante Studien zu Depressivität und Angstsymptomatik bei interstitiellen Lungenerkrankungen durch eine umfangreiche Recherche in der elektronischen Datenbank PubMed identifiziert wurden. Die Suche war auf Beiträge in englischer Sprache aus dem Zeitraum 2008 bis 2023 beschränkt. Ergebnisse: Die Prävalenz von psychischen Begleiterscheinungen bei ILD-Patienten liegt zwischen 14,3 und 31,7 % für moderate bis schwere Depressivität und zwischen 17,6 und 31 % für moderate bis schwere Angstsymptomatik. Diese können eine komplexe Rolle für das Krankheitsgeschehen spielen und sich negativ auf die Lebensqualität auswirken. Diskussion: Die Berücksichtigung von Depressivität und Angstsymptomatik bei der Behandlung von interstitiellen Lungenerkrankungen ist von hoher klinischer Relevanz. Die komplexen Wirkzusammenhänge erfordern weitere Forschungsbemühungen.

RationaleIn patients with COPD, oxygen (O2)-supplementation via a constant flow oxygen system (CFOS) can result in insufficient oxygen saturation (SpO2<90%) during exercise. An automatically titrating O2-system (ATOS) has been shown to be beneficial compared with an untitrated CFOS, however, it is unknown if ATOS is superior to CFOS, titrated during exercise as stipulated by guidelines. The aim was to investigate the effects of ATOS compared with titrated CFOS on walking capacity in people with hypoxaemic COPD.MethodsFifty participants completed this prospective randomised controlled, double-blind, crossover trial. Participants performed two endurance shuttle walk tests (ESWTs) with: (1) exercise titrated CFOS (ESWTCFOS) and (2) ATOS targeting an SpO2of 92% (ESWTATOS). Primary outcome measure was walking time. Secondary measures were SpO2, transcutaneous-PCO2(TcPCO2), respiratory rate (RR), heart rate (HR) at isotime (end of shortest ESWT) with blood gases and dyspnoea at rest and end exercise.ResultsParticipants (median (IQR): age 66 (59, 70) years, FEV128.8 (24.8, 35.1) % predicted, PO254.7 (51.0, 57.7) mm Hg, PCO244.2 (38.2, 47.8) mm Hg) walked significantly longer with ESWTATOSin comparison to ESWTCFOS(median effect (95% CI) +144.5 (54 to 241.5) s, p<0.001). At isotime, SpO2was significantly higher (+3 (95% CI 1 to 4) %, p<0.001) with ATOS while TcPCO2, RR and HR were comparable. End exercise, PO2(+8.85 (95% CI 6.35 to 11.9) mm Hg) and dyspnoea (−0.5 (95% CI −1.0 to −0.5) points) differed significantly in favour of ATOS (each p<0.001) while PCO2was comparable.ConclusionIn patients with hypoxaemia with severe COPD the use of ATOS leads to significant, clinically relevant improvements in walking endurance time, SpO2, PO2and dyspnoea with no impact on PCO2.Trial registration numberNCT03803384.

During exercise, dynamic hyperinflation (DH), measured by a reduction in inspiratory capacity (IC), increases exertional dyspnea and reduces functional capacity in many patients with severe COPD. Although noninvasive ventilation (NIV) during exercise can improve exercise duration, the effect on DH is unclear.

The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory and critical care medicine. This review summarises studies focussing on pulmonary rehabilitation and exercise training, physical activity, chronic respiratory failure and palliative respiratory care published in 2017.

BackgroundThis study aimed to investigate whether adjunctive inspiratory muscle training (IMT) can enhance the well-established benefits of pulmonary rehabilitation (PR) in patients with COPD.Methods219 patients with COPD (FEV1: 42%±16% predicted) with inspiratory muscle weakness (PImax: 51±15 cm H2O) were randomised into an intervention group (IMT+PR; n=110) or a control group (Sham-IMT+PR; n=109) in this double-blind, multicentre randomised controlled trial between February 2012 and October 2016 (ClinicalTrials.gov NCT01397396). Improvement in 6 min walking distance (6MWD) was a priori defined as the primary outcome. Prespecified secondary outcomes included respiratory muscle function and endurance cycling time.FindingsNo significant differences between the intervention group (n=89) and the control group (n=85) in improvements in 6MWD were observed (0.3 m, 95% CI −13 to 14, p=0.967). Patients who completed assessments in the intervention group achieved larger gains in inspiratory muscle strength (effect size: 1.07, p<0.001) and endurance (effect size: 0.79, p<0.001) than patients in the control group. 75 s additional improvement in endurance cycling time (95% CI 1 to 149, p=0.048) and significant reductions in Borg dyspnoea score at isotime during the cycling test (95% CI −1.5 to −0.01, p=0.049) were observed in the intervention group.InterpretationImprovements in respiratory muscle function after adjunctive IMT did not translate into additional improvements in 6MWD (primary outcome). Additional gains in endurance time and reductions in symptoms of dyspnoea were observed during an endurance cycling test (secondary outcome)Trial registration numberNCT01397396; Results.

The acute effect of supplemental oxygen during exercise has been shown to differ largely among patients with COPD. It is unknown what factors influence oxygen response.

Numerous studies have shown the effectiveness of comprehensive pulmonary rehabilitation (PR) programs in chronic obstructive pulmonary disease (COPD). At present, it is uncertain whether PR is also effective in the management of patients with various diseases awaiting lung transplantation (LTx).

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is associated with significant individual and socioeconomic burden. Recent research has begun to acknowledge the important role of psychological factors in the course and management of the disease. Therefore, the present review provides an overview on recent findings on psychological factors in COPD with a specific focus on anxiety and depression.