Sammanfattning Bakgrund Kronisk obstruktiv lungsjukdom orsakas ofta av rökning, vilket anses av de flesta vara en självförvållad sjukdom. Konsekvenserna av detta blir att patienter med KOL ofta upplever skuld och skamkänslor. Syfte Syftet med denna litteraturstudie är att beskriva patienters erfarenhet av skuld och skam vid kronisk obstruktiv lungsjukdom. Metod I litteraturstudien granskades åtta vetenskapliga artiklar för att få en kunskap om patienternas känslor kring sin sjukdom. Innehållsanalys användes med ett deduktivt förhållningssätt där data bearbetades för att identifiera mönster och teman. Resultat Två huvudkategorier; skuld och skam var från början definierade och under analysen identifierades en tredje; stigmatisering. Dessa kunde senare delas in i tre olika nivåer; individ, familj/omgivning och sjukvård. Konklusion Denna studie ger sjuksköterskan en bättre förståelse för vilka känslor som kan uppstå vid en ofta självförvållad sjukdom som KOL. Den visar också vikten av att möta patienterna med empati, respekt och höja deras känsla av värdighet och moral.

Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with chronic obstructive pulmonary disease (COPD). The main objective of this thesis was to describe balance impairment and fall risk in individuals with COPD and to examine interventions for improving balance and reducing fall risk in the context of pulmonary rehabilitation. The first study of this thesis showed that falls are common in patients with COPD and that fallers are characterized by impairments in standard clinical balance measures, such as the Berg Balance Scale and Timed Up and Go. In the second study, we found that the exercise component of conventional pulmonary rehabilitation has only modest effects on balance and fall risk in COPD, highlighting the need to examine the role of balance-specific training for these patients. The third study of this thesis identified the postural control subsystems most responsible for the observed balance deficits in COPD. Compared with age-matched controls, individuals with COPD demonstrated reductions in all balance control subsystems and slower reaction times in response to external perturbations. In this study, we also showed that deficits in balance in patients with COPD were associated with peripheral muscle weakness and reduced physical activity levels. These results informed the design of the final study of this thesis, a randomized controlled trial evaluating the addition of specific balance training to pulmonary rehabilitation for improving balance in patients with COPD. Preliminary results from this study suggest that the addition of thrice weekly balance exercises to a conventional pulmonary rehabilitation program is effective for optimizing gains in measures of functional balance and fall risk. The findings from the four studies included in this thesis support the need for incorporating balance assessment and treatment for at-risk patients with COPD, as part of their comprehensive management.

The incidence of Chronic Obstructive Pulmonary Disease (COPD) is expected to rise in the coming years. Presently, in health care there has been a shift of the provision of care to the home therefore, the major burden of care falls on informal caregivers. The challenges that these caregivers face may be compounded by residing in a rural area where the provision of health care services has been increasingly compromised. In the literature, there has been an abundance of information looking at the experiences of caregivers of people with other chronic illnesses. However, the information on the lived experience of caregivers of people with severe COPD has been minimal. The purpose of this study was to explore the lived experience and meaning of that experience for spousal caregivers providing care to a person with severe COPD living in rural Saskatchewan. Face-to-face, conversational interviews, along with observations of the caregivers and their spouses interactions and environment, were utilized to collect information from five women caring for their husbands with severe COPD living in rural Saskatchewan. Hermeneutic phenomenological reflection, as guided by the works of van Manen, utilized writing, collaborative discussion, life world existentials, and imaginative variation to illuminate themes and the overall essence of this experience. Five overlapping themes identified stemmed from the essence of unrelenting responsibility: 1) Assuming additional roles; 2) Ongoing vigilance; 3) Unfulfilled expectations; 4) Emotional burden; 5) Intermittent reprieve. This study assists in understanding the challenges faced by COPD caregivers and further aids in our understanding of how COPD patients manage their condition. In addition, it will facilitate the identification of strategies and actions to meet the needs sensitive to this population.

