CAT Score Research Articles

Effects of transitional nursing on the quality of life in patients with stable chronic obstructive pulmonary disease

Objective To explore the effects of transitional nursing on the quality of life in patients with chronic obstructive pulmonary disease (COPD) . Methods A total of 118 patients in the stable phase of COPD, who were discharged from the Affiliated Hospital of Xuzhou Medical University during March 2015 to June 2016 were selected by convenience sampling method and divided into observation group (n=60) and control group (n=58) according to the random number table. The patients in the control group were treated with routine nursing mode, while the patients in the observation group were given transitional care after discharged on the basis of routine nursing. The effects of the transitional care and patients' quality of life were evaluated with Care Transitions Measure (CTM) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT) at three time points, before intervention, three and six months after the intervention. Results There was no statistical difference in the score of CTM between the two groups before intervention (P>0.05) . After intervention for 3 and 6 months, the CTM score of the observation group patients were significantly higher than that of the control group, and the differences were statistically significant (P 0.05) . The CAT score of the patients in the observation group was lower than that in the control group after intervention for 6 months, and the difference was statistically significant (P<0.05) . Conclusions Transitional nursing mode can improve the cognition of patients in COPD stable phase, promote healthy lifestyle and behavior, and improve patients' quality of life. Key words: Pulmonary disease, chronic obstructive; Quality of life; Stable phase; Transitional nursing

Results of Bronchoscopic Lung Volume Reduction with One-way Valve in Patients with Severe Emphysema in Vietnam

Background: Bronchoscopic lung volume reduction (BLVR) has been applied in COPD patients with heterogeneous emphysema. In this first clinical trial in Vietnam, we evaluated the safety and initial results of BLVR by one-way valve in COPD patients with severe emphysema. Methods: We performed a prospective, nonrandomized, single center longitudinal study in 30 stable COPD patients with heterogeneous severe emphysema on CT-scanner, the average age of 65.17 years old, FEV1≤35 %pred., TLC ≥ 100 %pred., RV ≥ 150 %pred. and 6MWT &lt; 450 meters. The Zephyr one-way bronchial valves (PulmonX, Redwood City, CA, USA) with the size of 5.5 mm and 4mm were placed in lobar or segmental bronchi via flexible bronchoscopy. 28 patients were placed only one valve, 1 patient with two and 1 patient with three valves. 23 valves with the size 5.5 mm diameters and 10 valves with the size 4.0mm used. All patients received optimal medical treatment at the time of procedure and during the study period. Outcomes will be assessed at 3 months after treatment include the changes of clinic, and lung function, the occurrence of complications. Results: After 3 months, mean CAT scores decreased significantly compared with before procedure (17.73 ± 3.53 vs 20.10 ± 3.58) (p&lt;0.05), with the median change of 2.73 points and the improvement more than 2 points in 76.67% of patients. 6 MWT increased at 3 months with mean 32.13 meters, 93.33% of the patients increased 6MWT, 46.67% of the patients increased 6MWT more than 26 meters. MRC decreased with the median change of 0.5 score. VC decreased by a mean 0.2 (L) (0.42 - 0.02), FEV1 increased by a mean 0.05 (L) (0.04 - 0.05) but not statistically significant (p&gt;0.05); FVC increased by a mean 0.14 (L) (0.01 - 0.28), RV decreased by a mean 0.62 (L) (1.05 - 0.2), TLC decreased by a mean 0.52 (L) (0.77- 2.4) with statistically significant (P&lt;0.05). The early complications were 13.33%, the later complications were 23.34% of the patients. Conclusions: The unilateral bronchoscopic lung volume reduction with one-way valve (mainly one valve) in treatment of heterogeneous severe emphysema in stable COPD patients in Viet Nam have shown that this procedure is safe with encouraging initial results.

