The Aging Lung: Is lung health good health for older adults?
Chest. 2018 Sep 22;:
Authors: Bowdish DME
The prevalence of lung conditions, such as chronic obstructive pulmonary disease and pulmonary fibrosis, and lung infections such as pneumonia, increase sharply with age. The physiologic, cellular and immunologic changes that occur during aging contribute to the development of lung disease. Studies of age-related changes in physiology and function are not just key to preventing or ameliorating disease, they are essential for understanding healthy aging. Individuals with good lung function live longer, healthier lives, although the mechanisms by which this occurs are not understood. Herein, we review changes in the aging lung that facilitate development of disease and the evidence supporting the idea that robust lung function reduces the risk of developing chronic inflammatory conditions that occur with age.
PMID: 30253136 [PubMed - as supplied by publisher]
Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients.
PLoS One. 2018;13(9):e0204458
Authors: Lastrucci V, D'Arienzo S, Collini F, Lorini C, Zuppiroli A, Forni S, Bonaccorsi G, Gemmi F, Vannucci A
BACKGROUND: Cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) in the advanced stages have similar symptom burdens and survival rates. Despite these similarities, the majority of the attention directed to improving the quality of end-of-life (EOL) care has focused on cancer.
AIM: To assess the extent to which the quality of EOL care received by cancer, CHF, and COPD patients in the last month of life is diagnosis-sensitive.
METHODS: This is a retrospective observational study based on administrative data. The study population includes all Tuscany region residents aged 18 years or older who died with a clinical history of cancer, CHF, or COPD. Decedents were categorized into two mutually exclusive diagnosis categories: cancer (CA) and cardiopulmonary failure (CPF). Several EOL care quality outcome measures were adopted. Multivariable generalized linear model for each outcome were performed.
RESULTS: The sample included 30,217 decedents. CPF patients were about 1.5 times more likely than cancer patients to die in an acute care hospital (RR 1.59, 95% C.I.: 1.54-1.63). CPF patients were more likely to be hospitalized or admitted to the emergency department (RR 1.09, 95% C.I.: 1.07-1.10; RR 1.15, 95% C.I.: 1.13-1.18, respectively) and less likely to use hospice services (RR 0.08, 95% C.I.: 0.07-0.09) than cancer patients in the last month of life. CPF patients had a four- and two-fold higher risk of intensive care unit admission or of undergoing life-sustaining treatments, respectively, than cancer patients (RR 3.71, 95% C.I.: 3.40-4.04; RR 2.43, 95% C.I.: 2.27-2.60, respectively).
CONCLUSION: The study has highlighted the presence of significant differences in the quality of EOL care received in the last month of life by COPD and CHF compared with cancer patients. Further studies are needed to better elucidate the extent and the avoidability of these diagnosis-related differences in the quality of EOL care.
PMID: 30252912 [PubMed - in process]
Home-Based, Moderate-Intensity Exercise Training Using a Metronome Improves the Breathing Pattern and Oxygen Saturation During Exercise in Patients With COPD.
J Cardiopulm Rehabil Prev. 2018 Sep 24;:
Authors: Bernardi E, Pomidori L, Cassutti F, Cogo A
PURPOSE: One of the well-known but less-investigated effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is the change in breathing pattern toward a more efficient one (higher tidal volume [VT], lower breathing frequency). Evidence suggests this change can be obtained only with supervised, high-intensity exercise training (ExTr). However, some patients either do not have such programs available or are unable to exercise at higher intensity. We evaluated the effects of a 12-wk, moderate-intensity, home-monitored ExTr program using a metronome on the breathing pattern, oxygen saturation (SpO2), and dyspnea during exercise in patients with COPD.
METHODS: Twenty-one patients with COPD (7 female, aged 64-85 yr) performed spirometry, incremental, and endurance walking tests (at 60% of maximal walking speed) on a treadmill before and after training. During the endurance test, patients were equipped with an instrument that continuously monitored ventilation (VE), breathing pattern, and SpO2. Patients trained at home for 12 wk, 30 min/d for at least 4 d/wk at moderate intensity. A metronome paced the walking speed.
