Chronic Obstructive Pulmonary Disease
Resource for health workers
www.copdexchange.co.uk
NICE GUIDELINES 2010
www.nice.org.uk/nicemedia/live/13029/49397/49397.pdf
BTS/ACPRC Physiotherapy GUIDELINE:
Bott J, Blumenthal S, Buxton M et al (2009) Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax, 64(Suppl.1):i1-i52
thorax.bmj.com/cgi/content/full/64/Suppl_1/i1?HITS=10&sortspec=relevance&hits=10&FIRSTINDEX=0&resourcetype=HWCIT&fulltext=acprc&searchid=1
BTS GUIDELINE (2007) Intermediate careHospital-at-Home in COPD. Thorax, 62, 200-210
thorax.bmj.com/content/62/3/200.full?sid=e3f4a871-da6d-4a06-8772-9a7273b353fa
US GUIDELINES
www.guidelines.gov/summary/summary.aspx?doc_id=14439&nbr=007229&string=Pulmonary+AND+rehabilitation
RCP (2008) National COPD Audit. Royal College of Physicians and British Thoracic Society
www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/ncrop/Documents/Report-of-the-National-COPD-Audit-2008-UK-Primary-Care-Organisations-Resources-and-Organisation-of-Care.pdf
UK Department of Health (2010) - Consultation on a Strategy for Services for COPD in England
www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_113280.pdf
3 million people have COPD but only 2 million are diagnosed (England)
re-admissions rising
patients with respiratory failure should carry alert cards
25% of patients are unable to work due to the disease
people in lowest social groups are 14 times more likely to have COPD
up to 30% patients currently prescribed LTOT derive no benefit from it, but only half of eligible patients with severe disease receive it
UK Department of Health (2011) - An outcomes strategy for people with COPD and asthma
www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/COPD/Outcome%20Strategy%20for%20COPD_Asthma.pdf
patients admitted to hospital must be cared for by a respiratory team, have access to a specialist early supported-discharge scheme with community support, and be reviewed within two weeks of discharge
advanced disease requires patients and their carers to be identified and offered specialist palliative care
COPD Assessment Test (CAT)
www.catestonline.org/english/index.htm
self assessment based on shortened St. Georges Questionnaire.
OSTEOPOROSIS GUIDELINES
www.nos.org.uk/
NUTRITION GUIDELINES
www.guidelines.gov/summary/summary.aspx?ss=15&doc_id=4228&nbr=3233
Resource for health care workers:
www.copdexchange.co.uk
Alifano M et al (2010) Treatment of COPD: from pharmacological to instrumental therapies. Eur Respir Rev, 19(115): 723
err.ersjournals.com/cgi/content/full/19/115/7
patients with similar FEV1s show different functional status, lung pathology and comorbidities
excellent review of range of treatments
Almagro P (2006) Risk factors for hospital readmission in patients with COPD. Respiration, 73, 311-317
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224278&Ausgabe=231763&ArtikelNr=88092
quality of life, hospitalization for COPD in the previous year and hypercapnia at discharge are useful predictors of readmission
Arnardottir RH (2007) No increase in walking distance on repeated tests in COPD patients with exercise-induced hypoxaemia. Advances Physiother, 9, 4, 161 168
www.informaworld.com/smpp/content~content=a780589043~db=alhe~order=page
when using the 12-min walking distance, a practice walk is needed only in those patients who do not desaturate on exercise.
Bakerly ND (2009) Cost analysis of an integrated care model in the management of acute exacerbations of COPD. Chr Respir Dis, 6, 4, 201-8
crd.sagepub.com/cgi/content/abstract/6/4/201
hospital-at-home management of COPD exacerbations saves £600 per patient.