Anxiety and depression in patients with chronic obstructive pulmonary disease and their relation to serum vitamin D levels

Objectives: To determine whether serum vitamin D levels wererelated to the prevalence of anxiety and depression among patientswith chronic obstructive pulmonary disease (COPD), as well as theirspirometry parameters, disease severity, and other clinical findings.Materials and Methods: Ninety-two stable patients withCOPD aged over 18 years with no exacerbations in the previousmonth were included. Symptom severity was assessed using themodified Medical Research Council (mMRC) dyspnea scale andCOPD Assessment Test (CAT) scores. Spirometry tests wereperformed and previous hospitalization histories were recordedto determine ABCD groups of the patients according to theircombined COPD assessments. Their Body mass index, airflowObstruction, Dyspnea and Exercise capacity (BODE) indices werecalculated and the Hospital Anxiety and Depression Scale (HADS)was administered. Serum vitamin D levels were determined usingimmune electrochemiluminescence.Results: According to the HADS scores, 16 patients (17.4%) hadthe risk of anxiety and 29 (31.5%) had the risk of depression. Therisk of anxiety differed significantly (P= 0.016 Fischer’s exact test)between the ABCD groups. Anxiety scores were positively correlatedwith both mMRC (r= 0.315; P= 0.002) and CAT (r= 0.445; P= 0.000)scores. Similarly, depression scores correlated positively with mMRC(r= 0.249; P= 0.017) and CAT (r= 0.373; P= 0.000) scores. Neitheranxiety nor depression scores were significantly correlated with % ofpredicted FEV1 (p= 0.339, P= 0.671). Serum vitamin D levels wereinversely correlated with anxiety (r= -0.215; P= 0.039) and depression(r= -0.244; P= 0.019) scores. Anxiety scores were positively correlatedwith BODE although not statistically significantly (r= 0.199; P= 0.058).Conclusion: A negative correlation was revealed betweenserum vitamin D levels and HADS scores, and symptom scoreswere positively correlated to HADS scores, independent of % ofpredicted FEV1.

Patterns and predictors of exhaustion episodes in patients with stable COPD: A longitudinal study.

Exhaustion is the perception of low energy. Little is known about how exhaustion persists, remits or reappears over time in patients with chronic obstructive pulmonary disease (COPD) or how to predict these events. We determined the likelihood of transitions between states of exhaustion and no exhaustion among patients with stable COPD followed up for 2years. We investigated combinations of potential factors for their abilities to predict new-onset exhaustion episodes. We prospectively included 137 patients with stable COPD (mean age, 66.9years±8.3). Exhaustion states were measured at baseline and 1 and 2years later. Exhaustion was defined as an answer of "most of the time" or "a moderate amount of time" to 1 of 2 questions: "How often have you found it hard to get going?" and "How often does everything seem to require effort?" We evaluated demographic, non-respiratory and respiratory variables as potential predictors. The likelihoods of new episodes and recovery were calculated. Predictors were evaluated with generalised estimating equations. At baseline, 27 patients (19.7%) displayed exhaustion. Of the 110 patients without exhaustion at baseline, 17 (15.5%) displayed exhaustion at least once during the follow-up period. During the study period, a total of 204 annual transitions displaying no exhaustion at the beginning were identified. Of them, 10.3% transitioned to exhaustion in the next year. The likelihood of recovery after exhaustion was 50%. Independent predictors of new-onset exhaustion episodes within the following year were: the COPD assessment test score (odds ratio [OR]=1.10; 95% confidence interval [CI] 1.01-1.21), depression (OR=6.89; 95% CI: 1.00-47.41) and female gender (OR=6.88; 95% CI: 1.83-25.73). Patients in stable COPD with high CAT scores and depression were most likely to experience new-onset exhaustion episodes Thus, exhaustion might be predicted by a combination of psychological factors and respiratory health status. Nevertheless, exhaustion is dynamic in COPD; half of patients recover from exhaustion.

