| 1. |
- Bui, Kim-Ly, et al.
(författare)
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Functional tests in chronic obstructive pulmonary disease part 1 : clinical relevance and links to the International classification of functioning, disability and health
- 2017
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Ingår i: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 14:5, s. 778-784
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Tidskriftsartikel (refereegranskat)abstract
- Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability. A thorough patient-centered outcome assessment, including not only measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity and performance in activities of daily life, is imperative for a comprehensive management of chronic obstructive pulmonary disease. This American Thoracic Society Seminar Series is devoted to help clinicians substantiate their choice of functional outcome measures in this population. In Part 1 of this two-part Seminar Series, we aim to describe the various domains of functional status, to elucidate terms and key concepts intertwined with functioning, and to demonstrate the clinical relevance of assessing functional capacity in the context of activities of daily living, in agreement with the International Classification of Functioning, Disability and Health. We hope that a better understanding of the various defining components of functional status will be instrumental to healthcare providers to optimize chronic obstructive pulmonary disease evaluation and management, ultimately leading to improved quality of life of patients afflicted by this condition. This first paper also serves as an introduction to Part 2 of this Seminar Series, where the main functional tests available to assess upper and lower body functional capacity of these patients will be discussed.
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| 2. |
- Bui, Kim-Ly, et al.
(författare)
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Functional tests in chronic obstructive pulmonary disease part 2 : measurement properties
- 2017
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Ingår i: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 14:5, s. 785-794
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Tidskriftsartikel (refereegranskat)abstract
- Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient-centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity in activities of daily life are necessary. In Part 2 of this Seminar Series, we will discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD, to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving and climbing, as well as carrying, moving and handling objects. We will review the validity, reliability and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences and normative values for these functional tests.
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| 3. |
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| 4. |
- Nyberg, Andre, et al.
(författare)
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Why and How Limb Muscle Mass and Function Should Be Measured in Patients with COPD
- 2015
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Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621. ; 12:9, s. 1269-1277
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Tidskriftsartikel (refereegranskat)abstract
- Impaired limb muscle function is a common occurrence in patients with chronic obstructive pulmonary disease (COPD) and it negatively influences exercise tolerance, quality of life and even survival. Assessment of limb muscle mass and function in COPD is highly encouraged; it should include the quadriceps muscle, but other lower and upper limb muscles may be evaluated to provide valuable information. Quantification of muscle mass as well as assessment of muscle strength and endurance are suggested. Bioelectrical impedance and dual-energy X-ray absorption can be realistically used in the clinical environment to monitor body composition. Although sophisticated computerized dynamometers provide the most accurate assessment, simple exercise and testing equipment are valid alternatives and they should help implementing limb muscle function assessment in clinical settings. Isometric measurements using strain-gauges or hand-held dynamometers should be favored for their simplicity, availability and quality of information provided. This perspective provides a rationale for the evaluation of limb muscle mass and function in COPD in routine clinical practice. Additionally, measurement techniques used to assess limb muscle mass, strength, endurance and fatigue in various clinical settings are discussed.
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| 5. |
- Balcan, Baran, et al.
(författare)
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Continuous Positive Airway Pressure Treatment and Depression in Adults with Coronary Artery Disease and Nonsleepy Obstructive Sleep Apnea. A Secondary Analysis of the RICCADSA Trial
- 2019
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Ingår i: Annals of the American Thoracic Society. - 2325-6621. ; 16:1, s. 62-70
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Obstructive sleep apnea (OSA) and depression are common among adults with coronary artery disease (CAD). OBJECTIVES: To determine the impact of continuous positive airway pressure (CPAP) treatment on depression in adults with CAD and nonsleepy OSA. METHODS: This was a secondary analysis of the RICCADSA (Randomized Intervention with CPAP in CAD and Sleep Apnea) trial, conducted in Sweden between 2005 and 2013. Adults with CAD and nonsleepy OSA (apnea-hypopnea index ≥15/h, and Epworth Sleepiness Scale <10 at baseline) and complete Zung Self-Rating Depression Scale (SDS) questionnaires at baseline, after 3 and 12 months, were included. Participants analyzed in their randomized arm were CPAP (n = 99) or no-CPAP (n = 104). Depression was defined as a Zung SDS score of 50 or greater. The primary outcome was the between-group difference in the absolute change in the SDS score from baseline. RESULTS: No significant between-group differences were observed in SDS scores during follow-up in the entire study sample. Among the 56 participants with an SDS of 50 or greater at baseline (27.6%), the mean (±SD) baseline SDS was 55.0 (±5.5) in the CPAP group, and 53.9 (±4.0) in the no-CPAP group. In the CPAP group, SDS scores decreased at 3 months (47.2 ± 8.2) and 12 months (45.8 ± 7.6), but remained stable in the no-CPAP group at 3 months (53.1 ± 8.0) and 12 months (52.6 ± 8.1) (P = 0.01). The proportion with depression decreased from 30.3% at baseline to 16.2% after 3 months, and to 13.1% after 12 months in the CPAP group, from 25.0% at baseline to 23.1% after 3 months, and to 24.0% after 12 months in the no-CPAP group (P = 0.001). Moreover, there was an association between the duration of CPAP usage (h/night) and the longitudinal decline in SDS score (r = 0.46; P < 0.001). CPAP usage categories (3, 4, and 5 h/night) were significantly associated with improvement in SDS (odds ratio = 3.92, 4.45, and 4.89, respectively) in multivariate analyses adjusted for age, sex, body mass index, left ventricular ejection fraction, apnea-hypopnea index, and Epworth Sleepiness Scale at baseline. CONCLUSIONS: Among adults with depression, nonsleepy OSA, and CAD, 3 months of CPAP treatment improved depression scores. The improvement in mood persisted up to 12 months. An on-treatment adjusted analysis confirmed these findings. Clinical trial registered with www.clinicaltrials.gov (NCT00519597).
