Publications by authors named "Christian Clarenbach"

67 Publications

Blood-flow restricted strength training combined with high-load strength and endurance training in pulmonary rehabilitation for COPD: a case report.

Phys Ther 2021 Feb 14. Epub 2021 Feb 14.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

Objective: The purpose of this report is to describe the case of a patient with chronic obstructive pulmonary disease (COPD) who was load compromised and being referred for outpatient pulmonary rehabilitation. Low-load blood flow restriction strength training (LL-BFRT) was applied to prepare for and increase tolerability of subsequently applied high-load strength training (HL-ST).

Methods (case Description): A 62-year-old woman with COPD GOLD 2 B presented with severe breathlessness. Lower limb strength was severely reduced while functional exercise capacity was preserved. The patient was severely load compromised and had high risk to be intolerant of the high training loads required to trigger the desired adaptations. LL-BFRT was applied during the first 12 training sessions and HL-ST in the subsequent 12 training sessions of the rehabilitation program. Endurance training on a cycle ergometer was performed throughout the program.

Results: Symptom burden in the COPD Assessment test was reduced by 6 points (40%). Lower limb strength improved by 95.3 Nm (521%) and 88.4 Nm (433%) for the knee extensors and by 33.8 Nm (95%) and 56 Nm (184%) for the knee flexors, respectively. Functional exercise capacity improved by 44 m (11%) in the 6-Minute Walk Test and 14 repetitions (108%) in the 1-minute sit-to stand test. The patient did not experience any adverse events related to the exercise training.

Conclusion: Clinically relevant changes were observed in both strength-related functional and self-reported outcomes. The achievements translated well into daily living and enabled functioning according to the patients' desires. LL-BFRT was reported to be well tolerated and implementable into an outpatient pulmonary rehabilitation program.

Impact: The description of this case encourages the systematic investigation of LL-BFRT in COPD. LL-BFRT has the potential to increase benefits as well as tolerability of strength training in pulmonary rehabilitation. Consideration of the physiological changes achieved through LL-BFRT highlights potential in targeting peripheral muscle dysfunction in COPD.
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http://dx.doi.org/10.1093/ptj/pzab063DOI Listing
February 2021

Research priorities in α-antitrypsin deficiency: results of a patients' and healthcare providers' international survey from the EARCO Clinical Research Collaboration.

ERJ Open Res 2020 Oct 21;6(4). Epub 2020 Dec 21.

Pulmonology Dept, Centro Hospitalar do Porto, Porto, Portugal.

α-antitrypsin deficiency (AATD) is a rare and under-recognised genetic condition. Owing to its low prevalence, international initiatives are key for conducting high-quality research in the field. From July 2018 to December 2019, the European Alpha-1 Research Collaboration (EARCO) developed and conducted two surveys, one for healthcare providers and one for patients and caregivers, aiming to identify research priorities and barriers in access to treatment for AATD. A survey on 164 research questions was electronically sent to 230 AATD experts in Europe, and 94 completed surveys from 24 countries were received. The top research areas identified by healthcare providers were causes of variable progression and poor outcomes, improvement in diagnosis, initiation and optimal dosing of augmentation therapy and effectiveness of self-management interventions. During the same period, 438 surveys were completed by patients and caregivers from 26 countries. The top research areas identified were improving knowledge about AATD, in particular among general practitioners, access to AATD specialised centres and access to reliable, easy to understand information about living with AATD. Regarding barriers to treatment, participants from countries where augmentation therapy was reimbursed prioritised improving knowledge in AATD, while respondents in non-reimbursed countries regarded access to AATD augmentation therapy and to specialised centres as the most relevant. The main research and management priorities identified by healthcare providers and patients included understanding the natural history of AATD, improving information to physicians, improving access to specialised reference centres, personalising treatment and having equal opportunities for access to existing therapies.
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http://dx.doi.org/10.1183/23120541.00523-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792815PMC
October 2020

Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study.

Eur Respir J 2021 Jan 8. Epub 2021 Jan 8.

Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Background: The coronavirus infectious disease (COVID-19) pandemic is an ongoing global health care challenge. Up to one third of hospitalised patients develop severe pulmonary complications and ARDS. Pulmonary outcomes following COVID-19 are unknown.

Methods: The Swiss COVID-19 lung study is a multicentre prospective cohort investigating pulmonary sequela of COVID-19. We report on initial follow-up 4 months after mild/moderate or severe/critical COVID-19 according to the WHO severity classification.

Results: 113 COVID-19 survivors were included (mild/moderate 47, severe/critical 66). We confirmed several comorbidities as risk factors for severe/critical disease. Severe/critical disease was associated with impaired pulmonary function, diffusing capacity (DLCO) %-predicted, reduced 6-MWD, and exercise-induced oxygen desaturation. After adjustment for potential confounding by age, sex, and BMI, patients after severe/critical COVID-19 had a 20.9 (95% CI 12.4-29.4, p=0.01) lower DLCO %-predicted at follow up. DLCO %-predicted was the strongest independent factor associated with previous severe/critical disease when age, sex, BMI, 6MWD, and minimal SpO at exercise, were included in the multivariable model (adjusted odds ratio [OR] per 10%-predicted 0.59 [95% CI 0. 37-0.87], p=0.01). Mosaic hypoattenuation on chest computed tomography at follow-up was significantly associated with previous severe/critical COVID-19 including adjustment for age and sex (adjusted OR 11.7 [95%CI 1.7-239), p=0.03).

