COPD Assessment Test Questionnaire Research Articles

Adherence, Disease Control, and Misconceptions Related to the Use of Inhalation Therapy in Patients with Obstructive Pulmonary Diseases: A Cross-Sectional Study.

Background and Objectives: Inadequate treatment of asthma and chronic obstructive pulmonary disease (COPD) might have a negative impact on their progression. Inhalation therapy is the cornerstone of pharmacotherapy for these conditions. However, challenges such as low adherence, negative attitudes, and misconceptions about inhaled medications still persist, impeding effective disease management. This study aimed to evaluate adherence, ascertain the level of disease control in asthma and COPD, explore potential misconceptions surrounding inhalation therapy among patients with obstructive lung diseases and the general population in Vojvodina, and evaluate the reliability of newly developed questionnaires employed in the study. Materials and Methods: This cross-sectional study utilized a battery of questionnaires encompassing sociodemographic data, the Asthma Control Test (ACT), the COPD Assessment Test (CAT), along with two novel questionnaires-one for assessing adherence and another for analyzing attitudes toward inhalation therapy. Statistical analyses were conducted using SPSS software, version 25.0. Results: The average ACT score among patients with asthma was 17.31, while it was 19.09 for the CAT questionnaire among COPD patients. The composite score on the newly developed adherence assessment questionnaire was 2.27, exhibiting a reliability coefficient lower than recommended (α = 0.468). Significant statistical differences emerged among sample subgroups regarding attitudes and misconceptions toward inhalation therapy. The reliability coefficient for this questionnaire was deemed satisfactory (α = 0.767). Conclusions: Adherence rates were notably suboptimal in both subgroups of the studied population. The disease control levels were higher among asthma patients, while they exhibited less prevalent misconceptions regarding inhalation therapy compared to COPD patients and the healthy population.

Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype

Chronic obstructive pulmonary disease (COPD) has a high prevalence and a major impact on health-related quality of life (HRQL). COPD exacerbations are an important cause of morbidity and mortality, affecting cardiovascular risk, and are associated with poorer health status. The aim of this study was to assess the association between cardiovascular risk (CVR) and HRQL, according to exacerbator or non-exacerbator phenotype. We undertook a cross-sectional, observational, descriptive study of 107 patients with COPD. Patients with two or more moderate exacerbations or one severe exacerbation in the previous year were considered as exacerbators. The CVR was calculated with the Framingham scale and SCORE (Systematic Coronary Risk Evaluation) and the HRQL was assessed with the generic questionnaire Short Form-36 Health Survey (SF-36), the St George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). Statistical analysis was done with SPSS version 26.0 for Windows. The SF-36 and the SGRQ showed lower values for the exacerbator phenotype, indicating a poorer quality of life. The CAT questionnaire showed values above 10 for the exacerbator phenotype, and lower values in the non-exacerbator group. After categorizing the sample according to their median age (65 years), we found a greater deterioration in HRQL in patients under 65 years of age according to the SF-36, the SGRQ and the CAT. We also detected differences in HRQL between non-exacerbator patients with a high CVR according to the Framingham (≥ 20%) and SCORE (≥ 5%) scales compared to those without this risk. A tendency towards worse HRQL was observed in non-exacerbator patients with a high CVR, which was statistically significant for the SGRQ impact domain on the SCORE scale. The CAT also showed a worse quality of life in non-exacerbator patients with a high CVR, which was significant in the Framingham model (Framingham high risk 8.41 vs non-high risk 6.05, p < 0.01). These differences were not observed in exacerbator patients. Our findings confirm that a high CVR influences HRQL in patients with COPD, especially in non-exacerbator patients with a high CVR, measured according to the SGRQ and the CAT.

Cross-sectional validation of the COPD Assessment Test (CAT) among chronic obstructive pulmonary disease patients in rural Uganda.

