Chronic Respiratory Questionnaire Research Articles

Illness perceptions, cognitive and behavioural responses to chronic breathlessness in individuals living with advanced respiratory disease: an observational study.

Understanding the complexity and multidimensional nature of chronic breathlessness is key to its successful management. The aim of this study was to explore illness perceptions, cognitive and behavioural responses to chronic breathlessness in individuals living with advanced respiratory disease. This was a cross-sectional secondary analysis of data from a feasibility randomised control trial (SELF-BREATHE) for individuals living with chronic breathlessness due to advanced disease. All participants completed the following questionnaires: numerical rating scale (NRS) breathlessness severity, NRS distress due to breathlessness, NRS self-efficacy for managing breathlessness, Dyspnea-12 (D-12), Chronic Respiratory Disease Questionnaire (CRQ), Brief Illness Perception Questionnaire (Brief IPQ) and the Cognitive and Behavioural Responses Questionnaire, short version (CBRQ-S). The associations between the Brief IPQ and CBRQ-S with NRS breathlessness severity, distress and self-efficacy, D-12 and CRQ were examined using Spearman's rho correlation coefficient rs. A Spearman's rs of ≥0.50 was predefined as the threshold to denote important associations between variables. A p-value of <0.008 was considered statistically significant, to account for the number of comparisons performed. The illness perception items consequences, identity, concern and emotional response were associated with increased breathlessness severity, increased distress, reduced breathlessness self-management ability and lower health-related quality of life. Symptom focusing and embarrassment avoidance were identified as important cognitive responses to chronic breathlessness. Interventions that directly target illness perceptions, cognitive and behavioural responses to chronic breathlessness may improve symptom burden, self-efficacy and health-related quality of life.

Association of patient-reported outcome measures with lung function and mortality in fibrotic interstitial lung disease: a prospective cohort study.

Patient-reported outcome measures (PROMs) may provide clinicians and researchers with direct insights into disease impact and patient well-being. We assessed whether selected PROMs and their domains are associated with baseline and longitudinal changes in lung function and can predict mortality in patients with fibrotic interstitial lung disease (f-ILD). A single-centre prospective study of adult patients with f-ILD enrolled over 3 years was conducted assessing baseline and short-term changes in PROMs. Three questionnaires, the modified Medical Research Council dyspnoea scale (mMRC), Chronic Respiratory Questionnaire (CRQ) and Self-Management Ability Scale (SMAS-30) were administered at planned intervals and assessed for their association with baseline clinical findings, change in lung function (% predicted forced vital capacity (FVC%) and diffusion capacity of the lung for carbon monoxide (DLCO%)) and all-cause mortality. 199 patients were enrolled with a mean PROM follow-up of 9.6 months. When stratified by FVC% quartiles at presentation, lower mMRC (less dyspnoea), higher CRQ Physical and Emotional domain (better health-related quality of life) and higher total SMAS-30 scores (better self-management ability) were associated with higher FVC%. Short-term changes in all three PROMs appeared to be associated with changes in FVC% and DLCO%. Adjusted and unadjusted baseline and serial PROM changes were also predictive of mortality. Baseline and serial assessments of PROMs were associated with changes in lung function and predicted death in patients with f-ILD. PROMs may strengthen comprehensive assessments of disease impact in clinical practice as well as support patient-centred outcomes in research.

Inflammatory Markers and Fatigue in Individuals With Moderate to Severe Chronic Obstructive Pulmonary Disease.

Fatigue, a prevalent complex symptom among patients with chronic obstructive pulmonary disease (COPD), is considered an important clinical indicator of disease severity. However, the underlying mechanisms of COPD-related fatigue are not fully understood. This analysis explored the relationships between peripheral inflammatory markers and COPD-related fatigue in people with moderate to severe COPD. This is a secondary analysis of a longitudinal observational study of individuals with COPD examining the biological causes and functional consequences of depression. The data used in this study were collected at baseline. Systemic inflammation markers included C-reactive protein (CRP) and three pro-inflammatory cytokines consisting of interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α. COPD-related fatigue was self-reported using the Chronic Respiratory Questionnaire. Covariates included age; gender; smoking status; disease severity; symptoms of depression, anxiety, and pain; and social support. Multivariable linear regression analyses were conducted. The sample included 300 adults living with COPD; 80% were male, and the average age was 67.6 years. Modest correlations were found between two systemic inflammatory markers (CRP and IL-8) and COPD-related fatigue. CRP was the only inflammatory marker significantly associated with fatigue symptoms after adjusting for covariates in multivariable analyses. Depression, pain, and education level were also significant predictors of COPD-related fatigue. The findings suggest that altered immune response based on CRP may contribute to COPD-related fatigue. Management of depression and pain may work as an effective treatment strategy for COPD-related fatigue. Further longitudinal studies with a broader range of inflammatory markers and multidimensional measures of fatigue symptoms are warranted.

