Introduction
Diagnosis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is often challenging as it relies on patients’ clinical presentation. Computerized respiratory sounds ...(CRS), namely crackles and wheezes, may have the potential to contribute for the objective diagnosis/monitoring of an AECOPD.
Objectives: This study explored if CRS differ during stable and exacerbation periods in patients with COPD.
Methods
13 patients with stable COPD and 14 with AECOPD were enrolled. CRS were recorded simultaneously at trachea, anterior, lateral and posterior chest locations using seven stethoscopes. Airflow (0.4–0.6l/s) was recorded with a pneumotachograph. Breathing phases were detected using airflow signals; crackles and wheezes with validated algorithms.
Results
At trachea, anterior and lateral chest, no significant differences were found between the two groups in the number of inspiratory/expiratory crackles or inspiratory wheeze occupation rate. At posterior chest, the number of crackles (median 2.97–3.17 vs. 0.83–1.2, P < 0.001) and wheeze occupation rate (median 3.28%–3.8% vs. 1.12%–1.77%, P = 0.014–0.016) during both inspiration and expiration were significantly higher in patients with AECOPD than in stable patients. During expiration, wheeze occupation rate was also significantly higher in patients with AECOPD at trachea (median 3.12% vs. 0.79%, P < 0.001) and anterior chest (median 3.55% vs. 1.28%, P < 0.001).
Conclusion
Crackles and wheezes are more frequent in patients with AECOPD than in stable patients, particularly at posterior chest. These findings suggest that these CRS can contribute to the objective diagnosis/monitoring of AECOPD, which is especially valuable considering that they can be obtained by integrating computerized techniques with pulmonary auscultation, a noninvasive method that is a component of patients’ physical examination.
COPD is a highly incapacitating disease, particularly among older people, implying significant burden for family caregivers. Involving caregivers in comprehensive pulmonary rehabilitation programs ...might benefit their functional coping to care demands; however, there is no objective evidence to sustain such assumption. This study is a secondary analysis aiming to analyze the effects of a family-based pulmonary rehabilitation program on close family caregivers of older subjects with COPD.
This is a mixed-method study. Family caregivers were randomly assigned to family-based (experimental) or conventional (control) pulmonary rehabilitation. Caregivers from the family-based pulmonary rehabilitation (n = 20; 80.0% female; age 63.1 ± 9.5 y) attended the psychoeducational component together with their relatives. In the conventional pulmonary rehabilitation, caregivers did not participate (n = 19; 68.4% female; age 53.6 ± 11.3 y). Self-rated instruments (Family Crisis Oriented Personal Scales, Depression Anxiety and Stress Scales, and Carers' Assessment of Difficulties Index) and focus group interviews were used to assess the intervention.
Caregivers from the family-based pulmonary rehabilitation had significantly greater improvements in overall family coping (P = .01), reframing (P = .01), seeking spiritual support (P = .01), and mobilizing to acquire help (P = .02). No significant differences were found for emotional state. Significant improvements in overall burden (P = .01), reactions to caregiving (P = .01), physical demands of caring (P = .044), and poor family support (P = .038) were observed, although there were no significant between-group differences. Qualitative data sustained the benefits of involving family caregivers in pulmonary rehabilitation.
The findings provide valuable evidence to recommend the inclusion of COPD family caregivers in comprehensive pulmonary rehabilitation. Family-oriented pulmonary rehabilitation maximizes caregivers' adaptive coping and potentially prevents negative psychological outcomes; however, further research is needed.
Chronic Obstructive Pulmonary Disease (COPD) can be highly incapacitating, imposing a significant burden on family members, however, limited research has been conducted on psychological health of ...family carers. Thus, this study examined anxiety and depression symptoms in family carers of people with COPD and their predictors.
A cross-sectional study was conducted with family carers and respective patients with COPD. The caregiving situation and the perceived burden, through the Carers' Assessment of Difficulties Index, were collected from family carers. Patients' COPD severity and activities limitation were assessed. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression symptoms in family carers and patients. Scores ≥8 were considered clinically significant.
