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Effects of Depression Diagnosis and Antidepressant Treatment on Mortality in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease.

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Effects of Depression Diagnosis and Antidepressant Treatment on Mortality in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease.

J Am Geriatr Soc. 2013 Apr 25;

Authors: Qian J, Simoni-Wastila L, Langenberg P, Rattinger GB, Zuckerman IH, Lehmann S, Terrin M

Abstract
OBJECTIVES: To estimate the effects of depression diagnosis and antidepressant treatment on 2-year all-cause mortality in Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) and determine whether Social Security Disability Insurance (SSDI) eligibility modifies these relationships. DESIGN: Retrospective cohort study. SETTING: A 5% random sample of Medicare beneficiaries aged 65 and older in stand-alone Part D plans in 2006 to 2008. PARTICIPANTS: Beneficiaries diagnosed with COPD and continuously enrolled in Medicare Parts A, B, and D (N = 75,699). MEASUREMENTS: Depression diagnosis was assessed at baseline (2006). Evidence of antidepressant treatment was measured across time. Covariates included baseline characteristics, comorbidities, and disease severity. Survival analyses using Cox proportional hazards models estimated 2-year mortality associated with depression diagnosis or antidepressant treatment (in beneficiaries with depression). Interaction terms of SSDI eligibility with baseline depression and time-dependent antidepressant treatment were tested. RESULTS: More than one-fifth (21.6%) of beneficiaries with COPD had a depression diagnosis at baseline, and 82.1% of those received antidepressants. Nearly one-sixth (16.3%) of the sample were SSDI eligible. Baseline depression heightened risk of death (hazard ratio = 1.13, 95% confidence interval = 1.09-1.18) in beneficiaries who were not eligible for SSDI. In beneficiaries with depression, the association between antidepressant treatment and lower mortality was different according to SSDI eligibility status. CONCLUSION: Social Security Disability Insurance eligibility modifies the effects of depression and antidepressant treatment on mortality in Medicare beneficiaries with COPD. These data suggest that clinicians should identify and treat depression in individuals with COPD, but further studies are needed to determine the effect of these interventions.

PMID: 23617752 [PubMed - as supplied by publisher]

Serial Changes in Pulmonary Function after Video-Assisted Thoracic Surgery Lobectomy in Lung Cancer Patients.

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Serial Changes in Pulmonary Function after Video-Assisted Thoracic Surgery Lobectomy in Lung Cancer Patients.

Thorac Cardiovasc Surg. 2013 Apr 25;

Authors: Seok Y, Jheon S, Cho S

Abstract
Background The aim of this study is to evaluate the serial changes in pulmonary function and the recovery time for the observed postoperative values to reach the predicted postoperative values after video-assisted thoracic surgery (VATS) lobectomy for lung cancer.Patients and Methods Patients undergoing VATS lobectomy for lung cancer were prospectively evaluated using complete preoperative and repeated postoperative pulmonary function tests (PFTs). The parameters of PFT at each time were compared according to the resected lobe as well as the presence of chronic obstructive pulmonary disease (COPD). The differences between the observed and predicted postoperative values of PFT and the recovery time for the observed values to reach the predicted values were calculated.Results Seventy-two patients (33 men, 39 women; mean age: 63.9 years) received complete pre- and postoperative regular PFT after undergoing VATS lobectomy. Of these patients, 24 (33.3%) patients satisfied the criteria for COPD. During the immediate postoperative period, forced vital capacity (FVC) percentage of the patients who received right lower lobectomy patients was decreased most significantly compared with the preoperative values. Compared with the upper lobectomy (UL) group, the lower lobectomy (LL) group showed a significant decrease of FVC% up to 6 months. However, there was no significant difference at 12 months after surgery. Patients with COPD showed little reduction of FEV1% that persisted significantly until 1 month after the surgery in both UL and LL groups. The recovery time was shortest in the left lower lobectomy patients, and it was shorter in the LL group than in the UL group.Conclusions Postoperative pulmonary function and recovery time were different depending on the lobe resected and presence of COPD in VATS lobectomy patients. The information obtained from postoperative serial PFT would help accurately predict postoperative pulmonary function changes and recovery time after VATS lobectomy for lung cancer.

PMID: 23619593 [PubMed - as supplied by publisher]

The physiological Basis of Rehabilitation in Chronic Heart and Lung Disease.

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The physiological Basis of Rehabilitation in Chronic Heart and Lung Disease.

