RT Journal Article
SR Electronic
T1 The dyspnoea-inactivity vicious circle in COPD: Development and external validation of a conceptual model
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1800079
DO 10.1183/13993003.00079-2018
A1 Maria A Ramon
A1 Gerben Ter Riet
A1 Anne-Elie Carsin
A1 Elena Gimeno-Santos
A1 Alvar Agustí
A1 Josep M Antó
A1 David Donaire-Gonzalez
A1 Jaume Ferrer
A1 Esther Rodríguez
A1 Robert Rodriguez-Roisin
A1 Milo A Puhan
A1 Judith Garcia-Aymerich
A1 the PAC-COPD Study Group
YR 2018
UL http://erj.ersjournals.com/content/early/2018/07/05/13993003.00079-2018.abstract
AB The vicious circle of dyspnoea-inactivity has been proposed, but never validated empirically, to explain the clinical course of chronic obstructive pulmonary disease (COPD). We aimed to develop and validate externally a comprehensive vicious circle model.Methods: (1)identification and validation of all published vicious circle models by a systematic literature search and fitting structural equation models (SEM) to longitudinal data from the PAC-COPD Spanish cohort (n=210, 68 years, FEV1 54%) testing both the hypothesised relationships between variables in the model (“paths”) and model fit; and (2)development of a new model and external validation using longitudinal data of the Swiss and Dutch ICE COLD ERIC cohort (n=226, 66 years, FEV1 57%).We identified nine vicious circle models for which SEMs confirmed most hypothesised paths but showed inappropriate fit. In the new model, airflow limitation, hyperinflation, dyspnoea, physical activity, exercise capacity and COPD exacerbations remained related to other variables and model fit was appropriate. Fitting it to ICE COLD ERIC all paths were replicated and model fit was appropriate.Previously published vicious circle models do not fully explain the vicious circle concept. We developed and externally validated a new comprehensive model that gives a more relevant role to exercise capacity and COPD exacerbations.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. ter Riet has nothing to disclose.Conflict of interest: Dr. Carsin has nothing to disclose.Conflict of interest: Dr. Gimeno-Santos has nothing to disclose.Conflict of interest: Dr. Agusti reports grants and personal fees from Astra-Zeneca, grants and personal fees from GSK, grants from MSD, grants and personal fees from Menarini, personal fees from Novartis, personal fees from TEVA, personal fees from Chiesi, outside the submitted work.Conflict of interest: Dr. Josep M Antó has nothing to disclose.Conflict of interest: Dr. DONAIRE-GONZALEZ has nothing to disclose.Conflict of interest: Dr. Ferrer has nothing to disclose.Conflict of interest: Dr. RODRIGUEZ has nothing to disclose.Conflict of interest: Dr. RODRIGUEZ-ROISIN reports grants from Almirall and Menarini, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Pearl Therapeutics, personal fees from Takeda, and personal fees from TEVA during the conduct of the study, all related to COPD.Conflict of interest: Dr. Puhan has nothing to disclose.Conflict of interest: Dr. Garcia-Aymerich reports other from AstraZeneca, other from Esteve, other from Chiesi, outside the submitted work.Conflict of interest: Dr. Ramon has nothing to disclose.