Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease

Efficacy of Indacaterol vs Tiotropium in COPD patients due to biomass exposure in improving quality of life and reducing symptoms

BACKGROUND

Few treatment trials have been tested on COPD patients associated with biomass smoke exposure (COPD-B). Patients with COPD-B improve hyperinflation 24 h after inhaling long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA), and after six months of treatment, improve symptoms, quality of life, and exacerbations. However, the usefulness of LAMA or LABA for an extended period for improving quality of life and symptoms has not yet been demonstrated in the COPD-B phenotype. The primary aim of this trial was to compare tiotropium (TIO) with indacaterol (IND) in improving the quality of life measured by the Saint George's Respiratory Questionnaire (SGRQ) in COPD-B after six months of treatment.

METHODS

A randomized, open-label, parallel-group clinical trial designed at a third-level health institute in Mexico City. Seventy-three COPD-B women were randomly assigned to either 150 mcg of indacaterol or 18 mcg of tiotropium once daily for 24 weeks.

RESULTS

197 patients underwent the screening visit, of which 73 were randomized. There was no significant change in the three domains nor the total score of the SGRQ in either treatment group. For secondary outcomes, the TIO group showed a substantial change in the IC of 160 mL (p = 0.016) after six month-treatment. For both treatment groups, a significant reduction in BDI/TDI score of 3 points was shown (p < 0.001).

CONCLUSIONS

Neither TIO nor IND improved quality of life, nor dyspnea evaluated by the mMRC scale, but TIO did improve inspiratory capacity, and TIO and IND improved dyspnea evaluated by BDI/TDI.

CLINICAL TRIAL REGISTRATION

NCT05506865.

Associations of comorbid heart disease and depression/anxiety with multidimensional breathlessness in COPD - A cross-sectional study

BACKGROUND

Comorbid conditions and breathlessness are associated with poor outcomes in chronic obstructive pulmonary disease (COPD). We evaluated the associations of comorbid heart disease and depression/anxiety with breathlessness in daily life among people with COPD.

METHODS

Cross-sectional analysis from the PRAXIS cohort in central Sweden. Data on patient characteristics and the modified Medical Research Council (mMRC) and Dyspnea-12 breathlessness instruments (D-12) were obtained from questionnaires in 2022. Lung function data were collected from record review. Outcome variables were clinically significant breathlessness defined as mMRC≥2 and D-12 total (>2.7), physical (>1.4) and affective (>1.2) scores above published minimal clinical important differences. Associations of heart disease and depression/anxiety with each outcome were analyzed using multivariable Poisson regression adjusted for relevant confounders.

RESULTS

In 522 included patients, mMRC ≥2 was present in 59 % and increased D-12 total, physical and affective domain scores in 69 %, 74 %, and 50 %, respectively. Heart disease was independently associated with mMRC (relative risk ratio [95 % confidence interval] 1.34 [1.17-1.53]), D12 physical domain (1.12[1.02-1.24]) and D-12 affective domain (1.20[1.02-1.42]). Depression/anxiety was independently associated with increased D-12 affective domain (1.25[1.04-1.49]). In addition, previous exacerbations and GOLD stage 3-4 were associated with mMRC and D-12, respectively.

CONCLUSION

In COPD, comorbid heart disease is associated with both activity-related breathlessness and with physical and affective domains of breathlessness while depression/anxiety is associated with the affective domain of breathlessness. As the influence of different dimensions of breathlessness may differ according to comorbidity the D-12 instrument adds more information when assessing breathlessness in patients with COPD.

Digital gamification-based pursed lip breathing exercises driven by Behaviour Change Wheel in patients with COPD: a feasibility trial protocol using pre-post study design

INTRODUCTION

Effective chronic obstructive pulmonary disease (COPD) interventions require intensive and repetitive exercises, yet their monotonous nature can reduce adherence. Innovative rehabilitation devices that are safe, user-friendly, engaging and cost-effective are crucial. This study introduces a digital gamification-based approach to pursed lip breathing (PLB) exercises, guided by the Behaviour Change Wheel (BCW) framework. The digital platform transforms traditional PLB into an interactive and enjoyable experience, enhancing motivation and adherence. Using a pre-post study design, this feasibility trial aims to assess the safety, feasibility and acceptability of the digital gamification PLB intervention protocol driven by the BCW framework installed on WeChat (DT-PLB) for home-based COPD management.

METHODS AND ANALYSIS

The methodology of this study is divided into two phases. Phase 1 refers to the development of the DT-PLB system based on research evidence, behavioural analysis from the insight of the BCW and stakeholders' perspectives, and phase 2 points to present the pre-post trial design for the DT-PLB system consisting of five smartphone-based software interface modules: Ranking, Report, Daily PLB Tasks, Social Community and Mine. Eligible patients with COPD will be recruited from a university hospital in Sichuan Province, Mainland China. The DT-PLB will be conducted in non-hospital settings for patients with COPD for 10 min per session, three times a day on a daily basis for 8 weeks. Data collection will be conducted at two time points: baseline and post-intervention.Demographic data (eg, age, gender and marital status) will be collected only at baseline. The primary outcome measures in this study will be a series of feasibility outcomes involving participant recruitment and completion of the DT-PLB intervention. Additionally, several clinical outcomes in terms of the effects of the DT-PLB intervention on dyspnoea, exercise capability, quality of life, and pulmonary function index will be evaluated as secondary outcomes.

ETHICS AND DISSEMINATION

This study has received Manchester Metropolitan University ethical approval (REC reference 56631) and the Affiliated Hospital of Southwest Medical University ethical approval (REC reference KY2023105). The findings from DT-PLB will be disseminated widely through peer-reviewed publications, scientific conferences and workshops. If successful, DT-PLB will be directly applied to the Affiliated Hospital of Southwest Medical University to manage PLB exercises.

TRIAL REGISTRATION NUMBER

NCT06063733.

The Effect of Out-of-Hospital Extended Care on the Prognosis of Patients With Chronic Obstructive Pulmonary Disease

OBJECTIVE

Nursing services are crucial for the recovery and prognosis of patients with chronic obstructive pulmonary disease (COPD). This study is to evaluate the impact of out-of-hospital extended care services on patients with COPD.

METHODS

A total of 67 COPD patients were enroled in this study, divided into a control group and an intervention group. The intervention group was provided with out-of-hospital extended care services for 6 months, and at the end of the follow-up visit, the patients' psychological status, pulmonary function, and exercise endurance were assessed.

RESULTS

Compared with the control group, patients in the intervention group showed significant improvement in pulmonary function, as reflected in FVC, FEV1, FEV1%, and FEV1/FVC. Meanwhile, after 6 months of extended care services, patients in the intervention group showed significant improvement in exercise endurance, with a significant increase in 6-min walking distance. In addition, patients in the intervention group experienced a significant reduction in anxiety and depression after extended care services.

CONCLUSIONS

Extended care service as a new care model can significantly improve the prognosis of COPD patients.

Feasibility, Usability, and Pilot Efficacy Study of a Software-Enabled, Virtual Pulmonary Rehabilitation with Remote Therapeutic Monitoring

Objective

Fewer than 3% of adults with Chronic Obstructive Pulmonary Disease (COPD) attend in-person, center-based pulmonary rehabilitation (PR) despite demonstrated health benefits and reduction in mortality. This study evaluated the feasibility and usability of a novel home-based, virtual PR (V-PR) intervention compared to center-based PR (C-PR). The virtual PR intervention was supported by remote therapeutic monitoring (V-PR+RTM; Blue Marble Platform, Blue Marble Health, Altadena, CA). Additionally, we collected data on the 6-Minute Walk Test to explore the efficacy of the V-PR compared to C-PR.

Patients and Methods

Adults with stable COPD referred for PR were recruited. The participants self-selected C-PR or V-PR and were provided a 6-8-week personalized exercise and COPD self-management educational program. In addition, weekly phone contacts with the V-PR group were made. Feasibility was measured using qualitative analysis of adherence, reasons for withdrawal, and self-reported barriers to using the software at home. Usability was measured with the System Usability Scale (SUS). Efficacy was evaluated with the 6 minute Walk Test (6MWT) and various functional performance and patient-centered health-related quality of life (HRQoL) questionnaires.

Results

Forty-eight participants were enrolled, and 40 (83.3%) completed the intervention, n=17 in the C-PR group and n=23 in the V-PR group. Four participants from each group withdrew due to reasons related to health issues (appendicitis, thrush, COVID, back pain) or the health status of their spouse, no-shows, and time constraints. Adherence to the exercise dose (3x/week) and educational offerings were >80% in both groups. Participants in the V-PR group scored the software as having high usability. In both groups, 6MWT distance improved significantly, as did scores on the CAT and SGRQ. No adverse events were reported in either group.

Conclusion

A software-enabled virtual PR program with remote therapeutic monitoring is feasible, usable, and effective. It could offer an alternative model that increases PR uptake for those unable or unwilling to attend in-person, center-based PR.

Patient-Reported Outcome Scale for Idiopathic Pulmonary Fibrosis: Development and Validation in China

PURPOSE

To develop and validate the patient-reported outcome scale for idiopathic pulmonary fibrosis (IPF-PRO) to provide a reliable and scientific measure for clinical trials on idiopathic pulmonary fibrosis (IPF).