Barker AF (2010) Alpha-1 antitrypsin deficiency identification and management. COPD, 7, 3, 162-3
informahealthcare.com/doi/full/10.3109/15412555.2010.487042
AATD takes an average 6 years to be diagnosed
diagnosis and treatment of AATD
Barnes PJ (2003) New concepts in chronic obstructive pulmonary disease. Annu Rev Med, 54, 113-29
inflammatory process is relatively resistant to steroids
Barnes PJ, Stockley RA, (2005) COPD: current therapeutic interventions and future approaches. Eur Respir J, 25, 1084-106
erj.ersjournals.com/cgi/content/full/25/6/1084
no current drugs reduce progression of COPD or suppress the inflammation. Several new drugs that target the inflammatory process now being developed
Bastin AJ, Starling L, Ahmed R (2010) High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation. Chronic Resp Dis, 7, 2, 91-97
fewer than one in five patients are diagnosed
diagnosis was not made prior to admission in one-third of patients with severe disease
self management plans are associated with reduced admissions
one third of patients were not seen by the respiratory team during their admission
PR is safe after exacerbations
stopping smoking reduces mortality even in patients with severe COPD
Bιgin P (2000) Chronic hypoventilation helps to maintain the inspiratory muscle effort of COPD patients. Chest, 117, 271S-273S
www.chestjournal.org/cgi/content/full/117/5_suppl_1/271S?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=117&firstpage=271S&resourcetype=HWCIT
the purpose of chronic hypoventilation (common in Type 2 respiratory failure) may be to preserve the respiratory muscles
Behnke M (2000) Home-based exercise is capable of preserving hospital-based improvements in severe COPD. Respir Med, 94, 1184-91
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WWS-45BCP2H-7&_user=10&_coverDate=12%2F31%2F2000&_alid=481324586&_rdoc=1&_fmt=summary&_orig=search&_cdi=7138&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=30ebd5e7567ad2198ddbd394d2a82b99
Bekkering GE (2000) Guidelines for physiotherapeutic management in COPD. Phys Ther Rev, 5, 59-74
comprehensive, physiologically-sound guidelines, including flow-charts
Bellamy D Freeman D (2000) Chronic obstructive pulmonary disease. Prim Care Respir J, 9, S20-21
steroids are usually beneficial for exacerbations but unhelpful in the stable state
Bellone A (2002) Short-term effects of expiration under positive pressure in patients with acute COPD and mild acidosis requiring NIV. Int Care Med, 28, 581-5
expiration under positive pressure helps clear secretions in this group of patients
Berry JK (2001) Malnutrition in COPD: adding insult to injury. AACN Clin Issues, 12, 210-19
www.aacn.org/AACN/jrnlci.nsf/bd5ca01ff707c8948825653f000cd2b6/bd63ceac884291fa88256a5c005f34a5?OpenDocument
mechanisms and management
Biskobing DM (2002) COPD and osteoporosis. Chest, 121, 609-620
www.chestjournal.org/cgi/content/full/121/2/609?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=121&firstpage=609&resourcetype=HWCIT
many patients are not diagnosed as having osteoporosis until they get a fracture
Bon JM (2010) Plasma inflammatory mediators associated with bone metabolism in COPD. COPD, 7, 3, 186-191
informahealthcare.com/doi/abs/10.3109/15412555.2010.482114
osteoporosis is a significant problem in COPD
Bourjeily G (2000) Exercise training and COPD. Clin Chest Med, 21, 763-78
indications, upper and lower limb, intensity, inspiratory muscle training
Cahalin LP (2002) Efficacy of diaphragmatic breathing in persons with COPD: a review of the literature. J Cardiopulm.Rehab, 22, 7-21
www.nursingcenter.com
rationale of why diaphragmatic breathing may or may not be effective
Cai B (2003) Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Nutrition, 19, 229-32
pulmonary function in COPD improved by high-fat low-carbohydrate supplementary feeding
Carter R, Holiday DB (2003) Predicting oxygen uptake for men and women with moderate to severe COPD. Arch Phys Med Rehab, 84, 1158-64
www.archives-pmr.org/article/PIIS0003999303000479/abstract
estimation of VO2 from six-minute walk test
Casas A, Troosters T, Garcia-Aymerich J, et al (2006) Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J, 28,123130
