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Mindfulness aplicada a la EPOC - Dr. Jordi Roig Cutillas


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Qué es el Mindfulness y cómo puede ayudar a los pacientes con enfermedades respiratorias como la EPOC.

Presentación del Dr. Jordi Roig Cutillas, doctor en medicina y especialista en neumología, durante el XVI Simposio sobre EPOC, dónde introduce el Mindfulness, la evidencia científica y su uso como complemento en la terapia de pacientes con enfermedades respiratorias crónicas.

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Mindfulness aplicada a la EPOC - Dr. Jordi Roig Cutillas

  1. 1. Mindfulness aplicada a la EPOC J. Roig Cutillas Servicio de Neumología Clínica Creu Blanca Barcelona
  2. 2. • ¿Cómo vive el paciente su EPOC? • Base científica de la relación respiración “body&mind” • Aspectos de EPOC potencialmente mejorables • Actividad física • Estudios en EPOC 08/10/18 2 Mindfulness aplicada a la EPOC
  3. 3. The EASI model: A first integrative computational approximation to the natural history of COPD. RESEARCH ARTICLE Agusti A et al. PlosOne 2017 E the exposure to inhaled particles and gases (smoking) A the biological activity (inflammatory response) of the disease S the severity of airflow limitation (FEV1) and I the impact of the disease (breathlessness) in different clinical scenarios
  4. 4. Depression and Anxiety in COPD Montserrat-Capdevila J. Mental disorders in chronic obstructive pulmonary diseases. Perspect Psychiatr Care 2018 Miravitlles M. Depressive status explains a significant amount of the variance in COPD assessment test (CAT) scores. Int J Chron Obstruct Pulmon Dis. 2018 Yohannes AM. Depression and anxiety in patients with COPD. Eur Respir Rev. 2014
  5. 5. Self blame & catastrophizing interpretation • Plaufcan MR. Behavioral and characterological self-blame in chronic obstructive pulmonary disease. J Psychosom Res 2012. • Solomon BK. A breathlessness catastrophizing scale for chronic obstructive pulmonary disease. J Psychosom Res 2015. • Livermore N. Catastrophic interpretations and anxiety sensitivity as predictors of panic- spectrum psychopathology in chronic obstructive pulmonary disease. J Psychosom Res 2012.
  6. 6. Chen YW. Arch Phys Med Rehabil 2016; COPD 2018 Comorbidities That Cause Pain and the Contributors to Pain in Individuals With Chronic Obstructive Pulmonary Disease A Comparison of Pain, Fatigue, Dyspnea and their Impact on Quality of Life in Pulmonary Rehabilitation Participants with Chronic Obstructive Pulmonary Disease • Pain was highly prevalent (71 – 74%) • Most common causes of pain were musculoskeletal conditions • Prevalence of dyspnea 93%; fatigue 77% • Patients with COPD report similar severity scores of the 3 symptoms • All individually impacted QoL • All 3 interfere similarly on aspects of daily living • Assessment and management of pain need to be addressed
  7. 7. Shikhbahaer S. Science 2017 Breathing to inspire and arouse A small population of brainstem neurons connects breathing behavior to brain arousal Breathing control center neurons that promote arousal in mice NEUROSCIENCE Yackle K. Science 2017
  8. 8. The rhythmic activity of a cluster of neurons in the brainstem initiates breathing. This cluster is composed of distinct, though intermingled, subgroups of neurons. A small, molecularly defined neuronal subpopulation in this breathing rhythm generator that directly projects to a brain center that plays a key role in generalized alertness, attention, and stress. Removal of these cells did not affect normal breathing but left the animals unusually calm. The breathing center thus has a direct and dramatic influence on higher-order brain function. The calming effect of breathing Ascending neural circuit from preBötC. Cdh9/Dbx1 preBötC neurons provide monosynaptic excitatory input to noradrenergic LC neurons, which project throughout brain to promote arousal and active behaviors. Yackle K. Science 2017
