Maria A. Ramon

Benefits of physical activity on COPD hospitalisation depend on intensity

The present study aims to disentangle the independent effects of the quantity and the intensity of physical activity on the risk reduction of chronic obstructive pulmonary disease (COPD) hospitalisations. 177 patients from the Phenotype Characterization and Course of COPD (PAC-COPD) cohort (mean±sd age 71±8 years, forced expiratory volume in 1 s 52±16% predicted) wore the SenseWear Pro 2 Armband accelerometer (BodyMedia, Pittsburgh, PA, USA) for eight consecutive days, providing data on quantity (steps per day, physically active days and daily active time) and intensity (average metabolic equivalent tasks) of physical activity. Information on COPD hospitalisations during follow-up (2.5±0.8 years) was obtained from validated centralised datasets. During follow-up 67 (38%) patients were hospitalised. There was an interaction between quantity and intensity of physical activity in their effects on COPD hospitalisation risk. After adjusting for potential confounders in the Cox regression model, the risk of COPD hospitalisation was reduced by 20% (hazard ratio (HR) 0.79, 95% CI 0.67–0.93; p=0.005) for every additional 1000 daily steps at low average intensity. A greater quantity of daily steps at high average intensity did not influence the risk of COPD hospitalisations (HR 1.01, p=0.919). Similar results were found for the other measures of quantity of physical activity. Greater quantity of low-intensity physical activity reduces the risk of COPD hospitalisation, but high-intensity physical activity does not produce any risk reduction. Greater quantity of low-intensity physical activity reduces the risk of COPD hospitalisation http://ow.ly/Oe2RE

Hospital admissions and exercise capacity decline in patients with COPD

Exercise capacity declines with time and is an important determinant of health status and prognosis in patients with chronic obstructive pulmonary disease (COPD). We hypothesised that hospital admissions are associated with exercise capacity decline in these patients. Clinical and functional variables were collected for 342 clinically stable COPD patients. The 6-min walk distance (6MWD) was determined at baseline and after a mean±sd of 1.7±0.3 years. Information on hospitalisations during follow-up was obtained from centralised administrative databases. Linear regression was used to model changes in exercise capacity. Patients were mostly male (92%), with mean±sd age 67.9±8.6 years, post-bronchodilator forced expiratory volume in 1 s 54±17% predicted and baseline 6MWD 433±93 m. During follow-up, 6MWD decreased by 21.9±51.0 m·year−1 and 153 (45%) patients were hospitalised at least once. Among patients admitted only for COPD-related causes (50% of those ever admitted), the proportion presenting a clinically significant loss of 6MWD was higher than in patients admitted for only nonrespiratory conditions (53% versus 29%, p=0.040). After adjusting for confounders, annual 6MWD decline was greater (26 m·year−1, 95% CI 13–38 m·year−1; p<0.001) in patients with more than one all-cause hospitalisation per year, as compared with those with no hospitalisations. Hospitalisations are related to a greater decline in exercise capacity in COPD. Hospitalisations are associated with higher decline in exercise capacity in COPD patients http://ow.ly/rB8cc

Prevalence of Possible Occupational Asthma in Hairdressers Working in Hair Salons for Women

Background: The aim of this study was to determine the prevalence of possible occupational asthma (OA) in hairdressers. Methods: A telephone questionnaire (Q1) was administered to 1,334 individuals from a total of 1,875 hairdressers working in hair salons for women in Barcelona (response rate 71%) to identify those with respiratory symptoms. Multiple correspondence analysis showed 5 specific questions for assessing symptoms of asthma. Individuals who gave a positive response to 1 of these questions (n = 251) were given a second validated questionnaire (Q2) to identify those with suspected OA. OA was defined according to a classification tree based on the response to queries on nasal itching, daily symptoms throughout the week at work, nasal secretions, voice loss, wheezing, and sputum production as reported previously. Moreover, we calculated the prevalence of OA according to the conventional criteria of improvement and/or worsening of symptoms in relation to exposure at work and during off-work time on weekends and during vacations. Results: Asthma was present in 9.5% of hairdressers. From Q2 data, 72 were classified as having possible OA, yielding a prevalence of OA from 5.4 (72/1,334) to 7.8% according to the classification tree previously described. A prevalence from 4.6 (62/1,334) to 6.7% was obtained using conventional criteria. Rhinitis or dermatitis (OR 7.80), as well as exacerbation of symptoms at work and persistence of symptoms on weekends (OR 2.99) were associated with the development of OA. Conclusions: Hairdressing employment can induce asthma. Episodes of rhinitis or dermatitis seem to be risk factors for the development of OA in this population.

