Chronic obstructive pulmonary disease (COPD) is one of the most widespread diseases globally. A commonly reported symptom is impaired nutritional status, which is often discussed in the literature as difficult to assess. Because nurses play a key role in the care of patients with COPD, knowledge needs to be supplemented with clinically relevant methods that can be used for identification of nutritional needs. The overall aim of this thesis is to investigate factors associated with the nutritional status of persons with COPD and to describe the assessment of nutritional status in different settings and for persons of varying ages. Both qualitative and quantitative methods were used. Two studies with descriptive and exploratory designs (I, II) and two studies with comparative (III), and correlational design (IV). In three of the studies participants were persons with COPD (I, III, IV), whereas one involved registered nurses (RNs). Qualitative data were collected using diaries (I), vignettes (II) and interviews (I, II) and analyzed using qualitative content analysis. Data collection (III, IV) included body size and body composition measurements, assessment of nutritional status using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), the Evaluation of Nutritional Status (ENS), and lung function measurements. These were analyzed using statistical methods. The main findings from the interviews with 13 respondents in PHC in study I showed that eating difficulties alone do not cause reduced nutritional intake for persons with COPD. Eating is only one aspect in a chain of meal-related situations that involve additional physiological and psychological demands. Assessment of nutritional status, performed by 19 RNs, consisted mainly of single observations. For a half of the RNs it was more important to establish trustful relationships with patients than to give nutritional information, while the other RNs had different opinions on when it was best to provide nutritional information and assess nutritional status. Study III findings showed poor nutritional status for nearly half of the 50 older participants. Many who were identified as malnourished lived alone and were dependent on daily community services. Six out of the 81 participants in Study IV were similarly identified as malnourished by each of the three instruments (MNA, MUST and ENS). There was a significant correlation between each of the instruments and body composition, assessed as fat-free mass index (FFMI). The MNA Short Form (MNA-SF) incorrectly identified thirteen participants’ nutritional status as not needing attention for their nutritional status. To be evaluated as ‘in need of qualified help with nutrition’ by the ENS the respondents needed to be identified as malnourished by the MNA. A general conclusion is that nutritional status is complex for persons with COPD and is difficult to measure by currently recommended methods. Individuals’ experiences are important to elicit because some of their experiences, in combination with RNs’ judgement, might serve as a hindrance for nursing care and delay the sharing of important information. The methods currently recommended for identification of nutritional status should be used with caution, and assessment should not depend on one single method. The findings from this thesis can contribute to early accurate identification of nutritional status and prompt interventions that have importance for an improved disease trajectory and better quality of life for individuals with COPD.