  9. 9. Aging-Related Systemic Manifestations in COPD Patients and Cigarette Smokers Boyer L. PlosOne 2015 • Cross-sectional study: 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD) • Compared to control smokers, patients with COPD had shorter telomere length, … DNA damage response at telomeres contributes to lung aging and COPD Birch J. Am J Physiol Lung Cell Mol Physiol 2015 • Smoke accelerates telomere dysfunction via reactive oxygen species • Telomere dysfunction may underlie decline of lung function observed during aging and in COPD
  10. 10. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres Epel E. Ann NY Acad Sci, 2009.
  11. 11. Jacobs et al. Psychoneuroendocrinology 2011. A schematic depiction of how meditation practice might influence telomerase activity by increasing perceived control and decreasing neuroticism
  12. 12. Intensive meditation training, immune cell telomerase activity, and psychological mediators Telomerase Activity higher in the Retreat Group post- Jacobs et al. Psychoneuroendocrinology 2011.
  13. 13. Mindfulness During Pregnancy Linked To Healthier Birth Weight In Newborns Nyklíček I. Mindfulness skills during pregnancy: Prospective associations with mother's mood and neonatal birth weight. J Psychosom Res 2018 Savran O. Early life insults as determinants of chronic obstructive pulmonary disease in adult life. Int J COPD 2018
  14. 14. Troosters T. Respir Research 2013 …addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.
  15. 15. When analyzing individual intervention types, cognitive behavioral therapy appeared to be effective (g = 0.39, CI = 0.15–0.62; p = 0.001) for improving psychological outcomes. In contrast for physical outcomes, only mind-body interventions (e.g. mindfulness based therapy, yoga, and relaxation) revealed a statistically significant effect (g = 0.40; CI = 0.01–0.79; p = 0.042). Physical (dyspnea + exercise capacity + fatigue + lung function) Farver-Vestergraard I. Psychother Psychosom 2015
  16. 16. Farver-Vestergraard I. Psychother Psychosom 2015
  17. 17. Mularski RA. JACM 2009. Change in dyspnea at entry and completion of the study, by treatment group. MBBT, mindfulness-based breathing therapy.
  18. 18. • Veterans • Elderly men Aryal S. COPD and gender differences: an update. Transl Res 2013. • Severe COPD • Breathing ? • >40 % drop out Blackstock FC. Why don’t our COPD patients listen to us? The enigma of nonadherence. Ann Am Thorac Soc 2016. • Motivation? Mularski RA. JACM 2009.
  19. 19. Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial Farver-Vestergraard I. ERJ 2018 • COPD patients eligible for PR were cluster randomised to receive either an 8-week, group-based MBCT programme as an add-on to an 8-week PR programme (n=39), or PR alone (n=45) • The primary outcomes of psychological distress and physical health status impairment were measured with the Hospital Anxiety and Depression Scale (HADS) and the COPD Assessment Test (CAT) • Before randomisation (T1), mid- (T2) and post-intervention (T3), and at 3 (T4) and 6 (T5) months’ follow-up
  20. 20. Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial Farver-Vestergraard I. ERJ 2018 MBCT: mindfulness-based cognitive therapy; PR: pulmonary rehabilitation; HADS: Hospital Anxiety and Depression Scale total score; CAT: COPD Assessment Test
  21. 21. Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial Farver-Vestergraard I. ERJ 2018 Tumour necrosis factor (TNF)- mRNA foldα change. *p<0.05.
  22. 22. La historia no contada del movimiento Mindfulness de Norteamérica New York Society for Ethical Culture 2017
  23. 23. Mindfulness aplicada a la EPOC • Optimizar diseño estudio • Selección adecuada pacientes: prejuicios, estereotipos • Definir opción Mindfulness MBSR • Valorar dificultad en fase inicial de respiración • Innovar outputs: incluir dolor • Énfasis en obviar “lo estoy haciendo bien o mal” • Mindfulness es un aprendizaje en el que se progresa • Instructores titulados