Search

Introduction: Physical activity (PA) is a significant clinical dimension in COPD, but no useful tools are available to determine this variable in routine clinical practice. Objective: To create a simple, easy-to-use, specific questionnaire to detect PA deficits. Method: A multidisciplinary panel of COPD experts was formed to review PA, its determinants, and measuring methods. The methodology for selecting specific dimensions and items was agreed in rounds, and the aspects to be included in the preliminary version were determined. The questionnaire structure was defined according to applicability of these aspects in clinical practice. Agreements were reached by consensus of the members. Results: A total of 148 items were reviewed, of which only 3 were directly selected. It was decided that the questionnaire should evaluate the intensity (low, moderate, or intense), amount, and frequency of PA, and inactivity or sedentary lifestyles. It also gathers information on the profile of inactive patients, and includes a measure of impact, defined as the patient's perception of their expectations regarding activity, their personal experience, characteristics of their environment, and their personality. The questionnaire is divided into 2 blocks, one aimed at quantifying PA, and the other at collecting data for defining the profile and impact in patients with low PA only. Conclusion: The SAQ-COPD is a simple, short, specific questionnaire, designed to evaluate PA in COPD patients in clinical practice. (C) 2018 SEPAR. Published by Elsevier Espafia, S.L.U. All rights reserved.

Patients with chronic obstructive pulmonary disease (COPD) often suffer episodes of exacerbation (ECOPD) that impact negatively the course of their disease. ECOPD are heterogeneous events of unclear pathobiology and non-specific diagnosis. Network analysis is a novel research approach that can help unravelling complex biological systems. We hypothesised that the comparison of multi-level (i.e., clinical, physiological, biological, imaging and microbiological) correlation networks determined during ECOPD and convalescence can yield novel patho-biologic information. In this proof-of-concept study we included 86 patients hospitalised because of ECOPD in a multicentre study in Spain. Patients were extensively characterised both during the first 72 h of hospitalisation and during clinical stability, at least 3 months after hospital discharge. We found that 1) episodes of ECOPD are characterised by disruption of the network correlation observed during convalescence; and 2) a panel of biomarkers that include increased levels of dyspnoea, circulating neutrophils and C-reactive protein (CRP) has a high predictive value for ECOPD diagnosis (AUC 0.97). We conclude that ECOPD 1) are characterised by disruption of network homeokinesis that exists during convalescence; and 2) can be identified objectively by using a panel of three biomarkers (dyspnoea, circulating neutrophils and CRP levels) frequently determined in clinical practice.

BACKGROUND: COPD is characterized by chronic inflammation. In vitro and ex vivo observations suggest that this inflammatory response is partially resistant to the effect of corticosteroids and that low-dose theophylline can restore this response via enhancement of histone deacetylase (HDAC) activity. Whether this occurs in vivo and what its potential clinical consequences are is unclear. OBJECTIVES: The objective of this trial was to determine whether low-dose theophylline on top of inhaled long-acting beta(2)-agonists and inhaled corticosteroids (ICS) in patients with COPD (1) enhances HDAC activity and the antiinflammatory effects of ICS in vivo, (2) reduces the concentration of inflammatory markers, and (3) reduces exacerbation frequency. METHODS: In this prospective, double-blind, placebo-controlled clinical trial, we randomized patients with COPD (FEV1 < 50% predicted plus at least one hospitalization due to exacerbation in the previous year) to ICS plus theophylline 100 mg bid or matched placebo. We determined the following at baseline and at the end of 52 weeks of follow-up: (1) HDAC activity in blood monocytes and sputum macrophages, (2) the concentration of several inflammatory markers (IL-8, IL-6, IL-1 beta, and tumor necrosis factor - alpha) in serum and sputum supernatant, and (3) the rates of exacerbations and adverse effects. RESULTS: Seventy patients were randomized-36 to theophylline and 34 to placebo. HDAC activity and inflammatory marker levels were not different in the two arms either at baseline or after 52 weeks. Likewise, the rate of exacerbations during follow-up was similar in both groups. CONCLUSIONS: The combination of low-dose oral theophylline and ICS did not enhance the antiinflammatory properties of ICS in vivo or influence exacerbation rate.