Conclusions: Four months after SARS CoV-2 infection, severe/critical COVID-19 was associated with significant functional and radiological abnormalities, potentially due to small airway and lung parenchymal disease. A systematic follow-up for survivors needs to be evaluated to optimise care for patients recovering from COVID-19.
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http://dx.doi.org/10.1183/13993003.03690-2020DOI Listing
January 2021

A few more steps lead to improvements in endothelial function in severe and very severe COPD.

Respir Med 2021 Jan 20;176:106246. Epub 2020 Nov 20.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland. Electronic address:

Introduction: Cardiovascular disease is among the most prevalent concomitant chronic diseases in COPD. Physical activity (PA) modifies endothelial function and is commonly impaired in COPD. However, studies directly investigating the effects of increased PA on endothelial function in COPD are lacking. We investigated the effect of changes in PA on endothelial function in patients with severe to very severe COPD. Furthermore, we determined which variables modify this effect.

Materials And Methods: This is a secondary outcome analysis from a randomised controlled trial investigating the effects of combined PA counselling and pedometer-based feedback in COPD. We analysed the change in PA based on three visits during one year. We measured PA using a validated triaxial accelerometer, and endothelial function using flow-mediated dilation.

Results: Data was analysed from 54 patients, which provided 101 change scores. Multiple regression modelling, including adjustment for baseline step count, showed strong evidence for an association between changes in flow-mediated dilation and changes in PA (p < 0.001). The analysis of several effect modificators showed no evidence of any influence on the interaction between PA and endothelial function: smoking status (p = 0.766), severity of airflow obstruction (p = 0.838), exacerbation frequency (p = 0.227), lung diffusion capacity of carbon monoxide % pred. (p = 0.735).

Conclusion: We found strong evidence that increasing steps per day ameliorates the heavily impaired endothelial function in patients with severe and very severe COPD. Further studies should examine which factors influence this relationship in a positive or negative manner.
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http://dx.doi.org/10.1016/j.rmed.2020.106246DOI Listing
January 2021

Long-Term Effects of Pedometer-Based Physical Activity Coaching in Severe COPD: A Randomized Controlled Trial.

Int J Chron Obstruct Pulmon Dis 2020 6;15:2837-2846. Epub 2020 Nov 6.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

Background And Objective: Limited evidence on long-term effects of physical activity programs in COPD is available. The aim of the study was to investigate the effects of a three-month program combining physical activity counselling and pedometer-based feedback in addition to usual care, followed by a nine-month unsupervised observation period as compared to usual care in participants with severe to very severe COPD.

Methods: Participants were randomized to either a control group receiving usual care or an intervention group receiving motivational support, an activity diary with an individual step count goal (ie, an increase of ≥15% from baseline) and a pedometer in addition to usual care. The intervention ended after three months and an unsupervised observational period followed until twelve months. Primary outcome was daily step count after one year.

Results: Seventy-four participants were included, 61 (82%) completed the study. Linear regression modelling, adjusted for baseline step count, showed no significant difference in change in step count after 12 months between the groups (Β = 547.33, 95% CI = -243.55/1338.20).

Conclusion: A three-month program combining physical activity counselling and pedometer-based feedback in addition to usual care does not attenuate the declining course of physical activity in participants with severe and very severe COPD during a long term follow-up of one year as compared to usual care. This result was primarily determined by the low intervention response rates to the combined program.

Clinical Trial Registration: www.ClinicalTrials.gov, NCT03114241.
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http://dx.doi.org/10.2147/COPD.S279293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655791PMC
November 2020

A Telemonitoring and Hybrid Virtual Coaching Solution "CAir" for Patients with Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2020 Oct 22;9(10):e20412. Epub 2020 Oct 22.

Department of Management, Technology, and Economics, ETH Zürich, Zürich, Switzerland.

Background: Chronic obstructive pulmonary disease (COPD) is one of the most common disorders in the world. COPD is characterized by airflow obstruction, which is not fully reversible. Patients usually experience breathing-related symptoms with periods of acute worsening and a substantial decrease in the health-related quality-of-life. Active and comprehensive disease management can slow down the progressive course of the disease and improve patients' disabilities. Technological progress and digitalization of medicine have the potential to make elaborate interventions easily accessible and applicable to a broad spectrum of patients with COPD without increasing the costs of the intervention.

Objective: This study aims to develop a comprehensive telemonitoring and hybrid virtual coaching solution and to investigate its effects on the health-related quality of life of patients with COPD.

Methods: A monocentric, assessor-blind, two-arm (intervention/control) randomized controlled trial will be performed. Participants randomized to the control group will receive usual care and a CAir Desk (custom-built home disease-monitoring device to telemonitor disease-relevant parameters) for 12 weeks, without feedback or scores of the telemonitoring efforts and virtual coaching. Participants randomized to the intervention group will receive a CAir Desk and a hybrid digital coaching intervention for 12 weeks. As a primary outcome, we will measure the delta in the health-related quality of life, which we will assess with the St. George Respiratory Questionnaire, from baseline to week 12 (the end of the intervention).

Results: The development of the CAir Desk and virtual coach has been completed. Recruitment to the trial started in September 2020. We expect to start data collection by December 2020 and expect it to last for approximately 18 months, as we follow a multiwave approach. We expect to complete data collection by mid-2022 and plan the dissemination of the results subsequently.

Conclusions: To our knowledge, this is the first study investigating a combination of telemonitoring and hybrid virtual coaching in patients with COPD. We will investigate the effectiveness, efficacy, and usability of the proposed intervention and provide evidence to further develop app-based and chatbot-based disease monitoring and interventions in COPD.

