Chronic Respiratory Questionnaire Total Score Research Articles

Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease.

Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease (COPD), but gains are not maintained over time. Maintenance pulmonary rehabilitation has been defined as ongoing supervised exercise at a lower frequency than the initial pulmonary rehabilitation programme. It is not yet known whether a maintenance programme can preserve the benefits of pulmonary rehabilitation over time. Studies of maintenance programmes following pulmonary rehabilitation are heterogeneous, especially regarding supervision frequency. Furthermore, new maintenance models (remote and home-based) are emerging. To determine whether supervised pulmonary rehabilitation maintenance programmes improve health-related quality of life (HRQoL), exercise performance, and health care utilisation in COPD patients compared with usual care. Secondly, to examine in subgroup analyses the impact of supervision frequency and model (remote or in-person) during the supervised maintenance programme. We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PEDro, and two additional trial registries platforms up to 31 March 2020, without restriction by language or type of publication. We screened the reference lists of all primary studies for additional references. We also hand-searched conference abstracts and grey literature through the Cochrane Airways Trials Register and CENTRAL. We included only randomised trials comparing pulmonary rehabilitation maintenance for COPD with attention control or usual care. The primary outcomes were HRQoL, exercise capacity and hospitalisation; the secondary outcomes were exacerbation rate, mortality, direct costs of care, and adverse events. Two review authors independently screened titles and abstracts, extracted data, and assessed the risk of bias. Results data that were similar enough to be pooled were meta-analysed using a random-effects model, and those that could not be pooled were reported in narrative form. Subgroup analyses were undertaken for frequency of supervision (programmes offered monthly or less frequently, versus more frequently) and those using remote supervision (e.g. telerehabilitation versus face-to-face supervision). We used the GRADE approach to assess the certainty of evidence. We included 21 studies (39 reports) with 1799 COPD patients. Participants ranged in age from 52 years to 88 years. Disease severity ranged from 24% to 88% of the predicted forced expiratory volume in one second. Programme duration ranged from four weeks to 36 months. In-person supervision was provided in 12 studies, and remote supervision was provided in six studies (telephone or web platform). Four studies provided a combination of in-person and remote supervision. Most studies had a high risk of performance bias due to lack of blinding of participants, and high risk of detection, attrition, and reporting bias. Low- to moderate-certainty evidence showed that supervised maintenance programmes may improve health-related quality of life at six to 12 months following pulmonary rehabilitation compared to usual care (Chronic Respiratory Questionnaire total score mean difference (MD) 0.54 points, 95% confidence interval (CI) 0.04 to 1.03, 258 participants, four studies), with a mean difference that exceeded the minimal important difference of 0.5 points for this outcome. It is possible that supervised maintenance could improve six-minute walk distance, but this is uncertain (MD 26 metres (m), 95% CI -1.04 to 52.84, 639 participants, 10 studies). There was little to no difference between the maintenance programme and the usual care group in exacerbations or all-cause hospitalizations, or the chance of death (odds ratio (OR) for mortality 0.73, 95% CI 0.36 to 1.51, 755 participants, six studies). Insufficient data were available to understand the impact of the frequency of supervision, or of remote versus in-person supervision. No adverse events were reported. This review suggests that supervised maintenance programmes for COPD patients after pulmonary rehabilitation are not associated with increased adverse events, may improve health-related quality of life, and could possibly improve exercise capacity at six to 12 months. Effects on exacerbations, hospitalisation and mortality are similar to those of usual care. However, the strength of evidence was limited because most included studies had a high risk of bias and small sample size. The optimal supervision frequency and models for supervised maintenance programmes are still unclear.

Multi-omics links IL-6 trans-signalling with neutrophil extracellular trap formation and Haemophilus infection in COPD.

