Chronic Respiratory Disease

The aim of the present study is to conduct a social media content analysis of chronic obstructive pulmonary disease (COPD) patient education videos on YouTube. A systematic search protocol was used to locate 223 videos. Two independent coders evaluated each video to determine topics covered, media source(s) of posted videos, information quality as measured by HONcode guidelines for posting trustworthy health information on the Internet, and viewer exposure/engagement metrics. Over half the videos (n = 113, 50.7%) included information on medication management, with far fewer videos on smoking cessation (n = 40, 17.9%). Most videos were posted by a health agency or organization (n = 128, 57.4%), and the majority of videos were rated as high quality (n = 154, 69.1%). HONcode adherence differed by media source (Fisher’s exact test = 20.52, p = 0.01), however with user-generated content receiving the lowest quality scores. Overall level of user engagement as measured by number of “likes,” “favorites,” “dislikes,” and user comments was low (median range = 0–3, interquartile range = 0–16) across all sources of media. Study findings suggest that COPD education via YouTube has the potential to reach and inform patients; however, existing video content and quality varies significantly. Future interventions should help direct individuals with COPD to engage with high-quality patient education videos on YouTube that are posted by reputable health organizations and qualified medical professionals. Patients should be educated to avoid and/or critically view low-quality videos posted by individual YouTube users who are not health professionals.

The most important long-term complication of pulmonary thromboembolism is chronic thromboembolic pulmonary hypertension (CTEPH) that is associated with considerable morbidity and mortality. It is uncertain why some patients with acute pulmonary embolism (PE) develop CTEPH and others do not. Elevated red cell distribution width (RDW) has been associated with adverse outcomes of heart failure, PE, and idiopathic pulmonary hypertension. The aim of the present study was to investigate whether RDW might be a predictor of CTEPH in PE patients or not. This study is a retrospective cohort study. A total of 203 consecutive patients with acute PE were included. The RDW was higher in the CTEPH patients than the patients without CTEPH (17.04 ± 3.46, 14.64 ± 1.82, respectively, p = 0.015). RDW was also higher in the CTEPH patients at the time of diagnosis of CTEPH during follow-up compared with the baseline RDW level at the time of PE diagnosis (18.63 ± 3.58, 17.02 ± 3.59, respectively, p = 0.014). The optimal cutoff value of the RDW for predicting CTEPH was 14.65. The area under the curve of RDW for the prediction of CTEPH was 0.735 (95% confidence interval (CI): 0.600–0.869); in cases with RDW levels >14.65%, the specificity, sensitivity, and negative predictive value for CTEPH were 62% (95% CI: 0.55–0.69), 75% (95% CI: 0.47–0.92), and 96.7% (95% CI: 0.91–0.99), respectively. A multivariate regression analysis showed that RDW, hazard ratio: 1.58 (95% CI: 1.09–2.30), was a predictor of CTEPH (p = 0.016). High level of RDW was an independent predictor of CTEPH in PE patients. Therefore, RDW levels may provide a prediction for CTEPH in PE patients.

Several studies have shown gender differences in prevalence of asthma but there is little information about asthma control. In this study, we aimed to evaluate the effect of gender on asthma control in adult asthmatics. Medical records of 242 patients older than 18 years of age who regularly visited the allergy unit were evaluated. Standardized asthma questionnaires like the asthma control test (ACT) were performed. ACT scores, clinical characteristics, and demographic data such as smoking status, education, duration and severity of asthma, atopic status, family history of asthma, analgesic hypersensitivity, number of emergency visits, and hospitalization in the previous year were compared based on gender. In this study, 77.3% of the patients were female. Mean age, body mass index, and duration of asthma were 39.0 ± 0.7, 27.3 ± 0.3, and 6.6 ± 0.4 years, respectively. Of the total, 14.9% of the patients were smokers. Also, 55.8% of them were graduated from middle school, 22.7% from high school, and 14% from university. Atopy rate was 57%. Analgesic hypersensitivity was found in 18.6% of them. There was 30.2% family history of asthma. The asthma severity was mild in 45.5%, moderate in 40.9%, and severe in 13.6% of the patients. One-third of the patients were admitted to emergency room; 1/10th were hospitalized due to asthma in the previous year. ACT scores indicated complete control in 67.8%, partial control in 17.8%, and uncontrolled asthma in 14.5%. Comparing the results of males with females having asthma, there was no statistically significant difference between the two gender according to ACT scores and clinical characteristics. Finally, the results conclude that there was no effect of gender on asthma control assessed with standardized questionnaire in adult asthmatics.

