Takako Tanaka

Effect of a chronic obstructive pulmonary disease (COPD) intervention on COPD awareness in a regional city in Japan.

OBJECTIVE The purpose of this study was to examine the effect of an intervention for chronic obstructive pulmonary disease (COPD) on COPD awareness in a regional city in Japan. METHODS Self-administered questionnaires were completed by the residents of the city of Matsuura, Japan. Residents (≥50 years) of the mainland in Matsuura were included in a COPD intervention project (mainland group), while residents of the islands district received no intervention due to geographical issues (island group). The rates of COPD awareness and accuracy of responses to the questions about COPD were compared between the two groups. MATERIALS The study included 5,891 residents 40 to 74 years of age of Matsuura in 2013. The mainland group comprised 4,419 subjects, and the island group 1,472 included subjects. RESULTS The overall response rate to the questionnaire was 24.6%, with similar response rates between the two groups. The rate of COPD awareness in the mainland group was 24.5%, which was significantly higher than that observed in the island group (11.8%) (p<0.01). The rate of awareness tended to decrease in association with increasing age. Among 276 responders who stated they were aware of COPD, the accuracy rate for responses to the questions about COPD was not significantly different between the groups. CONCLUSION In the present study, there was a difference in COPD awareness between the two groups, suggesting that COPD interventions may increase awareness of the disease. However, the level of knowledge regarding COPD remained low and modifications to the intervention are required to improve awareness of the condition, especially among elderly subjects.

A comparison of objective physical activity, muscle strength, and depression among community-dwelling older women living in sloped versus non-sloped environments

ObjectiveTo examine the relationship between the living location and outcomes of physical activity level and physical and psychological functioning in older women. The specific aim was to understand the association between living in a sloped versus non-sloped environment and these outcomes.DesignCross-sectional study.Setting and Participants108 older women aged 65 years or older who resided in Nagasaki prefecture participated.MeasurementsPhysical activity, lung function, muscle strength (hand grip and quadriceps force) and depressive symptoms were assessed objectively.ResultsIn logistic regression, activity counts per day (OR 0.779, 95%CI 0.715-0.841, p<0.01), activity times per day (OR 0.821, 95%CI 0.801-0.913, p<0.01), hand grip force (OR 0.666, 95%CI 0.558-0.796, p<0.001), and depressed (Center for Epidemiological Studies Depression Scale score ≥16) (OR 1.093, 95%CI 1.019-1.427, p<0.05) showed statistically significant inverse associations with living in a sloped ground.ConclusionsSince dwelling on sloped ground was associated with negative (lower physical activity levels, lower grip strength, and more depression) outcomes, a comprehensive geriatric assessment, related to all aspects of older women, is recommended. Planning of home exercise programs for the elderly should take such environmental factors into consideration.

Value of systematic intervention for chronic obstructive pulmonary disease in a regional Japanese city based on case detection rate and medical cost

Objective We established a COPD taskforce for early detection, diagnosis, treatment, and intervention. We implemented a pilot intervention with a prospective and longitudinal design in a regional city. This study evaluates the usefulness of the COPD taskforce and intervention based on COPD case detection rate and per capita medical costs. Method We distributed a questionnaire to all 8,878 inhabitants aged 50–89 years, resident in Matsuura, Nagasaki Prefecture in 2006. Potentially COPD-positive persons received a pulmonary function test and diagnosis. We implemented ongoing detection, examination, education, and treatment interventions, performed follow-up examinations or respiratory lessons yearly, and supported the health maintenance of each patient. We compared COPD medical costs in Matsuura and in the rest of Nagasaki Prefecture using data from 2004 to 2013 recorded by the association of Nagasaki National Health Insurance Organization, assessing 10-year means and annual change. Results As of 2014, 256 people have received a definitive diagnosis of COPD; representing 31% of the estimated total number of COPD patients. Of the cases detected, 87.5% were mild or moderate in severity. COPD medical costs per patient in Matsuura were significantly lower than the rest of Nagasaki Prefecture, as was rate of increase in cost over time. Conclusion The COPD program in Matsuura enabled early detection and treatment of COPD patients and helped to lower the associated burden of medical costs. The success of this program suggests that a similar program could reduce the economic and human costs of COPD morbidity throughout Japan.

