Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) är en av de vanligaste dödsorsakerna i Sverige och globalt. I Sverige lider mellan 8-10 procent av alla personer över 50 år av KOL, vilket motsvarar fler än 400 000 personer. Endast 40 procent är kända av sjukvården vilket visar på ett stort mörkertal. Sjukdomen räknas som den tredje vanligaste dödsorsaken globalt och orsakar fler än 3 miljoner dödsfall per år. Syfte: Syftet var att beskriva patienters upplevelser av att leva med kronisk obstruktiv lungsjukdom (KOL). Metod: Arbetet är en litteraturöversikt baserad på 10 vetenskapliga artiklar. För att få svar på erfarenheter och upplevelser valdes en kvalitativ metod enligt Friberg. Resultat: I resultatet framkom fem teman: känsla av skuld över att ha orsakat sjukdomen, känsla av skam och hopplöshet över att inte klara sig själv, känsla av rädsla på grund av andningsbesvär, känsla av ensamhet samt känsla av hopp trots begränsningar i tillvaron. Sammanfattning: Känslan av sjukdomen skapade oro, frustration, hopplöshet och rädsla hos patienten. Livet med KOL beskrevs som att utkämpa ett krig utan vapen, i en ständigt krympande värld och med en förlust av frihet. KOL bidrog till ett stort lidande för patienterna och gav dem minskad livskvalitet. Sjuksköterskan har ansvar att se dessa patienter som en helhet och förmedla hopp för att få patienten att uppleva hälsa och välbefinnande samt minskat lidande i sin sjukdom. / Background: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality in Sweden and globally. In Sweden, between 8-10 percent of people over the age of 50 suffer from COPD, which corresponds to more than 400,000 people. Only 40 percent are known to Swedish healthcare, which shows a large number of unreported cases. The disease is considered the third most common cause of death globally, causing more than 3 million deaths per year. Aim: The aim was to describe patients' experience of living with chronic obstructive pulmonary disease (COPD). Method: This study is a literature review based on 10 scientific articles. To get answers to experiences, a qualitative method was chosen by Friberg. Results: The results revealed five themes: feelings of guilt over having caused the disease, feelings of shame and hopelessness about not being able to cope on their own, feelings of fear due to breathing difficulties, feelings of loneliness and feelings of hope despite limitations in life. Conclusion: The feeling of the disease created anxiety, frustration, hopelessness and fear in the patient. Life with COPD was described as fighting a war without weapons, in an ever-shrinking world and with loss of freedom. COPD contributed to suffering for the patients and gave them a reduced quality of life. The nurse is responsible for seeing these patients as a whole and conveying hope to make the patient experience health and well-being as well as reduce suffering in their illness.

Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in the systemic vasculature have been proposed as potential mechanisms linking COPD to cardiovascular disease, and patients with COPD may be at increased risk of acute myocardial infarction during acute exacerbations. Notwithstanding causation, FEV1 may be a useful prognostic marker in patients undergoing cardiac surgery. This thesis examined these three aspects of cardiovascular co-morbidity in relation to COPD and FEV1. In 2,241 consecutive cardiac surgery patients, FEV1 was associated with length of hospital stay (p<0.001) and mortality (p<0.001) adjusting for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, chronic pulmonary disease, and type/urgency of surgery. In a survey of Scottish Respiratory Consultants there was no consensus regarding the investigation and management of acute coronary syndrome in exacerbation of COPD. In a case-series of 242 patients with exacerbations 2.5% (95% CI 1.0 to 5.6%) had chest pain, raised serum troponin and serial electrocardiogram changes suggestive of acute coronary syndrome. However, over half reported chest pain, while raised troponin was not associated with chest pain or serial ECG changes. Carotid-radial pulse wave velocity (PWV), aortic distensibility, and aortic calcification were measured to assess the relationship of the systemic vasculature to FEV1 and emphysema severity on CT. In adjusted analyses, emphysema was associated with PWV in patients with COPD (p = 0.006) and, in population based samples, with extent of distal aortic calcification (p=0.02) but not with aortic distensibility (p=0.60). This thesis found that FEV1 was associated with mortality and length of hospital stay in patients undergoing cardiac surgery, and that chest pain and raised troponin were common but unrelated in exacerbation of COPD. In the vascular studies distal but not proximal vascular pathology was associated with FEV1, and if COPD is truly related to systemic arterial disease, the distal arterial tree is implicated.

Η τηλεϊατρική στηρίζεται στην εφαρμογή της σύγχρονης τεχνολογίας των τηλεπικοινωνιών,της πληροφορικής και τον ηλεκτρονικών υπολογιστών για παροχή υπηρεσιών υγείας, σε απομακρυσμένες περιοχές. Συνδυάζει δηλαδή την τεχνολογία με την ιατρική θέτοντας τις δυνατότητες της πρώτης στην διάθεση της δεύτερης. / The telemedicine is supported in the application of modern technology of telecommunications, information technology and computers for benefit of services of health, in removed regions. It combines that is to say the technology with the medicine placing the possibilities first in the disposal second.

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...

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,...