Minimal Clinically Important Differences (MCIDs) of the Thai Version of the Leicester Cough Questionnaire for Subacute and Chronic Cough

Roflumilast (Daliresp®) to reduce acute pulmonary events in fibrotic sarcoidosis: a multi-center, double blind, placebo controlled, randomized clinical trial

Background:

Fibrotic sarcoidosis patients often have acute events of increased cough and sputum production. We evaluated the impact of roflumilast in fibrotic sarcoidosis patients with repeated episodes of increased cough and sputum.

Methods:

Sarcoidosis patients with pulmonary fibrosis and at least two acute episodes in the previous year were randomized to receive either roflumilast (ROF) or placebo (PLA) in a double blind, placebo controlled multi-center trial. Subjects were assessed initially and every three months for 12 months. At each visit, spirometry and health related quality of life questionnaires were completed. For each subject, the best forced expiratory volume at 1 second (FEV-1) was noted.

Results:

Of the 38 subjects who enrolled in the study, 28 subjects (14 in each group) received at least three months of treatment and 10 in each arm completing all 12 months of study. During the treatment, patients treated with ROF were less likely to have visits in which the FEV-1 was less than 90% of the best FEV-1 (Odds ratio=0.34 (0.16 to 0.76 95% confidence interval, p=0.0073). At the end of treatment with ROF, patients had a significant improvement in their KSQ LUNG (Initial visit: 45.3 ± 6.89 (Mean ± S.D.); Last visit: 52.6± 7.91, p<0.05) with no change for PLA treated patients.

Conclusion:

Patients treated with at least three months of roflumilast had fewer follow-up visits with an FEV-1 of less than 90% of best value. At the end of treatment, ROF treated patients had a better quality of life as assessed by KSQ LUNG.

Clinical Trial Registration:

NCT01830959

Minimal Clinically Important Differences (MCID) for the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) and the Oxford Shoulder Score (OSS)

Background

The minimal clinically important difference (MCID) is an important instrument in the interpretation of changes in patient-reported outcome measures (PROM). To our knowledge, no MCID of the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) score has ever been reported and no studies have reported an MCID for the Oxford Shoulder Score (OSS) based on patients with glenohumeral osteoarthritis, treated with an anatomical total shoulder arthroplasty (aTSA). The aim of this study was to determine MCID for WOOS and OSS in a cohort of patients with glenohumeral osteoarthritis treated with an aTSA.

Methods

All patients treated with an aTSA for glenohumeral osteoarthritis at our institution between March 2017 and February 2019 were included. Each patient completed the WOOS and the OSS preoperatively and one year postoperatively. At one year, the patients were asked to rate their overall improvement on a 7-point scale. We used an anchor-based method as our primary method to calculate the MCID, supported by two different distribution-based methods.

Results

A total of 45 primary aTSA were included. The MCID of WOOS was 12.3 according to the anchor-based method and 14.2 and 10.3 according to the two distribution-based methods. The MCID of OSS was 4.3 according to the anchor-based method and 5.8 and 4.3 according to the two distribution-based methods.

Conclusion

The anchor-based method is considered superior to the distribution-based method, and therefore we advocate to use this as MCID. For patients with glenohumeral osteoarthritis treated with an aTSA, the MCID values were 12.3 points for WOOS and 4.3 points for OSS. To our knowledge, this is the first study to report a MCID value for WOOS and the first study to report a MCID value for OSS in this subgroup of patients.

Incidence and risk factor for short term postoperative cough after thyroidectomy

Background

The prevalence of potential risk factors for postoperative cough after thyroidectomy remain unknown. The current study aimed to research postoperative cough in patients undergoing thyroid surgery prospectively.

Methods

Adult patients who underwent primary thyroid surgery were selected prospectively. Data regarding age, sex, BMI, pathology and surgical procedure were collected and analyzed. The Leicester Cugh Questionnaire (LCQ) was required to be completed by all patients before operation, 2 weeks and 4 weeks after operation.

Results

There were 1264 patients enrolled in total. Eleven patients with vocal cord paralysis were excluded. In patients with benign disease, postoperative cough occurred in 61 patients, with an prevalence rate of 17. 0% compared to an prevalence rate of 33.1% in patients with malignant disease; the difference was significant. For benign patients, the factors of smoking and operation time were independently related to the occurrence of postoperative cough. For malignant patients, the factors of smoking, operation time, operation extent, and the number of positive nodes at level 6 were independently related to the occurrence of postoperative cough. There was no significant difference regarding the LCQ score in patients with benign or malignant disease at the preoperative and the postoperative 4-week time periods. Patients with malignant disease had a significantly lower LCQ score than patients with benign disease at the postoperative 2-week time point (p = 0.004).

Conclusions

Patients undergoing thyroid cancer surgery had a higher incidence of postoperative cough and were also associated with a decreased cough-related quality of life. The factors of smoking and operation time were the most important predictors for postoperative cough after thyroidectomy.

Effects of Oral Procaterol for Postinfectious Cough in Adults: Single-Centre, Randomized Double-Blind, Placebo-Controlled Trial

Background

Persistent cough following an upper respiratory tract infection (URTI) is common in clinical practice. We investigated the effects of procaterol on cough-specific quality of life (QoL) and peripheral-airway function among adults suffering from postinfectious cough (PIC).

