69 research outputs found
Lung Hyperinflation as Treatable Trait in Chronic Obstructive Pulmonary Disease: A Narrative Review
No full textMaud Koopman,1– 3 Rein Posthuma,1– 3 Lowie EGW Vanfleteren,4 Sami O Simons,2,3 Frits ME Franssen1– 3 1Research and Development, Ciro+, Horn, the Netherlands; 2NUTRIM, Institute of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, the Netherlands; 3Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; 4COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, SwedenCorrespondence: Frits ME Franssen, CIRO+, Hornerheide 1, Horn, 6085, NM, the Netherlands, Email [email protected]: Lung hyperinflation (LH) is a common clinical feature in patients with chronic obstructive pulmonary disease (COPD). It results from a combination of reduced elastic lung recoil as a consequence of irreversible destruction of lung parenchyma and expiratory airflow limitation. LH is an important determinant of morbidity and mortality in COPD, partially independent of the degree of airflow limitation. Therefore, reducing LH has become a major target in the treatment of COPD over the last decades. Advances were made in the diagnostics of LH and several effective interventions became available. Moreover, there is increasing evidence suggesting that LH is not only an isolated feature in COPD but rather part of a distinct clinical phenotype that may require a more integrated management. This narrative review focuses on the pathophysiology and adverse consequences of LH, the assessment of LH with lung function measurements and imaging techniques and highlights LH as a treatable trait in COPD. Finally, several suggestions regarding future studies in this field are made.Keywords: COPD, hyperinflation, treatable trait, emphysema, phenotyp
Physiological changes differ between responders and non-responders to pulmonary rehabilitation in COPD
No full textPURPOSE: Not all patients with chronic obstructive pulmonary disease (COPD) experience similar benefits after pulmonary rehabilitation (PR). This pre-post PR study used a large sample of patients with COPD to determine whether PR-induced changes of oxygen uptake (V˙O2) kinetics and exercise responses of V˙O2, carbon dioxide output (V˙CO2), minute ventilation (V˙E), V˙E/V˙CO2, breathing frequency, and tidal volume differed between responders and nonresponders to PR. METHODS: Responders to PR were defined as patients with a minimal clinically important increase in endurance time of 105 s. Isotime (=180 s) values of V˙O2, V˙CO2, V˙E, V˙E/V˙CO2, breathing frequency, and tidal volume; gains of V˙O2, V˙CO2, and V˙E; and V˙O2 mean response time of 183 patients with COPD (forced expiratory volume in 1 s: 56% ± 19% predicted) were compared between pre- and post-PR constant work rate tests. RESULTS: After PR, only the group of responders significantly decreased V˙O2 mean response time (P < 0.05), V˙CO2 gain, V˙E gain, and isotime values of V˙CO2, V˙E, and V˙E/V˙CO2 (all, P < 0.001), while also improving their breathing pattern (e.g., decreased breathing frequency isotime value; P < 0.0001). These changes were not observed in the group of nonresponders. Changes in physiological exercise responses were correlated with changes in physical performance (e.g., correlation between changes in V˙O2 mean response time and endurance time: P = 0.0002, r = -0.32). CONCLUSIONS: PR-induced changes in physiological exercise responses differed between responders and nonresponders. Physiological changes are relevant to explain the variable improvements of physical performance after PR in patients with COPD.sponsorship: This research is part of a PhD research funded by Flemish Institute for Technological Research (VITO), Mol, Belgium. The original study (CHANCE study) was supported by the Lung Foundation Netherlands (3.4.10.015) and GlaxoSmithKline (SCO115406). J. B. acknowledges the support from the European Respiratory Society-ERS Long-Term Research Fellowship 2020, the Spanish Ministry of Science and Innovation through the "Centro de Excelencia Severo Ochoa 2019-2023" Program (CEX2018-000806-S), and the Generalitat de Catalunya through the CERCA Program. These funding organizations only provided financial support and did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to express their gratitude to Miriam Groenen (CIRO, Horn, the Netherlands) for the meticulous data management. (Flemish Institute for Technological Research (VITO), Mol, Belgium, Lung Foundation Netherlands|3.4.10.015, GlaxoSmithKline|SCO115406, European Respiratory Society-ERS Long-Term Research Fellowship 2020, Spanish Ministry of Science and Innovation through the "Centro de Excelencia Severo Ochoa 2019-2023" Program|CEX2018-000806-S, Generalitat de Catalunya through the CERCA Program)status: Publishe