METHODS

We analyzed the relevant literature and medical records and conducted interviews and panel discussions to develop the conceptual framework and generate the item pool. We subjected the collected items to removal, mergence, or modification to form the initial scale through a qualitative review by experts and patients. Subsequently, we conducted two field surveys to select items for the final scale based on the classical test theory and item response theory (IRT). Finally, we conducted a formal survey to assess the measurement properties of the IPF-PRO.

RESULTS

The IPF-PRO included 18 items across four domains, namely physiology, psychology, environment, and satisfaction. The Cronbach's α coefficient and generalized coefficient of the IPF-PRO were 0.917 and 0.931, respectively. The content validity, structural validity, criterion validity, and discriminant validity all met relevant standards. The results of the item analysis based on IRT were considered acceptable. The ordinal logistic regression analysis findings showed that all items' p values were greater than 0.01 when the domain scores matched variables. The IPF-PRO response and completion rates were both 100%. The median completion time was 7 min [IRQ = 3.7 min (Q3 = 9.0 min, Q1 = 5.3 min)].

CONCLUSION

The 18-item IPF-PRO developed in this study has demonstrated good reliability and validity, indicating that it is a reliable and scientific measure for IPF clinical trials.

Effectiveness of ICS/LABA and LAMA/LABA in COPD due to biomass

Background

COPD due to biomass exposure (COPD-B) is highly prevalent in low- and middle-income countries, and there are no clinical trials designed to evaluate the effectiveness of the treatments currently recommended for patients with COPD due to cigarette smoking (COPD-C). The purpose of the study was to compare the efficacy of fluticasone furoate/vilanterol (FF/V) 100/25 μg and umeclidinium/vilanterol (UMEC/VI) 62.5/25 μg on the rate of exacerbations, the time to first exacerbation, on dyspnoea, health-related quality of life (HRQL), forced expiratory volume in 1 s (FEV1) and inspiratory capacity (IC) during a period of 6 months in patients with COPD-B and COPD-C, at a third level referral centre in Mexico City.

Methods

A pilot, single-centre, open-label, parallel-group study included 132 patients with a history of at least two exacerbations. They were randomised to receive one of four treatment groups: 33 COPD-B patients received FF/VI 100/25 μg, 31 COPD-B patients received UMEC/VI 62.5/25 μg, 34 COPD-C patients received FF/V and 34 COPD-C patients received UMEC/VI.

Results

There were no differences in exacerbation rates between patients receiving FF/VI or UMEC/VI in either the COPD-B (0.07 (95% CI 0.03-0.13), 0.06 (95% CI 0.03-0.12)) or COPD-C group (0.06 (95% CI 0.04-0.11), 0.08 (95% CI 0.05-0.13)), nor in the time of first exacerbation, nor FEV1 and IC. All groups showed improvement in dyspnoea and HRQL, independently of medication used.

Conclusions

Among patients with COPD-B and COPD-C with a history of exacerbation, FF/VI was equally effective as UMEC/VI in preventing exacerbations and improving dyspnoea and HRQL.

The Validity and Reliability of the Turkish version of Modified Medical Research Council Dyspnea Scale in Systemic Sclerosis Patients with Interstitial Lung Disease

Objective

The aim was to investigate the validity and reliability of the Turkish version of the Modified Medical Research Council (mMRC) Dyspnea Scale in Systemic Sclerosis (SSc) patients with Interstitial Lung Disease.

Material and Methods

Thirty patients diagnosed with SSc according to the 2013 EULAR/ACR criteria were included. After recording the demographic data of the patients, dyspnea was evaluated with the Visual Analogue Scale (VAS), exercise capacity with the 6 Minute Walk Distance (6MWD), fatigue level with the Fatigue Severity Scale (FSS), disease activity with the Medsger Disease Severity Scale, skin involvement with the Modified Rodnan Skin Score, and dyspnea level with the mMRC Dyspnea Scale. The mMRC Dyspnea Scale was administered to the patients with SSc who did not receive any treatment for test-retest reliability at 1-week intervals.

Results

The observed scale range in mMRC (TR) was 0-4, and twelve out of the thirty patients (40%) were classified as having "moderate dyspnea." mMRC (TR) showed a significant moderate positive correlation with VAS dyspnea (rho: 0.718), a low negative correlation with 6MWD (rho: -0.445), and a low positive correlation with FSS (rho: 0.385). The weighted kappa statistic, used as an agreement scale for ordinal responses, was found to be 0.587 (indicating moderate agreement).

Conclusion

The Turkish version of the mMRC Dyspnea Scale demonstrates validity and reliability in SSc patients with interstitial lung disease.

Evaluation of upper extremity functional capacity and activities of daily living in patients with heart failure: A cross-sectional study

BACKGROUND

Considering the limitations in activities of daily living (ADL) and the impact of improvements in patients with heart failure (HF), appropriate assessment of upper extremity functional capacity and ADL is important.

OBJECTIVES

To evaluate upper extremity functional capacity and ADL in patients with HF and compare them with healthy controls.

METHODS

This study included 30 HF patients and healthy controls. Upper extremity functional capacity was assessed with the 6-Minute Pegboard Ring Test (6PBRT), ADL by the Londrina protocol, exercise capacity by 6-Minute Walk Test (6MWT), peripheral muscle strength by hand dynamometer, and dyspnea by Modified Medical Research Council Scale (MMRC). For performance tests, pre-test (resting) and post-test (after performance) values ​​were also measured.

RESULTS

Patients with HF with ejection fraction ≤50 % and controls were similar in terms of age (52.63±6.2 and 50.03±6.5 years, respectively) and gender (25 females for each group) (p > 0.05). Patients showed a statistically significant increase in total test time in the Londrina protocol and fewer rings moved in 6PBRT (p < 0.0001). The post-test dyspnea (p = 0.03) and pre-test arm fatigue (p < 0.0001) were observed to be higher in patients in the Londrina protocol. There was a statistically significant group by time interaction in the patients' pre- and post-test lower heart rate (F= 4.80, p = 0.03), post-test dyspnea (p < 0.0001), and post-test arm fatigue (p = 0.005) were observed to be higher in patients in 6PBRT.

CONCLUSIONS

The evidence showed a decrease in upper extremity functional capacity in patients with HF. Patients required more time to perform their ADLs compared with healthy controls.

Psychometric properties of computerized adaptive testing for chronic obstructive pulmonary disease patient-reported outcome measurement

BACKGROUND

Computerized adaptive testing (CAT) is an effective way to reduce time, repetitious redundancy, and respond burden, and has been used to measure outcomes in many diseases. This study aimed to develop and validate a comprehensive disease-specific CAT for chronic obstructive pulmonary disease (COPD) patient-reported outcome measurement.

METHODS

The discrimination and difficulty of the items from the modified patient-reported outcome scale for COPD (mCOPD-PRO) were analyzed using item response theory. Then the initial item, item selection method, ability estimation method, and stopping criteria were further set based on Concerto platform to form the CAT. Finally, the reliability and validity were validated.

RESULTS

The item discrimination ranged from 1.05 to 2.71, and the item difficulty ranged from - 3.08 to 3.65. The measurement reliability of the CAT ranged from 0.910 to 0.922 using random method, while that ranged from 0.910 to 0.924 using maximum Fisher information (MFI) method. The content validity was good. The correlation coefficient between theta of the CAT and COPD assessment test and modified Medical Research Council dyspnea scale scores using random method was 0.628 and 0.540 (P < 0.001; P < 0.001) respectively, while that using MFI method was 0.347 and 0.328 (P = 0.007; P = 0.010) respectively. About 11 items (reducing by 59.3%) on average were tested using random method, while about seven items (reducing by 74.1%) on average using MFI method. The correlation coefficient between theta of the CAT and mCOPD-PRO total scores using random method was 0.919 (P < 0.001), while that using MFI method was 0.760 (P < 0.001).

CONCLUSIONS

The comprehensive disease-specific CAT for COPD patient-reported outcome measurement is well developed with good psychometric properties, which can provide an efficient, accurate, and user-friendly measurement for patient-reported outcome of COPD.

Obesity Impact on Dyspnea in COPD Patients

Background

The role of obesity on dyspnea in chronic obstructive pulmonary disease (COPD) patients remains unclear. We aimed to provide an assessment of dyspnea in COPD patients according to their Body Mass Index (BMI) and to investigate the impact of obesity on dyspnea according to COPD severity.

Methods

One hundred and twenty seven COPD patients with BMI ≥ 18.5 kg/m² (63% male, median (interquartile range) post bronchodilator forced expiratory volume of 1 second (post BD FEV1) at 51 (34-66) % pred) were consecutively included. Dyspnea was assessed by mMRC (Modified medical research council) scale. Lung function tests were recorded, and emphysema was quantified on CT-scan (computed tomography-scan).

Results

Twenty-five percent of the patients were obese (BMI ≥ 30kg/m²), 66% of patients experienced disabling dyspnea (mMRC ≥ 2). mMRC scores did not differ depending on BMI categories (2 (1-3) for normal weight, 2 (1-3) 1 for overweight and 2 (1-3) for obese patients; p = 0.71). Increased mMRC scores (0-1 versus 2-3 versus 4) were associated with decreased post BD-FEV1 (p < 0.01), higher static lung hyperinflation (inspiratory capacity/total lung capacity (IC/TLC), p < 0.01), reduced DLCO (p < 0.01) and higher emphysema scores (p < 0.01). Obese patients had reduced static lung hyperinflation (IC/TLC p < 0.01) and lower emphysema scores (p < 0.01) than non-obese patients. mMRC score increased with GOLD grades (1-2 versus 3-4) in non-obese patients but not in obese patients, in association with a trend towards reduced static lung hyperinflation and lower emphysema scores.

