<p><strong>Abstract:</strong><strong> </strong></p> <p><em>Introduction:</em></p> <p>Because the relationship between pulmonary function and exercise tolerance is highly variable in COPD, other contributing factors were investigated. Physiological factors that contribute to exercise tolerance must contribute to the symptoms limiting exercise, thus the symptoms limiting exercise in COPD and their contributing factors were explored, including an investigation of novel mechanisms to explore the reported tiotropium bromide-mediated improvement in exercise tolerance in COPD.</p> <p><em>Methods:</em></p> <p>We conducted a retrospective, cross-sectional analysis of 4,424 COPD patients and 4,221 healthy subjects; referred to McMaster University Medical Center for exercise testing. Multiple linear regression, ridge regression, and MANOVA were utilized to determine the factors contributing to exercise tolerance, important symptoms limiting exercise, and factors contributing to dyspnea.</p> <p>A randomized, double-blind, placebo-controlled, crossover study of 20 COPD subjects was performed. Repeated measures ANOVA was utilized to determine effects of 3 weeks tiotropium bromide vs. 3 weeks placebo on cardiac output and efficiency of gas exchange during exercise.</p> <p><em> </em></p> <p><em>Results:</em></p> <p>MBC, DL_CO, and quadriceps strength were the three major, independent, contributors to exercise capacity (MPO = -206.3 + 5.1*Quadriceps Strength + 1.8*MBC + 10.0*DL_CO, r² = 0.677). MANOVA further illustrated this.</p> <p>Dyspnea, alone or in equal combination with leg effort, was the most important symptom limiting exercise in COPD. V_E and MBC were the two major, independent, contributors to dyspnea (Dyspnea = 0.95 + 0.08*V_E + -0.01*MBC, r² = 0.457). The increase in dyspnea with V_E was much greater than the decrease with MBC.</p> <p>Tiotropium bromide did not significantly (p = 0.72) improve the efficiency of gas exchange for oxygen, significantly worsened (p = 0.005) the efficiency of gas exchange for carbon dioxide, and did not improve cardiac output.</p> <p><em>Conclusion:</em></p> <p>We concluded the reported tiotropium bromide-mediated improvement in exercise tolerance in COPD is not mediated through improvements in gas exchange efficiency and/or cardiac output.</p> <p><strong><br /></strong></p> / Doctor of Philosophy (Medical Science)

Background: Air pollution has been associated with adverse health effects for all-cause and specific respiratory morbidity and mortality outcomes. Acute exacerbations of COPD (AE-COPD) accelerate the decline in pulmonary function and are associated with greater mortality, morbidity, health care utilization, and reduced quality of life. Since the 1970 Clean Air Act was implemented, important reductions in air pollution have been achieved, but no safe threshold has been identified. Objectives: The study was planned to evaluate associations between exposure to ambient concentrations of five criteria air pollutants (CO, SO2/, NO2/, ozone, PM2.5/) in Philadelphia, Pennsylvania, and visits to Temple University Hospital for AE-COPD, from January 1, 2005 through March 31, 2007. To identify subgroups with greater susceptibility to air pollution, associations were examined according to age, gender, race, residence, and antibiotic prescription. Methods: Average daily air pollutant concentrations were obtained from the EPA's Air Quality Services Data Mart. Air pollutant exposures were evaluated for the day of the visit (lag0), one and two days preceding the visit (lag1 and lag2), and the average concentration over three days (lag012). Poisson regression provided rate ratios (RRs) to estimate associations between air pollution exposures and AE-COPD hospital visits. Results: Of 1546 hospital visits for AE-COPD, 43% were from persons 65 years or older, 50% of each gender, and 90% from Philadelphia. In single pollutant models, increased RRs were present at all lags for NO2/ (e.g., RR = 2.27 [95%CI: 1.52, 3.38] at lag012) and SO2/ (e.g., RR = 1.70 [95%CI: 1.38, 2.08] at lag012). For PM2.5/, the direct effect was present only during the winter at lag1, lag2, and lag012 (RR = 1.79 [95%CI: 1.08, 2.96]). Inverse associations were present for ozone at all lags (e.g., RR = 0.64 [95%CI: 0.53, 0.76] at lag012). Compared to the cohort as a whole, those ≥ 65 years of age were at greater risk of an AE-COPD hospital visit associated with PM2.5/ and