Meaning in Life: A Novel Factor for Promoting Wellbeing in COPD.

Research evidence indicates that meaning in life (MIL) is a meaningful outcome in individuals living with chronic illness, but evidence is lacking for chronic obstructive pulmonary disease (COPD). We hypothesized that MIL is independently associated with clinically meaningful outcomes for patients with COPD. We performed cross sectional analysis from a large cohort with moderate - severe COPD that participated in a home pulmonary rehabilitation study. MIL was measured using the Meaning in Life Questionnaire (MLQ), with domains of Presence and Search. The study included 340 participants: mean age 69 y/o (SD 9.4), 55.3% female, FEV1% 44.3% (SD 19.4) and mMRC dyspnea scale of 2.69 (SD 0.84). Patients with high MLQ Presence (vs low score) had meaningfully better scores (beyond the MCID) across all Chronic Respiratory Questionnaire domains Dyspnea, Fatigue, Emotions and Mastery (p ≤ 0.02), self-management (p ≤ 0.001), social support (p ≤ 0.001); anxiety (p ≤ 0.001) and depression (p ≤ 0.01) scores. When adjusting for age, sex, FEV1, mMRC, social support, and anxiety, MLQ Presence was independently associated with CRQ domains Fatigue, Emotions, and self-management (p ≤ 0.01). MLQ Search was independently associated with CRQ Dyspnea, Fatigue, and Mastery (p < 0.05). In patients with COPD, the perception that life has meaning or the willingness to search for MIL, is associated with the outcomes that patients consider most important. Our results are novel as MIL is a potentially modifiable outcome that could complement person-centered conversations during clinical visits, pulmonary rehabilitation, and health coaching.

Development of Urdu version of Chronic Respiratory Disease Questionnaire Self-Administered Standardized (CRQ-SAS); validity and reliability analysis in COPD patients.

Chronic Respiratory Disease Questionnaire Self-Administered Standardized (CRQ-SAS) is a valid and reliable tool that evaluates the health-related quality of life among the adult population affected with chronic respiratory disorders (CRDs) and has been translated into many languages as per need. The main objective of this study was to translate the CRQ-SAS into the Urdu language and evaluate its psychometric properties. It was a two-staged study that consisted of translating the original version into Urdu language and then psychometric testing of the translated version. The reliability of the translated questionnaire was assessed by measuring its internal consistency, test-retest reliability, standard error of mean (SEM) & minimal detectable change (MDC). Validity was determined by evaluating its content for content validity, construct (convergent and discriminative) validity, and exploratory factor analysis. Data was analyzed using SPSS v 28 with an alpha level < 0.05 considered to be significant. CRQ-SAS U had an excellent internal consistency (Cronbach's Alpha α = 0.89), test-retest reliability (ICC2,1) = 0.91 of all items, and low SEM = 0.11 and MDC = 0.65. S-CVI was 0.9, with statistically significant difference across the response of COPD patients and healthy subjects, and a high degree of correlation with St Georges Respiratory Questionnaire (r = 0.7-0.9) proving CRQ-SAS U content, discriminant and convergent valid respectively. Exploratory factor analysis identified two factors responsible for 80% of the variance. CRQ-SAS U demonstrated optimal psychometric properties which renders it to be used in Urdu speaking populations with COPD.

Five-Repetition Sit-to-Stand Test: Responsiveness and Minimal Important Difference in Idiopathic Pulmonary Fibrosis.