Measuring quality of life is a key component in the management of Chronic Obstructive Pulmonary Disease (COPD). The COPD assessment test (CAT), an easy to administer and shorter instrument than the standard Saint George's respiratory questionnaire (SGRQ), could be an alternative tool for measuring the quality of life of COPD patients in rural Uganda. A cross-sectional study was conducted between June and August 2022, consecutively recruiting 113 COPD patients aged > 40 years from the Low-Dose Theophylline for the management of Biomass-associated COPD (LODOT-BCOPD) study. Upon obtaining consent, participants answered an interviewer administered social demographic, CAT and SGRQ questionnaire. Internal consistency for both SGRQ and CAT was determined using Cronbach's alpha coefficient and values > 0.7 were considered acceptable while correlations were determined using Spearman's rank correlation. Limits of Agreement were visualised using Bland Altman and pair plots. Of the 113 participants, 51 (45.1%) were female. The mean age was 64 ± 12 years, 19 (16.8%) had history of smoking while majority (112 (99.1%)) reported use of firewood for cooking. There was a strong correlation of 0.791 (p < 0.001) between the CAT and SGRQ total scores with a high internal consistency of CAT, Cronbach's alpha coefficient of 0.924 (0.901-0.946). The agreement between the absolute CAT scores and the SGRQ scores was good with a mean difference of -0.932 (95% Confidence Interval: -33.49-31.62). In summary, CAT has an acceptable validity and can be used as an alternative to the SGRQ to assess the quality of life of COPD patients in rural Uganda.

High burden of symptoms reported among patients diagnosed with chronic obstructive pulmonary disease (COPD) in Greenland after introducing the COPD Assessment Test in clinical practice

ABSTRACT The aim was to test the internal consistency of the Greenlandic version of the COPD Assessment Test (CAT) questionnaire and to estimate the symptom burden in patients with chronic obstructive pulmonary disease (COPD) in Greenland using the CAT questionnaire. A Greenlandic version of the CAT questionnaire was developed including forward translation, reconciliation, backwards translation, and pilot test. Afterwards, a cross-sectional study of patients with COPD was conducted. The internal consistency assessed by the Cronbach α coefficient was 0.823 for the Greenlandic version of the questionnaire (n = 103). The CAT was negatively correlated to spirometry values and current smoking. In the cross-sectional study (n = 250), 81.1% of the patients experienced a high symptom burden (≥10). The main CAT score was 17 (range 0–38). The CAT was used in 9 out of 17 towns in Greenland. The Greenlandic version of the CAT questionnaire demonstrated a good internal consistency. We observed a high burden of symptoms associated with reduced lung function and active smoking status among patient diagnosed with COPD in Greenland. The questionnaire can be used in clinical practice for assessment of symptom burden in patients with COPD in Greenland and may help to increase focus on symptom control and quality of care.

Functional capacity and inflammatory biomarkers as predictors for right atrial volume index in COPD patients.

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and right-heart complications. So, this study aimed to evaluate the role of right atrial volume index (RAVI), inflammatory biomarkers and functional capacity in predicting poor outcomes for patients with COPD, classified by COPD assessment test (CAT) questionnaire, as early predictors of right heart diseases. 151 patients with COPD with ejection fraction (LVEF) > 55% were enrolled and classified according to CAT questionnaire into CAT ≥ 10 (group I) and CAT < 10 (group II). RAVI was calculated using Echocardiography. Assessment of RV systolic function was done by Doppler imaging. Functional capacity parameters were assessed by modified medical research council dyspnea scale (mMRC). IL-1β, adiponectin, hs-CRP and neopterin were evaluated by ELSA kits. Group I (CAT ≥ 10)had higher RAVI (73.92 ± 21.20ml/m2 vs 22.73 ± 6.24ml/m2, p < 0.001), lower S`tri (0.05 ± 0.01 vs 0.13 ± 0.03m/s, p < 0.001), lower tricuspid annular plane systolic excursion (TAPSE) (1.20 ± 0.17cm vs 2.17 ± 0.48cm, p < 0.001), higher RVSP (54.88 ± 7.97 vs 26.79 ± 9.84mmHg, p < 0.001) compared withgroup II(CAT < 10). RAVI was good predictor of CAT (r = 0.954, p < 0.001) and strongly correlated with tricuspid S`tri, RVSP, tricuspid E/e' and Mitral E/e' (r = -0.737, r = 0.753, r = 0.817 and r = 0.515, respectively, p < 0.001). RAVI was correlated with TAPSE (r = -0.673, p < 0.001) and with tricuspid E/A ratio & LVEF (r = 0.628, r = -0.407, respectively, p < 0.001). Hs-CRP: 2.50 ± 1.43 vs 2.03 ± 1.19, IL-1β: 37.96 ± 14.35 vs 27.57 ± 8.06, neopterin: 91.37 ± 17.30 vs 76.90 ± 16.75, p < 0.05) were significantly higher besides lower adiponectin levels (3.19 ± 1.98 vs 5.32 ± 1.33 p < 0.05) in group I as compared to group II. Functional capacity might be useful predictor for right heart diseases in COPD patients. Inflammatory biomarkers, low adiponectin and high Hs-CRP, IL-1β and neopterin levels, might not only be useful to monitor treatment response but may also help to discriminate patients with a worsen prognosis.