Trial Registration: ClinicalTrials.gov identifier: NCT04373070; https://clinicaltrials.gov/ct2/show/NCT04373070.

International Registered Report Identifier (irrid): DERR1-10.2196/20412.
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http://dx.doi.org/10.2196/20412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644383PMC
October 2020

Gesundheitsverhalten und Bedürfnisse von Menschen mit COPD während der COVID-19-Pandemie - Eine Dokumentenanalyse.

Pflege 2020 08;33(4):237-245

Zentrum Klinische Pflegewissenschaft, Universitätsspital Zürich, Schweiz.

Health behaviours and needs of people with COPD during COVID-19 pandemic: a document analysis Background: The government's guidelines affected people with COPD on different levels during the COVID-19 pandemic. In addition to belonging to a group of particularly vulnerable persons, they had to adapt their health behaviours, in particular physical activity, to recommendations provided in order to prevent negative effects on disease progression. There is little knowledge regarding how this group of patients coped with these challenges during the COVID-19 pandemic.

Objective: To describe the health behaviours and needs people with COPD convey during nursing phone consultations and which nursing interventions have been carried out.

Methods: A document analysis of 50 nursing phone consultations was performed. The data were summarised descriptively and analysed thematically.

Results: The main topics were the adaptation of physical activity, the implementation of the recommendations to the individual life situation, the detection of a COVID-19 infection and questions concerning the planning of medical appointments.

Conclusion: The COVID-19 pandemic poses additional challenges to the disease management of people with COPD. The increased need for care brought on by the pandemic was able to be met by the knowledge provided in the nursing phone consultations. What remains to be established is what role the consultations play in a sustainable change in behaviour and in dealing with negative emotions.
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http://dx.doi.org/10.1024/1012-5302/a000754DOI Listing
August 2020

Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland?

ERJ Open Res 2020 Apr 15;6(2). Epub 2020 Jun 15.

Centre of Clinical Nursing Science, University Hospital Zürich, Zürich, Switzerland.

Aim: This study aimed to address the need for adaptation of the current model of chronic obstructive pulmonary disease (COPD) care in Switzerland, particularly in regard to acute exacerbations, and how far an integrated approach involving advanced nursing practice can meet those needs.

Methods: A state analysis guided by the PEPPA framework was initiated by the Pulmonology Clinic of University Hospital Zürich. Literature describing the current provision of COPD care regarding exacerbations in Switzerland and international qualitative studies describing the patient perspective were systematically searched and summarised. The health providers' perspective was investigated in three focus-group interviews.

Results: A lack of systematic and state-of-the-art support for patient self-management in Switzerland was described in literature and confirmed by the health providers interviewed. While care was assessed as being comprehensive and of good quality in each individual sector, such as inpatient, outpatient, rehabilitation and home settings, it was identified as being highly fragmented across sectors. The interview participants described day-to-day examples in which a lack of support in COPD self-management and fragmentation of care negatively affected the patients' disease management.

Conclusion: The necessity of coordinating the transition between healthcare sectors and self-management support and that these organisational boundaries should be addressed by a multi-professional team were identified. Initial evaluation indicates that advanced practice nurses potentially have the skill set to coordinate the team and address patients' self-management needs in complex patient situations. However, the legal foundation and a reimbursement system to ensure long-term implementation is not yet available.
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http://dx.doi.org/10.1183/23120541.00354-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293988PMC
April 2020

Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD.

Int J Chron Obstruct Pulmon Dis 2020 26;15:627-635. Epub 2020 Mar 26.

Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.

Objective: To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting.

Methods: This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA.

Results: Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%).

Conclusion: The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.
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http://dx.doi.org/10.2147/COPD.S240444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105357PMC
March 2020

Arterial Stiffness Increases Over Time in Relation to Lung Diffusion Capacity: A Longitudinal Observation Study in COPD.

Int J Chron Obstruct Pulmon Dis 2020 23;15:177-187. Epub 2020 Jan 23.

Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.

Background: Cardiovascular events are, after cancer, the most common cause of death in COPD patients. Arterial stiffness is an independent predictor of all-cause mortality and cardiovascular events. Several cross-sectional studies have confirmed increased arterial stiffness in patients with COPD. Various mechanisms in the development of arterial stiffness in COPD such as reduced lung function or systemic inflammation have been proposed. However, clinical predictors of arterial stiffness that had been reported in cross-sectional studies have not yet been confirmed in a longitudinal setting. We have assessed the course of augmentation index (AIx) - a measure of systemic arterial stiffness - and possible predictors in a cohort of COPD patients over a period of up to 7 years.

Methods: COPD patients underwent annual AIx measurement by applanation tonometry for a maximum duration of 7 years. Additionally, we performed annual assessments of lung function, blood gases, systemic inflammation, serum lipids and blood pressure. Associations between the course of AIx and potential predictors were investigated through a mixed effect model.

Results: Seventy-six patients (mean (SD) age 62.4 (7.1), male 67%) were included. The AIx showed a significant annual increase of 0.91% (95% CI 0.21/1.60) adjusted for baseline. The change in diffusion capacity (DLco), low-density lipoprotein (LDL), and high-sensitivity c-reactive protein (hsCRP) was independently associated with the increasing evolution of AIx (Coef. - 0.10, p<0.001, Coef. 1.37, p=0.003, and Coef. 0.07, p=0.033, respectively).

