Chronic Obstructive Pulmonary Disease Symptoms Research Articles

Emotional Distress and Physical Activity Engagement in U.S. Veterans With Chronic Obstructive Pulmonary Disease: A Qualitative Study.

Physical activity is recommended as part of guideline-based care for managing chronic obstructive pulmonary disease (COPD) at all stages of the disease. However, physical activity interventions are less effective in individuals with co-occurring emotional distress (i.e., depression and/or anxiety symptoms). Interventions that dually promote improved physical and mental health in COPD are needed. The first step for intervention development is understanding individuals' experience of these factors. To understand the experience of emotional distress in U.S. Veterans diagnosed with COPD and to explore how emotional distress impacts physical activity engagement. Structured interviews informed by the cognitive and behavioral models of psychopathology were conducted with 29 United States Veterans with COPD (89.66% male, age 67.72 ± 6.55 years, 93.10% White) at the VA Boston Healthcare System. Interviews were audio recorded, transcribed, and underwent thematic analysis. Three major themes encapsulating 17 codes emerged through thematic analysis: (i) the experience of emotional distress in Veterans with COPD; (ii) the complex relationship between emotional distress, physical activity engagement, and COPD; (iii) contextual and personal factors. Veterans' interpretation of their COPD symptoms as unpredictable and uncontrollable and COPD-related physical limitations influenced their experience of emotional distress, while the experience of emotional distress both promoted and deterred physical activity engagement. Veterans were motivated to engage in physical activity despite experiencing emotional distress when they faced a responsibility in daily life. They identified motivational strategies and self-regulation techniques to manage emotional distress and to foster physical activity.

Knowledge of Undergraduate Students About Chronic Obstructive Pulmonary Disease in King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Aims Chronic obstructive pulmonary disease (COPD) is one of the most common causes of death worldwide. This study assesses the level of knowledge about COPD among undergraduate students that makes it different from other respiratory illnesses. Methods A cross-sectional study was conducted among undergraduate students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). The Bristol Chronic obstructive pulmonary disease Knowledge Questionnaire (BCKQ) was used to evaluate the knowledge about COPD, epidemiology, symptoms, exercise, smoking, and breathlessness domains. The questionnaire was distributed among the different male colleges. Results There were 304 respondents from five colleges. The overall BCKQ mean score was 15.16±4.52 (maximum 30). The mean score was highest for the Colleges of Pharmacy (18.89±2.17) and Medicine (18.00±3.84), and the College of Science and Health Professions had the lowest score (11.56±5.58). The highest overall means for the different domains (max=5) were for smoking (2.19±1.2), and epidemiology (2.83±1.27), while symptoms of COPD (2.23±1.06) and breathlessness (1.96±1.13) were the lowest among the domains. Conclusions There was a low level of understanding among undergraduate students in general, but the Colleges of Medicine and Pharmacy had better knowledge. On the other hand, the College of Science and Health Professions had a lower score. This indicates some areas for improvement in the education program. Appropriate development in the education program is recommended, such as increasing the awareness of symptoms of COPD and other aspects of the disease.

Improving patient education in hospitalized patients with chronic obstructive pulmonary disease: A quality improvement initiative using LEAN methodology.

Chronic obstructive pulmonary disease (COPD) is a costly chronic disease affecting more than 15 million Americans. The prevalence among US veterans is 3 times higher than the general population. The Veteran Health Administration developed a standardized, evidence-based COPD educational tool called Green Light to Go (GLTG) designed to educate patients on managing their COPD symptoms at home. Despite the availability of this resource, inpatient education on COPD self-management practices is highly variable across different medical teams. This quality improvement (QI) initiative sought to standardize inpatient COPD patient education using the GLTG tool. This initiative also assessed whether patients receiving standardized patient education during their index hospitalization had lower COPD 30-day readmission rates. The QI initiative followed the LEAN methodology and the A3 framework. The team performed rapid tests of change (plan-do-study-act cycles) to increase the percentage of veterans receiving COPD education. The interventions implemented for this QI initiative focused on clinical, patient, and system improvements. This initiative standardized COPD patient education and increased the percentage of veterans receiving (a) daily COPD education from 0% to 66%, (b) verbal COPD education on discharge from a baseline of 20% to 100%, (c) receipt of written educational material on discharge from 20% to 100%, and (d) the cohort all-cause 30-day readmission rate declined from 19.3% to 14.3%. Given the substantial economic burden of COPD readmissions on the health care system and patients, evidence-based educational interventions may potentially improve outcomes and reduce hospital readmissions in this veteran population.