ВЛИЯНИЕ РЕСПИРАТОРНЫХ СИМПТОМОВ НА КАЧЕСТВО ЖИЗНИ ПАЦИЕНТОВ С ПРОФЕССИОНАЛЬНОЙ БРОНХО-ЛЕГОЧНОЙ ПАТОЛОГИЕЙ

A comparative analysis of the intensity of respiratory symptoms was carried out using the COPD Assessment Test questionnaire, followed by an assessment of the limitation of the quality of life in patients with occupational bronchopulmonary pathology in the post-contact period

Perfil de un paciente con enfermedad obstructiva crónica tratado con la combinación de un agonista β2 adregénico de acción prolongada y un corticoide inhalado en un dispositivo presurizado en la práctica clínica habitual: estudio ARIES

Background and objectiveThe study aimed to describe the profile of patients with stable chronic obstructive pulmonary disease (COPD) and maintenance treatment with a long-acting beta2-adrenergic agonist and an inhaled corticosteroid (LABA/ICS) in a pressurised device (pMDI), and to assess the quality of life (HRQoL). Materials and methodsObservational, multicentre, cross-sectional study in routine clinical practice, conducted in 50 sites in Spain. 390 patients aged ≥ 40 years, treated with LABA/ICS in a pMDI device for at least the previous 3 months before the inclusion, were assessed. Demographic and clinical data were collected from medical records and patient-reported COPD Assessment Test (CAT). ResultsThe patients analysed in the study were mostly male (71.3%); 84.9% in GOLD 2-3 groups; and 32.6% and 38.2% of participants with dyspnoea grade 1 and 2 according to the modified Medical Research Council (mMRC) scale, respectively. The mean CAT questionnaire score (standard deviation [SD]) was 16.3 (8.4). ConclusionsThe profile of the patients treated with LABA/ICS in a pMDI device is mainly male, with no or low comorbidities, moderate-severe functional severity, and mild-moderate dyspnoea. Patients reported a medium impact on their quality of life.

Spirometry and respiratory disease risk factors in firefighters in Almaty

Objective: to ascertain respiratory symptoms, lung function and selected respiratory disease risk factors in firefighters of the city of Almaty. Materials and methods: N=1379, 91% males, firefighters working in Almaty were recruited at the annual screening, where CAT (COPD Assessment Test) and mMRC (Modified Medical Research Council) questionnaires were offered to quantify the severity of respiratory symptoms. We also assessed respiratory risk factors, including cigarette smoking, exposure to environmental tobacco smoke, fossil fuel use for heating and cooking, and regular physical activity, followed by spirometry. Vital capacity (VC), forced VC (FVC) and forced expiratory volume in one second (FEV1) were measured. Results: Median age was 28 (interquartile range (IQR) 25-35) years, years in service median 5 (IQR 3-13) years. 41% of employees were daily cigarette smokers (significantly more among males, 43 vs. 16%), whereas 93% were exposed to environmental tobacco smoke and only 57% were engaged in regular leisure physical activity. With the overall low score of respiratory symptoms, the prevalence of postbronchodilator FEV1/FVC reduction below lower limit of normality in males was 2%, whereas the diagnosis of chronic bronchitis in the past was found in 2% of participants. Conclusions: healthy worker effect in firefighters of Almaty can explain very low prevalence of bronchoobstructive syndrome among those enrolled in this analysis, even despite high smoking prevalence.