erj.ersjournals.com/cgi/content/abstract/28/1/123?ijkey=e56a48572f85c2f741c22831f90c261296c53e60&keytype2=tf_ipsecsha
individually tailored care plan on discharge, shared with primary care team and specialist nurse via a web-based call centre, reduces hospitalisation
Cazzola M (2006) Should the choice of a long-acting bronchodilator in the long-term therapy of COPD depend entirely on the onset of action? Respiration, 73, 410-11
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224278&Ausgabe=231972&ArtikelNr=93346&filename=93346.pdf
FEV1 is only weakly correlated with patient-centered outcomes such as dyspnoea
tolerance occurs with long-acting beta2-agonists
Celli BR (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J, 23, 932 46
erj.ersjournals.com/cgi/content/full/23/6/932
Cherniack NS (2002) Singing the COPD blues. Respiration, 69, 115-16
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224278&Ausgabe=228221&ArtikelNr=56312
a short sweet reminder of the mechanism of long term oxygen to prevent organ damage
Collins EG (2001) Breathing pattern retraining and exercise in persons with COPD. AACN Clin Issues, vol.12
www.aacn.org/AACN/jrnlci.nsf/bd5ca01ff707c8948825653f000cd2b6/bd63ceac884291fa88256a5c005f34a5?OpenDocument
literature review
Coronell C (2004) Relevance of assessing quadriceps endurance in patients with COPD. Eur Respir J, 24,129-136
erj.ersjournals.com/cgi/content/full/24/1/129?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Resistance+versus+endurance+training+in+patients+with+COPD+and+peripheral+muscle&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
impaired quadriceps endurance is present in COPD patients even if they have mild airflow obstruction, indicating that other factors as well as deconditioning are responsible
Cotton MM, Bucknall CE, Dagg KD (2000) Early discharge for patients with exacerbations of COPD. Thorax, 55, 902-6
thorax.bmjjournals.com/cgi/content/full/55/11/902?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=55&firstpage=902&resourcetype=HWCIT
early discharge does not appear to increase re-admission rates or mortality, so long as home support is available
Couillard A, Muir JF, Veale D (2010) COPD recent findings: impact on clinical practice. COPD, 7, 3, 204-213
informahealthcare.com/doi/abs/10.3109/15412555.2010.482115
co-morbidities - muscle dysfunction, nutritional and endocrine dysfunction, anaemia, osteoporosis, and cardiovascular and metabolic disorders
NEW
Cvejic L, Harding R, Churchward T (2011) Laryngeal penetration and aspiration in individuals with stable COPD. Respirology, 16, 2, 269-75
upper airway protective mechanisms may be flawed in COPD through reduced coordination of breathing with swallowing, leading to aspiration.
Dahlιn I, Janson C (2002) Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Chest, 122, 1633-7
www.chestjournal.org/cgi/content/full/122/5/1633?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=122&firstpage=1633&resourcetype=HWCIT
significant association between treatment failure and anxiety and/or depression
Lo Coco D (2008) Increased frequency of restless legs syndrome in chronic obstructive pulmonary disease patients. Sleep Medicine, 10, 5, 572-576
(also - Russell M (2007) Massage therapy and restless legs syndrome. J Bodywork and Movement Therapies, 11, 2, 146-150)
De Godoy DV (2003) A randomized controlled trial of the effect of psychotherapy on anxiety and depression in COPD. Arch Phys Med Rehab, 84, 1154-7
www.archives-pmr.org/article/PIIS0003999303002399/abstract
De Miguel-Dνez J (2010) The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings. BMC Cardiovasc Dis, 10, 8
www.biomedcentral.com/1471-2261/10/8
patients with heart disease as a comorbidity show worse quality of life and increased consumption of drugs
de Souza GF (2010) Lactic acid levels in patients with chronic obstructive pulmonary disease accomplishing unsupported arm exercises. Chronic Resp Dis, 7, 2, 75-82
extra energy, equivalent to 50% of the peak required for maximal leg exercises, is needed for unsupported arm exercises to compensate for dyssynchronous contraction of the different ventilatory muscle compartments
Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V (2009) Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med, 15, 3, 225-34 www.liebertonline.com/doi/abs/10.1089/acm.2008.0389
Dowson CA, Kuijer RG, Town IG (2010) Impact of panic disorder upon self-management educational goals in chronic obstructive pulmonary disease? Chronic Respir Dis, 7, 2, 83-90
24%50% of hospitalized patients with COPD have panic disorder, compared to 10%19% in general medical inpatients
Drazen J (2003) Guidance concerning surgery for emphysema. New Eng J Med, 348, 2134-5
content.nejm.org/cgi/content/extract/348/21/2134
evidence-base for lung volume reduction surgery
Eisner MD (2010) Influence of anxiety on health outcomes in COPD
Thorax, 65(3): 22934
thorax.bmj.com/content/65/3/229.abstract
anxiety is related to poorer health outcomes
Ekberg A (2001) Preventing exacerbations of chronic bronchitis and COPD. BMJ, 322, 1259-61
bmj.bmjjournals.com/cgi/content/full/322/7297/1259?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=322&firstpage=1259&resourcetype=HWCIT
Farquhar M (2010) Diversity of experience and impacts of caring for a patient with breathlessness in advanced COPD. Palliat Med, 24, 2, 211
proquest.umi.com.ezproxy.brighton.ac.uk/pqdweb?index=0&did=1974326301&SrchMode=3&sid=1&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1272994644&clientId=109189&aid=1
Fernandes M, Cukier A, Feltrim MIZ (2011) Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease. Chron Respir Dis, 8, 237-44
crd.sagepub.com/content/8/4/237.abstract?etoc
diaphragmatic breathing reduces SOB and hypoxaemia in the majority of COPD patients, but in some patients with severe COPD it may cause asynchronous breathing thus worsening SOB
Fishwick D, Barber CM, Darby AC (2010) Review series: Occupational and environmental lung disease: Chronic obstructive pulmonary disease and the workplace. Chronic Respir Dis, 7, 2, 113-122
workplace exposure is probably responsible for 15% of the total burden of COPD
problems with patients perceiving limitation in own capacity to work
Garcia-Aymerich J (2003) Risk factors of readmission to hospital for a COPD exacerbation. Thorax, 58, 100
thorax.bmjjournals.com/cgi/content/full/58/2/100?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Garcia-Aymerich+J+&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=58&firstpage=100&resourcetype=HWCIT
strong association between physical activity and reduced risk of readmission with COPD
Gay PV (2004) Chronic obstructive pulmonary disease and sleep. Respir Care, 49, 39-51
www.rcjournal.com/contents/01.04/01.04.0039.pdf
Gigliotti F (2003) Exercise training improves exertional dyspnea in patients with COPD. Chest, 123, 1794 1802
www.chestjournal.org/cgi/content/full/123/6/1794?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=123&firstpage=1794&resourcetype=HWCIT
Gosselink R (2004) Breathing techniques in patients with COPD. Chronic Respir Dis, 1, 163-72
crd.sagepub.com/cgi/content/abstract/1/3/163
Guarnieri G (2010) Effects of inhalation of thermal water on exhaled breath condensate in chronic obstructive pulmonary disease. Respiration, 79, 216-221
Gysels MH, Higginson IJ (2007) Self-management for breathlessness in COPD: the role of pulmonary rehabilitation. Chr Respir Dis, 6, 133-140
crd.sagepub.com/cgi/content/abstract/6/3/133
well-being needs to be understood not as the end point, but as a precarious balance needing skilful maintenance and hard work
Gysels MH, Higginson IJ (2008) Access to services for patients with chronic obstructive pulmonary disease: the invisibility of breathlessness. J Pain Symptom Manage, 36, 5, 451-60.
www.ncbi.nlm.nih.gov/pubmed/18495412
a palliative care approach is identified to reduce barriers to access.
Hansen-Flaschen J (2004) COPD: the last year of life. Respir Care, 49, 1, 90-7
www.rcjournal.com/contents/01.04/01.04.0090.pdf
difficulty of uncertain prognosis, the case for hospice care, how to communicate with patients
Hill K, Jenkins S, Hillman DR, Eastwood PR (2004) Dyspnoea in COPD: can inspiratory muscle training help? Austr J Physiother, 50,169-80.