AERIFY-1/-2: 2 phase 3 randomised controlled trials of itepekimab in former smokers with moderate-to-severe COPD

BackgroundAccumulating data implicate interleukin (IL)-33, a proinflammatory cytokine released locally upon epithelial cell damage, in the pathogenesis of chronic obstructive pulmonary disease (COPD). In a phase 2 study, itepekimab, a human monoclonal antibody against IL-33, reduced exacerbations and improved lung function in a subgroup analysis of former smokers with COPD with an acceptable safety profile.MethodsThe study designs of AERIFY-1 and AERIFY-2 are described in this article.Results and conclusion:The primary objective of AERIFY-1/2 (NCT04701983/NCT04751487), two phase 3 randomized, double-blind, placebo-controlled trials, is to assess the efficacy and safety of itepekimabversusplacebo in a population of former smokers with moderate-to-severe COPD over up to 52 weeks. An additional secondary population of current smokers are being enrolled in AERIFY-2. These two studies will enrol patients (aged 40–85 years) with COPD and chronic bronchitis who had ≥2 moderate or ≥1 severe exacerbations within the previous year despite standard-of-care triple or double background therapy. All participants are required to have ≥10-pack year smoking history, and ≥6 months since smoking cessation for former smokers. The primary endpoint is the annualized rate of moderate or severe acute exacerbation of COPD. Secondary endpoints include change from baseline in pre- and post-bronchodilator FEV1, and annualized frequency of severe exacerbations. Symptomatic endpoints include Evaluating Respiratory Symptoms in COPD, and St. George's Respiratory Questionnaire, safety and anti-drug antibody responses.

Combating With COPD by QiGong Physical and Mental Exercise.

Physical activity levels of patients with chronic obstructive pulmonary disease (COPD) are low due to the symptoms of COPD. The patients diagnosed with COPD are headed for complementary and alternative treatments to reduce the COPD symptoms, facilitate the treatment, and increase their physical activity. One of these treatments is QiGong, which is not yet common in our country. QiGong is a type of exercise based on ancient Chinese medicine, and mainly consists of active and passive exercises. These exercises open energy channels in the body, and thus prevent and/or heal diseases by establishing energy balance in the body through meditation, breath control, and bodily exercises. According to a literature review abroad, there are a small number of scientific studies related the therapeutic effect of QiGong exercises on symptom control, anxiety, reduction of stress and depression, increase in physical activity and quality of life, and the development of lung function of patients with COPD. By considering the educative role of nurses, it is important that the nurse has adequate knowledge of the treatment and care of patients with COPD. Therefore, this review is compiled to be informative about the effects of QiGong in the treatment of COPD, and assistance to subsequent studies.

ZC3H13 promotes ITGA6 m6A modification for chronic obstructive pulmonary disease progression

Chronic obstructive pulmonary disease (COPD) is potentially fatal, and as society ages, its effects on human health are predicted to deteriorate. The potential function of m6A modifications within COPD has become a hot topic recently. This study was conducted to clarify the function and related mechanisms of the m6A methylation transferase ZC3H13 in COPD. The expression of m6A-associated protease and ITGA6 in COPD tissues was assessed using GEO data, qRT-PCR, and western blot. COPD models in cells and mice were established through cigarette smoke extract (CSE) and smoke exposure. Inflammatory marker levels were measured by ELISA, apoptosis by flow cytometry, and mRNA stability with Actinomycin D assay. m6A modification levels were checked by MeRIP-PCR. HE and Masson staining evaluated lung pathology, and alveolar lavage fluid analysis included total cell count and Giemsa staining. ZC3H13 and METTL3 were differentially expressed m6A regulators in COPD, with ZC3H13 being more significantly upregulated. Further analysis revealed the ZC3H13 expression-related differentially expressed genes (DEGs) functions were enriched in the immunoinflammatory pathway, indicating ZC3H13's involvement in COPD pathogenesis through inflammation, and immune responses. Knockdown studies in cellular and mouse models demonstrated ZC3H13's role in exacerbating COPD symptoms, including inflammation, apoptosis, and EMT, and its suppression led to significant improvements. The identification of ITGA6 as a target gene further elucidated the mechanism, showing that ZC3H13 enhances ITGA6 expression and mRNA stability through m6A modification, influencing bronchial epithelial cell inflammation and fibrosis. In conclusion, targeting ZC3H13/ITGA6 could be an underlying therapeutic approach for treating COPD.

