Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) är kronisk luftrörs/lungsjukdom. World Health Organisation [WHO] informerar att KOL kommer bli den tredje största dödsorsaken globalt och 3 miljoner människor har dött på grund av KOL år 2012 i världen och samtidigt sjukdomen har ökat bland kvinnor. Syfte: Syftet med studien var att belysa upplevelserna av att leva med KOL hos kvinnor. Metod: En litteraturstudie baserad på sju vetenskapliga, kvalitativa artiklar. I de inkluderade artiklarna kunde man läsa om kvinnors upplevelser. Artiklar analyserades utifrån beskrivning av allmän textanalys. Resultat: Resultat presenterades i följande tre kategorier, upplevelser av fysiska svårigheter och begräsningar såsom förlorat styrka att göra vardagliga saker, att vara begränsad till sitt rum, begränsad aktiviteter och sömn svårigheter. Upplevelser av oro och rädsla såsom om att bli andfådd, att dö i sömnen eller att andningstekniken inte ska fungera. Upplevelser av skuldkänslor relaterad till rökning, att man sätter skulden på myndigheterna då man inte fick information om konsekvenserna. Slutsats: Patienter med sjukdomen KOL kan uppleva begränsningar i vardagen på grund av sjukdomen. Deras sociala liv kan också påverkas då de ofta blir bundna till sina hem. Det kan man påstå att det behövs vidare forskning. / Background: Chronic obstructive pulmonary disease (COPD) is a chronic bronchial/pulmonary disease. World Health Organisation (WHO) informs that COPD will become the third largest cause of death globally and 3 million people have died due to this disease in the year 2012 in world and same time this disease have increased among women. Aim: The aim of this study was to examine the experiences of women living with COPD disease. Method: A general literature review was performed based on seven scientific qualitative articles. The included articles were about women´s experiences. Analysis of the selected qualitative studies was performed by a general text analysis. Results: The result was presented in three categories. The first category was about experiences of physical difficulties and limitations that dealt loss of the strength to do daily life things, being confined to own room or house, limited activities in and outside of house and insomnia. The second category was about experiences of anxiety and fear of being short of breath, dying in sleep and breathing techniques failure. Third category dealt with experiences of Guilt related to smoking, blaming authorities that they did not given information about consequences of smoking. Conclusion: Patients with COPD may experience limitations in daily life because of the disease. Their daily life can also be affected as they are often confined to their homes. It may be argued that it is needed further research.

This is a foundational study that applies Receiver Operating Characteristic (ROC) analysis to the evaluation of a chronic disease model that utilizes Remote Monitoring (RM) devices to identify clinical deterioration in a Chronic Obstructive Pulmonary Disease (COPD) population. Background: RM programmes in Disease Management (DM) are proliferating as one strategy to address management of chronic disease. The need to validate and quantify evidence-based value is acute. There is a need to apply new methods to better evaluate automated RM systems. ROC analysis is an engineering approach that has been widely applied to medical programmes but has not been applied to RM systems. Evaluation of classifiers, determination of thresholds and predictive accuracy for RM systems have not been evaluated using ROC analysis. Objectives: (1) apply ROC analysis to evaluation of a RM system; (2) analyse the performance of the model when applied to patient outcomes for a COPD population; (3) identify predictive classifier(s); (4) identify optimal threshold(s) and the predictive capacity of the classifiers. Methods: Parametric and non-parametric methods are utilized to determine accuracy, sensitivity, specificity and predictive capacity of classifiers Saturated Peripheral Oxygen (SpO2), Blood Pressure (BP), Pulse Rate (PR) based on event-based patient outcomes that include hospitalisation (IP), accident & emergency (A&E) and home visits (HH). Population: Patients identified with a primary diagnosis of COPD, monitored for a minimum of 183 days with at least one episode of in-patient (IP) hospitalisation for COPD in the 12 months preceding the monitoring period. Data Source: A subset of retrospective de-identified patient data from an NHS Direct evaluation of a COPD RM programme. Subsets utilized include classifiers, biometric readings, alerts generated by the system and resource utilisation. Contribution: Validates ROC methodology, identifies classifier performance and optimal threshold settings for the classifier, while making design recommendations and putting forth the next steps for research. The question answered by this research is that ROC analysis can provide additional information on the predictive capacity of RM systems. Justification of benefit: The results can be applied when evaluating health services and planning decisions on the costs and benefits. Methods can be applied to system design, protocol development, work flows and commissioning decisions based on value and benefit. Conclusion: Results validate the use of ROC analysis as a robust methodology for DM programmes that use RM devices to evaluate classifiers, thresholds and identification of the predictive capacity as well as identify areas where additional design may improve the predictive capacity of the model.