CO at lag012, with NO2/ and SO2/ at lag0 and lag012, but there was no difference in ozone effect. Conclusions: Primary gaseous air pollution exposures (SO2/, CO, NO2/) were associated with increased AE-COPD hospital visits among COPD patients at Temple University Hospital. The effects of SO2/, CO, NO2/, and PM2.5 were greater for the subgroup ≥ 65 years of age compared to the cohort as a whole. Inverse associations with ozone were consistent across subgroups. These results suggest that air quality during the study period was insufficient to protect the health of COPD patients, especially those ≥ 65 years old. Further study is needed to understand generalizability to other populations and to evaluate lower ranges of exposure from current levels of air pollution. / Public Health

COPD is characterized by an abnormal regulatory T cell (Treg) response with a shift towards a Th1 and Th17 cell responses. However, it is unclear if the function of Treg cells is impaired by smoking and in COPD. In addition, the miRNA profile of Treg cells in COPD is unknown and whether miRNA deregulation contributes to COPD immunopathogenesis. We set the objective to study Treg cell function isolated from peripheral blood of patients with COPD versus controls and to compare their miRNA profiles. We also were interested in exploring the function of some of the differentially expressed Treg cell miRNAs. We assessed the Treg cell function by observing their suppressive activity on autologous effector T cells and analyzed their miRNA expression initially by microarray analysis then conducted real time RT-PCR validation for selected miRNAs. In Silico target gene analysis for the validated miRNAs suggested that miR-199-5p is particularly relevant to Treg cell physiology so its function was investigated further using CCD-986Sk and MOLT-4 cells. We found no difference in Treg cell function between COPD and controls but we were able to identify 6 and 96 miRNAs that were differentially expressed in COPD versus control Treg cells. We confirmed that miR-199a-5p was repressed by approximately 4 fold in Treg cells of COPD patients compared to cells in healthy smokers. Importantly, miR-199a-5p had significant overrepresentation of its target genes in the Treg cell transcriptome, with many targets associated with the TGF-b activation pathway. We also confirmed the function of miR-199a5p in an in-vitro loss-of-function cell model running TaqMan® arrays of the Human TGF-b Pathway. These findings suggest that the abnormal repression of miR-199a-5p in patients with COPD compared to unaffected smokers may be involved in modulating the adaptive immune balance in favor of a Th1 and Th17 response. / Microbiology and Immunology

Yes / Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit COX enzyme activity which affects the inflammatory response. Inflammation is associated with increasing cancer incidence. Pre-clinical and clinical studies have shown that NSAID treatment could cause an anti-tumor effect in cancers. In the present study, blood was taken from healthy individuals (n = 17) and patients with respiratory diseases or lung cancer (n = 36). White blood cells (WBC) were treated with either a micro-suspension, i.e., bulk (B) or nano-suspension (N) of aspirin (ASP) or ibuprofen (IBU) up to 500 μg/ml in the comet assay and up to 125 μg/ml in the micronucleus assay. In this study results were compared against untreated lymphocytes and their corresponding treated groups. The results showed, that NSAIDs in their nano form significantly reduced the DNA damage in WBCs from lung cancer patients in bulk and nano compared to untreated lymphocytes. Also, there was a decrease in the level of DNA damage in the comet assay after treating WBCs from healthy individuals, asthma and COPD groups with aspirin N (ASP N) but not with IBU N. In addition, the number of micronuclei decreased after treatment with NSAIDs in their nano form (ASP N and IBU N) in the healthy as well as in the lung cancer group. However, this was not the case for micronucleus frequency in asthma and COPD patients. These data show that lymphocytes from different groups respond differently to treatment with ASP and IBU as measured by comet assay and micronucleus assay, and that the size of the suspended particles of the drugs affects responses. / The present study was part funded by United Kingdom India Education Research Initiative (UKERI) SA 07-067.

Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) hör till en av de globalt sett vanligast förekommande folksjukdomarna. Sjukdomen är obotlig och medför omfattande luftvägssymtom. Sjuksköterskan möter personer med KOL i olika vårdkontexter och har en väsentlig del i omvårdnaden för att främja hälsa. Psykosociala aspekter utgör en del av hälsan varför dessa bör tas hänsyn till i sjuksköterskans omvårdnadsarbete. Syfte: Syftet var att beskriva personers upplevelser av att leva med KOL, med fokus på psykosociala aspekter. Metod: En litteraturöversikt genomfördes, baserad på elva vetenskapliga originalartiklar med kvalitativ ansats. Artiklarna söktes i databaserna PubMed och Cinahl och analyserades med stöd av Fribergs beskrivning av analys. Resultat: Resultatet visade att personer med KOL upplevde ångest, oro och rädsla i samband med sjukdomens fysiska besvär och tankar om framtiden. Personerna upplevde även känslor av skuld och skam relaterat till stigmatisering kring sjukdomen och dess koppling till rökning. Dessa känslor kunde påverka personernas hela livssituation. Sjukdomen medförde begränsningar i personernas sociala liv vilket kunde leda till isolering. En reducerad självständighet och att vara beroende av andras hjälp orsakade att personer kände sig som en börda, vilket även kunde påverka familjerelationer. Samtidigt visade resultatet att stöd från omgivningen var en viktig del i att hantera sjukdomen. Slutsats: Personer med KOL upplever att sjukdomen på olika sätt har inverkan på den psykosociala hälsan. Omgivningens attityder och subjektiva förnimmelser påverkar personernas känslor av egenvärde. Sjuksköterskans omvårdnadsarbete bör utgå ifrån ett personcentrerat förhållningssätt och därmed omfatta samtliga faktorer som påverkar välbefinnandet, inklusive stöd till närstående. / Background: Chronic obstructive pulmonary disease (COPD) is one of the most common global public diseases. The disease is incurable and causes extensive respiratory symptoms. The nurse meets people with COPD in different care contexts and has an essential part in patient care and promoting health. Psychosocial aspects are part of health, which is why these should be considered in the nurses’ work.AimThe aim was to describe peoples’ experiences of living with COPD, with a focus on psychosocial aspects. Method: A literature review was conducted, based on eleven original scientific articles with a qualitative approach. The articles were searched in the databases PubMed and Cinahl and analyzed with the support of Friberg’s description of analysis. Results: The results showed that people with COPD experienced anxiety, worry and fear in connection with the physical symptoms of the disease and thoughts about the future. The people also experienced feelings of guilt and shame related to stigmatization surrounding the disease and its connection to smoking. These feelings could affect the peoples’ entire life situation. The disease entailed limitations in persons’ social lives, which could lead to isolation. A reduced independence and reliance on the help of others caused people to feel like a burden, which could also affect family relationships. At the same time, the results showed that support from the environment was an important part in managing the disease. Conclusions: People with COPD experience that the disease has an impact on psychosocial health in different ways. The attitudes of the environment and the subjective perceptions affect people's feelings of self-worth. The nurse's patient work should be based on a person-centered approach and thus include all factors that affect well-being, including family support.

