A Longitudinal Study Evaluating the Effect of Exacerbations on Physical Activity in Patients with Chronic Obstructive Pulmonary Disease.

Ann Am Thorac Soc. 2013 Sep 20;

Authors: Ehsan M, Khan R, Wakefield D, Qureshi A, Murray L, Zuwallack R, Leidy NK

Abstract
Background: Physical inactivity is common in stable COPD and independently predicts poor outcomes. Longitudinal assessments of physical activity in outpatients with COPD, covering periods of stability and exacerbations, have not been evaluated previously. Methods: Patients with clinically-stable COPD and a history of 2 or more clinical exacerbations in the preceding 12 months were recruited. Physical activity was measured using a tri-axial accelerometer worn continuously on the non-dominant wrist. Mean minutes per day of higher level physical activity was the primary outcome variable. Symptom-defined exacerbations were assessed using the 14-item Exacerbations of Chronic Pulmonary Disease Tool (EXACT) daily dairy. Clinically-reported exacerbations were also captured. Minutes per day of higher level physical activity during exacerbation and non-exacerbation days were compared using a mixed model analysis. Results: Seventeen patients were followed for 135 ± 18 days. Nine were male with a mean age of 63 ±12 years and mean FEV1 of 52 ± 20 %. Fifteen patients had 27 symptom (EXACT) defined exacerbations, including 9 that were also clinically-reported. Patients spent fewer minutes per day at a higher level physical activity during exacerbation days than non-exacerbation days: 131 ± 14 vs.157 ± 14 minutes, p<0.0001. The greatest reduction in physical activity was during the first week of the exacerbation; activity remained low for approximately 2 weeks after exacerbation resolution. Conclusions: Physical activity decreased significantly during exacerbations. Reduction in activity occurs early during an exacerbation and persists for about 2 weeks following symptomatic recovery.

PMID: 24053416 [PubMed - as supplied by publisher]

Related Articles

Obstructive lung diseases and inhaler treatment: results from a national public pragmatic survey.

Respir Res. 2013 Sep 22;14(1):94

Authors: Braido F, Baiardini I, Sumberesi M, Blasi F, Canonica GW

Abstract
BACKGROUND: The opinions held by the general population on obstructive lung disease and inhaler devices could influence asthma and chronic obstructive pulmonary disorder (COPD) management and treatment adherence.The aim of the present public pragmatic survey was to evaluate the opinions, beliefs and perceptions of Italian people with respect to respiratory diseases as well as their perspectives on the use of inhaler devices.
METHODS: This survey was conducted on a group of 2,008 individuals forming a representative sample of the Italian population aged 15 years and over. It was based on personal interviews that were administered in the homes of the respondents using a structured questionnaire that took approximately 30 minutes.
RESULTS: Awareness of obstructive lung diseases is poor. Asthma, but not COPD, was perceived as a common and increasingly prevalent disease by the majority of the interviewees. Allergy, pollution and smoking were considered to be responsible for both of these diseases. The rates at which the respondents claimed to be suffering from asthma and COPD were lower than expected (4% and 2%, respectively). Inhaled drugs were recognised as the main treatment by 65% of the respondents. The great majority of respondents attributed positive characteristics to the inhaler device (e.g., safety, reliability, effectiveness, ease of use and practicality). Compared to people who have never used inhaler devices, individuals who suffer from asthma or COPD were more confident in their use and showed a greater belief in their safety, reliability and trustworthiness. People older than 64 years showed less attention to the properties of these devices.
CONCLUSIONS: The present results highlight the need for public interventions aimed at improving awareness of obstructive lung disease and reveal various potentialities and critical issues for inhaler device usage. Switching of devices was considered feasible by most of the interviewees, as long as the choice is carefully explained by their physician.

PMID: 24053694 [PubMed - as supplied by publisher]

Related Articles

Infectious Aetiology of Acute Exacerbations in Severe COPD Patients.

J Infect. 2013 Sep 19;

Authors: Domenech A, Puig C, Martí S, Santos S, Fernández A, Calatayud L, Dorca J, Ardanuy C, Liñares J

Abstract
OBJECTIVES: Since the new GOLD guidelines were implemented no data have been published about the etiology of acute exacerbations (AECOPD) in severe COPD patients with a different frequency of annual episodes.
METHODS: One hundred and eleven COPD patients (FEV1<50%) were prospectively followed up for a year. Good-quality sputum samples recovered during AECOPD were processed, including quantitative culture and PCR detection of atypical bacteria.
RESULTS: A total of 188 sputum samples were obtained from AECOPD episodes. Forty patients had a single episode, and 71 patients had ≥2. In 128 episodes a single pathogen was isolated, while 42 episodes were polymicrobial (≥2 pathogens). Overall, the most frequent pathogen isolated was Pseudomonas aeruginosa (n=54), followed by Haemophilus influenzae (n=37), Streptococcus pneumoniae (n=31), Moraxella catarrhalis (n=29) and Staphylococcus aureus (n=12. P. aeruginosa was the most frequent in both groups of patients (35% and 27% in those with 1 and ≥2 AECOPD, respectively). H. influenzae was associated with patients with a single annual AECOPD (33% vs. 16%; P=0.006), while Enterobacteriaceae were associated with frequent exacerbators (0% vs. 12%; P<0.044).
CONCLUSION: Overall, P. aeruginosa was the most frequent pathogen isolated from exacerbations. However, different bacterial etiology was observed depending on the number of annual episodes.

PMID: 24055804 [PubMed - as supplied by publisher]

Chemokines And Chemokine Receptors Blockers As New Drugs For The Treatment Of Chronic Obstructive Pulmonary Disease.

Curr Med Chem. 2013 Sep 13;

Authors: Caramori G, Stefano AD, Casolari P, Kirkham PA, Padovani A, Chung KF, Papi A, Adcock IM

Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by an abnormal inflammatory response of the lung to noxious particles or gases. The cellular inflammatory response in COPD is characterised by an increased number of inflammatory cells in the lungs. Although the molecular and cellular mechanisms responsible for the development of COPD are not well understood; several mediators are assumed to regulate the activation and recruitment of these inflammatory cells into the lung of COPD patients particularly those belonging to the chemokine family. Inhibitors or blockers of chemokine and chemokine receptors are therefore of great interest as potential novel therapies for COPD and many are now in clinical development. A high degree of redundancy exists in the chemokine network and inhibition of a single chemokine or receptor may not be sufficient to block the inflammatory response. Despite this, animal studies suggest a strong rationale for inhibiting the chemokine network in COPD. As such, every leading pharmaceutical company maintains a significant interest in developing agents that regulate leukocyte navigation as potential anti-inflammatory drugs. Drugs and antibodies targeting chemokines and their receptors are generally still in early stages of development and the results of clinical trial are awaited with great interest. These agents may not only provide improved management of COPD but also, importantly, indicate proof-of-concept to further clarify the role of chemokines in the pathophysiology of COPD.

PMID: 24059236 [PubMed - as supplied by publisher]