Audhild Hjalmarsen

Effect of Long-Term Oxygen Therapy on Cognitive and Neurological Dysfunction in Chronic Obstructive Pulmonary Disease

The aim of this study was to assess effect of long-term oxygen therapy (LTOT) on the function of central and autonomic nervous system in patients with hypoxaemic chronic obstructive pulmonary disease (COPD). A battery of neuropsychological tests was used together with the Short Test of Mental Status in addition to transcranial Doppler ultrasonography, and five cardiovascular tests as well as a questionnaire on autonomic function. Ten COPD patients, 4 males and 6 females, with a mean age of 65.9 ± 7.3 (SD) years, were studied at the beginning and after 3 months of LTOT. At start PaO2 was 6.7 ± 1.1 kPa without oxygen and 9.9 ± 1.5 kPa after 3 months with oxygen. Our results demonstrate that neuropsychological function, cerebral blood flow velocity and autonomic function were positively influenced after 3 months of LTOT although the changes did not reach statistical significance. The COPD patients were cognitively impaired as compared to age-matched healthy controls. Our findings were consistent with the previous notion of improvement of hypoxic cognitive dysfunction by LTOT.

Cardiovascular responses to tests for autonomic dysfunction in patients with chronic obstructive pulmonary disease with and without continuous long-term oxygen therapy

The aim of this study was to investigate autonomic neuropathy, with and without oxygen therapy, in patients with chronic obstructive pulmonary disease (COPD). Four cardiovascular tests for autonomic function were used, and in addition, basal pancreatic polypeptide (PP) was measured. The following COPD patients were studied: 10 normoxemic (mean PaO2 10.9 +/- SD 1.1 kPa), 10 hypoxemic (PaO2 7.6 +/- 0.7 kPa before, and 10.6 +/- 1.4 kPa after 24 h oxygen therapy), and 6 hypoxemic on long-term oxygen therapy (LTOT) (PaO2 10.3 +/- 1.3 kPa before, and 7.0 +/- 0.8 kPa after 4 h of low dose or oxygen free interval). Twenty healthy age-matched subjects served as controls. In the individual tests the hypoxemic and the LTOT groups had a significantly decreased heart rate response to the Valsalva manoeuvre (ratio 1.23 +/- 0.17 and 1.12 +/- 0.07 versus controls 1.45 +/- 0.26 (p < 0.01 and 0.005, respectively) and versus the normoxemic group 1.46 +/- 0.30 (p < 0.05)) and the hypoxemic as well as the LTOT group had a significantly decreased heart rate response to standing up (ratio 0.97 +/- 0.04 and 0.97 +/- 0.07, respectively, versus the controls 1.06 +/- 0.09 (p < 0.005 and 0.05)). The blood pressure response to standing up and to sustained handgrip did not differ significantly between the groups. In spite of apparent autonomic dysfunction, PP levels in the LTOT group were significantly higher than in the controls (p < 0.01-0.001) and the normoxemic group (p < 0.05-0.01). Twenty-four hours of oxygen treatment in the hypoxemic group or four hours of oxygen withdrawal in the LTOT group did not change the results significantly. In conclusion, our findings are consistent with the previous notion of neurological dysfunction from hypoxemia, but this may not be corrected by the use of short term oxygen treatment. This contrasts to previous findings in which longer term oxygen did correct some of these problems.

Long-term telerehabilitation of COPD patients in their homes: Interim results from a pilot study in Northern Norway

We investigated the feasibility of a long-term telerehabilitation service for COPD patients comprising exercise training at home, telemonitoring and education/self-management. The service was offered as a 2-year follow-up programme by a physiotherapist. Equipment included a treadmill, a pulse oximeter and a tablet computer. Participants had weekly videoconference sessions with the physiotherapist. A website was used to access a training programme and to fill in a daily diary and a training diary. Ten patients with moderate or severe COPD participated in a pilot study in Northern Norway. After more than one year, all participants were still participating actively and no drop-outs had occurred. On average, there were 2.0 training sessions/week, 3.3 measurements/week registered via the website and 0.5 videoconference contacts/week. There was a reduction of 27% in the COPD-related hospital costs. Feedback from the participants was very positive. Long-term telerehabilitation of COPD patients at home is feasible and interim results suggest that it reduces healthcare utilization.

Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study

BackgroundTelemedicine may increase accessibility to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), thus enhancing long-term exercise maintenance. We aimed to explore COPD patients’ adherence and experiences in long-term telerehabilitation to understand factors affecting satisfaction and potential for service improvements.MethodsA two-year pilot study with 10 patients with COPD was conducted. The intervention included treadmill exercise training at home and a webpage for telemonitoring and self-management combined with weekly videoconferencing sessions with a physiotherapist. We conducted four separate series of data collection. Adherence was measured in terms of frequency of registrations on the webpage. Factors affecting satisfaction and adherence, together with potential for service improvements, were explored through two semi-structured focus groups and an individual open-ended questionnaire. Qualitative data were analysed by systematic text condensation. User friendliness was measured by the means of a usability questionnaire.ResultsOn average, participants registered 3.0 symptom reports/week in a web-based diary and 1.7 training sessions/week. Adherence rate decreased during the second year. Four major themes regarding factors affecting satisfaction, adherence and potential improvements of the intervention emerged: (i) experienced health benefits; (ii) increased self-efficacy and independence; and (iii) emotional safety due to regular meetings and access to special competence; (iv) maintenance of motivation. Participants were generally highly satisfied with the technical components of the telerehabilitation intervention.ConclusionsLong-term adherence to telerehabilitation in COPD was maintained for a two-year period. Satisfaction was supported by experienced health benefits, self-efficacy, and emotional safety. Maintenance of motivation was a challenge and might have affected long-term adherence. Four key factors of potential improvements in long-term telerehabilitation were identified: (i) adherence to different components of the telerehabilitation intervention is dependent on the level of focus provided by the health personnel involved; (ii) the potential for regularity that lies within the technology should be exploited to avoid relapses after vacation; (iii) motivation might be increased by tailoring individual consultations to support experiences of good health and meet individual goals and motivational strategies; (iv) interactive functionalities or gaming tools might provide peer-support, peer-modelling and enhance motivation.

Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability

BackgroundThe prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers.This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education.MethodsWe have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user’s own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews.ResultsBoth home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long.ConclusionsThe Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home.

Pulmonary Function 3–12 Months after Pneumonectomy, Lobectomy or Bilobectomy for Lung Cancer

Pulmonary function was studied 3 and 12 months after pulmonary resection for lung cancer in 37 patients, ten of whom had undergone pneumonectomy, 17 lobectomy and eight bilobectomy. The resection was right-sided in 25 cases and left-sided in 12. Tumour site and diameter were registered, arterial blood gases measured and spirometry performed Three months after all types resection there was significant decrease in forced vital capacity (FVC), and forced expiratory volume/1 second (FEV1), but not in FEV1/FVC%. At 12 months pneumonectomy had reduced FVC to 58% of predicted values, FEV1 to 50% and FEV1/FVC% to 70%. After lobectomy the corresponding figures were 86%, 73% and 67% and after bilobectomy they were 88%, 78% and 70%. Between 3 and 12 months postoperatively, FVC increased in all groups, significantly in those with lobectomy or bilobectomy (p<0.01 and 0.05, respectively).

Severe nocturnal hypoxaemia in geriatric inpatients

BACKGROUND oxygen levels are decreased in older people especially in the supine position, and during sleep. Geriatric inpatients often suffer from stroke and heart disease. Respiratory control may be substantially affected. OBJECTIVE the aim of this study was to examine oxygen levels during night in inpatients on geriatric medical wards to find out if they needed nocturnal oxygen therapy. DESIGN prospective observational study. SETTING/PARTICIPANTS we consecutively examined 133 patients with SpO(2) >or=92% in sitting position by an overnight -8-h pulse oximetry. Patients with severe obesity, dementia or pulmonary disease were excluded. The test was performed at least 4 days after the event in stroke cases. OUTCOME VARIABLES ninety two patients, m/f 43/49, with mean age 78.3 +/- 6.9 SD completed the test. Sixty six patients suffered from stroke; 34 left-sided and 19 right-sided stroke. Nine patients suffered from a heart disease only, and 17 patients suffered from other diseases. RESULTS according to the guidelines for long-term oxygen therapy recommendations for nocturnal oxygen therapy, we found that 26% of the patients fulfilled the criteria of SpO(2) <or=90% for >or=30% of the time. There was a significant positive correlation between age and the amount of time with SpO(2) between 80 and 84% (0.215, P < 0.05). Diagnosis or severeness of disease did not significantly affect nocturnal SpO(2) %. The 1-year survival rate was 75% in group I (hypoxaemic) versus 84% in group II (normoxaemic) (NS). CONCLUSION nearly 30% of the inpatients in geriatric medical wards suffered from severe oxygen-requiring nocturnal hypoxaemia irrespective of diagnosis.