Rationale: Standing from a sitting position is an important activity of daily living. The five-repetition sit-to-stand test (5STS) is a simple physical performance test that measures the fastest time taken to stand five times from a chair with arms folded. It can be measured in most healthcare settings and at home, where traditional field walking tests may not be possible. The 5STS has been validated in community-dwelling older adults and people with chronic obstructive pulmonary disease, but data in idiopathic pulmonary fibrosis (IPF) are limited.Objectives: The aims of this cohort study were to establish the construct validity, responsiveness to pulmonary rehabilitation (PR), and minimal important difference (MID) of the 5STS in IPF.Methods: In 149 people with IPF, we compared the 5STS with measures of lung function, exercise capacity, quadriceps strength, breathlessness, and health-related quality of life. Responsiveness and effect sizes were determined by measuring the 5STS before and after PR. The MID was estimated using anchor- and distribution-based methods.Results: The 5STS correlated significantly with incremental shuttle walk test (ISW) (r = -0.55), isometric quadriceps maximum voluntary contraction (QMVC) (r = -0.45), Medical Research Council dyspnea scale score (r = 0.40), Chronic Respiratory Questionnaire-Total (r = -0.21), and King's Brief Interstitial Lung Disease Questionnaire-Total (r = -0.21) but not forced vital capacity percentage predicted or quadriceps one-repetition maximum (1RM). There was a significant but very weak correlation between change in 5STS and changes in Medical Research Council (r = 0.18), ISW (r = -0.21), and Chronic Respiratory Questionnaire-Total (r = -0.26) but no significant correlation with change in 1RM (r = -0.12) or QMVC (r = -0.18). 5STS time improved with PR (median [25th percentile, 75th percentile] change, -1.97 [-3.47, -0.62] s; P < 0.001). The effect size for the 5STS was 0.66 and higher than quadriceps 1RM, QMVC, and ISW. The mean (range) MID estimate was -1.93 (-1.85 to -2.10) seconds.Conclusions: In people with IPF, the 5STS is a valid physical performance measure that is responsive to exercise-based interventions and suitable for use in most healthcare settings.

Home-Based Physical Activity Program With Health Coaching for Participants With Chronic Obstructive Pulmonary Disease in Sweden: A Proof-of-Concept Pilot Study

Home-based interventions are at the center stage of current health care demands. There is a clear need to translate pulmonary rehabilitation into a home-based setting. This 8-week pilot study aimed to determine the feasibility of a home-based physical activity program for participants with chronic obstructive pulmonary disease (COPD) in Sweden. Patients with COPD, aged 40 years or older and clinically stable in the past 3 months, were recruited. The program used a fitness tracker to monitor step count, weekly health coaching calls using motivational interviewing, and video-guided mindful movements. The outcome measures were adherence to the 8-week program’s video-guided exercises (number of times videos were watched), adherence to health coaching calls (minimum 8), monthly and daily step count, and quality of life (QoL) using the chronic respiratory questionnaire. Thirteen participants were enrolled, and 12 participants adhered to health coaching calls and step monitoring. We had 643 video-exercise views, which exceeded the minimum standard (576 views). The mean difference comparing total monthly steps from baseline and the 8-week time point was 47,039 steps (95% CI, –113,625 to 1623.5; P=.06). The minimal clinical improvement of 500 daily steps was found for 8 of the patients. No significant improvement was found in the QoL measures and mental health. We found the home-based physical activity program to be a feasible intervention. Patients reported high adherence to tracking step counts, health coaching calls, and video-guided exercise. No improvements in QoL or monthly step count emerged; however, we found high adherence and a positive trend in the number of monthly step counts, and improvements of at least 500 daily step counts improved in most patients with this small sample size.

Less social deprivation is associated with better health-related quality of life (HRQoL) in asthma and is mediated by less anxiety and better sleep quality.

