June 4, 2013

The effectiveness of a structured education pulmonary rehabilitation programme for improving the health status of people with moderate and severe COPD in primary care


Thorax doi:10.1136/thoraxjnl-2012-203103
  • Chronic obstructive pulmonary disease
  • Original Article

The effectiveness of a structured education pulmonary rehabilitation programme for improving the health status of people with moderate and severe chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial

Open Access
+Author Affiliations
  1. 1School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
  2. 2HRB Clinical Research Facility and School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
  3. 3School of Business & Economics, National University of Ireland, Galway, Ireland
  4. 4Statistics Mathematic and Statistics Department, University of Canterbury, Christchurch, New Zealand
  5. 5Department of General Practice, National University of Ireland, Galway, Ireland
  1. Correspondence toDr Dympna Casey, School of Nursing & Midwifery, National University of Ireland, Galway, Ireland; dympna.casey@nuigalway.ie
  • Received 11 December 2012
  • Revised 4 April 2013
  • Accepted 11 April 2013
  • Published Online First 4 June 2013

Abstract

Objective To evaluate the effectiveness of a structured education pulmonary rehabilitation programme on the health status of people with chronic obstructive pulmonary disease (COPD).
Design Two-arm, cluster randomised controlled trial.
Setting 32 general practices in the Republic of Ireland.
Participants 350 participants with a diagnosis of moderate or severe COPD.
Intervention Experimental group received a structured education pulmonary rehabilitation programme, delivered by the practice nurse and physiotherapist. Control group received usual care.
Main outcome measure Health status as measured by the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12–14 weeks postcompletion of the programme.
Results Participants allocated to the intervention group had statistically significant higher mean change total CRQ scores (adjusted mean difference (MD) 1.11, 95% CI 0.35 to 1.87). However, the CI does not exclude a smaller difference than the one that was prespecified as clinically important. Participants allocated to the intervention group also had statistically significant higher mean CRQ Dyspnoea scores after intervention (adjusted MD 0.49, 95% CI 0.20 to 0.78) and CRQ Physical scores (adjusted MD 0.37, 95% CI 0.14 to 0.60). However, CIs for both the CRQ Dyspnoea and CRQ Physical subscales do not exclude smaller differences as prespecified as clinically important. No other statistically significant differences between groups were seen.
Conclusions A primary care based structured education pulmonary rehabilitation programme is feasible and may increase local accessibility to people with moderate and severe COPD.
Trial registration ISRCTN52403063.
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Impact of Adiponectin Overexpression on Allergic Airways Responses in Mice 

Journal of Allergy
Volume 2013 (2013), Article ID 349520, 13 pages
http://dx.doi.org/10.1155/2013/349520
Research Article

Impact of Adiponectin Overexpression on Allergic Airways Responses in Mice

Norah G. Verbout,1 Leandro Benedito,1 Alison S. Williams,1 David I. Kasahara,1 Allison P. Wurmbrand,1 Huiqing Si,1 Andrew J. Halayko,2Christopher Hug,3 and Stephanie A. Shore1
1Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
2Departments of Physiology and Internal Medicine, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
3Children’s Hospital, Boston, MA 02115, USA
Received 21 March 2013; Accepted 7 May 2013
Academic Editor: Akshay Sood
Copyright © 2013 Norah G. Verbout et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Obesity is an important risk factor for asthma. Obese individuals have decreased circulating adiponectin, an adipose-derived hormone with anti-inflammatory properties. We hypothesized that transgenic overexpression of adiponectin would attenuate allergic airways inflammation and mucous hyperplasia in mice. To test this hypothesis, we used mice overexpressing adiponectin (Adipo Tg). Adipo Tg mice had marked increases in both serum adiponectin and bronchoalveolar lavage (BAL) fluid adiponectin. Both acute and chronic ovalbumin (OVA) sensitization and challenge protocols were used. In both protocols, OVA-induced increases in total BAL cells were attenuated in Adipo Tg versus WT mice. In the acute protocol, OVA-induced increases in several IL-13 dependent genes were attenuated in Adipo Tg versus WT mice, even though IL-13 per se was not affected. With chronic exposure, though OVA-induced increases in goblet cells numbers per millimeter of basement membrane were greater in Adipo Tg versus WT mice, mRNA abundance of mucous genes in lungs was not different. Also, adiponectin overexpression did not induce M2 polarization in alveolar macrophages. Our results indicate that adiponectin protects against allergen-induced inflammatory cell recruitment to the airspaces, but not development of goblet cell hyperplasia.


