Novel protein biomarkers for pneumonia and acute exacerbations in COPD: a pilot study.

Introduction: Community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in high morbidity, mortality, and socio-economic burden. The usage of easily accessible biomarkers informing on disease entity, severity, prognosis, and pathophysiological endotypes is limited in clinical practice. Here, we have analyzed selected plasma markers for their value in differential diagnosis and severity grading in a clinical cohort. Methods: A pilot cohort of hospitalized patients suffering from CAP (n = 27), AECOPD (n = 10), and healthy subjects (n = 22) were characterized clinically. Clinical scores (PSI, CURB, CRB65, GOLD I-IV, and GOLD ABCD) were obtained, and interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-2-receptor (IL-2R), lipopolysaccharide-binding protein (LBP), resistin, thrombospondin-1 (TSP-1), lactotransferrin (LTF), neutrophil gelatinase-associated lipocalin (NGAL), neutrophil-elastase-2 (ELA2), hepatocyte growth factor (HGF), soluble Fas (sFas), as well as TNF-related apoptosis-inducing ligand (TRAIL) were measured in plasma. Results: In CAP patients and healthy volunteers, we found significantly different levels of ELA2, HGF, IL-2R, IL-6, IL-8, LBP, resistin, LTF, and TRAIL. The panel of LBP, sFas, and TRAIL could discriminate between uncomplicated and severe CAP. AECOPD patients showed significantly different levels of LTF and TRAIL compared to healthy subjects. Ensemble feature selection revealed that CAP and AECOPD can be discriminated by IL-6, resistin, together with IL-2R. These factors even allow the differentiation between COPD patients suffering from an exacerbation or pneumonia. Discussion: Taken together, we identified immune mediators in patient plasma that provide information on differential diagnosis and disease severity and can therefore serve as biomarkers. Further studies are required for validation in bigger cohorts.

Pulmonary rehabilitation in long COVID: more than just natural recovery!?

In the light of missing randomised controlled trials, some arguments suggest that pulmonary rehabilitation has beneficial effects beyond natural recovery https://bit.ly/3ze2xvw.

Influence of an Acute Exacerbation During Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease Awaiting Lung Transplantation.

PURPOSE: Pulmonary rehabilitation (PR) has been shown to be an effective intervention in patients with very severe chronic obstructive pulmonary disease (COPD) awaiting lung transplantation (LTx). The objective of this study was to characterize the prevalence of acute exacerbations (AEs) during PR and their impact on the outcomes of pre-LTx PR. METHODS: In this retrospective analysis, 559 patients with COPD awaiting LTx who were referred to a 4-wk inpatient PR program were evaluated. A total of 114 patients (20%) acquired an AE during PR and continued in an adapted fashion. Pulmonary function testing, 6-min walk test (6MWT), and a health-related quality-of-life questionnaire (SF-36) were administered on admission and on discharge of PR. RESULTS: Following PR, both groups, patients with and without AE, increased their 6MWT significantly (P < .001) to a clinically relevant amount (58 ± 72 and 52 ± 64 m, respectively). The sum scores of the SF-36 also improved significantly without any between-group differences. No observed changes were different between the two groups. No relevant predictors for PR outcomes could be detected by logistic regression. CONCLUSIONS: Our data show that patients with end-stage COPD listed for LTx can achieve clinically relevant improvements in functional exercise capacity and quality of life even if they develop an AE during PR.

Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can result in a large variety of chronic health issues such as impaired lung function, reduced exercise performance and diminished quality of life. Our study aimed to investigate the efficacy, feasibility and safety of pulmonary rehabilitation in COVID-19 patients and to compare outcomes between patients with a mild/moderate and a severe/critical course of the disease. METHODS: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive 3-week inpatient pulmonary rehabilitation programme were included in this prospective, observational cohort study. Several measures of exercise performance (6-min walk distance (6MWD)), lung function (forced vital capacity (FVC)) and quality of life (36-question short-form health survey (SF-36)) were assessed before and after pulmonary rehabilitation. RESULTS: 50 patients were included in the study (24 with mild/moderate and 26 with severe/critical COVID-19). On admission, patients had a reduced 6MWD (mild: median 509 m, interquartile range (IQR) 426-539 m; severe: 344 m, 244-392 m), an impaired FVC (mild: 80%, 59-91%; severe: 75%, 60-91%) and a low SF-36 mental health score (mild: 49 points, 37-54 points; severe: 39 points, 30-53 points). Patients attended a median (IQR) 100% (94-100%) of all provided pulmonary rehabilitation sessions. At discharge, patients in both subgroups improved in 6MWD (mild/moderate: +48 m, 35-113 m; severe/critical: +124 m, 75-145 m; both p<0.001), FVC (mild/moderate: +7.7%, 1.0-17.8%, p=0.002; severe/critical: +11.3%, 1.0-16.9%, p<0.001) and SF-36 mental component (mild/moderate: +5.6 points, 1.4-9.2 points, p=0.071; severe/critical: +14.4 points, -0.6-24.5, p<0.001). No adverse event was observed. CONCLUSION: Our study shows that pulmonary rehabilitation is a feasible, safe and effective therapeutic option in COVID-19 patients independent of disease severity.

Whole-body vibration training versus conventional balance training in patients with severe COPD-a randomized, controlled trial.

BACKGROUND: Whole-body vibration training (WBV) performed on a vibration platform can significantly improve physical performance in patients with chronic obstructive pulmonary disease. It has been suggested that an important mechanism of this improvement is based on an improvement in balance. Therefore, the aim of this study was to investigate the effects of WBV compared to conventional balance training. METHODS: 48 patients with severe COPD (FEV1: 37 ± 7%predicted) and low exercise performance (6 min walk distance (6MWD): 55 ± 10%predicted) were included in this randomized controlled trial during a 3 week inpatient pulmonary rehabilitation. All patients completed a standardized endurance and strength training program. Additionally, patients performed 4 different balance exercises 3x/week for 2 sets of 1 min each, either on a vibration platform (Galileo) at varying frequencies (5-26 Hz) (WBV) or on a conventional balance board (BAL). The primary outcome parameter was the change in balance performance during a semi tandem stance with closed eyes assessed on a force measurement platform. Muscular power during a countermovement jump, the 6MWD, and 4 m gait speed test (4MGST) were secondary outcomes. Non-parametric tests were used for statistical analyses. RESULTS: Static balance performance improved significantly more (p = 0.032) in favor of WBV (path length during semi-tandem stand: - 168 ± 231 mm vs. + 1 ± 234 mm). Muscular power also increased significantly more (p = 0.001) in the WBV group (+ 2.3 ± 2.5 W/kg vs. - 0.1 ± 2.0 W/kg). 6MWD improved to a similar extent in both groups (WBV: 48 ± 46 m, p < 0.001 vs. BAL: 38 ± 32 m; p < 0.001) whereas the 4MGST increased significantly only in the WBV-group (0.08 ± 0.14 m/s2, p = 0.018 vs. 0.01 ± 0.11 m/s2, p = 0.71). CONCLUSIONS: WBV can improve balance performance and muscular power significantly more compared to conventional balance training. TRIAL REGISTRATION: Clinical-Trials registration number: NCT03157986; date of registration: May 17, 2017. https://clinicaltrials.gov/ct2/results?cond=&term=NCT03157986&cntry=&state=&city=&dist = .

Benefits of pulmonary rehabilitation in patients with advanced lymphangioleiomyomatosis (LAM) compared with COPD - a retrospective analysis.

Lymphangioleiomyomatosis (LAM) is a rare and progressive cystic lung disease with limited therapeutic options. We retrospectively analyzed the effects of a comprehensive 4-week inpatient pulmonary rehabilitation (PR) program in 58 patients with advanced LAM (FEV1: 45 ± 34%predicted, 6-min walk distance (6MWD): 338 ± 167 m). Exercise performance (6MWD: + 49 ± 50 m; p < 0.001) and quality of life (SF-36 physical component: + 2.4 ± 7.8 points; p = 0.049 and mental component: + 5.2 ± 12.1 points; p < 0.001) increased significantly after PR comparable to an COPD cohort. There were no clinical parameters that predicted changes in outcomes following PR. PR seems to be an effective therapeutic option even in patients with advanced LAM. TRIAL REGISTRATION: Clinical-Trials registration number: NCT04184193 ; date of registration: December 3, 2019.

