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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical role of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) has not been established, because data on its clinical effect is scarce and controversial. To further investigate these aspects we studied 20 COPD patients (FEV1 37 +/- 3% P) who were randomly and double blindly trained for 30 minutes a day during 10 weeks using a threshold inspiratory trainer with either 30% (group 1) or 10% (group 2) of PIMax as a training load. The training load was crossed after each patient completed 10 weeks of training. Effects were assessed through changes in PIMax, dyspnea through the transition dyspnea index (ITD) and the respiratory effort with Borg's score. Walking capacity was measured with the six minutes walking distance test (6WD) and depression symptoms with Beck's score. Daily life activities were also assessed. Results showed that after 10 weeks of IMT, PIMax increased in both groups (p < 0.05), dyspnea improved in group 1 as compared to group 2 (p < 0.04), 6WD increased significantly in patients of group 1, who also complained of less dyspnea (p < 0.05). Depression scores fell significantly in group 2. Daily activities improved more in group 1. After the crossover patients in group 1 disclosed a significant deterioration in PIMax whereas group 2 disclosed significant improvements in PIMax, dyspnea and 6WD. We conclude that IMT using a threshold device with 30% PIMax is a useful procedure for the treatment of severe COPD patients.
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PMID:[Clinical effects of inspiratory muscle training in patients with chronic airflow limitation]. 872 34

The aim of this study was to compare the quality of life of patients under home mechanical ventilation (HMV) for restrictive lung disease, with the quality of life of patients with chronic obstructive pulmonary disease (COPD), having similar decrease in forced expiratory volume in one second (FEV1), but not receiving HMV. Sixteen patients who were receiving intermittent HMV (six post-tuberculosis, four post-poliomyelitis, two neuromuscular diseases, two kyphoscoliosis, two obesity-hypoventilation syndromes) were compared to 15 COPD patients who were receiving only usual conservative treatment, including long-term oxygen therapy. Dyspnoea scores, anxiety, depression, and psychosocial scores, as well as a panel of functional parameters were measured. The two groups did not differ in terms of functional impairment. However, patients under HMV had much better scores for anxiety, depression, and adjustment to illness than COPD patients. Scores for dyspnoea at rest were also better in the HMV group, but showed no relationship to quality of life. In spite of a cumbersome and intrusive type of treatment, patients under home mechanical ventilation for predominantly restrictive lung disease were found to have a better quality of life than chronic obstructive pulmonary disease patients under conservative therapy. In the first group, a longer history of coping with a chronic disease and the perception that medical intervention is effective may in part account for this difference.
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PMID:Quality of life of patients under home mechanical ventilation for restrictive lung diseases: a comparative evaluation with COPD patients. 876 89

We examined the relationships among dyspnea ratings in daily life, the physiologic state, and anxiety and depression of fifty-two patients with chronic obstructive disease (COPD) during long-term domiciliary oxygen therapy (LTOT). Clinical ratings of dyspnea were assessed by the visual-analog scale (VAS) during eight types of basic behavior in indoor daily life. Analysis of the physiologic state included forced expiratory volume in 1 second (FEV1.0), and arterial blood gas (PaO2, PaCO2) at rest while breathing room air. The hospital anxiety and depression (HAD) scale, which consists of 14 questions, was used to assess the degree of anxiety (HAD-A) and depression (HAD-D). The mean age of the patients was 69.5 +/- 10.8 year (SD), and the duration of LTOT was 944 +/- 739 days. The mean values were 0.77 +/- 0.45 L for FEV1.0, 57.7 +/- 7.4 Torr for PaO2, and 47.4 +/- 8.1 Torr for PaCO2. FEV1.0 was correlated with PaCO2(r = -0.548, p < 0.0001), but it was not correlated with PaO2. High correlation was noted between HAD-A and HAD-D (r = 0.693, P < 0.0001), whereas correlation was not noted between HAD and the physiologic state. VAS was significantly correlated with FEV1.0 (r = 0.320, p < 0.05), as well as with HAD-A (r = 0.358, p < 0.01) and HAD-D (r = 0.444, p < 0.01). Dyspnea ratings were found to be influenced by anxiety and the depression state, and also by the degree of flow limitation in patients with COPD during LTOT. In contrast, the physiologic state scarcely influenced the anxiety and depression state. Thus, psychotherapy may play an important role in the reduction of dyspnea sensation, which is an important determinant of quality of life.
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PMID:Relationship between dyspnea in daily life and psycho-physiologic state in patients with chronic obstructive pulmonary disease during long-term domiciliary oxygen therapy. 883 95

