Chronic Respiratory Disease current issue

Music: More than just a melody

Bauldoff, G. — Mon, 26 Oct 2009 09:39:16 PDT

Use of pedometers to measure activity in COPD patients -- a step too far?

Walker, P. — Mon, 26 Oct 2009 09:39:16 PDT

Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease

Bakerly, N. D., Davies, C., Dyer, M., Dhillon, P. — Mon, 26 Oct 2009 09:39:16 PDT

Home treatment models for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) proved to be a safe alternative to hospitalization. These models have the potential to free up resources; however, in the United Kingdom, it remains unclear to whether they provide cost savings compared with hospital treatment. Over a 12-month period from August 2003, 130 patients were selected for the integrated care group (total admissions with AECOPD = 546). These patients were compared with 95 retrospective controls in the hospital treatment group. Controls were selected from admissions during the previous 12 months (total of 662 admissions) to match the integrated care group in age, sex, and postal code. Resource use data were collected for both groups and compared using National Health Service (NHS) perspective for cost minimization analysis. In the integrated care group (130 patients), 107 (82%) patients received home support with average length of stay 3.3 (SD 3.9) days compared with 10.4 (SD 7.7) in the hospital group (95 patients). Average number of visits per patients in the integrated care group was 3.08 (SD = 0.95; 95% CI = 2.9—3.2). Cost per patient in the integrated care group was £1653 (95% CI, £1521—1802) compared with £2256 (95% CI, £2126— 2407) in the hospital group. The integrated care group resulted in cost saving of approximately £600 (P < 0.001) per patient. This integrated care model for the management of patients with AECOPD offered cost savings of £600 per patient over the conventional hospital treatment model using the new NHS tariff from an acute trust provider perspective.

Comparison of the effectiveness of music and progressive muscle relaxation for anxiety in COPD--A randomized controlled pilot study

Singh, V., Rao, V., V., P., RC, S., K., K. P. — Mon, 26 Oct 2009 09:39:16 PDT

Acute effects of music and relaxation have not been evaluated in hospitalized subjects with chronic obstructive pulmonary disease (COPD). This study aims to evaluate the acute effects of music and progressive muscle relaxation (PMR) in hospitalized COPD subjects after a recent episode of exacerbation. A Randomized controlled study was performed of pre-test post-test design after recruiting 82 COPD subjects from K.M.C hospitals. All patients were admitted for acute exacerbation and were medically stabilized. After being screened for the inclusion and exclusion criteria, 72 subjects were selected for the study. Demographic and baseline data was taken on the day subjects were screened. Music group listened to a self selected music of 60-80 beats per minute for 30 minutes. PMR group practiced relaxation through a pre-recorded audio of instructions of 16 muscle groups. Outcome variables were Spielberger’s state anxiety inventory (SSAI), Spielberger’s trait anxiety inventory (STAI), dyspnea, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and respiratory rate (RR). There was statistically significant main effect across the sessions for state anxiety (F = 62.621, p = 0.000), trait anxiety (F = 19.528, p = 0.000), dyspnea (F = 122.227, p = 0.000), SBP (F = 63.885, p = 0.000), PR (F = 115.780, p = 0.000) and RR (F = 202.977, p = 0.000). There was statistically significant interaction effect between the two groups for state anxiety (F = 6.024, p = 0.003), trait anxiety (F = 8.222, p = 0.000), dyspnea (F = 10.659, p = 0.000), SBP (F = 12.889, p = 0.000), PR (F = 4.746, p = 0.008) and RR (F = 12.078, p = 0.000). There were greater changes observed after the second session in both groups however, change in DBP was not significant in either group. Music and PMR are effective in reducing anxiety and dyspnoea along with physiologic measures such as SBP, PR and RR in two sessions in COPD patients hospitalized with exacerbation. However, reductions in the music group were greater compared to the PMR group.

