Chronic Obstructive Pulmonary Disease Publications (64130)


Chronic Obstructive Pulmonary Disease Publications

Dtsch Arztebl Int
Dtsch Arztebl Int 2016 Dec;113(49):834-845
Department of Cardiology and Angiology, Hannover Medical School; Institute for General Practice, Hannover Medical School; Department of Respiratory Medicine, Hannover Medical School.
Iran J Parasitol
Iran J Parasitol 2016 Apr-Jun;11(2):284-289
Dept. of Public Health, School of Public Health, Gonabad University of Medical Sciences, Gonabad, Iran.

A 74 yr old woman from Gonabad, southern part of Khorasan Razavi Province of Iran was admitted to a Hospital of Gonabad, because of respiratory distress, exertional dyspnea and fever. Close contact with domestic animals, history of chronic obstructive pulmonary disease (COPD), and completely resolved pulmonary tuberculosis (TB) in remote past, were notable parts of her past medical history. Due to clinical, paraclinical and radiographic findings and because of recent hospitalization, she was admitted to internal medicine ward with the diagnosis of health care associated pneumonia (HCAP). Read More

Despite the application of broad-spectrum antibiotics and appropriate supportive care, she had a poor response to the treatment. During the daily visit in Intensive Care Unit (ICU), numerous white larvae were detected in both nostrils. Further investigation of oropharynx and tracheal tube aspiration, showed no more larvae in mentioned parts. An hour later, nasal spontaneous bleeding occurred. Otorhinolaryngology consultation was performed and led to surgical procedure. In ENT examination, there were numerous larvae and massive clot formation in both inferior meatuses and distal nasal septum perforation. Thirty-seven extracted larvae were transferred to Medical Entomology lab by vial 70% ethanol and 5 live larvae for rearing. After precise investigation by aid of light microscopy, the larvae were identified as Chrysomya bezziana. Due to discovered 2(nd) larvae stage and duration of hospitalization, this infestation was identified as nasal myiasis.

Med Devices (Auckl)
Med Devices (Auckl) 2017 29;10:1-9. Epub 2016 Dec 29.
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Differences in tidal breathing patterns have been reported between patients with chronic obstructive pulmonary disease (COPD) and healthy individuals using traditional measurement techniques. This feasibility study examined whether structured light plethysmography (SLP) - a noncontact, light-based technique - could also detect differences in tidal breathing patterns between patients with COPD and healthy subjects.
A 5 min period of tidal (quiet) breathing was recorded in each patient with COPD (n=31) and each healthy subject (n=31), matched for age, body mass index, and sex. Read More

For every participant, the median and interquartile range (IQR; denoting within-subject variability) of 12 tidal breathing parameters were calculated. Individual data were then combined by cohort and summarized by its median and IQR.
After correction for multiple comparisons, inspiratory time (median tI) and its variability (IQR of tI) were lower in patients with COPD (p<0.001 and p<0.01, respectively) as were ratios derived from tI (tI/tE and tI/tTot, both p<0.01) and their variability (p<0.01 and p<0.05, respectively). IE50SLP (the ratio of inspiratory to expiratory flow at 50% tidal volume calculated from the SLP signal) was higher (p<0.001) in COPD while SLP-derived time to reach peak tidal expiratory flow over expiratory time (median tPTEFSLP/tE) was shorter (p<0.01) and considerably less variable (p<0.001). Thoraco-abdominal asynchrony was increased (p<0.05) in COPD.
These early observations suggest that, like traditional techniques, SLP is able to detect different breathing patterns in COPD patients compared with subjects with no respiratory disease. This provides support for further investigation into the potential uses of SLP in assessing clinical conditions and interventions.

Int J Chron Obstruct Pulmon Dis
Int J Chron Obstruct Pulmon Dis 2017 23;12:123-133. Epub 2016 Dec 23.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.

Self-management is becoming increasingly important in COPD health care although it remains difficult to embed self-management into routine clinical care. The implementation of self-management is understood as a complex interaction at the level of patient, health care provider (HCP), and health system. Nonetheless there is still a poor understanding of the barriers and effective facilitators. Read More

Comprehension of these determinants can have significant implications in optimizing self-management implementation and give further directions for the development of self-management interventions. Data were collected among COPD patients (N=46) and their HCPs (N=11) in three general practices and their collaborating affiliated hospitals. Mixed methods exploration of the data was conducted and collected by interviews, video-recorded consultations (N=50), and questionnaires on consultation skills. Influencing determinants were monitored by 1) interaction and communication between the patient and HCP, 2) visible and invisible competencies of both the patient and the HCP, and 3) degree of embedding self-management into the health care system. Video observations showed little emphasis on effective behavioral change and follow-up of given lifestyle advice during consultation. A strong presence of COPD assessment and monitoring negatively affects the patient-centered communication. Both patients and HCPs experience difficulties in defining personalized goals. The satisfaction of both patients and HCPs concerning patient centeredness during consultation was measured by the patient feedback questionnaire on consultation skills. The patients scored high (84.3% maximum score) and differed from the HCPs (26.5% maximum score). Although the patient-centered approach accentuating self-management is one of the dominant paradigms in modern medicine, our observations show several influencing determinants causing difficulties in daily practice implementation. This research is a first step unravelling the determinants of self-management leading to a better understanding.