Bakgrund Kroniskt obstruktiv lungsjukdom (KOL) är en kostsam folksjukdom med stora risker att utveckla följdsjukdomar. Rökning är den enskilt största orsaken till KOL och en framgångsrik tobaksavvänjning ger därför stora hälsovinster. Distriktssköterskans arbetsuppgift är att motivera och vägleda patienter till egenvård och livsstilsförändringar. Syftet med studien var att belysa astma-KOL-sköterskans erfarenheter av att stödja patienter med KOL till tobaksavvänjning. Metod En studie med kvalitativ ansats och deskriptiv design har gjorts. Sju astma-KOL-sköterskor som arbetar med tobaksavväjning har intervjuats via semistrukturerade intervjuer som spelades in och analyserades med hjälp av kvalitativ innehållsanalys. Resultatet visade vikten av att vara lyhörd och skapa en god relation med patienten samt att undvika ett anklagande förhållningssätt. Patientens motivation uppfattades vara den dominerande framgångsfaktorn. Motiverande samtal kunde väcka, stärka och upprätthålla motivation till rökstopp. Även socialt stöd och konsekvensinsikter uppgavs vara stora framgångsfaktorer. Patienters upplevelser av skam och skuld, psykisk ohälsa och ensamhet beskrevs vara hindrande faktorer som försvårade arbetet med tobaksavvänjning. Svårigheter att fånga upp patienter antogs höra samman med en bristande följsamhet till befintliga rutiner gällande att identifiera, registrera och remittera patienter till astma-KOL-mottagningen. Personal- och tidsbrist bidrog till upplevelser av stress och nedprioritering av astma-KOL-mottagningens arbete vilket uppgavs förhindra ett effektivt stöd till tobaksavvänjning. Slutsatsen är att astma-KOL-sköterskorna strävade efter att följa rekommenderade riktlinjer i sitt arbete. Arbetet upplevdes som komplext och var såväl stimulerande som frustrerande, samt att de önskade sig mer stöd från chefer i form av ytterligare tid för det specifika arbetet med tobaksavvänjning. / Background Chronic obstructive pulmonary disease (COPD) is a costly public health problem with major risks of developing complications. Smoking is the single biggest cause of COPD and a successful tobacco cessation therefore provides great health benefits. District nurse's duty is to motivate and guide patients to self-care and lifestyle changes. The purposeof this study was to elucidate the Asthma-COPD nurse’sexperience in supporting patients with COPD to tobacco cessation. MethodA study with qualitative approach and descriptive design has been made. Seven Asthma-COPD nurses who work with tobacco cessationwere interviewed through semi-structured interviews were recorded and analyzed using qualitative content analysis.The resultsshowed the importance of being responsive and create a good relationship with the patient and to avoid an accusatory approach. The patient's motivation was perceived to be the dominant factor for success. Motivational interviewing could awaken, strengthen and sustain the motivation to quit smoking. Even social support and consistency insights were reported to be major success factors. Patients experiences of shame and guilt, mental illness and loneliness was described to be impeding factors that hampered the work on tobacco cessation. Difficulty in identifying patients were adopted to correlate with poor adherence to existing procedures in force to identify, register and refer patients for asthma-COPD clinic. Human resource and time constraints contributed to the experiences of stress and de-prioritization of asthma-COPD clinic's work, which was reported to prevent effective aid to smoking cessation. The conclusionis that asthma-COPD nurses strove to follow the recommended guidelines in their work. The work was perceived as complex and was both stimulating and frustrating, and that they wanted more support from managers in the form of additional time for the specific work on tobacco cessation.