The aim of this study was to help orthodontic professionals to measure patient satisfaction objectively within their own clinical setting. We also aimed to share these benchmark data with an international audience. The philosophy of the EURO-QUAL project was adopted, with 18 orthodontists participating in this benchmarking project. We used the STOPS-questionnaire tested on validity between 1998 and 2002. It consisted of 23 statements measuring five dimensions of care and two open questions. Age and gender were collected as demographic data, and the respondents were anonymized. Either the internet or a paper version of the questionnaire was used for data collection. 1,538 patients responded during a 3-month period. When asked about the various dimensions of care, patients expressed satisfaction with the professional competence of their orthodontists and the treatment they received. Patients were least satisfied with the discomfort associated with the treatment and with the appointment procedures. The STOPS-questionnaire was further validated, revealing a Cronbach’s Alpha score of 0.75. Average values for a benchmark were presented. Changes in society are always reflected in health care, therefore knowledge management is important. This study demonstrates a method for gaining explicit knowledge about patient satisfaction, which facilitates practice management and can be done quickly.

This Pulmonary Perspective summarizes the content and main conclusions of an international workshop on personalized respiratory medicine coorganized by the Barcelona Respiratory Network (www.brn.cat) and the AJRCCM in June 2014. It discusses (1) its definition and historical, social, legal, and ethical aspects; (2) the view from different disciplines, including basic science, epidemiology, bioinformatics, and network/systems medicine; (3) the bottlenecks and opportunities identified by some currently ongoing projects; and (4) the implications for the individual, the healthcare system and the pharmaceutical industry. The authors hope that, although it is not a systematic review on the subject, this document can be a useful reference for researchers, clinicians, healthcare managers, policy-makers, and industry parties interested in personalized respiratory medicine. Copyright © 2015 by the American Thoracic Society.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a known risk factor for pulmonary embolism (PE); however, neither the clinical nor the pulmonary function characteristics are well described in COPD patients admitted for PE. Methods: We conducted a retrospective cohort study of 395 patients admitted for acute PE in a tertiary hospital setting. In COPD patients, clinical characteristics and pulmonary function were compared between the survivor and non-survivor groups during a 3-month follow-up period after PE. Results: Thirty-three patients (8.3%) had previously documented diagnoses of COPD with moderate to severe airflow obstruction at least 6 months prior to the development of PE. The total number of deaths after three months of follow-up was 9 (27%) in COPD patients and 65 (17%) in patients without COPD (p = 0.03). PE was the leading cause of death in COPD. Only 15% of COPD patients had previous frequent exacerbations. The diffusion lung capacity for carbon monoxide (DLco, % predicted) was the only statistically significant variable that differed between the survivor and non-survivor groups of COPD patients (p = 0.002). The non- survivor group had decreased DLco values, with a DLco equal to or lesser than 60% being the best predictive value of mortality in these patients (AUC=0.88; p < 0.001). Conclusion: COPD patients admitted for PE presented a higher risk of mortality than non-COPD patients. The COPD patient non- survivor group showed an important reduction of DLco prior to PE development. The degree of airflow obstruction; however, was similar between COPD survivors and non-survivors.

Background and Purpose. The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. Case Description. Four men and 3 women (mean age=50.2 years, SD=6.0, range=41–65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range= 3–12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. Outcomes. After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70–120) to 151 degrees (SD=22, range=110–170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90–145) to 147 degrees (SD=18, range=115–175), and mean lateral rotation increased from 13 degrees (SD=13, range=0–40) to 31 degrees (SD=11, range=15–50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70–125) to 159 degrees (SD=24, range 110–180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95–145) to 154 degrees (SD=19, range=120–180), and mean lateral rotation increased from 21 degrees (SD=11, range=10–45) to 41 degrees (SD=8, range=35–55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6–15) to 15 cc (SD=3, range=10–20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up. Discussion. There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.