Conclusion

By contrast with non-obese patients, dyspnea did not increase with spirometric GOLD grades in obese patients. This might be explained by a reduced lung hyperinflation related to the mechanical effects of obesity and a less severe emphysema in severe COPD patients with obesity.

Relevance of multidimensional dyspnea assessment in the context of pulmonary rehabilitation

Objectives: While dyspnea is the main symptom in chronic obstructive pulmonary disease (COPD), it is often inadequately evaluated in pulmonary rehabilitation (PR), as it is typically measured using only the impact dimension (ID). However, dyspnea is a multidimensional construct including perception (PD) and emotional (ED) domains. Our work aimed to study the complementarity of dyspnea dimensions and their respective ability to identify different evolutions during PR. Methods: 145 people with COPD attending PR were included in this retrospective study. Dyspnea scores from the modified Medical Research Council scale (ID) and the Multidimensional Dyspnea Profile questionnaire (PD/ED), exercise capacity, quality of life at the start (T1) and the end of PR (T2) were collected from existing databases/medical files. The evolution of each dyspnea dimension was evaluated using the delta score between T2-T1. PR response was defined using the minimal clinically important difference. Results: Our results show that each dyspnea dimension was associated with different health-outcomes. Positive correlations were found between PD-ED at baseline and between their T2-T1 delta score (ρ = 0.51; ρ = 0.41 respectively, p < .01), but there was no significant correlation between ID-PD or -ED (p > .05). 51% of the patients did not respond on ID, but 85% of them nonetheless responded on either PD or ED. Finally, 92% of patients responded on at least one dimension after PR. Discussion: Our study emphasizes the significance of assessing each dimension of dyspnea independently and complementary, as dimensions are associated with different elements and evolve differently under PR effects. This approach is crucial to identifying weak points and allows professionals to focus on program elements that most effectively address the specific dimension causing problems.

Clinical effect of aerobic exercise training in chronic obstructive pulmonary disease: A retrospective study

Aerobic exercise training is a kind of pulmonary rehabilitation for lung diseases. This was a retrospective study to assess the efficacy of aerobic exercise training in chronic obstructive pulmonary disease (COPD) at a stable stage. A total of one hundred and fifty-six stable COPD patients who had accepted self-education only or self-education combined with an aerobic exercise training between January 2017 to January 2019 were reviewed retrospectively. A total of 79 patients who had received self-education combined with an aerobic exercise training schedule comprised the aerobic exercise training group (AET group) and 77 patients who had received self-education only were regarded as the education group (EDU group). The acute incidence rate in AET group was 7.6% better than that in EDU group 20.7% (P < .05). The AET group patients expressed higher levels of 6 minutes walking distance (6MWD) (P < .05) and better evaluations of both lung function (P < .05) and T lymphocyte immune response (P < .05), as well as significantly decreased chronic obstructive pulmonary disease assessment test (CAT) scores and modified British medical research council (mMRC) grades (P < .05). Patients in EDU group did not report any changes in any of these characteristics. The aerobic exercise training intervention contributed to an increasing in 6MWD and decrease in CAT scores and mMRC grades, as well as improving the T lymphocyte immune response in stable COPD patients.

Study of nasal mucosa histopathological changes in patients with hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP) is an interstitial lung disease that develops after inhalation of a variety antigens in susceptible individuals. The nasal mucosa is constantly exposed to these antigens that can irritate the respiratory mucosa. So, the purpose of this study was to study nasal histopathological changes in order to identify any shared pathological changes between the upper airways and the well-known pathological features of HP. 40 HP patients diagnosed at the Chest Department, Kasr Alainy hospital following ATS/JRS/ALAT guidelines were included. Patients were subjected to thorough history, high-resolution computed tomography, spirometry, cough evaluation test (CET), sinonasal outcome test-22 (SNOT-22), sinonasal examination and nasal mucosal biopsy by an otolaryngologist under visualization by a rigid nasal endoscope. The mean age of the patients was 46.2 ± 13.5 (85% were females and 15% were males). 90% of patients presented with cough and the mean CET was 17.15 ± 5.59.77.5% of patients suffered from sinonasal symptoms and the mean SNOT-22 was 12.18 ± 3.8. There was a significant correlation between the burden of sinonasal symptoms represented by the SNOT-22 and the severity of the cough represented by CET (r 0.40, p 0.01). 87.5% of HP patients had chronic inflammation of the nasal mucosa with predominant lymphocytic infiltration in 72.5% of patients. 77.5% of HP patients had a high burden of sinonasal symptoms which is positively associated with cough severity. 72.5% of patients had predominately lymphocytic infiltration of the nasal mucosa.Trial registration: retrospectively registered, registration number is NCT05723796, date of registration 13/02/2023.

Early versus non-early desaturation during 6MWT in COPD patients: A follow-up study

Introduction

Six-minute walk test (6MWT) has a significant prognostic value in chronic obstructive pulmonary disease (COPD). Those who desaturate early during 6MWT are likely to have frequent exacerbations.

Aims and Objectives

To follow-up and compare exacerbations and hospitalisations of COPD patients having early desaturation versus nonearly desaturation determined during baseline 6MWT.

Methods

It was a longitudinal follow-up study conducted in a tertiary care institute from November 1, 2018 to May 15, 2020 involving 100 COPD patients. A decrease in SpO2 by ≥4% in baseline 6MWT was considered a significant desaturation. If the desaturation occurred within first minute of the 6MWT, the patient was called early desaturator (ED); if it occurred later, the patient was called nonearly desaturator (NED). If the saturation did not fall, then the patient was called nondesaturator. During the follow-up, 12 patients dropped out and 88 remained.

Results

Of 88 patients, 55 (62.5%) were desaturators and 33 were nondesaturator. Of 55 desaturators, 16 were ED and 39 were NED. EDs had significantly higher number of severe exacerbations (P <.05), higher hospitalisation (P <.001), and higher BODE index (P <.01) compared to NEDs. The receptor operating characteristic curve and multiple logistic regression analysis showed that previous exacerbations, presence of early desaturation, and distance saturation product during the 6MWT were significant predictors for predicting hospitalizations.

Conclusion

Early desaturation can be used as a screening tool for assessing the risk of hospitalization in COPD patients.

Long-Term High Flow Nasal Cannula Therapy in Primary and Secondary Bronchiectasis

BACKGROUND

Bronchiectasis is the consequence of chronic bronchial inflammation, inappropriate mucus clearance, bacterial colonization, and recurrent or chronic infection. High flow therapy (HFT) is a type of non-invasive respiratory therapy, usually delivered through a nasal cannula interface (HFNC). It delivers heated and humidified air with a stable fraction of inspired oxygen and a wide range of possible flow rates.

AIM OF THE STUDY

Determine the effectiveness of HFNC as add-on therapy in adult primary and secondary bronchiectasis with frequent acute exacerbations (AEs) and/or hospitalizations.

METHODS

This is a single-center crossover study on long-term home therapy with HFNC in adult bronchiectasis. Pharmacological therapy included pulse therapy with mucolytics and bronchodilators. After one year, all patients were switched to additional HFNC. The temperature range was 31-37 °C. The flow range was 35-60 L/m. FiO₂ was 0.21.

RESULTS

Seventy-eight patients completed the follow-up; 54% were females; the median age was 70 years (IQR 60-76). The etiology of bronchiectasis was mainly post-infective (51%), COPD related (26%), and congenital (11%). AEs at baseline were 2.81 (±2.15). A significant reduction in AEs was observed after 24 months with a mean of 0.45 (±0.66) (f-ratio value 79.703. p-value < 0.00001). No significant difference was observed after HFNC therapy on FEV₁ (2.39 ± 0.87 vs. 2.55 ± 0.82; f-ratio 0.79. p-value 0.45) and FVC (2.73 ± 0.88 vs. 2.84 ± 0.90; f-ratio 0.411. p-value 0.66). A significant reduction in mMRC score was observed after HFNC therapy (2.40 ± 0.81 vs. 0.97 ± 0.97 at 2 months vs. 0.60 ± 0.78 at 24 months; f-ratio value 95.512. p-value < 0.00001).

CONCLUSIONS

HFNC is a well-tolerated add-on therapy for adult bronchiectasis. Dyspnea improved after 2 months and further after 2 years. The exacerbation rate decreased during the 2 years follow-up. No significant difference was observed in lung function.

Effect of Perceived Dyspnea on Attitude Toward Death From the Perspective of COPD Patients

In this study, it was aimed to examine attitudes toward dyspnea and death from the perspective of Chronic Obstructive Pulmonary Disease (COPD) patients and to determine the relationship between them. This descriptive research was carried out in the chest diseases clinic of a public hospital and with the participation of COPD patients (n = 124). The data were obtained from the Personal Information Form, Death Attitude Profile-Revised, and Medical Research Council Scale. The neutral acceptance and approach acceptance subscale is explained as believing that death is an inevitable part of life and a transition to life after death. The escape acceptance subscale is explained as believing that life will save from physical or psychological harms. It was determined that the Neutral Acceptance and Approach Acceptance sub-dimension of the predictors of dyspnea, comorbid diseases, and COPD had a significant effect at a rate of 33% (p = 0.000). Dyspnea, Comorbid diseases, and the predictors of the severity of COPD affect the Escape Acceptance sub-dimension by 57% (p = 0.000). This research has shown that fear of death is high in COPD patients with high perceived dyspnea. The psychological support provided to patients with COPD should be considered to relieve the fear of death. New studies are needed in which these should be reevaluated in the same context.