We conducted a study to assess the validity of the occlusion pressure (P0.1) measured during activation of the trigger mechanism (P0.1(aw)trig) in patients showing variable levels of PEEPi during pressure-support ventilation. We first compared P0.1(aw)trig and P0.1 measured with the conventional method (i.e., the airway pressure drop after the first 100 ms of an occluded inspiration) in 16 patients with chronic obstructive pulmonary disease (COPD). We observed good agreement and a highly significant correlation (r = 0.99; bias = 0.3 +/- 0.5 cm H20) between the two methods. In a second part of the study, we compared, in 17 patients, P0.1(aw)trig with (P0.1(es)), measured as the depression generated on the esophageal pressure tracing in the first 100 ms of the inspiratory negative swing, and with P0.1 measured on the P(es) tracing simultaneously with P(aw)trig (P0.1(es-synchro)). Our results showed a good correlation and good agreement between P(aw)trig and P0.1(es) (r = 0.92; bias = 0.3 +/- 0.5 cm H20); P(aw)trig and P0.1(es-synchro) (r = 0.97; bias = 0.1 +/- 0.2 cm H20); and P0.1(es) and P0.1(es-synchro) (r = 0.95, bias = 0.2 +/- 0.4 cm H20), respectively. This study suggests that reliable measurements of inspiratory drive can be obtained easily, on a breath-by-breath basis, from airway pressure tracings during pressure-support ventilation in patients with variable levels of PEEPi.
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PMID:Estimation of occlusion pressure during assisted ventilation in patients with intrinsic PEEP. 888 84

We investigated the association of non-insulin-dependent (Type 2) diabetes mellitus and depression symptoms in a representative community-dwelling elderly population independently of other conditions such as gender, age, status, disability, cognitive impairment and a number of chronic medical conditions such as chronic obstructive lung disease, degenerative joint disease, heart disease, cirrhosis of the liver, cholelithiasis, peptic ulcer and kidney stones. A total of 1339 elderly subjects living in southern Italy were randomly selected from electoral rolls and evaluated. All subjects were tested by the Geriatric Depression Scale to detect depression, the Mini-Mental State Examination to study cognitive function and the Activity Daily Living Index to evaluate disability. Non-insulin-dependent diabetes mellitus affected 14.7% of our sample. Depression was more prevalent in women over 75 years of age than in younger women (15.9 vs 8.1%, p < 0.001). In multiple linear regression analysis, diabetes mellitus was found to be significantly associated with depression independently of age, gender, loneliness, cognitive impairment, chronic obstructive lung disease, degenerative joint disease, heart diseases, cancer, kidney disease, cirrhosis of the liver and cholelithiasis. It is concluded that non-insulin-dependent diabetes mellitus is significantly associated with depression in the elderly, which may have clinical implications for the achievement of sufficient blood glucose control.
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PMID:Non-insulin-dependent diabetes mellitus is associated with a greater prevalence of depression in the elderly. The Osservatorio Geriatrico of Campania Region Group. 889 92

Cognitive function, psychological status, and attitudes were investigated in 90 patients with chronic obstructive pulmonary disease before the initiation of long-term oxygen therapy and after one year of treatment. Assessment included clinical interview, Wechsler Intelligence Scale I.Q., Bourdon-Wiersma Test, Benton Verbal Retention Test, Rey's Test of Remembering 15 Words, Beck's Depression Scale, Taylor's Manifest Anxiety Scale, and Tylka's Psychological Evaluation Scale of the Effectiveness of Rehabilitation. The mean I.Q. of the patients studied was slightly above average at 107 points. Tests of cognitive function showed reduced performance. These included tests of repeating numbers, pictorial anecdotes and numerical symbols. Rey's Test of Word Memory was also below average but increased following treatment. In the Bourdon Test, there were 58 correct deletions and 7 omissions initially, improving to 67 and 8, respectively, after treatment. Poor visual and spatial memory did not improve after treatment. Before treatment, patients demonstrated depressed mood, low self-esteem with narrow interests, signs of anxiety, mental stress and depression. After a year of long-term oxygen therapy significant improvements in mood and attitudes were demonstrated. We conclude that long-term oxygen therapy may be capable of producing a significant improvement in emotional status. However, the effects of oxygen treatment are difficult to separate from effects of other aspects of care in producing a sense of increased security and well-being.
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PMID:Psychological status of COPD patients before and after one year of long-term oxygen therapy. 890 13

