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Articles of Interest

Comorbidities that cause pain and the contributors to pain in individuals with chronic obstructive pulmonary disease

Chen, Y.-W., Camp, P.G., Coxson, H.O., Road, J.D., Guenette, J.A., Hunt, M.A., Reid, W.D. Comorbidities that cause pain and the contributors to pain in individuals with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2016; doi:10.1016/j.apmr.2016.10.016.

This study involves a prospective cross-sectional survey design implemented across six pulmonary rehabilitation programs in British Columbia. The sample included individuals over 40 years old with a diagnosis of COPD confirmed by spirometry. Surveys were sent to 137 people, with a 73% response rate. Of the 96 (70%) people in the final sample 68 (71%) reported pain.

The following surveys were administered: “Participant information form” with demographic characteristics including socioeconomic status; Brief Pain Inventory (BPI); “List of health conditions that might contribute to pain and medication record” to survey comorbidities using lay terms; Dyspnea Inventory (DI); Brief Fatigue Inventory (BFI); Clinical COPD Questionnaire (CCQ) a quality of life questionnaire; General Self-efficacy Scale (GSE).

From these outcome measures, reported pain was analyzed through a number of associations and determined to be an underappreciated feature of COPD.

Results included that pain prevalence and characteristics were higher in those with COPD, with low back pain the most common, and the most frequent pain was associated with comorbidities such as arthritis, back problems and muscle cramps. Pain in people with COPD appeared to be confounded by lower socioeconomic status while contributors of pain magnitude and pain interference in activities of daily living approximated to other chronic conditions.

This study supports the importance of considering pain along with dyspnea and fatigue as it limits physical ability and negatively impacts the quality of life of people with COPD. The authors conclude that the inclusion of pain assessment and management is an essential component of COPD treatment.


Asthma and Exercise-Induced Bronchoconstriction in Athletes

Boulet, L.-P. & O’Byrne, P.M. Asthma and Exercise-induced Bronchoconstriction in Athletes. N Engl J Med 2015; 372:641-8. DOI: 10.1056/NEJMra1407552.

It is no secret that regular exercise provides effective means to maintain good health. The same can be said about chronic disease. The prevalence of asthma and exercise-induced bronchoconstriction among athletes has been estimated to be between 30% and 70% among elite athletes, depending on the type of sports performed. In the case of asthma, when controlled, it does not restrict exercise performance. In fact, exercise can improve asthma symptoms, quality of life, exercise capacity, and pulmonary function, as well as reduce airway responsiveness. In this article, the authors review current management of asthma and exercise-induced bronchoconstriction in athletes, focusing specifically on high-performance athletes who engage in endurance sports.

Some of the main points of this review highlight the importance of early diagnosis and treatment of asthma or exercise-induced bronchoconstriction in athletes in preventing impaired performance. Diagnosis can be made based on history of characteristic symptom patterns and documentation of variable airflow limitation, bronchodilator reversibility testing or other means, such as bronchoprovocation tests.

Education about asthma self-management is an essential component of managing asthma in athletes. The article goes on to provide non-pharmacological as well as pharmacological recommendations on treating and managing asthma in athletes. The conclusion is that asthma and exercise-induced bronchoconstriction can usually be well managed in athletes, with maintenance inhaled glucocorticoids and occasional inhaled short-acting β2-agonists before exercise. An interesting point that applies specifically to this demographic is adherence to antidoping regulations regarding asthma drugs in order to develop an adequate asthma-management plan for competitive athletes.


 

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