Introduction: COPD is a progressive disease, characterised by symptoms of dyspnoea, fatigue, exercise intolerance and reduced physical activity, resulting in impaired quality of life. Furthermore, the disease poses a significant burden on healthcare systems around the world. SPACE FOR COPD is a new self-management programme which aims to support individuals in acquiring the knowledge and skills required to optimise their emotional and medical well-being. Methods: This thesis describes a randomised controlled trial which aims to establish the effectiveness of a SPACE FOR COPD compared with usual care alone. 184 people with COPD were recruited from primary care. Individuals were randomly allocated to receive either the SPACE FOR COPD intervention or to continue with their usual care. The primary outcome was a measure of health-related quality of life (HRQoL), the Chronic Respiratory Questionnaire – Self Report (CRQ-SR) dyspnoea domain. Secondary measures included exercise performance, anxiety, depression, knowledge, self-efficacy and physical activity. Outcome measures were recorded at baseline, six weeks and six months. Results: There was no significant between-group difference in the change in dyspnoea at six months, therefore our hypothesis was rejected. In secondary outcomes, there were significant gains in HRQoL, exercise, performance, anxiety, knowledge and steps at six weeks, and at six months changes in exercise performance and anxiety remained statistically significant. Correction for multiple comparisons, however, had not been made. Conclusions: SPACE FOR COPD did not result in improved dyspnoea, over and above usual care at six months. The programme may confer significant benefits in HRQoL, exercise performance, anxiety, knowledge and physical activity over and above usual care in the short-term, and gains in anxiety and exercise performance maintained at six months. Although these patients were relatively early within the course of their disease, physical activity was low, highlighting the need for a lifestyle intervention in this group of patients. Exploration of the potential benefit of additional on-going support, and delivery within group settings may of value in order to support the maintenance of these benefits in the medium- and longer-term.

Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94 – 1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

PURPOSE: Previous studies have reported an increased prevalence of ocular diseases in patients with obstructive sleep apnea. The purpose of this study was to examine the link between such ocular diseases as diabetic retinopathy, diabetic macular edema, retinal vein occlusion, central serous chorioretinopathy, age-related macular degeneration, non-arteritic anterior ischemic optic neuropathy, and glaucoma. METHODS: This meta-analysis was conducted through a search using PubMed, Web of Science, Scopus and EMBASE. We identified both retrospective and prospective studies. RESULTS: The final meta-analysis looked at 30 studies and 7 ocular diseases. The data showed a high prevalence of obstructive sleep apnea for diabetic retinopathy and diabetic macular edema patients. Data for glaucoma and non-arteritic anterior ischemic optic neuropathy patients did not show a statistical increase. There was not enough data for retinal vein occlusion, central serous chorioretinopathy and age-related macular degeneration to calculate statistical significance. CONCLUSION: These data suggests that patient populations with diabetic retinopathy and macular edema show increased rates of obstructive sleep apnea. Data suggest that hypoxia is an important part of the pathophysiology of diabetic retinopathy and diabetic macular edema. Because obstructive sleep apnea has been shown to affect the progression of the ocular diseases included in this study, ophthalmologists should screen for the presence of obstructive sleep apnea to better help their patients. / 2021-06-14T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Efforts to encourage the medical community to prescribe exercise for disease prevention and management have increased significantly in recent years. In patients with obstructive sleep apnea (OSA), it is encouraging that exercise has been shown to improve sleep efficiency, daytime sleepiness, and disease severity. However, in order to better understand the dose-response relationship between exercise and OSA-related outcomes, accurate and reliable methods for assessing physical activity habits are needed. Purpose: To determine the test-retest reliability and validity of two self-report physical activity questionnaires [Physical Activity Vital Sign (PAVS); International Physical Activity Questionnaire-Short Form (IPAQ-SF)] in an OSA population. Methods: 39 adults with moderate-to-severe OSA wore an accelerometer for seven consecutive days and completed the PAVS and IPAQ-SF (twice within 10 d), along with questionnaires on quality of life, sleepiness, and treatment adherence. Test-retest reliability was determined using intraclass correlation coefficients (ICC). Criterion and construct validity were determined using Pearson (r) and Spearman correlation coefficients (ρ), respectively. Results: PAVS and IPAQ-SF scores were reported as total min/wk of moderate-vigorous physical activity (MVPA). Test-retest reliability for MVPA was excellent for PAVS (ICC = 0.982) and good for IPAQ-SF (ICC = 0.766). MVPA assessed via accelerometry was strongly correlated with PAVS (r = 0.802) and moderately with IPAQ-SF (r = 0.569). Both PAVS and IPAQ-SF were significantly correlated with body mass index (BMI) (ρ = -0.273 and -0.268, respectively), but no other variables. Conclusions: The PAVS and IPAQ-SF are reliable and valid PA questionnaires and may be utilized as a tool for accurately assessing physical activity levels in OSA patients.

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Rationale: The prevalence of obesity among individuals with chronic obstructive pulmonary disease (COPD) is increasing, which contributes to further ventilatory limitations, and compromised exercise capacity, and health-related quality of life (HRQOL) compared to COPD alone. Objective: To conduct a systematic review to evaluate the effects of exercise interventions on walking capacity, ventilatory parameters, anthropometrics and HRQOL in individuals with COPD and elevated weight. Methods: A search was conducted on March 16, 2018 of Embase, Medline, CINAHL, AMED and PsycINFO for controlled trials of exercise interventions, involving adults with any stage of severity and stability of COPD with concurrent obesity or overweight. Overall effects were determined with standardized (SMD) and weighted (WMD) mean difference, using Review Manager 5.3. Results: Nineteen studies with 1716 participants (BMI mean ± SD 28.2 ± 5.1 kg/m2) were included. Exercise interventions were effective in improving walking capacity measured by the 6-Minute Walk Test (6MWT), Endurance Shuttle Walk Test and Incremental Shuttle walk Test (12 studies, 1215 participants, SMD 0.25 (95% CI [0.06, 0.43]); p=0.01), fat-free mass index (2 studies, 285 participants, WMD 0.33 kg/m2 (95% CI [0.21, 0.46]); p<0.00001), St. George Respiratory Questionnaire (6 studies, 648 participants, WMD -7.49 points (95% CI [-13.01, -1.98]); p=0.008) and Chronic Respiratory Disease Questionnaire Dyspnea (5 studies, 478 participants, WMD 0.51 points (95% CI [0.00, 1.02]); p=0.05), Emotion (4 studies, 404 participants, WMD 0.28 points, 95% CI [0.03, 0.54]); p=0.03), and Mastery domains (4 studies, 404 participants, WMD 0.31 points (95% CI [0.02, 0.59]); p=0.03). There were no effects on ventilatory parameters or anthropometric measures. Conclusions: Exercise interventions were effective in improving walking capacity and HRQOL in individuals with COPD and elevated weight. There is an important opportunity to establish effective interventions to minimize the functional and health effects in this subset of the COPD population. / Thesis / Master of Health Sciences (MSc)