scholarly journals Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial

10.2196/17597 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e17597
Author(s):  
Ahmed M Al Rajeh ◽  
Yousef Saad Aldabayan ◽  
Abdulelah Aldhahir ◽  
Elisha Pickett ◽  
Shumonta Quaderi ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Once Daily ◽  
Copd Exacerbations ◽  
Daily Monitoring ◽  
The Mean

Background Earlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations. Objective This study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations. Methods A total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline. Results The mean age of the patients was 70.6 (SD 8.1) years, 52% (43/83) were female, and the mean FEV1 was 53.0% (SD 18.5%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2%. However, this was not statistically better than examining changes in symptoms alone. Conclusions Overnight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations. Trial Registration ClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702

scholarly journals Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Ahmed M Al Rajeh ◽  
Yousef Saad Aldabayan ◽  
Abdulelah Aldhahir ◽  
Elisha Pickett ◽  
Shumonta Quaderi ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Once Daily ◽  
Copd Exacerbations ◽  
Daily Monitoring ◽  
The Mean

BACKGROUND Earlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations. OBJECTIVE This study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations. METHODS A total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline. RESULTS The mean age of the patients was 70.6 (SD 8.1) years, 52% (43/83) were female, and the mean FEV1 was 53.0% (SD 18.5%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2%. However, this was not statistically better than examining changes in symptoms alone. CONCLUSIONS Overnight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations. CLINICALTRIAL ClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702

scholarly journals Effort Oxygen Saturation and Effort Heart Rate to Detect Exacerbations of Chronic Obstructive Pulmonary Disease or Congestive Heart Failure

2019 ◽  
Vol 8 (1) ◽  
pp. 42 ◽  
Author(s):  
César Gálvez-Barrón ◽  
Felipe Villar-Álvarez ◽  
Jesús Ribas ◽  
Francesc Formiga ◽  
David Chivite ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Pulmonary Disease ◽  
Physiological Parameters ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Mean

Background: current algorithms for the detection of heart failure (HF) and chronic obstructive pulmonary disease (COPD) exacerbations have poor performance. Methods: this study was designed as a prospective longitudinal trial. Physiological parameters were evaluated at rest and effort (walking) in patients who were in the exacerbation or stable phases of HF or COPD. Parameters with relevant discriminatory power (sensitivity (Sn) or specificity (Sp) ≥ 80%, and Youden index ≥ 0.2) were integrated into diagnostic algorithms. Results: the study included 127 patients (COPD: 56, HF: 54, both: 17). The best algorithm for COPD included: oxygen saturation (SaO2) decrease ≥ 2% in minutes 1 to 3 of effort, end-of-effort heart rate (HR) increase ≥ 10 beats/min and walking distance decrease ≥ 35 m (presence of one criterion showed Sn: 0.90 (95%, CI(confidence interval): 0.75–0.97), Sp: 0.89 (95%, CI: 0.72–0.96), and area under the curve (AUC): 0.92 (95%, CI: 0.85–0.995)); and for HF: SaO2 decrease ≥ 2% in the mean-of-effort, HR increase ≥ 10 beats/min in the mean-of-effort, and walking distance decrease ≥ 40 m (presence of one criterion showed Sn: 0.85 (95%, CI: 0.69–0.93), Sp: 0.75 (95%, CI: 0.57–0.87) and AUC 0.84 (95%, CI: 0.74–0.94)). Conclusions: effort situations improve the validity of physiological parameters for detection of HF and COPD exacerbation episodes.

scholarly journals Impact of a Positive Viral Polymerase Chain Reaction on Outcomes of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations

2020 ◽  
Vol 17 (21) ◽  
pp. 8072 ◽  
Author(s):  
Kulothungan Gunasekaran ◽  
Mudassar Ahmad ◽  
Sana Rehman ◽  
Bright Thilagar ◽  
Kavitha Gopalratnam ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Respiratory Virus ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
The Mean

Introduction: More than 15 million adults in the USA have chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) places a high burden on the healthcare system. Many hospital admissions are due to an exacerbation, which is suspected to be from a viral cause. The purpose of this analysis was to compare the outcomes of patients with a positive and negative respiratory virus panel who were admitted to the hospital with COPD exacerbations. Methods: This retrospective cohort study was conducted in the Geisinger Healthcare System. The dataset included 2729 patient encounters between 1 January 2006 and 30 November 2017. Hospital length of stay was calculated as the discrete number of calendar days a patient was in the hospital. Patient encounters with a positive and negative respiratory virus panel were compared using Pearson’s chi-square or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank-sum tests for continuous variables. Results: There were 1626 patients with a total of 2729 chronic obstructive pulmonary disease exacerbation encounters. Nineteen percent of those encounters (n = 524) had a respiratory virus panel performed during their admission. Among these encounters, 161 (30.7%) had positive results, and 363 (69.3%) had negative results. For encounters with the respiratory virus panel, the mean age was 64.5, 59.5% were female, 98.9% were white, and the mean body mass index was 26.6. Those with a negative respiratory virus panel had a higher median white blood cell count (11.1 vs. 9.9, p = 0.0076). There were no other statistically significant differences in characteristics between the two groups. Respiratory virus panel positive patients had a statistically significant longer hospital length of stay. There were no significant differences with respect to being on mechanical ventilation or ventilation-free days. Conclusion: This study shows that a positive respiratory virus panel is associated with increased length of hospital stay. Early diagnosis of chronic obstructive pulmonary disease exacerbation patients with positive viral panel would help identify patients with a longer length of stay.

