Introdução: A característica clínica principal da DPOC é a intolerância ao exercício físico. O mecanismo dessa limitação é complexo e multifatorial. Os principais mecanismos considerados responsáveis são a hiperinsuflação pulmonar dinâmica (HD) e disfunção muscular periférica. A hipótese principal do presente estudo é que a diminuição da massa livre de gordura (MLG) nesses pacientes, além de diretamente contribuir para redução da capacidade aeróbia, poderia contribuir indiretamente causando acentuação da HD durante o exercício. Objetivo: Investigar se a quantidade de MLG tem efeitos diretos na hiperinsuflação pulmonar dinâmica, durante o exercício em pacientes com DPOC. Métodos: 38 pacientes em estádio moderado a grave realizaram teste de exercício cardiopulmonar incremental até o limite da tolerância com medidas seriadas de capacidade inspiratória (CI). A MLG foi medida pelo teste de bioimpedância elétrica de corpo inteiro. Foram coletados também dados de função pulmonar (espirometria). Resultados: A média de idade dos pacientes foi de 66,5 ± 7,3 anos de idade, com média de VEF1 de 0,98 ± 0.05L (42 ± 15% do previsto). Valores de CI no pico do exercício (uma variável inversamente relacionada com os volumes pulmonares operacionais, ou seja, quanto maior a CI menor é hiperinflação pulmonar) foram significativamente (p <0,05) correlacionados com a CI de repouso (r = 0,78), VEF1 (r = 0,66), CVF (r = 0,56), MLG (r = 0,46) e com o índice de massa livre de gordura (IMLG) (r = 0,39). No entanto, na análise multivariada apenas o VEF1 e a CI em repouso permaneceram preditivos da CI de pico de exercício. A CI de pico foi um preditor significativo da capacidade aeróbia máxima. Conclusão: A MLG apresentou relação direta com as medidas de hiperinsuflação dinâmica durante o exercício. Contudo, a associação não se manteve quando foram feitos ajustes para indicadores de limitação do fluxo aéreo expiratório (VEF1) e hiperinflação pulmonar em repouso (CI de repouso). / Purposes: Investigate if the amount of fat free mass (FFM) has direct effects in dynamic hyperinflation during exercise in COPD patients. Methods: 38 patients with moderate to severe COPD performed treadmill incremental cardiopulmonary exercise test to the limit of tolerance with serial measurements of inspiratory capacity (IC). FFM was measured by whole-body bioelectrical impedance. Results: Patients were 66.5±7.3 years-old with mean FEV1 of 0.98±0.05L (42±15% of predicted). Peak exercise values of IC (a variable inversely related with operational lung volumes, i.e. the greater IC lower is pulmonary hyperinflation) was significantly (p<0.05) correlated with IC at rest (r=0.78), FEV1 (r=0.66), FVC (r=0.56), FFM (r=0.46) and FFM index (r=0.39). However, in multivariable analyzes only FEV1 and IC at rest remained predictive of peak IC. Peak IC was a significant predictor of peak aerobic capacity. Conclusion: FFM was directly related with measurements of dynamic hyperinflation. Nonetheless, this association disappeared when adjustments were made for indicators of expiratory airflow limitation (FEV1) and lung hyperinflation at rest (rest IC).

Elderly patients with chronic obstructive pulmonary disease may be at increased risk of exacerbation due to physical and cognitive deficits that make proper inhaled medication adherence more difficult despite consistent medication access. This retrospective study utilized administrative medical and pharmacy claims data to examine the likelihood of having a COPD exacerbation requiring acute medical care by means of an emergency room visit or hospitalization in elderly patients receiving maintenance COPD medications from mail order and retail pharmacies. It was hypothesized that mail order patients would be more likely to experience exacerbations despite differences in medication access when compared to retail patients. The primary outcome of interest was exacerbation frequency expressed as the incidence density rate, and the secondary outcome was the proportion of days covered (PDC). The incidence rate ratio for acute exacerbations was not significantly different for mail order and retail groups, indicating patients using mail-order pharmacies were not significantly more likely to experience an exacerbation requiring acute medical care. Despite insignificant differences in incidence rates, mail order patients had significantly higher adherence rates.

