Related Articles

Coronary artery disease concomitant with chronic obstructive pulmonary disease.

Eur J Clin Invest. 2013 Sep 25;

Authors: Roversi S, Roversi P, Spadafora G, Rossi R, Fabbri LM

Abstract
BACKGROUND: Numerous epidemiologic studies have linked the presence of chronic obstructive pulmonary disease (COPD) to coronary artery disease (CAD). However, prevalence, pathological processes, clinical manifestations and therapy are still debated, as progress towards uncovering the link between these two disorders has been hindered by the complex nature of multimorbidity.
METHODS: Articles targeting CAD in patients with COPD were identified from the searches of MEDLINE and EMBASE databases in July 2013. Three authors reviewed available evidence, focusing on the latest development on disease prevalence, pathogenesis, clinical manifestations and therapeutic strategies. Both clinical trial and previous reviews have been included in this work.
RESULTS: The most accredited hypothesis asserts that the main common risk factors, that is, cigarette smoke and ageing, elicit a chronic low-grade systemic inflammatory response, which affects both cardiovascular endothelial cells and airways/lung parenchyma. The development of CAD in patients with COPD potentiates the morbidity of COPD, leading to increased hospitalizations, mortality and health costs. Moreover, correct diagnosis is challenging and therapies are not clearly defined.
CONCLUSIONS: Evidence from recently published articles highlights the importance of multimorbidity in patient management and future research. Moreover, many authors emphasize the importance of low-grade systemic inflammation as a common pathological mechanism and a possible future therapeutic target.

PMID: 24164255 [PubMed - as supplied by publisher]

An exploration of self-efficacy and self-management in COPD patients.

Br J Nurs. 2013 Oct 23;22(19):1105-9

Authors: Simpson E, C Jones M

Abstract
Aim: This study examined if self-efficacy in managing chronic obstructive pulmonary disease is associated with better mood, less breathlessness and fewer exacerbations; what helps or hinders patients in managing their chronic obstructive pulmonary disease (COPD); and patients' suggestions to improve the self-management support they receive. Background: COPD is the fifth leading cause of death in the UK, and it has been suggested that supporting self-efficacy and self-management could improve patient outcomes and reduce demands for NHS resources. Methods: An exploratory, descriptive survey involving the collection of both quantitative and semistructured qualitative data was chosen. Participants were randomly selected from four GP practices across the north east of Scotland. Results: Higher levels of self-efficacy were associated with lower levels of breathlessness, lower levels of anxiety and lower levels of depression in COPD patients. There was no association between high self-efficacy and exacerbation rates. Conclusion: Increasing self-efficacy and reducing anxiety and depression in patients living with COPD are important focus points for self-management support.

PMID: 24165403 [PubMed - in process]

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The Relationship Between Physical Activity and Metabolic Syndrome in People With Chronic Obstructive Pulmonary Disease.

J Cardiovasc Nurs. 2013 Oct 24;

Authors: Park SK, Larson JL

Abstract
BACKGROUND:: The prevalence of metabolic syndrome has been reported to be 20% to 50% in people with chronic obstructive pulmonary disease (COPD). Because such people are sedentary and physically inactive, they are at risk of metabolic syndrome. The extent of this problem, however, is not fully understood.
OBJECTIVES:: This study examined the relationship of sedentary time and physical activity to metabolic syndrome and the components of metabolic syndrome in a population-based sample of people with COPD.
METHODS:: This was a secondary analysis of existing cross-sectional data. Subjects with COPD (n = 223) were drawn from the National Health and Nutrition Examination Survey data set (2003-2006). Physical activity was measured by accelerometry. Waist circumference, triglyceride level, high-density lipoprotein cholesterol level, blood pressure, and fasting glucose level were used to describe metabolic syndrome. Descriptive and inferential statistics were used for analysis.
RESULTS:: Fifty-five percent of the sample had metabolic syndrome. No significant differences in sedentary time and level of physical activity were found in people with COPD and metabolic syndrome and people with COPD only. However, those with a mean activity count of greater than 240 counts per minute had a lower prevalence of metabolic syndrome. Waist circumference and glucose level were significantly associated with the time spent in sedentary, light, and moderate to vigorous physical activity.
CONCLUSION:: Metabolic syndrome is highly prevalent in people with COPD, and greater physical activity and less sedentary time are associated with lower rates of metabolic syndrome. This suggests that interventions to decrease the risk of metabolic syndrome in people with COPD should include both reducing sedentary time and increasing the time and intensity of physical activity.

PMID: 24165700 [PubMed - as supplied by publisher]

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Pharmacokinetics and pharmacodynamics of tiotropium solution and tiotropium powder in chronic obstructive pulmonary disease.

J Clin Pharmacol. 2013 Oct 25;

Authors: Hohlfeld J, Sharma A, van Noord J, Cornelissen P, Derom E, Towse L, Peterkin V, Disse B

Abstract
Aim of the study was to characterise pharmacokinetics of tiotropium solution 5µg compared to powder 18µg and assess dose-dependency of tiotropium solution pharmacodynamics in comparison to placebo. In total 154 patients with chronic obstructive pulmonary disease (COPD) were included in this multicenter, randomized, double-blind within-solution (1.25, 2.5, 5µg, and placebo) and open-label powder 18µg, crossover study, including 4-week treatment periods. Primary endpoints were peak plasma concentration (Cmax,ss ), and area under the plasma concentration-time profile (AUC0-6h,ss ), both at steady state. The PD response was assessed by serial spirometry (forced expiratory volume in 1 second/forced vital capacity). Safety was evaluated as adverse events and by electrocardiogram/Holter. Tiotropium was rapidly absorbed with a median tmax,ss of 5 to 7 minutes postdosing for both devices. The gMean ratio of solution 5µg over powder 18µg was 81% (90% confidence interval, 73-89%) for Cmax,ss and 76% (70-82%) for AUC0-6h,ss , indicating that bioequivalence was not established. Dose ordering for bronchodilation was observed. Powder 18µg and solution 5µg were most effective, providing comparable bronchodilation. All treatments were well tolerated with no apparent relation to dose or device. Comparable bronchodilator efficacy to powder18µg at lower systemic exposure supports tiotropium solution 5µg for maintenance treatment of COPD.

PMID: 24165906 [PubMed - as supplied by publisher]