The incidence of Chronic Obstructive Pulmonary Disease (COPD) is expected to rise in the coming years. Presently, in health care there has been a shift of the provision of care to the home therefore, the major burden of care falls on informal caregivers. The challenges that these caregivers face may be compounded by residing in a rural area where the provision of health care services has been increasingly compromised. In the literature, there has been an abundance of information looking at the experiences of caregivers of people with other chronic illnesses. However, the information on the lived experience of caregivers of people with severe COPD has been minimal. The purpose of this study was to explore the lived experience and meaning of that experience for spousal caregivers providing care to a person with severe COPD living in rural Saskatchewan. Face-to-face, conversational interviews, along with observations of the caregivers and their spouses interactions and environment, were utilized to collect information from five women caring for their husbands with severe COPD living in rural Saskatchewan. Hermeneutic phenomenological reflection, as guided by the works of van Manen, utilized writing, collaborative discussion, life world existentials, and imaginative variation to illuminate themes and the overall essence of this experience. Five overlapping themes identified stemmed from the essence of unrelenting responsibility: 1) Assuming additional roles; 2) Ongoing vigilance; 3) Unfulfilled expectations; 4) Emotional burden; 5) Intermittent reprieve. This study assists in understanding the challenges faced by COPD caregivers and further aids in our understanding of how COPD patients manage their condition. In addition, it will facilitate the identification of strategies and actions to meet the needs sensitive to this population.

Despite the efficacy of pulmonary rehabilitation programs which assist patients in managing chronic obstructive pulmonary disease (COPD), the high costs and lack of availability of such programs pose considerable barriers for underserved COPD patients, such as those living in rural communities. Because of this, patients are encouraged to actively self-manage COPD. Unfortunately, COPD patients have reported dissatisfaction with the self-management education they are provided. This mixed methods study assessed the self-management learning needs of COPD patients treated at a Certified Federal Rural Health Clinic through conducting focus group interviews (n = 2) to inform the development a targeted self-management education DVD. The effectiveness of 3 distinct educational treatments (DVD vs. Pamphlet vs. DVD Pamphlet) was evaluated by comparing outcomes related to informational needs, self-management self-efficacy, and generic/lung-specific HRQoL in a randomly-assigned, multiple-group pretestposttest design with a control group (n = 41). Focus group data was analyzed using three qualitative analysis tools. Findings from the interviews indicated that patients viewed self-management as simply taking prescribed medications and reducing activity. Patients reported a lack of knowledge and skill development related to rehabilitative activities such as controlled breathing and stress reduction. A multivariate analysis of covariance was conducted to determine the effect of 3 educational treatments on multiple outcome measures. Three nontrend orthogonal planned contrasts were tested to determine selected contrast effects. The data analysis revealed that participants receiving a DVD reported statistically significantly higher levels of lung-specific physical functioning as compared to those in the Pamphlet group. Additionally, the DVD group revealed clinically significant improvements on the physical ( 19.01) and emotional ( 10.74) functioning dimensions of lung-specific HRQoL; whereas, no such improvement occurred within the Pamphlet and control groups. Results also suggested that providing patients with a Pamphlet alone was more effective than providing participants with both interventions concurrently to increase self-management self-efficacy. The simultaneous provision of both interventions did, however, enhance generic HRQoL more so than the provision of one of the two treatments alone. Finally, any type of self-management education as compared to usual care did not statistically significantly improve outcome variables among this small sample of rural patients.