<p>The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; <em>the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others </em>and <em>to lose one´s identity.</em></p>

The aim of this thesis was to describe fatigue, functional limitations due to fatigue and health in patients with chronic obstructive pulmonary disease (COPD), as well as to compare patients with individuals from the general population and to test if pulmonary rehabilitation can reduce fatigue and functional limitations, and thus improve health. A further aim was to test the Fatigue Impact Scale (FIS) among patients with COPD. Two studies (I, II) had a descriptive comparative design with data from 36 and 151 patients with COPD respectively, and 37 and 95 individuals respectively, randomly selected from the general population. One study (III) was a randomised pre-test post-test study with 12 patients with COPD randomised to 12 weeks’ pulmonary rehabilitation and 14 patients in a control group. In a further study (IV), the FIS was tested for validity and reliability among 296 patients with COPD who reported fatigue. Assessments: Structured questions frequency, duration and severity of fatigue, functional limitations due to fatigue with FIS, six minutes’ walking distance, hand grip strength, functional performance and satisfaction with Canadian Occupational Performance Measure and health with St George’s Hospital Respiratory Questionnaire and Short Form-36. Almost half of the patients with COPD had a problem with fatigue every day and experienced fatigue as a severe symptom. More than 44% reported that fatigue was one of the worst symptoms. The experience of fatigue was related to the patients’ functional performance and health perceptions. Patients with COPD experienced a higher frequency, longer daily duration and greater severity of fatigue than individuals from the general population. After a 12 week pulmonary rehabilitation programme, there were no statistically significant differences between the patients randomised to the rehabilitation group and those in the control group. The patients in the rehabilitation group improved walking distances, performance and satisfaction with regard to their own selected activities compared with baseline. Confirmatory factor analysis on the three-factor model proposed for FIS showed that the fit of the model was not acceptable. Further validation of the FIS resulted in a removal of 15 items (FIS-25) and support for Pipers´ theoretical framework of subjective manifestations of fatigue including physical, emotional and cognitive dimensions and a general behavioural factor. The internal consistency, sensitivity and stability correlations of FIS-25 were satisfactory. In conclusion, fatigue is a major concern among patients with COPD, impacting on functioning and health. Interventions with 12 weeks’ pulmonary rehabilitation might not be effective enough to reduce fatigue and the functional limitations due to fatigue. More research is needed to solve the symptom burden of fatigue and its impact on functioning and health in patients with COPD.

The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others and to lose one´s identity.

