Karakteristieken van lichamelijke activiteit bij niet-ernstig COPD Amanda van Buul, MD Afdeling longziekten LEIDS UNIVERSITAIR MEDISCH CENtrum

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Introductie Lichamelijke (in)activiteit bij COPD Beter begrip van lichamelijk activiteit Ontwikkeling van interventies & ruimte voor verbetering Figuur van Garcia-Aymerich J. et al Thorax 2006 Figuur van Troosters et al. Respir Med 2010 Onderzoeksvraag: Welke patiëntkarakteristieken zijn gerelateerd aan lichamelijke activiteit bij GOLD 0-2? NHG wetenschapsdag 2018 29-nov-18

Methode Basisgegevens van de Netherlands Epidemiology of Obesity (NEO) studie1 Inclusie GOLD 0-2 die door een dokter gediagnosticeerd was (N=77) of GOLD 1-2 die voldeden aan criteria voor nieuw gediagnosticeerd COPD (N=246) Lichamelijke activiteit Short Questionnaire to Assess Health-Enhancing Physical Activity questionnaire (SQUASH)2 Patiëntkarakteristieken Sociodemografische en lifestyle karakteristieken Functionele karakteristieken Longmedicatie Regressie analyses, gewogen voor BMI, gecorrigeerd voor leeftijd en geslacht 1 de Mutsert et al Eur J Epidemiol 2013; 2Wendel-Vos et al J Clin Epidemiol 2003 Cross-sectionele analyses Astma patienten geexcludeerd In metabolic equivalent task uren per week (MET-uren/week) NHG wetenschapsdag 2018 29-nov-18

Resultaten Patiëntkarakteristieken Regressie analyses Karakteristieken Totaal N = 323   Leeftijd (jaren, mediaan [IQR]) 60 [54-63] Geslacht (% vrouw) 44 COPD (% nieuw gediagnosticeerd) 80.4 Lichamelijke activiteit in vrije tijd (MET-uur/week, mediaan [IQR]) 31 [15;46] Karakteristieken Lichamelijke activiteit in vrije tijd (MET-uur/week) Regressie coefficient 95% CI Functionele karakteristieken   BMI (kg/m2) -0.85 -2.09;0.39 Angst (score) -0.01 -0.72;0.69 Depressie (score) -0.09 -0.58;0.40 Verergering van symptomen n de ochtend (ref geen verergering) 10.2 -13.3;33.7 FEV1 (% voorspeld) 0.40 0.09;0.71 FVC (% voorspeld) 0.34 0.06;0.61 Pulmonale symptomen (ref geen symptomen) 0.79 -9.05;10.6 Dokters diagnoseerd COPD (ref nieuw gediagnosticeerd COPD) -15.1 -22.3;-7.99 Karakteristieken Lichamelijke activiteit in vrije tijd (MET-uur/week) Regressie coefficient 95% CI Longmedicatie   Longmedicatie (ref geen) -11.4 -20.0;-2.91 Kortwerkend (ref geen) -2.22 -22.0;17.6 Langwerkend (ref geen) -13.8 -21.7;-6.01 ICS (ref geen) -12.5 -21.4;-3.61 LABA (ref geen) -10.3 -19.6;-0.99 LAMA (ref geen) -17.8 -25.8;-9.77 ICS/LABA (ref geen) -3.93 -14.9;7.06 ICS/LABA/LAMA (ref geen) -17.0 -27.9;-6.12 Karakteristieken Lichamelijke activiteit in vrije tijd (MET-uur/week) Regressie coefficient 95% CI Sociodemografische en lifestyle karakteristieken   Educatie level (ref laag) -7.13 -16.8;2.51 Werkstatus (ref geen werk) -6.93 -21.1;7.27 Rookstatus (ref ex-roker) -2.19 -12.7;8.36 Alcoholgebruik (g/d) 0.15 -0.22;0.52 Nieuw gediagnosticeerd GOLD I (%) 55.4% NHG wetenschapsdag 2018 29-nov-18