Effect of Inhaled Magnesium Sulphate on Bronchodilating Response, Levels of Substance P and Clinical Improvement of Acute Exacerbations COPD Patients

Background: Inhaled magnesium sulphate has a bronchodilator and antiinflammatory effect by block the calcium channels and inhibiting substance P. This study aimed to analyze the effect of magnesium sulfate inhalation on bronchodilator response, substance P levels, and clinical improvement on AECOPD patients.&#x0D; Methods: A quasi-experimental clinical trial, pre-test and post-test design with 34 acute exacerbation of COPD patients who are hospitalized in emergency room on Dr. Moewardi Hospital, Surakarta and Ario Wirawan Hospital, Salatiga on March-April 2017 used consecutive sampling. The independent variable is inhaled magnesium sulphate dose of 150 mg 3 times every 20 minutes when the patients was admitted in emergency room, while the dependent variables are peak expiratory flow rate, the plasma levels of substance P and CAT score acute exacerbation of COPD patients. &#x0D; Results: There was a significant difference (P=0.009) decrease of PEFR value of treatment group (111.76±12.37) compared to control group (141.18±24.21). There was a significant difference (P=0.0001) decrease in CAT score of treatment group (-14.88±1.75) compared to control group (-9.00±1.17). There was a significant difference (P=0.0001) treatment group (-1305.92±417.91) than control group (-355.95±206.25).&#x0D; Conclucions: The addition of MgSO4 inhalation of 150 mg during exacerbation increased PEFR, decreased the level of P substance, and decreased the CAT score with statistically significant results. (J Respir Indo 2018; 38(1): 16-23)

Evaluation of criteria for clinical control in a prospective, international, multicenter study of patients with COPD.

The concept of clinical control in COPD has been developed to help in treatment decisions, but it requires validation in prospective studies. This international, multicenter, prospective study aimed to validate the concept of control in COPD [control=stability (no exacerbations or impairment in CAT scores)+low impact (low level of symptoms)]. Data from the screening visit was used to: investigate the level of control, compare characteristics of patients according to the control status, and perform a sensitivity analysis of the levels of control using either clinical criteria or questionnaires (COPD Assessment Test -CAT- or Clinical COPD Questionnaire -CCQ-). A total of 314 patients were analysed, mean age was 68.5 years and mean FEV1 was 52.6% of predicted. According to the prespecified criteria 21% of patients were classified as controlled, all of them with mild/moderate COPD (Body mass index, Obstruction, Dyspnea and Exacerbations, -BODEx-index <5). A high level of dyspnea, a high CAT score or an exacerbation in the previous 3 months were found, using univariate analysis, to be the main reasons for patients not being classified as controlled. Multivariate analysis showed that female sex, chronic bronchitis and having exacerbations in the previous year were associated with uncontrolled COPD. Changing the severity cut off of BODEx from 5 to 3 did not change significantly the percentage of patients fulfilling the criteria of control. The proposed criteria of control were only fulfilled by 21% of patients. The suggested cut offs and their predictive value for poor outcomes need to be refined in prospective studies.

Evaluation and Exploration on the Effect of the Management of Chronic Obstructive Pulmonary Disease in Rural Areas through an Internet-Based Network Consulting Room

Objective: This study aims to improve the management quality of chronic obstructive pulmonary disease (COPD) in rural areas. Methods: Two hundred forty discharged COPD patients were divided into an intervention group and a control group. In the intervention group, 120 patients established contact with doctors through the network consulting room, i.e., the doctor’s mobile platform, and were managed through video, voice, and text by the doctors, kept close contact with the doctors after discharge (education, consultation), and received electronic prescriptions, and drugs were sent to the patients’ door by online retailers. The patients in the control group were managed in the traditional manner. One year later, the predicted forced expiratory volume in 1 s (FEV1)%, FEV1/forced vital capacity (FVC), and CAT scores and the number of rehospitalized patients were compared between these 2 groups. Results: After 1 year of follow-up, the predicted FEV1% and the FEV1/FVC ratio were significantly higher in the intervention group than in the control group (p < 0.05). CAT scores were lower for patients in the intervention group than for those in the control group after 1 year of follow-up (p < 0.05). After 1 year of follow-up, 22 (18.33%) patients were rehospitalized in the intervention group and 58 (48.33%) patients were rehospitalized in the control group (p < 0.05). Conclusion: Doctors can improve the quality of life of patients with COPD and reduce the number of rehospitalizations through use of the network consulting room.