Effects and long-term outcomes of endurance versus resistance training as an adjunct to standard medication in patients with stable COPD: a multicenter randomized trial

BackgroundComparisons between endurance training (ET) and resistance training (RT) have produced equivocal findings in chronic obstructive pulmonary disease (COPD) patients. The purpose of our study is to investigate the effectiveness and long-term outcomes of adding ET and RT to conventional medical treatment in patients with COPD. A secondary objective is to investigate the clinical improvements resulting from exercise training in patients with different disease severities.MethodsThe study was a multicenter, prospective trial in people with stable COPD. The cohort was randomized to three groups: individualized medical treatment group (MT), MT + endurance training group (MT + ET) and MT + resistance training group (MT + RT). Exercise was performed 3 times weekly over a 12-week period. The endpoints of exercise capacity, health-related quality of life, COPD symptoms, lung function, and anxiety and depression questionnaires were re-evaluated at baseline, at the completion of the intervention and at 6 and 12-month follow-up. According to the COPD assessment tool offered by GOLD guidelines, patients were stratified into GOLD A and B groups and GOLD C and D groups for further subgroup analysis.ResultsThe intention-to-treat (ITT) population included 366 patients, 328 of them completed the study protocol over 12 months (the PP-population). There were no significant differences in the primary outcome, quality of life, between patients who underwent medical treatment (MT) alone, MT + endurance training (MT + ET), or MT + resistance training (MT + RT) at the completion of the intervention, 6-, or 12-month follow-up. Additionally, no significant differences were observed between MT, MT + RT, or MT + ET groups concerning the primary outcome, exercise capacity (3MWD), after initial 3 months of intervention. However, a small statistically significant difference was noted in favor of MT + ET compared to MT + RT at 12 months (ITT: Δ3MWD in ET vs RT = 5.53 m, 95% confidence interval: 0.87 to 13.84 m, P = 0.03) (PP: Δ3MWD in ET vs RT = 7.67 m, 95% confidence interval: 0.93 to 16.27 m, P = 0.04). For patients in the GOLD C and D groups, improvement in quality of life following ET or RT was significantly superior to medical intervention alone. Furthermore, upon completion of the exercise regimen, RT exhibited a greater improvement in anxiety compared to ET in these patients (ITT: ΔHAD-A at 3-month: RT = -1.63 ± 0.31 vs ET = -0.61 ± 0.33, p < 0.01) (PP: ΔHAD-A at 3-month: RT = -1.80 ± 0.36 vs ET = -0.75 ± 0.37, p < 0.01).ConclusionsOur study presents evidence of the beneficial effects of ET and RT in combination with standard medical treatment, as well as the long-term effects over time after the intervention. While the statistically significant effect favoring ET over RT in terms of exercise capacity was observed, it should be interpreted cautiously. Patients in severe stages of COPD may derive greater benefits from either ET or RT and should be encouraged accordingly. These findings have implications for exercise prescription in patients with COPD.Trial registrationChiCTR-INR-16009892 (17, Nov, 2016).

