Romme E.A.,Catharina Hospital |
Smeenk F.W.,Catharina Hospital |
Rutten E.P.,Program Development Center |
Wouters E.F.,Maastricht University
Expert Review of Respiratory Medicine | Year: 2013
Chronic obstructive pulmonary disease (COPD) is being regarded as a heterogeneous disease with clinically significant pulmonary and extrapulmonary manifestations, such as emphysema, cardiovascular disease and osteoporosis. Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and, consequently, an increased risk of fracture. Fractures resulting from osteoporosis might contribute to increased morbidity and mortality, particularly in COPD patients. The high prevalence of osteoporosis in COPD patients is assumed to be due to common risk factors, such as older age and tobacco smoking, and COPD-specific risk factors, such as systemic inflammation, vitamin D deficiency and the use of oral or inhaled corticosteroids. This review provides a state-of-the-art summary of the prevalence, pathophysiology, diagnosis, risk factors and treatment of osteoporosis in COPD patients. It also discusses potential mechanisms linking COPD with osteoporosis. © 2013 Informa UK Ltd.
Janssen D.J.A.,Program Development Center |
Janssen D.J.A.,Maastricht University |
McCormick J.R.,University of Kentucky
Clinics in Chest Medicine | Year: 2014
Numerous barriers exist to the timely introduction of palliative care in patients with advanced chronic obstructive pulmonary disease (COPD). The complex needs of patients with advanced COPD require the integration of curative-restorative care and palliative care. Palliative care and pulmonary rehabilitation are both important components of integrated care for patients with chronic respiratory diseases. Pulmonary rehabilitation provides the opportunity to introduce palliative care by implementing education about advance care planning. Education about advance care planning addresses the information needs of patients and can be an effective strategy to promote patient-physician discussion about these issues. © 2014 Elsevier Inc.
Vanfleteren L.E.G.W.,Program Development Center |
Spruit M.A.,Program Development Center |
Groenen M.,Program Development Center |
Gaffron S.,Viscovery Software GmbH |
And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2013
Rationale: Comorbidities contribute to disease severity and mortality in patients with chronic obstructive pulmonary disease (COPD). Comorbidities havebeenstudied individually andweremostly based on self-reports. The coexistence of objectively identified comorbidities and the role of low-grade systemic inflammation in the pathophysiology of COPD remain to be elucidated. Objectives: To cluster 13 clinically important objectively identified comorbidities, and to characterize the comorbidity clusters in terms of clinical outcomes and systemic inflammation. Methods: A total of 213 patients with COPD (FEV1, 51 ± 17% predicted; men, 59%; age, 64 ± 7 yr) were included prospectively. Comorbidities were based on well-known cut-offs identified in the peer-reviewed English literature. Systemicinflammatory biomarkers were determined in all patients. Self-organizing maps were used to generate comorbidity clusters. Measurements and Main Results: A total of 97.7% of all patients had one or more comorbidities and 53.5% had four or more comorbidities. Five comorbidity clusters were identified: (1) less comorbidity, (2) cardiovascular, (3) cachectic, (4) metabolic, and (5) psychological. Comorbidity clusters differed in health status but were comparable with respect to disease severity. An increased inflammatory state was observed only for tumor necrosis factor (TNF) receptors in the metabolic cluster (geometric mean [lower and upper limit]; TNF-R1, 2,377 [1,850, 3,055] pg/ml, confidence, 98.5%; TNF-R2, 4,080 [3,115, 5,344] pg/ml, confidence, 98.8%) and only for IL-6 in the cardiovascular cluster (IL-6, 3.4[1.8, 6.6] pg/ml; confidence, 99.8%). Conclusions: Multimorbidity is common in patients with COPD, and different comorbidity clusters can be identified. Low-grade systemic inflammation is mostly comparable among comorbidity clusters. Increasing knowledge on the interactions between comorbidities increases the understanding of their development and contributes to strategies for prevention or improved treatment. Copyright © 2013 by the American Thoracic Society.
Franssen F.M.,Program Development Center |
Spruit M.A.,Program Development Center |
Wouters E.F.M.,Program Development Center |
Wouters E.F.M.,Maastricht University
International Journal of COPD | Year: 2011
Background: Polypharmacy of respiratory medications is commonly observed in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD. Methods: Data were extracted from the records of all patients with a diagnosis of COPD referred for pulmonary rehabilitation to CIRO+ between 2005 and 2009. Use of respiratory medications, self-reported COPD exacerbations, lung function, blood gases, exercise capacity, Medical Research Council (MRC) dyspnea grade, and St George's Respiratory Questionnaire (SGRQ) were recorded as part of assessment of health status. Results: In total, 1859 COPD patients of mean age (± standard deviation) 64.3 ± 9.7 years and with a forced expiratory volume in one second (FEV1) of 44.7% ± 18.2% were included. On average, patients used 3.5 ± 1.5 respiratory medications; this number increased with increasing GOLD stage, MRC score, and SGRQ scores. FEV1 (% predicted), SGRQ, and number of recent exacerbations were independent determinants of polypharmacy. Use of long-acting bronchodi-lators and inhaled corticosteroids was substantial and comparable in all GOLD stages. Use of corticosteroids was not restricted to patients with frequent exacerbations. Conclusion: Polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines. © 2011 Franssen et al, publisher and licensee Dove Medical Press Ltd.
Stoilkova A.,Maastricht University |
Janssen D.J.A.,Program Development Center |
Wouters E.F.M.,Maastricht University |
Wouters E.F.M.,Program Development Center
Respiratory Medicine | Year: 2013
Background According to practice guidelines, educational programmes for patients with COPD should address several educational topics. Which topics are incorporated in the existing programmes remains unclear. Objectives To delineate educational topics integrated in current COPD management interventions; and to examine strengths, weaknesses, and methods of delivery of the educational programmes. Data sources A systematic literature search was performed using MEDLINE/PubMed, Cochrane Central Registry of Controlled Clinical Trials, and Web of Science. The authors of included studies were contacted for additional information. Study selection Studies that contained educational programmes incorporated in COPD management interventions were included. Data extraction Data were extracted using a pre-designed data form. The Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework was used for evaluating the strengths and weaknesses of the programmes. Data synthesis In total, 81 articles, describing 67 interventions were included. The majority (53.8%) of the studies incorporated 10 or more educational topics. The following topics were frequently addressed: smoking cessation (80.0%); medication (76.9%); exercise (72.3%); breathing strategies (70.8%); exacerbations (69.2%); and stress management (67.7%). Printed material and/or brochure (90.5%) and demonstrations and practice (73.8%), were the predominant tool and method, respectively. Nurses (75.8%), physicians (37.9%) and physiotherapists (34.8%) were the most involved healthcare professionals. Conclusions Heterogeneity and wide variation in the content and the method of delivery of educational interventions were present. Alignment between educational topics incorporated in the existing programmes and those recommended by the COPD guidelines, involvement of various professionals and combined use of methods should be emphasised. © 2013 Elsevier Ltd. All rights reserved.