Development of airflow limitation, dyspnoea, and both in the general population: the Nagahama study

Subjects with subclinical respiratory dysfunction who do not meet the chronic obstructive pulmonary disease (COPD) criteria have attracted attention with regard to early COPD intervention. Our aim was to longitudinally investigate the risks for the development of airflow limitation (AFL) and dyspnoea, the main characteristics of COPD, in a large-scale community-based general population study. The Nagahama study included 9789 inhabitants, and a follow-up evaluation was conducted after 5 years. AFL was diagnosed using a fixed ratio (forced expiratory volume in one second (FEV₁)/forced vital capacity (FVC) < 0.7). We enrolled normal subjects aged 40-75 years with no AFL, dyspnoea or prior diagnosis of asthma or COPD at baseline. In total, 5865 subjects were analysed, 310 subjects had subclinical respiratory dysfunction (FEV₁/FVC < the lower limit of normal; n = 57, and FEV₁ < 80% of the predicted value (preserved ratio impaired spirometry); n = 256). A total of 5086 subjects attended the follow-up assessment, and 449 and 1021 subjects developed AFL and dyspnoea, respectively. Of these, 100 subjects developed AFL with dyspnoea. Baseline subclinical respiratory dysfunction was independently and significantly associated with AFL with dyspnoea development within 5 years. Subjects with subclinical respiratory dysfunction are at risk of developing COPD-like features and require careful monitoring.

Real-world opioid prescription to patients with serious, non-malignant, respiratory illnesses and chronic breathlessness

BACKGROUND

Chronic breathlessness is a disabling symptom that is often under-recognised and challenging to treat despite optimal disease-directed therapy. Low-dose, oral opioids are recommended to relieve breathlessness, but little is known regarding long-term opioid prescription in this setting.

AIM

To investigate the long-term efficacy of, and side-effects from, opioids prescribed for chronic breathlessness to patients with advanced, non-malignant, respiratory diseases.

METHODS

A prospective cohort study of all patients managed by the advanced lung disease service, an integrated respiratory and palliative care service, at the Royal Melbourne Hospital from 1 April 2013 to 3 March 2020.

RESULTS

One hundred and nine patients were prescribed opioids for chronic breathlessness. The median length of opioid use was 9.8 (interquartile range (IQR) = 2.8-19.8) months. The most commonly prescribed initial regimen was an immediate-release preparation (i.e. Ordine) used as required (37; 33.9%). For long-term treatment, the most frequently prescribed regimen included an extended-release preparation with an as needed immediate-release (37; 33.9%). The median dose prescribed was 12 (IQR = 8-28) mg oral morphine equivalents/day. Seventy-one (65.1%) patients reported a subjective improvement in breathlessness. There was no significant change in the mean modified Medical Research Council dyspnoea score (P = 0.807) or lung function measurements (P = 0.086-0.727). There was no association between mortality and the median duration of opioid use (P = 0.201) or dose consumed (P = 0.130). No major adverse events were reported.

CONCLUSION

Within this integrated respiratory and palliative care service, patients with severe, non-malignant respiratory diseases safely used long-term, low-dose opioids for breathlessness with subjective benefits reported and no serious adverse events.

Openreuma Consensus on the role of nursing in the care of patients with rheumatoid arthritis and diffuse interstitial lung disease

OBJECTIVES

To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD).

METHODS

The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations.

RESULTS

Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%.

CONCLUSIONS

This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.

The optimal cut-off points of 4-meter gait speed to discriminate functional exercise capacity and health status in elderly patients with chronic obstructive pulmonary disease

Background

Gait speed, a vital sign of health and functional capacity, is commonly used to measure mobility. Although studies have assessed gait speed in older adults and individuals with chronic obstructive pulmonary disease (COPD) separately, few have evaluated gait speed in older adults with COPD. Therefore, the primary objective of our study was to determine the threshold point for the 4-meter gait speed test (4MGS) to better discriminate between functional exercise capacity and health status in older patients with COPD. The second objective was to determine possible predictors of gait speed.

Methods

In this cross-sectional study, we assessed participants’ pulmonary function, dyspnea, health status (COPD Assessment Test [CAT]), gait speed (4MGS), functional exercise capacity (6-minute walk test [6MWT]), and physical activity.

Results

Forty-five older patients with COPD participated in this study. The predicted 6MWT and CAT scores were independent and significant determinants of the 4MGS score, explaining 54% of the variance (p<0.001). We identified gait speeds of 0.96 m/s and 1.04 m/s as thresholds to predict abnormal functional exercise capacity (sensitivity 85% and specificity 56%) and impaired health status (sensitivity 90% and specificity 69%), respectively (p<0.05).

Conclusion

Our findings demonstrated that gait speed can discriminate between abnormal functional exercise capacity and impaired health status in older patients with COPD. Moreover, functional exercise capacity and health status are predictors of gait speed.

Sequelae of COVID-19 at long-term follow-up after hospitalization

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.

Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. 

Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0; 64.0]; men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%; 10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.

Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

Adjunctive inspiratory muscle training during a rehabilitation program in patients with breast cancer: an exploratory double-blind, randomized, controlled pilot study

Objective

To investigate whether inspiratory muscle training (IMT) offered adjunctively to an exercise training program reduces symptoms of dyspnea in survivors of breast cancer.

Design

Double-blind, parallel-group, randomized controlled trial.

Setting

Outpatient rehabilitation program in a university hospital.

Participants

Ninety-eight female patients with breast cancer who completed adjuvant treatment and subsequently entered cancer rehabilitation were screened for participation. Inclusion criteria were reduced inspiratory muscle strength and/or symptoms of dyspnea. Twenty patients (N=20) were randomly assigned to an intervention group (n=10) or a control group (n=10).

Intervention

Both groups received a 3-month exercise training program in combination with either IMT (intervention) or sham-IMT (control).

Main Outcome Measures

Changes in dyspnea intensity perception (10-point Borg Scale) at comparable time points (isotime) during constant work rate cycling was the primary outcome. Secondary outcomes included changes in respiratory muscle function, exercise capacity, and changes in symptoms of dyspnea during daily life (Transitional Dyspnea Index [TDI]).

Results

The intervention group achieved a larger reduction in exertional dyspnea at isotime compared with the control group (−1.8 points; 95% CI, −3.7 to 0.13; P=.066). The intervention group also exhibited larger improvements in dyspnea during daily life (TDI score, +2.9 points; 95% CI, 0.5-5.3; P=.022) and improved both respiratory muscle endurance (+472 seconds; 95% CI, 217-728; P=.001) and cycling endurance (+428 seconds; 95% CI, 223-633; P=.001) more than the control group.

Conclusions

Because of the limited sample size all obtained findings need to be interpreted with caution. The study offers initial insights into the potential of adjunctive IMT in selected survivors of breast cancer. Larger multicenter studies should be performed to further explore the potential role and general acceptance of this intervention as a rehabilitation tool in selected patients after breast cancer treatment.

Effects of pulmonary rehabilitation on diaphragm thickness and contractility in patients with chronic obstructive pulmonary disease

BACKGROUND

Studies are showing that pulmonary rehabilitation (PR) increases diaphragmatic excursion by decreasing hyperinflation in patients with chronic obstructive pulmonary disease (COPD). However, there is a lack of knowledge about its effects on the diaphragm thickness (dt) and contractility. This study aims to evaluate the dt and contractility before and after PR in patients with COPD.

METHODS

All subjects participated in an out-patient PR of 6 weeks and 3 sessions per week prospectively. Dyspnea severity, the disease-specific quality of life (St. Georges Respiratory Questionnaire-SGRQ), pulmonary function tests (PFT), exercise capacity, the dt at the end of the expiration and at maximal inspiration (B-mode ultrasound) were evaluated at baseline and after PR.

RESULTS

A total of 34 patients with a mean age and FEV1 61.05 ± 8.22 years and 57.9 ± 20.4% predicted respectively showed improvements in exercise capacity and some items of PFT and SGRQ. Diaphragmatic thickness at the end of the expiration also significantly improved regardless of the disease severity and was positively correlated with functional performance. The 6-weeks of PR didn't result in a significant difference in diaphragm contractility.

Physical and affective components of dyspnoea are improved by pulmonary rehabilitation in COPD

Background

Dyspnoea is a multidimensional experience of breathing discomfort, but its affective dimension is unfrequently assessed in people with chronic obstructive pulmonary disease (COPD). We evaluated the effectiveness of a home-based pulmonary rehabilitation (PR) programme on the physical and affective components of dyspnoea assessed by the Dyspnoea-12 (D-12) questionnaire. We also determined the baseline characteristics that contributed to the change in D-12 scores.

