Emiel F M Wouters

Technische Universiteit Eindhoven, Eindhoven, North Brabant, Netherlands

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Publications (711)3440.71 Total impact

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    ABSTRACT: The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD.
    European Respiratory Journal 10/2015; DOI:10.1183/13993003.00350-2015 · 7.64 Impact Factor
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    European Respiratory Journal 09/2015; DOI:10.1183/13993003.00692-2015 · 7.64 Impact Factor
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    Paul M Peeters · Emiel F Wouters · Niki L Reynaert
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    ABSTRACT: The epithelium regulates the interaction between the noxious xenogenous, as well as the microbial environment and the immune system, not only by providing a barrier but also by expressing a number of immunoregulatory membrane receptors, and intracellular danger sensors and their downstream effectors. Amongst these are a number of inflammasome sensor subtypes, which have been initially characterized in myeloid cells and described to be activated upon assembly into multiprotein complexes by microbial and environmental triggers. This review compiles a vast amount of literature that supports a pivotal role for inflammasomes in the various epithelial barriers of the human body as essential factors maintaining immune signaling and homeostasis.
    Journal of Immunology Research 09/2015; 2015(2):828264. DOI:10.1155/2015/828264 · 2.93 Impact Factor
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    European Respiratory Journal 09/2015; DOI:10.1183/13993003.00667-2015 · 7.64 Impact Factor
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    ABSTRACT: The burden of chronic obstructive pulmonary disease (COPD) on society is increasing. Healthcare systems should support patients with COPD in achieving an optimal quality of life, while limiting the costs of care. As a consequence, a shift from hospital care to home care seems inevitable. Therefore, patients will have to rely to a greater extent on informal caregivers. Patients with COPD as well as their informal caregivers are confronted with multiple limitations in activities of daily living. The presence of an informal caregiver is important to provide practical help and emotional support. However, caregivers can be overprotective, which can make patients more dependent. Informal caregiving may lead to symptoms of anxiety, depression, social isolation and a changed relationship with the patient. The caregivers' subjective burden is a major determinant of the impact of caregiving. Therefore, the caregiver's perception of the patient's health is an important factor. This article reviews the current knowledge about these informal caregivers of patients with COPD, the impact of COPD on their lives and their perception of the patient's health status.
    European Respiratory Review 09/2015; 24(137):498-504. DOI:10.1183/16000617.00010114
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    ABSTRACT: INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Patients with COPD are characterised by a reduced health status, which can be easily assessed by the COPD Assessment Test (CAT). Previous studies show that health status can be worsened by the presence of comorbidities. However, the impact of cardiovascular comorbidities on health status as assessed with CAT is not sufficiently investigated. Therefore, the current study has the following objectives: (1) to study the clinical, (patho)physiological and psychosocial determinants of the CAT, and impact of previously established and/or newly diagnosed cardiovascular comorbidities on health status in tertiary care patients with COPD; (2) to assess the effects of pulmonary rehabilitation on CAT scores in patients with COPD; (3) to develop reference values for the CAT in Dutch elderly patients without COPD; and (4) to validate the CAT in a broad sample of Dutch patients with COPD. METHODS AND ANALYSIS: The COPD, Health status and Comorbidities (Chance) study is a monocentre study consisting of an observational cross-sectional part and a longitudinal part. Demographic and clinical characteristics will be assessed in primary care, secondary care and tertiary care patients with COPD, and in patients without COPD. To assess health status, the CAT, Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ) will be used. The longitudinal part consists of a comprehensive pulmonary rehabilitation programme in 500 tertiary care patients. For the cross-sectional part of the study, 150 patients without COPD, 100 primary care patients and 100 secondary care patients will be assessed during a single home visit. ETHICS AND DISSEMINATION: The Medical Ethical Committee of the Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands (METC 11-3-070), has approved this study. The study has been registered at the Dutch Trial Register (NTR 3416).
    BMJ Open 07/2015; 5(7). DOI:10.1136/bmjopen-2014-007536 · 2.27 Impact Factor
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    ABSTRACT: Vitamin D deficiency is common in patients with chronic obstructive pulmonary disease (COPD) and has also been linked to co-morbidities often present in COPD. The aim of this study was to investigate whether vitamin D deficiency was related specifically to airflow limitation or whether vitamin D deficiency was determined by conditions that frequently co-exist with COPD: insulin resistance, hypertension, anemia, obesity, and hypercholesterolemia. For this cross-sectional analysis, we included 897 subjects from the Baltimore Longitudinal Study of Aging. Subjects taking vitamin D supplements were excluded. Airflow limitation was defined as FEV1 /FVC<lower limit of normal. Logistic regression was used to assess the association between vitamin D deficiency (25-hydroxy vitamin D<20 ng/mL) and possible determinants. Vitamin D deficiency was not specific for subjects with airflow limitation. Body mass index (BMI) (OR: 1.05, p<0.03) and obesity (BMI>30 kg/m(2) ) (OR: 1.9, p<0.002) were significantly associated with vitamin D deficiency in the adjusted multivariate regression analysis. Physical activity was associated with a decreased risk of vitamin D deficiency. Airflow limitation was not an independent determinant of vitamin D deficiency. The effect of weight loss and increased physical activity on vitamin D levels should be investigated further in intervention studies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    European Journal of Clinical Investigation 07/2015; 45(9). DOI:10.1111/eci.12498 · 2.73 Impact Factor
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    ABSTRACT: Walking aids, such as rollator or draisine, improve mobility and functional exercise performance in individuals with chronic obstructive pulmonary disease (COPD) during an indoor 6-min walk test. However, this test does not reflect everyday walking, which is the most frequently reported problematic activity of daily life in individuals with COPD. To date, efficacy of walking aids during self-paced outdoor walking remains unknown. Therefore, we aimed to determine the efficacy of a rollator and draisine on self-paced outdoor walking in individuals with COPD. Fifteen individuals with COPD (68% men; age: 63 ± 8 years; forced expiratory volume in 1 s: 40 ± 14% predicted) performed three self-paced outdoor walking tests on two consecutive days: test 1 unaided, and tests 2 and 3 with rollator or draisine in random order. Participants had to walk as long as possible at their own pace. The test ended when participants needed to stop, with a maximum duration of 30 min. The use of rollator resulted in the highest walk distance and time (P < 0.05 vs unaided and draisine). Furthermore, individuals with COPD walked significantly further and longer during an unaided test compared with a draisine aided test (P < 0.05). Moreover, use of draisine resulted in a significantly higher walking speed, fewer strides, greater stride length, and higher step and stride variability (P < 0.05 vs unaided and rollator). To conclude, a rollator improves the self-paced outdoor walk distance and time in individuals with moderate and advanced COPD and a poor functional exercise capacity, whereas the use of a draisine had a detrimental effect compared with unaided walking. © 2015 Asian Pacific Society of Respirology.
    Respirology 07/2015; 20(6). DOI:10.1111/resp.12570 · 3.35 Impact Factor
  • European Respiratory Journal 07/2015; 46(1):250-4. DOI:10.1183/09031936.00012215 · 7.64 Impact Factor
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    07/2015; 3(7):e21-2. DOI:10.1016/S2213-2600(15)00192-7
  • 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; 9(3). DOI:10.1097/SPC.0000000000000146 · 1.66 Impact Factor
  • European Respiratory Journal 06/2015; 46(2). DOI:10.1183/09031936.00026215 · 7.64 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; 109(9). DOI:10.1016/j.rmed.2015.06.013 · 3.09 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 · 7.48 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 · 1.29 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 · 1.44 Impact Factor