Investigation into the Individualized Treatment of Traditional Chinese Medicine through a Series of N-of-1 Trials.

Purpose To compare the efficacy of individualized herbal decoction with standard decoction for patients with stable bronchiectasis through N-of-1 trials. Methods We conducted a single center N-of-1 trials in 17 patients with stable bronchiectasis. Each N-of-1 trial contains three cycles. Each cycle is divided into two 4-week intervention including individualized decoction and fixed decoction (control). The primary outcome was patient self-reported symptoms scores on a 1–7 point Likert scale. Secondary outcomes were 24-hour sputum volume and CAT scores. Results Among 14 completed trials, five showed that the individualized decoction was statistically better than the control decoction on symptom scores (P < 0.05) but was not clinically significant. The group data of all the trials showed that individualized decoction was superior to control decoction on symptom scores (2.13 ± 0.58 versus 2.30 ± 0.65, P = 0.002, mean difference and 95% CI: 0.18 (0.10, 0.25)), 24 h sputum volume (P = 0.009), and CAT scores (9.69 ± 4.89 versus 11.64 ± 5.59, P = 0.013, mean difference and 95% CI: 1.95 (1.04, 2.86)) but not clinically significant. Conclusion Optimizing the combined analysis of individual and group data and the improvement of statistical models may make contribution in establishing a method of evaluating clinical efficacy in line with the characteristics of traditional Chinese medicine individual diagnosis and treatment.

The relation between serum surfactant protein-d level and chronic obstructive pulmonary disease severity

Surfactant Protein D (SP-D), a glycoprotein released by type II pneumocytes, reportedly predicts pulmonary functional integrity and disease progression. The aim of this study was to define the relationship between SP-D level and COPD severity. Sixty-three patients with stable COPD and 25 healthy control subjects were enrolled. Demographics and COPD severity according to GOLD 2013 staging criteria were evaluated. Arterial blood gases, pulmonary function tests, and exercise test were performed. CAT score, Charlson Comorbidity Index, St. George’s Questionnaire scores, and BODE index were calculated. The relationship between SP-D level and COPD severity, dyspnea level, and quality of life was investigated. According to GOLD 2013, 30 subjects were in group A, 12 in group B, 12 in group C, and 9 in group D. The serum SP-D level was significantly higher in the COPD group (171.9 ± 113.0 ng/mL) than in the control group (106.8 ± 46.7 ng/mL) (p<0.01). SP-D was significantly correlated to FEV1 (p=0.01) and FEV1/FVC (p<0.01). Furthermore, there was a significant negative correlation between SP-D and carbon monoxide diffusion capacity (p=0.03). There was a statistically significant correlation between SP-D and PaCO2 (p=0.02). High-risk GOLD groups (C and D) had a significantly higher SP-D level than the low-risk groups (A and B) (p=0.01). Serum SP-D level significantly correlated with the BODE index (p<0.01). Serum SP-D was elevated in patients with COPD and associated with impaired lung function, high PaCO2 level and decreased diffusion capacity for carbon monoxide. In addition, the correlation found between serum SP-D levels and the BODE index could reflect the overall severity of COPD.

Independent determinants of disease-related quality of life in COPD &amp;ndash; scope for nonpharmacologic interventions?

