Fatigue in patients with COPD participating in a pulmonary rehabilitation program

Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,31College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, CanadaBackground: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD). While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors.Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records.Results: Almost all (95.3%) participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%), reduced motivation (83.3%), mental fatigue (69.9%), and general fatigue (54.5%). Close to half (42.9%) of participants reported symptoms of anxiety, while almost one quarter (21.4%) reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01) and reduced motivation (ρ = 0.31, P < 0.05). Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01). Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores.Conclusions: Fatigue (particularly the physical and reduced motivation dimensions of fatigue) was experienced by almost all participants with COPD attending this pulmonary rehabilitation program. Fatigue affected greater proportions of participants than either anxiety or depression. The high prevalence of fatigue may impact on enrolment, participation, and attrition in pulmonary rehabilitation programs. Further investigation of the nature, correlates, and impact of fatigue in this population is required.Keywords: COPD, fatigue, pulmonary rehabilitation, anxiety, depression, sleep qualit

Prevalence and Determinants of Sinus Problems in Farm and Non-Farm Populations of Rural Saskatchewan, Canada

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Canadian Institutes of Health Research - MOP-187209-POP-CCAA-11829Peer ReviewedAlthough sinus problems have long been recognized as the most common respiratory symptoms associated with agricultural work, there is a scarcity of recent studies and/or reliable estimates as to the true prevalence or risk factors of sinus problems related to farming. The aim of this study was to determine the prevalence of sinus problems in farming and non-farming rural populations and further investigate the association of individual (for example life-style, occupational), contextual (e.g., environmental), and important covariates (e.g., age, sex) with sinus problems. A large-scale cross-sectional study was conducted in farm and non-farm residents of rural Saskatchewan, Canada. A logistic regression model based on a generalized estimating equations approach were fitted to investigate the risk factors of sinus problems. Sinus problems were reported by 2755 (34.0%) of the 8101 subjects. Farm residents were more likely to spend their first year of life on farm compared with non-farm residents, and indicated a significantly lower risk of sinus problems. Meanwhile, occupational exposure to solvent and mold were associated with an increased risk of sinus problems. Some health conditions such as allergy and stomach acidity/reflux, family history, and female sex were also related to a higher risk of sinus problems. Farm residents had a significantly lower risk of sinus problems than non-farm residents, likely due to the exposure to farm specific environments in their early life

Association of the TLR4 Asp299Gly polymorphism with lung function in relation to body mass index

<p>Abstract</p> <p>Background</p> <p>Previous studies have shown conflicting results for the association between TLR4 polymorphism (Asp299Gly) and lung function. We investigated the influence of TLR4 Asp299Gly, a polymorphism, on lung function in a community population.</p> <p>Methods</p> <p>In 2003, a cross-sectional survey was conducted to assess the respiratory health of residents living in and around the town of Humboldt, Saskatchewan, Canada. There were 2090 adults age 18-79 years who completed a questionnaire that included a medical and smoking history, as well as socio-economic and lifestyle variables. Genetic information and lung function test measurements were available on 1725 subjects (754 males and 971 females) of the 2090 respondents. These subjects were selected for further analysis to investigate the association between TLR4 Asp299Gly genotype and forced expiratory volume in the first second in liters (FEV₁), forced vital capacity in liters (FVC), FEV₁/FVC ratio, and forced expiratory flow rate in liters/second (FEF_25-75). Multivariable linear regression analysis was used to investigate associations.</p> <p>Results</p> <p><b>A</b>djusted mean values of FEV₁and FVC were significantly different between TLR4 wild type and TLR4 variant groups [Mean ± S.E.: (TLR4 wild type - FEV₁: 3.18 ± 0.02, FVC: 3.95 ± 0.03; TLR4 variant - FEV₁: 3.31 ± 0.06, FVC: 4.14 ± 0.07)]. Based on multivariable regression analysis, we observed that body mass index (BMI) was associated with decreased FEV₁/FVC ratio and FEF_25-75in TLR4 variant group but not in wild type group.</p> <p>Conclusion</p> <p>BMI may modify the associations of TLR4 Asp299Gly polymorphism with FEV₁/FVC ratio and FEF_25-75.</p

Composition of Human Skin Microbiota Affects Attractiveness to Malaria Mosquitoes