EHealth Innovation for Chronic Obstructive Pulmonary Disease: A Context-Aware Comprehensive Framework

Chronic Obstructive Pulmonary Disease (COPD) poses a significant global healthcare challenge. It is a progressive lung disease that causes breathing difficulties and can significantly impact a person's quality of life. COPD is primarily caused by smoking, but other factors, such as air pollution and genetic predisposition, can also contribute to its development. This paper introduces a novel Context-Aware Framework for the Diagnosis and Personalized Management of COPD. We discuss the limitations of traditional COPD management, highlighting the importance of early detection and remote monitoring. Early detection and remote monitoring are crucial in managing COPD as they allow for timely interventions and better disease management. In this paper, we propose a framework based mostly on contextual data and other parameters of COPD as put forth by the World Health Organization (WHO) in the form of the International Classification of Functioning, Disability, and Health. Ontologies drive this architecture and incorporate dynamic contextual information from patient environments, user profiles, and sensor data. In addition to the various obvious data items like patient personal details (gender, contact, medical history) and COPD risks and symptoms, the COPD ontology also considers the details about the caregiver and healthcare professional. This is in addition to the contextual data processed separately using the Context Ontology. The ontology we constructed using Protégé serves as the framework for the structured representation and logical inference of contextual information. By harnessing dynamic contextual data, our ontology enables real-time decision-making tailored to individual patient requirements. It empowers healthcare professionals to make informed choices and deliver timely interventions, enhancing healthcare services by offering proactive care to detect early signs of health deterioration and suggest preventive measures. This approach improves patient experiences and optimizes resource allocation within the healthcare system. To uphold ethical standards and prioritize the needs of patients, we emphasize the significance of safeguarding data, obtaining informed permission, and recognizing data ownership. The ontology-based approach presented in this study offers a scalable and flexible framework that can be readily incorporated into existing healthcare systems, redefining the management of COPD in response to evolving demands. Security poses one of the biggest threats in context-based environments due to the different data formats acquired by the diverse sensors. Another essential consideration is confidentiality because the data in hand is sensitive patient information.

Exploring the impact of OSA on short-term survival in patients with AECOPD admitted to the ICU.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is characterized by a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms, which significantly contributes to hospitalizations related to COPD symptoms. Previous research has mainly focused on the correlation between obstructive sleep apnea (OSA) and COPD. However, there were few studies that investigated the short-term mortality rate of AECOPD patients with or without OSA. Data for our research was taken from the Medical Information Mart for Intensive Care Database IV. A total of 1332 patients were included in the study based on well-defined criteria for selection and exclusion. By analyzing the characteristics of AECOPD patients, we compared those with and without OSA. There were 1122 AECOPD patients without OSA, 210 patients with OSA. In comparison to those without OSA, patients with OSA exhibited lower 30-day and 90-day ICU mortality with unadjusted HR, as well as lower hospital mortality with unadjusted OR. However, after adjustments were made, there were no significant associations observed between OSA and short-term mortality, including 30-day ICU mortality, 90-day ICU mortality, ICU mortality, and hospital mortality in AECOPD patients. Subgroup analysis revealed that OSA may act as a risk factor for AECOPD patients with a BMI lower than 30 kg/m2. There is no impact on short-term survival in AECOPD patients with OSA under intensive care unit (ICU) management and nursing.

Lung Cancer among outpatients with Chronic Obstructive Pulmonary Disease - A seven-year cohort Study

IntroductionLung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with chronic obstructive pulmonary disease (COPD) face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aim to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, to outline the COPD-related variables associated with referral for LC examination.MethodsWe conducted a retrospective analyses encompassing the period from January 1, 2012, to December 31, 2018, on all outpatients with COPD, LC, and individuals referred to LC examinations.ResultsAmong all COPD outpatients, 2231 patients (18%) were referred for LC examinations, and 565 were diagnosed with LC (4.6%). LC patients with COPD were more likely to be stage I-II in contrast to the non-COPD LC population (46%versus26%, p&lt;0.001 for all). Patients referred to LC examinations exhibited higher consumption of COPD-related medications, reported more severe dyspnea (69%versus66% with MRC &gt;2), and experienced a greater frequency of exacerbations (30%versus24% with ≥2 exacerbations).ConclusionOur study reveals a notable high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasizes the importance of tailoring specific screening initiatives for this demographic.

Clinical Burden of Chronic Obstructive Pulmonary Disease in Patients with Suboptimal Peak Inspiratory Flow.