PurposeQuality-of-life (QoL) scores in chronic obstructive pulmonary disease (COPD) have a weak relationship with physiologic impairment. We investigated factors associated with poor QoL, focusing on psychological measures potentially amenable to intervention.Patients and methodsWe utilized a pre-existing Birmingham (UK) COPD cohort to assess factors associated with QoL impairment (COPD Assessment Test [CAT] scores). Univariate and multivariate regression models were constructed from three categories of variables: demographic, lung function/COPD-related symptoms, and psychosocial/behavioral factors.ResultsAnalyses were based on self-report questionnaire data from 735 participants. The multivariate model of variables independently associated with CAT included depression, dysfunctional breathing symptoms (Nijmegen score), and illness perception, in addition to COPD symptoms (wheeze, cough), exercise capacity, breathlessness, exacerbations, and deprivation; this model explained 72% of CAT score variation. In a dominance analysis assessing the relative contribution of variables, similar contributions were made by breathlessness (20.2%), illness perception (19.8%), dysfunctional breathing symptoms (17.5%), and depression (12.5%) with other variables contributing <5%.ConclusionPsychological factors significantly contribute to disease-specific QoL impairment in COPD, and potentially explain the mismatch between objective physiologic impairment and patients’ experience of their disease. Interventions targeting psychological factors, illness perception, and dysfunctional breathing should be assessed.

Sputum microbiome temporal variability and dysbiosis in chronic obstructive pulmonary disease exacerbations: an analysis of the COPDMAP study

BackgroundRecent studies suggest that lung microbiome dysbiosis, the disease associated disruption of the lung microbial community, might play a key role in chronic obstructive pulmonary disease (COPD) exacerbations. However, characterising...

Varenicline in smokers with severe or very severe COPD after 24 weeks of treatment. A descriptive analysis: VALUE study.

A large number of COPD patients are smokers. The particular characteristics of this group as well as their need to quit usually require psychological counselling and pharmacological treatment to achieve abstinence and, often, intensively. Little information is available about this issue. The main objective of the study was to evaluate the effectiveness of varenicline after 24 weeks of treatment, with continuous abstinence between weeks 9 and 24. This study was a post-authorization, open label, observational study of prospective follow-up. Patients included were smokers with severe or very severe COPD criteria who were treated with varenicline for 24 weeks, i.e. with a 12-week extension over the usual treatment. The outcomes in the population of subjects completing 24 weeks of follow-up were at week 24: continuous abstinence 36.8%, 7 days point prevalence abstinence 65.7%, and continuous smoking 31.5%.The outcomes in the intention-to-treat population included at baseline were: continuous abstinence 17.7% of patients, 7 days point prevalence abstinence 31.6%, continuous smoking 15.1% and not valid/unknown 51.8%. The mean CAT score at week 24 was 15 and reduction from the baseline was 3.77 (paired T test, p<0.01). The most common adverse events reported were nausea, vivid dreams, stomach ache, insomnia, headache and vomiting. Patients included in VALUE were active smokers despite all of them had a severe COPD which suggests a very high degree of dependence. Although the study do not allow to infer the results to the global population of smokers with severe COPD, the outcomes have shown that, at 24 weeks follow up 36.8% of the patients were successful in quitting but from 79 patients enrolled initially only 17.7% quit.

The Relationship of PROMIS Pain Interference and Physical Function Scales.

To examine the relationship between the Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and PROMIS Physical Function (PF) scales in patients with spinal pain at a university spine center. Retrospective analysis of prospectively collected patient-reported outcome data at a university spine clinic. Pearson correlation was done to examine the relationship of the PROMIS PF and PROMIS PI scores. Age, gender, and race were analyzed by subgroups on the PROMIS Physical Function and Pain Interference score. Linear regression analyzed predictive relationships. Statistical significance was set at P < 0.05. A total of 1,992 participants completed an assessment, with 1,923 completing the PF CAT and 1,927 the PI CAT. Participants' mean age was 52.8 years (range = 18-94 years, SD = 6.5 years). Correlation analysis of the PROMIS PF with the PROMIS PI showed a Pearson correlation value of -0.717 (P < 0.05). There was a strong linear relationship with a high negative correlation between PF CAT and PI CAT. The PI CAT predicted PF CAT scores (β = -0.707, P < 0.001). For patients with pain from spinal origin, there is a strong negative correlation between self-reported physical function and pain interference related to physical, social, and mental health. The predictive relationship of function from pain scores supports the PROMIS PI being used as an important adjunct measure of physical function in patients with spinal pain.

