Effects of Pedometer-Based Step-Feedback on Physical Activity of Severe COPD Patients.

Purpose: This study investigated whether adding step-feedback (step-FB) from a pedometer to pulmonary rehabilitation (PR) programs could increase the physical activity (PA) of low-activity patients with severe chronic obstructive pulmonary disease (COPD). Patients and Methods: We included low-activity patients with severe COPD (step-FB group: 14 patients; control group: 17 patients) who underwent PR for the first time. The usual PR program for patients with severe COPD consisted of two 8-week sessions (PR session 1: PR1, PR session 2: PR2). The step-FB group was provided a program with step-FB added to PR2 (PR2+step-FB). Furthermore, all patients were evaluated at pre-intervention (baseline), PR1, and PR2. The primary outcome of this study was the number of daily steps (steps) and energy expenditure from activity (energy expenditure), as measured by a pedometer. The secondary outcomes were dyspnea and exercise tolerance. Results: In PR1, dyspnea, exercise tolerance, steps, and energy expenditure were significantly improved as compared to baseline, in both groups. During PR2, dyspnea and exercise tolerance were significantly improved as compared to PR1, in both groups. Steps and energy expenditure were significantly improved in the step-FB group, but not in the control group. Conclusion: PR improved PA by improving physical function in severe COPD patients. Adding step-FB improved PA in severe COPD patients by presenting an activity goal for improving PA. Therefore, pedometer-based step-FB is a viable addition to PR and has the potential to improve PA continuously in these patients.

Effect of pulmonary rehabilitation with assistive use of short-acting ß2 agonist in COPD patients using long-acting bronchodilators.

Background: Assistive use of short-acting ß2 agonists (SABAs) reportedly improves exercise tolerance, activities of daily living, and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). However, the effect of SABA on physical activity (PA) is unclear.Objective: This study aimed to determine whether assistive use of SABA increases PA and whether additional pulmonary rehabilitation (PR) can aid further improvement.Methods: Twelve outpatients with COPD and dyspnea during daily activities despite regular use of long-acting bronchodilators were enrolled. This study comprised a 2-week pre-intervention investigation, a 12-week investigation of SABA effects, and an 8-week investigation of the additional effects of PR. Assistive use of SABA was allowed up to 4 times per day after the pre-intervention period. PA was measured for 14 consecutive days using an accelerometer sensor. Dyspnea, exercise tolerance, and HRQOL were evaluated at entry, at 4 and 12 weeks after initiating SABA use, and after completing PR.Results: Assistive use of SABA improved breathlessness during daily activities and increased PA (p < .001). PA and HRQOL were also improved following PR (p < .001 and p = .013, respectively).Conclusions: Combined therapy of SABA and PR can increase PA and HRQOL in COPD patients.

Factors influencing the physical activity in daily life of male patients with different levels of severity of chronic obstructive pulmonary disease.

[Purpose] Physical activity influences the prognosis of chronic obstructive pulmonary disease and is influenced by exercise tolerance, and environmental, psychological, and many other factors, but the influence of these factors on physical activity levels in each stage of chronic obstructive pulmonary disease is unknown. This study aimed to clarify this matter. [Participants and Methods] Seventy-one male patients with chronic obstructive pulmonary disease (aged 72.2 ± 4.5 years) participated in this study. We compared physical activity levels (determined as daily steps), presence or absence of daily routine (e.g., housework or hobby), 6-minute walking distance, psychological factors (using the Hospital Anxiety and Depression Scale), and health-related quality of life (Physical and Mental component summary of the 36-item short-form health survey) between patients in different stages of chronic obstructive pulmonary disease. [Results] When examined at each stage of chronic obstructive pulmonary disease, physical activity levels correlated with the presence or absence of daily routine, 6-minute walking distance, and Physical component summary in all stages, but the scores in the anxiety and depression components of the Hospital Anxiety and Depression Scale and Mental component summary correlated only with stage 4. [Conclusion] Physical functioning was related to physical activity levels at any stage of chronic obstructive pulmonary disease, although psychological functioning was related to the progress of disease severity. The approach to promote an active lifestyle must be selected depending on the stage of chronic obstructive pulmonary disease.

Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals.

BACKGROUND: There is no systematic analysis to identify problems involved with instruction on inhalation therapy for elderly patients. We conducted a nationwide questionnaire survey for patients and medical professionals. METHODS: A questionnaire survey was conducted of adult patients on inhaled drugs (ages 18-92 years, 820 individuals) and medical professionals (pharmacists or nurses) who provided instruction on inhalation therapy to these patients in 23 institutions in Japan to investigate the technique and the level of understanding (knowledge) of the inhalation therapy. Changes in the recognition of performance of inhalation technique and inhalation knowledge with increasing age were analyzed. RESULTS: According to patients' subjective assessment, there was no deterioration in the performance of the inhalation technique or loss of the knowledge with increasing age. On the other hand, medical professionals' objective assessment revealed a significant loss of both inhalation technique and knowledge with increasing age. Not many elderly patients noticed their own problems themselves, revealing a great perception gap between elderly patients and medical professionals. Thus, there was concern that patients would unconsciously practice the inhalation procedure improperly. On the other hand, in comparison with non-elderly patients, elderly patients were less resistant to continuation of therapy, suggesting that they would be more likely to accept instruction on inhalation therapy. CONCLUSIONS: Elderly patients are apt to assume that they "understand well", therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy.