Patienter med kronisk obstruktiv lungsjukdom (KOL) upplever ofta oro relaterat till dyspné. Syftet med studien var att undersöka vilka icke-farmakologiska åtgärder som kan vidtas för att lindra patienters oro relaterat till dyspné vid KOL.  En litteraturstudie genomfördes där vetenskapliga artiklar granskades och sammanställdes. Resultatet visade att det finns ett flertal icke-farmakologiska åtgärder så som andningstekniker, fysisk träning, avledning, nutrition och kommunikation som sjuksköterskan kan undervisa och informera om för att lindra oro relaterad till dyspné. Åtgärderna bör vara individanpassade, eftersom varje patient är unik. Sjuksköterskan bör själv eller tillsammans med andra vårdinstanser försäkra sig om att patienten får den information och utbildning om sin sjukdom som krävs för att lindra patientens oro i möjligast mån. Informationen och utbildningen bör vara omfattande, för att patienten ska kunna finna de strategier och hjälpmedel som hjälper just dem vid oro. Lungrehabiliteringsprogram visade sig vara av betydelse för patienternas möjlighet att finna strategier för att lindra oro relaterad till dyspné. Ytterligare forskning men även utbildning av sjuksköterskor behövs angående specifika icke-farmakologiska åtgärder som kan lindra oro relaterad dyspné. Det behövs även forskning om vilka icke-farmakologiska åtgärder som bör ingå i ett lungrehabiliteringsprogram. / Patients with chronic obstructive pulmonary disease (COPD) often experience anxiety related to dyspnea. The purpose of this study was to investigate the non-pharmacological interventions that can be performed to alleviate patients' anxiety related dyspnea. A literature review was conducted and scientific articles were reviewed and summarized. The results showed that there are several non-pharmacological interventions that nurses can conduct to relieve anxiety related dyspnea, such as breathing techniques, physical exercise, diversion, nutrition and communication. Every patient is unique and therefore should the nurse interventions be individualized. It is the nurse task together with other health care professionals to ensure that the patients receives and understands the information that is given. The information and education should be extensive so that the patient will be able to find the right strategies that will help them to alleviate their anxiety. Pulmonary rehabilitation programs proved to be of great importance to patients' ability to find strategies to relieve anxiety related to dyspnea. Further research and education to nurses are needed on specific non- pharmacological interventions that can relieve anxiety related dyspnea. Research is also needed on which non-pharmacological interventions that should be part of a pulmonary rehabilitation program.

Syfte: Syftet med studien var att, utifrån vetenskaplig litteratur, beskriva hur patienter med KOL upplever att livskvaliteten påverkas av sjukdomen och hur sjuksköterskor kan bidra till att bibehålla livskvaliteten hos dessa patienter samt att beskriva artiklarnas kvalitet gällande deltagare och bortfall i undersökningsgruppen. Metod: Deskriptiv litteraturstudie. Artiklarna har sökts i databasen Medline och via manuella sökningar vilket resulterade i 13 artiklar. Resultat: Patienter med KOL beskriver att oro och ångest över de fysiska begränsningarna som kommer med sjukdomen kan ha en negativ inverkan på livskvaliteten. Genom att delta i fritidsaktiviteter samt att umgås med familj och vänner höjdes välmående och livskvaliteten. Trots att de flesta patienterna var påverkade av symtom, sjukdom och oförmåga att delta i aktiviteter ansåg sig de flesta ha en god livskvalitet. För sjuksköterskan är det viktigt att inge hopp, ge stöd och stärka patienternas hanteringsförmåga. En viktig del i sjuksköterskans roll är att lindra patienternas oro och ångest genom att visa en vänlig attityd och empati. Slutsats: Det är olika från person till person hur livskvaliteten påverkas. Att umgås med anhöriga och delta sociala aktiviteter främjar livskvaliteten. Vårdpersonal behöver mer utbildning i hur man ska stötta och hjälp patienterna till att bibiehålla livskvaliteten.

The overall aim of this thesis was to assess measurement properties of methods suitable for screening or monitoring of physical capacity and physical activity in subjects with chronic obstructive pulmonary disease (COPD), and to explore factors associated with physical activity levels. Methods: Four observational studies were conducted. Participants in studies I-III (sample sizes) (n=49, n=15, n=73) were recruited from specialist clinics, and in study IV from a population-based cohort (COPD n=470 and Non-COPD n=659). Psychometric properties of methods assessing physical capacity (study I) and physical activity (study II) were investigated in laboratory settings. Daily physical activity and clinical characteristics were assessed with objective methods (study III) and with subjective methods (study IV). Results: Physical capacity as measured by walking speed during a 30-metre walk test displayed high test-retest correlations (ICC&gt;0.87) and small measurement error. The accuracy for step count and body positions differed between activity monitors and direct observations. In study III 92% of subjects had an activity level below what is recommended in guidelines. Forty five percent of subjects’ activity could be accounted for by clinical characteristics with lung function (22.5%), walking speed (10.1%), quadriceps strength (7.0%) and fat-free mass index (3.0%) being significant predictors. In study IV, low physical activity was significantly more prevalent in COPD subjects from GOLD grade ≥II than among Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10-4.08) and fatigue, OR 2.33 (1.31-4.13) while obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17-4.35). Conclusion: The 30 meter walk test and activity monitors are useful when assessing physical capacity and physical activity, respectively in patients with COPD. Impaired physical activity in severe COPD is related to low lung function, low walking speed, low muscle strength and altered body composition, whereas comorbidities and fatigue are linked to insufficient physical activity in patients with moderately severe COPD.