CAT-ТЕСТ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ

The goal of study: to investigate CAT-test in those suffering from chronic obstructive pulmonary disease (COPD). Subjects and Methods . 53 COPD patients were examined. The studied group included COPD patients with the long history of smoking. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. The patients were requested to fill in the Beck Depression Inventory. CAT test was used to evaluate the general condition. Results . As the stages of COPD progressed, the number of CAT scores increased: in the patients with stage 2 of COPD it made 21.30 ± 7.34 and with stage 4 CAT scores made 26.7 ± 10.2. The level of depression was increasing with higher severity of COPD: the maximum number of scores of the Beck Depression Inventory was observed in COPD patients with stage 4 and it made 19.62 ± 11.2, and it was the lowest in COPD patients, stage 2 - 10.68 ± 8.41 The direct moderate association was observed between CAT and the level of depression (r = 0.53, p 0.05).

Effects of Omega-3 Polyunsaturated Fatty Acids to The Serum Level of Interleukin-8, Percentage of Forced Expiratory Volume in 1 Second (%FEV1), and COPD Assesment Test Scores in Stable COPD Patients

Backgorund: Cigarette smoke inhalation and the other exposure can cause of airway inflammatory and it was the most cause of chronic obstruction pulmonary desease (COPD) pathogenesis. The airway inflammatory will release cytokines proinflammation, one of them was interleukin (IL)-8. Omega-3 polyunsaturated fatty acids (PUFA) have anti-inflammatory effect and its can decrease cytokines production in COPD pathogenesis. &#x0D; Methods: This study aimed to analyze effects of omega 3 PUFAs on serum IL-8, %FEV1, and CAT score in stable COPD patients. Clinical trials of experimental with pretest and posttest designs were conducted of 32 stable COPD patients came to clinic in Dr. Moewardi Hospital Surakarta from December 2016 until February 2017. Samples were taken by consecutive sampling. Subjects were divided into two groups include the treatment group (n=16) received standard COPD therapy omega 3 PUFA 600mg/day and the control group (n=16) received only standard COPD therapy for 28 days.&#x0D; Results: There were significant difference (P=0.0001) towards decreased of serum IL-8 between treatment group (-3.56+5.32pg/ml) and control group (8.90+9.98pg/ml), increase difference were no significantly of %VEP1 value (P=0.473) between treatment group (7.02+7.17pg/ml) and control group (5.32+5.97pg/ml), decrease difference of CAT scores significantly (P=0.0001) between treatment group (-16.13+3.03pg/ml) and control group (-4.75+4.17pg/ml).&#x0D; Conclusions: Omega-3 PUFA may decrease airway inflammation with decrease serum IL-8 level significantly, increase of %FEV1 no significantly and improve the clinical symptoms of stable COPD by decreased CAT scores significantly in stable COPD patients. (J Respir Indo. 2017; 37(4): 265-77)