[Relationship between chronic obstructive pulmonary disease and gastroesophageal reflux disease defined by the Frequency Scale for the Symptoms of gastroesophageal reflux disease].

Little is known about gastroesophageal reflux disease (GERD) in chronic obstructive pulmonary disease (COPD) patients. The aim of this study was to investigate the prevalence, clinical characteristics and risk factors for GERD in COPD patients, based on the Frequency Scale for the Symptoms of GERD (FSSG). In 228 COPD patients, the prevalence of GERD was 26.7%, independent of COPD stage. Logistic regression multivariate analysis revealed significant risk factors for accompanying GERD were age (p = 0.009; odds ratio (OR), 0.933; 95% confidence interval (CI) 0.885 to 0.983) and number of COPD exacerbation within one year (p = 0.043; OR, 1.675; 95% CI, 1.075 to 2.764). The risk factors of COPD exacerbation were total FSSG score (p = 0.031; OR, 1.079; 95% CI, 1.007 to 1.156) and inhaled corticosteroid use (p = 0.003; OR, 3.238; 95% CI, 1.482 to 7.076). Moreover, the Spearman rank correlation test showed that FSSG score was weakly but significantly correlated with the number of COPD exacerbations (rs = 0.317, p < 0.001). In conclusion, the incidence of GERD in COPD patients is high, and the incidence of GERD is closely related to COPD exacerbation.

Life-long physical activity involvement reduces the risk of chronic obstructive pulmonary disease: a case-control study in Japan.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Because only 20% of cigarette smokers develop COPD, certain environmental and lifestyle factors may protect against the disease development. METHODS: To investigate the relationship between life-long physical activity involvement and the COPD risk, a case-control study was conducted in central Japan. A total of 278 eligible patients (244 men and 34 women) age 50 to 75 years were referred by respiratory physicians, while 335 controls (267 men and 68 women) were recruited from the community. All participants underwent spirometric measurements of lung function. Information on demographic and lifestyle characteristics was obtained by face-to-face interview using a structured questionnaire. RESULTS: Older adults who remained physically active had better lung function than others inactive over the life course. The COPD patients were found to be less active than their healthy counterparts. Significant reductions in risk of COPD and breathlessness were evident by being active life-long, with adjusted odds ratio 0.59 (95% CI 0.36-0.97) and 0.56 (95% CI 0.36-0.88), respectively. CONCLUSIONS: The study suggested an inverse association between life-long physical activity and the risk of COPD and breathlessness. Promotion of physical activity to prevent this major disease should be encouraged.

Breathlessness is associated with urinary incontinence in men: A community-based study.

BACKGROUND: Urinary incontinence (UI) is a distressing problem for older people. To investigate the relationship between UI and respiratory symptoms among middle-aged and older men, a community-based study was conducted in Japan. METHODS: A convenience sample of 668 community-dwelling men aged 40 years or above was recruited from middle and southern Japan. The International Consultation on Incontinence Questionnaire-Short Form, the Medical Research Council's dyspnoea scale and the Australian Lung Foundation's Feeling Short of Breath scale, were administered by face-to-face interviews to ascertain their UI status and respiratory symptoms. RESULTS: The overall prevalence of UI was 7.6%, with urge-type leakage (59%) being most common among the 51 incontinent men. The presence of respiratory symptoms was significantly higher among incontinent men than those without the condition, especially for breathlessness (45% versus 30%, p = 0.025). The odds of UI for breathlessness was 2.11 (95% confidence interval 1.10-4.06) after accounting for age, body mass index, smoking and alcohol drinking status of each individual. CONCLUSIONS: The findings suggested a significant association between UI and breathlessness in middle-aged and older men.

Spontaneous pneumomediastinum: an algorithm for diagnosis and management.

Spontaneous pneumomediastinum (SPM) is a rare disorder most often affecting young males which is generally self-limiting. Despite the benign prognosis with few complications and little morbidity, it frequently confuses clinicians in primary settings, who may have difficulty differentiating SPM from other serious organ ruptures, especially oesophageal rupture (the so-called Boerhaave syndrome), which may lead to mediastinitis and may be fatal, even with appropriate interventions. An overview of adult SPM is provided, reviewing 17 studies (414 patients), including our clinical experience, and finally an algorithm for diagnosis and management of SPM is proposed, based on the characteristics of SPM.

