Emiel F M Wouters

Maastricht Universitair Medisch Centrum, Maestricht, Limburg, Netherlands

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Publications (685)3183.65 Total impact

  • European Respiratory Journal 07/2015; 46(1):250-4. DOI:10.1183/09031936.00012215 · 7.13 Impact Factor
  • Daisy J A Janssen, Emiel F M Wouters, Martijn A Spruit
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    ABSTRACT: Breathlessness is one of the most important symptoms of patients with advanced life-limiting disease, such as chronic obstructive pulmonary disease, chronic heart failure, cancer, or pulmonary fibrosis. Breathlessness has major implications for patients as well as their family caregivers. The present review provides an overview of recent knowledge concerning the psychological and social consequences of breathlessness, including behavioural responses to breathlessness, and the impact of breathlessness on the family caregiver. Breathlessness results in avoidance of exertion and deterioration of functional status. Functional impairment leads to care dependency and social limitations, resulting in a change in social role. Anxiety is an emotional response to breathlessness, but also increases the perception of breathlessness. Family caregivers of patients have to cope with changes in daily life, witnessing breathlessness and adapt to new and challenging role as family caregiver. The consequences of living with breathlessness are multidimensional and arise in all aspects of daily life of patients, their family caregivers and their social environment. Multidimensional treatment programmes should become widely available to support patients with advanced disease and their family caregivers in coping with the functional, psychological and social consequences of living with breathlessness.
    Current opinion in supportive and palliative care 06/2015; DOI:10.1097/SPC.0000000000000146
  • European Respiratory Journal 06/2015; DOI:10.1183/09031936.00026215 · 7.13 Impact Factor
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    ABSTRACT: In addition to the six-min walk distance (6 MWD), other six-min walk test (6 MWT) derived variables, such as mean walk-speed (6MWSpeed), 6-min walk-work (6 MWW), distance-saturation product (DSP), exercise-induced oxygen desaturation (EID), and unintended stops may be useful for the prediction of mortality and hospitalization in patients with chronic obstructive pulmonary disease (COPD). We studied the association between 6 MWT-derived variables and mortality as well as hospitalization in COPD patients and compared it with the BODE index. A three-year prospective study (ECLIPSE) to evaluate the prognostic value of 6 MWT-derived variables in 2010 COPD patients. Cox's proportional-hazard regressions were performed to estimate 3-year mortality and hospitalization. During the follow-up, 193 subjects died and 622 were hospitalized. An adjusted Cox's regression model of hazard ratio [HR] for impaired 6 MWT-derived variables was significant referring to: mortality (6 MWD ≤334 m [2.30], 6MWSpeed ≤0.9 m/sec [2.15], 6 MWW ≤20000 m kg [2.17], DSP ≤290 m% [2.70], EID ≤88% [1.75], unintended stops [1.99]; and hospitalization (6 MWW ≤27000 m kg [1.23], EID ≤88% [1.25], BODE index ≥3 points [1.40]; all p ≤ 0.05). The 6 MWT-derived variables have an additional predictive value of mortality in patients with COPD. The 6 MWW, EID and the BODE index refine the prognosis of hospitalization. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Respiratory medicine 06/2015; DOI:10.1016/j.rmed.2015.06.013 · 2.92 Impact Factor
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    ABSTRACT: Accelerated ageing has been proposed as a pathological mechanism of various chronic diseases, including chronic obstructive pulmonary disease (COPD). This concept has almost exclusively been approached by analyses of individual markers. We investigated if COPD is associated with accelerated ageing using a panel of markers representing various interconnected aspects of the ageing process. Lung function, leukocyte telomere length, lymphocyte gene expression of anti-ageing (sirtuin1, total (T) and soluble (S)klotho), senescence (p16/21) and DNA repair (Ku70/80 and TERF2) proteins, and markers of systemic inflammation and oxidative stress were determined in 160 COPD patients, 82 smoking and 38 never smoking controls. Median levels for telomere length, Sklotho, Ku70 and sirtuin1 gene expression were lower (respectively 4.4, 4.6 and 4.7kbp for telomere length; 74, 82 and 100% for Sklotho; 88, 92 and 100% for Ku70 and 70, 92 and 100% for sirtuin1, all p<0.05) in patients compared to the smoking and never smoking control groups. P21 gene expression was higher in patients compared to smoking controls. Telomere length correlated with Ku70 gene expression (r=0.15, p=0.02). After correction for age, smoking history, systemic inflammation and oxidative stress, telomere length and p21 were the only markers which remained independently associated with lung function. In separate groups, only telomere length remained associated with lung function parameters. Markers of the ageing mechanism represent distinct molecular aspects of ageing. Among them, different markers were altered in COPD, but only telomere length was consistently associated with lung function, and seems a useful marker for expressing accelerated ageing in COPD.