This study examined the relationship between adherence to domiciliary nebulized therapy and psychological factors; patient attitudes, anxiety, depression, and quality of life. Ninety three patients aged 45-77 yrs with chronic obstructive pulmonary disease (COPD) and using domiciliary nebulizers were recruited from a hospital database. They completed the St George's respiratory questionnaire (SGRQ)-1 and the hospital anxiety and depression scale (HADS) and attended a semistructured interview. Their usual nebulizers were replaced by Dataloggers, which record the date, time and duration of each treatment, to use for 4 weeks. The SGRQ was then repeated (SGRQ-2). Eighty two patients completed the study. Fifty six percent were poorly adherent; taking less than 70% of the dose prescribed (or less than 60% on regimens of > or = 5 times daily). The total scores on the SGRQ-2 were negatively correlated with percentage adherence. Multiple regression analysis showed that the SGRQ-2 total score was associated with percentage adherence, depression score, feeling supported by clinic staff, and patients feeling that they tried to ignore their chest disease. Patients who report poor quality of life are more likely to be depressed, feel unsupported by clinic staff and be poorly adherent to treatment. Increased levels of clinic support, with the addition of psychological treatments, may be of benefit to some patients with chronic obstructive pulmonary disease.
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PMID:Psychological factors associated with use of home nebulized therapy for COPD. 894 83

Close to three-fourths of patients with chronic obstructive pulmonary disease (COPD) suffer from weight loss. Identifying a single cause for this is difficult, as several factors-including chronic mouth breathing, dyspnea, aerophagia, certain medications, and depression-often act in concert. Malnutrition can exacerbate symptoms of COPD by decreasing ventilatory muscle strength, exercise tolerance, and immunocompetence, and by increasing the risk of depression and anxiety. Goals of nutrition intervention are to prevent or reverse malnutrition without worsening the disease process and to improve respiratory function, thereby reducing morbidity and delaying mortality. Recommendations for intake of fats, carbohydrates, protein, and water must be individualized.
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PMID:COPD: using nutrition to prevent respiratory function decline. 896 87

The purpose of this study was to test an explanatory model of variables influencing functional status in chronic obstructive pulmonary disease (COPD). The sample consisted of 104 patients with COPD (85 males, 19 females, mean age = 65.5, SD = 7.7). The variables in the initial model were age, length of illness, pulmonary function, oxygen desaturation during exercise, dyspnea, depressed mood, anxiety, self-esteem, exercise capacity, and functional status. Path analysis revealed that exercise capacity (beta = .337, p = .0007), dyspnea (beta = .324, p = .0009), and depressed mood (beta = -.204, p = .011) directly influenced functional status Dyspnea (beta = .488, p < .0001), depression (beta = -.217, p = .003), and pulmonary function (beta = .421, p < .0001) indirectly influenced functional status through exercise capacity. Self-esteem (beta = -.492, p = .004) and anxiety (beta = .696, p < .0001) indirectly influenced functional status through depressed mood. The findings of this study suggest that efforts to improve functional status of individuals with COPD should focus on interventions that influence exercise capacity, dyspnea, anxiety, and depressed mood.
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PMID:An explanatory model of functional status in chronic obstructive pulmonary disease. 902 21

To clarify the demographic and clinicolaboratory features of postdialysis fatigue (PDF), we enrolled 85 patients on maintenance hemodialysis in a cross-sectional study using validated questionnaires and chart review. Forty-three patients complained of fatigue after dialysis. On formal testing using the Kidney Disease Questionnaire, the PDF group had statistically greater severity of fatigue and somatic complaints than the group of patients without subjective fatigue (P = 0.03 and 0.04, respectively). On a scale measuring intensity of fatigue (1 = least to 5 = worst), the PDF group average was 3.4 +/- 1.2. PDF subjects reported that 80% +/- 25% of dialysis treatments were followed by fatigue symptoms. In 28 (65%) of patients, the symptoms started with the first dialysis treatment. They reported needing an average of 4.8 hours of rest or sleep to overcome the fatigue symptoms (range, 0 to 24 hours). There were no significant differences between patients with and without PDF in the following parameters: age; sex; type of renal disease; presence of diabetes mellitus, heart disease (congestive, ischemic), or chronic obstructive lung disease; blood pressure response to dialysis; type or adequacy of dialysis regimen; hematocrit; electrolytes; blood urea nitrogen; creatinine; cholesterol; albumin; parathyroid hormone; ejection fraction; and use of antihistamines, benzodiazepines, and narcotics. In the fatigue group, there was significantly greater use of antihypertensive medications known to have fatigue as a side effect (P = 0.007). Depression was more common in the fatigue group by Beck Depression score (11.6 +/- 8.0 v 7.8 +/- 6.3; P = 0.02). We conclude that (1) postdialysis fatigue is a common, often incapacitating symptom in patients on chronic extracorporeal dialysis; (2) no routinely measured parameter of clinical or dialytic function appears to predict postdialysis fatigue; and (3) depression is highly associated with postdialysis fatigue, but the cause-effect relationship is unclear.
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PMID:Postdialysis fatigue. 915 12


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