Bakgrund: KOL är en relativt vanlig och obotlig sjukdom som orsakar en gradvis försämring på andningen. Hur man upplever sjukdomen kan skilja sig åt mellan individer och mellan olika stadier av sjukdomen. Det är därför av stor vikt att sjuksköterskan får insikt i dessa upplevelser för att kunna erbjuda god omvårdnad till dessa personer. Syfte: Syftet med litteraturstudien är att beskriva personers upplevelser av att leva med KOL samt att beskriva vilka datainsamlingsmetoder som använts i de inkluderade artiklarna. Metod: Litteraturstudie med en deskriptiv design. De 12 inkluderade artiklarna är av kvalitativ ansats och söktes fram via databaserna Cinahl och PubMed. Innehållet i artiklarnas resultat granskades för att urskilja likheter och skillnader samt de inkluderade artiklarnas datainsamlingsmetod.Huvudresultat: Resultatet i litteraturstudien påvisade att personer med KOL upplevde psykiska, fysiska och sociala aspekter som påverkade personernas liv. Den psykiska påverkan gjorde att personerna fick göra många förändringar i livet. Andningssvårigheterna gjorde att den fysiska förmågan blev nedsatt. Sjukdomen påverkade även den sociala samhörigheten med andra människor. För att hantera och underlätta livet med KOL använde personerna sig av olika strategier. Den vanligaste datainsamlingsmetod som framkom i artiklarna var semistrukturerade intervjuer. Slutsats: Personerna med KOL påverkades psykiskt, fysiskt och socialt av att leva med sjukdomen. Personerna använde sig av olika strategier för att hantera sitt liv med sjukdomen. Det är viktigt som sjuksköterska att ha kunskap om personernas upplevelser av att leva med KOL eftersom det gör att det blir lättare att bevara personernas integritet, värdighet, och autonomi som kan öka personernas välbefinnande. / Background: COPD is a relative common and incurable disease that causes a progressive deterioration of breathing. How to experience the disease may differ between individuals and between different stages of the disease. It is therefore essential that nurses gain insight into these experiences to provide good care to these people. Aim: The aim of this study was to describe people's experiences of living with COPD. Furthermore, the aim of this study was to describe the included articles data collection method. Method: A literature study with a descriptive design. The 12 included articles are of qualitative approach and sought out through the databases CINAHL and PubMed. The contents of the articles results were reviewed to identify similarities and differences and also the included articles data collection method. Main result: The results of the literature study showed that people with COPD experienced psychological, physical and social aspects that affect people's lives. The psychological impact was that the people had to make many changes in life. Breathing difficulties made the physical ability to reduce. The disease also affected the social affinity with other people. To manage and facilitate life with COPD people used different strategies. The most common data collection method that emerged in the articles were semi-structured interviews. Conclusion: The people with COPD were affected psychologically, physically and socially to live with the disease. The people used different strategies to manage their life with the disease. It is important that nurses having knowledge of people´s experience of living with COPD because it makes it easier to preserve people´s integrity, dignity, and autonomy that can increase people's well-being.

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.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical sciences Student: Veronika Krčmářová Supervisor of master thesis: PharmDr. Miroslav Kovařík Ph.D. Title of master thesis: Resting energy expenditure in patients with chronic obstructive pulmonary disease II The aim of this study was to compare the resting energy expenditure (REE) and nutritional substrate utilization among patients with chronic obstructive pulmonary disease (COPD) and control group. Previous studies have confirmed increased values of REE in COPD patients. On the basis of the increase of this parameter there was a loss of lean and muscle mass. The utilization of nutritional substrates in patients with COPD is not yet known. Our study by a total of 20 patients includes 11 patients with COPD, and 9 from the control group . The age of patients ranged from 55 to 71 years. Each patient was examined once. We determined the value of REE by indirect calorimetry and utilization of nutritional substrates. According to our results, there was an increase in REE in 82 % of patients with COPD, while only 33 % of patients from the control group was hypermetabolic. Comparing the results of REE between groups we observed REE increase by about 20 % in patients with COPD compared with the control...

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Lucie Sehnalová Supervisor of master thesis: PharmDr. Miroslav Kovařík Ph.D. Title of master thesis: Determination of body composition by bioelectrical impedance method in patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is one of the top leading causes of death and its morbidity and mortality worldwide is still increasing. Besides the respiratory symptoms there are often developed alterations in metabolism and body composition in COPD patients. Clinically important are mainly malnutrition and skeletal muscle protein loss. Especially if the respiratory muscles are affected, the lung function is negatively influenced. The main aim of this study was to compare the body composition between 15 patients with COPD 3rd and 4th stage and 9 patients of control group without respiratory impairment and comparable anthropometric characteristics (age, body height and weight). By means of bioelectrical impedance analysis we determined the composition of main body compartments. In patients with COPD was the mean amount of lean tissue of body weight (rel LTM) 47.2 ± 8.4 %, amount of fat mass (rel Fat) 37.8 ± 6.4 % and mean overhydration (OH) 0.31...

