Uppskattningsvis har mellan 400 000 och 700 000 personer i Sverige kronisk obstruktiv lungsjukdom (KOL). KOL fastställs genom mätning av andningsvolymen på en astma- och KOL-mottagning ledd av en distriktssköterska med en specialistutbildning avseende astma och KOL från vilken fortsatt vård och uppföljning sedan utgår. Syfte : Syftet var att beskriva distriktssköterskeledd patientutbildning och dess effekter på patienter med astma och kronisk obstruktiv lungsjukdom. Metod : Integrativ litteraturstudie. Resultat: Utbildningens innehåll, utbildningsmetoder, effekter av utbildning och effekter av utbildningsmetoder framkom som genomgående teman. Innehållet i utbildningen som erbjuds via en mottagning för patienter med astma och kronisk obstruktiv lungsjukdom är baserat på generella riktlinjer, men valet av utbildningsmetod varierar och baseras på patientens egenskaper och inställning vilket avgör utbildningens effekt på sjukdomen. Genom implementeringen av patientutbildning kan ett stabilt sjukdomsförlopp uppnås, men behovet av uppföljning är genomgående. / Approximately between 400 000 and 700 000 individuals has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) in. COPD is diagnosed at an asthma- and COPD-reception led by a district nurse with residency in asthma and COPD where the patients will receive further care. Aim : The aim of this study was to describe the district nurse led patient education and the effects on patients with asthma- and chronic obstructive pulmonary disease. Method : The method of choice was an integrative literature review. Results: The content of the education, education method, the effects of education and the effects of education methods were revealed as pervading themes. The content of the education is based on general guidelines, but the method of choice is based on the capacity and attitude of the patient which determines the effect on the disease. Through the implementation of patient education a stable condition can be achieved in the patients with chronic obstructive pulmonary disease.

Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) är ett sjukdomstillstånd som kännetecknas av ett begränsat luftflöde, främst vid utandning, till följd av exponering av giftiga ämnen i inandningsluften. Sjuksköterskan möter dessa patienter i primärvården, allmän medicinavdelning och specialiserad lungmedicinsk avdelning.   Syfte: Syftet med denna litteraturstudie var att utifrån vetenskaplig litteratur beskriva upplevelser av att leva med kroniskt obstruktiv lungsjukdom (KOL) utifrån ett psykiskt perspektiv. Syftet var även att beskriva artiklarnas datainsamlingsmetoder.   Metod: Deskriptiv design. Tio stycken vetenskapliga artiklar söktes i databaserna CINAHL och Medline via Pubmed. Dessa användes som underlag till resultatet.   Huvudresultat: Många patienter med KOL upplevde oro, rädsla, depression, en känsla av förlorad identitet, förändrad familjesituation och en känsla av otillräcklighet. Resultatet visade även att flertalet patienter med KOL påvisade symtom liknande PTSD-symtom. Generellt tyckte alla KOL-patienter att andnöden var den främsta orsaken till deras oro. Patienterna upplevde att deras familjer blev drabbade då diagnos ställdes. Familjeaktiviteter och individens potential att bidra till hushållet ändrades vilket bidrog till en förändrad familjesituation, en känsla av förlorad identitet och otillräcklighet.   Slutsats: Upplevelsen hos KOL-patienter definieras av oro, rädsla, depression, en känsla av förlorad identitet, förändrad familjesituation och en känsla av otillräcklighet. Symtom liknande PTSD-symtom påvisades dessutom hos denna patientgrupp. Andnöden generaliserades som den främsta orsaken till deras upplevda psykiska ohälsa.