Research on sex and gender in chronic obstructive pulmonary disease (COPD) has primarily focused on differences in pulmonary function. Detailed gender- and sex-based analyses of other aspects of COPD, including epidemiology, risk factors other than cigarette smoke, pathophysiology, and measurement tools are warranted. In Chapter Two we analyzed administrative health services data to compare the prevalence, mortality and use of drugs and spirometry in men and women with COPD. Contrary to recent predictions, we did not detect a dramatic increase in the prevalence or mortality of COPD over time in women compared to men. We discuss how different coding practices in medical billing can impact the results. In Chapter Three we examined sex differences in COPD phenotypes. We hypothesized that male smokers would have more emphysema whereas female smokers would have more airway wall remodeling using data from high resolution computed tomography (HRCT) scans. We did detect more emphysema in male smokers but there was no evidence of increased airway remodeling in women. We discuss the limits of HRCT to detect airway differences in women and men. In Chapter Four we examined the use of HRCT in assessing emphysema. We hypothesized that the computer-derived estimates of emphysema (the fractal value and the % low attenuation area (%LAA)) would differentiate COPD from non-COPD as accurately as the radiologist’s emphysema scores, and would provide similar predictions in both men and women. Instead, we found that the subjective rating of emphysema best differentiated COPD, and the fractal value (a measure of emphysematous lesion size) better differentiated COPD compared with an established objective measurement, the %LAA. These results were generally the same in men and women. In Chapter Five we examined characteristics of COPD in women exposed to biomass smoke. We hypothesized that biomass smoke would induce an airway disease-predominant phenotype. We found that women with biomass smoke-exposed COPD had greater airway remodeling and less emphysema than women with tobacco smoke-exposed COPD. In summary, these findings suggest that sex and gender differences are present in COPD epidemiology and pathophysiology. However, current research measurement tools may limit the ability to accurately measure these differences.

Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) är en av vår tids vanligaste sjukdomar och förväntas bli den tredje största dödsorsaken i världen inom tio år. Sjukdomen orsakar ofta andnöd, hosta och ökad slembildning. De flesta som drabbas av sjukdomen är personer som är eller har varit rökare. Personer som lever med sjukdomen upplever ofta ett lidande av att inte ha samma ork som tidigare och upplever stigmatiserande fördömanden på grund av sjukdomens troliga orsak. Syfte: Syftet med översikten var att beskriva upplevelsen av att leva med kronisk obstruktiv lungsjukdom. Metod: Detta är en litteraturöversikt som är baserad på elva vetenskapliga artiklar. Artiklarna är analyserade och kvalitetsgranskade av båda författarna i flera steg enligt rekommendationer för analysarbete av Friberg (2012). Alla artiklar är tillgängliga i databaserna CINAHL och PubMed och är utgivna mellan 2008-2013. Resultat: Resultatet visade att det fysiska symtom som var mest påtagligt var andnöden. Andra symtom som togs upp som bes värande var den ökade slem bildningen,hostan och tröttheten. Psykiska symtom som var vanligt förekommande vid KOL var ångest, depression och frustration över förlorad ork och detta framförallt till följd av andnöden. Dömande attityder kring sjukdomens uppkomst med återkommande frågor om tidigare och/eller nuvarande rökvanor skapade känslor av skuld och skam. Många valde att fortsätta att röka trots sin diagnos, och trots dessa skuldkänslor. De såg rökningen som en rutin och en aktivitet i sin vardag som de inte ville vara utan. Diskussion: KOL innebär ett stort lidande för den drabbade. Lidande kunde bland annat upplevas vid förlust av sociala interaktioner. Enligt omvårdnadsteoretikern Katie Eriksson kan livslidande uppstå när energin inte räcker till för att delta i sociala interaktioner. Lidande upplevdes även vid beroende av andra för att få vardagliga sysslor utförda. De fysiska och psykiska symtom som uppkom till följd av sjukdomen upplevdes minska livskvaliteten. Dömande attityder som kunde uppstå gentemot personer med KOL kunde orsaka ett lidande. Orsaken kan vara att personen inte känner sig värdesatt som människa enligt Eriksson. De som valde att fortsätta röka ansåg att rökningen gav livskvalitet och ett minskat lidande. / Background: Chronic obstructive pulmonary disease (COPD) is one of today's most common diseases, and is expected in less than ten years to become the third largest cause of death worldwide. The disease causes breathlessness, cough and increased sputum. Most people who contract the disease are individuals who are or have been smokers. People living with the disease often experience a hard time to not have the same strength as before and experiencing stigmatizing condemnation because the presumable cause of the disease. Aim: The aim with this study was to describe the experience of living with chronic obstructive pulmonary disease. Methods: This is a literature review based on eleven scientific articles. The articles are reviewed and quality analyzed by both the authors in several steps according to the recommendations of the analysis procedure by Friberg (2012). All the articles are available in the databases PubMed and CINAHL and are published 2008-2013. Results: The results proved that the physical symptoms that were most problematic for a person with the disease is to have problem with their breathing. Other symptoms recognized as troublesome was the increased mucous secretion, cough and fatigue, which are common in COPD. The psychological symptoms that were common were anxiety, depression and frustration about the loss of energy and this was mainly due to the breathing. Condemnatory attitudes about the disease's onset with questions about the past and/or current smoking behavior which created feelings of guilt and shame. Many people decided to continue smoking despite their diagnosis and feelings of guilt. They saw the smoking as a routine and an activity in their daily lives that they didn’t want to be without. Discussion: The discussion concluded that COPD involved a life of suffering for those who gets the disease. Suffering was experienced in loss of social interactions. According to the nursing theorist Katie Eriksson life suffering arise when energy is not sufficient to engage in social interactions. Suffering could also be experienced when a person became dependent on others to cope with everyday tasks, when the energy wasn’t enough. The physical and psychological symptoms that emerged because of the disease were experienced as a lower quality of life. Judgmental attitudes that could occur to people with COPD could cause a suffering. According to Eriksson the reason to this can be that the person does not feel valued as a person. Those who chose to continue smoking felt that smoking resulted in a quality of life and reduced suffering.