The problem of this study is to determine the vitamin B-6 status of patients who have chronic obstructive pulmonary disease (COPD). Erythrocyte aspartate transaminase assay was the method for measuring vitamin B-6 status. The vitamin B-6 status was examined in thirty subjects (ten COPD subjects and twenty control subjects). An unpaired t-test was used to compare the vitamin B-6 status of the COPD group versus the control group. Four determinants (percentage stimulation, ratio of basal to stimulated activity, basal activity, and stimulated activity) were used to determine vitamin B-6 status in both groups of subjects. Percentage stimulation and ratio of basal to stimulated activity were not significantly different (control group versus COPD group) at the .05 level. However, two of ten COPD subjects had values for percentage stimulation that were two standard deviations above the mean, indicating a poor B-6 status. In contrast, basal activity and stimulated activity of erythrocyte aspartate transaminase were found to be significantly lower at the .05 level in the COPD group than the control group. Therefore, the COPD subjects as a group had some biochemical characteristics of a lower level of vitamin B-6 than the controls.

Diploma thesis "Body schema in Patients with Chronic Obstructive Pulmonary Disease" is an experimental work which deals with body schema perception. As a part of the thesis there are particular tests of body schema included, which examine difference between control group and group of patients with chronic obstructive pulmonary disease. Research part of the work deals with current findings about body schema and with findings about chronic obstructive pulmonary disease. There is more detailed analyze of musculoskeletal questions in patients with chronic obstructive pulmonary disease included. In an experimental part of the thesis there are comments on results of the body schema tests. The tests are focused on stereognosis, on position sense, on perception of self body size and on the ability to achieve isolated movement. Powered by TCPDF (www.tcpdf.org)

Bibliographic identification BĚLOUSOVOVÁ, Anna. Monitoring of postural and respiratory changes in patients with chronic obstructive pulmonary disease Prague: Charles University, 2. Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2014. 66 p. Supervisor doc. PaedDr. Libuše Smolíková Ph.D. Abstract The thesis Monitoring of Postural and Respiratory Changes in Patients with Chronic Obstructive Pulmonary Disease summerises knowledge of etiology, etiopathogenesis and pathophysiology of the chronic obstructive pulmonary disease. It also contains chapters dealing with pathophysiology and changes of the breathing mechanics in COPD patients, changes of the spirometry results within the disease, chapters following posture and postural functions, dysfunctional breathing and alterations of the function of postural muscles and an increase of the work of breathing. In the practical part of the thesis, 18 patients was involved in kinesiological assessment, dynamic tests of the movement of the spine, an assesment of the pathological barriers of the cervical, thoracic spine and ribs according to Lewit, tests of the deep stabilizing system and tests of the quality of life - CAT and SGRQ. These data were statistically processed together with the spirometrical data of the patients. There were three groups...

Chronic respiratory diseases (CRDs) include chronic diseases involving the airways and other structures of the lung. In the current circumstance of Vietnam, people are exposed to numerous risk factors of CRD, such as heavy smoking, high frequency of pulmonary tuberculosis, chronic helminthiasis, allergic factors, migration and urbanization (the last associated with traffic-related pollution). The phenotype diagnoses should take into account the risk factors of each individual besides the clinical features, while the differential diagnoses mostly depend on the available techniques in each healthcare center. Our aim was to improve the differential diagnoses of the 3 most frequent CRDs: chronic obstructive pulmonary disease (COPD), asthma and COPD – asthma overlap syndrome (ACOS), in Vietnam. In the first part, we evaluated the prevalence of the allergen sensitization among patients with CRD, in regard to the urban and rural area in the South of Vietnam. House dust mites and cockroach droppings were the most frequent sensitizer. Compared with participants born in the urban setting, those born in the rural environment were less frequently sensitized and this protective effect disappeared in the case of migration from rural to urban areas. In the second part, we evaluated skin prick test as a method to screen dust mite sensitization in CRD in southern Vietnam. The data suggested that, in the present circumstance, skin prick test can be used to screen mite sensitization. In the third part, we evaluated the risk of mite sensitization in the native and migrant population, in regard to several environmental factors. Consistently with the hygiene hypothesis, compared to urban, exposure to high endotoxin concentration in rural was a protective factor against allergic sensitization. We reported for the first time that this effect was reversible among the migrants from rural to urban setting in association with lower endotoxin exposure. In the fourth part, we have defined asthma, COPD and ACOS based on clinical symptoms, cumulative smoking and airway expiratory flow with reversibility, on one side, and the age-related of the different phenotypes, on the other side. We hypothesized that the cumulative exposure to noxious particles should increase the age-related prevalence of COPD, while due to the immunosenescence process, the prevalence of IgE-mediated asthma should decrease with age, and ACOS prevalence being not related to age due to the combined mechanisms.  In conclusion, we showed in the South of Vietnam that:1) mites and cockroach allergens were the most frequent sensitizer in chronic respiratory diseases;2) the skin prick test to mite has been validated to screen mite sensitization;3) associated with a reduced level of endotoxin level, migration from rural to the urban setting was a risk factor of mite sensitization in chronic respiratory diseases;4) based on the clinical symptoms, spirometric values, and cumulative smoking, the diagnosis of asthma, COPD and ACOS have been made and their prevalence were 25, 42 and 33%, respectively. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