Previous studies on health-related quality of life (HRQoL) in asthma have mainly focused on clinical and environmental determinants. Little is known about the role of social determinants on HRQoL in asthma. We aimed to investigate the association between social deprivation and HRQoL in asthma. 691 adult asthmatics from Canada, India, New Zealand, and the United Kingdom were administered a digital questionnaire containing demographic information, and questions about social and psychological attributes, sleep disturbances, and alcohol abuse. HRQoL was measured using the short-form chronic respiratory disease questionnaire (SF-CRQ). We analyzed the direct and indirect relationships between social deprivation and HRQoL using structural equation models with social deprivation as a latent variable. We tested for mediation via anxiety, depression, sleep disturbances, and alcohol abuse. We found that less social deprivation (latent variable) was directly associated with better SF-CRQ domain scores such as dyspnea (β: 0.33; 95%CI: 0.07 to 0.58), fatigue (β: 0.39; 95%CI: 0.14 to 0.64), and emotional function (β: 0.37; 95%CI: 0.11 to 0.62), but with worse mastery score (β: -0.29; 95%CI: -0.55 to -0.03); however, those associations varied across participating countries. We also observed that among all individual social deprivation indicators, education, companionship, emotional support, instrumental support, and social isolation were directly associated with HRQoL and the relationship between social deprivation and HRQoL was mediated through anxiety and sleep disturbances. Our results demonstrated that less social deprivation was directly, and indirectly through less anxiety and better sleep quality, associated with better HRQoL in asthma.

Effect of internet-based pulmonary rehabilitation on physical capacity and health-related life quality in patients with chronic obstructive pulmonary disease-a systematic review and meta-analysis

Purpose Pulmonary rehabilitation (PR) is now recognized as the most effective treatments for individuals with chronic obstructive pulmonary disease (COPD), internet-based PR arises a promising method. The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based PR programs on physical capacity and health-related quality of life in patients with COPD. Materials and methods Randomized controlled trials were identified through systematically searches in PubMed, EMBASE, web of science, CENTRAL, Cochrane Library, and Google Scholar databases. Results Twelve studies (1433 patients) were included. For physical capacity, there was no significant difference between groups was found according to the 6-min walk test (6MWT) (MD10.42, 95% CI −2.92 to 23.77, p = 0.13, I2 = 0%). For the health-related quality of life, no significant difference between groups was found regarding the St George’s Respiratory Questionnaire (SGRQ) (MD −0.64, 95% CI −3.52 to 2.23, p = 0.66), COPD assessment test (CAT)(MD −0.34, 95% CI −1.62 to 0.94, p = 0.60), modified Medical Research Council scale (mMRC)(MD 0.17, 95% CI −0.06 to 0.39, p = 0.15) and Chronic Respiratory Questionnaire (CRQ)(MD 1.32 95% CI −5.88 to 8.53, p = 0.72). Conclusions: This study has established the potential for delivery of PR via the internet in demonstrating non-inferiority of physical capacity and health-related quality of life (HRQoL) compared with conventional PR. IMPLICATIONS FOR REHABILITATION Long-term rehabilitation training for patients with chronic obstructive pulmonary disease needs a more convenient and feasible way. In this study, internet-based rehabilitation showed similar effects as conventional rehabilitation on physical activity and health-related quality of life. Internet-based rehabilitation strategies would be helpful for this population. All internet-based rehabilitation strategies should be simple and sustainable.

Validity and reliability of the University of California and Los Angeles Loneliness Scale in individuals with chronic obstructive pulmonary disease

BACKGROUND The psychometric properties of loneliness measures have not been reported in individuals with chronic obstructive pulmonary disease (COPD). This study aimed to assess the validity and reliability of the University of California and Los Angeles Loneliness Scale (UCLA-LS) version 3 for use in this population. METHODS The UCLA-LS was administered at baseline and again after 1 to 2 weeks for test-retest reliability assessment. Intraclass Correlation Coefficient (ICC) was used to assess reliability and estimate minimal detectable change (MDC). Construct validity was established by assessing known groups, and convergent and divergent validity. RESULTS Of the 47 individuals included in this study, 40 persons (87%) reported moderate to high loneliness levels. The UCLA-LS discriminated (p < 0.03) between groups based on marital status, with higher loneliness levels for single (mean difference [MD] = 8 points) and widowed (MD = 7 points) compared to married individuals. The scale had moderate to strong associations with measures of depression (ρ = 0.69-0.72; p < 0.001), anxiety (ρ = 0.46-0.52; p < 0.03), and quality of life (Chronic respiratory questionnaire [CRQ]-Fatigue: ρ = −0.51-−0.53; CRQ-Emotional function: ρ = −0.59-−0.57; CRQ-Mastery: ρ = −0.43-−0.46; p < 0.003). The UCLA-LS showed excellent test-retest reliability with ICC values of 0.96. To detect a change in version 3 UCLA-LS, the MDC score should equal or exceed 7.8 points. CONCLUSION UCLA-LS demonstrated excellent known groups, convergent and divergent validity, and test-retest reliability. These findings may help improve the interpretability of loneliness levels in individuals with COPD.