Methods

In this retrospective study, 225 people with COPD (age, 65±11 years; forced expiratory volume in 1 s (FEV₁), 35±15% of predicted value) were enrolled into a person-centric home-based PR, consisting of a weekly supervised 90 min home session during 8 weeks. D-12 questionnaire, health status, anxiety and depressive symptoms, exercise tolerance and general fatigue were assessed at baseline (M0), at the end of PR programme (M2), and 8 (M8) and 14 months (M14) after M0. Multivariable analysis of covariance (ANCOVA) models were performed to identify the baseline characteristics that contributed to the change in D-12 scores.

Results

Both physical and affective components of dyspnoea and all the other outcome measures were improved at M2, M8 and M14 compared with baseline (p<0.05). Baseline body mass index was the only significant independent predictor of the changes in physical dyspnoea score, while the change in the affective dimension of dyspnoea after PR was associated with FEV₁, anxiety symptoms and exercise tolerance (6 min stepper test). However, since these variables had only a small impact on the changes in D-12 questionnaire scores, results from the ANCOVA analysis should be taken cautiously.

Conclusion

Both physical and affective components of dyspnoea were improved, at short term and long term, by 8 weeks of individualised home-based PR. The present results support the importance of assessing dyspnoea as a multidimensional experience during PR, warranting replication by robustly designed randomised and controlled studies.

Racial and Ethnic Minorities Have a Lower Prevalence of Airflow Obstruction than Non-Hispanic Whites

Racial and ethnic disparities in chronic obstructive pulmonary disease (COPD) are not well-studied. Our objective was to examine differences in limited COPD-related outcomes between three minority groups-African Americans (AAs), Hispanics, and American Indians (AIs) versus non-Hispanic Whites (NHWs), as the referent group, in separate cohorts. Separate cross-sectional evaluations were performed of three US-based cohorts of subjects at risk for COPD: COPDGene Study with 6,884 NHW and 3,416 AA smokers; Lovelace Smokers' Cohort with 1,598 NHW and 378 Hispanic smokers; and Mining Dust Exposure in the United States Cohort with 2,115 NHW, 2,682 Hispanic, and 2,467 AI miners. Prebronchodilator spirometry tests were performed at baseline visits using standard criteria. The primary outcome was the prevalence of airflow obstruction. Secondary outcomes were self-reported physician diagnosis of COPD, chronic bronchitis, and modified Medical Research Council dyspnea score. All minority groups had a lower prevalence of airflow obstruction than NHWs (adjusted ORs varied from 0.29 in AIs to 0.85 in AAs; p < 0.01 for all analyses). AAs had a lower prevalence of chronic bronchitis than NHWs. In our study, all minority groups had a lower prevalence of airflow obstruction but a greater level of self-reported dyspnea than NHWs, and covariates did not explain this association. A better understanding of racial and ethnic differences in smoking-related and occupational airflow obstruction may improve prevention and therapeutic strategies.

Predictors of Outpatient Pulmonary Rehabilitation Uptake, Adherence, Completion, and Treatment Response Among Male U.S. Veterans With Chronic Obstructive Pulmonary Disease

OBJECTIVE

To examine predictors of uptake (never start), adherence (drop out), and completion of pulmonary rehabilitation (PR), as well as PR treatment response based on minimal clinically important difference (MCID) on the 6-minute walk test (6MWT) distance and Chronic Respiratory Questionnaire-Self-Report (CRQ-SR).

DESIGN

Retrospective, cohort study.

SETTING

Veterans Health Administration.

PARTICIPANTS

U.S. veterans with chronic obstructive pulmonary disease (COPD) (N=253) referred to PR between 2010 and 2018.

INTERVENTIONS

Outpatient PR program.

MAIN OUTCOME MEASURES

Participants completed baseline (time 1) measures of depression (Beck Depression Inventory-II), health-related quality of life (CRQ-SR), self-efficacy (Exercise Self-Regulatory Efficacy Scale [Ex-SRES]), and COPD knowledge. Exercise capacity was assessed with the 6MWT. Participants who completed all 18 sessions of PR repeated assessments (time 2). Logistic regression models examined predictors of uptake, adherence, and completion of PR as well as treatment response based on MCID.

RESULTS

Participants were referred to PR with 24.90% never starting, 28.90% dropping out, and 46.20% completing. No differences emerged between never starters and dropouts. Having a history of any cancer increased the likelihood of completing PR (vs never starting; odds ratio [OR], 3.18; P=.003). Greater CRQ-SR dyspnea score, indicating less dyspnea, was associated with increased likelihood of completing PR (OR, 1.12; P=.006). Past smoking compared with current smoking was associated with increased likelihood of completion (OR, 3.89; P≤.002). Those without a history of alcohol use disorder had increased likelihood of completing PR (OR, 2.23; P=.048). Greater baseline 6MWT distance was associated with lower likelihood of achieving MCID in 6MWT (OR, 0.99; P<.001). Greater Ex-SRES was associated with decreased likelihood of achieving 6MWT MCID (OR, 0.98; P=.023).

CONCLUSIONS

Findings suggest that early psychoeducation on dyspnea management and smoking and alcohol cessation may increase completion of PR.

Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease

Background

The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.

Methods

Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramér's V and Kendall's tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.

Results

In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramér's V: 0.46; Kendall's tau B: 0.57) with similar results for COPD (Cramér's V: 0.46; Kendall's tau B: 0.66) and heart failure (Cramér's V: 0.46; Kendall's tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes.

Conclusion

In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

There is moderate agreement between the mMRC and NYHA scales for assessment of functional impact of breathlessness in outpatients with COPD and heart failure.https://bit.ly/2XBPuXF

Radiological and Physiological Predictors of IPF Mortality

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) has a variable clinical course, which ranges from being asymptomatic to progressive respiratory failure. The purpose of this study was to evaluate the novel clinical parameters of IPF patients who receive an anti-fibrotic agent. Materials and Methods: From January 2011 to January 2021, we identified 39 IPF patients at Okinawa Chubu Hospital. Clinical information was obtained, such as laboratory data, pulmonary function test (PFT) results, and chest images, including of soft tissue thickness and the high-resolution computed tomography (HRCT) pattern at diagnosis. Results: The mean age was 72.9 ± 7.0 (53–85); 27 patients were men and 12 were women. The mean body mass index was 25.1 ± 3.9 (17.3–35). Twenty-four were active smokers and the median number of packs per year was 20. Regarding laboratory findings, mean white blood cell (WBC), lactate dehydrogenase (LDH), and Krebs Von den Lungen-6 (KL-6) values were 7816 ± 1859, 248 ± 47, and 1615 ± 1503, respectively. In PFT, the mean percent predicted FVC, percent predicted total lung capacity, percent predicted functional residual capacity (FRC), and percent predicted diffusion capacity of the lung for carbon monoxide (DLco) were 66.8 ± 14.9%, 71.8 ± 13.7%, 65 ± 39.6%, and 64.6 ± 27.9%, respectively. In chest radiological findings, soft tissue thickness at the right 9th rib was 26.4 ± 8.8 mm. Regarding chest HRCT patterns, 15 showed the definite usual interstitial pneumonia (UIP) pattern, 16 showed the probable UIP pattern, and eight showed the indeterminate for UIP pattern. In the treatment, 24 patients received pirfenidone and 15 patients took nintedanib. The mean observation period was 38.6 ± 30.6 months and 24 patients died. The median survival time was 32.4 months (0.9–142.5). Multivariate analysis adjusted for age showed that both soft tissue thickness [Hazard ratio (HR): 0.912, 95% confidence interval (CI): 0.859–0.979, p-value: 0.009] and percent FRC [HR: 0.980, 95% CI: 0.967–0.992, p-value: 0.002] were robust predictors of IPF mortality. Conclusions: In IPF patients treated with anti-fibrotic agents, both soft tissue thickness at the right 9th rib shown on the chest radiograph and %FRC can be novel predictors of IPF mortality.

Stable Chronic Obstructive Pulmonary Disease Associated With Cognitive Impairment: Possible Causality Factor

BACKGRUOUND

Chronic Obstructive Pulmonary Disease (COPD), a preventable and underdiagnosed pathology, can be defined as a progressive and poorly reversible limitation to airflow as a result of a persistent inflammatory response due to inhalation of harmful substances, particularly tobacco smoke. The disease has a systemic impact. Among other conditions, it may increase the risk of cognitive impairment along with its associated consequences.

METHODS

Prospective, cross-sectional, observational and analytical design. The space were COPD patients who visited in two health institutions from June 2017 to September 2018. Non-probabilistic and convenience sampling. Data were collected on demographics, tobacco consumption, comorbidities (Charlson index), a validated scale for dyspnea (MCRm), the main symptom in COPD and the COPD Assessment Test (CAT) were applied along with a history of exacerbation of the disease. The severity of COPD was evaluated by spirometry according to GOLD guideline. Cognitive impairment was assessed using Neuropsi.

OUTCOMES

The final sample consisted of 44 subjects. According to spirometry and GOLD, 7 patients (15.9%) classified in group 1 (mild), 19 (43.2%) in group 2 (moderate), 11 (25%) in group 3 (severe) and 7 (15.9%) in group 4 (very serious). Of the 44 patients recruited, 28 (63.6%) had normal cognitive function and 16 (36.3%) had some degree of cognitive impairment. Memory was the most compromised function.