Many patients with chronic obstructive pulmonary disease (COPD) may derive inadequate benefit from dry powder inhalers (DPIs) because of suboptimal peak inspiratory flow (sPIF). To assess the clinical burden of COPD by characterizing the clinical characteristics of participants with sPIF against medium-low resistance DPIs versus those with optimal PIF (oPIF) from two phase 3 clinical trials. Baseline data were collected from two randomized, controlled, phase 3 trials (NCT03095456; NCT02518139) in participants with moderate-to-severe COPD. oPIF (60 L/min) against the medium-low resistance DPIs was used as the threshold for defining the PIF subgroups (<60 L/min (sPIF) vs ≥60 L/min (oPIF)). Most participants included in this analysis were White (92%) and male (63%); the mean (range) age was 65 (43-87) years. Participants with sPIF had significantly greater dyspnea than those with oPIF as measured using the modified Medical Research Council scoring (mean (95% CI): 2.1 (2.0-2.2) vs 1.6 (1.4-1.7); P < 0.001) and baseline dyspnea index (mean (95% CI): 5.1 (4.9-5.4) vs 6.1 (5.8-6.3); P < 0.001). Based on COPD Assessment Test scores, participants with sPIF had a higher COPD symptom burden than those with oPIF (mean (95% CI): 21.5 (19.7-23.3) vs 19.5 (18.6-20.4); P = 0.05). In these trials, participants with COPD who had sPIF against the medium-low resistance DPIs had more dyspnea and worse health status than those with oPIF. These results demonstrate that sPIF is associated with a higher clinical burden as measured by patient-reported outcomes.

Effectiveness of Immunotherapy in Non-Small Cell Lung Cancer Patients with a Diagnosis of COPD: Is This a Hidden Prognosticator for Survival and a Risk Factor for Immune-Related Adverse Events?

The interplay between the immune system and chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) is complex and multifaceted. In COPD, chronic inflammation and oxidative stress can lead to immune dysfunction that can exacerbate lung damage, further worsening the respiratory symptoms. In NSCLC, immune cells can recognise and attack the cancer cells, which, however, can evade or suppress the immune response by various mechanisms, such as expressing immune checkpoint proteins or secreting immunosuppressive cytokines, thus creating an immunosuppressive tumour microenvironment that promotes cancer progression and metastasis. The interaction between COPD and NSCLC further complicates the immune response. In patients with both diseases, COPD can impair the immune response against cancer cells by reducing or suppressing the activity of immune cells, or altering their cytokine profile. Moreover, anti-cancer treatments can also affect the immune system and worsen COPD symptoms by causing lung inflammation and fibrosis. Immunotherapy itself can also cause immune-related adverse events that could worsen the respiratory symptoms in patients with COPD-compromised lungs. In the present review, we tried to understand the interplay between the two pathologies and how the efficacy of immunotherapy in NSCLC patients with COPD is affected in these patients.

CT trachea surface roughness is associated with chronic obstructive pulmonary disease symptoms

Abstract Background Trachea structural abnormalities occur in patients with chronic obstructive pulmonary disease (COPD), yet there are few methods for quantifying trachea surface topology. Purpose To develop a method to quantify trachea surface roughness on CT imaging and investigate the association with airflow limitation and symptoms in COPD. Materials and Methods Participants from the multicenter prospective Canadian Cohort Obstructive Lung Disease study between 2009 and 2015 underwent CT imaging and analysis. Established CT measurements included: tracheal index (TI), defined as the smallest ratio of coronal-to-sagittal trachea diameter, low attenuation areas below –950 HU, and wall thickness of a theoretical 10-mm airway. Trachea surface roughness shape (SRS) was calculated as the percent fraction of the measurement box filled by the surface mesh. Multivariable regression models were used to determine association for CT measurements with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and Medical Research Council dyspnea scale (MRC)≥3, adjusting for covariates. Results A total of 1253 participants (mean age, 66 ± 10 years; 727 men) from 9 centers were investigated: n = 267 never smokers, n = 369 ever smokers, n = 352 mild COPD, and n = 265 moderate-to-severe COPD. There were no differences between groups for age or race (P &amp;lt; .05). In models including SRS and TI, a 1-standard deviation (SD) increase in SRS was independently associated with a 0.11-SD decrease in FEV1 (β = –0.11; P &amp;lt; .001) and a 0.16-SD decrease in FEV1/FVC (β = –0.16; P &amp;lt; .001); a 1-point increase in SRS was associated with a 13% increased likelihood of MRC ≥ 3 (odds ratio = 1.13; P = .003). In models including SRS, low attenuation areas below –950 HU and wall thickness of a theoretical 10-mm airway, a 1-SD increase in SRS was associated with a 0.21-SD decrease in FEV1 (β = –0.21; P &amp;lt; .001) and a 0.13-SD decrease in FEV1/FVC (β = –0.13; P &amp;lt; .001); a 1-point increase in SRS was associated with a 12% increased likelihood of MRC ≥ 3 (odds ratio = 1.12; P = .006). Conclusion Increased trachea surface shape roughness is independently associated with worse airflow and increased symptom burden in COPD.