A total of 203 family carers (58.2 ± 14.8 years old; 75.4% female) and respective patients with COPD (69.2 ± 11.5 years old; 36.5% female) were included. Clinically significant anxiety symptoms (HADS-anxiety ≥8) were present in 63.5% (n = 129) of family carers, depression symptoms (HADS-depression ≥8) were in 34% (n = 69) and both were in 27.1% (n = 55). Perceived burden odds ratio (OR) 1.04, 95% confidence intervals (CI) = 1.01-1.06; 1.05, 95% CI = 1.03-1.07 and patients' activities limitation (OR 1.32, 95% CI = 1.01-1.79; 1.41, 95% CI = 1.01-1.96) were significant predictors of anxiety and depression symptoms. Anxiety symptoms were also predicted by female gender (OR 0.33, 95% CI = 0.16-0.66) and depression symptoms by older age (OR 1.03, 95% CI = 1.01-1.06).
Family carers of patients with COPD experience anxiety and depression symptoms. Perceived burden, female gender, older age, and patient's activities limitation were predictors of these distressing symptoms. These findings highlight the need to address family carers' needs, namely by investigating the effectiveness of supportive interventions on family's psychological health.
Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for families. However, information on ...the impacts of caring for relatives with COPD on carers' psychological health is limited. This study aimed to analyse the subjective burden of family carers of people with early and advanced COPD and its predictor variables.
Methods: A cross-sectional study was conducted. A structured questionnaire was used to collect socio-demographics and care-giving characteristics. Self-rated physical and mental health were measured by two items from the International Classification of Functioning, Disability and Health checklist. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Subjective burden was assessed with the Carers' Assessment of Difficulties Index (CADI). Descriptive and inferential analyses were performed.
Results: A total of 167 family carers participated: 113 were caring for people with early and 54 with advanced COPD. Both groups presented anxiety/depression symptoms. Those caring for people with advanced COPD reported higher subjective burden, more depression symptoms and poorer self-rated mental health than those caring for early COPD. Advanced COPD (coefficient 6.7), depression (coefficient 6.3), anxiety (coefficient 5.6), care-giving hours per week (coefficient 3.2) and self-rated mental health (coefficient 2.8) were significant predictors of carers' subjective burden.
Conclusion: The findings suggest that the gradual course of COPD imposes an increasing physical and emotional burden on carers, with negative impacts on their psychological health. The study highlights the relevance of early interventions in the context of COPD to prevent carers' burden.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Telemonitoring technologies are rapidly evolving, offering a promising solution for remote monitoring and timely management of asthma acute episodes. We aimed to describe current pediatric asthma ...telemonitoring technologies. A systematic review was conducted until September 2023 on Medline, Scopus, and Web of Science. We included studies of children (0-18 years) with asthma or recurrent wheezing whose respiratory condition was telemonitored outside the healthcare setting. A narrative synthesis was performed. We identified 40 telemonitoring technologies described in 40 studies. The more frequently used technologies for telemonitoring were mobile applications (n = 21) and web-based systems (n = 14). Telemonitoring duration varied between 2 weeks and 32 months. Data collection included asthma symptoms (n = 30), patient-reported outcome measures (PROMs) (n = 11), spirometry/peak flow readings (n = 20), medication adherence (n = 17), inhaler technique (n = 3), air quality (n = 2), and respiratory sounds (n = 2). Both parents and children were the technology target users in most studies (n = 23). Technology training was reported in 23 studies of which 3 provided ongoing support. Automatic feedback was found in 30 studies, mostly related with asthma control. HCP were involved in data management in 27 studies. Technologies were tested in samples from 4 to 327 children, with most studies including school-aged children and/or adolescents (n = 38) and eight including preschool children. This review provides an overview of existing technologies for the outpatient telemonitoring of pediatric asthma. Specific technologies for preschool children represent a gap in the literature that needs to be specifically addressed in future research.