Using pedometers to monitor walking activity in outcome assessment for pulmonary rehabilitation

Mon, 26 Oct 2009 09:39:16 PDT

Background: The purpose of this study was to determine whether a commercially available pedometer could detect changes in home-based walking activity among chronic obstructive pulmonary disease (COPD) patients completing pulmonary rehabilitation (PR). Methods: Patients with COPD referred to outpatient PR wore a pedometer to count steps for 1 week at the beginning and 1 week at the end of PR. Patients also completed the 6-min walk test (6MWT), the Medical Research Council (MRC) dyspnea scale and the self-administered chronic respiratory disease questionnaire (CRQ) at the beginning and the end of PR. Paired t tests were used to compare pre- and post-PR changes in outcome variables. Results: 45 patients with severe COPD (forced expiratory volume in 1 second [FEV₁] 45% ± 18% of predicted) participated in a total of 17.4 ± 4.6 PR sessions. Significant improvements in 6MWT (49 ± 59 m; p < .0001), MRC dyspnea score (—0.64 ± 0.96 units; p = .003) and CRQ score (10 ± 18 units; p = .0007) were noted following PR. Patients whose pedometer-measured steps were within 20% of observed counted steps were included in the analysis. Pedometer counts increased by 33 ± 149 steps per hour worn after, as compared with before PR (p = .14). There was a significant inverse relationship between baseline pedometer counts and change in pedometer counts per hour post-PR (r = —.46; p = .001). Patients with low baseline activity levels had significant increases in pedometer activity (88 ± 30 counts per hour worn) and a greater reduction in MRC dyspnea score (—0.94 vs —0.29; p = .04) following PR, whereas those with higher baseline activity levels had a decrease in pedometer activity (—19 ± 29 counts/hour; p = .015). Conclusions: A standard pedometer worn at the waist did not detect changes in lower extremity activity following PR. This negative finding occurred despite demonstrated improvements in dyspnea, exercise tolerance and quality of life measures. Although pedometers are inexpensive and easy to use, they may not be sensitive enough to be used routinely as an outcome measure for PR.

PatientsLikeMe the case for a data-centered patient community and how ALS patients use the community to inform treatment decisions and manage pulmonary health

Frost, J., Massagli, M. — Mon, 26 Oct 2009 09:39:16 PDT

What happens when patients go online to not only discuss health and daily living but to share detailed health data? PatientsLikeMe© is an online platform where patients with life-altering conditions share structured information about symptoms, treatments, and outcomes, view individual and aggregated reports of these data, and discuss health and garner support on forums and through private messages. In this case study, we describe the components of this platform and how people with Amyotrophic lateral sclerosis have used the site to manage and improve pulmonary health. A qualitative analysis of forum content containing preset terms reveals patterns in use. As in other online communities, members of PatientsLikeMe offer one another support based on their own personal experience and advise each other on both medical issues and how to improve day-to-day life. Unique to this patient platform, members tailor questions and consults by referencing concrete data displayed for each patient member. PatientsLikeMe adds data into patient investigations on how to improve daily life and long term health outcomes.

Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease

Aboussouan, L. — Mon, 26 Oct 2009 09:39:16 PDT

Indications for exercise and pulmonary rehabilitation extend to neuromuscular diseases tough these conditions pose particular challenges given the associated skeletal muscle impairment and respiratory muscle dysfunction. These challenges are compounded by the variety of exercise prescriptions (aerobic, muscle strengthening, and respiratory muscle training) and the variety of neuromuscular disorders (muscular, motor neuron, motor nerve root, and neuromuscular transmission disorders). Studies support a level II evidence of effectiveness (i.e., likely to be effective) for a combination of aerobic exercise and strengthening exercises in muscular disorders, and for strengthening exercises in amyotrophic lateral sclerosis. The potential deleterious effects of work overload in the dystrophinopathies have not been confirmed in Becker muscular dystrophy. Adjunctive pharmacologic interventions (e.g., theophylline, steroids, PDE5 inhibitors, creatine), training recommendations (e.g., interval or lower intensity training) and supportive techniques (e.g., noninvasive ventilation, neuromuscular electrical stimulation, and diaphragm pacing) may result in more effective training but require more study before formal recommendations can be made. The exercise prescription should include avoidance of inspiratory muscle training in hypercapnia or low vital capacity, and should match the desired outcome (e.g., extremity training for task-specific performance, exercise training to enhance exercise performance, respiratory muscle training where respiratory muscle involvement contributes to the impairment).