Background: Exercise capacity (EC) is widely recognized as a strong and independent predictor of mortality and disease progression in various diseases, including cardiovascular and pulmonary diseases. Furthermore, it is generally accepted that exercise capacity in healthy individuals and in patients suffering from cardiovascular diseases is mainly limited by the maximum cardiac output. Objectives: This thesis investigated the impact of different lung function indices on EC in healthy individuals, patients with cardiovascular disease (e.g., pulmonary hypertension (PH)) and patients with pulmonary disease (e.g., chronic obstructive pulmonary disease (COPD)). Methods: The present thesis is based on cross-sectional and longitudinal analyses of patients suffering from COPD, attending pulmonary rehabilitation at Uppsala University Hospital (studies I and II), and healthy men enrolled in the “Oslo ischemia study” (study IV). Study III is a cross-sectional study of patients suffering from PH attending the San Giovanni Battista University Hospital in Turin. EC was assessed using a bicycle ergometer in studies I and IV, with 12-minute walk tests (12MWT) in study II and with 6-minute walk tests (6MWT) in study III. Extensive pulmonary function tests, including diffusing capacity of the lung (DLCO), were performed in studies I-III and dynamic spirometry was used to assess lung function in study IV. Results: DLCO is more closely linked to decreased levels of EC than airway obstruction in COPD patients. Furthermore, the decline in 12MWT over a 5-year period was mainly explained by deterioration in DLCO in COPD patients. Spirometric parameters indicating airway obstruction significantly related to EC and exercise-induced desaturation in PH patients. A significant, but weak association between lung function parameters and EC was found in healthy subjects and this association is strengthened with increasing age. Conclusion: DLCO is the strongest predictor of low EC and EC decline in COPD. In PH, airway obstruction is strongly related to reduced 6MWT. Therefore, extensive analysis of lung function, including measurements of diffusing capacity, along with standard assessment of airway obstruction, gives a more comprehensive assessment of the functional exercise capacity in patients suffering from pulmonary hypertension or COPD. Lung function is also significantly linked to EC even in healthy subjects, lacking evident cardiopulmonary diseases.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Chronic obstructive pulmonary disease (COPD) has a severe impact on quality of life (QOL). Using the Health Promotion Model as a guide, a cross-sectional, correlational design was used to describe relationships among individual characteristics and experiences (age, gender, race, severity of illness, resilience), behavior-specific cognitions and affect (self-efficacy, barriers, social support), behavioral outcomes (health promoting lifestyle), and QOL in this patient population. One hundred and twenty participants were recruited from three clinics at Virginia Commonwealth University Health System. In addition to a demographic survey, participants completed a 151-item questionnaire incorporating measures resilience, severity of illness, self-efficacy, and barriers to a health-promoting lifestyle, social support, lifestyle, and QOL. Spirometric evaluation of lung function and the 6-minute walking test were also completed. Structural equation modeling was used to determine the effect of nine independent variables on QOL.Participants were white (51.2%), female (63.6%), and approximately 60.5 years old. Severity of illness, characterized by symptoms and functional capacity, suggested they were not severely ill (mean = 3.18, S.D.= 2.69). They were somewhat resilient (mean = 136.01, S.D.= 23.01), had adequate social support (mean = 68.10, S.D.= 19.95), were uncertain about their competency (self-efficacy) to manage their health (mean = 24.91, S.D.= 4.92), sometimes experienced barriers (mean = 33.33, S.D.= 9.02), and sometimes included attributes of a healthy lifestyle in their lives (mean = 123.93, S.D.= 25.22). Their QOL was fair to poor (mean = 6.10, S.D.= 2.39).A series of analyses using structural equation modeling was conducted. The first model that was tested did not fit the data χ2(df = 13)= 67.989,p = 0.000, GFI = 0.895, CFI = 0.781, RMSEA = 0.189). Next, modification indices were use to reexamine for fit. Using the recommended modifications, a good fit model was obtained χ2(df = 9)=5.016, p = 0.833, GFI = 0.992, CFI = 1.0, RMSEA = 0.0); however, non-significant paths were present. An alternative model was tested and fit the data very well χ2(df=18)= 10.011, p = 0.932, GFI = 0.981, CFI = 1.0, RMSEA = 0.0). The independent variables explained about 45.1% of the variance in health-promoting lifestyle. All the variables explained 45.3% of variance in QOL. The most significant predictor of a healthy lifestyle was social support (0.383) and the most significant predictor of QOL was self-efficacy (0.364). The findings confirmed the utility of the HPM.