Evaluation of Exacerbation and Symptom-Free Time in Patients with COPD

In clinical practice, clinicians mainly focus on Chronic Obstructive Pulmonary Disease (COPD) exacerbations and symptoms, while patients may prefer to evaluate periods free of COPD exacerbations and deteriorated symptoms. The latter would suit the positive health approach that centralizes people and their beliefs. We aimed to identify patient characteristics and health outcomes relating to: 1) COPD exacerbation-free days; 2) days with no more symptoms than usual; and 3) combined COPD exacerbation and comorbid flare-up-free days (i.e. chronic heart failure, anxiety, depression flare-ups) using negative binomial regression analyzes. Data were obtained from two self-management intervention trials including COPD patients with and without comorbidities. 313 patients (mean age 66.0 years, 63.6% male, 68.7% comorbidity) were included. Better baseline chronic respiratory questionnaire (CRQ) fatigue (incidence rate ratio (IRR) = 1.03 (95% CI 1.01–1.05), p = 0.02) and mastery scores (IRR = 1.03 (95% CI 1.00–1.06), p = 0.04) and fewer courses of antibiotics (IRR = 0.95 (95% CI 0.94–0.96), p < 0.01) were related to more COPD exacerbation-free days. Additionally, better baseline CRQ fatigue (IRR = 1.05 (95% CI 1.00–1.10), p = 0.04) and mastery scores (IRR = 1.06 (95% CI 1.00–1.12), p = 0.04), fewer courses of antibiotics (IRR = 0.94 (95% CI 0.91–0.96), p < 0.01), and improved CRQ dyspnea scores over 12 months of follow-up (IRR = 1.07 (95% CI 1.01–1.12), p < 0.01) were correlated to more days free of deteriorated symptoms. Less baseline dyspnea (modified Medical Research Council score) (IRR = 0.95 (95% CI 0.92–0.98), p < 0.01) and fewer courses of antibiotics (IRR = 0.94 (95% CI 0.93–0.95), p < 0.01) were associated with more combined COPD exacerbation and comorbid flare-up-free days. Healthcare professionals should be aware that less fatigue and better mastering of COPD relate to more exacerbation and symptom-free time in COPD patients.

“When I am breathless now, I don’t have the fear that’s linked to it”: a case series on the potential of EMDR to break the dyspnea-anxiety cycle in COPD

BackgroundExpectations can enhance the intensity and the neural processing of breathlessness. Previous breathlessness episodes may influence the perception of subsequent episodes because of psycho-traumatic consequences. In post-traumatic stress disorder, eye movement desensitization and reprocessing (EMDR) is the therapy of choice.Aims and objectivesWe explored the hypothesis that EMDR in patients with chronic obstructive pulmonary disease (COPD) and previous severe breathlessness episodes, improves breathlessness mastery by decreasing the anxiety component.MethodsAs we found no literature on previous research on this subject, we undertook a qualitative case series on four patients with COPD GOLD 4/D and refractory breathlessness who wished to undergo EMDR for psychotraumatic breathlessness episodes. Amongst others, we used the Chronic Respiratory Disease Questionnaire (CRQ) before and after EMDR, and semi-structured, face-to-face, in-depth interviews.ResultsAll patients had between three and five EMDR sessions. On CRQ, subset mastery, three patients had a large improvement and one patient a moderate improvement. On subset emotional functioning, three patients showed a large improvement and one showed no change. All patients made a distinction between ‘regular’ breathlessness and breathlessness intertwined with anxiety. They all stated that the anxiety component of their breathlessness diminished or disappeared. All four would recommend EMDR for other COPD patients.ConclusionThere is ground for a randomized controlled clinical trial to test the effects of EMDR on breathlessness mastery in a subset of COPD patients with previous severe breathlessness episodes and high levels of anxiety.

Reliability and Validity of Clinical COPD Questionnaire and Chronic Respiratory Questionnaire in Patients with COPD using Tiotropium Over a Period of 26 Weeks

Reliability and Validity of Clinical COPD Questionnaire and Chronic Respiratory Questionnaire in Patients with COPD using Tiotropium Over a Period of 26 Weeks

Dancing for Health and Wellbeing: A Feasibility Study of Examining Health Impacts of Online Dancing among Pulmonary Fibrosis Patients.

