Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD

BACKGROUND: A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). OBJECTIVE: To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. METHODS: A total of 115 patients participated in a 7- to 10-week outpatient PR programme in groups of 10–12 individuals. Half of the groups were assigned to PR plus a tablet (tablet group) and the other groups were assigned to PR only (controls). Primary effect parameters were endurance shuttle walk time (ESWT) and disease-specific health status (COPD Assessment Test=CAT). RESULTS: The change in ESWT was significantly better in the control group (mean 167 sec) compared with the tablet group (mean 51 sec) (p<0.01), whereas the change in CAT score did not differ significantly between the two groups (−0.6 vs. −2.3) (p=0.17). CONCLUSIONS: Compared with usual PR, no significant improvements were seen in the group equipped with the tablet after 7–10 weeks of rehabilitation. Future studies should focus on long-term effects

Outcomes of acute exacerbations in COPD in relation to pre-hospital oxygen therapy

BACKGROUND: Pre-hospital, high-concentration oxygen therapy during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been associated with increased mortality. Recent COPD guidelines have encouraged titrated oxygen therapy with a target saturation range of 88–92%. Oxygen therapy leading to saturation above 92% is defined as ‘inappropriate oxygen therapy’. OBJECTIVES: To examine the frequency of inappropriate oxygen therapy and whether inappropriate oxygen therapy in the ambulance in an urban area with short transit time to hospital was associated with poor outcome. METHODS: In an audit of 405 consecutive patients with AECOPD arriving by ambulance to Hvidovre Hospital, details of transit time, oxygen administration, saturation, and arterial blood gases were registered. Outcomes were respiratory acidosis, need of supported ventilation, length of hospitalisation, and in-hospital mortality. RESULTS: Only 15 patients were not treated with oxygen and information on oxygen flow was missing in seven patients and on saturation on one patient. Altogether, 352 (88.7%) of 397 patients received inappropriate oxygen therapy. Patients on ‘inappropriate oxygen therapy’ (saturation ≥92%) had a high frequency of respiratory acidosis at hospital admission, 108 (33.5%) of 324 patients, length of stay was on average 5.1 days, 12.5% of the patients needed ventilatory support, and in-hospital mortality was 3.4%. CONCLUSION: The majority of patients with AECOPD received inappropriate oxygen therapy in the ambulance, but their need of ventilatory support, length of stay, and mortality were low. Randomised studies are needed to clarify the optimal pre-hospital oxygen therapy

Prognosis of patients with alpha1-antitrypsine deficiency on long-term oxygen therapy

SummaryIntroductionData on patients with alpha1-antitrypsine deficiency (AATD) on long-term oxygen therapy (LTOT) is sparse. The aim of this study was to present the incidence of patients with AATD on LTOT, and compare their characteristics, comorbidities and prognosis (lung transplantation, termination of LTOT, and survival) with COPD patients without AATD.MethodsA National prospective study of all COPD patients who started LTOT for the first time in the period 01.11.1994 to 31.12.2010.ResultsAmong the 21,964 patients on LTOT, 234 patients had AATD. AATD patients were more often males and were on average about 17 years younger than patients without AATD. Cardio-vascular diseases and diabetes mellitus were significantly less prevalent among patients with AATD (60.4% versus 70.3% (P < 0.001) and 4.7% versus 12.2% (P < 0.001)), whereas osteoporosis was more frequent (28.5% versus 20.4%, p = 0.002. Eighty-nine (38.0%) AATD patients and 173 (0.8%) non-AATD patients were lung transplanted in the study period.Median survival was 8.7 years in AATD patients with lung transplantation, 3.3 years in AATD patients without lung transplantation, 6.3 years in non-AATD patients with lung transplantation, and 1.6 years in non-AATD without lung transplantation. Even after adjustment for gender, age, comorbidities, and the time between start of LTOT and lung transplantation, patients with AATD had a lower risk of death compared to non-AATD patients (Hazard ratio 0.73 (95% CI: 0.62–0.86; P < 0.001).ConclusionsCompared with COPD without AATD, AATD patients are younger, more often males, have a lower prevalence of cardio-vascular diseases and diabetes mellitus, and higher prevalence of osteoporosis. Moreover, they have better prognosis, partly due to greater chance of receiving a lung transplantation