Soy consumption and risk of COPD and respiratory symptoms: a case-control study in Japan.

BACKGROUND: To investigate the relationship between soy consumption, COPD risk and the prevalence of respiratory symptoms, a case-control study was conducted in Japan. METHODS: A total of 278 eligible patients (244 men and 34 women), aged 50-75 years with COPD diagnosed within the past four years, were referred by respiratory physicians, while 340 controls (272 men and 68 women) were recruited from the community. All participants underwent spirometric measurements of respiratory function. Information on demographics, lifestyle characteristics and habitual food consumption was obtained using a structured questionnaire. RESULTS: Total soy consumption was positively correlated with observed lung function measures. The mean soy intake was significantly higher among controls (59.98, SD 50.23 g/day) than cases (44.84, SD 28.5 g/day). A significant reduction in COPD risk was evident for highest versus lowest quartile of daily intake of total soybean products, with adjusted odds ratio (OR) 0.392, 95% CI 0.194-0.793, p for trend 0.001. Similar decreases in COPD risk were associated with frequent and higher intake of soy foods such as tofu and bean sprouts, whereas respiratory symptoms were inversely associated with high consumption of soy foods, especially for breathlessness (OR 0.989, 95% CI 0.982-0.996). CONCLUSION: Increasing soy consumption was associated with a decreased risk of COPD and breathlessness.

Do vegetables and fruits reduce the risk of chronic obstructive pulmonary disease? A case-control study in Japan.

OBJECTIVE: To investigate the relationship between vegetable and fruit consumption and the risk of chronic obstructive pulmonary disease (COPD), a case-control study was conducted in central Japan in 2006. METHODS: A total of 278 referred patients with COPD diagnosed within the past four years and 340 community-based controls undertook spirometric measurements of respiratory function. A structured questionnaire was administered face-to-face to obtain information on demographics, lifestyle and habitual food consumption. RESULTS: The mean vegetable and fruit intakes of cases (155.62 (SD 88.84) and 248.32 (SD 188.17) g/day) were significantly lower (p<0.01) than controls (199.14 (SD 121.41) and 304.09 (SD 253.72) g/day). A substantial reduction in COPD risk was found by increasing daily total vegetable intake, p for trend=0.037. The prevalence of breathlessness also decreased with vegetable consumption, the adjusted odds ratio being 0.49 (95% CI 0.27-0.88) for the highest versus lowest quartile of intake. However, the effects of fruit consumption were not significant. Among the nutrients contained in vegetables and fruits, vitamin A was particularly significant (p=0.008) with an estimated 52% reduction in COPD risk at the highest level of intake. CONCLUSION: The study provided evidence of an inverse association between vegetable consumption and the risk of COPD for Japanese adults.

[Predictors of survival in patients with chronic hypercapnic respiratory failure receiving domiciliary NPPV].

Fifty-four cases (36 men) with chronic hypercapnic respiratory failure were prescribed domiciliary NPPV during 9 years. COPD (26 patients) and sequelae of tuberclosis (16 patients) were the major primary diseases. At the initiation of NPPV, the age was 71.2 +/- 7.3 years-old (mean +/- standard deviation) and PaCO2 was 76.7 +/- 16.2Torr. Overall, the 1-year and 5-year survival rates were 63.8% and 26.0%, respectively. Multivariate analysis identified BMI (body mass index) (hazzard ratio : 0.837, p = 0.020) and the number of days of hospitalization during 1 year before NPPV (hazzard ratio: 1.013, p = 0.016) as predictors of survival. Patients with frequent hospitalization for exacerbation or with malnutrition had poor prognosis, so comprehensive supports aimed to improve general status are needed for patients with chronic respiratory failure received domiciliary NPPV.

Physical activity of patients with chronic obstructive pulmonary disease: implications for pulmonary rehabilitation.

PURPOSE: This study ascertained the extent to which Japanese patients with chronic obstructive pulmonary disease (COPD) were involved in various modes of physical activity in daily life and factors affecting their physical activity levels. METHODS: Information on physical activity, demographics, and lifestyle characteristics was obtained by face-to-face interviews with 257 eligible patients (227 men and 30 women) recruited from 6 hospitals in central Japan. RESULTS: Overall, 77% of patients participated in weekly physical activities, but only 25% engaged in moderate or vigorous activities. The mean metabolic equivalent tasks devoted to all physical activities were 1807 (SD = 3124) minutes per week for men and 1656 (SD = 3931) minutes per week for women. Stepwise regression analyses found that disease severity and perceived lifelong physical activity involvement were significant factors related to total physical activity, whereas age, COPD severity, and current smoking were negatively associated with walking. CONCLUSIONS: Patients with COPD had lower physical activity levels than the general elderly population. They should be encouraged to increase their participation in exercise activities.

