Printer Friendly

Improved health-related quality of life after lung volume reduction surgery and pulmonary rehabilitation.

INTRODUCTION AND PURPOSE

Chronic obstructive pulmonary disease chronic obstructive pulmonary disease
n. Abbr. COPD
A chronic lung disease, such as asthma or emphysema, in which breathing becomes slowed or forced.
 (COPD COPD chronic obstructive pulmonary disease.

COPD
abbr.
chronic obstructive pulmonary disease


Chronic obstructive pulmonary disease (COPD) 
) is the fourth leading cause of death in the United States, and it is estimated that it will be the third leading cause of mortality in the United States by 2020. (1) It is the only leading cause of death with a rising prevalence, accounting for more than 130,000 deaths annually. (2) Emphysema emphysema (ĕmfĭsē`mə), pathological or physiological enlargement or overdistention of the air sacs of the lungs. A major cause of pulmonary insufficiency in chronic cigarette smokers, emphysema is a progressive disease that commonly  is a progressive form of COPD with significant physical and psychological sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention .

While a variety of treatments improve the symptoms and quality of life in people with COPD, such as bronchodilators, corticosteroids, and pulmonary rehabilitation, these interventions remain supportive and have not impacted survival in people with end-stage emphysema. (3-5) Long-term oxygen therapy (> 15 hours/day) (6) and smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective.  (7) have been the only therapies shown to improve survival in advanced emphysema. (5) Lung volume reduction surgery (LVRS LVRS Lung Volume Reduction Surgery
LVRS Lightweight Video Reconnaissance System
) is one of a long lineage of surgical approaches to emphysema and was reintroduced by Cooper in the early 1990s. (8) The National Emphysema Treatment Trial (NETT) (9) demonstrated that LVRS improves survival in a select group of patients with emphysema and this was the first time a new treatment impacted survival since the publication of the supplemental oxygen trials almost 30 years ago. (6,10)

In addition to improving survival, LVRS improves lung function, dyspnea dyspnea /dysp·nea/ (disp-ne´ah) labored or difficult breathing.dyspne´ic

paroxysmal nocturnal dyspnea
, and exercise tolerance in selected patients with advanced pulmonary emphysema pulmonary emphysema
n.
See emphysema.
. (8,9,11-14) Some investigators argue that symptom relief, dyspnea reduction, improvements in exercise tolerance, and quality of life may be more important to patients than survival when considering LVRS as a treatment option. (15) Although data on patients with emphysema are limited, increasing evidence suggests that health-related quality of life (HRQOL HRQOL Health-Related Quality of Life ) deteriorates with advanced disease and is related to the degree of airflow obstruction and level of dyspnea. (16) Pulmonary rehabilitation is an integral part of the recovery from LVRS and is recommended as a component of care in current practice guidelines practice guidelines Medical practice A set of recommendations for Pt management that identifies a specific or range of range of management strategies. See Peer review organization, Practice standards. Cf 'Cookbook' medicine.  because of the resultant improvement in conditioning and quality of life. (4,5,17)

Both general and disease-specific quality of life measures have been developed and used in COPD clinical studies such as the quality-of-well-being scale (QWB-SA), (18) the medical outcomes study 36-item short form (MOS (1) (Metal Oxide Semiconductor) See MOSFET.

(2) (Mean Opinion Score) The quality of a digitized voice line. It is a subjective measurement that is derived entirely by people listening to the calls and scoring the results from
 SF-36), (19,20) the St. George's Respiratory Questionnaire (SGRQ SGRQ St George's Respiratory Questionnaire ), (21) and the University of California, San Diego UCSD is consistently ranked among the top ten public universities for undergraduate education in the United States by U.S. News & World Report.[3] It is a Public Ivy. [1] For graduate studies, most of UCSD's Ph.D. , shortness-of-breath questionnaire (SOBQ SOBQ Signal Officer Branch Qualification (US Army) ). (22) The MOS SF-36 is the instrument used in this study and is a general quality-of-life questionnaire that measures both physical and mental health concepts as seen from the respondent's point of view. (19,23) There are few studies that have reported on the effects of LVRS on quality of life as measured with the MOS SF-36. Some have reported improvement in aspects of quality of life with the MOS SF-36 after LVRS for up to 3 months (significant improvements in the scales of physical functioning, social functioning social functioning,
n the ability of the individual to interact in the normal or usual way in society; can be used as a measure of quality of care.
, general health, and vitality), (8) 6 months (significant improvements in the scales of physical functioning, physical role limitations, general health, vitality, and a mean change in Physical Component Summary measure [PCS (1) (Personal Communications Services) Refers to wireless services that emerged after the U.S. government auctioned commercial licenses in 1994 and 1995. This radio spectrum in the 1. ]), (14,24,25) and only a small number of patients have been followed for longer periods (significant improvements in median score after 1 year; in scales of physical functioning, social functioning, and vitality after 2 years; and in the PCS measure after 5 years). (12,13,26,27) Although studies of HRQOL after LVRS have been published, the unique feature of this study is the long-term follow-up of patients after LVRS and intensive pulmonary rehabilitation on both the Physical Component Summary (PCS) and the Mental Component Summary (MCS) in order to illustrate the nature of improvement in HRQOL.

