Publications
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Celli B, Tetzlaff K, Criner G, et al., 2016, The 6-minute walk test as a COPD stratification tool: insights from the COPD biomarker qualification consortium, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 1483-1493, ISSN: 1535-4970
BACKGROUND: The 6-minute walk test distance (6MWD) predicts mortality in COPD. Whether variability in study type (observational versus interventional), region performed limits use of the test as a stratification tool or outcome measure for therapeutic trials is unclear. METHODS: Original data from 14,497 COPD patients from 6 observational (n = 9641) and 5 interventional (n=4856) studies larger than 100 patients and longer than 6 months in duration were included. The geographical, anthropometrics, FEV1, dyspnea, co-morbidities and health status scores were measured. Associations between 6MWD with mortality, hospitalizations and exacerbations adjusted by study type, age and gender were evaluated. Thresholds for outcome prediction were calculated using receiver-operating curves. The change in 6MWD after inhaled bronchodilator treatment and surgical lung volume reduction (LVRS) were analyzed to evaluate the responsiveness of the test as an outcome measure. RESULTS: The 6MWD was significantly lower in non-survivors, those hospitalized or who exacerbated compared with those without events at 6, 12 and > 12 months. At these time points, the 6MWD ROC-AUC to predict mortality was 0.71, 0.70 and 0.68 and for hospitalizations was 0.61, 0.60 and 0.59. After treatment, the 6MWD was not different between placebo or bronchodilators but increased after LVRS compared with medical therapy. Variation across study types (observational or therapeutic) or regions did not confound the ability of 6MWD to predict outcome. CONCLUSIONS: The 6MWD may help stratify COPD patients for clinical trials and interventions aimed at modifying exacerbations, hospitalizations or death.
Dueñas-Espín I, Demeyer H, Gimeno-Santos E, et al., 2016, Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study, International Journal of Chronic Obstructive Pulmonary Disease, Vol: 11, Pages: 1287-1295, ISSN: 1176-9106
Background: The role of anxiety and depression in the physical activity (PA) of patients with COPD is controversial. We prospectively assessed the effect of symptoms of anxiety and depression on PA in COPD patients.Methods: We evaluated anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), PA (Dynaport® accelerometer), and other relevant characteristics in 220 COPD patients from five European countries at baseline and at 6 and 12 months of follow-up. HADS score was categorized as: no symptoms (score 0–7), suggested (8–10), and probable (>11) anxiety or depression. We estimated the association between anxiety and depression at t (baseline and 6 months) and PA at t+1 (6 and 12 months) using regression models with a repeated measures approach.Results: Patients had a mean (standard deviation) age of 67 (8) years, forced expiratory volume in 1 second 57 (20)% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, -149 to -12, P=0.02) per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA.Conclusion: In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later.
Hopkinson NS, 2016, What comes after standardised packaging for tobacco?, British Medical Journal, Vol: 353, ISSN: 0959-8138
Demeyer H, Dueñas-Espín I, De Jongh C, et al., 2016, Can health status questionnaires be used as a measure of physical activity in COPD patients?, European Respiratory Journal, Vol: 47, Pages: 1565-1568, ISSN: 1399-3003
Britton J, Arnott D, McNeill A, et al., 2016, Nicotine without smoke-putting electronic cigarettes in context., British Medical Journal, Vol: 353, Pages: i1745-i1745, ISSN: 1468-5833
Electronic cigarettes have exploded on to global markets over the past decade and in the process have generated some strongly polarised views.1 2 3 Some believe that e-cigarettes are a disruptive technology that could consign tobacco smoking to history; others think that they are a distraction from core public health aims of eradicating all nicotine use and a tobacco industry ploy to perpetuate smoking and undermine international tobacco control treaties. This article summarises the findings of a new report by the Royal College of Physicians (RCP) on the role of e-cigarettes in tobacco harm reduction.4
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