gateway.ut.ovid.com.ezproxy.bton.ac.uk:2048/gw2/ovidweb.cgi
excellent explanation of the physiology of breathlessness; also evidence that specific loading of the respiratory muscles can reduce SOB
Holland AE, Button BM (2006) Is there a role for airway clearance techniques in chronic obstructive pulmonary disease? Chronic Respir Dis, 3, 2, 83-91
www.ingentaconnect.com/content/sage/crd/2006/00000003/00000002/art00005
PEP and autogenic drainage thought to be effective, but it may be advisable to avoid techniques that involve forced expiration
Hopkinson NS, Toma TP, Hansell DM et al (2004) Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema. Am J Respir Crit Care Med, 171, 453 - 60
ajrccm.atsjournals.org/cgi/content/abstract/171/5/453
lung volume reduction surgery improves gas exchange and exercise capacity
Houchen L, Steiner MC, Singh SJ (2009) How sustainable is strength training in chronic obstructive pulmonary disease? Physiotherapy, 95, 1, 1-7
www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%2318081%232009%23999049998%23876086%23FLA%23&_cdi=18081&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ed3533efea381ea1204c4c640e43c972
Hu J, Meek, P (2005) Health-related quality of life in individuals with COPD. Heart Lung, 34, 6, 415-22
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WG7-4HP9BHK-F&_user=10&_coverDate=12%2F31%2F2005&_alid=481347618&_rdoc=1&_fmt=summary&_orig=search&_cdi=6815&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=af1ba4eb765b0ec55a4ea4db22204fc0
Iwamot H, Yokoyama A, Kitahara Y (2009) Airflow limitation in smokers is associated with subclinical atherosclerosis. Am J Respir Crit Care Med, 173, 1, 35-40
COPD is associated with increased morbidity and mortality from cardiovascular disease
Janssen DJA, Spruit MA, Does JD (2010) End-of-life care in a COPD patient awaiting lung transplantation. BMC Palliative Care, 9, 6
www.biomedcentral.com/content/pdf/1472-684X-9-6.pdf
Jones PW (2001) Health status measurement in COPD. Thorax, 56, 880-7
thorax.bmjjournals.com/cgi/content/full/56/11/880?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=56&firstpage=880&resourcetype=HWCIT
leg fatigue can be as important, or more important, than breathlessness in limiting exercise tolerance
Jones AYM, Dean E, Chow CCS (2003) Comparison of the oxygen cost of breathing exercises with spontaneous breathing in patients with stable COPD. Phys Ther, 83, 424-31
www.ptjournal.org/cgi/content/full/83/5/424
abdominal breathing and pursed lip breathing reduce oxygen cost of breathing, but this is not maintained
Jones-Perrott S, Crutchley J, Rowley J et al (2004) Do comfort visits reduce hospital re-admissions in patients with COPD)? Thorax, 59, Supp II,16
after exacerbation, follow-up visits and telephone contact lead to a dramatic reduction in re-admissions
Kakizaki F et al (1999) Preliminary report on the effects of respiratory muscle stretch on chest wall mobility in COPD. Respir Care, 44, 409-414
www.rcjournal.com/contents/04.99/04.99.0409.asp
Knebel AR, Bentz E, Barnes P (2000). Dyspnea management in alpha-1 antitrypsin deficiency. Nurs Res, 49, 333-8
Lahzami S (2009) Lung transplantation for COPD evidence-based? Swiss Med Wkly, 139, (12), 48
www.smw.ch/docs/PdfContent/smw-12377.PDF
lung transplantation offers a survival benefit in 50% of patients, greater exercise tolerance and improved quality of life
Langer D, Hendriks D, Burtin C et al (2009) A clinical practice guideline for physiotherapists treating patients with COPD based on a systematic review of available evidence. Clin Rehab, 23, 5, 445 - 62.
cre.sagepub.com/cgi/content/abstract/23/5/445
exercise training improves health-related quality of life and functional exercise capacity
Larson JL (2002) Inspiratory muscle strength in COPD. AACN Clin.Issues, 3, 320-2
www.aacnclinicalissues.com/pt/re/aacn/abstract.00044067-200205000-00015.htm;jsessionid=FNqJLSGYf0h12XyM9tRv7LPshsP4CCsfgz4JWhgt9J18ZGzLfpTv!-1434154485!-949856145!8091!-1
Laude E (2004) Heliox and alveolar oxygenation in patients with COPD. Eur Respir J, 24: Suppl. 48, 243s
www.ersnet.org/ers/lr/browse/media.aspx?id_dossier=15898&id_fiche=119901
heliox can increase SaO2 at rest and during exercise in people with COPD
Liddell F, Janet Webber (2009) Pulmonary rehabilitation for chronic obstructive pulmonary disease: a pilot study evaluating a once-weekly versus twice-weekly supervised programme. Physiotherapy, 96, 1, 68-74
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7CVK-4WRD69B-1&_user=10&_coverDate=03%2F31%2F2010&_rdoc=10&_fmt=high&_orig=browse&_srch=doc-info%28%23toc%2318081%232010%23999039998%231628125%23FLA%23display%23Volume%29&_cdi=18081&_sort=d&_docanchor=&_ct=41&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=333984d7fbe021bad38c091e3e432b9c
once-weekly supervision may produce equivalent improvements in exercise tolerance as a twice-weekly programme, but HRQLme appeared to be poorer for once-weekly supervision
Livermore N (2010) Prevention of panic attacks and panic disorder in COPD. Europ Resp J, 35, 557-563
Lord VM, Cave P, Hume VJ et al (2010) Singing teaching as a therapy for chronic respiratory disease - a randomised controlled trial and qualitative evaluation. BMC Pulm Med, 10:41.