Conclusion: This study demonstrated a meaningful increase in arterial stiffness in COPD over time. A greater annual increase in arterial stiffness was associated with the severity of emphysema (measured by DLco), systemic inflammation, and dyslipidaemia.

Clinical Trial Registration: www.ClinicalTrials.gov, NCT01527773.
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http://dx.doi.org/10.2147/COPD.S234882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986246PMC
February 2021

Protocol for the EARCO Registry: a pan-European observational study in patients with α-antitrypsin deficiency.

ERJ Open Res 2020 Jan 2;6(1). Epub 2020 Mar 2.

Pneumology Dept, Hospital Universitari Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.

Rationale And Objectives: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that leads to an increased risk of emphysema and liver disease. Despite extensive investigation, there remain unanswered questions concerning the natural history, pathophysiology, genetics and the prognosis of the lung disease in association with AATD. The European Alpha-1 Clinical Research Collaboration (EARCO) is designed to bring together researchers from European countries and to create a standardised database for the follow-up of patients with AATD.

Study Design And Population: The EARCO Registry is a non-interventional, multicentre, pan-European, longitudinal observational cohort study enrolling patients with AATD. Data will be collected prospectively without interference/modification of patient's management by the study team. The major inclusion criterion is diagnosed severe AATD, defined by an AAT serum level <11 µM (50 mg·dL) and/or a proteinase inhibitor genotype ZZ, SZ or compound heterozygotes or homozygotes of other rare deficient variants. Assessments at baseline and during the yearly follow-up visits include lung function testing (spirometry, body plethysmography and diffusing capacity of the lung), exercise capacity, blood tests and questionnaires (symptoms, quality of life and physical activity). To ensure correct data collection, there will be designated investigator staff to document the data in the case report form. All data will be reviewed by the EARCO database manager.

Summary: The EARCO Registry aims to understand the natural history and prognosis of AATD better with the goal to create and validate prognostic tools to support medical decision-making.
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http://dx.doi.org/10.1183/23120541.00181-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049712PMC
January 2020

Handgrip Strength Seems Not to Be Affected by COPD Disease Progression: A Longitudinal Cohort Study.

COPD 2020 04 19;17(2):150-155. Epub 2020 Feb 19.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

Skeletal muscle dysfunction, functional exercise capacity impairment and reduced physical activity are characteristic features in patients with chronic obstructive pulmonary disease (COPD). Assessments addressing muscle strength of the upper limb, such as measurement of handgrip strength (HGS), are rarely performed and reported. We aimed to analyze the course of HGS and possible predictors of changes in HGS over time in COPD. Yearly assessments of various disease markers were performed for a follow-up of up to seven years in a cohort of COPD patients to assess the longitudinal disease process. Data of 194 patients with at least one follow-up measurement were analyzed. HGS decreased significantly by = -0.86 (95% CI -1.09/-0.62,  < 0.001) over time. The multivariate mixed effects model showed an independent association between greater annual declines in HGS and lower numbers of steps per day by  = 0.11 (95% CI 0.03/0.18,  = 0.006) and an enhanced change in COPD Assessment Test scores by = -0.01 (95% CI -0.01/-0.00,  = 0.034). No evidence for an independent association between annual decline in HGS and FEV% pred. by = -0.01 (95% CI -0.03/0.01,  = 0.297) was shown. Patients who died during follow-up did not exhibit greater declines in HGS compared to survivors ( = 0.884). Although HGS significantly decreased over time, no pathophysiological link with COPD disease progression could be demonstrated. Previous cross-sectional associations between HGS and mortality could not be confirmed in this longitudinal setting. Our data suggests that repeated monitoring of HGS in clinical settings seems not to be helpful to predict COPD specific disease progression.
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http://dx.doi.org/10.1080/15412555.2020.1727428DOI Listing
April 2020

"Can do, don't do" are not the lazy ones: a longitudinal study on physical functioning in patients with COPD.

Respir Res 2020 Jan 20;21(1):27. Epub 2020 Jan 20.

Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Background And Objective: Reduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of sub-groups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics.

Methods: In a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed.

Results: Data from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) "can't do, don't do": most severe and symptomatic, several comorbidities II) "can do, don't do": severe but less symptomatic, several comorbidities III) "can't do, do do": few patients, severe and symptomatic, less comorbidities IV) "can do, do do": mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual sub-groups.

Conclusion: Our findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the "can do, don't do" quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC.

Clinical Trial Registration: www.ClinicalTrials.gov, NCT01527773.
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http://dx.doi.org/10.1186/s12931-020-1290-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6972031PMC
January 2020

[Asthma, COPD or overlap? Symptoms and diagnostic procedures].

Ther Umsch 2019 Nov;76(6):287-292

Klinik für Pneumologie, UniversitätsSpital Zürich.

Asthma, COPD or overlap? Symptoms and diagnostic procedures Medical history combined with spirometry before and after bronchodilation provides important information, and allows distinguishing between asthma and Chronic obstructive pulmonary disease (COPD) in most of the cases. COPD and asthma are sometimes difficult to discriminate, mainly in older patients with a smoking history and /or history of atopia. Symptoms and the results of diagnostic tests are the basis on which therapeutic decisions are made. Differentiation between asthma and COPD is of great importance because management approaches and goals for these conditions differ. Asthma-COPD-overlap has to be considered if a significant interleave of clinical features of both conditions is identified. If it is not possible to differentiate between the two conditions, ways of additional diagnostic testing are described in this article.
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http://dx.doi.org/10.1024/0040-5930/a001098DOI Listing
November 2019

Prevalence of Obstructive Sleep Apnea in Patients with Thoracic Aortic Aneurysm: A Prospective, Parallel Cohort Study.

