Degree Of Dyspnea Research Articles

Degree of control of patients with chronic obstructive pulmonary disease in Spain: SINCON study

BackgroundDisease control is an important objective of COPD management. The SINCON study evaluated the level of control in terms of respiratory symptoms and exacerbations in Spanish patients with COPD for ≥2 years.MethodsSINCON was a descriptive, cross-sectional, multicenter study that assessed degree of control using a combined index comprising COPD assessment test (CAT), modified Medical Research Council dyspnea scale (mMRC), and number of moderate/severe exacerbations in the last year. Based on this score, patients were categorized as “well controlled” or “poorly controlled”. Degree of control was also assessed relative to patient phenotype, setting (primary care [PC] vs respiratory care [RC]), and impact of treatment on morning symptoms.ResultsOf the 481 patients (PC: 307, RC: 174) analyzed, COPD was poorly controlled in 63.2%. Some differences were found between clinical settings: PC patients were more poorly controlled (PC: 66.4% vs RC: 57.5%; P = 0.06) and had higher CAT score (PC: 17.9 vs RC: 15.5; P < 0.05), and higher rate of moderate/severe exacerbations during previous year (PC: 1.5 vs RC: 1.1; P < 0.05), while dyspnea degree was similar in both settings. Regarding phenotypes, non-exacerbators demonstrated better control vs exacerbators. Morning symptoms score improved between waking and 3 h after bronchodilator treatment (P < 0.05), with greater improvements in PC patients (PC: − 6.5 vs RC: − 5.0 points; P < 0.05).ConclusionsMost COPD patients were poorly controlled with some differences observed between PC and RC settings and between patient phenotypes. Our index may be easily used in PC settings to optimize COPD treatment.

Dependence of cytokinemia on the clinical course of chronic obstructive pulmonary disease combined with hypertension.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease. The prevalence of COPD continues to increase steadily. 90% of patients with COPD have at least one comorbid pathology. Among concomitant COPD diseases pathologies of the cardiovascular system prevail. The variety of the disease course in patients is the basis for distinguishing COPD patients with similar pathophysiological mechanisms based on analysis of biomarkers. The aim of the study was to analyze the dependence of cytokinemia (interleukin-18 and interleukin-10) on the clinical course of the disease in patients with COPD in combination with hypertension (HT). In total, 100 occupational COPD (GOLD 2, group B) patients in remission were monitored. The main group included 69 patients with COPD in combination with HT stage II, the comparison group - 31 patients with isolated COPD, and the control group - 20 healthy volunteers. All groups were comparable by sex and age. Levels of interleukin-18 (IL-18) and interleukin-10 (IL-10) were significantly higher in COPD patients combined with HT compared to healthy volunteers and isolated COPD. Growth of IL-18/IL-10 ratio is associated with increase in the degree of dyspnea, decrease in exercise tolerance, increase in desaturation during the 6-min walk test, decrease in body mass index, waist and mid-upper arm circumferences, and also more frequent detection of emphysematous changes in chest X-ray. Thus, the IL-18/IL-10 ratio reflects the state of the immune-inflammatory process and has the potential to predict the future risk of developing irreversible pathological changes in the respiratory tract, alveoli and lung vessels with the formation of emphysematous and fibrotic changes.

A High Degree of Dyspnea Is Associated With Poor Maximum Exercise Capacity in Subjects With COPD With the Same Severity of Air-Flow Obstruction.

In patients with COPD, limited data have been reported concerning the association between dyspnea perception and exercise tests. Moreover, the perception of dyspnea has not been analyzed in patients with the same severity of air-flow obstruction. The aim of our study was to evaluate the relationship between the degree of dyspnea and exercise capacity in subjects with COPD who had the same severity of air-flow obstruction. We assessed dyspnea perception and maximum exercise capacity by using the modified Medical Research Council dyspnea scale (mMRC) questionnaire and by using the symptom-limited incremental cardiopulmonary exercise test, respectively. A propensity score matching was used to obtain the balance between the subjects with COPD and with an mMRC questionnaire score <2 and ≥2 (mMRC score) according to the severity of air-flow obstruction. A total of 249 ambulatory adult patients with stable COPD (mean age, 68 y) were considered in the full cohort. After propensity score analysis, 160 subjects (65% men; mean ± SD FEV1, 47.5 ± 12.8% of predicted) were included in our study cohort. The subjects with an mMRC questionnaire score ≥2 in comparison with those with an mMRC questionnaire score <2 showed lower values in oxygen uptake at peak (VO2 max) (P = .002) and in maximum work load (P < .001). In the regression models, the mMRC questionnaire score was able to predict oxygen uptake at peak (P < .001) and at maximum work load (P < .001). In subjects with COPD and with the same severity of air-flow obstruction, a high score in dyspnea was related to a poor maximum exercise capacity. Our results support the view that, in COPD, the severity of air-flow obstruction was less informative than symptoms in the combined assessment of the disease.