The main purpose of this study was to report on the efficacy of LVRS followed by a 2-week (10 daily sessions) intensive pulmonary rehabilitation program on HRQOL over time with 18 months of follow-up. This research considered the roles of age and gender on HRQOL as important secondary outcomes. From a public health perspective, the investigation of age and gender is timely, because in 2000, the number of women dying of COPD surpassed the number of men. (1)

METHODS

Subjects

The subjects for this study were 49 patients with emphysema who had undergone LVRS and participated in pulmonary rehabilitation after LVRS in a single center clinical trial at Chapman Medical Center (Orange, CA). Subjects in this study were not enrolled in the National Emphysema Treatment Trial. There were 31 men and 18 women in the population analyzed with an age range of 51 to 84 years old. The mean age of the patients was 66.0 [+ or -] 6.7 years.

Surgical Procedure

Bilateral staple LVRS by video-assisted thoracic surgery Video-assisted thoracic surgery (VATS)
A technique used to aid in the placement of chest tubes or when performing decortications when treating advanced empyema.
 (VATS) was performed by one or both of two thoracic surgeons on the same surgical team. To qualify for surgery, the pattern of the patient's emphysema on computerized tomography (CT) had to be severe and heterogeneous. Radionuclide radionuclide /ra·dio·nu·clide/ (-noo´klid) a nuclide that disintegrates with the emission of corpuscular or electromagnetic radiations.

ra·di·o·nu·clide
n.
 lung perfusion scans were also used to confirm the heterogeneous pattern of emphysema. Exclusion criteria exclusion criteria AIDS Donor exclusion criteria, see there  for surgery included current cigarette smoking, severe cardiac disease (congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , significant coronary or valvular valvular /val·vu·lar/ (val´vu-ler) pertaining to, affecting, or of the nature of a valve.

val·vu·lar
adj.
Relating to, having, or operating by means of valves or valvelike parts.
 disease), history of cancer within the last 5 years, ventilator dependency, or prior thoracic surgery Thoracic Surgery Definition

Thoracic surgery is the repair of organs located in the thorax, or chest. The thoracic cavity lies between the neck and the diaphragm, and contains the heart and lungs (cardiopulmonary system), the esophagus, trachea, pleura,
.

Rehabilitation

No patients received preoperative pre·op·er·a·tive
adj.
Preceding a surgical operation.



preoperative

preceding an operation.


preoperative care
the preparation of a patient before operation.
 pulmonary rehabilitation at Chapman Medical Center prior to LVRS. The mean length of hospital stay post-LVRS was 8.8 [+ or -] 5.6 days. All patients underwent a similar regimen of intensive 2-week (10 daily sessions) outpatient pulmonary rehabilitation 4 hours/day for 5 days/week at Chapman Medical Center beginning the day following hospital discharge. In accordance with evidence-based guidelines, (4,17) the rehabilitation included a multidisciplinary approach with dietary, nursing, nutritional, physical therapy, psychosocial, occupational, and respiratory therapy respiratory therapy

Medical profession concerned with assisting the respiratory function of individuals who have severe lung disorders. Practices include suctioning to clear secretions from the airway, use of aerosol mists (sometimes medicated) or gases to ease breathing,
. The pulmonary rehabilitation program included patient education, physical exercise (ambulation am·bu·late  
intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates
To walk from place to place; move about.



[Latin ambul
, strengthening, and stretching), self-monitoring, breathing retraining, and airway clearance instruction. The attendance rate was 100%. No home exercise program was given during the rehabilitation phase.