Factors associated with the annual change in forced expiratory volume in 1 second of officially acknowledged victims of pollution-related illness in improved environments: a longitudinal study

[Purpose] We examined factors affecting annual change in pulmonary function in residents previously exposed to air pollution in an area where pollution has been reduced and a long time period has elapsed. [Subjects and Methods] Data of 730 officially acknowledged victims of pollution-related illness from an annual survey during 2000 to 2009 were analyzed. The primary outcome was forced expiratory volume in 1 second (FEV1), along with factors such as age, body composition, smoking habits, respiratory symptoms, and classification of medical management (an index of the need for treatment). Multiple regression analyses were used to identify factors associated with the annual change in FEV1. [Results] Three significant factors were identified: smoking habit, classification of medical management, and gender. Smoking habits and classification of medical management had stronger effects on the annual change in FEV1 than gender. [Conclusion] With an improved environment, continuation of smoking accelerates the decline in FEV1.

Physical Function Traits of Long-term Officially Acknowledged Victims of Pollution-related Illnesses Compared with Elderly Patients with Chronic Obstructive Pulmonary Disease

[Purpose] To examine the long-term effects of air pollution on the physical functioning of a group of officially acknowledged victims of pollution-related illnesses (Victims group) who were exposed to air pollution more than 50 years ago, we compared them with age-matched patients with chronic obstructive pulmonary disease (COPD group). [Subjects and Methods] The Victims group comprised 34 subjects and the COPD group 24, all of whom were aged over 65 years. Respiratory function, muscle strength, exercise capacity and physical activity were measured and compared between the groups. [Results] The Victims group had significantly higher forced expiratory volume in the first second (FEV1), proportion of predicted FEV1, proportion of predicted vital capacity (VC), and ratio of FEV1 to forced VC than the COPD group. Surprisingly, the muscle strength of the Victims group was significantly weaker, their incremental shuttle walking test distance was significantly shorter, and their physical activity was significantly less than those of the COPD group. [Conclusion] Although the pulmonary function of Victims was better than that of the COPD group, their physical functioning was worse. Exposure to air pollution 50 years ago appears to continue to adversely affect their physical function. It is particularly important to offer Victims rehabilitation to improve their exercise performance and physical activity.

Tobacco use among designated air pollution victims and its association with lung function and respiratory symptoms: a retrospective cross-sectional study

Objectives We sought to elucidate the long-term association of tobacco use and respiratory health in designated pollution victims with and without obstructive pulmonary defects. Design A retrospective cross-sectional study. Setting The register of pollution victims in Kurashiki, Japan. Participants 730 individuals over 65 years of age previously diagnosed with pollution-related respiratory disease. Patients were classified into four groups according to their smoking status and whether they had obstructive pulmonary disease. We then compared the prevalence of respiratory symptoms and lung function over time between groups. Primary outcome measures Spirometry was performed and a respiratory health questionnaire completed in the same season each year for up to 30 years. Results Rates of smoking and respiratory disease were high in our sample. Although respiratory function in non-smoking patients did not completely recover, the annual rate of change in lung function was within the normal range (p<0.01). However, smokers had worse lung function and were more likely to report more severe pulmonary symptoms (p<0.01). Conclusions Patients’ respiratory function did not fully recover despite improved air quality. Our results suggest that, in the context of exposure to air pollution, tobacco use causes additional loss of lung function and exacerbates respiratory symptoms.