Darbo tikslas. Įvertinti endoskopinio tyrimo reikšmę neužkrečiamųjų ligų diagnostikai arkliams. Darbo uždaviniai. Susipažinti su užsienio autorių publikuojama literatūra, apie endoskopinių tyrimų pritaikymą veterinarinėje medicinoje; įvertinti, kokiems tikslams naudojami endoskopijos metodai; įvertinti, kuris endoskopinis tyrimas dažniausiai atliekamas; įvertinti, kokios patologijos dažniausiai aptinkamos; nustatyti, pagal kokius simptomus atliekamas endoskopinis tyrimas. Tyrimo metodika. Tyrimas buvo atliekamas 2011 – 2013 metais magistrantūros studijų metais LSMU VA Stambiųjų gyvūnų klinikose. Tyrimo metu buvo atliekami endoskopiniai tyrimai: gastroskopija, bronchoskopija, laringoskopija. Tyrimo įranga – videoendoskopo sistema VIDEO MED. Iš viso konsultuoti 169 pacientai, iš jų 35 pacientams buvo atliktas endoskopinis tyrimas. Tyrimas buvo atliekamas remiantis klinikiniais simptomais. Rezultatai. Endoskopiniu tyrimu tirti 35 pacientai, kuriems pasireiškė būdingi klinikiniai simptomai. Gastroskopija buvo atlikta 17 pacientų (49 proc.), bronchoskopija atlikta 12 arklių (34proc.), o laringoskopija – 6 arkliams (17 proc.). Tyrimo metu nustatytos šios patologijos: EGUS, LOPL, gerklų paralyžius. Arklių skrandžio opų sindromas buvo nustatytas visiems 17 pacientų, kuriems buvo atliekama gastroskopija, tai sudaro 100 proc. LOPL nustatyta 10 pacientų iš 18, kuriems buvo atliekamas kvėpavimo takų endoskopinis tyrimas, tai sudaro 56 proc. Gerklų paralyžius buvo nustatytas visiems 6... [toliau žr. visą tekstą] / Objectives of the research paper. To get acquainted with material, about the appliance of endoscopic diagnosis in veterinary medicine, published by foreign authors; to study what these are the aims to use endoscopy methods; to discover the most highly endoscopic diagnosis used; to research what most common cases of pathology are diagnosed; to identify which symptoms are clues to determine an endoscopic diagnosis. Methodology. The research was carried out in 2011 – 2013, during the years of obtaining Master’s Degree in Heavy Animals clinics at LHSU VA. The following diagnoses of endoscopy were made in the course of the research: gastroscopy, bronchoscopy, laryngoscopy. The research equipment used was a video endoscopy system VIDEO MED. In total 169 patients were consulted and 35 out of the total were examined using endoscopy. The study was carried out on the basis of clinical symptoms. Results. 35 patients with clinical symptoms were examined using the method of endoscopy. Gastroscopy was carried out on 17 patients which make 49 per cent, bronchoscopy – 12 horses ( 34 per cent), laryngoscopy – 6 horses (17 per cent). During the research, the following cases of pathology were diagnosed: EGUS, COPD, laryngeal paralysis. Gastric ulcer syndrome in horses was diagnosed in all 17 patients (100 per cent), which underwent the medical examination. COPD was diagnosed in 10 patients out of 18 examined by the method of endoscopy, which makes 56 per cent. Laryngeal paralysis was... [to full text]