Respiration 2020;99(1):19-27. Epub 2019 Sep 25.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland,

Background: The pathogenesis and etiology of thoracic aortic aneurysms (TAA) are largely unknown. Preliminary data from patients with aortic dissection and abdominal aneurysms suggest a causal link of obstructive sleep apnea (OSA) on aortic disease.

Objectives: The aim of the study was to assess the prevalence of OSA in patients with TAA compared to a matched control group.

Method: In this prospective parallel-cohort study, we 2-to-1 matched 208 patients with verified TAA (at the aortic sinus and/or ascending aorta) to 104 controls without TAA according to sex, age, height, weight, and left ventricular ejection fraction. All participants underwent an ultrasound of the thoracic aorta and a level III respiratory polygraphy. OSA was defined as apnea-hypopnea index ≥5/h. The prevalence of OSA was compared with conditional logistic regression and controlling for the matching variables.

Results: A total of 312 patients (mean age 65 ± 11 years, 82% male, mean body mass index 27 ± 4 kg/m2) were successfully 2-to-1 matched in the final model. Prevalence of OSA was significantly higher in the TAA-group when compared to the matched control group (63 vs. 47%; odds ratio 1.87 [95% CI 1.05-3.34]; p = 0.03). When applying a higher apnea-hypopnea index threshold (≥15/h), the odds ratio increased to 3.25 (95% CI 1.65-6.42; p < 0.001). The median apnea-hypopnea index was higher in patients with TAA (9.2/h [3.3-20.0] vs. 4.5/h [2.2-11.1], p < 0.001).

Conclusions: Patients with TAA have a higher prevalence of OSA when compared to the general population. Since OSA is effectively treatable and might contribute to the pathogenesis of TAA, further longitudinal trials are needed to assess the association between OSA and TAA.
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http://dx.doi.org/10.1159/000502892DOI Listing
September 2019

Obstructive sleep apnea and quality of life in Fabry disease: a prospective parallel cohort study.

Sleep Breath 2020 Mar 2;24(1):95-101. Epub 2019 Apr 2.

Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Study Objectives: Patients with Fabry disease (FD) report impaired quality of life and excessive daytime sleepiness. Obstructive sleep apnea (OSA) is frequently reported among patients with FD; however, its prevalence and its influence on quality of life and daytime sleepiness in this population are unclear.

Methods: Patients with FD in a cohort from the University Hospital Zurich (n = 52) were one-to-two matched to healthy adult controls (n = 104) according to age, sex, and body mass index. Participants underwent structured interviews (including Short Form-36) and level-3 respiratory polygraphy. An apnea-hypopnea index of ≥ 5/h was defined as OSA and the severity of FD was quantified with the Mainz Severity Score Index (MSSI). Conditional logistic regression was used to compare the outcomes.

Results: In patients with FD the mean MSSI was 13.3 ± 10.5 points and OSA prevalence was 19.2% vs. 9.0% in the matched control group (p = 0.09). The apnea-hypopnea index was significantly higher in patients with FD than in the control group (0.5/h [0.2-3.0] vs. 0.2/h [0.1-1.8], p = 0.026). OSA severity was associated with impaired quality of life in four dimensions for the whole study population. Furthermore, patients with FD did report significantly higher daytime sleepiness (Epworth Sleepiness Scale 7.6 points vs. 6.3 points; p = 0.01) than healthy controls.

Conclusion: Patients with mild FD do not have a higher OSA prevalence than matched control subjects. Differences in OSA severity did not reach clinical significance. Further studies are warranted to determine the impact of OSA in patients with moderate-to-severe FD.
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http://dx.doi.org/10.1007/s11325-019-01832-4DOI Listing
March 2020

No impact of exacerbation frequency and severity on the physical activity decline in COPD: a long-term observation.

Int J Chron Obstruct Pulmon Dis 2019;14:431-437. Epub 2019 Feb 15.

Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,

Introduction: COPD exacerbations are associated with a concomitant profound reduction in daily physical activity (PA). Thereby, exacerbation frequency and severity may have an amplifying effect. Whether the reduced level of PA returns to the level prior to exacerbation or has a sustained negative impact on activity behavior over time is unclear.

Methods: The number of steps per day over 1 week, as a measure of daily PA, was assessed annually in a cohort of patients with COPD. Exacerbation frequency and severity were documented. Uni- and multivariate mixed effect models were used to investigate associations between change in number of steps per day (dependent variable) and exacerbations. Stratification by possible confounders was performed.

Results: One hundred and eighty one COPD patients (median [quartile] age 64 [59/69] years, 65% male, median [quartiles] FEV % pred. 46 [33/65]) suffered a total of 273 exacerbations during the observation period (median [quartiles] follow-up time of 2.1 [1.6/3.1] years). Neither the frequency nor the severity of exacerbations was significantly related to the overall decline in PA over time. Stratification by different possible confounders such as age, sex and disease severity did not yield a subgroup in which exacerbations enhance the decrease in PA over time.

Conclusion: The drop in PA during the phase of an acute exacerbation seems not to be a lasting phenomenon leading to a fundamental change in activity behavior.

Trial Registration: www.ClinicalTrials.gov, NCT01527773.
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http://dx.doi.org/10.2147/COPD.S188710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388775PMC
July 2019

The Swiss Primary Ciliary Dyskinesia registry: objectives, methods and first results

Swiss Med Wkly 2019 01 13;149. Epub 2019 Jan 13.