Die COPD (chronic obstructive pulmonary disease) ist eine weltweit vorkommende, chronisch obstruktive Erkrankung der Lunge. Sie gilt als vierthäufigste Todesursache weltweit, wobei ein Viertel der akuten bakteriellen Exazerbationen auf eine Infektion mit Moraxella catharralis zurückzuführen sind. Sowohl das akute, als auch das chronische Entzündungsbild der COPD wird überwiegend durch neutrophile Granulozyten in den Atemwegen bestimmt, die neben antimikrobiellen Effektorfunktionen durch Freisetzung von Zytokinen auch die Entzündungsreaktion bzw. Immunantwort regulieren können. In dieser Arbeit wurde untersucht inwiefern die Interaktion von M.catarrhalis mit dem humanen Granuloyzten-spezifischen Rezeptor carcinoembryonic antigen-related cell adhesion molecule (CEACAM)3 zu einer Aktivierung der neutrophilen Granuloyzten sowie zu einer NF-kappaB-abhängigen Chemokinproduktion führt. Primäre Granulozyten gesunder Spender sowie NB4 Zellen wurden mit M.catarrhalis in Anwesenheit verschiedener Inhibitoren, siRNA oder CEACAM-blockender Antikörper infiziert und anschließend die Chemokinsekretion mittels ELISA bestimmt. Mit Hilfe eines Luziferase Reportergenassays und Chromatinimmunpräzipitation wurde die Aktivierung des Transkriptionsfaktors NF-kappaB untersucht. Im Rahmen dieser Arbeit konnte nachgewiesen werden, dass die spezifische Interaktion von CEACAM3 mit M. catarrhalis UspA1 in einer Aktivierung neutrophiler Granulozyten resultiert. Desweiteren kommt es zu einer CEACAM3-UspA1 abhängigen Aktivierung des Transkriptionsfaktors NF-kappaB und verstärkter Sekretion proinflammatorischer Chemokine. Die NF-kappaB-Aktivierung ist abhängig von der Phosphorylierung des CEACAM3 ITAM-like Motivs und erfolgt über den Syk und Card9 Signalweg. Die Ergebnisse lassen den Schluss zu, dass neutrophile Granulozyten in der Lage sind, die durch M. catarrhalis induzierte Atemwegsentzündung in der COPD über den Oberflächenrezeptor CEACAM3 spezifisch zu modulieren. / The chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death worldwide. 25 % of the acute bacterial exacerbations are caused by infection with the human restricted pathogen Moraxella catharralis. Both the acute and the chronic inflammatory stage of COPD are predominantly determined by neutrophil granulocytes in the respiratory tract, which in addition to antimicrobial effector functions can also regulate the inflammation or immune response by releasing cytokines. This work investigated if the interaction of M. catarrhalis with the human granulocyte-specific receptor carcinoembryonic antigen-related cell adhesion molecule (CEACAM) 3 leads to an activation of the neutrophil granulocytes and to a NF-kappaB-dependent chemokine production. Primary granulocytes from healthy donors as well as NB4 cells were infected with M. catarrhalis in the presence of various inhibitors, siRNA or CEACAM-blocking antibodies, and then chemokine secretion was determined by ELISA. Using a luciferase reporter gene assay and chromatin immunoprecipitation, activation of the transcription factor NF-kappaB was investigated. In this work it could be shown that the specific interaction of CEACAM3 with M. catarrhalis UspA1 results in the activation of neutrophil granulocytes. Furthermore, there is a CEACAM3-UspA1-dependent activation of the transcription factor NF-kappaB and increased secretion of proinflammatory chemokines. NF-kappaB activation is dependent on the phosphorylation of the CEACAM3 ITAM-like motif and occurs via the Syk and Card9 signaling pathways. The results suggest that neutrophil granulocytes are able to specifically modulate M. catarrhalis induced airway inflammation in COPD via the surface receptor CEACAM3.

Hintergrund: Die chronisch obstruktive Lungenerkrankung (COPD) ist eine der Haupttodesursachen weltweit. Eine gesteigerte Aktivität des sympathischen Nervensystems wird als wesentlicher pathophysiologischer Aspekt vermutet. Grundsätze: Die vorliegende Arbeit untersuchte die muskelsympathische Nervenaktivität (MSNA) und die Baroreflex-Sensitivität bei COPD-Patienten und gesunden Probanden in Ruhe sowie unter moderater körperlicher Belastung. Ergebnisse: COPD-Patienten zeigten in Ruhe eine signifikant gesteigerte MSNA sowie eine signifikant verminderte Baroreflex-Sensitivität. Diese Ergebnisse bestätigen die Resultate vorausgegangener Publikationen der Arbeitsgruppe. In der vorliegenden Arbeit konnte erstmals ein signifikanter Anstieg der MSNA unter moderater statischer Belastung bei COPD-Patienten nachgewiesen werden. Fazit: In der vorliegenden Arbeit konnte erstmals eine Korrelation zwischen sympatho-vagaler Imbalance und verminderter körperlicher Leistungsfähigkeit bei COPD-Patienten nachgewiesen werden. Eine Modifikation der neuro-humoralen Aktivität bei COPD-Patienten könnte in Zukunft eine Rolle in der Behandlung der COPD spielen und sollte in größeren, randomisierten Studien untersucht werden.

Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-06-07T12:32:04Z No. of bitstreams: 1 DissEZK.pdf: 2194814 bytes, checksum: f579334d7cc673d9063f83b128e26017 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-13T13:24:43Z (GMT) No. of bitstreams: 1 DissEZK.pdf: 2194814 bytes, checksum: f579334d7cc673d9063f83b128e26017 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-13T13:24:49Z (GMT) No. of bitstreams: 1 DissEZK.pdf: 2194814 bytes, checksum: f579334d7cc673d9063f83b128e26017 (MD5) / Made available in DSpace on 2017-06-13T13:29:54Z (GMT). No. of bitstreams: 1 DissEZK.pdf: 2194814 bytes, checksum: f579334d7cc673d9063f83b128e26017 (MD5) Previous issue date: 2017-02-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Chronic obstructive pulmonary disease (COPD) is a major cause of disability, hospital admissions, and the demand for care in health systems. Periods of exacerbations are frequent and are associated with increased risk for cardiovascular disease and reduced overall health status. The involvement of cardiac autonomic modulation (CAM) has been evidenced in this population in stable periods; however, knowledge about CAM in exacerbated hospitalized COPD, as well as on the influence of functional aspects in this function is still scarce. In this context, of exacerbation of COPD and the possibility of advancing the knowledge about the cardiac autonomic nervous system and the functional capacity in this clinical condition motivated the development of this dissertation, which will consist of the presentation of a study titled " Increased parasympathetic cardiac modulation in patients with acute exacerbation of chronic obstructive pulmonary disease: how should we interpret it?". The aim of this study was to evaluate MAC responses in patients with COPD during exacerbation of the disease compared to patients in stable condition and to verify the possible association of these responses with functional capacity. Patients with COPD were included in the study and divided into two groups according to the clinical condition: stable and exacerbated. The exacerbated patients were evaluated in the first 24-48 hours after initiation of pharmacological therapy for exacerbation. The HR signal and the RR intervals were recorded for 10 minutes in seated position for later analysis of MAC using heart rate variability (HRV) indices. Clinical and functional data were obtained by evaluating handgrip strength, dyspnea and general health status. Our results showed higher values of the representative indices of the parasympathetic modulation for the exacerbated patients compared to the stable patients: RMSSD (17.8 ± 5.6 vs 11.7 ± 9.5 ms); HF (111.3 ± 74.9 vs. 45.6 ± 80.7 ms2); SD1 (12.7 ± 3.9 vs. 8.3 ± 6.7 ms). Significant and negative associations between HF and handgrip strength (r = -0.58) and LF with dyspnea were found (r = -0.53) (P <0.05). These findings can be attributed, among other factors, to the influence of vagal activity on the respiratory system, which results in narrowing of the airways and consequent worse clinical status. Reinforcing these findings it was possible to verify that the parasympathetic modulation is inversely associated to the functional capacity in the exacerbation of the disease. These results add knowledge that may be useful to the clinical practice of the professional involved in the care of this patient. / A doença pulmonar obstrutiva crônica (DPOC) representa causa importante de invalidez, internações hospitalares e da demanda de cuidados dos sistemas de saúde. Os períodos de exacerbações são frequentes e associam-se ao risco aumentado para doenças cardiovasculares e redução do estado geral de saúde. O comprometimento da modulação autonômica cardíaca (MAC) tem sido evidenciado nesta população em períodos estáveis, no entanto, o conhecimento sobre a MAC em pacientes com DPOC exacerbados hospitalizados, bem como sobre a influência de aspectos funcionais nesta função ainda é escasso. Neste contexto, a temática da exacerbação da DPOC e possibilidade de avanço no conhecimento sobre o sistema nervoso autonômico cardíaco e a capacidade funcional nesta condição clínica motivou o desenvolvimento desta dissertação que constará da apresentação de um estudo intitulado de “Predomínio da modulação cardíaca parassimpática em pacientes com doença pulmonar obstrutiva crônica exacerbada: como devemos interpretar?”