Lėtinė obstrukcinė plaučių liga pasireiškia nevisiškai išnykstančia kvėpavimo takų obstrukcija, kuri įprastai progresuoja ir sutrikdo kvėpavimo takų pralaidumą bei dujų apykaitą plaučiuose ir audiniuose. Pasaulinės sveikatos organizacijos (PSO) duomenimis lėtine obstrukcine plaučių liga serga apie 600 mln. žmonių. Lietuvoje statistikos duomenimis 2012 metais sirgo apie 60 tūkstančių žmonių. Šie skaičiai verčia jieškoti lėtinės obstrukcinės plaučių ligos problemų sprendimo būdų. Vienas iš tokių būdų yra plaučių ligomis sergančiųjų reabilitacija. Moksliniais tyrimais įrodyta, kad efektyviausia reabilitacija yra tuomet , kai ji pradedama iš karto po ligos paūmėjimo. Garsų mankšta mažina bronchų reaktyvumą ir bronchospazmą, aktyvūs kvėpavimo pratimai stiprina kvėpavimo raumenis, gerina atsikosėjimą, stiprina kvėpavimo raumenis bei skatina širdies ir kraujagyslių veiklą, o tuo pačiu ir plaučių kraujotaką. Tyrimo tikslas : Įvertinti skirtingų kineziterapijos metodų efektyvumą gydant sergančiuosius lėtine obstrukcine plaučių liga ūmiu ligos laikotarpiu. Uždaviniai : 1. Išanalizuoti tiriamųjų rizikos veiksnius, būdingus lėtinei obstrukcinei plaučių ligai. 2. Įvertinti tiriamųjų dusulio laipsnį. 3. Nustatyti tiriamųjų plaučių ventiliacijos rodiklius, kraujo spaudimo bei krūtinės ląstos ekskursiją prieš ir po kineziterapijos. 4. Palyginti tiriamųjų, kuriems buvo taikyta garsų mankšta ir tiriamųjų, kuriems buvo taikyti aktyvūs kvėpavimo pratimai, visus... [toliau žr. visą tekstą] / The chronic obstructive lung disease is characterized by presence of airways obstruction which, as a rule, would be progressing and disturbing airflow passing and gas exchange in lungs and tissues. According to the World Health Organisation (WHO) data approximately 600 million people suffer from chronic obstructive lung disease. The Lithuanian statistic data show that in 2012 about 60 thousand Lithuanian residents had this disease. The above figures make us look for solutions to the problems created by chronic obstructive lung disease. One of the ways is rehabilitation of patients with lung diseases. The scientific research proved that the rehabilitation was most efficient when commenced immediately following exacerbation of the disease. Speech-language exercises reduce bronchi reactivity and bronchospasm, active breathing exercises strengthen the breathing muscles, improve expectoration, strengthen breathing muscles and stimulate better heart and blood vessels performance at the same time resulting in better blood circulation in lungs. Goal of the study: to assess the effectiveness of different physiotherapy methods in treatment of chronic obstructive lung disease in the acute stage. Objectives: 1. to analyse the risk factors in patients under study typical of the chronic obstructive lung disease; 2. to evaluate the degree of dyspnoea in patients under study; 3. to establish lung ventilation, blood pressure and thorax excursion values in patients... [to full text]

