Multimorbidity, frailty and COPD: are the challenges for pulmonary rehabilitation in the name?

The overwhelming majority of people with chronic obstructive pulmonary disease (COPD) have at least one coexisting medical condition often conceptualized as ‘comorbidities’. These coexisting conditions vary in severity and impact; it is likely that for some patients, COPD is not their most important or severe condition. The concepts of multimorbidity and frailty may be useful to understand the broader needs of people with COPD undergoing pulmonary rehabilitation. Multimorbidity describes the coexistence of two or more chronic conditions, without reference to a primary condition. Best care for people with multimorbidity has been described as a shift from providing disease-focused to patient-centred care. Pulmonary rehabilitation is well placed to deliver such care as it focuses on optimizing function, encourages integration across care settings, values input from multidisciplinary teams and measures patient-important outcomes. When designing optimal pulmonary rehabilitation services for people with multimorbidity, the concept of frailty may be useful. Frailty focuses on impairments rather than medical conditions including impairments in mobility, strength, balance, cognition, nutrition, endurance, mood and physical activity. Emerging data suggest that frailty may be modifiable with pulmonary rehabilitation. The challenge for pulmonary rehabilitation clinicians is to broaden our perspective on the role and outcomes of pulmonary rehabilitation for people with multimorbidity. </jats:p

Interventions to support informal caregivers of people with chronic obstructive pulmonary disease: a systematic literature review

Chronic obstructive pulmonary disease (COPD) imposes tremendous challenges for both patients and informal caregivers. Caregivers are key players in the management of COPD. Recently, COVID-19 further increased reliance on informal caregivers who urgently need specific support. This systematic literature review aimed to systematically describe the content and explore the effects of interventions to support informal caregivers of people with COPD.publishe

PICk UP: PersonalIsed CommUnity-based Physical activities for patients with chronic obstructive pulmonary disease

No abstract available.publishe

Patient-oriented outcomes in pulmonary rehabilitation of patients with interstitial lung diseases: a systematic review

No abstract availablepublishe

Optimizing nonpharmacological management following an acute exacerbation of chronic obstructive pulmonary disease.

Samantha L Harrison,1 Roger Goldstein,1 Laura Desveaux,1 Verity Tulloch,1 Dina Brooks2 1Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; 2Department of Medicine Physical Therapy, University of Toronto, Toronto, ON, Canada Abstract: Though the guidelines for the optimal management of chronic obstructive pulmonary disease (COPD) following an acute exacerbation (AE) are well established, issues associated with poor adherence to nonpharmacological interventions such as self-management advice and pulmonary rehabilitation will impact on hospital readmission rates and health care costs. Systems developed for clinically stable patients with COPD may not be sufficient for those who are post-exacerbation. A redesign of the manner in which such interventions are delivered to patients following an AECOPD is necessary. Addressing two or more components of the chronic care model is effective in reducing health care utilization in patients with COPD, with self-management support contributing a key role. By refining self-management support to incorporate the identification and treatment of psychological symptoms and by providing health care professionals adequate time and training to deliver respiratory-specific advice and self-management strategies, adherence to nonpharmacological therapies following an AE may be enhanced. Furthermore, following up patients in their own homes allows for the tailoring of advice and for the delivery of consistent health care messages which may enable knowledge to be retained. By refining the delivery of nonpharmacological therapies following an AECOPD according to components of the chronic care model, adherence may be improved, resulting in better disease management and possibly reducing health care utilization.Keywords: acute exacerbation, chronic obstructive pulmonary disease, pulmonary rehabilitation, self-management, physical activity, oxygen, adherence, chronic care mode

Outcomes in exercise-based interventions in interstitial lung diseases

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Assessing caregiving experience in COPD: content validity of the Zarit Burden Interview

Caring for a relative with COPD influences multiple dimensions of carers' lives. Several instruments have been used to assess the caregiving experience in COPD,1 e.g. the Zarit Burden Interview (ZBI). This instrument was originally developed for use in carers of people with dementia, however, its applicability in COPD has not been tested. This study explored the content validity of the ZBI in carers of patients with COPD. Ten carers (68.2±6.9yrs, all female) of patients with COPD (74.7±5.3yrs, all male, FEV1=49.2±19.0%pred) participated in cognitive debriefing interviews. They were asked to complete the ZBI and verbalise their thinking process to assess the adequacy of its content and instructions. Interviews were recorded and transcribed for further analysis using the qualitative data analysis software (WebQDA). Responses to the ZBI were also analysed to explore floor/ceiling effects. From the 22 items of the ZBI, 6 items were relevant for all carers and 11 items were not relevant for at least one participant. Five of these 11 items were not relevant for ≥40% of the sample and were related to stress for providing care, embarrassment about patient’s behaviour and impacts on social/leisure time. The remaining 5 items were not consensual. Overall, the ZBI was well-understood although 8 items were less clear for some carers. They suggested: improving questions (n=1) and scoring (n=5); eliminating item 4 (n=2); including 2 questions about the caregiving context (n=1). Responses were mostly distributed in the option ‘Never/Not at all’. The ZBI in its current form should not be used to assess carer experience among those caring for patients with COPD.publishe

Exploring self-conscious emotions in individuals with chronic obstructive pulmonary disease:A mixed-methods study

This study aimed to explore the extent to which self-conscious emotions are expressed, to explore any associations with adverse health outcomes, and to compare self-conscious emotions in individuals with chronic obstructive pulmonary disease (COPD) to healthy controls. A two-stage mixed-methods study design was employed. Interviews with 15 individuals with COPD informed the choice of questionnaires to assess self-conscious emotions which were completed by individuals with COPD and healthy controls. Five overarching themes were abstracted: grief, spectrum of blame, concern about the view of others, concealment, and worry about the future. The questionnaires were completed by 70 patients (mean( SD) age 70.8(9.4) years, forced expiratory volume in one second predicted 40.5(18.8), 44% male) and 61 healthy controls (mean( SD) age 62.2(12.9) years, 34% male]. Self-conscious emotions were associated with reduced mastery, heightened emotions, and elevated anxiety and depression (all p &lt; 0.001). Individuals with COPD reported lower self-compassion, higher shame, and less pride than healthy controls (all p ≤ 0.01). There is a need to increase awareness of self-conscious emotions in individuals with COPD. Therapies to target such emotions may improve mastery, emotions, and psychological symptoms. </jats:p