Evaluation of body composition in COPD patients using multifrequency bioelectrical impedance analysis
No full textBackground: Multifrequency bioelectrical impedance analysis (MF-BIA) is a technique that measures body impedance (Z) at different frequencies (5, 10, 50, 100, and 250 kHz). Body composition may be estimated using empirical equations, which include BIA variables or, alternatively, raw BIA data may provide direct information on water distribution and muscle quality. Objectives: To compare raw MF-BIA data between COPD patients and controls and to study their relationship with respiratory and functional parameters in COPD patients. Methods: MF-BIA was performed (Human Im-Touch analyzer) in 212 COPD patients and 115 age-and BMI-matched controls. Fat-free mass (FFM) and fat mass were estimated from BIA data, and low-to high-frequency (5 kHz/250 kHz) impedance ratio was calculated. Physical fitness, lung function and respiratory muscle strength were also assessed in COPD patients. Results: After adjusting for age, weight, and body mass index, FFM and the 5/250 impedance ratio were lower in COPD patients (P<0.001) and were negatively affected by disease severity. In both male and female patients, the 5/250 impedance ratio was significantly correlated mainly with age (r=-0.316 and r=-0.346, respectively). Patients with a 5/250 impedance ratio below median value had lower handgrip strength (P<0.001), 6-minute walk distance (P<0.005), respiratory muscle strength (P<0.005), forced expiratory volume in 1 second (P<0.05) and vital capacity (P<0.005). Finally, the 5/250 impedance ratio was reduced (P<0.05) in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) III and IV (compared to those with GOLD I and II) or a BODE index between 6 and 10 points (compared to those with BODE index between 1 and 5 points). Conclusion: MF-BIA may be a useful tool for assessing body composition and nutritional status in COPD patients. In particular, the impedance ratio could give valuable information on cellular integrity and muscle quality
Correlates of variability in endurance shuttle walk test time in patients with chronic obstructive pulmonary disease
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Domain-specific cognitive impairment in patients with COPD and control subjects
No full textFiona AHM Cleutjens,1 Frits ME Franssen,1 Martijn A Spruit,1 Lowie EGW Vanfleteren,1 Candy Gijsen,1 Jeanette B Dijkstra,2 Rudolf WHM Ponds,2 Emiel FM Wouters,1,3 Daisy JA Janssen1 1Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, 2Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), 3Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands Abstract: Impaired cognitive function is increasingly recognized in COPD. Yet, the prevalence of cognitive impairment in specific cognitive domains in COPD has been poorly studied. The aim of this cross-sectional observational study was to compare the prevalence of domain-specific cognitive impairment between patients with COPD and non-COPD controls. A neuropsychological assessment was administered in 90 stable COPD patients and 90 non-COPD controls with comparable smoking status, age, and level of education. Six core tests from the Maastricht Aging Study were used to assess general cognitive impairment. By using Z-scores, compound scores were constructed for the following domains: psychomotor speed, planning, working memory, verbal memory, and cognitive flexibility. General cognitive impairment and domain-specific cognitive impairment were compared between COPD patients and controls after correction for comorbidities using multivariate linear and logistic regression models. General cognitive impairment was found in 56.7% of patients with COPD and in 13.3% of controls. Deficits in the following domains were more often present in patients with COPD after correction for comorbidities: psychomotor speed (17.8% vs 3.3%; P<0.001), planning (17.8% vs 1.1%; P<0.001), and cognitive flexibility (43.3% vs 12.2%; P<0.001). General cognitive impairment and impairments in the domains psychomotor speed, planning, and cognitive flexibility affect the COPD patients more than their matched controls. Keywords: cognitive domains, cognitive functioning, cognitive impairment, comorbidities, COP