Two short interventions to reduce health care requirements in asthma patients. A multicentre controlled study (ASTHMACAP II)

BACKGROUND AND OBJECTIVE Asthma control is suboptimal. The objective of this study was to reduce health care requirements and work absenteeism. MATERIAL AND METHODS Multicenter randomized controlled study investigating asthma control, educational parameters, health service use, and absenteeism. After adjusting treatment according to GINA recommendations, control group patients (CG) followed their physicians recommendations, while intervention group (IG) patients additionally underwent a 5-minute educational intervention. This protocol was repeated at 3 months, and a final assessment was carried out at 6 months. RESULTS 479 patients (mean age 40 (SD 17) years) were recruited from primary care, and 334 completed the study. Comparatively, IG patients showed an improvement at the 3- and 6-month evaluations in the six educational parameters (P<0.001) and required fewer urgent visits to the GP for exacerbations [RR=0.49 (95% CI 0.26-0.90); P<0.04], and before the third evaluation, also in urgent GP visits [RR=0.25 (95% CI 0.12-0.52); P<0.001]. Before this third evaluation, IG had fewer scheduled visits to the GP [RR=0.48 (95% CI 0.28-0.82); P<0.003], and fewer visits to the primary care [RR=0.40 (95% CI 0.18-0.87); P<0.05], and to hospital emergency rooms [RR=0.13 (95% CI 0.04-0.42); P<0.001]. In addition, before the third evaluation, IG patients were less often absent from work [RR=0.22 (95% CI 0.05-0.98); P<0.03] or unable to work at home [RR=0.31 (95% CI 0.12-0.82); P<0.02]. CONCLUSIONS Two short educational interventions improved asthma education and decreased the use of health resources and work absenteeism.

Self-reported daily walking time in COPD: relationship with relevant clinical and functional characteristics

Background Quantifying physical activity in chronic obstructive pulmonary disease (COPD) is important as physical inactivity is related to poor health outcomes. This study analyzed the relationship between patients’ self-reported daily walking time and relevant characteristics related to COPD severity. Methods Pooled analysis was performed on data from four observational studies on which daily walking time was gathered from a personal interview. Patients were classified as physically inactive if walking time was <30 min/day. Walking times were described and compared according to several markers of disease severity. Results The mean daily walking time of 5,969 patients was 66 (standard deviation [SD] 47) min/day; 893 (15%) patients were inactive. A linear dose–response relationship was observed between walking time and the modified Medical Research Council (mMRC) dyspnea score, admissions, COPD assessment test (CAT), body mass index, airway obstruction, dyspnea, exacerbation (BODEx) index, and Charlson index (P<0.001). Daily walking times were lower in patients classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B and D (P<0.001). Often, inactive patients had mMRC or Charlson index >3, post-bronchodilator forced expiratory volume in the first second <30% predicted, at least one hospitalization for COPD, classified as GOLD B or D, BODEx >4, and CAT score >30. Conclusion Lower self-reported walking times are related to worse markers of disease severity in COPD.