control of breathing and posture that accompany singing lead to improved quality of life and reduced anxiety
Mador MJ (2003) Quadriceps fatigability after single muscle exercise in patients with COPD. Am J Respir Crit Care Med, 168, 102-8
ajrccm.atsjournals.org/cgi/content/full/168/1/102?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&volume=168&firstpage=102&resourcetype=HWCIT
quadriceps in patients with severe disease are more fatigable than in normal subjects
Malaguti C (2009) Reliability of chest wall mobility and its correlation with pulmonary function in patients with chronic obstructive pulmonary disease. Respir Care, 54, 12, 1703-11
McKeough ZJ, Alison JA (2003) Arm positioning alters lung volumes in subjects with COPD and healthy subjects. Austr J Physiother, 49, 133-7
www.physiotherapy.asn.au/AJP/vol_49/2/AustJPhysiotherv49i2McKeough.pdf
raising the arms above 900 increases FRC but decreases inspiratory capacity
Mikelsons C (2007) The role of physiotherapy in the management of COPD. Respir Med, 4, 1, 2-7
Miravitlles M (2010) Prevention of exacerbations of COPD with pharmacotherapy. Eur Respir Rev, 19, 116, 119126
err.ersjournals.com/cgi/content/full/19/116/119
exacerbations may be reduced by long-acting bronchodilators (alone or combined with inhaled corticosteroids), rehabilitation and self-management plans
Mokhlesi B (2002) Oropharyngeal deglutition in stable COPD. Chest, 121, 361-369
www.chestjournal.org/cgi/content/full/121/2/361?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Mokhlesi+B+&fulltext=Oropharyngeal+deglutition+in+stable+COPD&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=121&resourcetype=HWCIT
Morgan MDL (2003) Chronic obstructive pulmonary disease: 8: Non-pharmacological management. Thorax, 58, 453-7
thorax.bmjjournals.com/cgi/content/full/58/5/453?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=58&firstpage=453&resourcetype=HWCIT
Neder JA (2002) Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with COPD. Thorax, 57, 333-7
thorax.bmjjournals.com/cgi/content/full/57/4/333?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=57&firstpage=333&resourcetype=HWCIT
electrical stimulation of leg muscles in patients with COPD improves exercise tolerance and breathlessness
Nici L (2000) Mechanisms and measures of exercise intolerance in COPD. Clin Chest Med, 21, 4, 693-702
ODonohue WJ (2000) Hypoxemia during sleep in patients with COPD. Respir Care, 45, 188-91
evidence for severe nocturnal desaturations in COPD patients
ODonnell AE (2011) Bronchiectasis in patients with COPD: a distinct COPD phenotype? Chest, 140, 5 1107-1108
Oga T (2003) Analysis of the factors related to mortality in COPD: role of exercise capacity and health status. Am J Resp Crit Care Med, 167, 544-9
exercise capacity and health status show greater relevance than RFTs in evaluation of disease severity
Pierson DJ (2000) Pathophysiology and clinical effects of chronic hypoxia. Respir Care, 45, 1, 39-51
www.rcjournal.com/contents/01.00/01.00.0039.asp
excellent description of the oxygen cascade and the pathophysiology of COPD
Plant PK, Owen JL, Elliott MW (2002) Non-invasive ventilation in acute exacerbations of COPD. Thorax, 56, 708-12
thorax.bmjjournals.com/cgi/content/full/56/9/708?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=56&firstpage=708&resourcetype=HWCIT
noninvasive ventilation can prevent intubation
Poole PJ (2001) Oral mucolytic drugs for exacerbations of COPD. BMJ, 322, 1271-3
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mucolytics reduce exacerbations and days of illness
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self-administered questionnaire to identify patients with a high likelihood of having COPD
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meta-analysis showing that long-acting β2-agonists or anticholinergics are the treatment of choice for reduction of COPD exacerbations, with the addition of an inhaled corticosteroid if FEV1 is < 40% predicted
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expiratory muscle endurance is decreased in COPD.