scholarly journals Using a Virtual Game System to Innovate Pulmonary Rehabilitation: Safety, Adherence and Enjoyment in Severe Chronic Obstructive Pulmonary Disease

2013 ◽  
Vol 20 (5) ◽  
pp. 357-361 ◽  
Author(s):  
Rima Wardini ◽  
Esther Dajczman ◽  
Nathan Yang ◽  
Marcel Baltzan ◽  
David Préfontaine ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Upper Body ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Patient Reported ◽  
Virtual Game

OBJECTIVE: The present pilot study tested the use of a virtual game system (VGS) for exercise training in patients with moderate to very severe chronic obstructive pulmonary disease undergoing pulmonary rehabilitation (PR). Safety, feasibility, enjoyment and adherence were assessed.METHODS: VGS (Wii [2006], Nintendo, USA) games were prescreened and categorized into lower- and upper-body workouts. Patients admitted for a three- to four-week inpatient PR program exercised daily. They were provided an opportunity to individually engage in VGS sessions three times weekly, varying with length of stay. Dyspnea, oxygen saturation and heart rate were measured before, during and after game sessions. Patients were considered to be adherent if they attended at least 50% of VGS sessions. Adverse events and enjoyment were evaluated.RESULTS: Thirty-two patients with a mean (± SD) age of 66±9 years and a mean forced expiratory volume in 1 s of 0.72±0.40 L participated. Among the 25 patients completing the program, adherence was 76%, with a mean attendance rate of 64±35%. Mean dyspnea score was 1.5±1.1 before and 3.2±1.2 after exercise. Mean oxygen saturation changed from 94±3% to 91±5% (P<0.001), while heart rate increased from 88±15 beats/min to 102±18 beats/min (P<0.001). One patient reported chest pain requiring nitroglycerin spray and five experienced transient desaturation below 85% with play. Patients enjoyed the program (visual analogue score 8±2.6/10) and most would highly recommend it to others.CONCLUSIONS: Moderate exercise using a VGS was safe, feasible and enjoyed as an adjunct to inpatient PR. This modality may encourage patients to maintain physical activity after PR.

scholarly journals Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study (Preprint)

2018 ◽  
Author(s):  
Joren Buekers ◽  
Jan Theunis ◽  
Patrick De Boever ◽  
Anouk W Vaes ◽  
Maud Koopman ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Blood Oxygen ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Finger Pulse ◽  
Pulse Oximeters

BACKGROUND Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood oxygen saturation (SpO2), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO2. OBJECTIVE This study used wearable finger pulse oximeters to continuously measure SpO2 during daily home routines of COPD patients and assess natural SpO2 fluctuations. METHODS A total of 20 COPD patients wore a WristOx2 pulse oximeter for 1 week to collect continuous SpO2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO2 time series were preprocessed and data quality was assessed afterward. Mean SpO2, SpO2 SD, and cumulative time spent with SpO2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO2 fluctuations. RESULTS A high percentage of valid SpO2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO2 (89.9%, SD 3.4) was lower than mean daytime SpO2 in rest (92.1%, SD 2.9; P<.001). On average, SpO2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 week. CONCLUSIONS Continuous SpO2 measurements with wearable finger pulse oximeters identified significant SpO2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO2 measurements during daily home routines of patients with COPD generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO2 measurements over longer time periods to determine the clinical relevance of the identified SpO2 fluctuations.

scholarly journals Impact of Air Pollution and Outdoor Temperature on the Rate of Chronic Obstructive Pulmonary Disease Exacerbations

Folia Medica ◽  
2017 ◽  
Vol 59 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Iliya I. Krachunov ◽  
Nikolay H. Kyuchukov ◽  
Zlatina I. Ivanova ◽  
Nikolay A. Yanev ◽  
Petkana A. Hristova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Air Pollution ◽  
Pulmonary Disease ◽  
Air Pollutants ◽  
Chronic Obstructive ◽  
Outdoor Temperature ◽  
Obstructive Pulmonary Disease ◽  
Daily Number ◽  
Copd Exacerbations ◽  
The Mean

AbstractBackground: Environmental pollution can be one of the main risk factors for acute exacerbations of chronic obstructive pulmonary disease (COPD). Aim: To study the relationship between air pollution, outdoor temperature and exacerbations of COPD. Materials and methods: COPD patients (n=1432) were followed up for one year. The levels of particulate matter up to 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2) and outside temperatures were collected from the Environmental Agency database. Results: A total of 309 acute COPD exacerbations (AECOPD) were recorded in the analysis. The daily mean concentrations of PM10were found to correlate significantly with the daily mean concentrations of NO2and SO2(ρ 0.34 and ρ 0.49, respectively; p=0.0001). The negative correlations between the daily mean temperature and the daily mean levels of PM10, NO2and SO2were also significant (ρ -0.44, ρ -0.11, and ρ -0.37, respectively; p=0.0001). The daily number of AECOPD correlated with the mean levels of PM10in the previous six days (ρ 0.14; p=0.02) and the lower outdoor temperature (ρ -0.2; p=0.001). The negative correlation between the daily number of AECOPD and the mean daily temperature was stronger in days with levels of PM10above 50 μg/m3(ρ -0.3 p=0.02 vs. ρ -0.18 p= 0.01). Conclusion: Lower daily mean temperatures were associated with the levels of air pollutants. The level of PM10correlated with the levels of the other air pollutants. The daily number of AECOPD was found to correlate weakly, but signifi cantly with the mean level of PM10in the previous six days.

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