Conclusie Longfunctie was positief geassocieerd met lichamelijk activiteit Medicatie gebruik was negatief geassocieerd met lichamelijke activiteit  Prospectieve interventiestudies zijn nodig om het effect van vroege behandeling met medicatie en/of lichamelijke activiteit op COPD progressie in niet-ernstige COPD te bestuderen NHG wetenschapsdag 2018 29-nov-18

Dank aan de co-auteurs, de onderzoekers en de deelnemers van de NEO studie Raoul G.A.J.M. Helmes1 Marise J. Kasteleyn1,2 Tobias N. Bonten1,2 Renée de Mutsert3 Pieter S. Hiemstra2 Saskia le Cessie3,4 Frits R. Rosendaal3,5 Niels H. Chavannes1 Christian Taube2,6 1Department of Public Health and Primary Care, Leiden University Medical Center 2Department of Pulmonology, Leiden University Medical Center 3Department of Clinical Epidemiology, Leiden University Medical Center 4Department of Medical Statistics and Bioinformatics, Leiden University Medical Center 5Department of Thrombosis and Hemostasis, Leiden University Medical Center 6Department of Pulmonary Medicine, University Hospital Essen

APPENDIX NHG wetenschapsdag 2018 29-nov-18

Figuur 1 Study flow diagram NHG wetenschapsdag 2018 29-nov-18

Figuur 2 Lichamelijke activiteit NHG wetenschapsdag 2018 29-nov-18

Basiskarakteristieken (1)   Total N = 323 Sociodemographic and lifestyle characteristics Age (years, median [IQR]) 60 [54-63] Sex (% women) 44 Ethnicity (% white) 98 Education level (% high) 34 Working status (% working) 53 Smoking (% current) 50 Pack-years (mean, (SD)) 29 (18) Alcohol intake (g/d, median [IQR]) 21 [6-34] NHG wetenschapsdag 2018 29-nov-18

Basiskarakteristieken (2)   Total N = 323 Clinical and functional characteristics Physical activity in leisure time ( MET-h/week, median [IQR]) 31 [15;46] Pulmonary symptoms (% yes) 58 Worsening of symptoms in the morning (% yes) 16 Cardiovascular disease (%) 11 BAI (median [IQR]) 3 [1-6] IDS (median [IQR]) 8 [5-14] BMI (kg/m2, mean (±SD)) 27 (5) FEV1 (% predicted, mean (±SD)) 88 (16) FVC (% predicted, mean (±SD)) 111 (16) FeNO (ppb, (median [IQR]) 13 [9-17] COPD stage Physician diagnosed GOLD 0 (%) 5.6 Physician diagnosed GOLD I (%) 7.3 Newly diagnosed GOLD I (%) 55.4 Physician diagnosed GOLD II (%) 6.7 Newly diagnosed GOLD II (%) 25.0 NHG wetenschapsdag 2018 29-nov-18

Basiskarakteristieken (3)   Total N = 323 Pharmacological characteristics Any pulmonary (%) 19.8 Short acting (%) 5.2 SABA (%) 4.9 SAMA (%) 0.7 Long acting (%) 15.7 ICS monotherapy (%) 3.5 LABA monotherapy (%) 0.6 LAMA monotherapy (%) 2.1 ICS+LABA (%) 5.3 LABA+LAMA (%) 0.2 ICS+LABA+LAMA(%) 4.0 ICS (%) 12.9 LABA (%) 10.0 LAMA (%) 6.4 NHG wetenschapsdag 2018 29-nov-18