Instrument

The Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36) was the chosen instrument because it is comprehensive in both its representation of multidimensional health concepts and its measurement of a wide range of health states. It is a 36-item general measure, as opposed to one that targets a certain disease, age, or treatment group. It has been shown to be a valid and reliable instrument to measure health-related quality of life (HRQOL) in patients with COPD. (28,29) The survey was used to assess subjects' perceived levels of function during the 4 weeks prior to the administration of each survey. The MOS SF-36 has nine separate scales including the following: (1) physical functioning, (2) social functioning, (3) role limitations (physical), (4) role limitations (emotional), (5) emotional well-being, (6) energy/fatigue, (7) pain, (8) general health perceptions, and (9) current general health perceptions compared to 1 year ago. (19,23) Data from the ninth scale were excluded from data analyses because they are typically not reported. The sensitivity of measurement for each concept is achieved by a short multi-item scale which is scored using the Likert method of summated ratings. (19,23) All 8 scales are used to calculate the 2 component summary measures. (20) The physical component summary (PCS) measure represents the four physical health scales (ie, physical functioning, role physical, bodily pain, and general health perceptions), while the mental component summary (MCS) measure reflects the 4 mental health scales (ie, mental health, role emotional, vitality, and social functioning). The two summary scores are standardized so that the general population mean score is 50 points with a standard deviation of 10 points for each summary score. The two summary scores were used in this study. These component scores have been demonstrated to explain 70% to 80% of the variance in the individual domain scores, however, the component scores may not have as good a sensitivity for detecting change as the individual domain scores. (30) Higher scores indicate better health status. A clinically relevant change or the "minimally important difference" (MID) of the SF-36 is reported to be 5 units on each summary score, although this has not been replicated in patients with COPD. (31)

Procedures

All patients provided written informed consent, and the study was approved by the Institutional Review Board at Chapman Medical Center. The MOS SF-36 was administered at the preoperative evaluation and the opportunity to ask any questions was given. The MOS SF-36 surveys were requested from subjects postoperatively at the following time periods: 3 months, 6 months, 12 months, and 18 months. A pre-LVRS survey for each patient served as the baseline for comparison with the post-LVRS data of that patient. The survey was scored according to the protocol established by the MOS SF-36 scoring manual. (20,31) The scores were transformed into a scale ranging from 0 to 100, with 0 denoting poor health. (20,31)

Data Analysis

All data analyses were performed using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance.  16.0 for Windows (SPSS Inc. Chicago, Il). A research design of group X time with stratification for age and gender was used. Groups with nonsignificant non·sig·nif·i·cant  
adj.
1. Not significant.

2. Having, producing, or being a value obtained from a statistical test that lies within the limits for being of random occurrence.
 differences for time were compressed when stratifying for age and gender. Patients were divided into 2 age groups: younger than 65 years (n=23) and 65 years and older (n=26). (32) Data were compressed into the following times: 3 months post-LVRS through 6 months post-LVRS (Time 2) and 12 through 18 months post-LVRS (Time 3) for comparison with pre-LVRS baseline data (Time 1). A repeated measures multivariate analysis of variance (MANOVA MANOVA Multivariate Analysis of the Variance , Wilk's criterion) was performed to examine the effects of time on component summary measures in all subjects and in groups stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers.

strat·i·fied
adj.
Arranged in the form of layers or strata.
 by age and gender. Post-hoc analysis of significant data was determined with the Scheffe's Comparison. Alpha was set at P < .05.

RESULTS

The effect of time was analyzed on both the PCS and MCS measures in all subjects and in groups stratified by age and gender. There was a main effect for time on both the PCS and MCS measures in all subjects. There were significant increases in the mean scores for both Physical and Mental Component Summary measures (PCS and MCS, respectively) at Times 2 and 3 compared to Time 1, P < .05 (Table 1). Analysis between Time 2 and Time 3 failed to reveal significant increases in component summary measures.

There was a main effect for time on MCS when groups were stratified by age. There was a significant improvement for patients younger than 65 years old compared to those 65 years and older at Time 3 on the MCS, P < .05 (Table 2). The interaction for time with age was significant on the MCS, P < .05 (Figure 1). Older subjects had higher mean MCS measures than younger patients preoperatively, but lower measures postoperatively at both Times 2 and 3.

[FIGURE 1 OMITTED]

There was a main effect for time on PCS when groups were stratified by gender. There were significant improvements for women compared to men at Time 3 on the PCS, P < .05 (Table 3). A significant time-gender interaction occurred on the PCS, P < .05 (Figure 2). Men had higher mean PCS measures than women preoperatively, but lower PCS measures postoperatively at both Times 2 and 3.