Effects of Vibration Training in Interstitial Lung Diseases: A Randomized Controlled Trial.

BACKGROUND: Numerous studies have reported positive effects of exercise training in patients with interstitial lung disease (ILD) on physical capacity and quality of life. However, evidence is rare on the effects of specific forms of training and further pathophysiological mechanisms in these patients. OBJECTIVES: In this multicenter study we aimed to explore the clinical effects of whole-body vibration training (WBVT) in patients with ILD on various outcome measures, including proinflammatory cytokines and myostatin. METHODS: We randomly assigned 26 patients with different forms of multidisciplinary confirmed fibrotic ILDs either to the WBVT group (n = 11; 55% male, 61 ± 14 years old, forced vital capacity 83.2 ± 29.3% predicted, 6-min walking distance [6MWD] 478 ± 79 m) performing 3 months of a standardized training (3 times per week), or to a control training group (CTG, n = 15; 60% male, 63 ± 9 years old, FVC 74.6 ± 20.5% predicted, 6MWD 455 ± 85 m) performing sham WBV training. Training in the two groups was performed on a GalileoTM vibration plate (6-20 vs. 5 Hz). The functional assessments before and after the intervention period included pulmonary function, 6MWD test, chair rise test, ultrasonographic measurement of quadriceps muscle thickness (cross-sectional area), quality of life questionnaires, and serum samples. RESULTS: We observed a significant increase in 6MWD (∆Training = 30 m [12-67], p = 0.024) and a decrease of myostatin (∆Training = -465 pg/mL [-713 to -166], p = 0.008) in the WBVT group. In contrast, no significant differences were observed in the CTG. CONCLUSIONS: The present study demonstrates that WBVT is able to significantly increase 6MWD and decrease myostatin in patients with fibrotic ILDs. Therefore, WBVT seems to be a beneficial and feasible training modality in ILD patients. Clinical Trial Registry: German Clinical Trials Registry (DRKS00012930).

Measuring Sleep Quality and Efficiency With an Activity Monitoring Device in Comparison to Polysomnography.

BACKGROUND: Monitoring for physical activity becomes popular and actually many devices are available. Some physical activity monitors (PAMs) provide data about sleep quality for the user, but there are scarce data concerning validity and usability of these measurements. This study compared the data of sleep parameters generated by a PAM with the polysomnography (PSG). METHODS: In 2016, data of 26 patients in two consecutive PSGs as well as in two daytime and nighttime measurements with a PAM according to physical activity and sleep quality were collected. Furthermore, sleep quality, using the Pittsburgh sleep quality index (PSQI), daytime fatigue, using the multidimensional fatigue inventory (MFI-20) and additionally data of a sleep diary were collected. RESULTS: There were positive correlations of both methods with respect to total sleep time (TST) (r = 0.76, P < 0.01) and sleep efficiency (r = 0.71, P < 0.01). Data analysis over two nights showed that over 90% of the TST (95% confidence interval (CI) -1.59 to 0.82) and of the sleep efficiency (95% CI -8.28 to 15.51) were within the limits of agreement. The analysis of the PSQI and the sleep efficiency of the PAM showed no significant correlations. The daytime fatigue correlated negatively with the physical activity (r = -0.72, P < 0.01). CONCLUSION: The sleep efficiency and TST measured with the PAM sufficiently reflect the PSG sleep parameters and the subjects' subjective feelings. At the same time, PAM results are also correlated with the subjectively perceived quality of sleep. Further investigations to assess the long-term results are pending.

Sleep and rheumatic diseases.

This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective. BACKGROUND: A large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep. Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep. THERAPY: Sleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD.

Effect of Pulmonary Rehabilitation on Inspiratory Capacity During 6-min Walk Test in Patients With COPD: A PROSPECTIVE CONTROLLED STUDY.