Primary ciliary dyskinesia (PCD) is a rare, hereditary, multiorgan disease caused by defects in the structure and function of motile cilia. It results in a wide range of clinical manifestations, most commonly in the upper and lower airways. Central data collection in national and international registries is essential to studying the epidemiology of rare diseases and filling in gaps in knowledge of diseases such as PCD. For this reason, the Swiss Primary Ciliary Dyskinesia Registry (CH-PCD) was founded in 2013 as a collaborative project between epidemiologists and adult and paediatric pulmonologists. We describe the objectives and methodology of the CH-PCD, present initial results, and give an overview of current and ongoing projects. The registry records patients of any age, suffering from PCD, who are treated and resident in Switzerland. It collects information from patients identified through physicians, diagnostic facilities and patient organisations. The registry dataset contains data on diagnostic evaluations, lung function, microbiology and imaging, symptoms, treatments and hospitalisations. By May 2018, CH-PCD has contacted 566 physicians of different specialties and identified 134 patients with PCD. At present, this number represents an overall 1 in 63,000 prevalence of people diagnosed with PCD in Switzerland. Prevalence differs by age and region; it is highest in children and adults younger than 30 years, and in Espace Mittelland. The median age of patients in the registry is 25 years (range 5–73), and 41 patients have a definite PCD diagnosis based on recent international guidelines. Data from CH-PCD are contributed to international collaborative studies and the registry facilitates patient identification for nested studies. CH-PCD has proven to be a valuable research tool that already has highlighted weaknesses in PCD clinical practice in Switzerland. Trial registration number: NCT03606200
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http://dx.doi.org/10.4414/smw.2019.20004DOI Listing
January 2019

Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018.

Respiration 2018;96(4):382-398. Epub 2018 Aug 23.

Pulmonary Division, University Hospital Basel, Basel, Switzerland.

The Swiss National Guidelines 2013 for chronic obstructive pulmonary disease have been revised in order to acknowledge recent progress in diagnosis and management of this disease. The resulting new Swiss recommendations are based on best evidence from the literature, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report and other published national guidelines. Misdiagnosis of chronic obstructive pulmonary disease is common and means that patients do not always receive optimal treatment. To improve the management of patients with chronic obstructive pulmonary disease in Switzerland, these recommendations encourage a more comprehensive assessment of patients, based on the combined assessment of symptoms, degree of airflow limitation, risk of exacerbation and the presence of comorbidities. Recommendations for evidence-based preventive measures, as well as pharmacological and non-pharmacological strategies for the management of both stable and acute exacerbations of chronic obstructive pulmonary disease are provided in this update.
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http://dx.doi.org/10.1159/000490551DOI Listing
October 2019

Physical activity declines in COPD while exercise capacity remains stable: A longitudinal study over 5 years.

Respir Med 2018 08 18;141:1-6. Epub 2018 Jun 18.

Pulmonary Division, University Hospital Zurich, Switzerland. Electronic address:

Background And Objective: Daily physical activity (PA) and exercise capacity are reduced in patients with COPD. Whether the natural longitudinal course of both appears synchronically or one precedes the other is currently unclear. The aim was to assess the longitudinal relationship between exercise capacity and physical activity and their changes over time in patients with COPD.

Methods: In a longitudinal observation-study of heterogeneous COPD patients, recruited from pulmonary outpatient clinics or hospital settings, we annually investigated two exercise capacity tests (1-min sit to stand test (STS) and 6 min walking test (6MWT)) and daily physical activity assessed by number of steps per day for minimum one, up to seven years. Univariable and multivariable mixed effect models were used to investigate the annual change in STS, 6MWD and number of steps per day.

Results: 202 COPD patients (17% COPD risk group (considers symptoms and future exacerbation risk to grade disease severity) A, 49% B, 4% C and 34% D) with a mean (min/max) follow-up time of 2.4 (0.9/6.8) years were annually assessed. The number of steps per day decreased significantly over time (annual mean (95% CI) of -451.0 (-605.3/-296.6) steps, p < 0.001) while STS and 6MWD remained stable.

Conclusion: Our findings suggest that COPD patients are increasingly impaired in their daily PA while exercise capacity remains stable during the study period. Thus, the longitudinal decline in PA seems not to be explained by a concomitant reduction in exercise tolerance.

Clinical Trial Registration: www.Clinicaltrials.Gov, NCT01527773.
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http://dx.doi.org/10.1016/j.rmed.2018.06.013DOI Listing
August 2018

Lung volume reduction surgery does not increase daily physical activity in patients with severe chronic obstructive pulmonary disease.

J Thorac Dis 2018 May;10(5):2722-2730

Division of Pulmonary, University Hospital of Zurich, Zurich, Switzerland.

Background: Lung volume reduction surgery (LVRS) is a treatment option for selected patients with severe chronic obstructive pulmonary disease (COPD) and emphysema. The positive effects of LVRS on exercise capacity are well known. In contrast, the effect of LVRS on daily physical activity (PA) is less clear.

Methods: In a prospective case-control study we evaluated selected patients with severe COPD and emphysema who underwent LVRS and COPD patients following usual care. Controls were matched for age, severity of airflow obstruction (FEV) and hyperinflation [residual volume to total lung capacity (RV/TLC)]. Treatment effect of LVRS on activity parameters was analysed using univariable regression model adjusting for treatment group.