The African malaria mosquito Anopheles gambiae sensu stricto continues to play an important role in malaria transmission, which is aggravated by its high degree of anthropophily, making it among the foremost vectors of this disease. In the current study we set out to unravel the strong association between this mosquito species and human beings, as it is determined by odorant cues derived from the human skin. Microbial communities on the skin play key roles in the production of human body odour. We demonstrate that the composition of the skin microbiota affects the degree of attractiveness of human beings to this mosquito species. Bacterial plate counts and 16S rRNA sequencing revealed that individuals that are highly attractive to An. gambiae s.s. have a significantly higher abundance, but lower diversity of bacteria on their skin than individuals that are poorly attractive. Bacterial genera that are correlated with the relative degree of attractiveness to mosquitoes were identified. The discovery of the connection between skin microbial populations and attractiveness to mosquitoes may lead to the development of new mosquito attractants and personalized methods for protection against vectors of malaria and other infectious diseases

A population-based study of asthma and wheeze in school-age children

Occupational exposures to farming activities are known to be associated with respiratory symptoms in adults. It is not known if exposures to similar activities are also risk factors for respiratory symptoms in children. In order to assess the risk of asthma and wheeze in children exposed to farming activities, a cross-sectional survey was conducted with parents of 2374 school children attending Grades 1 to 5 in the west-central farming region of Saskatchewan, Canada. The overall response rate to the survey questionnaire was 80.5%. The prevalence of ever asthma was 10.2% and the prevalence of ever wheeze excluding asthma was 10.5%. In the past year, 1517 children (63.9%) had exposures of more than one hour at a time to farming activities. After adjusting for potential covariates, the risk for asthma and current asthma with exposure to regular farming activities was 0.70 (CI: 0.49-0.99) and 0.58 (CI: 0.38 to 0.90), respectively. The risk of current wheeze for children exposed to regular farming activities was1.92 (95% CI: 1.23-2.98). For children who lived on farms or acreages, the risk of wheeze with regular farming activity was 2.43 (CI: 1.52-3.92) and with any farming activity was 5.11 (CI: 1.58-16.55). Parental report of asthma by questionnaire was validated with a random sample of 30 children (males = 18; females = 12) with questionnaire report of asthma or wheeze who were matched on sex and grade to 30 asymptomatic children. Accompanied by parents, all children underwent a clinical examination by a respiratory physician. Mean peak expiratory flow rates (PEFR) were measured prior to a free-running exercise challenge and again at 5, 10 and 15 minutes post exercise. There was 89% agreement between questionnaire reported asthma and the physician diagnosis of asthma (Kappa = 0.77). Children with questionnaire reported asthma and/or wheeze and children who were classified as having asthma on clinical assessment had greater percent reductions in mean PEFR at 10 minutes following exercise than did their controls (p

International Journal of COPD Factors associated with opioid dispensation for patients with COPD and lung cancer in the last year of life: A retrospective analysis

Background: For patients in late stages of chronic obstructive pulmonary disease (COPD), dyspnea is often refractory to conventional treatment. We know little about the use of opioids in ameliorating dyspnea in this population. In this study we explored factors associated with opioid dispensation within the last year of life and differences in opioid dispensation for persons with lung cancer or COPD. Methods: In this retrospective cohort study we used administrative health data gained from 1,035 residents of Saskatchewan, Canada to examine patterns of community opioid dispensation in the last year of life. Factors associated with opioid use were determined using multiple logistic regression. Results: When compared with those with lung cancer, fewer patients with COPD were given opioids within the last week of life; the last month of life, and the last 3 months of life. After adjusting for relevant predictors, patients with lung cancer were more than twice as likely as those with COPD to fill prescriptions for the following: morphine (odds ratio [OR] 2.36, 95% confidence interval [CI]: 1.52-3.67); hydromorphone (OR 2.69, 95% CI: 1.53-4.72); transdermal fentanyl (OR 2.25, 95% CI: 1.28-3.98); or any of these opioids (OR 2.61, 95% CI: 1.80-3.80). Conclusion: These opioids are dispensed only for a small proportion of patients with COPD at the end of their lives. Future researchers could explore the efficacy and safety of opioid use for patients with advanced COPD, and whether their limited use is justified