Chronic Respiratory Disease

Shifts in natural or spontaneous language have been reported with psychological and physical changes, as well as shifts in predetermined words selected to describe dyspnea. Less evidence exists for natural language shifts and breathing intensity, particularly for everyday life and for negative emotion. Therefore, this study purpose was to describe the relationship between levels of everyday breathing intensity and the natural language word categories used in describing breathing, including a negative emotion category. A longitudinal descriptive research design and a convenience sample of 45 individuals were used. Natural language was analyzed as rates of word used based on three levels of breathing intensity. Non-parametric statistics were used to test differences between rates of word use and non-use on low, moderate, and high breathing intensity days, as well as correlations to subscales that measured negative emotion on the Bronchitis–Emphysema Symptom Checklist (BESC) and the Breathing Standard Index. Statistically significant associations were reported between level of breathing intensity and negative emotion, anger, cause, insight, time, and body words. Several significant correlations were reported with the psychosocial measures, including negative emotion and anxiety words with the BESC hopelessness/helplessness, time subscale, and negative emotion words with the inverse of typical breathing (i.e., atypical breathing). By showing significant associations between key word categories, in particular negative emotion and anger word use, levels of breathing intensity, and selected psychosocial measures, this study contributes to the body of knowledge about the influence of levels of breathing intensity on natural word use in everyday life.

Although obesity is increasing in prevalence, relatively little attention has been given to its impact on outcomes in patients with chronic obstructive pulmonary disease (COPD) completing pulmonary rehabilitation. We conducted a retrospective chart review of 114 patients with COPD who completed outpatient pulmonary rehabilitation at our center. Body habitus categories were determined based on body mass index (BMI). Underweight patients (BMI < 21 kg/m²) were excluded from the analysis. Normal weight and overweight patients were classified as non-obese. Obese patients (BMI >30 kg/m²) were compared with non-obese patients in the following areas: forced expiratory volume in 1 s (FEV₁) percent predicted, the 6-min walk distance (6MWD), health status, the number of unsupported arm lifts per minute, and functional performance. Health status was determined using the Self-Reported Chronic Respiratory Questionnaire (CRQ-SR), which has dimensions of dyspnea, fatigue, emotion, and mastery. Functional performance was determined using the Pulmonary Functional Status Scale Daily Activities subscore. Compared with non-obese patients, obese patients had a higher FEV₁ percent-predicted (44 ± 15% vs 52 ± 16%; P = 0.01), yet had lower 6MWD (269 ± 11 vs 203 ± 13; P = 0.0002), lower functional status, and greater fatigue at initial evaluation. However, the two groups had similar walk-work, which adjusts for differences in weight. Despite the baseline differences, both groups improved similarly following pulmonary rehabilitation (change in 6MWD was 52 ± 7 m in the non-obese patients versus 47 ± 9 in the obese patients; P = 0.65). Our study suggests that obese COPD patients are referred to pulmonary rehabilitation at an earlier spirometric stage of their disease, but have a poorer exercise performance, a greater degree of functional impairment and greater fatigue levels. This is probably, largely because of the effect of an increased weight burden. However, obesity did not seem to adversely affect the pulmonary rehabilitation outcomes.

Chronic cough is a common symptom in a wide range of respiratory conditions, and may also occur as a result of upper airway or gastro-esophageal problems. Whilst chronic cough of any cause may be exacerbated by work, in some cases it has a direct occupational cause, resulting from a harmful acute or chronic workplace exposure. Such occupational conditions may only be suspected by taking a detailed occupational history, and directly asking employed patients whether their cough improves away from work. Early and accurate diagnosis, linked with tailored drug therapy, modification of workplace exposures, and expert compensation advice is likely to offer the best outcome for this group of patients.

Prospective cohort studies have provided a useful tool for the study of the natural history of asthma and lung function and for the development of concepts of asthma phenotypes during childhood. However, although observational epidemiology has indicated a large number of credible associations between environmental variables and asthma onset in childhood, it can be argued that it has yet to fulfill the promise of identifying modifiable, causal risk factors that are amenable to intervention for the primary or secondary prevention of disease. The development of efficient, high-throughput genotyping that can be applied to large, longitudinal cohorts with detailed data on exposures and phenotypic outcomes, opens the way for studies of genetic effects and gene–environment interactions that may come closer to identifying causal pathways between exposure and disease. Therefore, there continues to be an important role for large-scale, observational studies with careful attention to definition and evaluation of outcomes and plausible risk factors.

Obesity is a worldwide epidemic and is known to increase the risk of cardiovascular disease, type 2 diabetes, and certain forms of cancer. In addition, obesity is now recognized as an important risk factor in the development of several respiratory diseases. Of these respiratory diseases, it has already been well established that obesity can lead to obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS). More recent data suggest that the prevalence of wheezing and bronchial hyper-responsiveness, two symptoms often associated with asthma, are increased in overweight and obese individual. Indeed, epidemiological studies have reported that obesity is a risk factor for the development of asthma. Furthermore, a number of studies indicate that obesity is also associated with a higher risk of developing deep vein thrombi, pulmonary emboli, pulmonary hypertension, and pneumonia. Finally, weight reduction has been shown to be effective in improving the symptoms and severity of several respiratory diseases, including OSA and asthma. Thus, overweight and obese patients should be encouraged to lose weight to reduce their risk of developing respiratory diseases or improve the course of pre-existing conditions.