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic disease that causes illness and death over the whole world. There are a little available data about COPD patients in Vietnam and how the disease affects their health related quality of life (HRQL). Aim: The aim of this study was to examine HRQL among patients with COPD in Ho Chi Minh City, Vietnam, and investigate differences in HRQL between men and women with COPD. Method: This was a descriptive study with a cross-sectional design. The method was quantitative by using a questionnaire. The study was performed at the respiratory department at Cho Ray Hospital in Ho Chi Minh City, Vietnam. The sampling was made through a consecutive sample. The questionnaire was based on Short Form 36 (SF-36) which is a widely used questionnaire to measure HRQL. The answers from the questionnaires were turned into a scale where 0 represent the lowest possible HRQL and 100 represent the highest possible HRQL. Results: The results showed that patients with COPD have a low HRQL. Mean value for HRQL in the total group of respondents was 22.42.The result also showed that women suffering from COPD have a significant lower HRQL than men concerning total HRQL (P-value= 0.04), general health (P-value= 0.02) and pain (P-value= 0.05). Conclusion: Patients suffering from COPD in Ho Chi Minh City have a low score of HRQL. Better routines and knowledge about the symptoms and caring for these patients are needed. Keywords: Chronic Obstructive Pulmonary Disease, Health related quality of life, Vietnam, SF-36

Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with chronic obstructive pulmonary disease (COPD). The main objective of this thesis was to describe balance impairment and fall risk in individuals with COPD and to examine interventions for improving balance and reducing fall risk in the context of pulmonary rehabilitation. The first study of this thesis showed that falls are common in patients with COPD and that fallers are characterized by impairments in standard clinical balance measures, such as the Berg Balance Scale and Timed Up and Go. In the second study, we found that the exercise component of conventional pulmonary rehabilitation has only modest effects on balance and fall risk in COPD, highlighting the need to examine the role of balance-specific training for these patients. The third study of this thesis identified the postural control subsystems most responsible for the observed balance deficits in COPD. Compared with age-matched controls, individuals with COPD demonstrated reductions in all balance control subsystems and slower reaction times in response to external perturbations. In this study, we also showed that deficits in balance in patients with COPD were associated with peripheral muscle weakness and reduced physical activity levels. These results informed the design of the final study of this thesis, a randomized controlled trial evaluating the addition of specific balance training to pulmonary rehabilitation for improving balance in patients with COPD. Preliminary results from this study suggest that the addition of thrice weekly balance exercises to a conventional pulmonary rehabilitation program is effective for optimizing gains in measures of functional balance and fall risk. The findings from the four studies included in this thesis support the need for incorporating balance assessment and treatment for at-risk patients with COPD, as part of their comprehensive management.