[FIGURE 2 OMITTED]

DISCUSSION

There are few published studies that have evaluated either the HRQOL for patients with severe emphysema or the impact of interventions on HRQOL measures. This study has shown that LVRS and pulmonary rehabilitation can significantly improve health-related quality of life (HRQOL) in people with emphysema. Lung volume reduction surgery is able to improve HRQOL by improving lung function (forced expiratory ex·pi·ra·to·ry
adj.
Of, relating to, or involving the expiration of air from the lungs.



expiratory

relating to or employed in the expiration of air from the lungs.
 volume in the first second and/or lung volumes lung volumes Physiology A group of air 'compartments' into which the lung may be functionally divided

Lung volumes  


Expiratory reserve capacity–ERV The maximum volume of air that can be voluntarily exhaled

), dyspnea, and exercise tolerance in selected patients with advanced pulmonary emphysema. (8,9,11-14) Pulmonary rehabilitation is able to improve HRQOL by improving dyspnea, (33-35) exercise tolerance, (11,14,36) education, and coping strategies while having no effect on pulmonary physiology or function or improved survival in patients with COPD. (4) Pulmonary rehabilitation improves physical deconditioning physical deconditioning Medtalk The deterioration of heart and skeletal muscle, related to a sedentary lifestyle, debilitating disease, or prolonged bed rest Clinical ↓ lean body mass, maximum O2 , peripheral muscle abnormalities, improper pacing during exercise, and fear of dyspnea-producing activities which contribute to the systemic effects of COPD and much of its morbidity. (17,37) The NETT established that pulmonary rehabilitation is essential for patients after LVRS. (38-40) The combination of LVRS and pulmonary rehabilitation provides the greatest benefit for selected patients with severe emphysema, well above the effects of either intervention alone. (24)

Prior to LVRS and rehabilitation, the HRQOL of this study's subjects, as reflected by the Physical Component Summary measure, was profoundly impaired. Preoperatively, the SF-36 mean PCS measure was 25.3 [+ or -] 6.2, which is below both the general U.S. population norms (50 [+ or -] 10) (31) and norms for people with severe emphysema (28.3 + 7.4). (41) Lower levels of PCS in patients with lung disease lung disease Pulmonary disease Pulmonology Any condition causing or indicating impaired lung function Types of LD Obstructive lung disease–↓ in air flow caused by a narrowing or blockage of airways–eg, asthma, emphysema, chronic bronchitis;  predict higher mortality. (42) According to these data there is a significant self-reported improvement in the PCS measure from baseline to Times 2 and 3 on the MOS SF-36 following LVRS and rehabilitation (25.3 [+ or -] 6.2, 34.8 [+ or -] 10.7, and 32.7 [+ or -] 11.7, respectively). The improvement in the PCS measure was similar in studies with LVRS. Yusen et al (27) reported means of 26, 40, 35, and 31 on the PCS at baseline, 6 months, 3 years, and 5 years post-LVRS, respectively. There is strong scientific evidence that pulmonary rehabilitation improves HRQOL in patients with COPD, too. (4) Ten weeks of pulmonary rehabilitation, prior to LVRS, improved the PCS measure by a mean change of 2.2 [+ or -] 6.8 as reported by the NETT. (41)

Preoperatively, the impairments were less pronounced with respect to the Mental Component Summary measure (46.0 [+ or -] 13.2) compared to the U.S. population norms (50 [+ or -] 10) and norms for people with severe emphysema (50 [+ or -] 15). (43) Subjects significantly improved their MCS measure from baseline to both Times 2 and 3 (46 [+ or -] 13.2, 53.8 [+ or -] 10.2, and 52.8 [+ or -] 9.8, respectively). Significant improvements in MCS are corroborated by other researchers who reported similar improvements after LVRS and pulmonary rehabilitation, however, those data are reported differently than data from this study such as scales of mental health, median values, or quality adjusted values and therefore direct comparison with the MCS measure from this study is not possible. The MCS measure is most correlated with the mental health, role-emotional, and social functioning scales from the SF-36. (31) There was a significant mean 2.1 improvement after rehabilitation in the MCS after pulmonary rehabilitation in the NETT. (41)

Advancing age is a strong predictor of mortality in people with emphysema. (44) Patients younger than 65 years old showed significantly improved scores on the MCS at Time 3 compared to subjects 65 years and older (55.9 [+ or -] 6.6 and 50.0 [+ or -] 11.3, respectively). Anxiety and depression often accompany COPD and approximately 45% of patients with moderate-to-severe COPD have depressive symptoms. (45) Furthermore, depression may increase the sensation of breathlessness. (46,47) While the data suggest similar gains until 18 months post-LVRS and rehabilitation between the 2 age groups, the results indicate greater focus should be given to the emotional needs of our older patients.