    Chest 06/2015; DOI:10.1378/chest.15-0645 · 7.13 Impact Factor
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    ABSTRACT: This multicenter study sought to explore attitudes of pulmonary rehabilitation (PR) professionals toward self-management and which patients' competencies are considered important. Self-management in patients with chronic obstructive pulmonary disease (COPD) requires a patients' active role. Whether patient-clinician partnership in care is supported by PR professionals remains unknown. Attitudes of 75 PR professionals were assessed using an online version of the Clinician Support - Patient Activation Measure (CS-PAM) 13™. Mean CS-PAM 13™ activation score was 66.5 (11.9) points - professionals support patient's participation in the care process. However, competencies related to patient as member of a care team and patient as an independent information seeker were only extremely important for 30.7-38.7% and 9.3-17.3% of the professionals, respectively. PR professionals embrace the idea of a patients' active role in the process of COPD self-management. Nonetheless, endorsement of the patient's involvement as an independent information seeker is needed. Copyright © 2015 Elsevier Inc. All rights reserved.
    Heart & lung: the journal of critical care 05/2015; 44(4). DOI:10.1016/j.hrtlng.2015.05.003 · 1.32 Impact Factor
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    ABSTRACT: With the growing amount of physical activity (PA) measures, the need for methods and algorithms that automatically analyse and interpret unannotated data increases. In this paper PA is seen as a combination of multi-modal constructs that can co-occur in different ways and proportions during the day. The design of a methodology able to integrate and analyse them is discussed and its operation is illustrated by applying it to a data set comprising data from COPD patients and healthy subjects acquired in daily life. The method encompasses different stages. The first stage is a completely automated method of labelling low-level multi-modal PA measures. The information contained in the PA labels are further structured using topic modelling techniques, a machine learning method from the text processing community. The topic modelling discovers the main themes that pervade a large set of data. In our case, topic models discover PA routines that are active in the assessed days of the subjects under study. Applying the designed algorithm to our data provides new learnings and insights. As expected, the algorithm discovers that PA routines for COPD patients and healthy subjects are substantially different regarding their composition and moments in time in which transitions occur. Furthermore, it shows consistent trends relating to disease severity as measured by standard clinical practice.