Is the six-minute step test able to reflect the severity and symptoms based on cat score?

BackgroundThis is the first study to investigate the performance of 6MST in COPD patients divided into different symptom severity groups based on the CAT questionnaire score. ObjectivesTo evaluate the relationship between the degree symptomatology using the chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) with the six- minute step test (6MST) in COPD patients. METHODS: This is a cross-sectional study in which 59 patients with COPD were evaluated. The groups were stratified according to the subsequent cutoff points: CAT <10 (little impact) n= 22; CAT 11-20 (moderate impact) n=20; CAT <20 (large impact) n=17. During 6MST the individuals were instructed to go up and down a single step with a height of 20 centimeters (cm). ResultsComparing the groups in relation to performance on the 6MST, the number of climbs on the step were significantly higher in the CAT group <10 when compared to the CAT group >20, the variation in HR between rest and peak exercise (∆ HRpeak- rest) was lower in the CAT>20 group compared to the CAT<10 group and the CAT 11- 20 group. We found direct relationships between the number of ascents and descents in the 6MST vs the CAT score (r=0.35, p=0.007); and 6MST vs degree of obstruction of %FEV1 (r-0.46, p=0.002) We verified a linear regression model in which the FEV1 (L) and the CAT score influenced 29% in the performance of the 6MST. ConclusionThe COPD severity represented by the FEV1 and the CAT score are associated and influenced by 29% the performance of 6-minute step test. Our findings may have important implications for the clinical evaluation of these patients as well as for rehabilitation.

Assessing Severity of Chronic Obstructive lung disease (COPD) Using CAT score among high altitude residents of Nepal

Introduction: The goal of this study was to see if the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) score was beneficial in determining the severity of COPD patients. It produces a score that reflects the impact of the condition on their health status. GOLD guideline (2013) recommends CAT above other respiratory questionnaires since it is regarded to be a better assessment tool.&#x0D; Methods: Cross-sectional study conducted in Karnali Academy of Health Sciences, Jumla (Nepal) who presented with COPD exacerbation. A validated CAT questionnaire in the local language (Nepali) was employed and completed by the patient, and then the total CAT score was calculated and grouped into four impact levels. Data was evaluated using descriptive statistics (such as percentage and mean) and Pearson’s correlation tests to compare means.&#x0D; Results: Out of 55 patients, 52.7% were females; all 55 had firewood exposure with current smoking history more prevalent in the high-impact group 0.5%. At 3 months, the median number of COPD exacerbations was 2 (range: 0–90) with median CAT score 30 (range: 17–37). Patients were divided into severity groups based on their CAT scores. 47.3% were in the high impact group, whereas none were in the low impact group. The “very high impact” group had a considerably higher median number of exacerbations than the other high impact and medium groups (5 vs. 2 and 0) respectively with p&lt;0.001. In the “very high impact” group, significant use of inhalers in form of salbutamol or long-acting bronchodilators in combination with steroid was seen.&#x0D; Conclusions: CAT is an independent severity score that is higher in frequent exacerbates. The “very high impact” group had a considerably higher median number of exacerbations than the other groups (5 vs. 2 and 0) respectively with a significant p&lt;0.001 value. Thus, useful in monitoring patients health status and treatment.