There are gender differences in the natural history of emphysema. Women were significantly more improved than men at Time 3 on the PCS. Hamacher et al (26) did not find any significant differences between the MOS SF-36 responses of 39 men and women 24 months following LVRS. The Nurse's Health Study reports that women whose general mental health (as determined by the MCS measure) was initially poor and had improved over 4 years did not experience a higher mortality than did those whose health remained consistently good over the same time period. (48) What these data suggest is that even after declines in health, women can improve HRQOL later in life, and that improvement may help to delay mortality.

It has been suggested that disease-specific measures are significantly more responsive to clinical change compared to general measures of HRQOL. (49) Evidence from this study indicates that the MOS SF-36, a general measure of HRQOL, was able to detect significant clinical change following LVRS and rehabilitation. General measures have some advantage because comparisons can be made with other benchmarks. For example, the impact of COPD can be compared with the impact of other chronic diseases. Subjects at baseline in this study were comparable to patients with lumbar stenosis (PCS=26.6). (50) Their HQOL was lower than patients with cancer (PCS=38.4). (51) These comparisons cannot be made with disease-specific measures.

The question has been raised as to what portion of the measured benefits is attributable to the operation per se and what portion is attributable to the ongoing rehabilitation. Miller et al (14) compared the efficacy of LVRS and medical treatment (including pulmonary rehabilitation and pharmacologic therapy) and showed that the LVRS group had a significantly better outcome on the PCS of the SF-36 than the medically treated group after 6 months, whereas the MCS was not significantly different between the 2 groups. Although surgeons attempt to restore improvements in lung function through LVRS, the affective issues concerning this disease cannot be dealt directly with surgery. Patients with emphysema experience their disease differently from each other both physically and affectively. These differences, which may limit function, must be addressed independently with each patient. (19,23,52) It is critical for optimal treatment that all health professionals, including physical therapists, take into account differences among disability, subjective evaluations of personal health, and general well-being. (23,53)

These results seem to indicate an increased ability to perform activities of daily living post-LVRS. According to self-report on the MOS SF-36, patients after surgery and rehabilitation are better able to perform vigorous activities such as lifting heavy objects and moderate activities such as pushing a vacuum or playing golf. Patients also report improvements in carrying groceries, ascending stairs, bending down, walking farther distances, and bathing themselves.

Research is needed to define the exact contributions of pulmonary rehabilitation in other forms of lung disease and for other pulmonary interventions. There is strong scientific evidence that postoperative pulmonary rehabilitation allows the maximum benefit to be realized from LVRS. Work needs to determine the mechanism that improves survival with LVRS to enhance these treatment effects and produce even more potent and durable responses to therapy. Further work is needed to compare other HRQOL measures, develop standardized methods for assessing the minimally important difference for this population, and to translate the measures' scores into clinically meaningful results.

CONCLUSIONS

Lung volume reduction surgery and 2 weeks (10 daily sessions) of intensive pulmonary rehabilitation appears to improve quality of life in patients with emphysema up to at least 18 months postsurgery. According to the responses extracted from the MOS SF-36, the physical and mental limitations associated with emphysema are not as great after surgery and rehabilitation. More research is needed to assess the long-term effects beyond 18 months.

REFERENCES

(1.) Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance-United States, 1971-2000. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg,  Surveill Summ. 2002;51(6):1-16.

(2.) Kung H-C, Huyert D, Xu J, Murphy S. Deaths: Final data for 2005. National Vital Statistics Reports. 2008;56(10):1-121.

(3.) Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and use of an inhaled anticholinergic bronchodilator bronchodilator /bron·cho·di·la·tor/ (-di´la-ter)
1. expanding the lumina of the air passages of the lungs.

2. an agent which causes dilatation of the bronchi.
 on the rate of decline of FEV FEV forced expiratory volume.

FEV
abbr.
forced expiratory volume



FEV

forced expiratory volume.
1. The Lung Health Study. JAMA. 1994;272:1496-1505.

(4.) Ries AL, Bauldoff GS, Carlin car·line or car·lin  
n. Scots
A woman, especially an old one.



[Middle English kerling, from Old Norse, from karl, man.]
 BW, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology. : update. Chest. 2007;131(5 Suppl):4S-42S.