CONCLUSION

Difficulties in recruitment impeded reaching the expected sample size. However, a trend was observed favoring the association. It is important to insist on avoiding smoking because it seems to increase the risk of cognitive impairment that further disrupts the quality of life and makes treatment difficult.

Anti-glomerular basement membrane disease associated with thin basement membrane nephropathy: A case report

RATIONALE

Simultaneous occurrence of anti-glomerular basement membrane (anti-GBM) disease and thin basement membrane nephropathy (TBMN), both of which invade the type IV collagen subunits, is very rare. Here, we present the case of a 20-year-old male patient diagnosed with both anti-GBM disease and TBMN upon presenting dyspnea and hemoptysis.

PATIENT CONCERNS

No laboratory abnormalities, except arterial hypoxemia (PaO275.4 mmHg) and microscopic hematuria, were present. Chest computed tomography revealed bilateral infiltrations in the lower lung fields; thus, administration of empirical antibiotics was initiated. Gross hemoptysis persisted nonetheless, and bronchoscopy revealed diffuse pulmonary hemorrhage with no endobronchial lesions. Broncho-alveolar lavage excluded bacterial pneumonia, tuberculosis, and fungal infection.

DIAGNOSIS

Enzyme-linked immunosorbent assay of his serum was positive for anti-GBM antibody (95.1 U/mL). Human leukocyte antigen (HLA) test was positive for both HLA-DR15/-DR04. Other than diffuse thinning of the GBM (average thickness, 220 nm), index kidney biopsy did not demonstrate any specific abnormalities such as crescent formation.

INTERVENTIONS

Methylprednisolone was administered intravenously for 7 consecutive days (500 mg/day), followed by the daily dose of oral prednisolone (80 mg). Cyclophosphamide was also orally administered every day for 3 months (250 mg/day). Following 6 sessions of plasmapheresis, the anti-GBM antibody in serum became negative.

OUTCOMES

There was no clinical evidence suggesting recurrence of pulmonary hemorrhage or azotemia during hospitalization and 12-month follow-up period. Twelve months after hospital discharge, oral prednisolone was discontinued.

LESSONS

The patients with concurrent anti-GBM disease and TBMN will have a favorable prognosis after proper therapy. However, further research is needed to elucidate the pathogenesis and long-term outcome of the comorbidity of these 2 diseases.

Effects of an Integrated Exercise Program Including "Functional" Inspiratory Muscle Training in Geriatric Individuals with and without Chronic Obstructive Pulmonary Disease

BACKGROUND

Inspiratory muscle training (IMT) is a commonly used exercise method for both patients with chronic obstructive pulmonary disease (COPD) and the older adult population. In addition to their primary function, respiratory muscles play an active role in core stabilization. However, no IMT program includes both of these functions (i.e., core stabilization and postural control functions as well as respiration). This study investigated the effects of a newly integrated exercise program, termed "functional IMT," in geriatric individuals with and without COPD.

METHODS

This prospective and experimental study included 45 geriatric individuals with COPD (n=22) and without COPD (n=23). The training program consisted of 4 weeks of conventional IMT followed by 4 weeks of functional IMT. Respiratory muscle strength, symptoms, exercise capacity, balance, postural control, physical activity, and quality of life were evaluated.

RESULTS

After training, respiratory muscle strength, symptoms, exercise capacity, balance, postural control, and quality of life improved in both groups (p&lt;0.05). In addition, physical activity was increased in the COPD group (p&lt;0.05). We observed no statistically significant difference in outcomes between the two groups before and after treatment (p&gt;0.05).

CONCLUSION

The gains were similar in both groups. Functional IMT, which is an integrated approach that includes all respiratory muscle functions, is a safe, effective, and innovative method for use in geriatric individuals with and without COPD.

Improving clinical disease subtyping and future events prediction through a chest CT-based deep learning approach

PURPOSE

To develop and evaluate a deep learning (DL) approach to extract rich information from high-resolution computed tomography (HRCT) of patients with chronic obstructive pulmonary disease (COPD).

METHODS

We develop a DL-based model to learn a compact representation of a subject, which is predictive of COPD physiologic severity and other outcomes. Our DL model learned: (a) to extract informative regional image features from HRCT; (b) to adaptively weight these features and form an aggregate patient representation; and finally, (c) to predict several COPD outcomes. The adaptive weights correspond to the regional lung contribution to the disease. We evaluate the model on 10 300 participants from the COPDGene cohort.

RESULTS

Our model was strongly predictive of spirometric obstruction ( r 2  =  0.67) and grouped 65.4% of subjects correctly and 89.1% within one stage of their GOLD severity stage. Our model achieved an accuracy of 41.7% and 52.8% in stratifying the population-based on centrilobular (5-grade) and paraseptal (3-grade) emphysema severity score, respectively. For predicting future exacerbation, combining subjects' representations from our model with their past exacerbation histories achieved an accuracy of 80.8% (area under the ROC curve of 0.73). For all-cause mortality, in Cox regression analysis, we outperformed the BODE index improving the concordance metric (ours: 0.61 vs BODE: 0.56).

CONCLUSIONS

Our model independently predicted spirometric obstruction, emphysema severity, exacerbation risk, and mortality from CT imaging alone. This method has potential applicability in both research and clinical practice.

The determinants of dyspnoea evaluated by the mMRC scale: The French Palomb cohort

INTRODUCTION AND OBJECTIVE

Dyspnoea is a major symptom in COPD patients, but the determinants that could be associated with a higher dyspnoea mMRC score in COPD patients remain unclear. Our research aimed to study the determinants of dyspnoea at the threshold of 1, 2, 3 and 4 mMRC.

PATIENTS AND METHODS

Diagnosis of COPD was made using spirometry with post-bronchodilator FEV₁FVC<70%. An online questionnaire has been employed by pulmonologists to recruit COPD patients. The following variables were collected: age, gender, BMI, FEV₁, RV, IC, TLC, FRC, mMRC, frequency of exacerbations and comorbidities. The LASSO was used to select the variables associated with the mMRC dyspnoea scale in a subgroup (who had no missing IC, RV and FRC values) of 421 COPD patients defined by the previously mentioned variables.

RESULTS

One thousand nine hundred and sevety-three patients (65.3% males, average age=66±10, 38% current smokers) were included. Dyspnoea was correlated with a low FEV₁ and with the number of exacerbations in the past 12 months. Multivariate analysis showed that the determinants of dyspnoea(mMRC≥2) are: FEV₁: OR=3.71[2.86-4.82]; anxiety: OR=2.52[1.82-3.47]; cough: OR=1.94[1.57-2.40]; bronchiectasis: OR=1.84[1.03-3.29]; age: OR=1.80[1.45-2.24]; hyperinflation (RV/TLC): OR=1.68[1.34-2.11]; ischemic cardiopathy: OR=1.63[1.22-2.18]; hypertension: OR=1.52[1.21-1.91]; exacerbations (≥2): OR=1.41[1.10-1.81]; women: OR=1.39[1.10-1.74] and overweight: OR=1.33[1.06-1.67]. The subgroup analysis showed that: FEV₁: OR=3.47[1.96-6.12]; exacerbations (≥2) OR=2.31[1.33-4.17] and hyperinflation (IC/TLC) OR=0.57[0.35-0.85] were associated with higher dyspnoea (mMRC≥2).

CONCLUSION

Our results showed that dyspnoea is related to the severity of airflow limitation, gender, exacerbations, comorbidities and hyperinflation.

A study on the validity and reliability of the Turkish version of the Clinical Chronic Obstructive Pulmonary Disease Questionnaire

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive disease negatively affecting health-related quality of life. The related scales in Turkish are limited in number and generalizability.

OBJECTIVE

To perform validity and reliability studies of the Turkish version of the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ).

METHODS

This study was conducted at the Department of Chest Diseases, with 100 volunteer COPD patients with a mean age of 67.72 ± 9.78 years. After obtaining the necessary permission, translation procedures were applied for Turkish cultural adaptation. Finally, a single Turkish translation was created, and this questionnaire was evaluated by linguists. Incomprehensible items were corrected in a pilot study. Baseline and test-retest measurements after two weeks were performed. Internal consistency analysis was made for validity, and correlations were calculated with the 36-Item Short Form Health Survey (SF-36), the modified Medical Research Council (mMRC) Dyspnea Scale and Respiratory Function Tests (RFTs).

RESULTS

Cronbach's alpha value was found to be 0.90 for the first obtained data and 0.91 for the second obtained data. There was similarity at the rate of 0.97 between the first and second measurements in terms of total scores of the CCQ. The questionnaire significantly correlated with the SF-36, mMRC and RFTs (-0.85 ⩽r⩽ 0.69, p< 0.05).

CONCLUSIONS

As a result of this study, the Turkish version of CCQ was determined to be reliable and valid. The CCQ is an easy-to-use questionnaire in terms of application-calculation and can be safely used for the clinical assessment and monitoring of patients.

Association of Lung Function With HIV-Related Quality of Life and Health Care Utilization in a High-Risk Cohort

BACKGROUND

Chronic respiratory disease represents an important comorbidity for persons living with HIV (PLWH). HIV itself is associated with greater impairment in lung function. We aimed to determine the association between declining lung function and both quality of life (QOL) and health care utilization for PLWH.