RESULTS: Sixteen patients completed the program. After training, a significant change was observed in breathing pattern (lower VE and VE/VT ratio; P < .001), a higher SpO2 (P < .001), and a lower dyspnea perception at the same work intensity (P < .01). The VE/VT ratio and SpO2 during exercise were significantly related (r = 0.56, P = .001).
CONCLUSION: A change in breathing pattern towards more efficient ventilation can be obtained with a moderate, home-monitored ExTr program with a pace that is controlled by a metronome. Decreased VE/VT was associated with an improved SpO2 during exercise.
PMID: 30252781 [PubMed - as supplied by publisher]
Participation in Pulmonary Rehabilitation by Veterans Health Administration and Medicare Beneficiaries After Hospitalization for Chronic Obstructive Pulmonary Disease.
J Cardiopulm Rehabil Prev. 2018 Sep 24;:
Authors: Vercammen-Grandjean C, Schopfer DW, Zhang N, Whooley MA
BACKGROUND: Hospitalization with acute exacerbation of chronic obstructive pulmonary disease (COPD) is common and costly to the health care system. Pulmonary rehabilitation (PR) can improve symptom burden and morbidity associated with COPD. The use of PR among Medicare beneficiaries is poor, and the use by Veterans Health Administration (VHA) beneficiaries is unknown. We sought to determine whether participation in PR was similarly poor among eligible veterans compared with Medicare beneficiaries.
METHODS: We performed a retrospective study using national VHA and Medicare data to determine the proportion of eligible patients who participated in PR after hospitalization for an acute exacerbation of COPD between January 2007 and December 2011. We also evaluated patient characteristics including demographic factors and comorbid medical history associated with participation.
RESULTS: Over the 5-year study period, 485 (1.5%) of 32 856 VHA and 3199 (2.0%) of 158 137 Medicare beneficiaries hospitalized for COPD attended at least 1 session of PR. Among both VHA and Medicare beneficiaries, participation was higher in those who had had comorbid pneumonia or pulmonary hypertension and was lower in older patients. Although participation increased in both groups over time, it remained exceedingly low overall.
CONCLUSION: Pulmonary rehabilitation is significantly underused in both the VHA and Medicare populations. Although comorbid pulmonary disease is associated with higher use, the proportion of eligible patients who participate remains extremely low.
PMID: 30252780 [PubMed - as supplied by publisher]
Prevalence of Comorbidities among Older Head and Neck Cancer Survivors in the United States.
Otolaryngol Head Neck Surg. 2018 Sep 25;:194599818796163
Authors: Eytan DF, Blackford AL, Eisele DW, Fakhry C
Objective The aim of this study was to evaluate the prevalence of comorbidities among patients with head and neck squamous cell carcinoma (HNSCC) at the time of their cancer diagnosis and during their survivorship trajectory. The second aim was to evaluate the differences in comorbidities developed according to treatment type received. Study Design Retrospective cross-sectional. Setting SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database. Subjects and Methods Individuals with a first-incident primary diagnosis of HNSCC from 2004 to 2011 per the SEER-Medicare database were included in analysis. The presence or absence of 30 comorbid conditions of interest was identified during distinct periods and analyzed according to treatment with surgery alone, primary (chemo)radiation, or surgery with (chemo)radiation. Results The study population consisted of 10,524 individuals diagnosed with HNSCC, with a mean age of 74.8 years. At diagnosis, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and diabetes were the most prevalent comorbidities, and they increased over time. The probability of developing treatment-related comorbidities such as pneumonia, dysphagia, weight loss, malnutrition, and dental issues rose significantly in the short and long term following treatment ( P < .05). By 5 years from cancer diagnosis, patients were most likely to have newly diagnosed hypertension, dysphagia, anemia, and weight loss. Primary surgery alone was associated with a lower risk of diagnosis with these treatment-related comorbidities, as compared with treatments involving radiation therapy and/or chemotherapy in the primary or adjuvant settings ( P < .05). Conclusions There is a large burden of comorbidities among patients following HNSCC treatment, which warrant clinical attention during surveillance.
PMID: 30252608 [PubMed - as supplied by publisher]