L’hypertension pulmonaire (PH) compliquant la bronchopneumopathie chronique obstructive (BPCO) est associée à une augmentation du risque de décès. Le remodelage vasculaire pulmonaire en est la principale cause ; ce remodelage est le résultat de la combinaison des effets de l'hypoxie alvéolaire, d’une inflammation et de la perte du lit vasculaire pulmonaire. Sur le plan anatomique, on observe un épaississement de l’intima dû à une prolifération des cellules musculaires lisses (CML). Ces anomalies sont sous la dépendance du transporteur de la sérotonine (5-HTT). La quantité d’ARN messager du 5- HTT des CML humaines en culture est significativement plus élevée chez les sujets homozygotes pour la forme longue du promoteur de 5-HTT (LL), par rapport aux sujets hétérozygotes (LS) ou homozygotes pour la forme courte (SS), notamment en condition hypoxique. La pression artérielle pulmonaire (PAP) est significativement plus élevée chez les patients homozygotes LL (moy. 34 ± (ET)13 mm Hg), par rapport aux autres patients (22 ± 4 mm Hg et 23 ± 5 mm Hg ; p<0,001). Nous avons également observé que l’interleukine 6 (IL- 6) sérique est corrélée à la PAP (r=0,39 ; p< 0,001). De plus, un polymorphisme fonctionnel du gène codant pour l’IL-6 G(–174)C est associé dans sa forme homozygote GG à une HP plus fréquente (Odds Ratio ajusté= 4.32; [Intervalle de confiance à 95%, 1.96-9.54]) et une PAP significativement plus élevée. En conclusion, la prolifération des CML artérielles pulmonaires dans la BPCO est dépendante du 5-HTT et de l’inflammation. Cette prolifération est en partie induite par l’hypoxie alvéolaire entraînant un remodelage des petites artères et artérioles pulmonaires / The lung high blood pressure complicating (PH) the obstructive chronic bronchopneumopathie ( BPCO) is associated with an increase of the risk of death(deaths). The lung vascular reshaping is the main cause; this reshaping is the result(profit) of the combination(overall) of the effects of the alveolar hypoxie, the inflammation and the loss of the lung vascular bed

1 Abstract Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Martin Jenšík Supervisor of master thesis: PharmDr. Miroslav Kovařík Ph.D. Title of master thesis: Resting energy expenditure in patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is step by step moving ahead in public and scientific interest due to its fast rising in mortality rate. Contemporary studies observed a phenomena that patients with COPD have increased resting energy expenditure (REE) that leads to loss of fat free mass and total weight. Our goal was to confirm or disprove this hypothesis. Our research ran in Department of research and development at University hospital Hradec Králové. In our study participated 30 patients, 26 men and 4 women, mean age 67 ± 8 let. Every patient was once examined after twelve-hour fasting. We determined REE and substrate utilization by method of indirect calorimetry. We confirmed increased REE from the average value of REE - 122 ± 14 % predicted by Harris - Benedict equation. None patient was hypometabolic, 7 were normometabolic and 23 hypermetabolic. Substrate utilization did not differ contrary to physiological values. Furthermore we discovered correlation among fat mass, fat free mass,...

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Barbora Malinová Supervisor of Diploma thesis: PharmDr. Miroslav Kovařík Ph.D. Title of diploma thesis: Densitometric determination of body composition in patients with chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in 2004 according to the WHO Global Burden of Disease Project and its morbidity and mortality worldwide is still increasing. Besides the lung function impairment, there are often described changes in body composition in COPD patients e.g. the skeletal muscle protein loss. The main aim of the study was determining the body composition by DEXA in patients diagnosed with COPD and comparing them with physiological values or studies dealing with this issue. On each patient was performed one examination, patients were coming after twelve-hour fasting. Average age was 66 ± 8 years. The amount of fat-free mass was not reduced. There was not therefore a loss of muscle tissue due to COPD. When evaluating total fat, we find that men have more fat than normal levels. This is also indicated by BMI that has been in the majority in the range of overweight and obesity. We did not confirm the link between COPD...