The Home COPD and Open Ventilation Evaluation (HOPE) Study

SESSION TITLE: Top Posters - Electronic session SESSION TYPE: Original Investigation Poster PRESENTED ON: Monday, October 30, 2017 at 12:00 PM - 01:30 PM PURPOSE: Respiratory-related diseases, such as COPD, remain a major public health issue affecting millions of people worldwide. Clinical studies have shown that by providing ventilation to reduce respiratory insufficiency symptoms such as dyspnea and high work of breathing, patients may become more tolerant to exercise and be able to increase their functional activity levels, resulting in an overall positive impact to their quality of life. The Life2000 Ventilation System is the only ventilator to simultaneously provide full ventilatory support while enabling patients to ambulate. The HOPE Study was designed to assess the ventilatory efficacy of the Life2000 Ventilation System in patients with COPD. METHODS: This is a single-center, open-label, pilot study in 10 stable, Stage 3 & 4 COPD subjects, as compared to a control group. Subjects were randomized to either continued monitoring alone or monitoring with the use of the Life2000 Ventilation System for a period of six months. The primary endpoints will be the effectiveness of the Life2000 in reducing subjects’ BODE Index and COPD Assessment Test scores, as compared to baseline and control. Subject’s BODE Index and CAT scores will be measured prior to therapy initiation, and again at Days 30, 90, and 180. CAT scores will also be measured after Day 1 of therapy. Secondary endpoints will compare mean pre vs. on-ventilator days’ differences in: Borg Dyspnea Scale Physical Activity Scale for the Elderly(PASE) EtCO2 tracking Reductions in healthcare utilization and costs RESULTS: RESULTS The initial 5 of 10 patients are currently enrolled. Preliminary results at Day 30 show MCID improvement in both primary endpoints compared to baseline: 29% mean decrease in BODE Index (7 vs 5) and 18% mean decrease in CAT Scores (22 vs 18). Clinically significant improvements in median 6MWT Distance (13% or 42m) and post-6MWT Borg dyspnea score (34.6% decrease) at Day 30 as compared to baseline were also seen. Additionally, Day 90 results on the initial 2 patients enrolled showed MCID mean reductions in both BODE Index (31% from 6.4 to 4.5) and CAT Score (41%, from 29 to 17), as compared to baseline. Comparative Day 30 BODE Index scores will be available on all 10 subjects by early May, with Day 90 results available as well on the first 7 enrolled subjects. CONCLUSIONS: The use of a 1-lb, wearable ventilator by COPD patients can play an important role in increasing ambulation and functional activity levels. The Life2000 Ventilation System makes ventilation during activity both practical and achievable for patients, and may result in better disease management, healthcare utilization, and overall outcomes. CLINICAL IMPLICATIONS: The ability to increase functional activity by improving ventilation and oxygenation can result in better management and outcomes for a variety of patient types. DISCLOSURE: Chris Landon: Grant monies (from industry related sources): Sponsored by Breathe Technologies Raymon Gregg: Employee: Breathe Technologies No Product/Research Disclosure Information

Análisis de la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) que dejan de fumar

ObjectiveTo analyse the impact in COPD patients’ quality of life who stop smoking. Patients and methodsWe studied a group of COPD patients who received smoking cessation treatment. All patients were treated with bronchodilators according to the severity of their disorder. This treatment was not changed during the process of smoking cessation. Patients received a smoking cessation programme that consisted of a combination of pharmacological treatment plus cognitive-behavioural treatment. All subjects fill in CAT questionnaire before starting smoking cessation programme and after 6 months of abstinence. All subjects included had stop smoking. ResultsThe study included 59 patients, with 27 (45.8%) males, and a mean age of 61.8 (7.5) years. Mean CAT score before quitting was 18.9 (7.3) points, and after 6 months of abstinence was 8.1 (6.1) points, P=.038. Multiple regression analysis showed: a) the higher the baseline CAT score the greater is the difference after quitting, at 6 months, at same age, gender, and grade of severity of COPD, and b) the older the age, the lower is the difference between baseline CAT score and the 6 months CAT score. ConclusionsSmoking cessation is associated with improvement in the quality of life in COPD patients. Those with worse quality of life get the biggest benefit from quitting, although this difference can be diminished in ageing patients.

Analysis of risk factors for acute exacerbation of chronic obstructive pulmonary disease induced by community-acquired Pseudomonas aeruginosa infection

