Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease

February 25, 2009

Source: NLH Respiratory Specialist Library -http://www.library.nhs.uk/respiratory

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Year of publication: 2009

In a nutshell: This is a summary of a systematic review from the Cochrane Database of Systematic Reviews 2009, Issue 1

Background – Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. In unstable COPD patients who have suffered from an exacerbation recently, however, the effects of pulmonary rehabilitation are less established.

Objectives – To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other patient-important outcomes (mortality, health-related quality of life and exercise capacity).

Authors’ conclusions – Evidence from small studies of moderate methodological quality suggests that pulmonary rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients after suffering an exacerbation.

Length of Publication: 1 page

Some important notes:   The summary contains a link to the full text of the systematic review [34 page pdf]

Acknowledgements: NLH Respiratory Specialist Library


NHS Lothian Implements Intel’s Personal Health System to Manage Patients with Chronic Conditions

February 25, 2009

Source: EU Ehealth News http://www.ehealthnews.eu

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Year of publication: 2009

In a nutshell: Intel Corporation (NASDAQ: INTC) has announced that its Intel® Health Guide, a care management tool designed for healthcare professionals who manage patients with chronic conditions, is being used in the NHS Lothian telehealth programme.
This 400 unit programme is one of the largest of its kind in the UK and will provide in-home care for patients with chronic obstructive pulmonary disease (COPD) and other chronic conditions.

Length of Publication: 1 page

Some important notes: None

Acknowledgements: None


Incidence and risk factors of exacerbations among COPD patients in primary health care: APMPOC study

February 20, 2009

Source: BMC Public Health, 2009, vol./is. 9/(8), 1471-2458

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Year of publication: 2009

In a nutshell: Background – Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth cause of death. Exacerbations have a negative impact on the prognosis of COPD and the frequency and severity of these episodes are associated with a higher patient mortality. Exacerbations are the first cause of decompensation, hospital admission and death in COPD. The incidence of exacerbations has mainly been estimated in populations of patients with moderate-severe COPD requiring hospital care. However, little is known regarding the epidemiology of exacerbations in patients with less severe COPD forms. It is therefore possible that a high number of these less severe forms of exacerbations are underdiagnosed and may, in the long-term, have certain prognostic importance for the COPD evolution. The aim of this study was to know the incidence and risk factors associated with exacerbations in patients with COPD in primary care.
Methods and design – A prospective, observational, 3-phase, multicentre study will be performed involving: baseline evaluation, follow up and final evaluation. A total of 685 smokers or ex-smokers from 40 to 80 years of age with COPD, without acute respiratory disease or any other long-term respiratory disease will be randomly selected among the population assigned to 21 primary care centres. The diagnosis of COPD and its severity will be confirmed by spirometry. Information regarding the baseline situation, quality of life and exposure to contaminants or other factors potentially related to exacerbations will be collected. A group of 354 patients with confirmed COPD of varying severity will be followed for one year through monthly telephone calls and daily reporting of symptoms with the aim of detecting all the exacerbations which occur. These patients will be evaluated again at the end of the study and the incidence of exacerbations and associated relative risks will be estimated by negative binomial regression.
Discussion – The results will be relevant to provide knowledge about natural history of the initial phases of the COPD and the impact and incidence of the exacerbations on the patients with mild-moderate forms of the disease. These data may be important to know the milder forms of exacerbation wich are often silent or very little expressed clinically.

Length of Publication: 10 page pdf

Some important notes: Free full text available

Acknowledgements: Medline


Reduced risk of next exacerbation and mortality associated with antibiotic use in COPD