Vitamin D Status and Longitudinal Changes in Body Composition in Patients with Chronic Obstructive Pulmonary Disease – A Prospective Observational Study
No full textMaria Minter,1,2 Jenny van Odijk,1 Hanna Augustin,1 Felipe VC Machado,3,4 Frits ME Franssen,5,6 Martijn A Spruit,5,6 Lowie EGW Vanfleteren1,5 1Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30, Sweden; 2Department of Lung Medicine, Angered Hospital, SV Hospital Group, Angered, 424 22, Sweden; 3Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; 4Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; 5Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; 6Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University Medical Centre+, Maastricht, the NetherlandsCorrespondence: Maria Minter, Department of Lung Medicine, Angered Hospital, SV Hospital Group, Angered, 424 22, Sweden, Email [email protected]: Alterations in body weight and composition are common in patients with chronic obstructive pulmonary disease (COPD) and are independent predictors for morbidity and mortality. Low vitamin D status is also more prevalent in patients with COPD compared to controls and has been related to lower lung function, muscle atrophy and impaired musculoskeletal function. This study aimed to evaluate the association between vitamin D levels and status with body composition (BC), as well as with its changes over time.Patients and Methods: Patients with COPD and controls without COPD, participating in the Individualized COPD Evaluation in relation to Ageing (ICE‐Age) study, a prospective observational study, were included. Plasma 25-hydroxyvitamin D (25(OH)D) was measured at baseline and BC was measured by dual‐energy X‐ray absorptiometry scan, at baseline and after two years of follow-up. Multiple linear regression analyses were performed to assess the relationships between 25(OH)D (nmol/l) and longitudinal changes in BMI, fat-free mass index (FFMI), fat mas index (FMI) and bone mineral density (BMD).Results: A total of 192 patients with COPD (57% males, mean ± SD age, 62 ± 7, FEV1, 49 ± 16% predicted) and 199 controls (45% males, mean ± SD age 61 ± 7) were included in this study. Vitamin D levels were significantly lower in patients with COPD (64 ± 26 nmol/L, 95% CI 60– 68 nmol/L versus 75 ± 25 nmol/L, 95% CI 72– 79 nmol/L) compared to controls. Both patients and controls presented a significant decline in FFMI and T-score hip, but vitamin D level or status did not determine differences in BC or changes in BC over time in either COPD or controls.Conclusion: Vitamin D status was not associated with BC or longitudinal changes in BC. However, vitamin D insufficiency and low BMD were more prevalent in patients with COPD compared to controls.Keywords: chronic obstructive pulmonary disease, body composition, vitamin D, longitudinal changes, fat-free mass, bone mineral densit
Risk of community-acquired pneumonia in chronic obstructive pulmonary disease stratified by smoking status: a population-based cohort study in the United Kingdom
No full textDionne CW Braeken,1–3 Gernot GU Rohde,2 Frits ME Franssen,1,2 Johanna HM Driessen,3–5 Tjeerd P van Staa,3,6 Patrick C Souverein,3 Emiel FM Wouters,1,2 Frank de Vries3,4,7 1Department of Research and Education, CIRO, Horn, 2Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, 3Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, 4Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre (MUMC+), Maastricht, 5Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands; 6Department of Health eResearch, University of Manchester, Manchester, 7MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK Background: Smoking increases the risk of community-acquired pneumonia (CAP) and is associated with the development of COPD. Until now, it is unclear whether CAP in COPD is due to smoking-related effects, or due to COPD pathophysiology itself. Objective: To evaluate the association between COPD and CAP by smoking status. Methods: In total, 62,621 COPD and 191,654 control subjects, matched by year of birth, gender and primary care practice, were extracted from the Clinical Practice Research Datalink (2005–2014). Incidence rates (IRs) were estimated by dividing the total number of CAP cases by the cumulative person-time at risk. Time-varying Cox proportional hazard models were used to estimate the hazard ratios (HRs) for CAP in COPD patients versus controls. HRs of CAP by smoking status were calculated by stratified analyses in COPD patients versus controls and within both subgroups with never smoking as reference. Results: IRs of CAP in COPD patients (32.00/1,000 person-years) and controls (6.75/1,000 person-years) increased with age and female gender. The risk of CAP in COPD patients was higher than in controls (HR 4.51, 95% CI: 4.27–4.77). Current smoking COPD patients had comparable CAP risk (HR 0.92, 95% CI: 0.82–1.02) as never smoking COPD patients (reference), whereas current smoking controls had a higher risk (HR 1.23, 95% CI: 1.13–1.34) compared to never smoking controls. Conclusion: COPD patients have a fourfold increased risk to develop CAP, independent of smoking status. Identification of factors related with the increased risk of CAP in COPD is warranted, in order to improve the management of patients at risk. Keywords: COPD, respiratory infections, incidence, smoking ris
Association between patient-reported outcomes and exercise test outcomes in patients with COPD before and after pulmonary rehabilitation
No full textBackground: Over the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR).Methods: Correlations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory- and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR.Results: Overall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (rho:-0.65;pConclusions: PROs and exercise test outcomes, although significantly correlated with each other, assess different disease features in patients with COPD. Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a PR program.</p
Growth of InGaAs nanowires on Ge(111) by selective-area metal-organic vapor-phase epitaxy
No full textWe report the growth of InGaAs nanowires (NWs) on Ge(111) substrates using selective-area metal-organic vapor-phase epitaxy (SA-MOVPE) for novel InGaAs/Ge hybrid complementary metal-oxide-semiconductor (CMOS) applications. Ge(111) substrates with periodic arrays of mask opening were prepared, and InGaAs was selectively grown on the opening region of Ge(111). A uniform array of InGaAs NWs with a diameter around 100 nm was successfully grown using appropriate preparation of the initial surfaces with an AsH3 thermal treatment and flow-rate modulation epitaxy (FME). We found that optimizing partial pressure of AsH3 and the number of FME cycles improved the yield of vertical InGaAs NWs. Line-scan profile analysis of energy dispersive X-ray (EDX) spectrometry showed that the In composition in the InGaAs NW was almost constant from the bottom to the top. Transmission electron microscope (TEM) analysis revealed that the interface between InGaAs NW and Ge had misfit dislocations, but their distance was longer than that expected from the difference in their lattice constants
The Impact of Post-COVID-19 Syndrome on Self-Reported Physical Activity
No full textBackground: A subgroup of patients recovering from COVID-19 experience persistent symptoms, decreased quality of life, increased dependency on others for personal care and impaired performance of activities of daily living. However, the long-term effects of COVID-19 on physical activity (PA) in this subgroup of patients with persistent symptoms remain unclear. Methods: Demographics, self-reported average time spent walking per week, as well as participation in activities pre-COVID-19 and after three and six months of follow-up were assessed in members of online long-COVID-19 peer support groups. Results: Two hundred thirty-nine patients with a confirmed COVID-19 diagnosis were included (83% women, median (IQR) age: 50 (39-56) years). Patients reported a significantly decreased weekly walking time after three months of follow-up (three months: 60 (15-120) min. vs. pre-COVID-19: 120 (60-240) min./week; p < 0.05). Six months after the onset of symptoms walking time was still significantly lower compared to pre-COVID-19 but significantly increased compared to three months of follow-up (three months: 60 (15-120) min. vs. six months: 90 (30-150) min.; p < 0.05). Conclusions: Patients who experience persistent symptoms after COVID-19 may still demonstrate a significantly decreased walking time six months after the onset of symptoms. More research is needed to investigate long-term consequences and possible treatment options to guide patients during the recovery fromCOVID-19.</p
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