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How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study.

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How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study.

Int J Chron Obstruct Pulmon Dis. 2014;9:257-63

Authors: Apps LD, Harrison SL, Williams JE, Hudson N, Steiner M, Morgan MD, Singh SJ

Abstract
BACKGROUND: There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors.
METHODS: Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia).
RESULTS: Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD.
CONCLUSION: Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients' prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life.

PMID: 24600218 [PubMed - in process]

Sleep hypoventilation and daytime hypercapnia in stable chronic obstructive pulmonary disease.

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Sleep hypoventilation and daytime hypercapnia in stable chronic obstructive pulmonary disease.

Int J Chron Obstruct Pulmon Dis. 2014;9:265-75

Authors: Holmedahl NH, Overland B, Fondenes O, Ellingsen I, Hardie JA

Abstract
PURPOSE: To explore the associations between sleep hypoventilation (SH) and daytime arterial pressures of carbon dioxide (PaCO2), sleep stages, and sleep apneas/hypopneas (AHI) in subjects with chronic obstructive pulmonary disease (COPD). SH has previously been found in COPD-subjects with chronic hypercapnic respiratory failure (CHRF) using supplementary oxygen (LTOT), and has been proposed as a possible predictor for CHRF.
PATIENTS AND METHODS: A prospectively designed observational study in a pulmonary rehabilitation hospital of 100 (39 male) stable COPD inpatients with a mean forced expiratory volume in 1 second (FEV1) of 1.1 L (42% of predicted) and a mean age of 64 years, using polysomnography with transcutaneous measurement of carbon dioxide pressure increase (ΔPtcCO2).
RESULTS: SH as defined by the American Academy of Sleep Medicine (AASM) was found in 15 of the subjects, seven of whom used LTOT. However, six had SH despite being normocapnic during the daytime (only one on LTOT). Subjects with SH had a greater ΔPtcCO2 increase from nonrapid eye movement (NREM) to rapid eye movement (REM) sleep stages compared to non-SH subjects (mean [standard deviation] between-groups difference =0.23(0.20) kPa, P<0.0005). Subjects with apnea/hypopnea index ≥15 (overlap, N=27) did not differ from those with COPD alone (AHI <5, N=25) in sleep ΔPtcCO2 or daytime PaCO2. A regression model with the variables FEV1, LTOT, and sleep maximum ΔPtcCO2 explained 56% of the variance in daytime PaCO2 (F(3, 94) =40.37, P<0.001).
CONCLUSION: In stable COPD, SH as defined by the AASM was found both in normocapnic, non-LTOT subjects and in hypercapnic, LTOT-using subjects. Between-sleep-stage increase in ΔPtcCO2 was higher in subjects with SH. Overlap subjects did not differ from simple COPD subjects in sleep ΔPtcCO2 or daytime PaCO2.

PMID: 24600219 [PubMed - in process]

New developments in the assessment of COPD: early diagnosis is key.

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New developments in the assessment of COPD: early diagnosis is key.

Int J Chron Obstruct Pulmon Dis. 2014;9:277-286

Authors: Csikesz NG, Gartman EJ

Abstract
Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world, and its associated health burdens and costs are mounting. Until recently, it was generally accepted that targeting the diagnosis of COPD early in its course was a relatively fruitless effort, since treatments other than already ubiquitous smoking-cessation efforts were unlikely to alter its course. However, there is strong evidence to suggest that the majority of patients with objective COPD are not aware of their condition, and this leads to a significant delay in diagnosis, more aggressive smoking-cessation intervention, and potential treatment. Novel methods of diagnostic testing, community health programs, and primary-care provider recommendations hold promise to expand the recognition of COPD in its incipient stages - where recent evidence suggests a rapid decline in lung function occurs and may be prevented if acted upon. This review explores the evidence to support the efforts to justify programs aimed at early diagnosis, alternative diagnostic strategies that may augment traditional spirometry, therapeutic modalities that could potentially be used in the future to alter early lung-function decline, and emphasizes the necessary cooperative role that physicians, patients, communities, and governments need to play to realize the significant health impact that stands to be gained.

PMID: 24600220 [PubMed - as supplied by publisher]

HIV in the lung from 1982 to 2013

During the last 30years pulmonary involvement has played a major role in the history of HIV infection. Initially, the unexplained occurrence of pneumocystis revealed the emergence of AIDS and the suspicion of its African origin.

Before the era of triple therapy the natural history of AIDS was dominated by the occurrence of repeated lung infections and respiratory physicians were at the forefront of their diagnosis, treatment and prophylaxis. With the provision of antiretroviral therapy (ART), the natural history of AIDS has been transformed in those patients who benefit from it.

In addition to paradoxical reactions observed following the introduction of ART, the pulmonologist is also facing a chronic stage of controlled HIV infection, and unexpected events, the incidence of which increases with time: pulmonary arterial hypertension and lung cancer certainly, COPD and fibrosis perhaps… but this story remains to be written.

Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program.

There is a wide variability in measurement methodology of physical activity (PA). This study investigated the effect of different analysis techniques on the statistical power of PA outcomes after pulmonary rehabilitation.

METHODS PA was measured in 57 patients with COPD (mean±SD age, 66±7 years; FEV1, 46±17 % predicted) before and after 3 months of pulmonary rehabilitation. The choice of the outcome [steps per day (STEPS), time spent in moderate PA (TMA), mean METs level (METS) and activity time (ACT)], impact of weekends, number of days of assessment, post processing techniques and influence of daylight time (DT) on the sample size to achieve a power of 0.8 were investigated.

RESULTS The number of steps and time in activity (1.6-2.3 METs) were the more sensitive outcomes. Excluding weekends decreased the sample size for STEPS (83 vs. 56), TMA (160 vs. 148) and METS (251 vs. 207). Using 4 weekdays (STEPS and TMA) or 5 weekdays (METS) rendered the lowest sample size. Excluding days with less than 8 hours wearing time reduced the SS for STEPS (56 vs. 51). Differences in DT were an important confounder.

CONCLUSIONS Changes in PA following pulmonary rehabilitation are best measured for 4 weekdays, including only days with at least 8 hours of wearing time (during waking hours) and considering the difference in daylight time as a covariate into the analysis.

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