PURPOSE: Purpose of this study was to analyze the impact of a pulmonary rehabilitation (PR) program on the measured inspiratory capacity (IC) in patients with chronic obstructive pulmonary disease (COPD) while performing a 6-min walk test (6MWT). METHODS: Before and after PR, IC was measured by spirometry both at the beginning and at the end of the 6MWT for 15 patients with COPD in the PR group (PRG) and compared with a similar calisthenics training group (CTG; n = 15). In addition, the COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ), and other lung function tests were recorded and compared. RESULTS: Both groups were not significantly different at baseline. Compared with the CTG, the PRG achieved a significant increase in the delta of IC measured during the 6MWT (0.5 ± 0.2 L [PRG] vs -0.2 + 0.2 L [CTG], P = .001). Significant differences were found for the 6MWT walking distance (PRG: 99 ± 36 m vs CTG: 5 ± 25 m, P = .001). No significant increase in dyspnea while performing the 6MWT was found in either group. The differences in the CAT score and the SGRQ Global score were significant only for the PRG in intragroup comparisons, whereas the intergroup comparison showed no significant differences. Except for residual volume, no significant changes in all parameters of the static lung function tests were observed in either group. CONCLUSION: Participation in a PR may lead to a significant and clinically relevant increase in IC and the walking distance. Additional research is necessary to define the effects of this increase in IC on exercise capacity.

Obstructive sleep apnea patients can be identified by ion mobility spectrometry-derived smell prints of different biological materials.

BACKGROUND: The analysis of obstructive sleep apnoea syndrome (OSAS) is time- and cost-intensive. A number of studies demonstrated that the non-invasive analysis of exhaled breath (EB) may be suitable to distinguish between OSAS patients and healthy subjects (HS). Methods/Population: We included OSAS patients (n = 15) and HS (n = 15) in this diagnostic proof-of-concept-study. All participants underwent polygraphy to verify or exclude OSAS and performed spirometry to exclude pulmonary ventilatory diseases. The volatile organic compound profile of EB and of the headspaces over EB condensate, pharyngeal washing fluid, and serum was measured using ion mobility spectrometry (IMS) (BioScout®) and an e-nose (Cyranose® 320). For the statistical analysis, we fitted classification tree models using recursive partitioning, followed by a leave-one-out cross-validation. For the cross-validated predictions we calculated descriptive classification statistics, p-values from a [Formula: see text]-test with continuity correction, as well as ROC curves. RESULTS: Using IMS, OSAS patients and HS could be distinguished with high accuracy (values ranged from 79% to 97%). The results of the e-nose-derived analyses (with the exception of EB) were less accurate. However, the cross-validated accuracy for EB was very good (0.9), reflecting a positive predictive value of 100% and a negative predictive value of 83%. For each material, we identified the best five substances that may be used for diagnostic purposes. 2-Methylfluran was found in three different biological materials to be discriminative between OSAS and HS. CONCLUSION: The results strengthen the hypothesis that substances detectable in headspace measurements of different airway and blood materials may undergo a transition from blood into the alveoli (and EB) or vice versa. This means that substances from different compartments could be used to distinguish patients with airway diseases (in this case OSAS) from healthy controls.

Whole-Body Vibration Training During a Low Frequency Outpatient Exercise Training Program in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Trial.

BACKGROUND: The aim of the study was to investigate whether whole-body vibration training (WBVT) can be applied beneficially within an outpatient low frequency exercise program. METHODS: In a prospective, controlled, randomized study, WBVT effectiveness and safety were investigated in COPD stage II-IV patients undergoing a 3-month training program. Participants took part in a 90-min circuit training once a week. On top patients were randomized to either perform squats with WBVT, or without (conventional training group (CTG)). Before and after the intervention, a sit-to-stand test (STST), a 6-min walk test (6-MWT), the COPD assessment test (CAT), and the chronic respiratory disease questionnaire (CRQ) were evaluated. RESULTS: Twenty-eight out of 55 patients completed the study (n = 12 WBTV, n = 16 CTG). The STST time remained nearly constant for the CTG (Δ -0.8 ± 3.1 s) and the WBVT (Δ 1.4 ± 3.2 s; P = 0.227), respectively. Similarly, for both WBVT and CTG, the 6-min walk distance remained unchanged (Δ 7 ± 55 m vs. 9 ± 45 m, P = 0.961). In three out of four categories, the CRQ scores showed a significant improvement within WBVT, and in one category when comparing across groups. The CAT score dropped by -0.8 ± 2.9 points within CTG and by 2.4 ± 2.7 points within WBVT (P = 0.105). There were no adverse events related to WBVT. CONCLUSION: The implementation of WBVT in the context of an outpatient low frequency exercise program did not significantly improve the patients' exercise capacity. An improvement in CAT and partially in CRQ was shown within WBVT. However, regarding the high dropout rate (49%), these results must be interpreted with caution.