Results: A total of 19 patients underwent LVRS and 16 COPD patients without a surgical intervention during the study period were included. The median (quartile) FEV% was 28% (range, 21-33%), RV/TLC was 69% (range, 64-73%) in cases while controls had a median (quartile) FEV% of 33% (range, 28.5-49.5%) and a RV/TLC of 58% (range, 49-61%). Age and body mass index (BMI) were comparable between both groups. Number of steps per day following LVRS was comparable to before the intervention (mean change: -115, 95% CI: -994.6 to 764.3, P=0.779) and was not significantly different to the change in control subjects (mean treatment effect: 931.4, 95% CI: -252.4 to 2,115.1, P=0.117).

Conclusions: The results from this study reveal that patients undergoing LVRS did not increase their daily level of PA despite improvement of exercise capacity and symptoms.
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http://dx.doi.org/10.21037/jtd.2018.05.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006130PMC
May 2018

Diagnosis and Management of Asthma - The Swiss Guidelines.

Respiration 2018 3;95(5):364-380. Epub 2018 Apr 3.

University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland.

The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA ("Global Strategy for Asthma Management and Prevention") report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a "new" definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.
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http://dx.doi.org/10.1159/000486797DOI Listing
October 2018

Annual progression of endothelial dysfunction in patients with COPD.

Respir Med 2017 Nov 18;132:15-20. Epub 2017 Sep 18.

Pulmonary Division, University Hospital Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland.

Background: The risk to die from cardiovascular disease is particularly high in patients with COPD. This longitudinal study aims to evaluate changes of endothelial function over time and identify underlying mechanisms in COPD patients.

Methods: In stable COPD patients we performed annual assessments of endothelial function by flow-mediated dilatation (FMD), lung function, systemic inflammation and cholesterol, sympathetic activation, oxygenation, physical activity and exercise capacity. Associations between annual changes of potential predictors and FMD were investigated in mixed analysis.

Results: 76 patients (41% GOLD stage 1/2, 30% 3, 29% 4) were included. Endothelial function significantly decreased annually by -0.14% (95%CI -0.25/-0.04), equal to a relative decrease of -5.6%. Yearly change in 6-min walking distance was significantly associated with FMD in univariable analysis (Coef. -0.00, p = 0.045). Progressive airway obstruction and increase in level of total cholesterol were borderline significant with a greater decrease in FMD (Coeff. -0.02, p = 0.097 and Coeff. -0.16, p = 0.080, respectively). In multivariable analysis a greater annual decline in FEV1 tends to be independently associated with a decrease in FMD (p = 0.085).

Conclusion: The findings of this study demonstrated that COPD patients experience a significant decrease in endothelial function over time. A greater annual decline in lung function tends to be associated with greater decrease in FMD. However, no other independent predictors for endothelial dysfunction could be identified.

Clinical Trial Registration: www.ClinicalTrials.gov, NCT01527773.
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http://dx.doi.org/10.1016/j.rmed.2017.09.005DOI Listing
November 2017

Ipilimumab and early signs of pulmonary toxicity in patients with metastastic melanoma: a prospective observational study.

Cancer Immunol Immunother 2018 01 5;67(1):127-134. Epub 2017 Oct 5.

Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Ipilimumab, an immune checkpoint inhibitor, is approved for treatment metastastic melanoma and is a promising agent against other malignancies. There is some preliminary evidence from case reports that ipilimumab treatment may be associated with pulmonary side effects. However, data from prospective studies on ipilimumab-related pulmonary toxicity are still scarce. Serial spirometries and measurements of CO-diffusion capacity (DLCO) in patients with metastatic melanoma before and during treatment with ipilimumab were performed. A reduction from baseline of forced vital capacity (FVC) of ≥ 10%, or ≥ 15% of DLCO was defined as clinically meaningful and indicative for pulmonary toxicity. Of 71 patients included in this study, a clinically meaningful lung function decline was registered in 6/65 (9%), 5/44 (11%), and 9/38 (24%) patients after 3, 6, and 9 weeks of treatment initiation, respectively. Even after adjusting for age, concomitant melanoma treatment, progressive pulmonary metastases, and baseline pulmonary function values, mean ± SD DLCO decreased significantly during follow-up (-4.3% ± 13.6% from baseline, p = 0.033). Only 7% of patients reported respiratory symptoms. Clinically manifest ipilimumab-related pneumonitis was diagnosed only in one patient (1.4%). DLCO decline maybe an early indicator of subclinical pulmonary drug toxicity. Therefore, routine pulmonary function testing including DLCO measurement during treatment might help for risk stratification to screen for ipilimumab-related pneumonitis.
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http://dx.doi.org/10.1007/s00262-017-2071-2DOI Listing
January 2018

Physical activity patterns and clusters in 1001 patients with COPD.

Chron Respir Dis 2017 Aug 24;14(3):256-269. Epub 2017 Feb 24.

1 Department of Research & Education, CIRO, Horn, The Netherlands.

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV, worse dyspnoea and higher ADO index compared to other clusters ( p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.
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http://dx.doi.org/10.1177/1479972316687207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720232PMC
August 2017

Asymptomatic congenital tuberculosis: A case report.

Medicine (Baltimore) 2017 Jul;96(29):e7562

Division of Infectious Diseases and Hospital Epidemiology Children's Research Center, University Children's Hospital Zurich Division of Clinical Pathology, University Hospital Zurich Institute of Medical Microbiology Swiss National Center for Mycobacteria, University of Zurich Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

Rationale: Congenital tuberculosis (TB) is described as a rare, but severe disease. In contrast to the cases with severe symptoms reported so far, we describe a child with asymptomatic congenital TB.