A Doença Pulmonar Obstrutiva Crônica (DPOC) destaca-se como um grave problema de saúde no mundo. O enfisema pulmonar, dentro do espectro das DPOC, caracteriza-se pelo alargamento dos espaços aéreos distais resultante da destruição do parênquima pulmonar. O tabagismo é considerado o principal fator relacionado ao surgimento da patologia. Considerando a escassez de aparelhos comercializados para exposição à fumaça de cigarro, bem como o elevado custo dos existentes, o presente projeto propôs um modelo experimental de enfisema por exposição à fumaça utilizando um novo aparato. Foram realizadas avaliações morfométricas e funcionais nos pulmões de ratos expostos à fumaça ou ao ar ambiente. Além disso, o peso dos animais foi aferido semanalmente. Os resultados indicaram alargamento dos espaços aéreos pulmonares, além de redução do ganho de peso nos animais expostos. Não houve diferenças funcionais entre os grupos controle e experimental. O trabalho objetivou o desenvolvimento de um aparato eficiente e menos custoso para estudos relacionados ao enfisema pulmonar. / The Chronic Obstructive Pulmonary Disease (COPD) stands out as a serious health problem in the world. The pulmonary emphysema, in the spectrum of COPD, has as main feature the enlargement of the airspaces distal resulting from destruction of lung parenchyma. Smoking is considered the main factor related to the development of pathology. Considering the lack of machines marketed for exposure to cigarette smoke, as well as the high cost of devices available, the currently project has proposed a experimental model of pulmonary emphysema induced by the use of a new apparatus. Were performed morphometric and functional measurements in the lung of rats exposed to cigarette smoke or clean air. Further, the animal weight was measured weekly. The results indicated enlargement of the pulmonary airspaces, as well as reduction of weight gain in animals exposed. There were no functional differences between control and experimental groups. The current study aimed to the development of an efficient and less costly apparatus for experimental studies related to the pulmonary emphysema.