. Este teve como objetivo avaliar as respostas da MAC em pacientes com DPOC durante a exacerbação da doença comparada à pacientes em condição estável e verificar a possível associação destas respostas com a capacidade funcional. Pacientes com DPOC foram inseridos no estudo e divididos em dois grupos de acordo com a condição clínica: estáveis e exacerbados. Os pacientes exacerbados foram avaliados nas primeiras 24-48 horas após início da terapia farmacológica para exacerbação. O sinal de FC e dos intervalos RR foram registrados durante 10 minutos em repouso sentado para posterior análise da MAC por meio da utilização de índices da variabilidade da frequência cardíaca (VFC). Os dados clínicos e funcionais também foram obtidos, por meio da avaliação da força de preensão palmar, dispneia e estado geral de saúde. Nossos resultados apontaram maiores valores dos índices representativos da modulação parassimpática para os pacientes exacerbados comparados aos pacientes estáveis: RMSSD (17,8±5,6 vs 11,7±9,5 ms); AF (111,3±74,9 vs 45,6±80,7 ms2); SD1 (12,7±3,9 vs 8,3±6,7 ms). Também foram encontradas associações significativas e negativas entre AF e força de preensão palmar (r = -0,58) e BF com a dispneia (r = -0,53). (P <0,05). Estes achados podem ser atribuídos, entre outros fatores, à influência da atividade vagal no sistema respiratório, que se traduz em estreitamento das vias aéreas e consequente pior estado clínico. Reforçando estes achados foi possível verificar que a modulação parassimpática está inversamente associada à capacidade funcional na exacerbação da doença. Estes resultados adicionam conhecimento que pode ser útil à prática clínica do profissional envolvido no cuidado deste paciente.

Bakgrund Kroniskt obstruktiv lungsjukdom (KOL) är en av de sjukdomar som orsakar flest dödsfall världen över. Personer med KOL når sällan upp till rekommenderade aktivitetsnivåer, kan erhålla ett långsammare sjukdomsförlopp, en bättre bättre livskvalitet (QoL), samt bättre hälso relaterad livskvalitet (HRQoL) om de upprätthåller rekomenderade fysiska aktivitetsnivåer.  Syfte Syftet med denna studie är att undersöka sambandet mellan objektivt mätt intensitet vid fysisk aktivitet och QoL samt HRQoL hos personer med KOL, samt skillnader mellan män och kvinnor. Vidare undersöka sambandet mellan objektivt mätt fysisk aktivitet mätt i antal steg och QoL samt HRQoL. Metod  Antal steg  i vardagen samt durationen i moderat till hög intensitet (MVPA) mättes objektivt med en accelerometer (DynaPort, McRoberts BV, The Netherlands). QoL mättes med en visuell ordinalskala i EuroQol-5D (EQ-5D) och HRQoL skattades med formulären COPD Assessment Test (CAT), Modified Medical Research Council Questionnaire (mMRC). Spearman´s rangkorrelationskoefficiet (rho) användes för att undersöka korrelationen i statistikprogramvaran Jamovi.  Resultat Sambandet mellan MVPA och QoL (EQ-5D) HRQoL (CAT, mMRC) samt HRQoL (CAT, mMRC)  för hela gruppen visade liten eller ingen korrelation förutom för mMRC som visade en låg korrelation, (rho= -.327, p= &lt;0.001). Sambandet mellan MVPA och QoL (EQ-5D)  samt  HRQoL (CAT, mMRC) för gruppen kvinnor visade alla på en liten eller ingen korrelation. Sambandet mellan MVPA och QoL (EQ-5D) samt HRQoL (CAT, mMRC) för gruppen män visade alla på en låg korrelation. Sambandet mellan antal steg och QoL (EQ-5D) samt HRQoL (CAT, mMRC) samt för hela gruppen visade på en låg korrelation förutom för CAT som visade en liten eller ingen korrelation. Slutsats  Resultatet i denna studie visade tecken på att personer med KOL som spenderar mer tid i MVPA skattar något bättre HRQoL utifrån lägre skattad dyspné jämfört de forskningspersoner som spenderar mindre tid på samma intensitet. Resultatet visade även att duration i MVPA och antal steg per dag är två variabler som kan ha minst lika stor betydelse bland personer med KOL, då de ska skatta QoL och HRQoL. Dataanalysen i denna studie visade även på att det fanns ett starkare samband för män vad gäller totalt tid spenderad i MVPA och QoL samt HRQoL än vad det gör för kvinnor.

