Andreas Weissflog

Long-term Recording of Night-Time Respiratory Symptoms in Patients with Stable COPD II–IV

ABSTRACT Introduction: Night-time respiratory symptoms have a considerable impact on sleep and life quality in patients with chronic obstructive pulmonary disease (COPD). Lack of awareness of night-time symptoms can lead to worsened COPD control. Automated long-term monitoring of respiratory symptoms with LEOSound enables assessment of nocturnal wheezing and cough. Methods: In this observational study we investigated the prevalence and severity of cough and wheezing in patients with stable COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II–IV] disease for two consecutive nights with the LEOSound system. 48 patients (30 males, 63%) were eligible for inclusion, median age was 67 years, and body mass index (BMI) was 25.3 kg/m2. Results: In 15 out of 48 patients (31%), we found wheezing periods for at least 10-minute duration. Wheezing periods >30 minutes were monitored in seven patients and wheezing periods >60 minutes were monitored in three patients. The maximum duration of wheezing was 470 minutes in one patient with COPD II. The median wheezing rate differed between the COPD stages and between active and non-active smokers. Cough was found in 42 patients (87.5%) with a range of 1–326 events. The cough-period-index in night one was 0.83 n/hour (P25:0.33||P75: 2.04) and night two 0.97 n/hour (P25:0.25||P75: 1.9). Most of the cough events were non-productive with a median of 0.86. Conclusions: Night-time symptoms are common in COPD patients. LEOSound offers an opportunity to evaluate objectively night-time symptoms like wheezing and cough in patients with COPD which remain otherwise unnoticed. We found a high incidence of night-time wheezing in these patients, which was related to persistant smoking.

Was ist für die Diagnostik und Therapieverlaufskontrolle von chronischem Husten wichtig

Within the last years there has been significant progress in the field of chronic cough. So far, the analysis and evaluation of chronic cough was done mainly on the basis of subjective methods such as manual counts of cough events, questionnaires and diaries. Testing cough hypersensitivity and monitoring 24 h cough represent objective criteria. Validated questionnaires on cough frequency and quality of life represent the impact of chronic cough. Cough frequency monitoring, the preferred tool to objectively assess cough, should be used as primary end-point in clinical trials. It will also be possible to discriminate between productive and non-productive cough. The relationship with subjective measures of cough is weak. In the future, cough and its therapy should therefore be assessed with a combination of subjective and objective tools.

Description of nighttime cough epochs in patients with stable COPD GOLD II–IV

Purpose Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD. Materials and methods Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II–IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive). Results Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%). Conclusion We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively.

Home monitoring of nocturnal cough in COPD patients

Abstract Telemedicine approaches in the treatment of COPD can be useful for the detection of upcoming exacerbations. Specifically productive cough can serve as an effective monitoring parameter. By using modern technologies, we developed a smartphone application to record and analyze nocturnal cough in an outpatient environment. All results will be displayed through a web interface by patients, physicians and relatives. Monitoring cough could lead to an individual therapy and an increased quality of life.

Bestimmung der hyperkapnischen Atemantwort bei Patienten mit COPD

Previous studies showed a reduced hypercapnic ventilatory response (HCVR) in patients with COPD. However, the association between HCVR and COPD GOLD stages is unknown. The measurement of the HCVR is a methodological option to test the function of the breathing feedback cycle. The aim of this feasibility study was to present a new automatic and standardized device (MATAM) to measure and interpret the HCVR. This device determines if exposure to CO2 leads to an adequate increase in breathing frequency and tidal volume. Recordings are performed in a closed system that allows selective changes of each gas component. The minute ventilation (AMV) under hypercapnic stimulation is plotted against the end-tidal CO2 (ETCO2). The HCVR is defined as the linear regression line.28 patients (18 male; 10 female) with COPD GOLD stages 0 to IV were studied. The patients had a mean age of 57 ± 14 (standard deviation) years and a mean BMI of 32 ± 9 kg/m(2). We could show that the HCVR measurement in patients with COPD using MATAM was feasible. Patients with more severe COPD stages had a significantly more reduced HCVR. This could be an indication of reduced chemosensitivity due to a worsening of blood values (pH and pCO2) which affect the central chemoreceptors in the long term. Further studies will be needed to validate the MATAM device for healthy individuals and other patient groups, and for the investigation of standard values.

Ist die telemedizinische Versorgung von Patienten mit COPD sinnvoll

Berücksichtigt man den demografischen Wandel, die Zunahme älter werdender Menschen sowie den Anstieg chronischer Erkrankungen, wird klar, dass die Kosten im Gesundheitssystem zwangsläufig weiter steigen werden. Bereits heute sind etwa 75% der Ausgaben im Gesundheitswesen durch chronisch kranke Patienten verursacht. Die enorme sozioökonomische Bedeutung der chronischen Lungenerkrankungen, insbesondere der COPD, ist unbestritten. Die Prävalenz der chronischen Bronchitis wird bei der erwachsenen Bevölkerung in Deutschland auf 10 bis 15% geschätzt. Weltweit ist die COPD gegenwärtig die vierthäufigste Todesursache. Für die nächsten Jahrzehnte ist von einem weiteren Anstieg von Prävalenz, Morbidität und Mortalität der COPD auszugehen. Die jährlichen volkswirtschaftlichen Gesamtkosten der COPD werden auf 5,9 Mrd.€, die individuellen Kosten eines Patienten auf 3027 €/Patient geschätzt. Krankenhausaufenthalte stellen den bedeutendsten Kostenfaktor dar [1].

Telemedical monitored training for patients with chronic pulmonary disease

In German adults there is an estimated prevalence of chronic obstructive pulmonary disease (COPD) of 10 to 15%. Providing health care services via telemedicine opens new possibilities and offering cost efficient solutions for monitoring, assistance, and even training for patients with COPD. Particularly patients with severe COPD can benefit physical and physiological from moderate fitness training. A good understanding of their disease and a constant and adequate communication from the therapist to the patient and vice versa will improve not only therapy compliance but also the patients self management abilities.