A 58-year-old man, who spoke very little Dutch, had various symptoms and used several drugs including simvastatin. He was prescribed itraconazole for onychomycosis. Simvastatin was concurrently replaced with pravastatin to prevent drug interactions. However, the interaction still occurred when the pravastatin ran out, and the patient resumed taking simvastatin on his own initiative. Myalgia and muscle weakness developed after one week. The general practitioner found a strongly elevated creatine kinase level in the blood. The patient required hospitalisation for severe rhabdomyolysis. He was treated with an infusion of an ample quantity of physiological saline solution and made a full recovery. Due to the elevated risk of toxic interactions, doctors should beware of communication problems in complex patients and avoid new prescriptions not strictly required.

The ecological consequence of the effects of different social conditions on the behaviour of females with infants were examined in two different-sized groups of long-tailed macaques (Macaca fascicularis) that inhabited adjacent home ranges in Gunung Leuser National Park in Indonesia. This study aims to test predictions of the “within-group competition/predation avoidance” hypothesis of social organization. Females, particularly those carrying an infant, are considered to experience the most direct effects of environmental constraints on fitness prospects. Data on maintenance behaviour, height in canopy and spatial position were collected for five mothers in a small group and eight mothers in a large group. Comparisons were made on the basis of group size and dominance rank. Mothers from the large group spent less time “feeding” on clumped fruits and more time “foraging” on dispersed food items. Lower-ranking mothers, undergoing the highest rate of within-group competition, foraged most. For macaques in the study area, predation risk is considered to decrease with height in the canopy. Mothers in the small group, assumed to be more susceptible to predation, remained substantially higher in the canopy than mothers in the large group. In both groups, mothers adjusted their height to their spatial position in the group. Lower-ranking mothers were more often found without neighbours, presumably to avoid feeding competition. As a result they stay higher in the canopy than higher-ranking mothers. The results clearly demonstrate that individual females in the same reproductive state and living in the same area, but in different social environments, adapted their behaviour according to the hypothesis.

Background: The mechanisms underlying the benefits of regular physical activity in the evolution of COPD have not been established. Our objective was to assess the relationship between regular physical activity and the clinical and functional characteristics of COPD. Methods: Three hundred forty-one patients were hospitalized for the first time because of a COPD exacerbation in nine teaching hospitals in Spain. COPD diagnosis was confirmed by spirometry under stable conditions. Physical activity before the first COPD hospitalization was measured using the Yale questionnaire. The following outcome variables were studied under stable conditions: dyspnea, nutritional status, complete lung function tests, respiratory and peripheral muscle strength, bronchial colonization, and systemic inflammation. Results: The mean age was 68 years (SD, 9 years), 93% were men, 43% were current smokers, and the mean postbronchodilator FEV1 was 52% predicted (SD, 16% predicted). Multivariate linear regression models were built separately for each outcome variable and adjusted for potential confounders (including remaining outcomes if appropriate). When patients with the lowest quartile of physical activity were compared to patients in the other quartiles, physical activity was associated with significantly higher diffusing capacity of the lung for carbon monoxide (DLCO) [change in the second, third, and fourth quartiles of physical activity, compared with first quartile (+ 6%, + 6%, and + 9% predicted, respectively; p = 0.012 [for trend])], expiratory muscle strength (maximal expiratory pressure [PEmax]) [+ 7%, + 5%, and + 9% predicted, respectively; p = 0.081], 6-min walking distance (6MWD) [+ 40, + 41, and + 45 m, respectively; p = 0.006 (for trend)], and maximal oxygen uptake (Vo(2)peak) [+ 55, + 185, and + 81 mL/min, respectively; p = 0.110 (for trend)]. Similarly, physical activity reduced the risk of having high levels of circulating tumor necrosis factor alpha (odds ratio, 0.78, 0.61, and 0.36, respectively; p = 0.011) and C-reactive protein (0.70, 0.51, and 0.52, respectively; p = 0.036) in multivariate logistic regression. Conclusions: More physically active COPD patients show better functional status in terms of DLCO, PEmax, 6MWD, Vo(2)Peak, and systemic inflammation. (CHEST 2009; 136:62-70)