Interleukin (IL)-6 trans-signalling (IL-6TS) is emerging as a pathogenic mechanism in chronic respiratory diseases; however, the drivers of IL-6TS in the airways and the phenotypic characteristic of patients with increased IL-6TS pathway activation remain poorly understood. Our aim was to identify and characterise COPD patients with increased airway IL-6TS and to elucidate the biological drivers of IL-6TS pathway activation. We used an IL-6TS-specific sputum biomarker profile (soluble IL-6 receptor (sIL-6R), IL-6, IL-1β, IL-8, macrophage inflammatory protein-1β) to stratify sputum data from patients with COPD (n=74; Biomarkers to Target Antibiotic and Systemic Corticosteroid Therapy in COPD Exacerbation (BEAT-COPD)) by hierarchical clustering. The IL-6TS signature was related to clinical characteristics and sputum microbiome profiles. The induction of neutrophil extracellular trap formation (NETosis) and IL-6TS by Haemophilus influenzae were studied in human neutrophils. Hierarchical clustering revealed an IL-6TS-high subset (n=24) of COPD patients, who shared phenotypic traits with an IL-6TS-high subset previously identified in asthma. The subset was characterised by increased sputum cell counts (p=0.0001), persistent sputum neutrophilia (p=0.0004), reduced quality of life (Chronic Respiratory Questionnaire total score; p=0.008), and increased levels of pro-inflammatory mediators and matrix metalloproteinases in sputum. IL-6TS-high COPD patients showed an increase in Proteobacteria, with Haemophilus as the dominating genus. NETosis induced by H. influenzae was identified as a potential mechanism for increased sIL-6R levels. This was supported by a significant positive correlation between sIL-6R and NETosis markers in bronchoalveolar lavage fluid from COPD patients. IL-6TS pathway activation due to chronic colonisation with Haemophilus may be an important disease driver in a subset of COPD patients.

Early diagnosis and treatment of pulmonary embolism in Department of Traumatic Orthopedics

Objective To analyze the early diagnosis, treatment methods and effect of pulmonary embolism in Department of Traumatic Orthopedics. Methods From October 2014 to October 2016, 100 patients with pulmonary embolism in trauma department of orthopedics of Datong Coal Group Co three hospital were selected as the research subjects.Combined with the basic data of patients and clinical manifestations, the early diagnosis and clinical features were summarized.The chronic respiratory questionnaire(CRQ) and quality of life assessment table(QOL) were used to evaluate the respiratory status and living quality of the patients before and after treatment.At the same time, according to the different treatment methods, the effect of simple anticoagulant or combined with thrombolytic was compared. Results Before treatment, the CRQ total score, QOL total score were (5.9±1.3)points, (65.78±23.91)points, respectively, which after treatment were (3.1±0.7) points, (30.92±13.45) points, respectively, the differences were statistically significant(t=11.931, 20.104, all P 0.05). Conclusion In the perioperative period of Department of Traumatic Orthopedics, pulmonary embolism should be timely diagnosed, and reasonable treatment can improve the respiratory function and life quality of patients, anticoagulation combined with thrombolytic therapy can improve the efficacy. Key words: Wounds and injuries; Hospitals, osteopathic; Pulmonary embolism; Diagnosis; Anticoagulants; Thrombolytic therapy; Respiratory function tests; Quality of life

One-Legged Cycle Training for Chronic Obstructive Pulmonary Disease. A Pragmatic Study of Implementation to Pulmonary Rehabilitation.

In patients with chronic obstructive pulmonary disease (COPD), partitioned exercise training using one-legged cycling leads to greater improvements in peak oxygen uptake than conventional two-legged cycling. We evaluated the feasibility of incorporating one-legged cycling as the principal aerobic training modality for pulmonary rehabilitation in COPD. Physiotherapists underwent four teaching sessions about the principles and practical implementation of one-legged cycling training. Patients enrolled in a pulmonary rehabilitation program underwent 6-8 weeks of training in which one-legged cycling three times per week was the principal aerobic exercise activity. Participants cycled for 15 minutes with each leg, in each session. An incremental cardiopulmonary exercise test was completed before and after pulmonary rehabilitation along with standard pulmonary rehabilitation outcome measures. Participants and physiotherapists completed a satisfaction survey at the end of the program. A total of 22 out of 32 participants (14 male; mean [SD] age, 66 [7] years; FEV1% predicted, 32 [17]%; median [interquartile range] Medical Research Council dyspnea scale, 3.5 [3.0-4.3]) completed pulmonary rehabilitation. Peak oxygen uptake increased 1.1 (0.4-1.7) ml·min(-1)·kg(-1) (8%) from baseline (P<0.01). The mean (95% confidence interval) 6-minute-walk test distance improved by 72 (45-98) m (P=0.001). The change in the Chronic Respiratory Questionnaire total score of 1.6 (1.1-2.1; P<0.001) was achieved by improvement in all four domains above the clinically important difference. All the physiotherapists considered one-legged cycling safe and would continue to prescribe it; 75% of participants would recommend it to other patients. One-legged cycling was successfully implemented into a "real-life" pulmonary rehabilitation program, demonstrating improvements in cardiorespiratory fitness with associated improvement in function for patients with moderate/severe COPD. One-legged cycling should be recommended in professional pulmonary rehabilitation guidelines as an option for exercise training and be available in other pulmonary rehabilitation programs. Clinical trial registered with www.clinicaltrials.gov (NCT01930526).