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June 3, 2013

Exploring United Airways

Editorial
You have free access to this content

Exploring United Airways

  1. Philip G Bardin FRACP, PhD, 
  2. Peter W Holmes FRACP, 
  3. Garun Hamilton MBBS, FRACP, PhD
DOI: 10.1111/resp.12135
Additional Information(Show All)
  1. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/resp.12135

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Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores

Open Access
Research article

Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores: a cross-sectional analyses

Sunmin Kim, Jisun Oh, Yu-Il Kim, Hee-Jung Ban, Yong-Soo Kwon, In-Jae Oh, Kyu-Sik Kim, Young-Chul Kim and Sung-Chul Lim
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BMC Pulmonary Medicine 2013, 13:35 doi:10.1186/1471-2466-13-35
Published: 3 June 2013

Abstract (provisional)

Background

The GOLD 2011 document proposed a new classification system for COPD combining symptom assessment by COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores, and exacerbation risk. We postulated that classification of COPD would be different by the symptom scale; CAT vs mMRC.

Methods

Outpatients with COPD were enrolled from January to June in 2012. The patients were categorized into A, B, C, and D according to the GOLD 2011; patients were categorized twice with mMRC and CAT score for symptom assessment, respectively. Additionally, correlations between mMRC scores and each item of CAT scores were analyzed.

Results

Classification of 257 patients using the CAT score vs mMRC scale was as follows. By using CAT score, 60 (23.3%) patients were assigned to group A, 55 (21.4%) to group B, 21 (8.2%) to group C, and 121(47.1%) to group D. On the basis of the mMRC scale, 97(37.7%) patients were assigned to group A, 18 (7.0%) to group B, 62 (24.1%) to group C, and 80 (31.1%) to group D. The kappa of agreement for the GOLD groups classified by CAT and mMRC was 0.510. The mMRC score displayed a wide range of correlation with each CAT item (r = 0.290 for sputum item to r = 0.731 for dyspnea item, p < 0.001).

Conclusions

The classification of COPD produced by the mMRC or CAT score was not identical. Care should be taken when stratifying COPD patients with one symptom scale versus another according to the GOLD 2011 document.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

Open Access
Case report

Gastroesophageal reflux in Bronchiectasis and the effect of anti-reflux treatment

Zhi-Wei Hu, Zhong-Gao Wang, Yu Zhang, Ji-Min Wu, Jian-Jun Liu, Fang-Fang Lu, Guang-Chang Zhu and Wei-Tao Liang
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BMC Pulmonary Medicine 2013, 13:34 doi:10.1186/1471-2466-13-34
Published: 3 June 2013

Abstract (provisional)

Background

Bronchiectasis is a progressive and fatal disease despite the available treatment regimens. Gastroesophageal reflux (GER) may play an important role in the progression of bronchiectasis. However, active anti-reflux intervention such as Stretta radiofrequency (SRF) and/or laparoscopic fundoplication (LF) have rarely been used to treat Bronchiectasis.

Case presentation

Seven patients' clinical outcomes for treating GER-related deteriorated bronchiectasis were retrospective reviewed. All patients were treated by SRF and/or LF, and had follow-up periods ranging from one to five years. Typical GER symptoms, respiratory symptoms, medication consumption and general health status were assessed during the follow-ups. At the latest follow-up all patients were alive. The typical GER symptoms disappeared in five people and were significantly improved in the other two. Two had complete remissions of both respiratory symptoms and bronchiectasis exacerbations; four had significantly improved respiratory symptoms to mild/moderate degrees as well as reduced or zero bronchiectasis exacerbations, which allowed them to resume the physical and social functions; one's respiratory symptoms and bronchiectasis exacerbations were not much improved, yet she was in stable condition and satisfied with the results.