Cardiopulmonary response during whole-body vibration training in patients with severe COPD.

Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE)/carbon dioxide production (V'CO2 ): 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236). Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min-1 to 1060±160 mL·min-1 with WBVT and 988±124 mL min-1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD.

Benefits of High-Intensity Exercise Training to Patients with Chronic Obstructive Pulmonary Disease: A Controlled Study.

BACKGROUND: Various exercise training programs are used for patients with chronic obstructive pulmonary disease (COPD) of different severity. OBJECTIVES: To investigate the impact of individualized high-intensity training on exercise capacity with COPD. METHODS: A total of 49 patients agreed to participate. Of these, 31 were assigned to the training group and 18 served as controls. The training group exercised twice a week for 90 min with consecutively increasing loads. At the time of enrollment (T0), as well as after 3 (T1) and 6 (T2) months, a 6-min walk test (6-MWT) was performed and data on health-related quality of life, femoral muscle thickness, and various serum markers were obtained. RESULTS: The training group improved in their 6-MWT results (T0 = 407 ± 152 m vs. T1 = 459 ± 127 m, p = 0.002, vs. T2 = 483.2 ± 130.1 m, p = 0.004), in their cross-sectional area of the musculus rectus femoris (T0 = 6.2 ± 1.2 cm2 vs. T1 = 6.9 ± 1.2 cm2, p = 0.003, vs. 7.5 ± 1.6 cm2, p = 0.002), and in their St. George's Respiratory Questionnaire (SGRQ) score (T0 = 43.3 ± 18.0 vs. T1 = 36.0 ± 18.4, p = 0.001, vs. T2 = 34.7 ± 18. 0, p = 0.004). Serum levels of myostatin, irisin, resistin, and α-Klotho did not change significantly within the training period. Of note, the exercise group showed an inverse relationship between serum levels of resistin and those of α-Klotho after 6 months (r = -0.608, p = 0.021). CONCLUSIONS: COPD patients undergoing an individualized, structured, high-intensity training program improved their exercise capacity, gained muscle mass, and improved their quality of life.

[Pulmonary Rehabilitation after Acute Exacerbation of COPD Reduces the Rate of Reexacerbations]. / Eine pneumologische Rehabilitation nach akuter Exazerbation der COPD senkt die Rate erneuter Exazerbationen.

Objective Acute exacerbation of COPD (AECOPD) provides for patients a significant hazard and is crucial for the prognosis. Data on the effects of pulmonary rehabilitation (PR) on the frequency of reexacerbations after AECOPD are inconsistent. A prospective, case-control study was conducted with the aim of measuring the impact of PR on the frequency of reexacerbations after AECOPD. Patients and Methods A PR was performed in 57 patients with COPD after AECOPD. 30 participants were followed-up after one year and compared to 32 Control-Group (KG = hospitalized for AECOPD without PR). The rate of reexacerbations was both retrospectively in the year preceding the AECOPD, and prospectively in the year after AECOPD analyzed within groups and between groups. Results In the intra group comparison the exacerbation rate was significantly lower in the PR-group in the year after rehabilitation (0.97 ±â€Š2.67 vs. 1.52 ±â€Š1.12; p < 0.001). The intergroup comparison also showed a significantly lower number of exacerbations for the PR-group (0.97 ±â€Š1.52 vs 2.16 ±â€Š1.25; p < 0.001). Conclusion It was shown that the exacerbation rate after an AECOPD could be significantly reduced in the PR-group in comparison to the KG-group during the investigation period of one year by PR. More prospective studies are required to define the value of PR in the context of AECOPD.

Low-Volume Whole-Body Vibration Training Improves Exercise Capacity in Subjects With Mild to Severe COPD.