J Appl Physiol. 2013 Apr 25;

Authors: Vogiatzis I, Zakynthinos SG

Abstract
Cardiopulmonary rehabilitation is recognized as a core component of management of individuals with Congestive Heart Failure (CHF) or Chronic Obstructive Pulmonary Disease (COPD) which is designed to improve their physical and psychosocial condition without impacting on the primary organ impairment. This has lead scientific community increasingly to believe that the main effects of cardiopulmonary rehabilitative exercise training are focused on skeletal muscles that are regarded as dysfunctional in both CHF and COPD. Accordingly, following completion of a cardiopulmonary rehabilitative exercise training program there are important peripheral muscular adaptations in both disease entities namely, increased capillary density, blood flow, mitochondrial volume density, fiber size, distribution of slow twitch fibers, and decreased lactic acidosis and vascular resistance. Decreased lactic acidosis at a given level of sub-maximal exercise not only offsets the occurrence of peripheral muscle fatigue leading to muscle task failure and muscle discomfort, but also concurrently mitigates the additional burden on the respiratory muscles caused by the increased respiratory drive, thereby reducing dyspnea sensations. Furthermore in patients with COPD, exercise training reduces the degree of dynamic lung hyperinflation leading to improved arterial oxygen and central hemodynamic responses, thus increasing systemic muscle oxygen availability. In patients with CHF, exercise training has beneficial direct and reflex sympathoinhibitory effects, as well as favorable effects on normalization of neurohumoral excitation. These physiological benefits apply to all COPD and CHF patients independently of the degree of disease severity and are associated with improved exercise tolerance, functional capacity and quality of life.

PMID: 23620491 [PubMed - as supplied by publisher]

Hospitalization with acute exacerbation of chronic obstructive pulmonary disease and associated health resource utilization: A population-based Danish cohort study.

Hospitalization with acute exacerbation of chronic obstructive pulmonary disease and associated health resource utilization: A population-based Danish cohort study.

J Med Econ. 2013 Apr 29;

Authors: Johannesdottir S, Christiansen C, Johansen M, Olsen M, Xiao X, Parker J, Molfino N, Lash T, Fryzek J

Abstract
Abstract Objective: Health resource utilization (HRU) and outcomes associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are not well described. We therefore conducted a population-based cohort study to characterize patients hospitalized with AECOPD with regard to HRU, mortality, recurrence, and predictors of readmission with AECOPD. Methods: Using Danish healthcare databases, we identified COPD patients with at least one AECOPD hospitalization between 2005 and 2009 in Northern Denmark. We characterized hospitalized AECOPD patients' HRU, in-hospital mortality, 30-day, 60-day, 90-day, and 180-day post-discharge mortality and recurrence risk, and predictors of readmission with AECOPD in the year following study inclusion. Results: We observed 6,612 AECOPD hospitalizations among 3,176 prevalent COPD patients. Among all AECOPD hospitalizations, median length of stay was 6 days (interquartile range [IQR] 3-9 days); 5 days (IQR 3-9) among those without ICU stay and 11 days (IQR 7-20) among the 8.6% admitted to the ICU. Mechanical ventilation was provided to 193 (2.9%) and non-invasive ventilation to 479 (7.2%) admitted patients. In-hospital mortality was 5.6%. Post-discharge mortality was 4.2%, 7.8%, 10.5%, and 17.4% at 30, 60, 90, and 180 days, respectively. Mortality and readmission risk increased with each AECOPD hospitalization experienced in the first year of follow-up. Readmission at least twice in the first year of follow-up was observed among 286 (9.0%) COPD patients and was related to increasing age, male gender, obesity, asthma, osteoporosis, depression, myocardial infarction, diabetes I and II, any malignancy, and hospitalization with AECOPD or COPD in the prior year. Limitations: The study included only hospitalized AECOPD patients among prevalent COPD patients. Furthermore, we lacked information on clinical variables. Conclusion: These findings indicate that AECOPD hospitalizations are associated with substantial mortality and risk of recurrence.

PMID: 23621504 [PubMed - as supplied by publisher]

Vascular responsiveness in patients with chronic obstructive pulmonary disease (COPD).

Ischemic heart disease and peripheral vascular diseases are prevalent in COPD and it is estimated that any 10% decrease in forced expiratory volume in 1second (FEV1) is associated with 30% increased cardiovascular risk of death. Endothelial dysfunction may be one of the mechanistic pathways that link between COPD and cardiovascular mortality. Our aim was to study the vascular reactivity of patients with stable COPD and to try to correlate endothelial dysfunction, vascular reactivity and functional capacity of these patients that eventually may lead to cardiovascular mortality.

METHODS: This was a prospective study. Twenty-three consecutive ambulatory COPD patients were enrolled. All were smoking men, aged 64.4±8.4years. Twenty-two healthy volunteers aged 44.7±11.7years, BMI of 25.2±4.2, height of 172±8cm served as the control group. Vascular studies included endothelial function and ankle brachial index.

RESULTS: Baseline diameter of the brachial artery was larger in COPD patients compared with controls. The absolute change in diameter post hyperemia was significantly less in patients (0.004±0.02cm vs. 0.05±0.02cm, p<0.001) and COPD patients responded to hyperemia by constriction instead of dilatation (FMD% was -0.6±6.3% in patients vs. 15.6±7.6% in controls, p<0.001). There was no difference in ABI in patients and controls (0.95±0.26 vs. 1.06±0.16, p=0.07).

DISCUSSION: We found that patients with COPD have dilated arteries, have impaired ability to respond to high shear stress that triggers nitric oxide dependent flow mediated dilatation, and have also impaired ability to function - represented by the poor 6minute walk test.

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