Improving exercise capacity is a primary objective in chronic obstructive pulmonary disease (COPD). Declines in exercise capacity result in reduced physical activity (PA) and health-related quality of life (HRQL). Self-management interventions can teach patients skills and behaviours to manage their disease. Technology-mediated interventions have the potential to provide easily accessible support for disease self-management. We evaluated the effectiveness of a web-based self-management intervention, focused on PA promotion, on exercise capacity in COPD. This 6-month randomised controlled trial (NCT02099799) enrolled 153 persons with COPD at two U.S. sites (VABoston, n=108; VABirmingham, n=45). Participants were allocated (1:1) to the web-based self-management intervention (PA promotion through personalised, progressive step-count goals, feedback, online COPD-related education, and social support via an online community), or usual care. The primary outcome was exercise capacity (6-min walk test distance [6 MWD]). Secondary outcomes included PA (daily steps per day), HRQL (St. George's Respiratory Questionnaire Total Score), dyspnoea, COPD-related knowledge, and social support. Change in step-count goals reflected intervention engagement. Participants were 69±7 years old, mean FEV1% predicted 61±21%. Change in 6 MWD did not differ between groups. Intervention participants improved daily step counts by an average of 1312 more than usual care (p<0.001). Groups did not differ on other secondary outcomes. VABirmingham participants were significantly more engaged with the intervention, although site did not modify the effect of the intervention on 6 MWD or secondary outcomes. The intervention did not improve exercise capacity, but improved PA at 6 months. Additional intervention modifications are needed to optimise its COPD self-management capabilities.

Study DesignCross-sectional study.ObjectivesDetermine clinical factors associated with plasma C-reactive protein (CRP) in persons with chronic spinal cord injury (SCI).SettingVeterans Affairs Medical Center in Boston, MA.MethodsParticipants provided a blood sample, completed a respiratory health questionnaire, and underwent dual x-ray absorptiometry (DXA) to assess total and regional body fat. Linear regression models were used to assess cross-sectional associations with plasma CRP.ResultsIn multivariable models, factors associated with a higher CRP included a greater BMI, urinary catheter use, a respiratory illness in the past week, and non-white race. Mean CRP also increased with decreasing mobility (motorized wheel chair >hand propelled wheel chair > walk with an assistive device > walk independently). Results were similar when adjusting for % android, gynoid, trunk, or total fat mass in place of BMI. Level and completeness of SCI was not associated with CRP in multivariable models.ConclusionsClinical characteristics common in chronic SCI are associated with plasma CRP. These factors are more important than level and completeness of SCI and some are potentially modifiable.

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Adjusted and unadjusted for a number of confounders, there was no significant association between plasma vitamin D levels and FEV, FVC, or FEV/FVC. For example, in fully adjusted models, each 10 ng/ml increase in vitamin D was associated with a 4.4 ml (95%CI -64.4, 73.2, P = 0.90) ml change in FEV Conclusion: There was no significant cross-sectional association between plasma vitamin D and FEV, FVC, or FEV/FVC in this cohort of individuals with chronic SCI.

BackgroundSystemic inflammation has been associated with reduced pulmonary function in individuals with and without chronic medical conditions. Individuals with chronic spinal cord injury (SCI) have clinical characteristics that promote systemic inflammation and also have reduced pulmonary function. We sought to assess the associations between biomarkers of systemic inflammation with pulmonary function in a chronic SCI cohort, adjusting for other potential confounding factors.MethodsParticipants (n = 311) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma C-reactive protein (CRP) and interleukin-6 (IL-6) with forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC.ResultsThere were statistically significant inverse relationships between plasma CRP and IL-6 assessed in quartiles or continuously with FEV1 and FVC. In fully adjusted models, each interquartile range (5.91 mg/L) increase in CRP was associated with a significant decrease in FEV1 (−55.85 ml; 95% CI: -89.21, −22.49) and decrease in FVC (−65.50 ml; 95% CI: -106.61, −24.60). There were similar significant findings for IL-6. There were no statistically significant associations observed with FEV1/FVC.ConclusionPlasma CRP and IL-6 in individuals with chronic SCI are inversely associated with FEV1 and FVC, independent of SCI level and severity of injury, BMI, and other covariates. This finding suggests that systemic inflammation associated with chronic SCI may contribute to reduced pulmonary function.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0459-6) contains supplementary material, which is available to authorized users.