The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma

• BMJ Open
• v.3(6); 2013
• PMC3693416

BMJ Open. 2013; 3(6): e003177.

Published online 2013 June 19. doi:  10.1136/bmjopen-2013-003177

PMCID: PMC3693416

The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol

Simon L Bacon,1,2,3 Kim L Lavoie,1,3,4 Jean Bourbeau,5 Pierre Ernst,5,6 Karim Maghni,3 Denyse Gautrin,3,7 Manon Labrecque,3,7 Veronique Pepin,1,2,3 and Bente Klarlund Pedersen8

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Abstract

Objective

Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles.

Design

A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50–75% of heart rate reserve for weeks 1–4, then 70–85% for weeks 5–12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques.

Ethics and dissemination

The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time.

Results

The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research participants and (3) the general public.

Registration Details ClinicalTrials.gov Identifier

NCT00953342

Keywords: Exercise, Quality of life, Inflammation

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Research

Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea

Tsai-Yu Wang^1†, Yu-Lun Lo^1†, Kang-Yun Lee¹, Wen-Te Liu^2,3, Shu-Min Lin¹, Ting-Yu Lin¹,Yung-Lun Ni⁴, Chao-Yung Wang⁵, Shu-Chuan Ho^1,3 and Han-Pin Kuo^1*

• *Corresponding author: Han-Pin Kuo q8828@ms11.hinet.net
• † Equal contributors

Author Affiliations

¹Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan

²Division of Pulmonary, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan

³School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

⁴Department of Chest Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan

⁵Department of Cardiology Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan

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Respiratory Research 2013, 14:66 doi:10.1186/1465-9921-14-66

The electronic version of this article is the complete one and can be found online at:http://respiratory-research.com/content/14/1/66

Received:	11 February 2013
Accepted:	17 June 2013
Published:	19 June 2013

© 2013 Wang et al.; licensee BioMed Central Ltd. 

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Exercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea.

Methods

Forty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment.

Results

After two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564).

Conclusion

Nocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome.

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Trial registration

NCT00914264

Keywords: 

Chronic obstructive pulmonary disease; Obstructive sleep apnoea; Walking capacity; Autonomic dysfunction; Continuous positive airway pressure

 

International Journal of Chronic Obstructive Pulmonary Disease

Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis

Original Research

(419) Total Article Views

Authors: Yawn BP, Li YF, Tian HJ, Zhang J, Arcona S, Kahler KH

Published Date June 2013 Volume 2013:8 Pages 295 - 304

DOI: http://dx.doi.org/10.2147/COPD.S42366

Received:	05 January 2013
Accepted:	22 March 2013
Published:	27 June 2013

Barbara P Yawn,¹ Yunfeng Li,² Haijun Tian,² Jie Zhang,² Steve Arcona,² Kristijan H Kahler<sup>2

1</sup>Department of Research, Olmsted Medical Center, Rochester, MN, USA; ²Department of Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

Background: The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of pneumonia in controlled clinical trials and case-control analyses.
Objective: Using claims databases as a research model of real-world diagnosis and treatment, to determine if the use and dose of inhaled corticosteroids (ICS) among patients with newly diagnosed COPD are associated with increased risk of pneumonia.
Patients and methods: This was a retrospective cohort analysis of patients diagnosed with COPD between January 01, 2006 and September 30, 2010, drawn from databases (years 2006–2010). Patients (aged ≥45 years) were followed until first pneumonia diagnosis, end of benefit enrollment, or December 31, 2010, whichever was earliest. A Cox proportional hazard model was used to assess the association of ICS use and risk of pneumonia, controlling for baseline characteristics. Daily ICS use was classified into low, medium, and high doses (1 µg–499 µg, 500 µg–999 µg, and ≥1000 µg fluticasone equivalents daily) and was modeled as a time-dependent variable.
Results: Among 135,445 qualifying patients with a total of 243,097 person-years, there were 1020 pneumonia incidences out of 5677 person-years on ICS (crude incidence rate, 0.180 per person-year), and 27,730 pneumonia incidences out of 237,420 person-years not on ICS (crude incidence rate, 0.117 per person-year). ICS use was associated with a dose-related increase in risk of pneumonia, with adjusted hazard ratios (versus no use; (95% confidence interval) of 1.38 (1.27–1.49) for low-dose users, 1.69 (1.52–1.88) for medium-dose users, and 2.57 (1.98–3.33) for high-dose users (P - 0.01 versus no use and between doses).
Conclusion: The use of ICS in newly diagnosed patients with COPD is potentially associated with a dose-related increase in the risk of pneumonia.