    IEEE Journal of Biomedical and Health Informatics 05/2015; DOI:10.1109/JBHI.2015.2432033 · 1.98 Impact Factor
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    American Journal of Respiratory and Critical Care Medicine 05/2015; 191(9):1081-1082. DOI:10.1164/rccm.201412-2296RR · 11.99 Impact Factor
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    ABSTRACT: Decreased physical performance due to loss of muscle mass (i.e. sarcopenia) is prevalent in ageing and appears more pronounced in chronic disease. A comprehensive profile of the sarcopenic phenotype in chronic obstructive pulmonary disease (COPD) is not yet available. The aim of the present study was to characterise prevalence, functional implications and predictive value of sarcopenia with or without abdominal obesity in Dutch COPD patients eligible for pulmonary rehabilitation. 505 COPD patients (aged 37-87 years; 57% male) underwent assessment of lung function, body composition and physical functioning, before entering pulmonary rehabilitation. Sarcopenia was assessed by appendicular skeletal muscle index (ASMI) and abdominal obesity by android/gynoid percentage fat mass (A/G%FM) using dual energy X-ray absorptiometry (DEXA). 86.5% of patients were sarcopenic and showed lower physical functioning, while coexistent abdominal obesity (78.0%) resulted in higher physical functioning. Implications on endurance were less pronounced in women. The predictive value for physical functioning was higher for the "three-compartment" model (ASMI, bone mineral content and A/G%FM) than the "two-compartment" model (fat-free mass index and fat mass index) or "one-compartment" model (body mass index). In patients eligible for pulmonary rehabilitation, sarcopenia is highly prevalent in all BMI-categories and associated with impaired strength, and in men also with decreased endurance. Abdominal obesity seems to have protective effects on physical functioning. ASMI is a better predictor for physical functioning than FFMI. Copyright ©ERS 2015.
    European Respiratory Journal 04/2015; DOI:10.1183/09031936.00197314 · 7.13 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. Copyright ©ATS/ERS 2015.
    European Respiratory Journal 04/2015; 45(4):879-905. DOI:10.1183/09031936.00009015 · 7.13 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarized, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment, and management of COPD as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS Research Statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centered outcomes.
    American Journal of Respiratory and Critical Care Medicine 04/2015; 191(7):e4-e27. DOI:10.1164/rccm.201501-0044ST · 11.99 Impact Factor
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    Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544631
  • Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544632
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    ABSTRACT: Family caregivers already have a paramount role in daily care for patients with chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), or chronic renal failure (CRF). To date, it remains unknown whether and to what extent the experience of caregiving changes over time. To examine changes in caregiver burden and positive aspects of caregiving during 1-year follow-up in patients with advanced COPD, CHF or CRF and to study determinants of changes in caregiver burden and positive aspects of caregiving. In this longitudinal observational study, patients and their family caregivers who had complete data at baseline and 12 months (n = 104) and family caregivers of patients who died during 1-year follow-up (n = 15) were included. Caregiver burden and positive aspects of caregiving were assessed using the Family Appraisal of Caregiving Questionnaire for Palliative Care (FACQ-PC). Domain scores were classified into three categories, and baseline characteristics were compared between these categories. A majority of the individuals showed 1-year changes in FACQ-PC domain scores. These individual changes were not explained by demographic or clinical patient characteristics at baseline or changes in patient characteristics during 1-year follow-up. Furthermore, caregiver burden was higher for caregivers of patients who died during 1-year follow-up compared to caregivers whose relative completed 1-year follow-up. This study showed that caregiver burden and positive aspects of caregiving can change over time, and these changes are highly individual. Therefore, healthcare providers should regularly pay attention to family caregivers, regardless the patients' characteristics. © 2015 Nordic College of Caring Science.
    Scandinavian Journal of Caring Sciences 02/2015; DOI:10.1111/scs.12204 · 0.89 Impact Factor
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    ABSTRACT: Rationale: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that likely includes clinically relevant subgroups. Objectives: To identify subgroups of COPD in ECLIPSE subjects using unsupervised cluster analysis and to assess clinically meaningful outcomes of the clusters during 3 years of longitudinal follow-up. Methods: Factor analysis was used to reduce 41 variables determined at recruitment in 2,164 COPD patients to 13 main factors, and the variables with the highest loading were used for unsupervised cluster analysis. Clusters were then evaluated for their relationship with clinically meaningful outcomes during 3 years of follow-up. The relationships among clinical parameters were evaluated within clusters. Measurements and Main Results: Five subgroups were distinguished using cross-sectional clinical features. Importantly, these groups differed with regard to outcomes. Cluster A included milder patients and had fewer deaths and hospitalizations. Cluster B had less systemic inflammation at baseline but had notable changes in health status and emphysema extent. Cluster C had many comorbidities, evidence of systemic inflammation and the highest mortality. Cluster D had low FEV1, severe emphysema and the highest exacerbation and COPD hospitalization rate. Cluster E was intermediate for most variables and may represent a mixed group that includes further clusters. The relationships among clinical variables within clusters differed from that in the entire COPD population. Conclusions: Unsupervised cluster analysis using baseline data in ECLIPSE identified five COPD subgroups that differ in outcomes and inflammatory biomarkers and show different relationships between clinical parameters, suggesting the clusters represent clinically and biologically different subtypes of COPD.