Regressie Patients with COPD GOLD 0, 1 and 2 Characteristics Unadjusted leisure time physical activity (MET-h/week) Adjusted* leisure time physical activity (MET-h/week) Regression coefficient 95% CI Sociodemographic and lifestyle characteristics   Education level (ref low) -5.70 -14.9;3.49 -7.13 -16.8;2.51 Working status (ref not working) -9.11 -19.5;1.26 -6.93 -21.1;7.27 Smoking status (ref ex-smoker) -2.81 -13.4;7.72 -2.19 -12.7;8.36 Alcohol intake (g/d) 0.20 -0.20;0.60 0.15 -0.22;0.52 Clinical and functional characteristics BMI (kg/m2) -0.92 -2.22;0.38 -0.85 -2.09;0.39 Anxiety (score) -0.22 -0.88;0.44 -0.01 -0.72;0.69 Depression (score) -0.18 -0.72;0.35 -0.09 -0.58;0.40 Worsening of symptoms in the morning (ref no worsening) 10.7 -14.8;36.1 10.2 -13.3;33.7 FEV1 (% predicted) 0.43 0.11;0.74 0.40 0.09;0.71 FVC (% predicted) 0.31 0.05;0.58 0.34 0.06;0.61 Pulmonary symptoms (ref no symptoms) 0.39 -9.55;10.3 0.79 -9.05;10.6 Physician diagnosed COPD (ref newly diagnosed COPD) -16.1 -23.8;-8.35 -15.1 -22.3;-7.99 Pharmacological characteristics Any pulmonary medication (ref no) -12.0 -21.1;2.96 -11.4 -20.0;-2.91 Short acting therapy (ref no) -4.12 -23.2;14.9 -2.22 -22.0;17.6 Long acting therapy (ref no) -14.2 -22.9;-5.61 -13.8 -21.7;-6.01 ICS (ref no) -11.6 -20.8;-2.40 -12.5 -21.4;-3.61 LABA (ref no) -9.25 -19.1;0.59 -10.3 -19.6;-0.99 LAMA (ref no) -19.7 -27.3;-12.0 -17.8 -25.8;-9.77 ICS/LABA (ref no) -1.48 -13.1;10.2 -3.93 -14.9;7.06 ICS/LABA/LAMA (ref no) -16.9 -26.4;-7.45 -17.0 -27.9;-6.12 NHG wetenschapsdag 2018 29-nov-18

Regressie, patients with physician diagnosed COPD GOLD 0, 1 and 2 (N=77) Characteristics Unadjusted leisure time physical activity (MET-h/week) Adjusted* leisure time physical activity (MET-h/week) Regression coefficient 95% CI Sociodemographic and lifestyle characteristics   Education level (ref low) 6.67 -4.28;17.6 4.50 -6.43;15.4 Working status (ref not working) -11.1 -18.9;-3.27 -10.1 -18.6;-1.49 Smoking status (ref ex-smoker) -3.07 -12.2;6.02 -0.09 -9.65;9.47 Alcohol intake (g/d) 0.07 -0.13;0.26 0.00 -0.19;0.20 Clinical and functional characteristics BMI (kg/m2) 0.35 -0.29;0.99 0.36 -0.34;1.07 Anxiety (score) 0.67 -0.12;1.46 0.93 0.25;1.61 Depression (score) 0.26 -0.25;0.77 0.42 -0.05;0.88 Worsening of symptoms in the morning (ref no worsening) -8.82 -20.0;2.37 -6.52 -18.9;5.86 FEV1 (% predicted) 0.01 -0.27;0.30 -0.01 -0.28;0.25 FVC (% predicted) -0.16 -0.42;0.09 -0.23 -0.51;0.06 Pulmonary symptoms (ref no) 1.53 -7.42;10.5 3.62 -6.37;13.6 Pharmacological characteristics Any pulmonary medication (ref no) -5.96 -13.9;1.95 -6.01 -13.5;1.49 Short acting therapy (ref no) -1.30 -12.2;9.56 -1.16 -12.8;10.5 Long acting therapy (ref no) -6.77 -14.6;1.06 -6.81 -14.2;0.59 ICS (ref no) -2.08 -11.4;7.23 -3.95 -12.4;4.46 LABA (ref no) 1.98 -8.18;12.1 0.98 -8.71;10.7 LAMA (ref no) -7.94 -16.0;0.13 -7.21 -15.6;1.14 ICS/LABA (ref no) 8.88 -8.02;25.8 8.60 -6.24;23.4 ICS/LABA/LAMA (ref no) -3.72 -13.8;6.34 -4.83 -15.9;6.20 29-nov-18

