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October 20, 2011 Patients with chronic obstructive pulmonary disease (COPD) may benefit from treatment of cardiac autonomic dysfunction, as measured by heart rate variability (HRV).
Although research has shown that patients with COPD have unpaired health-related quality of life (HRQL), little research has been done to understand contributing physiological factors. Forced expiratory volume (FEV1), for example, does not entirely reflect disease severity, according to Arnoldus J.R. van Gestel, MD, from the Zurich University of Applied Sciences, Switzerland, and colleagues.
"Researchers have been trying to investigate the main causes of poor quality of life in COPD patients in order to improve their health status," said Dr. van Gestel in a news release. "In this study we found that the autonomic nervous system, which controls heart rate, plays an important role in the decrease in quality of life."
The study, published online July 25 and in the August issue of Respirology, described 60 patients with COPD, measuring their quality of life through a questionnaire and their heart rates through Holter electrocardiogram monitoring devices. Clinically stable patients aged 40 to 75 years with COPD were recruited between November 2008 and December 2009 at the University Hospital Ruhrlandklinik in Essen, Germany. Additional inclusion criteria were baseline post bronchodilator FEV1 of less than 80% predicted, and an FEV1/forced vital capacity ratio of less than 0.7. The mean age of the patients was 65.20 years, and the cohort included 37 women. Three patients had GOLD stage 1 (mild) COPD, 23 patients had GOLD II (moderate) COPD, 16 patients had GOLD III (severe) COPD, and 18 patients had GOLD IV (very severe) COPD.
Pulmonary function was tested using spirometry, whole-body plethysmography, and diffusion capacity measurements. The Chronic Respiratory Disease Questionnaire consists of 20 items on the topics of dyspnea, fatigue, emotional function, and mastery that are reflective of HRQL. The autonomic nervous system was assessed, using HRV as measured using a Holter electrocardiogram device, during a recording period of 5 minutes. Cardiovascular autonomic function was assessed by measuring the standard time and frequency domain measures of HRV from 5 minutes of the N-N interval (intervals between normal sinus beats) recordings in the electrocardiogram.
The study found that resting parasympathetic tone is independently associated with HRQL in patients with COPD. Specifically, there was a significant correlation between Chronic Respiratory Disease Questionnaire total score and both variables of HRV reflecting parasympathetic tone (r = 0.34; P = .012) and the density of the beat-to-beat oscillation in the N-N interval of HRV in the high-frequency band (r = .35; P = .01). The multivariate analysis found that the root mean square successive difference of RR intervals was independently associated with HRQL after correcting for parameters related to lung function (FEV1, carbon monoxide transfer coefficient), exercise capacity, body composition, systemic inflammation (C reactive protein), and respiratory symptoms. The authors also found that patients with COPD had elevated resting heart rate and diminished HRV when compared with the normal values of healthy participants at similar ages.
Study limitations include a cross-sectional design, which precludes drawing conclusions about causality, and that subject number was small and the researchers did not control for long-acting B2-agonist use the day before measurement of HRV.
Other researchers have suggested that autonomic dysfunction may explain a wide range of physical and physiological illnesses. The occurrence of myocardial ischemia cardiac autonomic dysfunction (as measured by reduced HRV), for example, may account for much of the risk associated with stress, anxiety, and depression.
"The results of the present study underline the importance of testing cardiac autonomic function, indexed by heart rate variability, in patients with COPD," the authors conclude. "Our findings imply that modification of cardiac autonomic dysfunction may be of benefit in the treatment of COPD patients and improve their outcome more than previously anticipated."
Medscape Medical News
http://www.medscape.com/viewarticle/75186
I found this very interesting, and thought you might too.
Love to all,
Holly
Although research has shown that patients with COPD have unpaired health-related quality of life (HRQL), little research has been done to understand contributing physiological factors. Forced expiratory volume (FEV1), for example, does not entirely reflect disease severity, according to Arnoldus J.R. van Gestel, MD, from the Zurich University of Applied Sciences, Switzerland, and colleagues.