Management of spontaneous pneumomediastinum based on clinical experience of 25 cases.

STUDY OBJECTIVES: Spontaneous pneumomediastinum (SPM) is a rare disorder that usually occurs in young individuals and has a self-limiting course and no recurrence in most cases. But actually in many cases, patients are undergo some examinations or some limitations. The purpose of this study was to evaluate the clinical characteristics and recommend appropriate management of SPM. DESIGN: Retrospective research of clinical records of a single institution. RESULTS: Over 11 years, we diagnosed 25 patients (18 males) with SPM. Their average age was 20.1 years (range 13-28 years). Chest pain or neck symptoms were most frequent, and 17 patients (68%) had subcutaneous emphysema. In all cases, blood counts and C-reactive protein (CRP) were measured, and their mean values were 10,100+/-4600/mm(3) and 1.0+/-1.5 mg/dL, respectively. In 20 patients (80%), either leucocytosis or elevated CRP was observed. Twenty-four patients (96%) were admitted (average 7.8+/-4.1 days) and 20 of them were prescribed antibiotics or limited oral intake. The symptoms were self-limiting in all cases and disappeared on average 1.8+/-0.9 days after diagnosis. No recurrence was noted in the approximately 2 years follow-up period. CONCLUSION: SPM is a self-limiting disease with mild inflammatory signs. For patients suspicious of SPM, shortened hospitalization for about 2 days with observation alone may be feasible, if their symptoms improve gradually. Otherwise, less invasive procedures, such as esophagram, should be performed immediately. Long-term follow-up is usually unnecessary. We propose a new algorithm for management of SPM based on clinical experience.

[Purpura fulminans due to pneumococcal pneumonia in a healthy adult: a case report].

We report a case of infectious purpura fulminans due to pneumococcal pneumonia in a 61-year-old man presenting multiple organ failure and pneumococcal bacteremia secondary to pneumonia on admission. His lower limbs showed rapidly progressive purpura and symmetrical dry gangrene. He had no history of or apparent immunodeficiency, including asplenia, in abdominal ultrasonography. Despite of therapy, he died on day 15 after admission. Infectious purpura fulminans involves skin lesions with severe infection often accompanied by disseminated intravascular coagulation and septic shock. Although it occurs mainly in childhood, especially as a complication of Neisseria meningitis or Varicella virus infection, it has also been reported in adult, as a rare complication of invasive pneumococcal infection. Most had immunodeficiency such as asplenia or postsplenectomy. Purpura fulminans in a previously healthy adult is very rare and this is insofar as we know, the first report in Japan detailing the development from pneumococcal pneumonia.

Usual interstitial pneumonia and chronic idiopathic interstitial pneumonia: analysis of CT appearance in 92 patients.

PURPOSE: To retrospectively analyze computed tomographic (CT) findings of chronic idiopathic interstitial pneumonia (IIP) and to determine which findings are most helpful for distinguishing IIP from usual interstitial pneumonia (UIP) with univariate and multivariate analyses. MATERIALS AND METHODS: Institutional review board approval and informed consent were not required for this retrospective review of patient records and images. Two observers working independently and without knowledge of the diagnosis evaluated the extent and distribution of various thin-section CT findings (ground-glass opacity, consolidation, reticulation, and honeycombing) in 92 patients (51 men, 41 women; mean age, 56 years; age range, 29-81 years) with a histologic diagnosis of UIP (n = 20), cellular nonspecific interstitial pneumonia (NSIP) (n = 16), fibrotic NSIP (n = 16), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) (n = 11), desquamative interstitial pneumonia (DIP) (n = 15), or lymphoid interstitial pneumonia (LIP) (n = 14). Observers used univariate and multivariate statistical analyses to compare their findings with the extent and distribution of UIP. RESULTS: Observers made the correct diagnosis in 145 (79%) of 184 readings. Multivariate logistic regression analysis showed that the independent findings that distinguished UIP from cellular NSIP were the extent of honeycombing and the most proximal bronchus with traction bronchiectasis (odds ratio, 5.16 and 0.37, respectively); the finding that distinguished UIP from fibrotic NSIP was the extent of honeycombing (odds ratio, 2.10). CT features that distinguished UIP from RB-ILD and DIP included extent of ground-glass opacity (odds ratio, 0.76), thickening of bronchovascular bundles (odds ratio, 1.58), the most proximal bronchus with traction bronchiectasis (odds ratio, 0.22), and the number of segments with traction bronchiectasis (odds ratio, 3.64). CONCLUSION: UIP has a characteristic appearance that usually facilitates distinction from other types of chronic IIPs at thin-section CT. The most useful finding when differentiating UIP from NSIP was the extent of honeycombing.