(5.) Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD executive summary. Am J Crit Care Med. 2007;176:532-555.

(6.) Report of the Medical Research Council Working Party. Long term domicilliary oxygen therapy in chronic hypoxic hypoxic

a state of hypoxia.


hypoxic cell sensitizers
compounds that selectively sensitize hypoxic tumor cells to the effects of radiation.
 cor pulmonale complicating chronic bronchitis and emphysema. Lancet. 1981;1:681-686.

(7.) Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE. Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial randomized clinical trial,
n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies.
. Ann Intern Med. 2005;142:233-239.

(8.) Cooper JD, Trulock EP, Triantafillou AN, et al. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg. 1995;109:106-116.

(9.) National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348:2059-2073.

(10.) Nocturnal Oxygen Therapy Trial Group. Continuous or noctural oxygen therapy in hypoxemic chronic obstructive lung disease Chronic Obstructive Lung Disease Definition

Chronic obstructive lung disease, also known as chronic obstructive pulmonary disease (COPD), is a general term for a group of conditions in which there is persistent difficulty in expelling (or exhaling) air
: a clinical trial. Ann Intern Med. 1980;93:391-398.

(11.) Pompeo E, Marino M, Nofroni I, Matteucci G, Mineo TC. Reduction pneumoplasty versus respiratory rehabilitation in severe emphysema: a randomized study. Ann Thorac Surg. 2000;70:948-954.

(12.) Geddes D, Davies M, Koyama H, et al. Effect of lung-volume-reduction surgery in patients with severe emphysema. N Engl J Med. 2000;343:239-245.

(13.) Miller JD, Malthaner RA, Goldsmith CH, et al. A randomized clinical trial of lung volume reduction surgery versus medical care for patients with advanced emphysema: a two-year study from Canada. Ann Thorac Surg. 2006;81(1):314-321.

(14.) Miller JD, Berger RL, Malthaner RA, et al. Lung volume reduction surgery vs medical treatment for patients with advanced emphysema. Chest. 2005;127:1166-1177.

(15.) Criner GJ, Sternberg AL. A clinician's guide to the use of lung volume reduction surgery. Proc Am Thorac Soc. 2008;5:461-467.

(16.) Gonzales E, Herrejon A, Incahurraga I, Blanquer R. Determinants of health-related quality of life in patients with pulmonary emphysema. Respir Med. 2005;99:638-644.

(17.) Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Thoracic Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390-1413.

(18.) Kaplan RM, Sieber WJ, Ganiats TG. The quality of well-being scale: comparison of the interviewer-administered version with a self-administered questionnaire. Pschol Health. 1997;12:783-791.

(19.) Ware JE, Jr, Sherbourne CD. The MOS 36-item Short-form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483.

(20.) Ware JE, Jr, Kosinski M, Keller SD. SF36 Physical and Mental Health Summary Scales: A User's Manual. Boston, MA: The Health Institute, New England Medical Center; 1994.

(21.) Jones PW, Quirk FH, Baveystock CM. The St George's respiratory questionnaire. Respir Med. 1991;85 (suppl):25-31.

(22.) Eakin EG, Resnikoff PM, Prewitt LM, Ries AL, Kaplan RM. Validation of a new dyspnea measure: the UCSD UCSD University of California, San Diego (La Jolla, California)
UCSD User Centered System Design
UCSD Urbana-Champaign Sanitary District (Illinois)
UCSD Ultra Cool Sexy Dudes
 Shortness of Breath questionnaire. Chest. 1998;113:619-624.

(23.) McHorney CA, Ware JE, Jr, Raczek AE. The MOS-36 item short-form health survey (SF-36): II. Psychometric psy·cho·met·rics  
n. (used with a sing. verb)
The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and
 and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247-263.

(24.) Moy ML, Ingenito EP, Mentzer SJ, Evans RB, Reilly JJ, Jr. Health-related quality of life improves following pulmonary rehabilitation and lung volume reduction surgery. Chest. 1999;115(2):383-389.

(25.) Kozora E, Emery CF, Ellison MC, Wamboldt FS, Diaz PT, Make B. Improved neurobehavioral functioning in emphysema patients following lung volume reduction surgery compared with medical therapy. Chest. 2005;128:2653-2663.

(26.) Hamacher J, Buchi S, Georgescu CL, et al. Improved quality of life after lung volume reduction surgery. Eur Respir J. 2002;19:54-60.