February 20, 2009

Source: European Respiratory Journal, February 2009, 33(2) pages 282-8

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Year of publication: 2009

Publication type: Journal article

In a nutshell: The long-term risk of a subsequent exacerbation of chronic obstructive pulmonary disease (COPD) after treatment with oral corticosteroids without (OS) or with antibiotics (OSA) was compared in a historical general practice-based cohort. Eligible patients were >/=50 yrs of age, had a registered diagnosis of COPD, were on maintenance respiratory drugs, and had experienced at least one exacerbation defined as a prescription OS or OSA. Times to second and third exacerbations were assessed using Kaplan-Meier survival analysis; the risk of a subsequent exacerbation was assessed in a Cox proportional hazards analysis; and all-cause mortality was assessed using Kaplan-Meier survival and Cox proportional hazards analyses. A total of 842 patients had one or more exacerbations. The median time from first to second exacerbation was comparable for the OS and OSA groups, but the time from second to third exacerbation differed: 189 versus 258 days, respectively. The protective effect of OSA was most pronounced during the first 3 months following treatment (hazards ratio 0.72, 95% confidence interval 0.62-0.83). Exposure to antibiotics unrelated to a course of oral corticosteroids almost halved the risk of a new exacerbation. Mortality during follow-up was considerably lower in the OSA group. Adding antibiotics to oral corticosteroids was associated with: reduced risk of subsequent exacerbation, particularly in patients with recurrent exacerbations; and reduced risk of all-cause mortality.

Length of publication: 9 pages

Some important notes: You will need an NHS Athens username and password to access this article. If you cannot access the full text, please contact your local NHS library.

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Acknowledgement: MEDLINE


Establishing a health qigong protocol for rehabilitation of patients with COPD

February 20, 2009

Source: International Journal of Therapy & Rehabilitation, 01 January 2009, 16(1) pages 25-33

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Year of publication: 2009

Publication type: Journal article

In a nutshell: This two-phased pilot study intended to validate the potential therapeutic values and applicability of a Health Qigong protocol as an alternative home exercise programme for patients suffering from chronic obstructive pulmonary diseases (COPD), and test its safety before proceeding to a randomized controlled trial. Methods: Eight experts in the area of pulmonary rehabilitation and traditional Chinese medicine were recruited to evaluate the Health Qigong protocol using a questionnaire specifi cally designed for the purpose. The safety of this protocol was then tested among eight participants with COPD in a field test. Safety indicators included physiological parameters, including pulse, blood pressure, oxygen saturation, as well as perceived symptoms. Results: All experts recognized that there were potential benefi ts of the Health Qigong protocol, and made suggestions as to how the protocol could be revised for COPD patients. No serious adverse event was reported in the fi eld test. Conclusions: The Health Qigong protocol is safe when applied to patients with COPD and has potential to be used an adjunct intervention in rehabilitation of COPD. The results support progression to the randomized controlled trial.

Length of publication: 9 pages

Some important notes: You will need an NHS Athens username and password to access this article. If you cannot access the full text, please contact your local NHS library.

Acknowledgement: CINAHL


Occupational exposures and the risk of COPD: Dusty trades revisited

February 20, 2009

Source: Thorax, January 2009, 64(1) pages 6-12

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Year of publication: 2009

Publication type: Journal article

In a nutshell: Workplace exposures are strongly associated with an increased risk of COPD. On a population level, prevention of both smoking and occupational exposure, and especially both together, is needed to prevent the global burden of disease.

Length of publication: 7 pages

Some important notes: You will need an NHS Athens username and password to access this article. If you cannot access the full text, please contact your local NHS library.

Acknowledgement: EMBASE


Clinical digest. Exposure to diesel exhaust increases the risk of COPD

February 20, 2009

Source: Nursing Standard, 14 January 2009, 23(19) page 17

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Year of publication: 2009

Publication type: Journal article

In a nutshell: US railroad workers have been exposed to diesel exhaust since the second world war. A retrospective cohort study examined the association of deaths from COPD and years in diesel-exposed jobs. Data on 30,871 subjects were studied, of whom 21,234 were exposed to diesel exhaust. All were aged 40-60 in 1959 and had ten to 20 years of railroad work. Workers with exposure had an increased risk of COPD mortality relative to those in unexposed jobs. For those hired after the conversion to diesel locomotives began, the association of COPD mortality and years of work was linear. But after approximately nine years, the risk remained steady and then declined. For each additional year of work, the risk of COPD mortality increased by 2.5 per cent. After adjustment for pack-years of smoking and years since quitting, the results were slightly attenuated. For each additional year of work, the smoking-adj usted risk of COPD mortality was 2.1 percent.

Length of publication: 1 page

Some important notes: You will need an NHS Athens username and password to access this article. If you cannot access the full text, please contact your local NHS library.

