Exercise prescription for hospitalized people with chronic obstructive pulmonary disease and comorbidities: a synthesis of systematic reviews.

Int J Chron Obstruct Pulmon Dis. 2012;7:297-320

Authors: Reid WD, Yamabayashi C, Goodridge D, Chung F, Hunt MA, Marciniuk DD, Brooks D, Chen YW, Hoens AM, Camp PG

Abstract
INTRODUCTION: The prescription of physical activity for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be complicated by the presence of comorbidities. The current research aimed to synthesize the relevant literature on the benefits of exercise for people with multimorbidities who experience an AECOPD, and ask: What are the parameters and outcomes of exercise in AECOPD and in conditions that are common comorbidities as reported by systematic reviews (SRs)?
METHODS: An SR was performed using the Cochrane Collaboration protocol. Nine electronic databases were searched up to July 2011. Articles were included if they (1) described participants with AECOPD, chronic obstructive pulmonary disease (COPD), or one of eleven common comorbidities, (2) were an SR, (3) examined aerobic training (AT), resistance training (RT), balance training (BT), or a combination thereof, (4) included at least one outcome of fitness, and (5) compared exercise training versus control/sham.
RESULTS: This synthesis examined 58 SRs of exercise training in people with AECOPD, COPD, or eleven chronic conditions commonly associated with COPD. Meta-analyses of endurance (aerobic or exercise capacity, 6-minute walk distance - 6MWD) were shown to significantly improve in most conditions (except osteoarthritis, osteoporosis, and depression), whereas strength was shown to improve in five of the 13 conditions searched: COPD, older adults, heart failure, ischemic heart disease, and diabetes. Several studies of different conditions also reported improvements in quality of life, function, and control or prevention outcomes. Meta-analyses also demonstrate that exercise training decreases the risk of mortality in older adults, and those with COPD or ischemic heart disease. The most common types of training were AT and RT. BT and functional training were commonly applied in older adults. The quality of the SRs for most conditions was moderate to excellent (>65%) as evaluated by AMSTAR scores.
CONCLUSION: In summary, this synthesis showed evidence of significant benefits from exercise training in AECOPD, COPD, and conditions that are common comorbidities. A broader approach to exercise and activity prescription in pulmonary rehabilitation may induce therapeutic benefits to ameliorate clinical sequelae associated with AECOPD and comorbidities such as the inclusion of BT and functional training.

PMID: 22665994 [PubMed - in process]

Physical inactivity and risk of hospitalisation for chronic obstructive pulmonary disease [Review article].

Int J Tuberc Lung Dis. 2012 Jun 5;

Authors: Seidel D, Cheung A, Suh ES, Raste Y, Atakhorrami M, Spruit MA

Abstract
The association between physical activity and risk of hospitalisation for chronic obstructive pulmonary disease (COPD) is not yet clear. We conducted a systematic review of the literature to fill this gap in knowledge. Eight electronic databases were searched using a selection of controlled vocabulary and keywords. The search resulted in more than 1000 initial hits, of which four met the inclusion criteria. For each identified study, relevant data were extracted and appraised. The results indicate that less physically active patients with COPD were more likely to be admitted to hospital. Consistent with a lower level of physical activity, the patients tended to have shorter walking times as well as spend fewer hours outdoors. In multivariate regression analysis, self-reported physical activity predicted hospitalisation in patients from the general population and re-hospitalisation in patients admitted for an acute exacerbation. The evidence for an association between physical activity and risk of hospitalisation for COPD is limited to a few prospective cohort studies. More research is needed to quantify the degree of physical activity associated with reduced risk of hospitalisation.

PMID: 22668830 [PubMed - as supplied by publisher]

Extended NO analysis in health and disease.

J Breath Res. 2012 Jun 7;6(4):047103

Authors: Högman M

Abstract
Extended NO analysis is a promising tool in different diseases where NO metabolism is altered. One single exhalation cannot give insight to the NO production in the respiratory system; rather the use of multiple exhalation flows can give the alveolar levels (C(A)NO), airway wall concentration (C(aw)NO) and the diffusion rate of NO (D(aw)NO). Increased values of C(A)NO are shown in COPD, systemic sclerosis, hepatopulmonary syndrome and in severe asthma. In asthma the C(aw)NO and D(aw)NO are increased leading to an increase in bronchial NO flux (J'(aw)NO). Low levels of J'(aw)NO are seen in cystic fibrosis, primary ciliary dyskinesia and in smoking subjects. More studies are needed to evaluate the clinical usefulness of the extended NO analysis, similar to what has been done in systemic sclerosis where a cut-off value has been identified predicting pulmonary function deterioration.

PMID: 22677778 [PubMed - as supplied by publisher]

Related Articles

Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield.

Respir Med. 2012 May;106(5):710-5

Authors: Lamprecht B, Porsch P, Wegleitner B, Strasser G, Kaiser B, Studnicka M

Abstract
OBJECTIVES: To determine factors associated with diagnostic yield of ENB.
METHODS: In 112 consecutive patients referred to our department between March 2010 and December 2010 the diagnostic work-up for solitary pulmonary lesions included a FDG-PET-CT scan, and ENB in combination with ROSE. The final diagnosis was confirmed by histopathological evaluation of specimen obtained either by ENB, or - if ENB was not diagnostic - by CT-guided fine needle aspiration or surgery.
RESULTS: Thirty-seven (33%) subjects were female, mean age was 66.7 (±1.04) years. The mean diameter of lesions was 27mm (range: 6-46mm). In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis, as defined by the definite histopathological result. 15.2% (17/112) of lesions were benign, and 84.8% (95/112) were malignant. For 112 procedures we observed a steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively. The diagnostic yield in lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively. No significant difference in diagnostic yield was seen depending on lung function, and the localization of the lesions. Two cases (1.8%) of pneumothorax were seen during and up to 24h after bronchoscopy, none of them required a chest tube.
CONCLUSION: Diagnostic yield increased with experience but was independent from the size of the lesion, the localisation in the lungs, and lung function. The diagnostic yield of ENB can be as high as for CT-guided transthoracic biopsies but carries a significantly lower complication rate.

PMID: 22391437 [PubMed - indexed for MEDLINE]