    02/2015; 12(3). DOI:10.1513/AnnalsATS.201403-125OC
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    ABSTRACT: Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. To examine the quality of end-of-life care communication during one-year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes towards the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. Clinically stable outpatients (n=265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication Questionnaire, QOC). Two years after baseline, survival status was assessed and if patients died during the study period, a bereavement interview was done with the closest relative. One-year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two-year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. End-of-life care communication is poor in patients with chronic organ failure and does not change towards the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of Pain and Symptom Management 01/2015; DOI:10.1016/j.jpainsymman.2014.12.008 · 2.74 Impact Factor
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    ABSTRACT: Note: MACVIALR (contre les maladies chroniques pour un vieillissement actif en Languedoc Roussillon), reference Site of the European Innovation Parternship on Active and Healthy Ageing (EIP on AHA), EIP on AHA Reference Site Network, European Union Geriatric Medicine Society (EUGMS), International Association of Gerontology and Geriatrics (IAGG), Groupe de recherche (GDR) français sur la longévité et le vieillissement, ECHAlliance, Healthy Ageing Research Center (HARC). Abstract: The broad concept of Active and Healthy Ageing was proposed by WHO as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both individuals and population groups. A universal active and healthy ageing definition is not available and may differ depending on the purpose of the definition and/or the questions raised. The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact but a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier October 2021, 2014 as the annual conference of the EIP on AHA Reference Site MACVIALR (contre les maladies chroniques pour un vieillissement actif en Languedoc Roussillon). The goal of the meeting was to propose an operational definition of Active and Healthy Ageing and tools that may be used for this definition. The current paper gives a summary of the plenary presentations that were given during the meeting.
    European geriatric medicine 12/2014; 5(6):406-415. DOI:10.1016/j.eurger.2014.12.006 · 0.55 Impact Factor
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    ABSTRACT: Background Acute respiratory distress syndrome (ARDS) is a life-threating condition with high morbidity and mortality. Inflammation is the main factor in the pathogenesis of ARDS. Therefore systemic corticosteroids are a rational therapeutic approach, but the effect of corticosteroids is still unclear. In this study, we looked at the effects of corticosteroids in ventilated sheep with ARDS, induced by lung lavage. Methods We performed a prospective, randomised study in 64 ventilated sheep with ARDS, to evaluate the effect of corticosteroids and oxygen concentration on gas exchange and lung injury. Oxygenation index (OI) and ventilation efficacy index (VEI) were calculated to evaluate gas exchange. Lung injury was assessed by inflammatory response in broncho-alveolar lavage fluid (BALF) and plasma and histology of the lung. Results OI, VEI, lung inflammation, surfactant production, or lung histology was not influenced by corticosteroids. In the 100 % oxygen groups, OI was higher and total number of cells and disaturated phospholipids were lower in BALF. Conclusion Our study showed that corticosteroids did not influence inflammation in early phase ARDS and that hyperoxia aggravated lung injury which could not be modulated by dexamethasone in early phase ARDS.