Rebusan Jahe Merah (Zingiber officinale var. rubrum) dalam Memperbaiki Gejala PPOK

Penyakit paru obstruktif kronik (PPOK) merupakan masalah kesehatan global yang utama dan berdampak pada peningkatan biaya kesehatan dan penurunan produktivitas. Jahe merah infus (Zingiber officinale var. rubrum) merupakan salah satu tanaman obat yang banyak dikonsumsi di Indonesia. Penelitian ini bertujuan mengetahui perbaikan gejala PPOK dengan kuesioner CAT (COPD Assesment Test) dari terapi jahe merah. Metode penelitian yang digunakan adalah pre-post design pada bulan Mei-September 2021. Responden adalah pasien PPOK dewasa yang berdomisili di Kota Mojokerto. Penelitian dilakukan dengan mengukur gejala PPOK dengan kuesioner CAT. Selanjutnya, terapi seduhan jahe merah dosis 250 gram selama 4 bulan diaplikasikan pada pasien. Analisis data untuk menguji efektifitas perbaikan gejala PPOK pada infusa jahe merah menggunakan uji-t. Responden penelitian sebanyak 21 orang. Rata-rata usia responden adalah 53,24 tahun. sebagian responden mengalami peningkatan nilai CAT setelah terapi jahe merah sebanyak 66,67%. Berdasarkan uji beda, menunjukkan nilai P=0,028 (P&lt;0,05), yang membuktikan ada perbedaan signifikan antara nilai CAT sebelum dan setelah terapi jahe merah selama 4 minggu. Rebusan jahe merah selama 4 minggu efektif memperbaiki gejala harian PPOK dibandingkan sebelum terapi. Oleh karena itu, terapi jahe merah perlu mendapatkan perhatian karena mungkin dalam membantu terapi penyakit PPOK.

Efektivitas Pengobatan pada Pasien Penyakit Paru Obstruksi Kronis (PPOK) di Rumah Sakit Wilayah Yogyakarta

Chronic Obstructive Pulmonary Disease (COPD) is a complex respiratory disorder that requires multiple approaches to assess treatment response, no specific therapy can stop the progression of disease cure. This study aimed to measure the response of COPD treatment in outpatients at Hospitals in Yogyakarta. The study was designed descriptive observational cross-sectional involved COPD outpatients in July 2018 - June 2019 (N = 156). Inclusion criteria the subjects: age&gt; 40 years, without other respiratory diseases (asthma, lung cancer), took theophylline for at least the last one month, complete the CAT questionnaire, and sign an informed consent. Data collected were characteristics of respondents, treatment profile (exacerbation, maintenance), and response therapy data. Evaluation of treatment response was measured using the COPD Assessment Test (CAT) questionnaire and classified the response into effective, quite effective, and not effective. These data were then presented in form of percentage distribution. The results showed that an exacerbation study with single bronchodilator 39.10%, and a combination of bronchodilator with other bronchodilators 60.90%, most LABA-ICS / LAMA rescue therapies (48.72%). Results of evaluation the use of LABA-ICS / LAMA / Methylxanthine (18.59%), LABA-ICS / LAMA / Methylxanthine/ Mucolytic (11.54%), LABA-ICS / LAMA / SABA / Methylxanthine / Mucolytic (9.62%) )) gave a fairly effective treatment response (CAT score ≥10-19) 50.64%, effective (CAT score &lt;10) 47.43%, ineffective (CAT score ≥20) 1.93%.

Concurrent Improvement Observed in Patient-Reported Burden and Sensor-Collected Medication Use Among Patients Enrolled in a COPD Digital Health Program.

Background: The COPD assessment test (CAT) is an 8-item questionnaire widely used in clinical practice to assess patient burden of disease. Digital health platforms that leverage electronic medication monitors (EMMs) are used to track the time and date of maintenance and short-acting beta-agonist (SABA) inhaler medication use and record patient-reported outcomes. The study examined changes in CAT and SABA inhaler use in COPD to determine whether passively collected SABA and CAT scores changed in a parallel manner.Methods: Patients with self-reported COPD enrolled in a digital health program, which provided EMMs to track SABA and maintenance inhaler use, and a companion smartphone application (“app”) to provide medication feedback and reminders. Patients completing the CAT questionnaire in the app at enrollment and at 6 months were included in the analysis. Changes in CAT burden category [by the minimally important difference (MID)] and changes in EMM-recorded mean SABA inhaler use per day were quantified at baseline and 6 months.Results: The analysis included 611 patients. At 6 months, mean CAT improved by −0.9 (95% CI: −1.4, −0.4; p < 0.001) points, and mean SABA use decreased by −0.6 (−0.8, −0.4; p < 0.001) puffs/day. Among patients with higher burden (CAT ≥ 21) at enrollment, CAT improved by −2.0 (−2.6, −1.4; p < 0.001) points, and SABA use decreased by −0.8 (−1.1, −0.6; p < 0.001) puffs/day.Conclusion: Significant and parallel improvement in CAT scores and SABA use at 6 months were noted among patients enrolled in a digital health program, with greater improvement for patients with higher disease burden.