Pulmonary emphysema is a serious worldwide illness, causing progressive and irreversible alveolar wall loss and difficulty in breathing. It is caused mostly by cigarette smoking. However, its unresolved complex and multiple pathogenic mechanisms have left this disease without effective pharmacotherapy. This project hypothesized that cinnamic acid-based dehydropolymers (DHPs), originally discovered as novel anti-coagulants, protect against emphysema through their potent triple inhibitory actions against oxidative stress, inflammation and elastase, some of the pathogenic mechanisms associated with this disease. Three in vitro inhibitory activity assays for oxidative stress, lung inflammation and neutrophil elastase (NE) were developed and used to identify the most potent triple inhibitor DHP. These activities were determined by chromogenic free radical generation in chemical oxidation, lung epithelial (Calu-3) repression of pro-inflammatory nuclear factor κB (NFκB) upon its plasmid transfection and chromogenic substrate NE hydrolysis, respectively. The sulfated caffeic acid DHP, CDS was shown to be the most potent in all three assessments, yielding the half-maximal inhibitory concentrations of 3.52, ~10 and 0.43 µM, respectively. CDS was tested with pulmonary delivery in an in vivo rat model of emphysema induced by elastase and cigarette smoke extract (HSE/CSE). CDS at 5 and 30 μg/kg was instilled into the lung at 2 h prior to HSE/CSE instillation. The lung tissues and bronchoalveolar lavage fluids (BALFs) were taken 1 or 48 h post-HSE/CSE instillation to determine the tissue reduced glutathione (rGSH), airway infiltration of inflammatory neutrophils and airway luminal elastase alongside lung hemorrhage. The HSE/CSE instillation significantly caused 43.0 % decrease in rGSH, 104.8-fold greater neutrophil infiltration, 2.8-fold higher elastase activity and 9.3-fold increased lung hemorrhage, compared to the saline (negative) control. However, all these inductions were significantly protected by CDS at 30 μg/kg, exhibiting 92.9, 76.6, 59.7 and 70.4 % inhibition, respectively; reduced effects were seen at 5 μg/kg, showing its dose-related responses. As a result, the HSE/CSE-induced airspace enlargement assessed on 28th day was also prevented by CDS at 30 μg/kg, yet not at 5 μg/kg. In conclusion, this study has demonstrated the in vitro and in vivo effectiveness of CDS for its possible use in the protection against emphysema development, specifically via inhalation.

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic respiratory diseases. Impairments in exercise capacity, kinesiology and skeletal muscle function are well established in these patients. Recently presented data also suggests impairments in postural balance and increased risk of falls in patients with COPD. The aim of this study is to examine postural balance functions in a group of patients and compare the results with a control group. Methods: Twelve patients (the average age 65,6 ± 7,1, 5 women, 7 men) with COPD hospitalized at the Pulmonary Clinic at the Faculty Hospital, Prague Motol and 10 healthy control subjects (the average age 58,6 ± 5,2, 7 women, 3 men) participated in this study. Participants were measured by The Activities-specific Balance Confidence Scale (ABC) and The Balance Evaluation Systems Test (BESTest). Results: COPD patients scored significantly worse (0,0099, p < 0,05) on the ABC scale total score compared to healthy controls, 78,38 ± 21,14 for COPD versus 97,78 ± 3,88 for controls. The total score and the six subsystem categories score of the BESTest were lower in COPD patients, but not significantly, compared to controls. Conclusion: Patients with COPD showed a lower degree of balance confidence and postural balance functions....