(27.) Yusen RD, Lefrak SS, Gierada DS, et al. A prospective evaluation of lung volume reduction surgery in 200 consecutive patients. Chest. 2003;123:1026-1037.

(28.) Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. JAMA. 1989;262:907-913.

(29.) Mahler DA, Mackowiak JI. Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD. Chest. 1995;107:1585-1589.

(30.) Curtis JR, Patrick DL. The assessment of health status among patients with COPD. Eur Respir J. 2003;21:36S-45S.

(31.) Ware JE, Jr, Snow K, Kosinski M, Gandek B. SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Center; 1993.

(32.) Lewis CA, Bottomley J. Geriatric Rehabilitation: A Clinical Approach. 3rd ed. Saddle River, NJ: Prentice Hall; 2007.

(33.) Lacasse Y, Wong E, Guyatt GH, King D, Cook DJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet. 1996;348:1115-1119.

(34.) Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Syst Rev 3: CD003793; 2002.

(35.) Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932-946.

(36.) Criner GJ, Cordova Cordova, Spain: see Córdoba.  FC, Furukawa S, et al. Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160:2018-2027.

(37.) American Thoracic Society/European Respiratory Society. Skeletal muscle dysfunction in chronic obstructive pulmonary disease: a statement of the American Thoracic Society and European Respiratory Society. Am J Crit Care Med. 1999;159(pt 2):S1-S40.

(38.) Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. The national emphysema treatment trial research group. N Engl J Med. 2003;348:2059-2073.

(39.) National Emphysema Treatment Trial Research Group. Rationale and design of the National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. Chest. 1999;116:1750-1761.

(40.) National Emphysema Treatment Trial Research Group. Rationale and design of the National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. J Cardiopulm Rehabil. 2000;20:24-36.

(41.) Kaplan RM, Ries AL, Reilly J, Mohsenifar Z. Measurement of health-related quality of life in the National Emphysema Treatment Trial. Chest. 2004;126:781-789.

(42.) Sprenkle MD, Newoehner DE, Nelson DB, Nichol KL. The Veterans Short Form 36 quesionnaire is predictive of mortality and health-care utilization in a population of veterans with a self-reported diangosis of asthma or COPD. Chest. 2004;126:81-89.

(43.) Stahl E, Lindberg A, Jansson S-A, et al. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes. 2005;3:56.

(44.) Martinez FJ, Foster G, Curtis JL, et al. Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med. 2006;173:1326-1334.

(45.) Mills TL. Comorbid depressive symptomatology symptomatology /symp·to·ma·tol·o·gy/ (simp?to-mah-tol´ah-je)
1. the branch of medicine dealing with symptoms.

2. the combined symptoms of a disease.


symp·to·ma·tol·o·gy
n.
: isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults. Soc Sci Med. 2001;53:569-578.

(46.) Di Marco F, Verga M, Reggente M, et al. Anxiety and depression in COPD patients: the roles of gender and disease severity. Respir Med. 2006;100:1767-1774.

(47.) Neuman A, Gunnbjornsdottir M, Tunsater A, et al. Dyspnea in relation to symptoms of anxiety and depression: a prospective population study. Respir Med. 2006;100:1843-1849.

(48.) Kroenke CH, Kubzansky LD, Adler N, Kawachi I. Prospective change in health-related quality of life and subsequent mortality among middle-aged and older women. Am J Public Health. 2008;98:2085-2091.

(49.) Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol. 1999;52:187-192.

(50.) Fanuele JC, Birkmeyer NJO NJO New Jedi Order
NJO New Jersey Online
, Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients. Have we underestimated the effect? Spine. 1999;25:1509-1514.

(51.) Anderson JP, Kaplan RM, Coons SJ, Schneiderman IJ. Comparison of the Quality of Well-Being Scale and the SF-36 results among two samples of ill adults: AIDS and other illnesses. J Clin Epidemiol. 1998;9:755-762.

(52.) Hynninen KM, Breitve MH, Wiborg AB, Pallesen S, Nordhus IH. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res. 2005;59:429-443.

(53.) Agusti A. COPD as a systemic disease. COPD. 2008;5(2):133-138.