    Beiträge zur Klinik der Tuberkulose 12/2014; 193(1). DOI:10.1007/s00408-014-9670-x · 2.17 Impact Factor
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    ABSTRACT: RationaleMineral particles in the lung cause inflammation and silicosis. In myeloid and bronchial epithelial cells the inflammasome plays a role in responses to crystalline silica. Thioredoxin (TRX) and its inhibitory protein TRX-interacting protein link oxidative stress with inflammasome activation. We investigated inflammasome activation by crystalline silica polymorphs and modulation by TRX in vitro, as well as its localization and the importance of silica surface reactivity in rats.Methods We exposed bronchial epithelial cells and differentiated macrophages to silica polymorphs quartz and cristobalite and measured caspase-1 activity as well as the release of IL-1beta, bFGF and HMGB1; including after TRX overexpression or treatment with recombinant TRX. Rats were intratracheally instilled with vehicle control, Dörentruper quartz (DQ12) or DQ12 coated with polyvinylpyridine N-oxide. At days 3, 7, 28, 90, 180 and 360 five animals per treatment group were sacrificed. Hallmarks of silicosis were assessed with Haematoxylin-eosin and Sirius Red stainings. Caspase-1 activity in the bronchoalveolar lavage and caspase-1 and IL-1ß localization in lung tissue were determined using Western blot and immunohistochemistry (IHC).ResultsSilica polymorphs triggered secretion of IL-1ß, bFGF and HMGB1 in a surface reactivity dependent manner. Inflammasome readouts linked with caspase-1 enzymatic activity were attenuated by TRX overexpression or treatment. At day 3 and 7 increased caspase-1 activity was detected in BALF of the DQ12 group and increased levels of caspase-1 and IL-1ß were observed with IHC in the DQ12 group compared to controls. DQ12 exposure revealed silicotic nodules at 180 and 360 days. Particle surface modification markedly attenuated the grade of inflammation and lymphocyte influx and attenuated the level of inflammasome activation, indicating that the development of silicosis and inflammasome activation is determined by crystalline silica surface reactivity.Conclusion Our novel data indicate the pivotal role of surface reactivity of crystalline silica to activate the inflammasome in cultures of both epithelial cells and macrophages. Inhibitory capacity of the antioxidant TRX to inflammasome activation was evidenced. DQ12 quartz exposure induced acute and chronic functional activation of the inflammasome in the heterogeneous cell populations of the lung in associated with its crystalline surface reactivity.
    Particle and Fibre Toxicology 11/2014; 11(1):58. DOI:10.1186/s12989-014-0058-0 · 6.99 Impact Factor

Publication Stats

21k Citations
3,183.65 Total Impact Points

Institutions

  • 1988–2015
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2011–2014
    • CIRO
      • Program Development Centre
      Roermond, Limburg, Netherlands
    • Philipps University of Marburg
      Marburg, Hesse, Germany
  • 1986–2014
    • Maastricht University
      • • Department of Respiratory Medicine
      • • Department of Respiratory Medicine
      • • Humane Biologie
      Maestricht, Limburg, Netherlands
  • 2012
    • Biometrics
      Saint-Clair, Île-de-France, France
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2010
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009
    • Universitair Ziekenhuis Ghent
      Gand, Flanders, Belgium
    • Catharina Hospital
      Eindhoven, North Brabant, Netherlands
  • 2006–2008
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 2007
    • Cardiff University
      Cardiff, Wales, United Kingdom
  • 2005
    • University of Groningen
      Groningen, Groningen, Netherlands
    • University of Vermont
      • Department of Pathology
      Burlington, VT, United States
    • Leiden University
      Leyden, South Holland, Netherlands
  • 2000
    • Zeeuws Radiotherapeutisch Instituut
      Flushing, Zeeland, Netherlands
  • 1997
    • Open Universiteit Nederland
      Heerlen, Limburg, Netherlands
  • 1996
    • Landesklinikum Horn
      Horn, Lower Austria, Austria
  • 1995
    • Wageningen University
      Wageningen, Gelderland, Netherlands
  • 1989–1995
    • Transnationale Universiteit Limburg
      Mississippi, United States