The thesis deals with the possibility to influence the values of the lung function in patiens with chronic obstructive pulmonary disease (COPD) after exercise carried out according to the Methodology of sensorimotor training. The thesis contains a summary of theoretical knowledge about the pathophysiologic expresion of COPD, including their consequences not only for the respiratory system, but musculoskeletal system as well. Furthermore the thesis includes the information about the Methodology of sensorimotor training, that was used to influence the posture correction in our research. Methods: The spirometric examination of flow-volume curves monitor the changes prior to and after the exercise according to sensorimotor training in patiens with COPD (mean age 60, 733 ± 11,817). Results: The using of sensorimotor training can provide correction of the position of the whole body, of the chest, and change a chest mobility and in total to set up conditions for more economical muscle activation. This enable the changes in the values of the lung functions in the patiens with COPD, that we measured. Not all changes showed statistically significant change. Conclusion: Using sensorimotor training have an objective effect on the values of the lung function in patiens with COPD.

Healthcare utilizations are typically measured independently of each other; neglecting the interdependencies between services. An episode of care is suitable for measuring healthcare utilizations of patients with complex health conditions because it tracks all contacts throughout the healthcare system. The overall goal of this research was to construct an episode of care data system to study healthcare utilizations and costs of chronic obstructive pulmonary disease (COPD) exacerbations. To achieve this goal, four related studies were undertaken. The first study (Chapter 2) evaluated the agreement between emergency department (ED) data and hospital records for capturing transitions between the two care settings. Using the κ statistic as a measure of concordance, we found good agreement between the two data sources for intra-facility transfers; but only fair agreement for inter-facility transfers. The results show that linking multiple data sources would be important to identify all related healthcare utilization across care settings. The second study (Chapter 3) linked hospital data, ED data, physician billing claims, and outpatient drug records to construct an episode of care data system for COPD patients. Latent class analysis was used to identify COPD patient groups with distinct healthcare pathways. Pathways were associated with outcomes such as mortality and costs. A few individuals followed complex pathways and incurred high costs. Building on the previous study, the next one (Chapter 4) predicted whether high-cost patients in one episode also incurred high costs in subsequent episodes. Using logistic regression models, we found that patient information routinely collected in administrative health data could satisfactorily predict those who become persistent high users. The final study (Chapter 5) used a cross-validation approach to compare the performance of eight alternative linear regression models for predicting costs of episodes of COPD exacerbations. The results indicate that the robust regression model, a model not often considered for cost prediction, was among the best models for predicting episode-based costs. Overall, this research demonstrated how population-based administrative health databases could be linked to construct an episode of care data system for a chronic health condition. The resulting data system supported novel investigations of healthcare system-wide utilizations and costs. / May 2016

Dans le but d'obtenir des composés originaux ayant une activité inhibitrice envers la NE, des triazoles et des 2-aminofuranes diversement substitués ont été synthétisés. Une réaction de "click chemistry" catalysée par le cuivre entre un azide et un alcyne a été appliquée pour la synthèse des triazoles. La synthèse des composés de type 2-aminofuranes est basée sur l'attaque nucléophile d'un isonitrile sur un γ-oxo butynoate d'alkyle en présence d'un aldéhyde aromatique.Les tests biologiques ont été réalisés tout au long de la thèse. Les composés présentant les meilleures IC50 envers la NE ont été sélectionnées pour une évaluation en terme de sélectivité vs les autres sérines protéases du PN (la cathepsine G et la protéinase 3). Enfin, les meilleurs inhibiteurs ont subi une évaluation de leur activité anti-oxydante selon deux méthodes: méthode au DPPH (1,1-diphényl-2-picryl-hydrazyl) et méthode au thiocyanate ferrique. / To prepare new compounds with an inhibitory activity towards NE, diversely substituted triazoles and 2-aminofuranes were synthesized. Triazoles were obtained using the copper catalyzed "click chemistry" between an azide and an alkyne. The synthesis of 2-aminofuranes is based on the nucleophilic attack of an isonitrile on an alkyl γ-oxo-butynoate in the presence of an aromatic aldehyde.Biological assays were carried out throughout the thesis. Compounds owning the best IC50 towards NE were selected for evaluation in terms of selectivity vs the two other serine-proteases of the PN (cathepsin G and proteinase 3). Finally, evaluation of antioxidant activity of the best compounds was achieved using by two approachs: DPPH (1,1-diphenyl -2-picrylhydrazyl) method and ferric thiocyanate method.