"Researchers have been trying to investigate the main causes of poor quality of life in COPD patients in order to improve their health status," said Dr. van Gestel in a news release. "In this study we found that the autonomic nervous system, which controls heart rate, plays an important role in the decrease in quality of life."
The study, published online July 25 and in the August issue of Respirology, described 60 patients with COPD, measuring their quality of life through a questionnaire and their heart rates through Holter electrocardiogram monitoring devices. Clinically stable patients aged 40 to 75 years with COPD were recruited between November 2008 and December 2009 at the University Hospital Ruhrlandklinik in Essen, Germany. Additional inclusion criteria were baseline post bronchodilator FEV1 of less than 80% predicted, and an FEV1/forced vital capacity ratio of less than 0.7. The mean age of the patients was 65.20 years, and the cohort included 37 women. Three patients had GOLD stage 1 (mild) COPD, 23 patients had GOLD II (moderate) COPD, 16 patients had GOLD III (severe) COPD, and 18 patients had GOLD IV (very severe) COPD.
Pulmonary function was tested using spirometry, whole-body plethysmography, and diffusion capacity measurements. The Chronic Respiratory Disease Questionnaire consists of 20 items on the topics of dyspnea, fatigue, emotional function, and mastery that are reflective of HRQL. The autonomic nervous system was assessed, using HRV as measured using a Holter electrocardiogram device, during a recording period of 5 minutes. Cardiovascular autonomic function was assessed by measuring the standard time and frequency domain measures of HRV from 5 minutes of the N-N interval (intervals between normal sinus beats) recordings in the electrocardiogram.
The study found that resting parasympathetic tone is independently associated with HRQL in patients with COPD. Specifically, there was a significant correlation between Chronic Respiratory Disease Questionnaire total score and both variables of HRV reflecting parasympathetic tone (r = 0.34; P = .012) and the density of the beat-to-beat oscillation in the N-N interval of HRV in the high-frequency band (r = .35; P = .01). The multivariate analysis found that the root mean square successive difference of RR intervals was independently associated with HRQL after correcting for parameters related to lung function (FEV1, carbon monoxide transfer coefficient), exercise capacity, body composition, systemic inflammation (C reactive protein), and respiratory symptoms. The authors also found that patients with COPD had elevated resting heart rate and diminished HRV when compared with the normal values of healthy participants at similar ages.
Study limitations include a cross-sectional design, which precludes drawing conclusions about causality, and that subject number was small and the researchers did not control for long-acting B2-agonist use the day before measurement of HRV.
Other researchers have suggested that autonomic dysfunction may explain a wide range of physical and physiological illnesses. The occurrence of myocardial ischemia cardiac autonomic dysfunction (as measured by reduced HRV), for example, may account for much of the risk associated with stress, anxiety, and depression.
"The results of the present study underline the importance of testing cardiac autonomic function, indexed by heart rate variability, in patients with COPD," the authors conclude. "Our findings imply that modification of cardiac autonomic dysfunction may be of benefit in the treatment of COPD patients and improve their outcome more than previously anticipated."
Medscape Medical News
http://www.medscape.com/viewarticle/75186
I found this very interesting, and thought you might too.
Love to all,
Holly
I have found that in pursed lip breathing that if you continue exhaling till you think you might faint (ie try to totally deflate the lungs)
the subsequent intakes of air are more effective.
Is this what the article is all about?
Thank you for sharing this information, Holly.
My Cardiologist and Pulmonary Specialist still maintain their own
positions; which are opposite of one another. These days, doctors only focus on one organ and do not look at the whole body and how organs interact with one another. That leaves it up to the patient to try and research and figure out what they should be doing. Very frustrating.
Might explain why some also show other signs of autonomic nervous system issues.. part of that includes the "flight or fight " response we trigger with exacerbation's or even episodes of SOB... then add the use of steroids that affect the adrenals and it would make sense.
I know in other studies ( diabetic) they have noticed the same issues of cardiac autonomic dysfunction and seen high levels of C- reactive protein ( also often times seen in COPDers) making researchers again consider that many of the problems seen in diseases like COPD have a associated base ( at least in part,) as an infectious, inflammatory / autoimmune disease and the autonomic nervous system response to chronic attack.