STUDY ON RISK FACTORS, CLINICAL AND THERAPEUTIC PROFILE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS IN GOVERNMENT GENERAL HOSPITAL

Objective: This study mainly aims to assess and evaluate risk factors, clinical and therapeutical profile in chronic obstructive pulmonary disease (COPD) patients and promote rational drug therapy; to identify the prevalence of COPD symptoms and to assess the drugs prescribed in treating COPD patients; and to evaluate patterns of diagnosing COPD in patients and determine the severity of COPD in patients using COPD assessment test (CAT).&#x0D; Methods: A prospective observational study conducted in government general hospital among 220 patients for 6 months. Data were collected from patients by CAT questionnaire through interviewing each subject.&#x0D; Results: The majority of the patients (36%) were in the age group of 71–80 years. Males are more prone to the COPD (91%). Most common initiation interdependence of these habits are 31–40 years and 61.8% are suffering with comorbidities. A total of 145 (65%) have social habits. About 68% of the patients are suffering from occupational exposure, 78% of the patients are suffering from old pulmonary problems.&#x0D; Conclusion: Clinical pharmacist main provision is providing care to individual patients by patient counseling, regarding the rational usage of drug and also providing proper education regarding the usage of nebulizers and creating awareness to the patients.

Validity of the Brazilian version of the COPD assessment test in patients with chronic obstructive pulmonary disease.

COPD Assessment Test (CAT) is a questionnaire defined as one of the main options in the assessment of the impact of Chronic Obstructive Pulmonary Disease on patients' life, according to the Global Initiative on Obstructive Lung Diseases. However, the Consensus-based Standards for the Selection of Health Measurement Instruments-COSMIN 2018 has recently determined a correlation coefficient greater than 0.70 and an optimal sample size must have a hundred subjects, hence, validity of the Brazilian version of this instrument is still not yet proven. To verify the validity of the Brazilian version of the Questionnaire CAT in patients with Chronic Obstructive Pulmonary Disease, comparing it to the Saint George's Respiratory Questionnaire (SGRQ) and correlate it with other outcomes. Observational transversal study with 101 COPD diagnosed subjects who underwent anthropometric data collection, life habits, CAT and SGRQ questionnaires, modified Medical Research Council (mMRC) dyspnoea scale. Spirometry, six-minute walking test (6MWT) and body mass index, Dyspnoea and exercise capacity (BODE). Each evaluative measure was compared to the total CAT score. The validity was considered for a significant Pearson correlation coefficient (r) greater than 0.7. It was observed a strong correlation between the total CAT score and the total SGRQ score (r=0.703; P<0.001), as well as moderate correlation with mMRC (r=0.518; P<0.001). SGRQ Symptoms (r=0.627; P<0.001). SGRQ Activity (r=0.636; P<0.001) and SGRQ Impact (r=0.655; P<0.001). There were similar correlations between CAT and other variables (6MWT, mMRC and BODE) and SGRQ and the same variables. The CAT questionnaire is a valid, reliable and easy-to-use instrument for assessing symptoms and can record the impact of COPD on the patient's quality of life.

Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial.

BackgroundEarlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations.ObjectiveThis study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations.MethodsA total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline.ResultsThe mean age of the patients was 70.6 (SD 8.1) years, 52% (43/83) were female, and the mean FEV1 was 53.0% (SD 18.5%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2%. However, this was not statistically better than examining changes in symptoms alone.ConclusionsOvernight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations.Trial RegistrationClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702

The Correlation of Sit-to-Stand Tests with COPD Assessment Test and GOLD Staging Classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD classification tool has been used to assess the symptom burden and exacerbation risk of patients with chronic obstructive pulmonary disease (COPD). An area requiring further exploration is the relationship between the GOLD classification's basic components and the measurements acquired by Sit-to-Stand tests (STST). We aimed to study the relationship between STST and the component of the GOLD classification tool. This study was conducted on a sample of 42 COPD subjects with patient history, COPD assessment test (CAT) and spirometry. 5STST performance time and the number 30s-STST repetitions showed differences of statistical significance in COPD subjects considered to be more symptomatic and in subjects with high risk of future exacerbations. Both STSTs correlated significantly with forced expiratory volume in one second % predicted (FEV1%), CAT, number of acute exacerbations in the past year and number of hospitalized exacerbations in the past year. STST performance correlates significantly with items of the CAT questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy. Using multivariate analysis, age, FEV1% and CAT score manifested the strongest negative association with STST performance. 5STST performance time and the number 30s-STST repetitions in COPD patients correlates with the level of symptoms and the risk of future exacerbations that define groups A-D based on GOLD 2018 classification tool (at the time of data acquisition). The correlation of STST performance with CAT score involves specific items of the questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy.

Criteria for differential diagnostics of the bronchopulmonary pathology in employees exposed to occupational air pollutants

Introduction. In recent years the nature of the developing professional pathology of the respiratory system and the features of clinical manifestations have been proved to be determined not only by harmful factors of the working environment but also by individual characteristics of the body, such as age, state of the immune system, etc. In some cases, the differential diagnosis of various forms of bronchopulmonary pathology to date causes certain difficulties.Aim. To establish the criteria for differential diagnosis of the nosological form of the pathology of the bronchopulmonary system from the effects of occupational airborne pollutants using fluorine compounds as an example at different times of diagnosis.Material and methods. 130 patients with an established diagnosis of occupational pathology of the broncho-pulmonary system were examined. All patients were divided into 2 groups: 1 - patients with professional bronchopulmonary pathology, in whom the disease was associated with the occupation during initial hospitalization, during the continuation of work in aluminum production or no later than a year after termination of work); Group 2 - persons with occupational bronchopulmonary pathology, who were diagnosed with respiratory pathology during the period of work, and the connection of the disease with the occupation more than 1 year after termination of work. Patients underwent spirometry, body plethysmography, a 6-minute walk test, questionnaires using the COPD Assessment Test (CAT) questionnaire, and respiratory symptoms were assessed using a 4-point mMRS scale. Statistical analysis methods were performed using the STATISTICA software package - version 6 of Stat Soft Inc. (USA). Intergroup comparison of quantitative indices was carried out using the nonparametric Mann-Whitney test. Values are presented as mean and mean error. To establish the criteria for differential diagnosis, a discriminant analysis was performed.Results. The CAT score (strong COPD influence on the patient’s life) was statistically significantly worse (25.91 points) in group 2 (versus 21.85 points in group 1), as well as spirometry indices: FVC, 68.30% of due values against 79.90% and FEV1 - 62.15% against 70.88%. (p &amp;lt;0.05). As a result of discriminant analyzes, informative criteria for the differential diagnosis of occupational bronchopulmonary pathology were established: the severity of shortness of breath on the CAT questionnaire, the total score on the CAT questionnaire; the ratio of the forced vital capacity of the lungs to the forced expiratory volume in 1 minute (FVC /FEV1), the instantaneous volumetric rate after expiration is 25% FVC (MOS25), the instantaneous volumetric rate after expiration is 50% FVC (MOS50, forced expiratory volume per 1 minute (FEV1); total bronchial resistance according to body plethysmography (sRtotal), residual lung volume according to body plethysmography (RLV). The results indicate the progression of clinical manifestations of bronchopulmonary pathology even after stopping work in aluminum new production.Conclusion. The criteria for differential diagnosis of bronchopulmonary pathology from the effects of occupational airborne pollutants taking into account the individual characteristics of the body are established.