Methods

This was a prospective, randomized, double-blinded placebo-controlled trial (NCT 02349919) conducted at a university hospital. Seventy-four non-asthmatic adults who had persistent post-URTI cough for ≥3 weeks were assessed by a physical examination, chest/paranasal sinus radiographs, spirometry, and impulse oscillometry (IOS) and were allocated to receive procaterol or placebo for 4 weeks. The Thai version of the Leicester Cough Questionnaire (LCQ-T), spirometry and IOS were assessed at baseline, 2 weeks, and 4 weeks.

Results

Mean LCQ-T total scores for the procaterol group (10.8) and placebo group (10.9) at baseline were not significantly different (P=0.821). After adjustment for baseline Borg Cough Scale score and post-nasal drip, the mean between-group difference was not significant for LCQ-T total score (-1.26; 95% confidence interval [CI], -2.69 to 0.17), physical domain score (-0.35; 95% CI, -0.76 to 0.06), psychological domain score (-0.53; 95% CI, -1.06 to 0.01), or social domain score (-0.38; 95% CI, -0.92 to 0.16). Large improvements in LCQ-T total score were reported in both groups after 2 weeks (procaterol, 4.21±2.73; placebo, 5.34±3.2), and 4 weeks (procaterol, 5.94±3.68; placebo, 7.07±3.44). No differences between groups were found in the mean changes of spirometry or IOS parameters after 4 weeks.

Conclusion

Our study shows that procaterol is not effective in the treatment of PIC, in terms of improvement of cough-specific QoL or peripheral-airway function.

Psychological distress at hospital admission is related to symptoms severity and health status in malignant pleural effusion patients

OBJECTIVE

The incidence and associated healthcare costs of malignant pleural effusion (MPE) are expected to rise, but there is limited evidence about which factors affect patients' prognosis. So, the aim of this study was to determine whether psychological distress at hospital admission is associated with symptom severity and health status in patients with MPE.

METHODS

A longitudinal observational prospective cohort study was carried out in the Pulmonology Service of the Granada University Hospital Complex in Granada, Spain. Patients diagnosed with MPE were included and evaluated at hospital admission, at discharge and at one month after discharge. Outcome measures included symptom severity (i.e. dyspnoea, pain and cough) and health status (functionality and self-perceived health status).

RESULTS

Significant differences were found in symptoms and the health status, with worse results in the group with psychological distress at discharge. One month after discharge, MPE patients with psychological distress exhibited greater symptoms, including more cough and dyspnoea (p < .05). Moreover, these patients showed worse functionality (p < .05) and self-perceived health status (p < .05).

CONCLUSION

Psychological distress is an important factor to take into account in patients with MPE. The presence of psychological distress appears to increase the symptoms and is associated with worse health status after hospitalisation.

Association between postoperative cough and thyroidectomy: a prospective study

Background

This study sought to determine whether thyroidectomy is associated with self-reported cough through a prospective analysis.

Methods

Patients undergoing unilateral thyroidectomy were prospectively enrolled. The control group was selected to avoid the effect of general anaesthesia. The experimental group consisted of 300 patients (202 females and 98 males) who underwent thyroidectomy, with a mean age of 48.6 years, and the control group consisted of 103 patients (53 females and 50 males) who underwent other head and neck operations, with a mean age of 50.3 years. All patients were required to complete the Leicester Cough Questionnaire (LCQ) preoperatively and 2 weeks postoperatively.

Results

The postoperative mean total LCQ scores in the experimental and control groups were 17.9 ± 5.0 and 19.8 ± 4.2, respectively; the difference was significant (p = 0.014). Adverse event analysis showed that patients in the experimental group scored significantly worse on items for chest or stomach pains, phlegm, feeling in control of coughing, sleep disturbances, coughing bouts, frustration, and feeling fed up with coughing. In the analysis of the three LCQ domains, a significant difference was noted in the physical domain between the two groups (p < 0.001). In the one-way analysis of variance, the factors of sex and anaesthesia time were associated with the postoperative LCQ score; in further multifactor analysis of variance, only the factor of sex was significantly related to the postoperative LCQ score.

Conclusion

Thyroidectomy may be associated with postoperative cough, and a higher number of female patients complained of cough and related symptoms.

Sarcopenia in patients with malignant pleural effusion: impact on symptoms, health status, and response to hospitalization

BACKGROUND

Malignant pleural effusion (MPE) refers to the presence of neoplastic cells in the pleural fluid and was previously associated with lung cancer, breast cancer, and lymphoma. Patients with MPE effusion have significant symptoms, diminishing their overall quality of life but little is known about the influence sarcopenia may have on their clinical presentation.

PURPOSE

To examine the prevalence of sarcopenia in patients with MPE and its relationship with symptoms, health status, and the response to hospitalization.

METHODS

Seventy-four patients with MPE underwent measurements of symptoms, health-related quality of life, and functional status upon admission, discharge, and 3 months after hospital discharge.

RESULTS

Patients with MPE and sarcopenia were symptomatic during hospitalization and at discharge. Additionally, health-related quality of life and functional status were worse in patients with MPE and sarcopenia. All measures of patients with MPE and sarcopenia were significantly poorer 3 months after hospital discharge.

CONCLUSIONS

Sarcopenia is a clinical characteristic with substantial negative effects in patients with MPE. Specific interventions may need to be provided, designed, and offered in the clinical setting.