IntroductionIn Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of ...disease severity, control and phenotypes remain scarce. Studies assessing the prevalence of asthma and its subgroups using accurate methods are needed. This study aims to determine the prevalence of asthma, difficult-to-treat asthma and severe asthma, and to evaluate sociodemographic and clinical characteristics of those patients, in mainland Portugal.Methods and analysisA population-based nationwide study with a multicentre stepwise approach will be conducted between 2021 and 2023 in 38 primary care centres of the Portuguese National Health Service. The stepwise approach will comprise four stages: Stage 0—telephone call invitation to adult subjects (≥18 years) randomly selected (n~15 000); stage 1—telephone screening interview assessing the participants’ respiratory symptoms (n~7500); stage 2—diagnostic visit, including physical examination, diagnostic tests (eg, spirometry, fraction of exhaled nitric oxide, blood eosinophil count) and patient-reported outcome measures for diagnostic confirmation of those identified with possible asthma at stage 1 (n~1800); stage 3—further evaluation of patients with asthma and of patients with difficult-to-treat asthma and severe asthma, after 3 months (n~460). At stage 3, data will be collected from a review of the patient’s electronic health records, a follow-up telephone call and the CARATm (Caracteristicas Auto-reportadas de Asma em Tecnologias Móveis) app database. The prevalence of asthma, difficult-to-treat asthma and severe asthma will be determined as the percentage of patients with asthma confirmed from the overall population (stage 1). For the analysis of factors associated with asthma, difficult-to-treat asthma and severe asthma, logistic regression models will be explored.Ethics and disseminationEthical approvals for the study were obtained from the ethics committee of the local health unit of Matosinhos, Porto (38/CES/JAS), Alto Minho (38/2021/CES) and the regional health administration of Lisbon-Vale do Tejo (035/CES/INV/2021). Results will be published in peer-reviewed journals.Trial registration numberNCT05169619.
Aims and objectives
To examine the coping strategies of family carers of people with early and advanced chronic obstructive pulmonary disease and how those relate to their subjective health.
...Background
Caring for a family member with chronic obstructive pulmonary disease can be a stressful experience. Understanding how carers cope with this is critical for improving outcomes. However, this topic has received little attention in the literature, particularly considering the care‐giving experience with early chronic obstructive pulmonary disease.
Design
A cross‐sectional study with a convenience sample of family carers of people with chronic obstructive pulmonary disease.
Methods
A structured questionnaire was used to collect data on socio‐demographics and care‐giving characteristics. Self‐rated physical and mental health was measured by two items from the International Classification of Functioning, Disability and Health checklist. Coping strategies were assessed with the Carers' Assessment of Managing Index. Descriptive and inferential analyses were performed.
Results
A total of 158 family carers participated: 109 caring for people with early and 49 with advanced chronic obstructive pulmonary disease. The two groups differed significantly on self‐rated mental health and on problem‐solving, emotional‐cognitive and managing stress coping type. Significant correlations between self‐rated physical health and problem‐solving coping and between self‐rated mental health and emotion‐cognitive and managing stress coping were found for carers of patients with advanced chronic obstructive pulmonary disease.
Conclusions
This study provides a unique insight into family carer coping strategies at different stages of chronic obstructive pulmonary disease. Carers of people with early and advanced chronic obstructive pulmonary disease cope differently with their caring demands. Nevertheless, problem‐focused coping strategies were perceived as the most helpful by both groups.
Relevance to clinical practice
The findings are relevant to informing early supportive interventions aiming to prevent burden and promote healthy adjustment to care‐giving demands within the specific context of chronic obstructive pulmonary disease.
Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off ...values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR.
A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values.
Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV
1
49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT (p > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD.
The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions.
Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for family carers. However, knowledge regarding the ...specific issues faced by men in the COPD caregiving role is nonexistent. This study explored the experience of husbands and sons providing care to a family member with moderate‐to‐severe COPD. A cross‐sectional qualitative study using in‐depth, semi‐structured individual interviews was conducted with twelve men carers: seven husbands with a mean age of 70.9 ± 8.8 years and five sons with a mean age of 43.4 ± 10.5 years. The interviews were analysed for recurrent themes using thematic analysis. Main findings suggest that men are committed and dedicated carers; however, differences between husbands and sons related to ‘meaning’, ‘challenges and constraints’, ‘fears and concerns about the future’, ‘needs’ and ‘positive aspects’ have emerged. These differences reflect relationship and generational differences and are of relevance when planning adequate community support interventions.
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