Respiratory rehabilitation techniques used for the treatment of COPD patients

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality throughout the world. At present, the pharmacological therapy is not enough for a patient with COPD in regard to heath status and exercise tolerance. It requires additional therapies aimed to improve the quality of life, delay the lung function decline, increase exercise capacity, and reduce the respiratory symptoms and the number of exacerbations. Pulmonary rehabilitation program (PRP) has been shown to improve respiratory muscle, to optimize functional, psychosocial, behavioral and nutritional status. The aim of the present study was to asses the impact of PRP on COPD patients, focusing on the clinical benefits of PRP, which may further provide to the patients a good support for change. Material and method. Sixty-seven patients with clinically stable COPD were enrolled in this prospective study, consisting in a 6-weeks of PRP. There were recorded demographic data, smoking and medical history, and abnormal findings at the physical examination. All patients completed CAT (COPD Assessment Test) questionnaire and dyspnea on Borg scale, they performed spirometry, and six minutes walking test (6MWT), before and after the completion of the rehabilitation program. Results and Discussions. After the 6-week period of PRP, a large proportion of patients presented higher values of spirometric parameters, although the change was no statistically significant. The impact of COPD on the patient’s health was significantly improved, 58.2% of patients registered &lt; 10 points of CAT questionnaire after PRP (p&lt;0.05). 75% of patients reported a 0-5 points of dyspnea on Borg scale comparing with 29% before the PRP (p=0.0147), and 56% a 0-5 points of fatigue while only 25% of patients had the same score before the rehabilitation programme (p=0,022). Only 8 patients (11.94% vs 31.34%, p&lt;0.05) reported a SaO2 lower than 90% after the PRP. The 6MWD was longer than 250m at the end of the 6-weeks of PRP for 38 patients (56.7% vs 22.38%, p&lt;0.05). Conclusions. The present study showed that a PRP added to pharmacological treatment had a beneficial role of increasing the patient’ health status and exercise tolerance for COPD patients.

Mouth Mask versus Pursed Lip Breathing for Dyspnea and pulmonary Function among Chronic Obstructive Pulmonary Disease Patients

Background: Chronic obstructive pulmonary disease (COPD) is considered a progressive respiratory disease that has a significant effect on the patient’s ability to work and the quality of life. Dyspnea is considered one of the most common health problems among chronic obstructive pulmonary disease patients. Aim: To compare the effect of mouth mask versus pursed lip breathing for dyspnea and pulmonary function among chronic obstructive pulmonary disease patients. Design: A quasi-experimental design was utilized to achieve this study. Sample: Included purposive sample of 50 adult patients were recruited and divided into two groups as a group (1) refers to mouth mask group (n=25) and group (2) which refers to pursed-lip breathing (n=25). Setting: The study was applied in the form of outpatient chest clinic Fayoum University Hospital. Tools of data collection included (1) Socio-demographic questionnaire, (2) Measurement of pulmonary function tests sheet, (3) Measurement of the sensation of breathlessness (dyspnea) by: Dyspnea index, (4) The 3-min step test, (5) Assessment of health status in chronic obstructive pulmonary disease patient questionnaire, and (6) Mouth mask. Results: It revealed that there was a significant improvement and increase in forced vital capacity FVC, forced expiratory volume in one second FEV 1, and FEV1 /FVC post-intervention compared with pre-intervention. There was a decrease in dyspnea index post- mouth mask intervention group more than pursed-lip breathing group; there is improvement in the CAT score questionnaire pre and post-intervention. There was a significant decrease in dyspnea index pre and post 3min step test post-intervention. Conclusion: The results concluded that a mouth mask was effective for COPD patients to improve dyspnea, while pursed-lip breathing has a minimal effect on improving dyspnea. There was an improvement in the COPD Assessment Test Questionnaire (CAT) score questionnaire and Dyspnea index in COPD patients. Recommendation: Applying mouth mask intervention is recommended to control dyspnea and improve ventilatory functions among COPD patients.