Electrical impedance tomography as a bedside assessment tool for COPD treatment during hospitalization.

For patients with chronic obstructive pulmonary disease (COPD), the assessment of the treatment efficacy during hospitalization is of importance to the optimization of clinical treatments. Conventional spirometry might not be sensitive enough to capture the regional lung function development. The study aimed to evaluate the feasibility of using electrical impedance tomography (EIT) as an objective bedside evaluation tool for the treatment of acute exacerbation of COPD (AECOPD). Consecutive patients who required hospitalization due to AECOPD were included prospectively. EIT measurements were conducted at the time of admission and before the discharge simultaneously when a forced vital capacity maneuver was conducted. EIT-based heterogeneity measures of regional lung function were calculated based on the impedance changes over time. Surveys for attending doctors and patients were designed to evaluate the ease of use, feasibility, and overall satisfaction level to understand the acceptability of EIT measurements. Patient-reported outcome assessments were conducted. User's acceptance of EIT technology was investigated with a five-dimension survey. A total of 32 patients were included, and 8 patients were excluded due to the FVC maneuver not meeting the ATS criteria. Spirometry-based lung function was improved during hospitalization but not significantly different (FEV1 %pred.: 35.8% ± 6.7% vs. 45.3% ± 8.8% at admission vs. discharge; p = 0.11. FVC %pred.: 67.8% ± 0.4% vs. 82.6% ± 5.0%; p = 0.15. FEV1/FVC: 0.41 ± 0.09 vs. 0.42 ± 0.07, p = 0.71). The symptoms of COPD were significantly improved, but the correlations between the improvement of symptoms and spirometry FEV1 and FEV1/FVC were low (R = 0.1 and -0.01, respectively). The differences in blood gasses and blood tests were insignificant. All but one EIT-based regional lung function parameter were significantly improved after hospitalization. The results highly correlated with the patient-reported outcome assessment (R > 0.6, p < 0.001). The overall acceptability score of EIT measurement for both attending physicians and patients was high (4.1 ± 0.8 for physicians, 4.5 ± 0.5 for patients out of 5). These results demonstrated that it was feasible and acceptable to use EIT as an objective bedside evaluation tool for COPD treatment efficacy.

Adherence to Exercise among COPD (Chronic Obstructive Pulmonary Disease) Patient- Barriers and Facilitators

Chronic obstructive pulmonary disease is a common inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation. There is compelling evidence that regular exercise can lower the chance of developing several chronic diseases. Although it helps in reducing COPD symptoms and improve quality of life, which is highly beneficial for COPD patients, there are still several reasons for barriers to adherence to exercise in COPD patients which further affects their health. Most COPD patients are typically compelled to minimize exercise and adopt sedentary lifestyles due to decrease activity related dyspnea and exercise tolerance. Relevant literature was obtained from platforms such as Google Scholar and PubMed. For thorough retrieval, the Boolean logic operators “AND, OR NOT” were applied. All pertinent keywords, mesh terms, and other index terms were searched for in relation to “barriers,” “facilitators,” “chronic obstructive pulmonary disease” and “exercise” which were then utilized to build the search strategy. This review found that exercise improved dyspnea, quality of life, lessened depression, enhanced cognitive and neurobehavioral function in COPD patients, and shortened hospital stays and COPD exacerbations. Many factors act as barriers of adherence to exercise among COPD patients, such as self, environment, health and psychosocial. While numerous factors such as positive feedback, support from family, self-initiation, etc. act as a facilitator of adherence to exercise among COPD patients. Keywords: Chronic Obstructive Pulmonary Disease, barriers, facilitators, benefits of exercise.