Publication Stats

22k Citations
3,440.71 Total Impact Points


  • 2015
    • Technische Universiteit Eindhoven
      Eindhoven, North Brabant, Netherlands
  • 2008–2015
    • CIRO
      • Program Development Centre
      Roermond, Limburg, Netherlands
  • 1990–2015
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 1986–2014
    • Maastricht University
      • • Department of Respiratory Medicine
      • • Department of Respiratory Medicine
      • • Department of Human Biology
      Maestricht, Limburg, Netherlands
  • 2012
    • Biometrics
      Saint-Clair, Île-de-France, France
  • 2011
    • Philipps University of Marburg
      Marburg, Hesse, Germany
  • 2010
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009
    • Universitair Ziekenhuis Ghent
      Gand, Flanders, Belgium
  • 2006–2008
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 2005
    • University of Groningen
      Groningen, Groningen, Netherlands
    • Leiden University
      Leyden, South Holland, Netherlands
    • University of Vermont
      • Department of Pathology
      Burlington, VT, United States
  • 2001
    • Erasmus Universiteit Rotterdam
      • Institute for Medical Technology Assessment (iMTA)
      Rotterdam, South Holland, Netherlands
    • VU University Amsterdam
      • Department of Radiation Oncology
      Amsterdamo, North Holland, Netherlands
  • 2000
    • Zeeuws Radiotherapeutisch Instituut
      Flushing, Zeeland, Netherlands
  • 1997
    • Open Universiteit Nederland
      Heerlen, Limburg, Netherlands
  • 1995
    • Wageningen University
      Wageningen, Gelderland, Netherlands
  • 1989–1995
    • Transnationale Universiteit Limburg
      Mississippi, United States