Conclusions

Potentially, GER plays an important role in some patients with bronchiectasis, and active anti-reflux treatments can be beneficial. Future clinical studies are suggested to clarify GER's role in bronchiectasis and to further determine whether anti-reflux interventions for GER can improve the outcomes of patients with bronchiectasis.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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Perinatal Pet Exposure, Faecal Microbiota, and Wheezy Bronchitis: Is There a Connection? 

ISRN Allergy
Volume 2013 (2013), Article ID 827934, 6 pages
http://dx.doi.org/10.1155/2013/827934
Research Article

Perinatal Pet Exposure, Faecal Microbiota, and Wheezy Bronchitis: Is There a Connection?

Merja Nermes,1 Katri Niinivirta,1,2 Lotta Nylund,3 Kirsi Laitinen,3,4Jaakko Matomäki,1 Seppo Salminen,3 and Erika Isolauri1,2
1Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
2Department of Clinical Sciences, University of Turku, Turku, Finland
3Functional Foods Forum, University of Turku, Turku, Finland
4Institute of Biomedicine, University of Turku, Turku, Finland
Received 22 November 2012; Accepted 11 December 2012
Academic Editors: B. F. Gibbs, A. Lorentz, and T. A. Popov
Copyright © 2013 Merja Nermes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The hygiene hypothesis suggests that high hygiene standards have led to an immune dysfunction and an increase in allergic diseases. Farming-related exposures are associated with a decreased risk of asthma. Since the gut microbiota may be a pivotal component in the hygiene hypothesis, we studied whether perinatal exposure to pets, doctor's diagnosed wheezy bronchitis (WB), and compositional changes in the gut microbiota are interrelated among urban infants. Methods. Data were collected prospectively from a mother-infant nutrition study. Data on perinatal pet ownership, WB, and the microbiota composition of faecal samples of the infants assessed by quantitative PCR at 1 month were compared. Results. None of the 30 infants exposed to pets had suffered from WB by 24 months, whereas 15 of the 99 (15%) nonexposed infants had had WB (). The counts ofBifidobacterium longum were higher in samples () from nonwheezing infants with pet exposure compared to those () in wheezing infants without pet exposure (8.59/10.44 versus 5.94/9.86, resp. (median/upper limit of range, bacteria(log)/g of stool); ). B. breve was more abundant in the wheezing infants ().


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Innate Immune Responses in House Dust Mite Allergy 

ISRN Allergy
Volume 2013 (2013), Article ID 735031, 18 pages
http://dx.doi.org/10.1155/2013/735031
Review Article

Innate Immune Responses in House Dust Mite Allergy

Alain Jacquet
Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Oor-Por-Ror Building, 10th Floor, Room No. 1010/5, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand
Received 4 November 2012; Accepted 22 November 2012
Academic Editors: Y. Gon, Y. L. Ye, and Z. Zhu
Copyright © 2013 Alain Jacquet. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Sensitizations to house dust mites (HDM) trigger strong exacerbated allergen-induced inflammation of the skin and airways mucosa from atopic subjects resulting in atopic dermatitis as well as allergic rhinitis and asthma. Initially, the Th2-biased HDM allergic response was considered to be mediated only by allergen B- and T-cell epitopes to promote allergen-specific IgE production as well as IL-4, IL-5, and IL-13 to recruit inflammatory cells. But this general molecular model of HDM allergenicity must be revisited as a growing literature suggests that stimulations of innate immune activation pathways by HDM allergens offer new answers to the following question: what makes an HDM allergen an allergen? Indeed, HDM is a carrier not only for allergenic proteins but also microbial adjuvant compounds, both of which are able to stimulate innate signaling pathways leading to allergy. This paper will describe the multiple ways used by HDM allergens together with microbial compounds to control the initiation of the allergic response through engagement of innate immunity.
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