Background: Physical activity (PA) is recommended in the management of patients with pulmonary fibrosis (PF) to improve health outcomes. Dance is one such form of PA which is meaningful, valuable, enjoyable and has demonstrated positive physical and mental health effects. Methods: With pre-post design, 16 patients, members of the Irish Lung Fibrosis Association, were enrolled in this study. Once weekly, 75-min dance sessions were delivered for eight weeks via Zoom by an experienced choreographer. Participants completed Chronic Respiratory Questionnaire Self-Administered Standardised Format (CRQ-SAS) and European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) to assess self-rated quality of life. A paired-sample t-test was employed to assess the mean differences between the pre-and post-intervention scores. Results: Most patients (78.57%) were aged over 60 years; with 71.43% diagnosed with pulmonary fibrosis more than 3 years ago. We performed an analysis of 10/16 participants who completed the intervention (5 males, 5 females). On CRQ-SAS scale we found, (a) dyspnoea—small to moderate magnitude improvement of 0.5–1.0 among 50%, (b) fatigue—small to moderate magnitude improvement of 0.5–1.0 among 40%, (c) emotional function—small to high magnitude improvement of 0.5–2.0 among 50%, (d) mastery—small magnitude improvement of 0.5 among 20%. Participants reported their health moderate to best on Visual Analogue Scale of EQ-5D-3L which improved by 1–3 scale among 40%. Mental health improved as percentage of not feeling anxious or depressed rose post event from 42.86% to 72.73%. Conclusion: Our findings demonstrate that a virtual dance intervention is acceptable, enjoyable and feasible for improving health outcomes among PF patients. More organised and continuous events in future may reveal cost-benefit ratio and impact on health outcomes.

Cost-Effectiveness of a Specialized Breathlessness Service Versus Usual Care for Patients With Advanced Diseases

ObjectivesThe Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal perspective. MethodsData included generic (5-level version of EQ-5D) health-related quality of life and disease-specific CRQ Mastery. Quality-adjusted life years (QALYs) were calculated based on 5-level version of EQ-5D utilities valued with German time trade-off. Direct medical costs and productivity loss were calculated based on standardized unit costs. Incremental cost-effectiveness ratios (ICER) and cost-effectiveness–acceptance curves were calculated using adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) and performing 1000 simultaneous bootstrap replications. Potential gender differences were investigated in stratified analyses. ResultsBetween March 2014 and April 2019, 183 eligible patients were enrolled. MBS intervention demonstrated significantly better effects regarding generic (AMD of QALY gains of 0.004, 95% confidence interval [CI] 0.0003 to 0.008) and disease-specific health-related quality of life at nonsignificantly higher costs (AMD of €605 [95% CI −1109 to 2550]). At the end of the intervention, the ICER was €152 433/QALY (95% CI −453 545 to 1 625 903) and €1548/CRQ Mastery point (95% CI −3093 to 10 168). Intervention costs were on average €357 (SD = 132). Gender-specific analyses displayed dominance for MBS in males and higher effects coupled with significantly higher costs in females. ConclusionsOur results show a high ICER for MBS. Considering dominance for MBS in males, implementing MBS on approval within the German health care system should be considered.

P02-11 Effectiveness and implementation of a long-term home-based exercise training programme using minimal equipment in COPD patients: A multi-centre randomised controlled trial