Janna Beling, PT, PhD

Professor, California State University, Northridge CSUN offers a variety of programs leading to bachelor's degrees in 61 fields and master's degrees in 42 fields. The university has over 150,000 alumni. It's also home to a summer musical theater/theater program known as TADW (TeenAge Drama Workshop) that leads teenagers through an , Department of Physical Therapy, Northridge, CA

Address correspondence to: Janna Beling, California State University, Northridge, Department of Physical Therapy, 18111 Nordhoff Street, Northridge CA 91330-8411 Ph: 818-677-7445, Fax: 818-677-7411 (Janna.beling@csun.edu).
Table 1. PCS * and MCS ([dagger]) Summary Mean Scores (n=49)

                   Mean       [+ or -]   Range of
      Variable     Score         SD       Scores

PCs
       Time 1       25.3        6.2      10.0-42.9
       Time 2       34.8        10.7     14.7-57.2
                 ([dagger])
       Time 3       32.7        11.7     11.5-57.0
                 ([dagger])
                 ([dagger])
MCS
       Time 1       46.0        13.2     19.2-70.9
       Time 2       53.8        10.2     21.7-69.8
       Time 3       52.8        9.8      29.3-66.5

* Physical Component Summary
([dagger]) Mental Component Summary
([double dagger]) Significantly improved from Time 1, P < .05

Table 2. Means and Standard Deviations of Scores
by Subsets of Gender and Age over Time on the
MCS Measure of the MOS

SF-36

                     Pre-Surgery           3-6 Months
Groups                  Time 1            post-LVRS/PR

< 65 yrs (n=23)   45.9 [+ or -] 14.1   54.4 [+ or -] 10.3
[greater than     46.0 [+ or -] 12.6   53.3 [+ or -] 10.2
  or equal to]
  65 yrs (n=26)
Male (n=31)       45.0 [+ or -] 14.4   51.9 [+ or -] 11.6
Female (n=18)     47.6 [+ or -] 10.9   57.2 [+ or -] 6.0

                     12-18 Months
Groups               post-LVRS/PR

< 65 yrs (n=23)   55.9 [+ or -] 6.6 *
[greater than     50.0 [+ or -] 11.3
  or equal to]
  65 yrs (n=26)
Male (n=31)       51.2 [+ or -] 10.4
Female (n=18)     55.4 [+ or -] 8.2

NOTE. MCS = Mental Component Summary; LVRS = lung volume
reduction surgery; PR-pulmonary rehabilitation.

* Subjects < 65 yrs significantly greater than subjects
65 yrs and older, P<.05

Table 3. Means and Standard Deviations of Scores by
Subsets of Gender and Age over Time on the PCS Measure
of the MOS
SF-36

                     Pre-Surgery          3-6 Months
Groups                 Time 1            post-LVRS/PR

< 65 yrs (n=23)   24.8 [+ or -] 5.8   36.4 [+ or -] 11.5
> 65 yrs (n=26)   25.8 [+ or -] 6.6   33.2 [+ or -] 9.9
Male (n=31)       26.4 [+ or -] 6.3   33.5 [+ or -] 9.6
Female (n=18)     23.5 [+ or -] 5.7   36.8 [+ or -] 12.4

                    12-18 Months
Groups              post-LVRS/PR

< 65 yrs (n=23)   34.8 [+ or -] 12.8
> 65 yrs (n=26)   30.9 [+ or -] 10.6
Male (n=31)       30.2 [+ or -] 9.8
Female (n=18)     37.1 [+ or -] 13.6 *

NOTE. PCS=Physical Component Summary; LVRS=lung volume
reduction surgery; PR-pulmonary rehabilitation.

* Women significantly greater than men, P<.05
COPYRIGHT 2009 Cardiovascular & Pulmonary Section, APTA
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Author:Beling, Janna
Publication:Cardiopulmonary Physical Therapy Journal
Article Type:Clinical report
Geographic Code:1USA
Date:Sep 1, 2009
Words:5068
Previous Article:Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence.
Next Article:Regression analysis for prediction: understanding the process.
Topics:


Related Articles
Lack of relationship between functional and perceived Quality of life outcomes following pulmonary rehabilitation.
Research corner: outcome measures in cardiopulmonary physical therapy: focus on the Glittre ADL-test for people with chronic obstructive pulmonary...
Chest: Are Patients with COPD More Active after Pulmonary Rehabilitation?
Outcomes in cardiopulmonary physical therapy: sickness impact profile.
COPD is a highly preventable and treatable disease, the latter often being forgotten.
The non-pharmacological management of COPD is a neglected area in the treatment of respiratory diseases.
Lung volume reduction surgery and pulmonary rehabilitation improve exercise capacity and reduce dyspnea during functional activities in people with...
Multivariate models of determinants of health-related quality of life in severe chronic obstructive pulmonary disease.

Terms of use | Copyright © 2014 Farlex, Inc. | Feedback | For webmasters