Chronic obstructive pulmonary disease (COPD) not only affects patients but also their partners. Gender-related differences in patients with COPD are known, for instance regarding symptoms and quality of life. Yet, research regarding gender differences in partners of patients with COPD has been conducted to a lesser extent, and most research focused on female partners. Read More

We aimed to investigate differences between male and female partners of patients with COPD regarding their own characteristics and their perceptions of patients' characteristics.
Cross-sectional study.
Four hospitals in the Netherlands.
One hundred and eighty-eight patient-partner couples were included in this cross-sectional study.
General and clinical characteristics, health status, care dependency, symptoms of anxiety and depression, social support, caregiver burden, and coping styles were assessed during a home visit.
Female partners had more symptoms of anxiety and a worse health status than male partners. Social support and caregiver burden were comparable, but coping styles differed between male and female partners. Female partners thought that male patients were less care dependent and had more symptoms of depression, while these gender differences did not exist in patients themselves.
Health care providers should pay attention to the needs of all partners of patients with COPD, but female partners in particular. Obtaining an extensive overview of the patient-partner couple, including coping styles, health status, symptoms of anxiety, and caregiver burden, is necessary to be able to support the couple as effectively as possible.

Eur Respir Rev
Eur Respir Rev 2017 Jan 17;26(143). Epub 2017 Jan 17.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Eur Respir Rev
Eur Respir Rev 2017 Jan 17;26(143). Epub 2017 Jan 17.
Dept of Experimental Medicine, Second University of Naples, Naples, Italy.

When there are no randomised clinical trials directly comparing all relevant treatment options, an indirect treatment comparison via meta-analysis of the available clinical evidence is an acceptable alternative. However, meta-analyses may be very misleading if not adequately performed. Here, we propose and validate a simple and effective approach to meta-analysis for exploring the effectiveness of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations in chronic obstructive pulmonary disease. Read More

14 articles with 20 329 patients (combinations n=9292; monocomponents n=11 037) were included in this study. LABA/LAMA combinations were always more effective than the monocomponents in terms of the improvement in trough forced expiratory volume in 1 s, transition dyspnoea index and St George's Respiratory Questionnaire scores after 3, 6 and 12 months of treatment. No significant publication bias was identified. Significant discrepancies with previous network meta-analyses have been found, with overall differences ranging from 26.7% to 43.3%.Results from previous network meta-analyses were misleading because no adequate attention was given to formulating the review question, specifying eligibility criteria, correctly identifying studies, collecting appropriate information and deciding what it would be pharmacologically relevant to analyse. The real gradient of effectiveness of LABA/LAMA fixed-dose combinations remains an unmet medical need; however, it can be investigated indirectly using a high-quality meta-analytic approach.

Appl Nurs Res
Appl Nurs Res 2017 Feb 28;33:85-92. Epub 2016 Oct 28.
Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box85500, 3508 GA Utrecht, The Netherlands.

The major challenges in Chronic Obstructive Pulmonary Disease (COPD) care are guiding a patient in daily living with the consequences of the disease, reducing the impact of symptoms and improving Health Related Quality of Life (HRQoL). The new nurse-led COPD-Guidance, Research on an Illness Perception (COPD-GRIP) intervention translates the evidence concerning illness perceptions and Health Related Quality of Life (HRQoL) into a practice nurse intervention. The aim is to explore the nurses' experiences with applying the new COPD-GRIP intervention. Read More

An explanatory mixed-method study nested in a cluster randomized trial in primary care was conducted. Pre-intervention questionnaires were sent to all participating nurses (N=24) to identify expectations. Post-intervention questionnaires identified experiences after applying the intervention followed by two focus groups to further extend exploration of findings. Questionnaires were analyzed by descriptive analyses. To identify themes the audio-taped and transcribed focus groups were independently coded by two researchers.
The nurses described the intervention as a useful, structured and individualized tool to guide COPD patients in living with the consequences of COPD. Applying the intervention took less time than the nurses initially expected. The intervention enables to provide patient-centered care and to address patient needs. Barriers were encountered, especially in patients with a lower social economic status, in patients with a lower health literacy and in patients with other cultural backgrounds than the Dutch background.
Nurses perceived the COPD-GRIP intervention as a feasible, individualized tool. According to the nurses, the intervention is a valuable improvement in the care for COPD patients.

BMC Health Serv Res
BMC Health Serv Res 2017 Jan 17;17(1):44. Epub 2017 Jan 17.
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark.

In recent years, the healthcare system in the western world has undergone a structural development caused by changes in demography and pattern of disease. In order to maintain the healthcare system cost-effective, new tasks are placed in general practice urging the general practitioners to rethink the working structure without compromising the quality of care. However, there is a substantial variation in the degree to which general practitioners delegate tasks to their staff, and it is not known how these various degrees of task delegation influence the job satisfaction of general practitioners and their staff. Read More

We performed a cross-sectional study based on two electronic questionnaires, one for general practitioners and one for their staff. Both questionnaires were divided into two parts, a part exploring the degree of task delegation regarding management of patients with chronic obstructive pulmonary disease in general practice and a part concerning the general job satisfaction and motivation to work.
We found a significant association between perceived "maximal degree" of task delegation in management of patients with chronic obstructive pulmonary disease and the staff's overall job satisfaction. The odds ratio of the staff's satisfaction with the working environment displayed a tendency that there is also an association with "maximal degree" of task delegation. In the analysis of the general practitioners, the odds ratios of the results indicate that there is a tendency that "maximal degree" of task delegation is associated with overall job satisfaction, satisfaction with the challenges in work, and satisfaction with the working environment.
We conclude that a high degree of task delegation is significantly associated with overall job satisfaction of the staff, and that there is a tendency that a high degree of task delegation is associated with the general practitioners' and the staff's satisfaction with the working environment as well as with general practitioners' overall job satisfaction and satisfaction with challenges in work. To qualify future delegation processes within general practice, further research could explore the reasons for our findings.