2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Cardiorespiratory Physiotherapy Australia
The prevalence of GOR in bronchiectasis was 40%; 37%
in COPD; 18% in controls. A diagnosis of GOR was not
associated with increased disease severity or a poorer QOL
in bronchiectasis or COPD (all p > 0.05). PEP therapy
did not increase distal NRE (p = 0.71) or RI (p = 0.642)
compared to BGT. Fewer distal NRE occurred during the
6MWT (p < 0.001) and GST (p < 0.001) compared to BGT.
GOR was a co-morbidity in bronchiectasis and COPD
across the disease spectrum but aspects of physiotherapy
performed in this study did not provoke GOR.
The impact of musculoskeletal pain on adults
with cystic fibrosis
Lee AL, 1,2 Kelemen L, 3 Button BM, 2,4 Wilson JW, 2,4
Presnell S, 2,3 Holland AE2 ,3
1
School of Physiotherapy, The University of Melbourne, Melbourne,
2
The Alfred, Melbourne, 3 La Trobe University, Melbourne, 4 Monash
University, Melbourne
Musculoskeletal pain is recognised as a complication
in cystic fibrosis (CF) but the prevalence and clinical
significance of this co-morbidity in adults with stable
lung disease has not been well described. The aim of
this study was to determine the location, intensity and
experience of musculoskeletal pain and its impact on
quality of life in individuals with CF. Participants with
clinically stable CF from an outpatient clinic completed
three questionnaires measuring the location, severity and
degree of interference in daily activities of musculoskeletal
pain (Brief Pain Inventory), the psychological impact
of pain (Pain Catastrophising Scale) and quality of life
(Cystic Fibrosis Quality of Life questionnaire). Seventyseven
participants with mean age 29 years (SD 8 years),
FEV 1 60 (25) % predicted were included. The prevalence
of musculoskeletal pain was 89% and was not influenced
by lung disease severity. Pain was commonly located in the
back, buttocks and hips (70%), head and neck (52%) and
lower limbs (29%). Although pain intensity was generally
mild, participants with musculoskeletal pain reported poorer
physical functioning (p = 0.01) and increased interference
with treatment aspects of CF (p = 0.03) compared to
those with no pain. Participants with symptoms of CF
arthropathy reported greater intensity and impact of pain.
Pain catastrophising and FEV 1 were independent predictors
of quality of life in adults with CF. Musculoskeletal pain
is a significant complication which negatively influences
quality of life in adults with stable CF. These results lend
support to the inclusion of musculoskeletal pain screening
as part of CF management.
Pepsin, a measure of pulmonary microaspiration in
COPD and bronchiectasis
Lee AL, 1,2 Button BM, 2,3 Denehy L, 1 Roberts S, 2,3 Bamford
TL, 3 Mifsud N, 3 Tjen F, 3 Stirling R, 2,3 Wilson J 2,3
1
School of Physiotherapy, The University of Melbourne, Melbourne,
2
The Alfred, Melbourne, 3 Monash University, Melbourne
Gastro-oesophageal reflux (GOR) in COPD and
bronchiectasis is a potential contributor to lung disease
severity. Pepsin in airways samples is a probable non-invasive
marker of pulmonary microaspiration. The aim of this study
was to determine the presence of pepsin in airway samples
in COPD and bronchiectasis and its association with GOR
and lung function. Patients with COPD and bronchiectasis
completed dual-probe 24-hour oesophageal pH monitoring,
measuring number of reflux episodes (NRE), % reflux time
(RI) and a DeMeester score (DMS). Lung disease severity
was assessed using spirometry. Four samples of sputum
and saliva were collected over the 24-hour study period,
with the concentration of pepsin measured by an ELISA.
Thirty patients with bronchiectasis (mean [SD] FEV 1 73.9%
[23.4]) and 27 with COPD (mean [SD] FEV 1 47.2% [17.4])
were recruited. A total of 36 sputum saliva and 71 saliva
samples were positive for pepsin (concentration > 1.953 ng/
ml). NRE, RI and DMS were not associated with pepsin
in sputum or saliva in COPD or bronchiectasis (all p >
0.05). There was a trend towards lower FEV 1 % in those
with positive sputum (pepsin present) in COPD (p = 0.079)
but not bronchiectasis (p = 0.411). In COPD, patients with
positive sputum only (not diagnosed with GOR) had a lower
FEV 1 % (p = 0.005) compared to those with GOR only
(sputum negative for pepsin). Pepsin in airways samples in
COPD and bronchiectasis is not reliant on a diagnosis of
GOR. Pulmonary microaspiration of GOR may contribute
to airway damage in COPD.
Communication with general practitioners enhances
the early intervention of exacerbations in people with
chronic obstructive pulmonary disease
Leung RWM, 1 Greer T 2
1
Department of Physiotherapy, Concord Repatriation General Hospital
(CRGH), Sydney, 2 The COPD program, CRGH, Sydney
An action plan is recommended for the management
of acute exacerbations of COPD (AECOPD) but the
completion rate by general practitioners is low. This study
aimed to investigate the completion rate of the COPD action
plan after written communication with GPs was initiated.
Those patients who consecutively attended pulmonary
rehabilitation between January and June 2009 were given
a letter addressed to their GP with a blank action plan
in addition to a self-management education pack. Each
participant was contacted 4 weeks after the letter was
issued in order to review the response from the GP. People
were excluded if they could not follow instructions in
English. The participants (n = 54, mean (SD) FEV 1 = 47
(18) % predicted) were interviewed and the results were
compared to a study conducted in 2007. Thirty-two percent
of participants had a completed action plan compared to
22% in the previous study. Seventy percent of participants
(including those without an action plan) had prescriptions
for prednisone and antibiotics for early intervention of
AECOPD compared to 60% in the last study. For those
who did not have an action plan, the majority (81%) were
advised to contact the GP at the onset of AECOPD. The
completion rate of the action plan has increased through
written communication to the GP. This improvement is
vital as early detection and prompt intervention reduces the
severity and recovery time of exacerbations.
The e-AJP Vol 55: 4, Supplement 13