Bakgrund: Malnutrition är vanligt hos patienter med kroniskt obstruktiv lungsjukdom (KOL). Malnutrition hos patienter med KOL kan orsaka nedsatt immunförsvar, ökad dyspné, minskad livskvalité samt att KOL-sjukdomen riskerar att öka i allvarlighetsgrad samt ha ett snabbare sjukdomsförlopp. År 2030 bedöms KOL vara den tredje vanligaste sjukdomen i världen. Därför är det viktigt som sjuksköterska att ha kunskap i vilka omvårdnadsåtgärder som kan användas vid malnutrition hos KOL-patienter. Syfte: Syftet med denna litteraturöversikt var att sammanställa KOL-patienters upplevda problem vid nutrition samt vilka omvårdnadsåtgärder sjuksköterskan kan vidta vid malnutrition. Metod: Litteraturöversikt baserad på 15 vetenskapliga artiklar. Resultat: Det fanns många olika problem som KOL-patienter upplevde i samband med nutrition. Dessa faktorer kunde vara både fysiska och psykiska. Sjuksköterskan kunde som omvårdnadsåtgärd upprätta kontakt med dietist för individuella råd och åtgärder till patienten. Som sjuksköterska var den stödjande samt kunskapsförmedlande rollen viktig, likväl att ge egenvårdsråd utifrån patientens önskemål samt förutsättningar. Slutsats: Den problematik som KOL-patienter upplevde i relation till nutrition var individuell. Nutrition hos KOL-patienter var ett komplext område då det innefattade både fysiska och psykiska bekymmer. Det är viktigt att sjuksköterskan arbetar personcentrerat vid vård av KOL-patienter då patienterna upplever olika problemområden i samband med nutrition, detta för att ge en god och säker vård. / Background: Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). Malnutrition in patients with COPD can cause impaired immune system, increased dyspnoea, decreased quality of life, and the COPD risk being increased in severity as well as having a faster disease course. In 2030, COPD is estimated to be the third most common disease in the world. Therefore, it is important as a nurse to have knowledge of which nurse care can be used in malnutrition in COPD patients. Aim: The aim of this literature review was to compile COPD patients' perceived problems with nutrition and what nurse care the nurse can take in malnutrition. Method: A literature review based on 15 scientific articles. Results: There were problems that occur for COPD patients that were caused according to their nutrition. These conditions could be both physical and psychological. The nurse could seek advice from a dietician to be informed of the best solution regarding nutritional needs of the patient. As a nurse it was important to pass on knowledge and give support to the patient whilst also advising on selfcare according to the patient's current condition and preferences. Conclusion: The variety of nutritional problems COPD patients face were highly individual and are therefore a complex subject as the effects are both physical and psychological. In general, the nurse should work closely with the patient as there can be nutrition related problems and in doing so, ensures appropriate and safe care.

Introduction: The association between daily air pollution exposure and risk of mortality is well established. Few studies have investigated in detail the associations beyond a seven day lag. The aim of this thesis was to investigate the change in risk across longer (30 day) periods post exposure for three specific causes of death: pneumonia, chronic obstructive pulmonary disease (COPD), and ischaemic heart disease (IHD). Methods: Daily Scottish mortality data (1980-2011) was matched to measurements from local fixed site pollution (Black smoke, PM10, PM2.5, SO2, & NO2) and temperature monitors. Exposure on subjects' 'day of death' was compared with control days in a time-stratified case-crossover analysis. Exposure effects on 30 days prior to day of death were modelled using distributed lag non-linear, lag stratified, and cubic distributed lag models. Matching hospital admissions data inferred subject location during exposure, further analyses investigated extreme outliers and missing data using multiple imputation techniques. The analysis accounted for several confounders including accurately modelling temperature relationships unique for each cause of death. Results: Of the 919,301 deaths, 20% were classified as being caused by pneumonia, 9.5% as COPD, and 30% as IHD in the 'any' cause of death field. Non-linear effects for temperature and linear effects for the pollutants were present across all 30 days. Temperature-mortality was observed to be U-shaped at shorter lags. Consistently increased risk occurred for longer in cold temperatures with 1oC increase (30 days lag) = %RR -0.35% Pneumonia, -0.62% COPD, and -0.26% IHD. PM2.5 on all three outcomes, and all pollutants on COPD showed the greatest effect sizes. In general, COPD risk only occurred after a delay, peaking between 12-18 days. COPD risk due to PM2.5 was immediate (%RR (95% C.I.) = 1.05% (0.14%,2.01%)) and lasted the full 30 days. Pneumonia risk often reported the shortest lag of 10-15 days, whereas IHD risk occurred 2 days after exposure but lasted the remaining 30 days. There was some evidence especially for pneumonia of a smaller association between air pollution on mortality when subjects included were present in hospital. A simulation study indicated slight improvement in accuracy when 'multiple imputation' was performed compared to 'complete cases' analysis; though both techniques reported similarly underestimated effect estimates. Extreme outliers in the main analysis of pollution exposure did not appear to have a strong influence on the risk. However, large variability between monitor measurements of pollution exposure was present and appeared to be influencing the results. Conclusion: This study provides additional evidence on the link between air pollution, and temperature, and acute mortality. Particular focus was on three causes of death (pneumonia, COPD, and IHD) that are shown to be influenced by air pollution in subtly different ways. Results also indicated that the 'true' effect of air pollution on mortality might be greater than shown by mortality studies which do not use hospital admission location during exposure into account.