The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial

ObjectiveTo assess the cost-effectiveness of a structured education pulmonary rehabilitation programme (SEPRP) for chronic obstructive pulmonary disease (COPD) relative to usual practice in primary care. The programme consisted of group-based...

Measuring unsupported arm lifts as an outcome in pulmonary rehabilitation of chronic obstructive pulmonary disease patients

Pulmonary rehabilitation includes upper and lower extremity exercise training. While validated tests such as the six-minute walk distance (6MWD) and shuttle walk tests are available to evaluate the effectiveness of lower extremity training, the optimal method of evaluating the effectiveness of upper extremity training has not been determined. This study evaluates the potential utility of unsupported arm lifts (UALs) testing as an outcome measurement for pulmonary rehabilitation. Records of chronic obstructive pulmonary disease (COPD) patients who underwent outpatient pulmonary rehabilitation at our institution were reviewed. Outcomes assessed before and immediately after the intervention included 6MWD, the self-administered Chronic Respiratory Questionnaire (CRQ-SA), and UALs. For the latter, the patient repeatedly raises a wooden dowel from thigh to arm level, with the number of repetitions per minute used as the outcome. Changes in variables from pre- to post-pulmonary rehabilitation were analyzed using paired t test. Pearson correlation coefficients were used to evaluate associations. Of the 241 patients, 51% were male. Mean age was 69 ± 9 years, body mass index was 28 ± 7 kg/m(2), and forced expiratory volume in 1 second was 50 ± 20 percent-predicted. All studied variables increased significantly post-pulmonary rehabilitation: the 6MWD by 45 ± 50 m (effect size 0.49), the CRQ-SA total score by 0.84 ± 0.86 units (effect size 0.89), and UAL by 12 ± 13 lifts/minute (effect size 0.75; p < 0.0001 for all). As a measure of upper extremity exercise capacity, UAL appears to be responsive to the comprehensive pulmonary rehabilitation intervention. Using effect sizes, the degree of improvement appears to be between that of 6MWD and CRQ-SA. UAL may be a useful outcome assessment for pulmonary rehabilitation in COPD patients.

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial

Objective To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients’ management...

Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD

Background:Long-term non-invasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure. A study was undertaken to...

The Safety and Efficacy of Infliximab in Moderate to Severe Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive, smoking-related, inflammatory lung disease in which tumor necrosis factor-alpha is overexpressed and has been suggested to play a pathogenic role. To determine if infliximab, an anti-TNF-alpha antibody, results in clinical benefit and has an acceptable safety profile in patients with moderate to severe COPD. In a multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-finding study, subjects with moderate to severe COPD received infliximab (3 mg/kg [n = 78] or 5 mg/kg [n = 79]) or placebo (n = 77) at Weeks 0, 2, 6, 12, 18, and 24. Efficacy, health status, and safety were assessed through Week 44. Infliximab was generally well tolerated, but showed no treatment benefit as measured by the primary endpoint, Chronic Respiratory Questionnaire total score. Similarly, there was no change in secondary measures, including prebronchodilator FEV(1), 6-min walk distance, SF-36 physical score, transition dyspnea index, or moderate-to-severe COPD exacerbations. Post hoc analysis revealed that subjects who were younger or cachectic showed improvement in the 6-min walk distance. Malignancies were diagnosed during the study in 9 of 157 infliximab-treated subjects versus 1 of 77 placebo-treated subjects. No opportunistic infections were observed, and there were no differences in the occurrence of antibiotic-requiring infections, although the incidence of pneumonia was higher in infliximab-treated subjects. No infection-related mortality was observed. Higher proportions of infliximab-treated subjects discontinued the study agent due to adverse events (20-27%) than did placebo-treated subjects (9%). Subjects with moderate to severe COPD did not benefit from treatment with infliximab. Although not statistically significant, more cases of cancer and pneumonia were observed in the infliximab-treated subjects. The impact of infliximab on malignancy risk in patients with COPD needs to be further elucidated.