BackgroundAlthough exercise training is an important component of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD), a majority of COPD patients fails to maintain training after PR. This study aimed to evaluate the effectiveness and implementation of a 12-months home-based, minimal equipment strength exercise programme.MethodsParallel arm, multicentre study across four Swiss PR clinics, random allocation of COPD patients (1:1 ratio) into intervention (IG) or control group (CG, usual care). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire, CRQ) from baseline to 12-months, secondary outcomes change in exercise capacity (1-minute-sit-to-stand-test [1-min-STST], 6-minute-walk-test [6MWT]), health-related quality of life, exacerbations and symptoms. Main effectiveness analyses were based on the intention-to-treat approach and adjusted linear regression models were used. To assess the implementation outcomes dose, reach, fidelity, adherence, acceptability and appropriateness, we conducted interviews with patients, coaches and stakeholder and analysed reports, diaries and notes.Results123 patients (IG: 61, CG: 62) were randomised, 61 females, mean (SD) age 66.8 (8.1) years, and 104 participants completed 12-months follow-up (IG: 53, CG: 51). Of 53 IG participants, 37 (70%) conducted the training until study end. We found no difference in change of CRQ dyspnoea over 12 months (adjusted mean difference 0.28, 95% CI -0.23-0.80, p = 0.27). We found moderate evidence for a difference in 1-min-STST repetitions favouring the IG (adjusted mean difference 2.6 (95% CI 0.22-5.03, p = 0.033) but no evidence for an effect in other outcomes.All involved groups perceived the strength-training exercises as appropriate, efficient for COPD patients and relevant to maintain improvements after PR. The patients' most important facilitators for long-term motivation were self-perceived improvement in strength, supervision by a coach and integration of the training in daily routine. Based on these insights, we redesigned and reworded the training material and introduced three new exercises.ConclusionsThe exercise program had no effect on dyspnoea but improved 1-min-STST performance and patient-perceived fitness. The results from the insights of the involved persons enabled us to optimize the program for sustainable further use in clinical and other settings and inform the future design of patient-centred home-based exercise programs in COPD.

O1-8 Evaluation of the implementation of the ‘Living well with COPD' self-management program in Switzerland

BackgroundSelf-management can improve health status and reduce hospitals admissions in patients with chronic obstructive pulmonary disease (COPD). The aim of this mixed-methods study was to evaluate the implementation of the ‘Living well with COPD’ self-management program, a nation-wide effort by the Swiss Lung Associations and the Swiss society of pulmonary medicine.MethodsFor the implementation evaluation we used qualitative (interviews, focus groups) and quantitative (questionnaires, documentation analysis) methods to assess indicators of the outcomes reach, dose, fidelity, acceptability and appropriateness of the program. To evaluate the effectiveness, we assessed exercise capacity (1-minute sit-to-stand test), disease specific quality of life (Chronic Respiratory Questionnaire CRQ), symptoms, health care utilisation and health behaviour including physical activity at baseline and at the end of the program (after 12 months).ResultsSeven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times during 1 year and included in total 122 COPD patients (mean age 69 years, 48% female). The patients' attendance rate and the coaches' fidelity to the protocol were high (81% and 94%, respectively). Overall, acceptance and satisfaction of all involved persons (patients, coaches, responsible persons from the Lung Associations) was very high; they particularly acknowledged the meaningfulness of the program. Challenges were sustainable funding, integration of the coaches' additional workload and uncertainties regarding roles and responsibilities. After 14 month, the patients did not just avoid a decline in exercise capacity and health status but significantly improved in the 1-minute sit-to-stand test (23.9 vs. 27.1 repetitions) and in 3 of 4 CRQ subscales (with 0.2-0.5 units).ConclusionsThe ‘Living well with COPD' program was successfully implemented despite a tight schedule and showed a remarkably positive impact of the COPD patients' health status. The insights of this study will support the broader multiplication of the program throughout Switzerland and also serves the international community since it is one of the first nation-wide implementations beyond study settings.

Filling the Gap: A Feasibility Study of a COPD-Specific Breathlessness Service

Refractory breathlessness is a devastating symptom in chronic obstructive pulmonary disease (COPD). Symptom-focused breathlessness services, involving palliative care teams, offer individualized support but are not yet widely available for people with nonmalignant disease among which COPD. Our primary aim was to demonstrate the feasibility of setting up a breathlessness service specifically for COPD patients within a respiratory outpatient clinic. Our secondary aims were to assess how many sessions patients need to complete the intervention; to obtain an indication of effect size (on the Chronic Respiratory Questionnaire (CRQ), subset mastery domain); and to evaluate patient and professional satisfaction. We conducted a non-randomized single-center feasibility study. Participants had COPD and refractory breathlessness. During at least one session with a respiratory nurse and a pulmonologist, and one session with a physiotherapist, patients learned non-pharmacological interventions to manage breathlessness. Of 34 screened patients, 19 were included. All completed the intervention. A median of two clinical visits and two telephone calls were needed to complete the intervention. The mean improvement of 1.55 in CRQ, mastery domain, significantly exceeded the clinically important difference of 0.5. The service was rated as excellent by the eight patients who completed the survey. The health professional team gave positive feedback on the experience of delivering the intervention. Delivery of a breathlessness service for COPD outpatients with refractory breathlessness appears feasible, easy to implement in a respiratory outpatient clinic, and has the potential to be effective. A randomized controlled clinical trial is needed to test effectiveness and cost-effectiveness in this context.