Regressie, patients with newly diagnosed COPD GOLD 1 and 2 (N=246) Characteristics Unadjusted leisure time physical activity (MET-h/week) Adjusted* leisure time physical activity (MET-h/week) Regression coefficient 95% CI Sociodemographic and lifestyle characteristics   Education level (ref low) -9.94 -20.8;0.91 -10.7 -21.6;0.24 Working status (ref not working) -8.98 -21.4;3.39 -5.66 -23.5;12.2 Smoking status (ref ex-smoker) -3.24 -15.7;9.18 -3.59 -15.5;8.34 Alcohol intake (g/d) 0.20 -0.27;0.66 0.16 -0.27;0.59 Clinical and functional characteristics BMI (kg/m2) -1.24 -2.88;0.41 -1.08 -2.64;0.48 Anxiety (score) -0.40 -1.22;0.41 -0.26 -1.11;0.59 Depression (score) -0.27 -0.97;0.43 -0.25 -0.91;0.41 Worsening of symptoms in the morning (ref no worsening) 10.9 -16.9;38.6 10.4 -15.0;35.9 FEV1 (% predicted) 0.45 0.08;0.82 0.43 0.06;0.79 FVC (% predicted) 0.38 0.11;0.66 0.42 0.13;0.72 Pulmonary symptoms (ref no) 1.15 -10.7;13.0 1.22 -10.1;12.6 Pulmonary medication characteristics Any pulmonary medication (ref no) -4.01 -17.1;9.06 -4.07 -17.4;9.21 Short acting therapy (ref no) 18.5 -20.4;57.4 21.0 -17.9;60.0 Long acting therapy (ref no) -4.57 -15.0;5.89 -5.95 -16.2;4.31 ICS (ref no) -4.19 -14.7;6.33 -5.40 -15.5;4.73 LABA (ref no) -2.32 -14.1;9.51 -5.56 -18.3;7.15 LAMA (ref no) -21.7 -30.8;-12.5 -27.9 -40.5;-15.3 ICS/LABA (ref no) 0.02 -11.2;11.2 -2.86 -14.8;9.09 ICS/LABA/LAMA (ref no) -24.7 -33.8;-15.6 -31.0 -42.7;-19.2 29-nov-18

Characteristics of patients with physician diagnosed COPD and newly diagnosed COPD Newly diagnosed (N=246) Sociodemographic and lifestyle characteristics   Age (years), median [IQR] 59 [54-64] 60 [54-63] Sex (% female) 64 40 Education level (% high) 23 36 Working status (% working) 51 54 Smoking status (% current) 47 Alcohol intake (g/d), median [IQR] 15 [0-28] 21 [7-35] Clinical and functional Characteristics BMI (kg/m2), mean (SD) 28 (5) 27 (4) Anxiety (score), median [IQR] 4 [1-8] 3 [1-6] Depression (score), median [IQR] 7 [6-17] 8 [5-13] FEV1 (% predicted), mean (SD) 82 (16) 90 (15) FVC (% predicted), mean (SD) 108 (17) 112 (16) Pulmonary symptoms (% yes) 64.8 56.8 Morning symptoms (% yes) 7 18 Physical activity in leisure time (MET hours per week), median [IQR] 20 [11-32] 33 [20-55] Pharmacological characteristics Any pulmonary medication (% yes) 63.6 9.2 Short acting (% yes) 19.1 1.9 Long acting (% yes) 60.2 4.9 ICS (% yes) 46.3 4.8 LABA (% yes) 37.5 3.3 LAMA (% yes) 30.8 0.5 ICS/LABA (% yes) 14.5 3.0 ICS/LABA/LAMA (% yes) 0.3 29-nov-18

Symptomatic and non-symptomatic patients COPD stage Percentage without pulmonary symptoms Percentage with pulmonary symptoms Physician diagnosed GOLD 0 Physician diagnosed GOLD 1 Newly diagnosed GOLD 1 Physician diagnosed GOLD 2 Newly diagnosed GOLD 2 41.9 58.1 45.8 54.2 49.5 50.5 18.1 81.9 29.1 70.9 29-nov-18