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| 6. |
- Ekström, Magnus, et al.
(författare)
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Effects of Opioids on Breathlessness and Exercise Capacity in Chronic Obstructive Pulmonary Disease: A Systematic Review.
- 2015
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Ingår i: Annals of the American Thoracic Society. - 2325-6621.
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Forskningsöversikt (refereegranskat)abstract
- Patients with chronic obstructive pulmonary disease commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD. We aimed to estimate the efficacy and safety of opioids on refractory breathlessness, exercise capacity, and HRQL in COPD.
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| 7. |
- Ikonomou, Laertis, et al.
(författare)
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Translating Basic Research into Safe and Effective Cell-based Treatments for Respiratory Diseases
- 2019
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Ingår i: Annals of the American Thoracic Society. - 2325-6621. ; 16:6, s. 657-668
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Forskningsöversikt (refereegranskat)abstract
- Respiratory diseases, such as chronic obstructive pulmonary disease and pulmonary fibrosis, result in severely impaired quality of life and impose significant burdens on healthcare systems worldwide. Current disease management involves pharmacologic interventions, oxygen administration, reduction of infections, and lung transplantation in advanced disease stages. An increasing understanding of mechanisms of respiratory epithelial and pulmonary vascular endothelial maintenance and repair and the underlying stem/progenitor cell populations, including but not limited to airway basal cells and type II alveolar epithelial cells, has opened the possibility of cell replacement-based regenerative approaches for treatment of lung diseases. Further potential for personalized therapies, including in vitro drug screening, has been underscored by the recent derivation of various lung epithelial, endothelial, and immune cell types from human induced pluripotent stem cells. In parallel, immunomodulatory treatments using allogeneic or autologous mesenchymal stromal cells have shown a good safety profile in clinical investigations for acute inflammatory conditions such as acute respiratory distress syndrome and septic shock. As yet, no cell-based therapy has been shown to be both safe and effective for any lung disease. Despite the investigational status of cell-based interventions for lung diseases, businesses that market unproven, unlicensed and potentially harmful cell-based interventions for respiratory diseases have proliferated in the U.S. and worldwide. The current status of various cell-based regenerative approaches for lung disease as well as the effect of the regulatory environment on clinical translation of such approaches are presented and critically discussed in this review.
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| 8. |
- Krishnan, Jerry A., et al.
(författare)
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Prevalence and characteristics of asthma-chronic obstructive pulmonary disease overlap in routine primary care practices
- 2019
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Ingår i: Annals of the American Thoracic Society. - 2325-6621. ; 16:9, s. 1143-1150
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Adults may exhibit characteristics of both asthma and chronic obstructive pulmonary disease (COPD), a situation recently described as asthma-COPD overlap (ACO). There is a paucity of information about ACO in primary care. Objectives: To estimate the prevalence and describe characteristics of individuals withACOin primary care practices among patients currently diagnosed with asthma, COPD, or both; and to compare the prevalence and characteristics of ACO among the three source populations. Methods: The Respiratory Effectiveness Group conducted a crosssectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in theUKOptimum Patient Care Research Database. Patients were classified into one of three source populations based on diagnostic codes: 1) COPD only, 2) both asthma and COPD, or 3) asthma only.ACOwas defined as the presence of all of the following 1) age ≥40 years, 2) current or former smoking, 3) postbronchodilator airflow limitation (forced expiratory volume in 1 second/ forced vital capacity <0.7), and 4) ≥12% and ≥200 ml reversibility in post-bronchodilator forced expiratory volume in 1 second. Results: Among 2,165 individuals (1,015 COPD only, 395 with both asthma and COPD, and 755 asthma only), the overall prevalence of ACO was 20% (95% confidence interval, 18-23%). Patients with ACO had a mean age of 70 years (standard deviation, 11 yr), 60% were men, 73% were former smokers (the rest were current smokers), and 66% were overweight or obese. Comorbid conditions were common in patients with ACO, including diabetes (53%), cardiovascular disease (36%), hypertension (30%), eczema (23%), and rhinitis (21%). The prevalence of ACO was higher in patients with a diagnosis of both asthma and COPD (32%) compared with a diagnosis of COPD only (20%; P<0.001) or asthma only (14%; P<0.001). Demographic and clinical characteristics of ACO varied across these three source populations. Conclusions: One in five individuals with a diagnosis of COPD, asthma, or both asthma and COPD in primary care settings have ACO based on the Respiratory Effectiveness Group ACO Working group criteria. The prevalence and characteristics of patients with ACO varies across the three source populations.