Keywords: COPD, ICS, LABA, pneumonia



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Thorax 2013;68:658-663 doi:10.1136/thoraxjnl-2012-203109

• Epidemiology

• Original article

Effectiveness of influenza vaccination in working-age adults with diabetes: a population-based cohort study

1. Darren Lau1, 
2. Dean T Eurich1, 
3. Sumit R Majumdar1,2, 
4. Alan Katz3, 
5. Jeffrey A Johnson1

+Author Affiliations

1. ¹Department of Public Health Sciences, University of Alberta, Edmonton, Canada
2. ²Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
3. ³Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

1. Correspondence toDr Jeffrey A Johnson, 2-040G Li Ka Shing Center for Health Research Innovation, 8602 112 Street, Department of Public Health Sciences, University of Alberta, Edmonton, Canada, AB T6G 2E1; jeff.johnson@ualberta.ca

• Received 7 December 2012
• Revised 7 February 2013
• Accepted 2 March 2013
• Published Online First 27 March 2013

Abstract

Background Guidelines recommend influenza vaccinations in all diabetic adults, but there is limited evidence to support vaccinating working-age adults ( - 65 years) with diabetes. We examined the effectiveness of influenza vaccine in this subgroup, compared with elderly adults (+ 65 years) for whom vaccination recommendations are well accepted.

Methods We identified all adults with diabetes, along with a sample of age-matched and sex-matched comparison subjects without diabetes, from 2000 to 2008, using administrative data from Manitoba, Canada. With multivariable Poisson regression, we estimated vaccine effectiveness (VE) on influenza-like illnesses (ILIs), pneumonia and influenza (PI) hospitalisations and all-cause (ALL) hospitalisations during periods of known circulating influenza. Analyses were replicated outside of influenza season to rule out residual confounding.

Results We included 543 367 person-years of follow-up, during which 223 920 ILI, 5422 PI and 94 988 ALL occurred. The majority (58%) of adults with diabetes were working age. In this group, influenza vaccination was associated with relative reductions in PI (43%, 95% CI 28% to 54%) and ALL (28%, 95% CI 24% to 32%) but not ILI (−1%, 95% CI −3% to 1%). VE was similar in elderly adults for ALL (33–34%) and PI (45–55%), although not ILI (12–13%). However, similar estimates of effectiveness were also observed for all three groups during non-influenza control periods.

Conclusions Working-age adults with diabetes experience similar benefits from vaccination as elderly adults, supporting current diabetes-specific recommendations. However, these benefits were also manifest outside of influenza season, suggesting residual bias. Vaccination recommendations in all high-risk adults would benefit from randomised trial evidence.

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The Asthma Phenotype in the Obese: Distinct or Otherwise?

Journal of Allergy
Volume 2013 (2013), Article ID 602908, 8 pages
http://dx.doi.org/10.1155/2013/602908

Review Article

The Asthma Phenotype in the Obese: Distinct or Otherwise?

Sherry Farzan

North Shore-Long Island Jewish Health System, Division of Allergy and Immunology, 865 Northern Bouelvard Suite 101, Great Neck, NY 11021, USA

Received 12 February 2013; Accepted 9 May 2013

Academic Editor: Anurag Agrawal

Copyright © 2013 Sherry Farzan. 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

Asthma is a heterogenous disorder that can be classified into several different phenotypes. Recent cluster analyses have identified an “obese-asthma” phenotype which is characterized by late onset, female predominance and lack of atopy. In addition, obesity among early-onset asthmatics clearly exists and heightens the clinical presentation. Observational studies have demonstrated that asthma among the obese has a clinical presentation that is more severe, harder to control, and is not as responsive to standard controller therapies. While weight loss studies have demonstrated improvement in asthma outcomes, further studies need to be performed. The current knowledge of the existence of two obesity-asthma phenotypes (early- versus late-onset asthma) should encourage investigators to study these entities separately since just as they have distinct presentations, their course, response to therapies, and weight loss strategies may be different as well.

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