Validation of clinical control in COPD as a new tool for optimizing treatment.

BackgroundIt has recently been proposed that the concept of clinical control in COPD may be useful for deciding treatment in COPD, but the original control criteria (OCC) were considered too restrictive.ObjectiveDefine and subsequently validate “modified” control criteria (MCC) of COPD.MethodProspective observational study in COPD patients with a 1-year follow-up. Control was defined as the presence of low clinical impact and clinical stability. To evaluate clinical impact, the following clinical parameters were assessed: the degree of dyspnea, use of rescue medication, physical activity, and sputum color. Stability was assessed by clinical changes and exacerbations in the last 3 months. The COPD assessment test score and their changes were also evaluated as alternative control criteria. To define the MCC, adjustment for disease severity using BODEx index (MCC-B) or FEV1 (MCC-F) was evaluated, and the best cutoff point was established. Time to first combined event (emergency visit, hospitalization, or death) was analyzed to evaluate the predictive capacity of risk of the OCC, MCC-B, and MCC-F.ResultsWe included 265 patients, 224 (83.9%) men, with a mean age (±SD) of 68±9 years and FEV1 of 58%±17%. The proportion of controlled patients was higher using clinical MCC-B or MCC-F (61.5% and 59.6%) than OCC (27.5%). Similar percentages were found using COPD assessment test scores. The time to the first combined event was significantly greater in controlled patients using MCC criteria (P<0.001, all cases). The predictive capacity of risk was similar in MCC-B (c-statistic [C]=0.639) and MCC-F (C=0.637) and higher than OCC (C=0.589).ConclusionsThe new MCC identified a higher number of controlled COPD patients. These patients have a better quality of life and lower risk of poor outcomes. The concept of control and the new MCC could be a useful tool to optimize therapy.

P3.01-10 Dyspnea as a Prognostic Factor in Hispanic Patients with Non-Small Cell Lung Cancer Cohort

Lung cancer is a commonly diagnosed cancer, and the leading cause of cancer death around the world. Over 80% of lung cancer patients in México are diagnosed in advanced stage. Common symptoms include cough, dyspnea, weight loss, and chest pain. Dyspnea is one of the most common symptoms in patients with lung cancer at initial presentation with a prevalence of 55–90%. The intensity of dyspnea is an important and validated factor for assessment of quality of life (QOL) in cancer patients. In addition, improvement of health-related QOL and symptoms, such as dyspnea, are related with the efficacy of chemotherapeutic regimens and favorable outcome in lung cancer. In this study, we investigated the association between the degree of dyspnea and clinical outcomes to identify the prognostic role of dyspnea in hispanic patients with non-small cell lung cancer (NSCLC). We retrospectively reviewed lung cancer database of Centro Oncologico Estatal ISSEMYM. From 2013 to 2016 we enrolled patients with diagnosis of advanced NSCLC. Clinicopathological information on age, sex, smoking history, histologic type, stage, Eastern Cooperative Oncology Group (ECOG) performance status, clinical outcomes and evaluation of symptoms of dyspnea at diagnosis using modified Medical Research Council (mMRC) scores from each patient were recorded. A total of 120 patients with diagnosis of NSCLC were identified, of these only in 65 patients (54%) the symptom of dyspnea were detected and evaluate using modified Medical Research Council (mMRC) scores at initial diagnosis. The median age was 58 years. Among those patient with dyspnea and mMRC scores available at diagnosis, 29 (45%) patients had an mMRC score ≥ 2, while 36 (55 %) had an mMRC score < 2. In multivariate analysis, poor performance status and an mMRC score ≥2 were found to be significant prognostic factors for patient survival. The overall median survival for all patients was 18 months. The overall survival of patients with dyspnea (mMRC grade 2 or higher) was significantly lower than that for patients without or low grade dyspnea (median survival, 17 months vs. 35 months, p<0.036). In conclusion, this study showed that the dyspnea mMRC mMRC grade 2 or higher in Hispanic patient with NSCLC were significantly associated with poor prognosis. Therefore, clinicians should pay more attention to evaluation and management of dyspnea.

Efficiency of vaccine prophylaxis concentrated pneumococcal vaccine in patients with chronic obstructive lung disease and chronic heart failure.