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| 14. |
- Subbarao, Padmaja, et al.
(författare)
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Multiple-Breath Washout as a Lung Function Test in Cystic Fibrosis. A Cystic Fibrosis Foundation Workshop Report.
- 2015
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Ingår i: Annals of the American Thoracic Society. - 2325-6621. ; 12:6, s. 932-9
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Tidskriftsartikel (refereegranskat)abstract
- The lung clearance index (LCI) is a lung function parameter derived from the multiple-breath washout (MBW) test. Although first developed 60 years ago, the technique was not widely used for many years. Recent technological advances in equipment design have produced gains in popularity for this test among cystic fibrosis (CF) researchers and clinicians, particularly for testing preschool-aged children. LCI has been shown to be feasible and sensitive to early CF lung disease in patients of all ages from infancy to adulthood. A workshop was convened in January 2014 by the North American Cystic Fibrosis Foundation to determine the readiness of the LCI for use in multicenter clinical trials as well as clinical care. The workshop concluded that the MBW text is a valuable potential outcome measure for CF clinical trials in preschool-aged patients and in older patients with FEV1 in the normal range. However, gaps in knowledge about the choice of device, gas, and standardization across systems are key issues precluding its use as a clinical trial end point in infants. Based on the current evidence, there are insufficient data to support the use of LCI or MBW parameters in the routine clinical management of patients with CF.
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| 16. |
- Thunström, Erik, 1980, et al.
(författare)
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Neuroendocrine and Inflammatory Responses to Losartan and Continuous Positive Airway Pressure in Patients with Hypertension and Obstructive Sleep Apnea A Randomized Controlled Trial
- 2016
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Ingår i: Annals of the American Thoracic Society. - 1546-3222 .- 2325-6621. ; 13:11, s. 2002-2011
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Blood pressure reduction in response to antihypertensive agents is less for patients with obstructive sleep apnea (OSA). Increased sympathetic and inflammatory activity, as well as alterations in the renin-angiotensin-aldosterone system, may play a role in this context. Objectives: To address the cardiovascular mechanisms involved in response to an angiotensin II receptor antagonist, losartan, and continuous positive airway pressure (CPAP) as add-on treatment for hypertension and OSA. Methods: Newly diagnosed hypertensive patients with or without OSA (allocated in a 2: 1 ratio for OSA vs. no OSA) were treated with losartan 50 mg daily during a 6-week two-center, open-label, prospective, case-control, parallel-design study. In the second 6-week, sex-stratified, open-label, randomized, parallel-design study, all subjects with OSA continued to receive losartan and were randomly assigned to either CPAP as add-on therapy or to no CPAP (1: 1 ratio for CPAP vs. no CPAP). Study subjects without OSA were followed in parallel while they continued to take losartan. Blood samples were collected at baseline, after 6 weeks, and after 12 weeks for analysis of renin, aldosterone, noradrenaline, adrenaline, and inflammatory markers. Measurements and Main Results: Fifty-four patients with OSA and 35 without OSA were included in the first 6-week study. Losartan significantly increased renin levels and reduced aldosterone levels in the group without OSA. There was no significant decrease in aldosterone levels among patients with OSA. Add-on CPAP treatment tended to lower aldosterone levels, but reductions were more pronounced in measures of sympathetic activity. No significant changes in inflammatory markers were observed following treatment with losartan and CPAP. Conclusions: Hypertensive patients with OSA responded to losartan treatment with smaller reductions in aldosterone compared with hypertensive patients without OSA. Sympathetic system activity seemed to respond primarily to add-on CPAP treatment in patients with newly discovered hypertension and OSA.
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