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Acknowledgement: CINAHL


Respiratory, cardiovascular and other physiological consequences of smoking cessation

February 20, 2009

Source: Current Medical Research & Opinion, February 2009, 25(2) pages 535-45

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Year of publication: 2009

Publication type: Journal article

In a nutshell: Based on the current literature, the beneficial effects of quitting are particularly evident on pulmonary and cardiovascular function, but the negative physiological effects of cessation are less well documented. SCOPE: The objective of this article was to review systematically data on the physiological effects of smoking cessation. Articles based upon clinical trials, randomised controlled trials and meta-analyses were selected from titles and abstracts obtained via a MEDLINE search (May 2003-May 2008). Additional studies were identified from the bibliographies of reviewed literature. FINDINGS: Smoking cessation is associated with improved lung function and a reduction in the presence and severity of respiratory symptoms. These changes, apparent within months of quitting, are sustained with long-term abstinence. The underlying pathophysiologies of smoking-induced airway inflammation and endothelial dysfunction are partially reversed following cessation in healthy ex-smokers, but not in those with chronic obstructive pulmonary disease. Smoking cessation is also associated with substantially improved cardiovascular function and reduced risk of primary and secondary cardiovascular morbidity and mortality. Although the overall long-term health benefits are unquestionable, smoking cessation is also associated with other possible undesirable short-term physiological effects such as weight gain, hypertension, constipation and mouth ulcers; and altered activity of the enzyme cytochrome P450 1A2 (CYP1A2), which metabolises many commonly used drugs. CONCLUSION: The negative physiological effects of smoking cessation may adversely affect a smoker’s attempt to quit, and physicians should provide their smoking patients with motivation and regular encouragement and support when attempting to quit, whilst educating them on the health benefits of abstinence. Additionally, since cigarette smoke is a potent inducer of CYP1A2, patients attempting to quit smoking should have their dosages of drugs metabolised by this enzyme closely monitored.

Length of publication: 10 pages

Some important notes: You will need an NHS Athens username and password to access this article. If you cannot access the full text, please contact your local NHS library.

Acknowledgement: MEDLINE


Prevalence, Incidence, and Lifetime Risk for the Development of COPD in the Elderly: The Rotterdam Study

February 20, 2009

Source: Chest, February 2009, 135(2) pages 368-77

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Year of publication: 2009

Publication type: Journal article

In a nutshell: The overall incidence of COPD in an elderly population is 9.2/1,000 PY, with a remarkably high incidence in the youngest women, suggesting a further shift toward the female sex in the gender distribution of COPD. During their further lives, one of four men and one of six women free of COPD at the age of 55 years will have COPD develop.

Length of publication: 10 pages

Some important notes: You will need an NHS Athens username and password to access this article. If you cannot access the full text, please contact your local NHS library.

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Acknowledgement: MEDLINE


Progression to chronic obstructive pulmonary disease (COPD): Could it be prevented by manual therapy and exercise during the ‘at risk’ stage (stage 0)?

February 20, 2009

Source: Medical Hypotheses, March 2009, 72(3) pages 288-90

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Year of publication: 2009

Publication type: Abstract to journal article

In a nutshell: A number of predisposing factors are recognised as increasing the risk of developing chronic pulmonary obstructive disease (COPD). There is increasing recognition that COPD may be an inflammatory disease with systemic consequences. However, the trigger for the transition from ‘at risk’ (stage 0) to COPD state remains unclear. The current approach to intervention for the ‘at risk’ group is risk factor avoidance. We propose that if interventions shown to improve chronic respiratory symptoms in COPD sufferers could be applied to the ‘at risk’ group, then moderation or even reversal of the changes typical of this transition becomes a possibility. Exercise training has been shown to be beneficial at all stages of COPD. Mobility of the chest wall influences lung function. We hypothesise that the application to ‘at risk’ individuals (stage 0) of therapeutic interventions known to improve chronic respiratory symptoms and cardiovascular function in mild/moderate COPD (stages 1 and 2) could delay progression of the disease (i.e. manifestation of mild/moderate COPD). If the hypothesis were confirmed, the potential to delay or even prevent the onset of COPD would be feasible.

Length of publication: 3 pages

Some important notes: This is an abstract.  To obtain a copy of this article please contact your local NHS library.

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Acknowledgement: MEDLINE


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