Patient Concerns: An 8-week-old girl was investigated because of newly diagnosed TB in her mother, which complained about cough since 21 weeks gestation. Lung biopsy tissue specimens of the mother revealed necrotizing granuloma with a single acid-fast bacillus (AFB) and Mycobacterium tuberculosis (MTB) was detected by polymerase chain reaction. Bronchoalveolar lavage was negative for AFB smear and culture, arguing against postnatal transmission of MTB. TB contact investigations were negative. The child, at the age of 8 weeks at first assessment, was in an excellent general condition and diagnosed with congenital TB by culture-positive lung TB and exclusion of postnatal transmission.

Diagnoses: The child fulfilled Cantwell criteria to diagnose congenital TB.

Interventions: Ambulatory anti-tuberculosis treatment was initiated for 6 months.

Outcomes: The 18 months follow-up was uneventful.

Lessons: This case of asymptomatic congenital TB in a young child illustrates the diagnostic difficulties in congenital TB and raises the question whether congenital TB is underestimated.
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http://dx.doi.org/10.1097/MD.0000000000007562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521925PMC
July 2017

Accelerometer- versus questionnaire-based assessment of physical activity and their changes over time in patients with COPD.

Int J Chron Obstruct Pulmon Dis 2017 10;12:1113-1118. Epub 2017 Apr 10.

Pulmonary Division, University Hospital of Zurich, Zurich.

Background And Objective: Physical activity (PA) is an important outcome parameter in patients with COPD regarding hospitalizations and mortality. Both objective assessment by accelerometers and self-evaluation by questionnaires were used in studies investigating PA in COPD. Whether self-reported questionnaires can adequately reflect PA and its changes over time compared to objective assessments has not been thoroughly investigated in COPD. In this COPD cohort study, we evaluated whether PA measured by accelerometer and its annual changes can also be assessed by self-reported questionnaires.

Methods: In 178 COPD patients with at least two assessments of PA, the agreement between objectively measured and self-reported activity was analyzed by Bland-Altman plots. Daily PA was assessed by a triaxial activity monitor over 1 week and by the self-reported German PA questionnaire 50+.

Results: Comparison between the two methods of measurement revealed no convincing agreement with a mean difference and limits of agreement (±1.96 standard deviation [SD]) of time spent in at least moderate PA (>3 metabolic equivalent of task [MET]) of -77.6 (-340.3/185.2) min/day, indicating a self-reported overestimation of PA by the questionnaire. The mean difference and limits of agreement (±1.96SD) in the annual change of PA was 1.2 min/day (-208.2/282.6 min/day), showing also a poor agreement on an individual level.

Conclusion: Evaluation of objectively measured and self-reported PA and their annual changes revealed no agreement in patients with COPD. Therefore, the evaluated questionnaire seems not helpful for measurement of PA and its changes over time.
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http://dx.doi.org/10.2147/COPD.S130195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391993PMC
March 2018

Determinants of annual change in physical activity in COPD.

Respirology 2017 08 30;22(6):1133-1139. Epub 2017 Mar 30.

Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.

Background And Objective: Daily physical activity (PA) is reduced in patients with COPD. Previous cross-sectional analyses indicate various predictors for a low level of PA including airway obstruction, exacerbations and co-morbidities. However, information from longitudinal studies evaluating PA in the context of disease progression, survival and co-morbidities is scant.

Methods: In a heterogeneous cohort of COPD patients, we annually assessed the number of steps per day over 1 week and potential determinants including lung function, exacerbations and co-morbidities. Univariable and multivariable mixed effect models were used to investigate associations between the change in steps per day (dependent variable) and possible predictors and their annual changes.

Results: A total of 177 COPD patients (46% GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 1/2, 38% stage 3 and 16% stage 4) with a mean (min/max) follow-up time of 2.7 (1/5) years were annually assessed. The number of steps per day decreased significantly over time (P < 0.001) with a mean annual change of -508 steps. The decrease in activity was significantly associated with forced expiratory volume in 1 s (FEV ) % predicted (P = 0.020) but not with annual changes in FEV . Hyperinflation, exacerbations, co-morbidities and their annual changes, and survival did not significantly affect change in PA.

Conclusion: COPD patients have a substantial decrease of PA over time. This decrease seems to be determined by the degree of airflow limitation. However, patients with a greater annual decline in lung function did not show a greater decrease in PA. The rate of decline in PA did not differ between survivors and non-survivors in this cohort.
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http://dx.doi.org/10.1111/resp.13035DOI Listing
August 2017

Idiopathic Pulmonary Fibrosis in Switzerland: Diagnosis and Treatment.

Respiration 2017 25;93(5):363-378. Epub 2017 Mar 25.

Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Idiopathic pulmonary fibrosis (IPF) is a severe progressive and irreversible lung disease. Novel antifibrotic drugs that slow disease progression are now available. However, many issues regarding patient management remain unanswered, such as the choice between available drugs, their use in particular subgroups and clinical situations, time of treatment onset, termination, combination or switch, or nonpharmacologic management. To guide Swiss respiratory physicians in this evolving field still characterized by numerous areas of uncertainty, the Swiss Working Group for interstitial and rare lung diseases of the Swiss Respiratory Society provides a position paper on the diagnosis and treatment of IPF.
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http://dx.doi.org/10.1159/000464332DOI Listing
October 2017