Management of Chronic Obstructive Pulmonary Disease: Constraints in Patient Pathway and Mitigation Strategies

Introduction: Respiratory diseases, ranking the third in Portugal, contribute significantly to illness and mortality. Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally. Identifying high-risk individuals and implementing early treatment is crucial due to the variability of COPD symptoms and exacerbations. This study aimed to identify effective strategies for preventing exacerbations and complications. Methods: A Delphi involving 15 experts was performed. Experts included physicians, nurses, health managers, policymakers, public health experts, and patient organizations. Consensus was achieved at 73.3% for each strategy using a scale ranging from “agree” to “disagree.” Three rounds were conducted to address six questions related to early diagnosis and patient follow-up. Challenges faced by the Portuguese Health System in managing COPD, obstacles in COPD exacerbation diagnosis and management, and effective strategies to overcome barriers were identified in the first round. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus, respectively. Indicators were categorized into constraints and barriers, and strategies for reducing COPD exacerbations and disease burden. Results: Out of a total of 134 valid indicators generated, 108 achieved consensus. Among the indicators agreed upon by experts, 18 pertained to barriers, challenges, and constraints, while 90 focused on action strategies for COPD. Among the strategies formulated, 25 consensus indicators target prevention strategies, 24 consensus indicators aim to enhance COPD referrals, and 41 consensus indicators focus on mitigating COPD exacerbations and reducing the overall disease burden. Discussion/Conclusion: This study emphasizes the need for integrated investment in respiratory healthcare and recognition of the impact of COPD on patients, healthcare systems, and economies. Prevention and appropriate treatment of exacerbations are crucial for effective COPD management and reducing associated morbidity and mortality. Experts highlight the importance of improving coordination between different levels of care, integrating information systems, and decentralizing hospital responsibilities. The COVID-19 pandemic has further emphasized the importance of individual and collective respiratory health, necessitating investment in health promotion and COPD awareness.

Effect of self-management intervention on patients with chronic obstructive pulmonary diseases, Chitwan, Nepal.

Self-management skills are important for patients with Chronic Obstructive Pulmonary Disease (COPD) who are responsible for their day to day care. Poor self-management behaviours have a significant influence on symptoms, functional impairments and quality of life. Evidence has shown that self-management interventions support patients to respond to changing symptoms and thereby make appropriate decisions regarding their self-management. This study aimed to find out the effect of self-management interventions in patients with COPD in terms of self-management practice, inhaler practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms. Quasi-experimental pre-test post-test design was carried out among patients with COPD attending respiratory units of Chitwan Medical College Teaching Hospital (CMC-TH), Nepal. Convenience sampling technique was used to select the 70 patients with COPD for the study. Baseline data was collected from the participants using (i) Semi-structured interview schedule for socio-demographic and clinical variables, (ii) COPD Self-Management Practice Questionnaire, (iii) Borg Dyspnoea Scale, and (iv) Six Minute Walking Distance (6MWD) Test (v) Pulmonary Function Test (PFT) and (vi) Observation Checklist. Self-management Intervention given was 2 ½ hour sessions per week for 6 weeks along with information booklets distribution. Participants were re-evaluated after 3 months of intervention using same tools. Data analysis was performed using IBMSPSS version 20.0 for window. Wilcoxon signed-rank test was performed to find the effectiveness of the self-management interventions on outcome parameters. Self-management interventions (2 ½ hour session per week for 6 weeks) elicited a statistically significant change on self-management practice (z = -7.215, p<0.001), inhaler practice (DPI practice z = -6.731, p<0.001, MDI practice, z = -1.816, p = 0.005), functional ability (z = -4.243, p<0.001), self-perceived dyspnoea (z = -4.443, p<0.001), COPD symptom burden (z = -7.009, p<0.001) and emotional symptoms (depression, z = -6.856, p<0.001, anxiety, z = -6.675, p<0.001) of patients with COPD. Self-management intervention acts as powerful equipment to improve self-management practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms of patients with COPD. Hence, clinician and policy maker need to plan and intervene the rehabilitation program for the patients with COPD to enhance the effectiveness of therapy, self-management practice and general longevity.