METHODS

Using longitudinal data from the Study of HIV Infection in the Etiology of Lung Disease 2009-2017, we studied the association between changes in lung function and both QOL and acute care events (emergency department visit or hospitalization). The Medical Outcomes Studies-HIV Questionnaire provided QOL domains. Multivariable regression models were performed with generalized estimating equations accounting for 1499 participants, 485 with HIV, contributing 10,825 spirometry visits.

RESULTS

Among PLWH, decreased FEV1 was associated with worse physical health for those with higher viral load [β: -1.66, 95% confidence interval (CI): -3.11 to -0.39] compared to those with viral suppression (β: -0.58, 95% CI: -1.06 to -0.162), even in those without airflow obstruction. Lower FEV1 was also associated with increased odds of both emergency department (odds ratio: 1.21, 95% CI: 1.09 to 1.34) and inpatient (odds ratio: 1.26, 95% CI: 1.12 to 1.42) hospitalizations for PLWH. Lung function was not associated with increased odds of acute care events for HIV-uninfected participants.

CONCLUSIONS

FEV1 declines represent an independent predictor of QOL and acute care events among PLWH. Although the generalizability of these results may be limited, because of the high-risk population included, findings suggest that care for PLWH should involve monitoring FEV1 over time, especially in those with poor virologic control, with emphasis on the development and implementation of interventions to mitigate lung function decline.

Cognitive and motor performances in dual task in patients with chronic obstructive pulmonary disease: a comparative study

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) may display a motor and/or cognitive disadvantage during dual tasking. However, studies investigating dual task are quite limited in patients with COPD.

AIMS

To compare cognitive and motor performances (i.e., muscle force production and functional balance/mobility together with a cognitive task) in dual task between patients with COPD and healthy controls.

METHODS

Thirty-five clinically stable patients with COPD and 27 age- and sex-matched healthy controls participated in this cross-sectional controlled study. The muscle force production (knee extension muscle strength assessed with an isokinetic strength dynamometer) and functional balance/mobility (Timed Up and Go (TUG) test) were performed with and without a cognitive task. Dual-task interference (DTI) was assessed. Additionally, the rate of correct responses per second (RCR) was calculated to evaluate cognitive performance.

RESULTS

The decrease in RCR_{muscle force production} values was greater in the COPD group compared with the control group (p = 0.045). Similarly, the cognitive DTI in muscle force production test was higher in the control group than in the COPD group (p < 0.001). There was no significant difference in other outcome measures between the two groups (p > 0.05).

CONCLUSION

The study results indicate that in individuals with COPD, cognitive performance deteriorations are more pronounced than motor performance defects during dual tasking. Further studies are needed to investigate the effects of dual task taking into account this disadvantage in patients with COPD rather than focusing solely on motor performance.

Self-Management Training in Chronic Obstructive Lung Disease Improves the Quality of Life

OBJECTIVES

Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD.

MATERIALS AND METHODS

Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters.

RESULTS

We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05).

CONCLUSION

Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.

Development and Validation of the Modified Patient-Reported Outcome Scale for Chronic Obstructive Pulmonary Disease (mCOPD-PRO)

Purpose

The present study aimed to develop and validate the modified patient-reported outcome scale for chronic obstructive pulmonary disease (mCOPD-PRO) for measuring the health status in COPD using both classical test theory and item response theory.

Methods

A working group was initially established. The conceptual framework of COPD-PRO was modified. Subsequently, items related to COPD were gathered and selected through expert consultation, patient cognitive interviewing, classical test theory methods, as well as the item response theory method. Finally, the formed mCOPD-PRO was evaluated in terms of reliability, content validity, construct validity, criterion validity, known groups validity, and feasibility.

Results

A total of 155 items were gathered in the item bank, and two rounds of expert consultation, interviews with patients and field survey were conducted. The mCOPD-PRO included 27 items in the physiological, psychological, and environmental domains. The Cronbach's alpha of the instrument was 0.954. The correlation coefficients between the scores of each item and its domain scores ranged from 0.429 to 0.902. Confirmatory factor analysis showed that the comparative fit index, incremental fit index, non-normed fit index, standardized root-mean-square residual, and root-mean-square error of approximate were 0.91, 0.91, 0.90, 0.11, and 0.16, respectively. The correlation coefficient between mCOPD-PRO total scores and COPD assessment test scores and the modified Medical Research Council dyspnea scale scores was 0.771 and 0.651, respectively. The differences in mCOPD-PRO total scores and domain scores between the mild/moderate group and severe/extremely severe group of patients with COPD were both statistically significant (P<0.01). The acceptance and completion rates of mCOPD-PRO were both 99.5%, and the median completion time was 5 min (IQR, 4-11 min).

Conclusion

The 27-item mCOPD-PRO is well developed and has good reliability, validity, and feasibility. It may provide a scientific and effective instrument for the clinical evaluation of COPD.

Significance of Dyspnoea as a symptom in the Emergency Department of the Primary Healthcare Centre

Background/Aim: Dyspnoea represents a subjective feeling of laboured breathing of different intensity. The aim of this study was to determine how often patients come with dyspnoea to a local Emergency Department of the Primary Healthcare Centre (EDPHC) and to analyse the assumed aetiology, diagnostics and therapy of the dyspnoeic patients. Methods: The records of the EDPHC of the City of Banja Luka for the period between 1 October 2019 to 31 December 2019 of all patients older than 15 years of age that have reported laboured breathing were identified and analysed. Following parameters were recorded: age, gender, diagnostics performed, administered therapy, whether the patient was examined in the field or in the ambulance, as well as whether the patient was referred to a hospital (Cardiology, Pulmonology or another department) or not. Results: Laboured breathing was reported by 665 patients. Out of this number, 108 patients were examined by their family doctor, 407 patients in EDPHC ambulance and 150 patients in the field. The average age of the patient was 61.03 ± 19.17, with an equal distribution in males and females. The aetiology of dyspnoea was cardiac and pulmonary in one-third of patients each, whereas the diagnosis in the other patients was versatile, from anxiety disorders, musculoskeletal diseases and active malignancy to unspecified chest pain that could not receive a definitive diagnosis. One half of the patients (N = 261 or 46.86 %) was completely taken care of in the ambulance or in the field, 199 (35.73 %) patients were sent to a cardiologist, 87 (15.62 %) to a pulmonologist and 10 (1.80 %) of patients to another specialist. Referral to hospital was registered more often in men (ch2 = 9.195, p = 0.027), elderly (ch2 = 53.29, p < 0.001), people with lower peripheral oxygen saturation (SpO2 ) (ch2 = 120.61, p < 0.001) and people with significant deviation of normal blood pressure values (ch2 = 120.61, p < 0.001). Conclusion: Dyspnoea can be caused by an array of different diseases and more than one diagnostic method is necessary to confirm/exclude any of the most common causes of dyspnoea. A broader diagnostical palette in ED would be preferred for purposes of ascertaining a timely diagnosis.

Predictors in routine practice of 6-min walking distance and oxygen desaturation in patients with COPD: impact of comorbidities

Background: The 6-min walk test (6MWT) allows exercise tolerance to be assessed, and it has a significant prognostic value in COPD. The goal of this study was to analyse the determinants (obtained in routine practice) of a low 6-min walking distance (6MWD) and exercise-induced desaturation (EID) in COPD, including comorbidities.

Methods: Patients were recruited from the real-life French COPD cohort “Initiatives BPCO”. A low 6MWD was defined as <350 m. EID was defined by a minimum pulse oxygen saturation (SpO2)<90% and delta SpO2≥4% from baseline. Multivariate logistic regression analyses assessed the influence on 6MWD and EID of age, sex, obesity (body mass index, BMI >30 kg/m²), low BMI (BMI <18.5 kg/m²), modified Medical Research Council (mMRC) dyspnea scale, FEV1% pred, FVC % pred, hyperinflation and comorbidities including cardiovascular diseases.

Results: Among 440 patients with available 6MWT data, a 6MWD <350 m was found in 146 patients (33%), which was positively associated in multivariate analyses with age and mMRC and negatively with resting SpO2 and FVC % pred (rescaled r²=0.34), whereas no comorbidity was associated with a low 6WMD. EID was found in 155 patients (35%). This was positively associated with hypertension and negatively with age, obesity, FEV1% pred and resting SpO2 (rescaled r²=0.37).

Conclusion: 6MWD and EID exhibit different determinants in COPD with a minor impact of comorbidities limited to hypertension in EID and to obesity, which was unexpectedly associated with less EID. Other variables including age, routine resting lung function and SpO2 were weakly associated with 6MWD and EID. Altogether, these results suggest that 6MWT performance remains difficult to predict with routine clinical/functional parameters.

Treatment response in COPD: does FEV1 say it all? A post hoc analysis of the CRYSTAL study

The association between clinically relevant changes in patient-reported outcomes (PROs) and forced expiratory volume in 1 s (FEV1) in patients with chronic obstructive pulmonary disease (COPD) has rarely been investigated. Using CRYSTAL, a 12-week open-label study in symptomatic, nonfrequently exacerbating patients with moderate COPD, we assessed at baseline the correlations between several PROs (Baseline Dyspnoea Index, modified Medical Research Council dyspnoea scale, COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ)), and between FEV1 and PROs. Associations between clinically relevant responses in FEV1, CAT, CCQ and Transition Dyspnoea Index (TDI) at week 12 were also assessed. Using data from 4324 patients, a strong correlation was observed between CAT and CCQ (rs=0.793) at baseline, with moderate or weak correlations between other PROs, and no correlation between FEV1 and any PRO. At week 12, 2774 (64.2%) patients were responders regarding TDI, CAT or CCQ, with 583 (13.5%) responding using all three measures. In comparison, 3235 (74.8%) were responders regarding FEV1, TDI, CAT or CCQ, with 307 (7.1%) responding concerning all four parameters. Increases in lung function were accompanied by clinically relevant improvements of PROs in a minority of patients. Our results also suggest that PROs are not interchangeable. Thus, the observed treatment success in a clinical trial may depend on the selected parameters.