Effectiveness of a Long-term Home-Based Exercise Training Program in Patients With COPD After Pulmonary Rehabilitation: A Multicenter Randomized Controlled Trial

Most patients with COPD do not maintain exercise training after pulmonary rehabilitation (PR). Does a 12-month home-based, minimal-equipment strength training program after PR have an effect on dyspnea, exercise capacity, and patient-reported outcomes in patients with COPD? In a parallel-arm multicenter study across four Swiss PR clinics, patients with COPD were allocated randomly (1:1 ratio) into an intervention group (IG; home-based strength training program) or control group (CG; usual care). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) dyspnea scale score from baseline to 12months. Secondary outcomes were change in exercise capacity (1-min sit-to-stand-test [1MSTST], 6-min walk test [6MWT]), health-related quality of life, exacerbations, and symptoms. We assessed the IG's experience by interviews at study end. Main analyses were based on the intention-to-treat approach, and adjusted linear regression models were used. One hundred twenty-three patients with COPD (IG, n= 61; CG, n= 62) were randomized, 61 of whom were women and whose mean ± SD age was 66.8 ± 8.1 years and mean ± SD FEV1 was 39.3 ± 15.3%predicted. One hundred four participants completed 12months of follow-up (IG, n= 53; CG, n= 51). Of the 53 IG participants, 37 participants (70%) conducted the training until study end. We found no difference in change in CRQ dyspnea scale score over 12months (adjusted mean difference, 0.28; 95%CI, -0.23 to 0.80; P= .27). We found moderate evidence for a difference in 1MSTST repetitions favoring the IG (adjusted mean difference, 2.6; 95%CI, 0.22-5.03; P= .033), but no evidence for an effect in other outcomes. Seventy-nine percent of the IG reported positive effects that they attributed to the training. The home exercise program had no effect on dyspnea, but improved 1MSTST performance and patient-perceived fitness. The supported program was well accepted by patients with COPD and may facilitate continued exercise training at home. ClinicalTrials.gov; No.: NCT03461887; URL: www. gov.

Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review.

BackgroundPulmonary rehabilitation is an effective intervention for people with chronic obstructive pulmonary disease (COPD). People with COPD undertake repeat programs, but synthesis of evidence regarding such practice has not been undertaken. The aim of this systematic review was to establish the effects of repeating pulmonary rehabilitation subsequent to an initial program in people with COPD.MethodsStudies where participants with COPD undertook >1 pulmonary rehabilitation program were included, incorporating RCT (randomized controlled trial) and non-randomized studies. Electronic database searches were undertaken. Two authors independently undertook study identification, data extraction and risk of bias assessment. The primary outcome was health-related quality of life (HRQoL); secondary outcomes were exercise capacity, hospitalizations and exacerbations, adherence, mortality and adverse events. Narrative synthesis was undertaken for clinically heterogeneous trials. Data from RCTs and non-randomized studies were not combined for analysis.ResultsTen included studies (2 RCTs) involved 907 participants with COPD (n=653 had undertaken >1 program). The majority of studies were at high risk of bias. One RCT (n=33) reported no difference in HRQol after a repeat program vs usual care following exacerbation (Chronic Respiratory Disease Questionnaire dyspnea domain score MD 0.4, 95% CI −0.5 to 3). In stable patients, clinically important and statistically significant improvements in HRQoL and exercise capacity were reported after repeat programs, but of a smaller magnitude than initial programs. There was evidence for reductions in exacerbations and hospitalizations, and shorter hospital length of stay for patients who repeated a program twice in 12 months compared to those who repeated once. No data for mortality or adverse events were available.ConclusionThis systematic review provides limited evidence for benefits of repeating pulmonary rehabilitation in people with COPD, including improved HRQoL and exercise capacity, and reduced hospitalizations. However, most studies have high risk of bias, which reduces the certainty of these conclusions.Study RegistrationPROSPERO (CRD42020215093).