Archive for the ‘COPD’ Category

Reanalysis of the 12-Minute Walk in Patients With Chronic Obstructive Pulmonary Disease - ConclusionIt has been shown that the 12-min walking test does not correlate significantly with FEV, but there have been differing results as to whether it does2 or does not correlate with FVC. Our results support the latter finding (r = -0.16). In addition, we found that there was a significant correlation between changes in the FEVj and changes in the 12-min (r = 0.53) and changes in the 6-min (r = 0.53) walking tests.
Previous studies, as well as our own, demonstrate that the results of walking tests correlate with functional capacity as assessed by symptom-limited maximal exercise tests. However, in assessing the effects of an intervention for a given individual, it is more important to understand how changes in walking test performance correlate with the changes in the maximum exercise capacity. It would be advantageous to be able to predict the change in Vo2max, that a patient is experiencing since his last examination from his walking test alone because it precludes the necessity of using more complicated apparatuses such as a treadmill or bicycle ergometer. canadian neightbor pharmacy

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More traditional ways to assess the aerobic capacity of a patient with COPD include treadmill and bicycle ergometry. The 12-min walking test has three specific advantages: (a) no sophisticated equipment is necessary; (b) the ability of a patient to walk is more clinically relevant than their maximal performance; (с) the act of walking is familiar to all, whereas some individuals may have difficulty riding a bicycle or using a treadmill. Despite these positive aspects, there are drawbacks from assessing the functional capacity of an individual with the 12-min test alone. These include: (a) it can only be used with moderate or severe disease because walking distance is not limited by mild disease; (b) with the 12-min walk there is no simultaneous measurement of minute ventilation, Vo2, or Vco2; and (c) it is difficult to objectively measure the effort involved while performing the test. With a progressive exercise test (ie, treadmill or bicycle ergometer), the heart rate and ventilation in relation to a predicted maximum are recorded. With the walking test, a Borg score or a visual analogue score for dyspnea is frequently obtained. canadian health&care mall

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Reanalysis of the 12-Minute Walk in Patients With Chronic Obstructive Pulmonary Disease - ResultsThe correlations are similar for all of the different walking distances except for the first 2-min distance, which correlates less well than the others. None of the walking distances was closely correlated with either the FEV, or the FVC.
The 6-niin and 12-min walking distances are more closely correlated with the Vo., than were the FEV, or FVC (Table 4). However, the FEV, is better correlated with the Vco, than are the walking distances. The negative correlation between the FVC and the Vo,/kg and the Vco,/kg demonstrates that the FEV, is much more important than the FVC in determining exercise capacity in patients with moderate obstructive disease. The v alues in the last rows of the table, labeled “12 min + Borg” and “6 min + Borg,” represent the multiple correlation coefficients when the 12- and 6-min walking distances and the Borg scores at the end of the walks were used as the independent variables in multiple regression analysis. The purpose of evaluating this is to determine if including a measure of ef fort (the Borg score) improves the correlations. The analysis shows that there is very little increase in the correlation coefficients when the Borg score was included. When other measures of the Borg score were used in multiple regression, there was likewise no increase in the correlation. my canadian pharmacy.com

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Results of the walking distances in each interv al and the cumulative Borg scores were compared by means of analysis of variance. Where statistical significance was achieved with the F test (p < 0.05), the least significant difference between the means was calculated. The relationship between the distance walked and the spirometric measurements or the measurements obtained from the symptom-limited maximal exercise tests were analyzed using simple linear regression. Multiple linear regression was used to determine the relationship between the independent variable of Vo max and the dependent variables of walking distance and Borg score. Values of probability less than 0.05 were considered statistically significant. All experimental values are reported as mean ± SD where applicable.
We analyzed the changes in the different test results from session to session by calculating the percentage change in each test from the initial measurement on that patient. Thus, there were five data points for each of the nine subjects, yielding a total of 45 points for analysis by simple linear regression.
The demographics of our patients are shown in Table 1. Nine male patients with a mean age of 67 years took part in the study. The average patient had moderate COPD, as evidenced by the FEVj of 1.32 ± 0.28 L. The mean maximal workload achieved in the exercise test was 81 W, which can be compared with the predicted workload of 180 W for men over 60 years of age/’ The Vo.,max was slightlv over a liter.
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Reanalysis of the 12-Minute Walk in Patients With Chronic Obstructive Pulmonary Disease - Materials and MethodsThe 12-min walking test has become a popular method by which one may determine the functional capacity of an individual with COPD. Cooper originally designed the 12-min running test as a means to correlate fitness with maximal oxygen intake (Vo2max) in healthy young men. McGavin et al2 adapted this idea in developing a walking test as a simple method to estimate exercise tolerance in patients with chronic bronchitis. Recently, several reports suggested that the same information can be obtained with tests of shorter duration.
The objectives of this study were (1) to determine the correlation between the different intervals in the 12-min walking test to assess if it is necessary to walk the patient for 12 full minutes; (2) to determine which of the intervals best correlated with Vo2max and maximal CO£ expelled (Vo2max); (3) to determine if adding a measure of effort (ie, the Borg score) improves the correlations; and (4) to determine the degree of correlation between changes in the Vo2max and changes in the walking test or spirometry.
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Therefore, the identification of an accelerated phase of respiratory failure is prog-nostically important. In fact, in this phase, other therapeutic measures (such as some form of intermittent mechanical ventilatory assistance) other than LTOT have been suggested to control the evolution of the disease.
In our patients treated with LTOT, the rate of decline of Pa02 over time as well as the rate of increase of PaC02 were less pronounced than those reported by Cooper and Howard. The life expectancy of our patients was very poor because they had had an episode of ARF requiring mechanical ventilation and also because they subsequently experienced several relapses of ARF. Despite this, the worsening of the respiratory function was relatively slight. One possible explanation is that all of our patients but one stopped smoking at the beginning of the follow-up. It is well known that FEVX is highly correlated with survival and that it decreases faster in smokers than in nonsmokers or ex-smokers. Stopping smoking reduces the decline of FEVX to the level found in nonsmokers. A lower survival rate has been reported in patients with COPD receiving LTOT who continued smoking compared with those who stopped. However, if one compares the survival rate at 2 years of our patients receiving LTOT with that of the nonsmokers of the Swedish study, the difference in favor of our group is considerable (86 percent vs 55 percent). Thus, other factors could have influenced the slight worsening of the respiratory function found in our patients.
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The Effect of Intermittent. Negative Pressure Ventilation and Long-term Oxygen Therapy for Patients With COPD - DiscussionLong-term oxygen therapy has been shown to improve the quality of life and the length of survival of patients with COPD with hypoxemia, even though this form of treatment does not seem to arrest the course of the underlying airway disease. Recendy, Cooper and Howard studied a series of 35 patients with COPD receiving LTOT and observed a worsening of FEVj before death despite the administration of oxygen. This observation suggests that oxygen therapy is ineffective in arresting the progression of the disease and that patients with low FEVj values at the commencement of LTOT are therefore likely to receive a limited benefit from oxygen. Long-term oxygen therapy is generally recognized to improve survival in patients with COPD who present with an acute exacerbation treated with mechanical ventilation. To our knowledge, however, no specific data supporting this conclusion have been published.
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