Effects of baseline symptom burden on treatment response in COPD

RATIONALE

In symptomatic patients with COPD, the decision whether to initiate maintenance treatment with a single agent or a combination of long-acting bronchodilators remains unclear.

OBJECTIVE

To investigate whether baseline symptomatic status influences response to tiotropium/olodaterol treatment.

MATERIALS AND METHODS

Post hoc analysis of the randomized OTEMTO® studies (NCT01964352; NCT02006732), in which patients with moderate-to-severe COPD received placebo, tiotropium 5 µg, tiotropium/olodaterol 2.5/5 µg, or tiotropium/olodaterol 5/5 µg once daily for 12 weeks via the Respimat® inhaler (Boehringer Ingelheim, Ingelheim am Rhein, Germany). Impact of baseline symptomatic status (modified Medical Research Council [mMRC] score) on response to treatment with tiotropium/olodaterol 5/5 µg, tiotropium 5 µg, or placebo at Week 12 was assessed by St George's Respiratory Questionnaire (SGRQ) total score and response rate, transition dyspnea index (TDI) focal score and response rate, and trough forced expiratory volume in 1 second response.

RESULTS

Tiotropium/olodaterol improved SGRQ total scores and response rates compared with placebo and tiotropium for patients with baseline mMRC scores 0-1 and ≥2. For tiotropium/olodaterol vs tiotropium, greater improvements were observed for patients with mMRC ≥2 (SGRQ score adjusted mean treatment difference -3.44 [95% CI: -5.43, -1.46]; P=0.0007; SGRQ response rate ORs 2.09 [95% CI: 1.41, 3.10]; P=0.0002). Dyspnea, measured by TDI score, was consistently improved with tiotropium/olodaterol vs placebo for patients with mMRC scores 0-1 and ≥2 (adjusted mean treatment difference 1.63 [95% CI: 1.06, 2.20]; P<0.0001 and 1.60 [95% CI: 1.09, 2.10]; P<0.0001, respectively). In patients with mMRC scores 0-1 and ≥2, tiotropium/olodaterol consistently improved TDI response rate and lung function vs placebo and tiotropium.

CONCLUSIONS

Patients with COPD with more severe baseline dyspnea appear to derive greater health status benefit with tiotropium/olodaterol compared with tiotropium alone.

Correlation of the modified Medical Research Council dyspnea scale with airway structure assessed by three-dimensional CT in patients with chronic obstructive pulmonary disease

BACKGROUND

Dyspnea is a common symptom in chronic obstructive pulmonary disease (COPD). The modified Medical Research Council (mMRC) dyspnea scale is a widely used questionnaire to assess dyspnea. However, the relationship of the mMRC dyspnea scale with morphological airway structures in COPD remains unclear. We evaluated the correlation between the mMRC dyspnea scale and imaging-based airway structures in patients with COPD.

METHODS

The wall area (WA) and airway inner luminal area (Ai) of third-to sixth-generation bronchi and the percentage of low attenuation area with less than -950 HU (%LAA) of the lungs were measured using three-dimensional computed tomography in patients with COPD. WA and Ai were corrected by body surface area (BSA).

RESULTS

Forty-two clinically stable patients with COPD were enrolled. The median (range) mMRC dyspnea scale was 2 (0-3). The mMRC dyspnea scale score was significantly correlated with WA/BSA of fifth- and sixth-generation bronchi (Spearman correlation coefficient ρ = 0.386, p = 0.012; ρ = 0.484, p = 0.001, respectively). Partial rank correlation analysis showed that the mMRC dyspnea scale score was significantly correlated with WA/BSA of sixth-generation bronchi, independent of the confounding factors of age, body mass index, %predicted forced expiratory volume in 1 s, %LAA, and Ai/BSA (ρ = 0.481, p = 0.003). However, the %LAA and Ai/BSA were not correlated with this dyspnea scale.

CONCLUSION

Bronchial WA assessed by three-dimensional computed tomography may be used as an assessment tool for dyspnea in patients with COPD.

Characteristics of 2017 GOLD COPD group A: a multicenter cross-sectional CAP study in Japan

PURPOSE

The 2017 GOLD ABCD classification shifts patients from groups C-D to A-B. Group A was the most widely distributed group in several studies. It would be useful to understand the characteristics for group A patients, but little has been reported concerning these issues.

PATIENTS AND METHODS

This was a multicenter cross-sectional study using the COPD Assessment in Practice study database from 15 primary or secondary care facilities in Japan. We investigated the clinical characteristics of group A by stratification according to a mMRC grade 0 or 1.

RESULTS

In 1,168 COPD patients, group A patients accounted for approximately half of the patients. Compared with the groups B-D, group A was younger and had a higher proportion of males, higher pulmonary function, and higher proportion of monotherapy with long-acting muscarinic antagonist or long-acting β-agonist. The prevalence of mMRC grade 1 patients was about two-thirds of group A. Compared with the mMRC 0 patients, mMRC 1 patients showed a tendency to have a higher proportion of exacerbations (P=0.054) and had a significantly lower pulmonary function. Regardless of the mMRC grade, 60% of group A patients were treated with monotherapy of long-acting muscarinic antagonist or long-acting β-agonist.

CONCLUSION

Group A patients accounted for approximately half of the patients, and they were younger, had higher pulmonary function, and had lower pharmacotherapy intensity compared with groups B-D. By stratifying according to the mMRC grade 0 or 1 in group A patients, there were differences in the exacerbation risk and airflow limitation.

Determinants of the 6-minute pegboard and ring test as an unsupported upper-extremity exercise capacity measure in older adults with chronic obstructive pulmonary disease

PURPOSE

Upper extremities play an important role in performing of many activities of daily living. Physical and pathological changes limit upper extremity functions in older adults with chronic obstructive pulmonary disease (COPD). Although the 6-minute pegboard and ring test (6PBRT) is a reliable and commonly used method for the assessment of unsupported upper-extremity exercise capacity in patients with COPD, there is lack of evidence about the possible determinants of the 6PBRT score. The study aimed to investigate the possible determinants of the 6PBRT in older adults with COPD.

METHODS

Fifty-two older adults (age ≥ 65 years) with stable COPD and 23 age-matched healthy older adults participated in this study. Demographic characteristics, unsupported upper-extremity exercise capacity, pulmonary function, functional exercise capacity, disease related symptoms, peripheral and respiratory muscle strength were evaluated. Stepwise multiple linear regression analysis was used to investigate the possible determinants of the 6PBRT score.

RESULTS

The 6PBRT score was significantly higher in healthy participants compared with those with COPD (p = 0.024). In participants with COPD, shoulder flexor muscle strength, age and functional exercise capacity were significant and independent predictors of the unsupported upper-extremity exercise capacity with explaining 55.4% of the variance.

CONCLUSIONS

This study suggests that shoulder flexor muscle strength, age and functional exercise capacity are independent determinants of the unsupported upper-extremity exercise capacity assessed by the 6PBRT in older adults with COPD.

Postoperative outcomes of frequent exacerbator patients with Chronic Obstructive Pulmonary Disease after resection of Non-Small Cells Lung Cancer

Chronic obstructive pulmonary disease (COPD) is a risk factor of post-operative complications after lung cancer resection. The influence of the "frequent exacerbator (FE)" phenotype (at least three exacerbations per year) is unknown. Postoperative outcomes of frequent exacerbators (POFE) was a prospective observational study of patients with COPD undergoing lung resection for cancer. The inclusion criteria were: age >40 years, FEV1/FVC <70%, non-urgent surgery for lung cancer, filled out self-questionnaires. The primary outcome was assessment of postoperative pulmonary complications (purulent tracheobronchitis, atelectasis, pneumonia, acute respiratory failure, need of mechanical ventilation). Secondary outcomes encompassed the prevalence of the FE phenotype and its impact on postoperative complications. A total of 682 patients were screened from June 2014 to October 2015. 93 patients with COPD were included, 21 (23%) were FE. Postoperative tracheobronchitis, atelectasis pneumonia or respiratory failure (isolated or associated) occurred in 47%, 48%, 26%, and 38% of patients, respectively. Non-invasive and invasive mechanical ventilation were necessary in 4 (4%) and 22 (23%) patients. Purulent tracheobronchitis, pneumonia and hypercapnia (this last requiring noninvasive mechanical ventilation) were more frequent in FE (p = 0.043, 0.042, 0.015); however the number of patients wth at least one respiratory complication was not different (76% vs. 52%, p = 0.056). In all patients, multivariate logistic regression identified two independent factors of postoperative respiratory complications: male sex (OR 10.6 [95% CI 1.97-57.6], p = 0.006) and the FE phenotype (OR 6.33 [1.04-38.39], p = 0.045). Occurrence of postoperative complications in patients with COPD is high. FE phenotype is an independent risk factor.