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people at home with COPD or bronchiectasis have found humidification helpful
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cardiac events are the major cause of death for patients with COPD
monitoring of lung function in cardiac patients should be routine
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patients with moderate to severe COPD are most likely to benefit.
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anxiety and depression occur in 50% of patients, 2-3 times that of the general population, which leads to poorer outcomes
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viral infection is associated with 56% of hospitalized patients with exacerbations
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dyspnea is a better indicator of disease impact among COPD patients than spirometry
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aetiology, oxygen, medication, ventilatory support
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IMT reduces SOB and increases exercise tolerance
IMT with arm exercises increases this improvement
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extensive injury and collagen accumulation has been found in the COPD diaphragm
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self-management of COPD in the community can reduce hospitalisation and exacerbation severity
previous admissions, lower FEV1, and under-prescription of oxygen are independently associated with a higher risk of admission for exacerbation
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there is no correlation of hypercapnia with ventilatory drive
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lung inflammatory overspill to distant organs may lead to inflammatory co-morbidities such as skeletal muscle dysfunction, cardiovascular disease, osteoporosis, diabetes and lung cancer
anti-inflammatory treatment targeted at the lung or co-morbid organs may be beneficial.
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inhaled anticholinergics are associated with increased risk of MI or stroke in COPD
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gastro-oesophageal reflux occurs in 30% of people with COPD
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out of 57 patients, 6 spontaneously performed PLB at rest, exercise and recovery, 18 during exercise and recovery, 7 during recovery only and 20 not at all.
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Sutherland ER et al (2002) Safety of sputum induction in moderate-to-severe COPD. Respir Med, 96, 482-6
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protocol in flow-chart format
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systematic review showing the benefits of PEP and IPPB for sputum clearance, and exercise for gas exchange, SOB and HRQL
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exercise training and IMT may improve breathlessness during ADL in severe COPD
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COPD affects other end-organs including the CVS and musculoskeletal systems, making it a multi-component, multi-system disease.
COPD increases risk of ischaemic heart disease, stroke, osteoporosis, cachexia, and muscle weakness by two to threefold.
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depression is 2.5 times higher than normal
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fat-free mass should be considered in the routine assessment of people with COPD
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impaired muscle endurance is associated with impaired O2 transport and utilization, resulting in altered muscle bioenergetics
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deep diaphragmatic is associated with improved blood gases but increased work of breathing in people with severe COPD
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normal body mass index predicts improvement in muscle performance on exercise training
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symptoms of depression overlap with those of COPD, eg. fatigue and insomnia
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definition, diagnosis, evidence of widespread co-morbidity
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interaction of viruses, bacteria, pollution and host factors increases inflammation
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enabling patients to `participate' rather than just `do' is important across the spectrum of severity of COPD:
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long-acting inhaled drugs, supplemental oxygen, and pulmonary rehabilitation are beneficial in adults who have bothersome symptoms, especially SOB
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during exacerbation, a quarter of patients produced mucopurulent or purulent sputum
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interaction of inflammation and muscle wasting
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breathlessness caused by dynamic hyperinflation may be relieved by pulmonary rehabilitation or NIV
responses to supplemental oxygen are highly variable and unpredictable.
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St Georges Respiratory Questionnaire shows greater correlation with acute illness in COPD than respiratory function tests
Picture: Milne A (1998) Smoking: The Inside Story. Woodside, Stafford
ACPRC = Association of Chartered Physiotherapists in Respiratory Care
ADL = activities of daily living
BMJ = British Medical Journal
BTS = British Thoracic Society
CVS = cardiovascular system
FEV1,= forced expiratory volume in one second
FRC = functional residual capacity
HRQL = health-related quality of life
IMT = inspiratory muscle training
IPPB = intermittent positive pressure breathing
MI = myocardial infarct
MRC = Medical Research Council
NEJM = New England Journal of Medicine
NICE = National Institute for Health and Clinical Excellence
NIV = non-invasive ventilation
PEP = positive expiratory pressure
PLB = pursed lips breathing
RFT = respiratory function test
PR = pulmonary rehabilitation
QoL = quality of life
SOB = shortness of breath
VO2 = oxygen consumption