Background and objectives: Recent research has shown an association between a healthy diet and reduced chronic obstructive pulmonary disease (COPD) incidence. However, the potential role of diet in COPD prognosis is unknown. This thesis aimed to describe the characteristics of diet in COPD patients and to estimate its association with the disease evolution, in terms of pathophysiological impairment and hospitalizations. A secondary objective was to study the role of diet in asthma, as a COPDrelated phenotype. Methods: A dietary ancillary protocol was included in a well phenotyped cohort of 342 COPD patients recruited during their first admission for a COPD exacerbation in Spain. Dietary data of the last 2 years was assessed using a validated food frequency questionnaire (122 items). Levels of oxidative stress and inflammatory markers were measured in serum. Hospital admissions during follow-up were obtained from national datasets. Additionally, data from the International Study of Asthma and Allergies in Childhood (ISAAC) in Mexico was used to assess the effect of diet in childhood asthma. Results: (i) COPD patients report an adequate intake of the main food groups and macro- and micro-nutrients according to local recommendations, excepting vitamin D; (ii) vitamin E and olive oil intakes are associated with reduced oxidative stress in COPD active smokers; (iii) intake of _3 and _6 fatty acids is related to the levels of serum inflammatory markers; (iv) cured meat intake increases the risk of COPD admission during follow-up; and (v) children adherence to a Mediterranean dietary pattern relates to reduced childhood asthma prevalence. Conclusions: Dietary habits may modify COPD prognosis and childhood asthma. Therefore, advice on healthy diet should be considered in chronic respiratory diseases guidelines. / Antecedents i objectius: Estudis recents mostren associacions entre una dieta sana i reduccions en la incidència de malaltia pulmonar obstructiva crònica (MPOC). Tanmateix, el possible rol de la dieta en l'evolució de l'MPOC és desconegut. L'objectiu d'aquesta tesi és descriure les característiques de la dieta en pacients amb MPOC i estimar-ne l’associació amb l'evolució de la malaltia en termes d’alteracions fisiopatològiques i hospitalitzacions. Com a objectiu secundari, també es vol estudiar el paper de la dieta en l'asma, com a malaltia estretament relacionada amb l'MPOC. Mètodes: Es va aniuar un protocol d’epidemiologia nutricional en una cohort de 342 malalts d’MPOC, ben fenotipats, reclutats a Espanya durant la seva primera hospitalització per agudització de l'MPOC. Es va administrar un qüestionari de freqüència de consum d'aliments (122 ítems) preguntant per la dieta dels darrers 2 anys. Es van mesurar en sèrum els nivells de marcadors d'estrès oxidatiu i d'inflamació. Les hospitalitzacions durant el temps de seguiment s’obtingueren a partir de registres nacionals. Per últim, s'utilitzaren dades de l'International Study of Asthma and Allergy in Childhood (ISAAC) a Mèxic per a estimar l'efecte de la dieta en l'asma infantil. Resultats: (i) El consum d'aliments i macro- i micro-nutrients fou considerat adient respecte a les recomanacions locals, exceptuant la vitamina D; (ii) la ingesta de vitamina E i oli d’oliva s’associà a menors nivells d’estrès oxidatiu en pacients fumadors actius; (iii) els nivells de ingesta d'àcids grassos _3 i _6 es va relacionar amb els nivells d’inflamació sistèmica; (iv) la ingesta d’embotits i carns curades va incrementar el risc d'hospitalització per MPOC durant el seguiment; i (v) l’adherència a un patró mediterrani d'alimentació s’associà a menor prevalença d'asma infantil. Conclusions: Els hàbits alimentaris poden modificar l'evolució de l'MPOC i el desenvolupament d'asma infantil. Per tant, s’hauria de considerar l’inclusió de consells alimentaris en les guies clíniques per a malalties respiratòries cròniques.