Inspiratory capacity‐to‐total lung capacity ratio and dyspnoea predict exercise capacity decline in COPD

Exercise capacity decline is a predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Static pulmonary hyperinflation is a key determinant of exercise performance, but its effect on the longitudinal decline in exercise capacity remains unknown. We aimed to study the relationship between the inspiratory capacity‐to‐total lung capacity (IC/TLC) ratio and exercise capacity decline in COPD.

Caminar al menos 30 minutos al día 5 días por semana. ¿Por qué y cómo prescribir ejercicio físico en la enfermedad pulmonar obstructiva crónica?

Eulogio Pleguezuelos , Maria A. Ramon , Eva Moreno e y Marc Miravitlles * a Servicio de Medicina Fı́sica y Rehabilitación, Hospital de Mataró, Mataró, Barcelona, España b Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, España c Servicio de Neumologı́a, Hospital Universitari Vall d’Hebron, Barcelona, España d Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España e Servicio de Medicina Fı́sica y Rehabilitación, Hospital General de L’Hospitalet, L’Hospitalet de Llobregat, Barcelona, España

Lung and heart-lung transplantation in pulmonary arterial hypertension

Background Real use of lung (LT) and heart-lung (HLT) transplantation in pulmonary arterial hypertension (PAH) is unknown. The objectives were to describe the indication of these procedures on PAH treatment in a national cohort of PAH patients, and to analyze the potential improvement of its indication in severe patients. Methods Eligibility for LT/HLT was assessed for each deceased patient. Incident patients from REHAP diagnosed between January 2007 and March 2015 and considered eligible for LT/HLT were grouped as follows: those who finally underwent transplantation (LTP) and those who died (D-Non-LT). Findings Of 1391 patients included in REHAP, 36 (3%) were LTP and 375 (27%) died. Among those who died, 36 (3%) were D-Non-LT. LTP and D-Non-LT were equal in terms of age, gender, and clinical status. Ten percent of those who died were functional class I-II. Patients functional class IV were less likely to undergo LT (8.3% LTP vs. 30.6% D-Non-LT, p = 0.017). Patients with idiopathic and drug/toxin-associated PAH were more likely to undergo LT (44.4% LTP vs. 16.7% D-Non-LT, p = 0.011). Conclusions The present results show that the use of LT/HLT could double for this indication. Relevant mortality in early functional class reflects the difficulties in establishing the risk of death in PAH.

Correction: Lung and heart-lung transplantation in pulmonary arterial hypertension

[This corrects the article DOI: 10.1371/journal.pone.0187811.].

The dyspnoea-inactivity vicious circle in COPD: Development and external validation of a conceptual model

The vicious circle of dyspnoea–inactivity has been proposed, but never validated empirically, to explain the clinical course of chronic obstructive pulmonary disease (COPD). We aimed to develop and validate externally a comprehensive vicious circle model. We utilised two methods. 1) Identification and validation of all published vicious circle models by a systematic literature search and fitting structural equation models to longitudinal data from the Spanish PAC-COPD (Phenotype and Course of COPD) cohort (n=210, mean age 68 years, mean forced expiratory volume in 1 s (FEV1) 54% predicted), testing both the hypothesised relationships between variables in the model (“paths”) and model fit. 2) Development of a new model and external validation using longitudinal data from the Swiss and Dutch ICE COLD ERIC (International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts) cohort (n=226, mean age 66 years, mean FEV1 57% predicted). We identified nine vicious circle models for which structural equation models confirmed most hypothesised paths but showed inappropriate fit. In the new model, airflow limitation, hyperinflation, dyspnoea, physical activity, exercise capacity and COPD exacerbations remained related to other variables and model fit was appropriate. Fitting it to ICE COLD ERIC, all paths were replicated and model fit was appropriate. Previously published vicious circle models do not fully explain the vicious circle concept. We developed and externally validated a new comprehensive model that gives a more relevant role to exercise capacity and COPD exacerbations. An externally validated model highlights exercise capacity and exacerbations as drivers of the COPD vicious circle http://ow.ly/NXvu30kW7CP