Background Chronic Obstructive Pulmonary Disease (COPD) is a common disease affecting people worldwide, with smoking being the most common cause. COPD affects the airways and presents symptoms such as breathlessness and coughing. The nurse's role is to identify and understand the patient's unique needs to provide adequate help and support.   Aim The aim was to describe patients’ experiences of living with COPD.  Method A litterature review was conducted based on eleven qualitative scientific articles. Articles searches were obtained from the databases Cinahl Complete and PubMed. The articles were analysed according to Friberg’s (2017) method. Results The results are presented within three main themes: physical limitations, emotional distress, and support in daily life. Regarding physical limitations, breathlessness, fatigue, and reduced mobility were common symptoms that restricted daily activities. In the theme of emotional distress, anxiety, fear, guilt, and shame were symptoms that negatively impacted patients with COPD. In the final theme support in daily life, patients reported that family members and healthcare professionals played crucial roles in providing support. Conclusions Patients with COPD experienced significant physical, psychological, and social challenges in their daily lives. These challenges negatively impact the quality of life and well-being of these patients and can lead to social isolation and loneliness. Person-centered care is crucial for meeting the needs of these patients and involving both the patient and relatives in care can be very helpful. / Bakgrund Kronisk obstruktiv lungsjukdom (KOL) är en folksjukdom som påverkar människor över hela världen, och den vanligaste orsaken till sjukdomen är rökning. KOL karaktäriseras av luftvägsobstruktion och ger symtom såsom andnöd och hosta. Det är av stor vikt att sjuksköterskan identifierar och förstår varje patientens unika behov för att kunna erbjuda ett optimaltstöd och vård. Syfte Syftet var att beskriva patienters erfarenheter av att leva med KOL. Metod En litteraturöversikt baserad på elva kvalitativa vetenskapliga artiklar. Artikelsökningar hämtades från databaserna Cinahl Complete och PubMed. Artiklarna analyserades enligt Fribergs (2017) metod. Resultat Resultatet presenteras i tre huvudteman; fysiska begränsningar, emotionella påfrestningar och stöd i vardagen. I temat fysiska begränsningar var andfåddhet, trötthet och nedsatt rörlighet vanliga symtom som begränsade patienters vardag. I temat emotionella påfrestningar var ångest, rädsla, skuld och skam, symtom som påverkade patienterna negativt. I det sista temat stöd i vardagen rapporterade patienterna att anhöriga och vårdpersonal var viktiga i stödarbetet. Slutsats Patienter med KOL upplevde betydande fysiska, psykiska och sociala utmaningar i sitt dagliga liv. Dessa utmaningar påverkade patienters livskvalitet och välbefinnande på ett negativt sätt och kan leda till social isolering och ensamhet. Personcentrerad vård är avgörande för att möta behov hos patienter med KOL och att involvera både patienter och närstående i vården kan vara till stor hjälp.