"The effects of a 'new' walking aid on exercise performance in patients with COPD: A randomized cross-over trial"

Chest. 2011 Nov 23;

Authors: Vaes AW, Annegarn J, Meijer K, Cuijpers MW, Franssen FM, Wiechert J, Wouters EF, Spruit MA

Abstract
ABSTRACTBackgroundGenerally, the use of a rollator improves mobility in patients with COPD. Nevertheless, not all patients benefit from its use and many patients feel embarrassed about its use. Therefore, other walking aids are worthwhile to consider. We compared the direct effects of a 'new' ambulation aid (a modern draisine) to a rollator on six-minute walk distance (6MWD) in COPD.Methods21 patients with COPD performed two 6-minute walk tests (6MWTs) during pre-rehabilitation assessment (best 6MWD: 369±88 m). Additionally, two extra 6MWTs were performed on two consecutive days in random order: 1x with rollator and 1x with modern draisine. Walking pattern (n=21) was determined using an accelerometer and metabolic requirements (n=10) were assessed using a mobile oxycon.ResultsWalking with the modern draisine resulted in a higher 6MWD compared to the rollator (466±189 vs. 383±85 m). Moreover, patients had fewer strides (245±61 vs. 300±49) and a greater stride length (1.89±0.73 vs. 1.27±0.14 m) using the modern draisine compared to the rollator (all: p≤0.001). Oxygen uptake, ventilation, heart rate, oxygen saturation and Borg symptom scores were comparable between both walking aids. Ten percent of the patients felt embarrassed using the modern draisine compared to 19% for rollator; while a significantly smaller proportion of patients would use the modern draisine in daily life.ConclusionThe mean difference in 6MWD between modern draisine and rollator seems clinically relevant, with the same metabolic requirements and symptom Borg scores. Therefore, this 'new' ambulation aid could be a good alternative for the rollator to improve functional exercise performance in patients with COPD.

PMID: 22116797 [PubMed - as supplied by publisher]

Pro-inflammatory phenotype of COPD fibroblasts not compatible with repair in COPD lung.

J Cell Mol Med. 2011 Nov 28;

Authors: Zhang J, Wu L, Qu JM, Bai CX, Merrilees MJ, Black PN

Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by loss of elastic fibers from small airways and alveolar walls, with the decrease in elastin increasing with disease severity. It is unclear why there is a lack of repair of elastic fibers. We have examined fibroblasts cultured from lung tissue from subjects with or without COPD to determine if the secretory profile explains lack of tissue repair. In this study, fibroblasts were cultured from lung parenchyma of patients with mild COPD (GOLD 1, n = 5), moderate-severe COPD (GOLD 2-3, n = 12), and controls (non-COPD, n = 5). Measurements were made of proliferation, senescence-associated beta-galactosidase-1, mRNA expression of IL-6, IL-8, MMP-1, tropoelastin and versican, and protein levels for IL-6, IL-8, PGE(2,) tropoelastin, insoluble elastin, and versican. GOLD 2-3 fibroblasts proliferated more slowly (p<0.01), had higher levels of senescence-associated beta-galactosidase-1 (p<0.001) than controls, and showed significant increases in mRNA and/or protein for IL-6 (p<0.05), IL-8 (p<0.01), MMP-1 (p<0.05), PGE(2) (p<0.05), versican (p<0.05) and tropoelastin (p<0.05). mRNA expression and/or protein levels of tropoelastin (p<0.01), versican (p<0.05), IL-6 (p<0.05) and IL-8 (p<0.05) were negatively correlated with FEV1% of predicted. Insoluble elastin was not increased. In summary, fibroblasts from moderate-severe COPD subjects display a secretory phenotype with up-regulation of inflammatory molecules including the matrix proteoglycan versican, and increased soluble, but not insoluble, elastin. Versican inhibits assembly of tropoelastin into insoluble elastin and we conclude that the pro-inflammatory phenotype of COPD fibroblasts is not compatible with repair of elastic fibers.

PMID: 22117690 [PubMed - as supplied by publisher]

Physical activity monitoring in COPD: Compliance and associations with clinical characteristics in a multicenter study.

Respir Med. 2011 Nov 24;

Authors: Waschki B, Spruit MA, Watz H, Albert PS, Shrikrishna D, Groenen M, Smith C, Man WD, Tal-Singer R, Edwards LD, Calverley PM, Magnussen H, Polkey MI, Wouters EF

Abstract
BACKGROUND: Little is known about COPD patients' compliance with physical activity monitoring and how activity relates to disease characteristics in a multi-center setting. METHODS: In a prospective study at three Northern European sites physical activity and clinical disease characteristics were measured in 134 COPD patients (GOLD-stage II-IV; BODE index 0-9) and 46 controls. Wearing time, steps per day, and the physical activity level (PAL) were measured by a multisensory armband over a period of 6 consecutive days (in total, 144h). A valid measurement period was defined as ≥22 h wearing time a day on at least 5 days. RESULTS: The median wearing time was 142 h:17 min (99%), 141 h:1min (98%), and 142 h:24 min (99%), respectively in the three centres. A valid measurement period was reached in 94%, 97%, and 94% of the patients and did not differ across sites (P = 0.53). The amount of physical activity did not differ across sites (mean steps per day, 4725 ± 3212, P = 0.58; mean PAL, 1.45 ± 0.20, P = 0.48). Multivariate linear regression analyses revealed significant associations of FEV(1), 6-min walk distance, quadriceps strength, fibrinogen, health status, and dyspnoea with both steps per day and PAL. Previously unrecognized correlates of activity were grade of fatigue, degree of emphysema, and exacerbation rate. CONCLUSIONS: The excellent compliance with wearing a physical activity monitor irrespective of study site and consistent associations with relevant disease characteristics support the use of activity monitoring as a valid outcome in multi-center studies.

PMID: 22118987 [PubMed - as supplied by publisher]

Therapeutic potential for novel ultra long-acting β(2)-agonists in the management of COPD: biological and pharmacological aspects.

Drug Discov Today. 2011 Nov 18;

Authors: Malerba M, Radaeli A, Morjaria JB

Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation. In moderate-to-severe COPD, long-acting bronchodilators are the basis of therapy. Inhaled long-acting β(2)-agonists (LABAs) are used for the treatment of COPD. LABAs have been in use since the 1990s enabling persistent bronchodilation for 12 hours; however, sustained bronchodilation is desirable. Compared with twice-daily LABAs, new LABAs with ultra-long duration (ultra-LABAs) could provide improvements in efficacy and compliance with fast onset of action, 24-hour bronchodilation and a good safety profile. Several novel ultra-LABAs showing once-daily delivery profiles are in development. In this article, we discuss these novel agents' properties and clinical trials of their efficacy and safety, including the only licensed ultra-LABA, indacaterol.

PMID: 22119310 [PubMed - as supplied by publisher]