Mother-infant dyads were studied among wild long-tailed macaques in North Sumatra (Indonesia). The influence of arboreality and mother's immediate activity on physical contact was examined during the first 5 months of infant life. Both factors were found to be contingent on the contact probability. It was suggested that mother long-tailed macaques might intensify protective behaviour when staying high in the canopy to prevent the infant from falling. Though mothers were very rarely observed rejecting their infants, the infants seemed to learn that they could be in or out of contact a particular times depending on their mother's activity. The development of this relationship is suggested to be based upon economical principles.

Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) presentan con frecuencia disfunción de sus músculos esqueléticos, sean respiratorios o localizados en las extremidades. Esta disfunción puede aparecer incluso en fases relativamente precoces y condiciona los síntomas y calidad de vida del paciente. En el caso de los músculos respiratorios, los factores que parecen determinar la disfunción muscular son sobre todo los cambios en la configuración torácica y el desequilibrio entre ofertas energéticas al músculo disminuidas y demandas elevadas. Sin embargo, los músculos respiratorios muestran signos de adaptación estructural y metabólica a dicha situación, compensando parcialmente los efectos deletéreos de los factores antes mencionados. Por su parte, en los músculos de las extremidades, sobre todo de las inferiores, la disfunción parece debida fundamentalmente al decondicionamiento por reducción en la actividad física. Los cambios estructurales en estos músculos son de tipo involutivo. Tanto en los músculos respiratorios como en los periféricos, otros factores como las alteraciones nutricionales, inflamación, estrés oxidativo, determinados fármacos y la presencia de comorbilidad parecen jugar también un papel relevante. Todos ellos condicionarán tanto disfunción como cambios estructurales, que serán heterogéneos para los diferentes grupos musculares en cada paciente. Patients with chronic obstructive pulmonary disease (COPD) frequently have skeletal muscle dysfunction, of either respiratory muscles or those located of the limbs.This dysfunction may appear even at relatively early stages and it conditions symptoms and patient's quality of life. In the case of respiratory muscles, factors that seem to determine muscle dysfunction are, particularly, changes in thorax configuration and an unbalance between decreased energy availability and increased energy demands by the muscle. However, respiratory muscles how signs of structural and metabolic adaptation to this situation, partially compensating the above-mentioned deleterious effects. However, at muscles of the limbs, particularly of the lower limbs, dysfunction seems to be essentially due to deconditioning by physical activity reduction. Structural changes in these muscles are involutional in nature. At both respiratory and peripheral muscles, other factors such as nutritional impairments, inflammation, oxidative stress, some drugs, and the presence of comorbidity seem to play a relevant role. All of them will condition both dysfunction and structuralchanges, which will be heterogeneous for the different muscle groups in each patient.

Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) presentan con frecuencia disfunción de sus músculos esqueléticos, sean respiratorios o localizados en las extremidades. Esta disfunción puede aparecer incluso en fases relativamente precoces y condiciona los síntomas y calidad de vida del paciente. En el caso de los músculos respiratorios, los factores que parecen determinar la disfunción muscular son sobre todo los cambios en la configuración torácica y el desequilibrio entre ofertas energéticas al músculo disminuidas y demandas elevadas. Sin embargo, los músculos respiratorios muestran signos de adaptación estructural y metabólica a dicha situación, compensando parcialmente los efectos deletéreos de los factores antes mencionados. Por su parte, en los músculos de las extremidades, sobre todo de las inferiores, la disfunción parece debida fundamentalmente al decondicionamiento por reducción en la actividad física. Los cambios estructurales en estos músculos son de tipo involutivo. Tanto en los músculos respiratorios como en los periféricos, otros factores como las alteraciones nutricionales, inflamación, estrés oxidativo, determinados fármacos y la presencia de comorbilidad parecen jugar también un papel relevante. Todos ellos condicionarán tanto disfunción como cambios estructurales, que serán heterogéneos para los diferentes grupos musculares en cada paciente.