BACKGROUND: The objective of this study was to investigate the benefits of a low-volume out-patient whole-body vibration training (WBVT) program on exercise capacity in comparison with a calisthenics training program in subjects with COPD. METHODS: In this single-center randomized controlled trial, 29 subjects with mild to severe COPD were randomized to WBVT or to calisthenics training, including relaxation and breathing retraining in combination with calisthenics exercises. Both groups equally exercised for a duration of 3 months with 2 sessions of 30 min/week. Outcome parameters were 6-min walk distance (6MWD, primary outcome), 5-repetition sit-to-stand test, leg press peak force, Berg balance scale, St George Respiratory Questionnaire, and COPD assessment test. RESULTS: Twenty-seven subjects completed the study (WBVT, n = 14; calisthenics training program, n = 13). Baseline characteristics between groups were comparable. Subjects in the WBVT group significantly improved median (interquartile range) 6MWD (+105 [45.5-133.5] m, P = .001), sit-to-stand test (-2.3 [-3.1 to -1.3] s, P = .001), peak force (28.7 [16.7-33.3] kg, P = .001), and Berg balance scale (1.5 [0.0-4.0] points, P = .055). Changes in 6MWD, sit-to-stand test, and leg press peak force were also found to be significantly different between groups in favor of the WBVT group. Only the between-group difference of the COPD assessment test score was in favor of the calisthenics training group (P = .02). CONCLUSIONS: A low-volume WBVT program resulted in significantly and clinically relevant larger improvements in exercise capacity compared with calisthenics exercises in subjects with mild to severe COPD. (ClinicalTrials.gov registration DRKS9706.).

The prevalence of diagnosed α1-antitrypsin deficiency and its comorbidities: results from a large population-based database.

α1-Antitrypsin deficiency (AATD) is a genetically determined disorder that is associated with different clinical manifestations. We aimed to assess the prevalence of diagnosed AATD and its comorbidities using a large healthcare database.In this retrospective longitudinal observational study, we analysed data from 4 million insurants. Using International Classification of Diseases revision 10 (ICD-10) codes, we assessed the prevalence, comorbidities and healthcare utilisation of AATD patients (E88.0 repeatedly coded) relative to non-AATD patients with chronic obstructive pulmonary disease (COPD), emphysema or asthma.In our study population, we identified 673 AATD patients (590 aged ≥30 years), corresponding to a prevalence of 23.73 per 100 000 in all age groups and 29.36 per 100 000 in those ≥30 years. Based on the number of AATD cases detected in the sample size (673 out of 2 836 585), we extrapolated that there were 19 162 AATD cases in Germany during the years studied. AATD patients had a higher prevalence of arterial hypertension, chronic kidney disease and diabetes relative to non-AATD asthma or emphysema patients. When compared to non-AATD COPD patients, AATD patients had significantly more consultations and more frequent and longer hospitalisations.Our data strengthen the assumption that AATD is associated with a variety of other diseases. Healthcare utilisation appears to be higher among AATD patients as compared to patients with non-AATD-related obstructive lung diseases.

Validity and Usability of Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND: A large proportion of COPD patients do not achieve the recommended level of physical activity. It is suggested that feedback on the level of activity by using an activity monitoring device (PAM) increases awareness and may stimulate patients to increase their physical activity in daily life. Our objective was to assess the validity and usability of a simple and low-cost physical activity monitor (Polar A300™) when compared with the validated and established Bodymedia-SenseWear™ (SWA) device. METHODS: To assess the diagnostic equivalent, two different PAM devices were used in parallel in 20 COPD patients GOLD I to IV during 3 consecutive days of daily life. Both systems were compared in terms of steps, calories burned, daily activity time and metabolic equivalents using linear regression analysis and Bland-Altman plots. Practical usability was examined by a 16-item-questionnaire. RESULTS: High correlations of both devices were observed with regard to the sensed step count (r = 0.96; p < 0.01) and calories burned (r = 0.74; p < 0.01), and a lower correlation of daily activity (r = 0.25; p < 0.01) was found. Data analysis over 3 days showed that 90% of the steps (95% CI -4223 to 1887), 100% of the calories (95% CI -2798 to 1887), 90% of the daily activity data (95% CI -12.32, 4065) and 95% of the MET (95% CI -3.11 to 2.75) were within the limits of agreement. A favorable usability (system-, information- and interface quality) of the A300™ device was shown (p < 0.01). CONCLUSION: The A300™ device with easy practical usability was shown not to be inferior for assessment of physical activity time, step count and calorie consumption in COPD patients when compared with the SWA. It is suggested to consider widespread available devices as commonly used for monitoring recreational sporting activities also in patients for assessment of physical activity in daily life.