The objective of this study was to derive and validate an equation to estimate the speed for the endurance shuttle walk test (ESWT) using results from the six-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD). Participants with diagnosed COPD (n = 84) performed two incremental shuttle walk tests (ISWTs) and two 6MWTs. ESWT speed was calculated from the ISWT results using the original published method. An equation was derived, which directly related six-minute walk distance (6MWD) to ESWT speed. The derived equation was validated in a different group of people with COPD (n = 52). There was a strong correlation between average 6MWD and the calculated ESWT speed (r = 0.88, p < 0.001). The ESWT speed (kilometre per hour) was estimated using the following equation: 0.4889 + (0.0083 × 6MWD). The mean difference (±limits of agreement) between ESWT speeds was calculated using the original published method and found to be 0.03 (±0.77) km/hour. When the ISWT is not the test of choice for clinicians, the 6MWT can be used to accurately estimate the speed for the ESWT.

Pulmonary rehabilitation (PR) is an effective treatment for people with chronic obstructive pulmonary disease (COPD). However, uptake and adherence to rehabilitation is poor and non-adherence is associated with poorer clinical outcomes. This study investigated the factors that might predict an individual completing his/her PR programme. Demographic, physiological and psychological data were collected from routine assessment information. Non-completers (N = 213) who dropped out after initial assessment were compared with completers (N = 438) who attended all 6 weeks of PR programme. Regression analysis indicated that smoking status was the strongest predictor for completing PR programme, that is, ex-smokers were 2.6 times (95% confidence interval (CI) = 1.7–3.9) and those who had never smoked were 2.5 times (95% confidence interval (CI) = 1.1–5.7) more likely to complete in comparison with those who were current smokers. Scoring better on psychological well-being measures (odds ratio = 1.6; 95% CI = 1.2–1.9) was also a strong predictor. The findings suggest the areas that could be addressed to enhance adherence to rehabilitation, for example, targeted interventions for clients who continue to smoke and for those who require support for psychological distress.

As life expectancy of patients with Duchenne muscular dystrophy (DMD) has increased to the 5th decade, in part due to improved ventilatory support, cardiomyopathy is projected to increase as a cause of death. International guidelines recommend an annual assessment of cardiac function and initiation of appropriate pharmacological treatment. We conducted an audit of the cardiac management in patients with DMD requiring ventilatory support and reported a case series of the collated cardiac investigations. Patients with DMD requiring ventilatory support were included in the study. The date of the last electrocardiogram (ECG), echocardiogram (ECHO), cardiology review and pharmacological management were retrieved from the medical records. If an annual cardiac assessment had not been performed this was requested and the latest ECGs and ECHO reports were collated. A total of 30 patients with DMD (29 males, mean (SD) age of 30 (7) years) met the inclusion criteria. Although there was ECG and ECHO documentation in 24 and 21 individuals, respectively, it was only recent in 10 and 6 individuals. In all, 60% of patients had been assessed by a cardiologist, but only 10% within the last year. Over half of the patients failed to attend their new appointments. From the available results, 18 of the 19 patients had an abnormal ECG, 11 of the 16 patients had left ventricular (LV) impairment and 55% of patients had a change in prescription following cardiac investigations. There is a need for a coordinated cardiorespiratory approach towards adult patients with DMD. Over a third of patients had normal LV function suggesting that cardiomyopathy is not inevitable in this group.

In view of the worldwide aging population, disease-specific geriatric rehabilitation (GR) programs are needed. Therefore, we developed and implemented a postacute GR program for patients with advanced chronic obstructive pulmonary disease (COPD) (the GR-COPD program). The aim of this study is to investigate the feasibility of the GR-COPD program and to present clinical data on patient characteristics and course of functional capacity and health status. This is a naturalistic prospective cohort study of patients with advanced COPD. A total of 61 patients entered the GR-COPD program and were eligible to participate in this study. All patients suffered from advanced COPD, and comorbidities were frequent. On admission, functional capacity and health status were severely limited but showed significant and clinically relevant improvement during the GR-COPD program. Patients with advanced COPD admitted to hospital for an acute exacerbation suffer from severely impaired functional capacity and poor health status. Development and implementation of a postacute GR program for these patients are feasible and likely to offer substantial improvements. Further research is essential and should focus on designing a controlled intervention trial to investigate the efficacy of the program.