Background: This study explored the differences between the seasonal mortality rates (by age and gender) between the two jurisdictions (the Republic of Ireland (RoI) and Northern Ireland (NI)). The study assessed the relationship between cold temperatures and daily mortality, and assessed for effect modification of the cold weather-mortality relationship by age and gender. Methods: Mortality rates were calculated for each cause-specific mortality group during various seasons in both jurisdictions. A time-stratified case-crossover approach was applied to examine the cold weather-mortality relationship, 1984-2007. The daily mortality risk was explored in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter months and extended cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship. Results: The winter mortality rates were significantly greater than the summer rates. NI experienced higher mortality from cardiovascular disease, respiratory disease and stroke. The impact of cold weather in the winter months persisted up to 35 days in the RoI, with a cumulative mortality increase for all-cause of 6.4% (95%CI: 4.8%-7.9%) with regards to every 1oC drop in the daily maximum temperature with similar associations for cardiovascular disease and stroke with twice as much for respiratory diseases. The associations were less pronounced and less persistent in NI. Conclusions: The study observed excess winter mortality. The cold weather-mortality associations increased with age with some suggestion of gender differences. There were strong cold weather-mortality associations in both jurisdictions, with suggestive differences in associations by age and gender. The findings suggest the potential contribution of societal differences, and require further exploration. These findings will hopefully contribute to the current efforts to modify fuel policy and reduce winter mortality in both jurisdictions.

La réponse de l’organisme contre un agent pathogène nécessite la mise en jeu d’interactions complexes entre cellules immunitaires et environnement. La matrice extra-cellulaire est remodelée au cours de la réponse immunitaire pour permettre la migration des cellules vers le site infectieux. Les peptides issus de la dégradation de la matrice peuvent influencer les fonctions biologiques des cellules immunitaires. Dans les pathologies impliquant des tissus riches en élastine, les cellules de la réponse inflammatoire et immunitaire, notamment les polynucléaires neutrophiles (PN) et les cellules dendritiques se retrouvent dans un environnement riche en produits issus de la dégradation de l’élastine. Le travail de thèse présenté ici nous a permis de montrer que les peptides d’élastine (PE) régulent les fonctions des PN de sujets sains en augmentant de façon significative leur capacité migratoire, leur capacité à produire des cytokines pro-inflammatoire et à phagocyter les agents pathogènes. Les effets régulateurs des PE sont moindres chez les sujets BPCO et varient en fonction de l’état clinique des patients. Les propriétés biologiques des PN de patients BPCO en exacerbation ne sont pas affectées par les PE. Cette différence de réponse aux PE des PN de patients BPCO à l’état stable ou à l’état exacerbé est proportionnellement liée au niveau d’expression du récepteur S-Gal à la surface des PN. Dans un second travail nous avons montré que les PE sont capables d’attirer les CD au niveau du site infectieux sans influencer la maturation des cellules induite par une activation antigénique. L’effet des PE sur la migration des CD met en jeu le récepteur S-Gal présent à la surface des cellules. Par ailleurs, les PE orientent la réponse cytokinique des CD activées par le LPS vers un profil de type Th-2 et favorisent l’émergence d‟un profil tolérogénique des CD. Ces effets régulateurs des PE sont médiés via l’interaction PE/S-Gal et conduisent au développement d’une réponse adaptative T régulatrice. L’ensemble de ces résultats suggère que les PE participent activement à la régulation de la réponse immunitaire innée et adaptative / Organisme defense against pathogens needs complexe interactions interactions between immune cells and environnement. The extracellular matrix is being remodeled to aloww cells to migrate to infectious site. Peptides generated by this degradation can influence biological fonctions of immune cells. In pathologies involving elastin rich tissue degradation inflammatory and immune cells, especially neutrophils and dendritic cells are in an environnement including numbers of matrix degradation products. This work shows that Elastin Peptides (EP) can regulate the fonctions of neutrophils from healthy subjects, by increasing significantly their migration, their cytokines production and their phagocytic capacity. These EP effects are howeever less important en stable COPD subject and depends on the clinical state of these patients. Indeed the biological properties of neutrophils from COPD patients in exacerbation are not affected by EP. This discrepancy considering the clinical state can be explained by the level of the S-Gal receptor expression. In a second part we have shown the ability of the EP to attract dendritic cell (DC) on the infection site without couetracting DC maturation. This effect involves the S-Gal receptor present on the surface of the cells. EP can also oriente the cytokine production by LPS-induced toward a Th-2 profil and favorise the emergence of DC with tolerogenic features. These effects are mediated throug EP/S-Gal interaction and leads to the developement of a T regulatory response. All of these results suggest that EP are involved in the regulation of innate and adaptative immunity.