Objective To study the risk factors of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)induced by community-acquired Pseudomonas aeruginosa(PA)infection which provides the basis for early clinical intervention in high-risk patients. Methods Retrospective analysis of clinical data from 236 patients with acute exacerbation of COPD was conducted in Department of Respiratory Medicine of our hospital from January 2015 to December 2015.The patients were divided into PA group(n=44)and the non-PA group(n=192)according to respiratory tract pathogen infection.The univariate analysis and multivariate logistic regression analysis were performed between the two groups to analyze risk factors for AECOPD induced by PA infection. Results Univariate analysis showed that hypoalbuminemia, AECOPD-induced hospitalization in the recent one year, application of broad spectrum antibiotic within recent 90 days, intermittent use of systemic corticosteroids within recent 90 days, lung function grading of GOLD3/4 level in COPD, acute exacerbation frequency>1 time in last year, the BODE index, walking distance during six minutes, mMRC grading, and CAT scores were significantly correlated with occurrence of community acquired PA-induced AECOPD(all P<0.05). Logistic regression analysis showed that higher BODE index, AECOPD-induced hospitalization in the last year, the use of broad spectrum antibiotic within 90 days and hypoalbuminemia were independent risk factors for community acquired PA induced-AECOPD(OR=14.573、18.958、4.170、5.112, all P<0.05). Conclusions We suggest that the COPD patients having a higher BODE index scores should be clinically intervened early to reduce the occurrence of AECOPD-induced hospitalization, should receive active etiology examination, and should receive therapies for community-acquired Pseudomonas aeruginosa(PA)infection with specific narrow-spectrum antibiotics according to the drug susceptibility and multiple comprehensive measurements, and for correcting hypoalbuminemia. Key words: Pseudomonas aeruginosa; Pulmonary disease chronic obstructive; Risk factors

Effect of Baseline Anxiety and Depression Symptoms on Selected Outcomes Following Pulmonary Rehabilitation.

Anxiety and depression are prevalent comorbidities in people with chronic respiratory diseases (CRDs). This study sought to quantify the influence of varying degrees of anxiety and depression on functional performance and disease impact in a population with CRDs following pulmonary rehabilitation (PR) intervention. The Hospital Anxiety and Depression Scale (HADS), the 6-Minute Walk Test (6MWT), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) were assessed pre- and post-PR. Participants were categorized into 3 groups (None, Probable, and Present) based on their level of anxiety and depression. Functional performance and disease impact outcomes were compared pre- and post-PR. Patients consisted of a total of 134 program completers (72 males, 62 females; mean age = 67.8 years). Significant improvements in functional performance with regard to 6MWT scores were observed across all groups postintervention (P < .05). The Present group, in both the anxiety and depression domains, failed to reach a minimally clinically important difference postintervention. The Probable and Present groups achieved a significant improvement in CAT scores postintervention (P < .05). This study showed that symptoms of anxiety and depression in people with CRDs were significantly related to lower exercise tolerance levels and higher levels of disease impact. People with increased levels of anxiety and depression have the potential to significantly improve disease impact outcomes post-PR. The results demonstrated that the detection and treatment of anxiety and depression symptoms in people with CRDs are likely to be clinically important.

Does any association exist between Chronic Obstructive Pulmonary Disease and Erectile Dysfunction? The DECODED study

IntroductionErectile dysfunction (ED) is the inability to achieve or maintain an erection for satisfactory sexual activity. Recent studies have shown an association between ED and chronic obstructive pulmonary disease (COPD). However, this issue is often ignored. We aimed to evaluate the ED prevalence in COPD patients and its risk factors and to study the impact of dyspnea in sexual activity. MethodsCross-sectional study that included sexually active male patients with COPD. The International Index of Erectile Function (IIEF-5) questionnaire evaluated ED and the Respiratory Experiences with Sexuality Profile (RESP) was used to evaluate the impact of dyspnea on sexual activity. Risk factors for mild-moderate or moderate ED were determined using logistic regression. Results84 patients were consecutively assessed for eligibility, 67 were included (median age: 65 years, 13% never-smokers). Twenty two percent had COPD 2011-GOLD A; 22% GOLD B, 14% GOLD C and 42% GOLD D. Fifty-eight patients (87%) had some degree of ED: 26 (45%) mild, 20 (34%) mild-moderate and 12 (21%) moderate ED. ED occurred in all GOLD stages of COPD, mainly in GOLD B and D stages. Higher CAT score was independently associated to mild-moderate/moderate ED. Most patients (85%) reported dyspnea during their sexual activity but 72% had never talked about it with their physician. ConclusionsED is highly prevalent among COPD patients and it is more severe in patients with higher CAT scores. Dyspnea affects their sexual activity but this is not a topic often discussed between patients and doctors, something which needs to be improved.