Effects of Systematic Intervention for Chronic Obstructive Pulmonary Disease on Follow-up and Smoking Cessation Rates and Changes of the Pulmonary Function: A 7-year Longitudinal Study in a Japanese Rural City

Objective The early detection and treatment of chronic obstructive pulmonary disease (COPD) requires comprehensive follow-up over a long period. The aim of this study was to determine the effects of a comprehensive long-term intervention system developed by the COPD Task Force for a rural city in Japan during a 7-year period. Methods This prospective, community-based longitudinal study encompassed 2006-2013 in Matsuura City, Japan. Primary and secondary screenings were performed for the early diagnosis and treatment of COPD. Individuals diagnosed with COPD were managed by the COPD Task Forces comprehensive early intervention system. The outcomes of interest were the rate of continuous follow-up after the diagnosis of COPD, the smoking cessation rate, and changes in the pulmonary function during a 7-year period. Subjects The study included 8,878 residents of 50-89 years of age who resided in Matsuura in 2006. Results In total, 140 participants received definitive diagnoses of COPD in 2006. After 7 years of intervention, 34 patients withdrew; 78 (74%) patients continued with treatment in our intervention system. The rate of smoking cessation was significantly increased in the intervention group (from 30% to 68%; p<0.01) over the 7-year period. The change in forced expiratory volume in 1 second (FEV1) was -23.2 mL/year. Conclusion Our systematic longitudinal intervention system during a 7-year period led to high rates of follow-up and smoking cessation. Furthermore, our system may be able to prevent the decline of FEV1 in COPD patients. This intervention system may be effective in rural cities with few respiratory physicians.

Exposure to environmental tobacco smoke from husband more strongly impacts on the airway obstruction of nonsmoking women

Background The impact of airway obstruction of nonsmoking women caused by their husband’s smoking is unclear, despite the association between environmental tobacco smoke (ETS) exposure at home and obstructive pulmonary diseases among nonsmoking women. The aim of this study was to provide evidence that ETS exposure from the husband at home has a more significant influence on the airway obstruction of nonsmoking women than other housemates. Participants and methods Nonsmoking women aged 40 years or older were recruited from the health checkup during May 2015–December 2016, Japan. They answered structured questionnaires, including ETS exposure from their husbands and other housemates (parents, siblings and dependants), and performed spirometry. We categorized the women with any history of ETS exposure from housemates into three groups (A = husband, B = others and C = both of husband and others) and defined the control group as those with no ETS exposure from housemates. Results A total of 811 nonsmoking women completed questionnaires and spirometry. The proportion of nonsmoking women who had airway obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] <70%) among Group A (7.5%) was significantly higher than those in the control group (1.1%, p<0.01) and Group B (0.8%, p<0.01). The proportion of airway obstruction in Group C (6.4%) was also higher than that in the control group (p<0.05) and Group B (p<0.05). ETS exposure from husband (odds ratio [OR], 3.53; 95% confidence interval [CI], 1.48–8.42) remained strongly associated with airway obstruction after multiple logistic regression analysis, adjusting for age, housemate’s smoking habits, family history and ETS exposure in childhood and at work. Conclusion Nonsmoking women who were exposed to ETS from their husband had the lowest FEV1/FVC, and a higher proportion of them had airway obstruction when compared to nonsmoking women who experienced ETS from housemates other than their husbands. The findings suggest that tobacco control in husbands is the most important measure to prevent airway obstruction of nonsmoking women at home.

Assessment of the pattern of breathing using scalene palpation

The purpose of this research was to verify a hypothesis that a new method of assessing the pattern of breathing using scalene palpation (NE) can correctly and more reliably, in conjunction with a polygraph, evaluate a respiratory pattern than conventional means of evaluation (CE). A team of six physiotherapists was randomly allocated to two groups of three; one group used the conventional evaluation of breathing pattern while the other group used the new method. The physiotherapists evaluated the breathing patterns of 13 patients with respiratory failure. Each patient was connected to a polygraph while the physiotherapist recorded the breathing pattern. The breathing pattern in each testing session was evaluated in supine, sitting, standing, and walking positions. The first measurement position for each testing session was decided at random. In all trials and all positions, reliability of scores was demonstrated by weighted kappa coefficient of 0.436 for CE and of 0.626 for NE. The weighted kappa coefficient for the NE was significantly higher than for CE ( p = 0.015). Reliability of evaluation of breathing as measured against the polygraph pattern was consistently higher for NE than CE. Consequently, NE was considered to be a useful tool for evaluating the breathing pattern.