Association between Nocturnal Hypoxemia and COPD Severity: A Cross-sectional Study

Introduction: Globally, Chronic Obstructive Pulmonary Disease (COPD) is the third most common cause of mortality. More than 80% of these fatalities happened in low- and middleincome nations. Transient desaturation during sleep occurs in healthy persons during Rapid Eye Movement (REM) sleep. This phenomenon is aggravated in COPD patients. As Nocturnal Desaturation (NOD) in COPD has been suggested to increase mortality, its early identification will aid in early initiation of treatment and prevention of associated complications. Aim: To estimate the prevalence of nocturnal hypoxemia in COPD and determine its association with COPD severity. Materials and Methods: A cross-sectional study was carried out at the Department of General Medicine, Apollo Hospitals, Guwahati, Assam, India during January to December 2021 involving 100 patients who had COPD symptoms. Continuous oxygen saturation monitoring with transcutaneous finger probe was done for the entire duration of sleep at night. Patients whose oxygen saturation falls below 90% for at least 30% of recording time in sleep were classified as desaturators. Statistical Package for Social Sciences (SPSS) Version 26.0 was used for data analysis. Using the Chi-square test, the relationship between the qualitative variables was evaluated. The Mann-Whitney test or the unpaired t-test was used to analyse the quantitative data between the two groups. A p-value of less than 0.05 was considered significant. Results: Prevalence of NOD among cases of COPD was observed as 26% in present study. A significant association was observed between presence of NOD in COPD cases with severity of COPD and with desaturation in 6-Minute Walk Test (6-MWT) (p&lt;0.01). Severe cases had a prevalence of NOD as 65% as compared to 28.2% and 4.9% in moderate and mild cases respectively (p&lt;0.01). A total of 61.9% cases with desaturation during 6-MWT showed NOD as compared to 38.1% without desaturation (p&lt;0.01). Conclusion: One fourth of the normoxemic COPD patients had significant NOD. NOD episodes were observed to be positively associated with increasing severity of COPD. Assessing variations in oxygen saturation during a 6-MWT can be helpful in identifying COPD patients who may be at risk for severe night time desaturation.

Особенности течения хронической обструктивной болезни легких у пациентов, перенесших COVID-19

Aim. To evaluate the course of chronic obstructive pulmonary disease (COPD) in patients who had SARS-CoV-2 infection of various severity. Design. Three-centre cross-sectional study under the STROBE standard (STrengthening the Reporting of OBservational studies in Epidemiology). Materials and methods. We conducted a complete medical examination of 46 patients with COPD who had COVID-19 during the past year: without viral damage to pulmonary tissue (CT 0, n = 18), with viral damage to pulmonary tissue of max. 50 % (CT 1–2, n = 24) and with viral damage to pulmonary tissue of at least 50 % (CT 3–4, n = 4). Examinations included analysis of clinical information, laboratory and functional tests, as well as assessment of physical and emotional condition of patients using questionnaires and scales. Results. After the novel coronavirus infection (NCI), 69.6 % of patients developed COPD complications, 26.1 % of patients presented with COPD symptoms for the first time, which required medical assistance. Disease exacerbation was observed approximately 24 weeks after COVID-19. Post-COVID-19 patients required intensification of baseline therapy. COPD patients who had NCI with viral pulmonary involvement had elevated D-dimer levels; CT 3–4 group also had significant impairment of diffusive capacity of lungs. Patients with pulmonary involvement, corresponding to CT 3–4, had statistically higher (p &lt; 0.001) risk of reduction in the quality of life and aggravated anxiety and depression. Conclusion. In post-COVID-19 period, patients with COPD are at high risk of disease exacerbation requiring review of outpatient COPD baseline therapy in post-COVID-19-patients. COPD patients who had mild SARS-CoV-2 require long-term monitoring of their coagulation profile and diffusive capacity of lungs and are recommended long-term psychological support. Keywords: COPD, COVID-19, post-COVID, body plethysmography, diffusive capacity of lungs.

From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses.

Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness. A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages. Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity. We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.