649 research outputs found
Assessment of the Risk of Severe COPD Exacerbations:Balancing Between Fat and Muscle
No full textSee related article.</p
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
Supplementary_Material - Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease
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Supplementary_Material for Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease by Fiona A H M Cleutjens, Martijn A Spruit, Rudolf W H M Ponds, Lowie E G W Vanfleteren, Frits M E Franssen, Candy Gijsen, Jeanette B Dijkstra, Emiel F M Wouters, and Daisy J A Janssen in Chronic Respiratory Disease
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Combined Exercise Training and Nutritional Interventions or Pharmacological Treatments to Improve Exercise Capacity and Body Composition in Chronic Obstructive Pulmonary Disease:A Narrative Review
No full textChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that is associated with significant morbidity, mortality, and healthcare costs. The burden of respiratory symptoms and airflow limitation can translate to reduced physical activity, in turn contributing to poor exercise capacity, muscle dysfunction, and body composition abnormalities. These extrapulmonary features of the disease are targeted during pulmonary rehabilitation, which provides patients with tailored therapies to improve the physical and emotional status. Patients with COPD can be divided into metabolic phenotypes, including cachectic, sarcopenic, normal weight, obese, and sarcopenic with hidden obesity. To date, there have been many studies performed investigating the individual effects of exercise training programs as well as nutritional and pharmacological treatments to improve exercise capacity and body composition in patients with COPD. However, little research is available investigating the combined effect of exercise training with nutritional or pharmacological treatments on these outcomes. Therefore, this review focuses on exploring the potential additional beneficial effects of combinations of exercise training and nutritional or pharmacological treatments to target exercise capacity and body composition in patients with COPD with different metabolic phenotypes
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
Inhaled corticosteroids in COPD:Friend or foe?
No full textThe efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients (“friend”) but can be ineffective or even associated with undesired side effects, e.g. pneumonia, in others (“foe”). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are >300 cells·µL−1, and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index (BMI), greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL−1. All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.</p
Analysis of retinal blood vessel diameters in patients with COPD undergoing a pulmonary rehabilitation program
No full textBackground: Regular exercise positively affects cardiovascular physiology, translating into the adequate capacity of microvascular blood vessels to dilate in response to acute bouts of exercise. However, this remains unstudied in patients with chronic obstructive pulmonary disease (COPD), who often suffer from cardiovascular comorbidity. Therefore, we studied acute changes in retinal blood vessel diameters in response to high-intensity exercise in patients with COPD. The effect of an exercise-based 8-week pulmonary rehabilitation (PR) program was evaluated. We consider changes in these retinal metrics as an indicator of microvascular reactivity. Methods: Demographics and clinical characteristics of 41 patients were collected at the start and end of the PR program. Patients performed a high-intensity exercise test on a cycle ergometer at the start and end of the PR program, during which we collected retinal images. Fundus images were taken immediately before and 0, 5, 10, 15, and 30 min after the ergometer test. Widths of retinal blood vessels, represented as Central Retinal Arteriolar and Venular Equivalents (CRAE and CRVE), were calculated. Results: Thirty patients with COPD completed the study protocol (57% males; mean age: 64 +/- 7 years; mean FEV1: 45 +/- 17%pred). We did not observe a change in retinal vessel widths following the ergometer test at the start of the PR program. This null result remained at the end of the 8-week PR program. Our observations did not alter when considering responders and non-responders to PR. Conclusion: Retinal blood vessel diameters of patients with COPD did not change following an exercise test on an ergometer. The exercise-based PR program of eight weeks did not counteract the blunted retinal microvascular response
Revision_Online_supplement_FatigueCOPD_Ther_Adv_Resp_Dis_YMJGoertz_3April2019 – Supplemental material for Fatigue is highly prevalent in patients with COPD and correlates poorly with the degree of airflow limitation
No full textSupplemental material, Revision_Online_supplement_FatigueCOPD_Ther_Adv_Resp_Dis_YMJGoertz_3April2019 for Fatigue is highly prevalent in patients with COPD and correlates poorly with the degree of airflow limitation by Yvonne M. J. Goërtz, Martijn A. Spruit, Alex J. Van ‘t Hul, Jeannette B. Peters, Maarten Van Herck, Nienke Nakken, Remco S. Djamin, Chris Burtin, Melissa S. Y. Thong, Arnold Coors, Yvonne Meertens-Kerris, Emiel F. M. Wouters, Judith B. Prins, Frits M. E. Franssen, Jean W. M. Muris, Lowie E. G. W. Vanfleteren, Mirjam A. G. Sprangers, Daisy J. A. Janssen and Jan H. Vercoulen in Therapeutic Advances in Respiratory Disease</p
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