Dyspnea as clinical indicator in patients with chronic obstructive pulmonary disease

The aim of this study was to evaluate the relationship between dyspnea and functional, psychosocial and quality of life parameters among persons with chronic obstructive pulmonary disease (COPD). We conducted a cross-sectional study of 90 stable COPD patients recruited from a specialized respiratory clinic. Dyspnea was measured using the ATS-DLD-78 questionnaire modified dyspnea scale (1-5 scale). Physical and functional evaluation included spirometry and six minute walking tests. Subjects then completed five psychological questionnaires: the Coping Inventory for Stressful Situations, the State/Trait Anxiety Inventory, the Beck Depression Index, the NEO-Five Factor Personality Inventory, and the Interpersonal Relationships Inventory. Patients also completed two disease-specific health-related quality of life (HRQL) questionnaires: St. George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ). Subjects were predominantly male (n = 65) with a mean age of 68 years (+/- standard deviation 7.6). Over half (54%) the patients reported severe dyspnea (grade 5), and a quarter (24%) reported moderate dyspnea (grade 3-4). Mean FEV1 was 37.8 +/- 14.8% predicted. The mean total SGRQ score was 49 +/- 16 and the CRQ total score was 4.2 +/- 0.9. Dyspnea severity was associated with poorer HRQL scores and decreased physical performance. Based on linear regression, dyspnea scores--but not spirometric values--also correlated with indices of anxiety, depression, and neuroticism. Dyspnea correlated more strongly with HRQL and with indices of anxiety and depression than spirometric values. Although spirometry is often used to evaluate disease severity, dyspnea which is a patient centered outcome better reflect overall disease impact among COPD patients.

Occupational status and bronchoprovocative factors in relation to health-related quality of life in patients with COPD. A cross-sectional study in general practice

Objective:To investigate (1) associations between occupational status, work-related airway symptoms and quality-of-life and (2) the relationship between quality-of-life and bronchial symptoms due to common provocative exposure (e.g., domestic dust exposure, smog) in patients with chronic obstructive pulmonary disease (COPD) in general practice.Design:Secondary analyses on baseline data from the COOPT study, a randomised controlled trial investigating the effectiveness of fluticasone and N-acetylcysteine in COPD. Patients were subdivided into four groups according to their occupational status: ‘paid employment’; ‘no paid employment’; ‘incapacitated for work’; and ‘retired’. Quality-of-life was assessed by Chronic Respiratory Questionnaire (CRQ). This questionnaire measures four domains of health status, i.e. ‘activity’, ‘emotions’, ‘fatigue’, and ‘mastery’. Susceptibility to exposure to common bronchoprovocative factors was assessed with an ad hoc questionnaire. Between-group differences in CRQ scores and associations between CRQ scores and work-related airway symptoms were analysed using univariate and multivariate techniques. Results: 320 COPD patients were included (mean age 59.4 [SD 9.6] years, FEV1 %predicted 60.5 [SD 18.8]). Univariate analysis revealed differences in FEV1 %predicted between occupational status subgroups (p<0.001): paid work 65.3% (SD 16.7), no paid work 58.5% (18.7), incapacitated for work 64.1% (SD 20.5) and retired 54.8% (SD 18.1). Multivariate analysis showed that patients incapacitated for work had statistically significant lower CRQ total, activity, fatigue and mastery domain scores compared with patients in paid employment. In those employed (n=93), severity of work-related airway symptoms correlated with the CRQ total score (r=−0.48, p<0.001). Univariately, patients susceptible to many common bronchoprovocative factors had a lower total CRQ score (r=−0.42, p<0.001).Conclusion:In patients with COPD, quality-of-life may depend on susceptibility to common bronchoprovocative factors. COPD patients who are incapacitated for work show equal severity of airflow limitation, but worse quality-of-life compared with patients in paid employment.