The article uses the analysis of clinical and pharmacoeconomic effectiveness of 13-valent conjugated pneumococcal vaccine in patients with combined course of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and chronic heart failure (CHF). 429 male patients with diagnoses of COPD, IHD, CHF were included in the study. The main endpoints of observation, for 5 years, for evaluation of effectiveness were dynamic assessment for class CHF, the number of exacerbations, hospitalizations, the number of pneumonias. The 13-valent conjugated pneumococcal vaccine (PCV13) Prevenar-13 was used for vaccine prophylaxis. The increase in age with the combined course of COPD and cardiovascular pathology leads to a deterioration in the basic clinical and functional indicators. With the increase in the clinical symptoms of the defeat of the respiratory system. There is an increase in the functional class of heart failure. Inclusion of vaccine prophylaxis PCV13 in the management plan of patients with combined pathology. Reduce the degree of dyspnea and stabilize the main functional indicators. Vaccination of patients with COPD using PCV13 combined with CHF and IHD made it possible to manage the health system expenses by 74-84%.

EXPERIENCE WITH VALSARTAN/SACUBITRILO IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: The main cause of admission in patients with heart failure (HF) is congestion. Treatment is complex, because of resistance to diuretics, and limitation to the use of potassium-sparing drugs. This situation is particularly frequent in patients with heart failure and chronic kidney disease (CKD). Therefore, the use of a drug that acts simultaneously on the renin angiotensin aldosterone system (RAAS) and on the Nerprisilina, can play an important role. Objectives: To evaluate the use of valsartan/sacubitrilo in patients with congestive heart failure and kidney disease 3B-4, analyzing its impact in the improvement of symptoms as overload and the effect on renal function. Analyze the safety profile of the drug Design and method: Prospective observational study (October 2016-October 2017): 7 patients with heart failure, a depressed ejection fraction and dyspnea functional grade II/IV onwards, to which had been added Valsartan/Sacubitrilo, previous suspension of ACE inhibitors or ARA II that came taking Results: The proportion F/M was 5/2. The mean age was 71 years. All patients are hypertensive, (85.6%) diabetic, 71.4% dyslipidemic. The 71 % with Cardiomyopathy. The 57.1% was being treated with combinations of diuretics, reducing this number to the 28.6%, after adding the new drug. 3 of the 7 patients (42.9%) stopped diuretics. There were no significant changes in the glomerular filtration rate, proteinuria and arterial blood pressure. 4 of the 7 patients improved the degree of dyspnea. Only 1 of these patients went to the emergency room with symptoms of heart failure once treated with the drug. None of the patients had adverse effects which would lead to the suspension of the drug. Conclusions: Valsartan/sacubitrilo in patients with CKD is useful to improve the functional class in patients with heart failure, allowing a lower use of diuretics and reducing emergency visits for symptoms in relation to the decompensation of heart failure. It is a reliable drug and help in the therapeutic management of these patients It will be necessary to assess the impact on the long-term preservation of renal function.

The impact of physical activity level, degree of dyspnoea and pulmonary function on the performance of healthy young adults during exercise

BackgroundIn addition to being simple and requiring minimal technology, the 6-min walk test (6MWT) has been found to be reproducible and well tolerated since its first use. However, the impact of non-anthropometric factors on functional capacity is less clear in healthy young adults because the majority experience no age-related changes in the locomotor system or associated comorbidities. AimTo identify the effect of physical activity level, degree of dyspnoea and pulmonary function on functional capacity, evaluated through the 6-min walking distance (6MWD) of healthy young adults, in order to prevent clinical abnormalities. MethodThis is a cross-sectional study including 190 healthy young adults who were subjected to the 6MWT to assess walking distance and degree of dyspnoea using the Borg scale. Furthermore, pulmonary function using spirometry and physical activity level using the International Physical Activity Questionnaire (IPAQ) were assessed. According to the IPAQ, the subjects were categorised as sedentary, irregularly active or active. ResultsThe 6MWD was positively correlated with pulmonary function parameters (P ≤ 0.002 for all parameters). There was a marginally significant correlation between the 6MWD and the difference between the scores assessed before and after the test using the Borg scale. There was a trend towards significant differences in 6MWD according to the IPAQ categories. Furthermore, forced vital capacity was the only pulmonary function parameter with significant differences between IPAQ categories (P = 0.02). ConclusionIn healthy young adults, greater pulmonary function indicates a greater 6MWD. In these subjects, physical activity level based on the IPAQ categories clearly affects pulmonary function. However, the IPAQ category and degree of dyspnoea are poorly related to the 6MWD of these subjects.

The use of trypsin-like blood activity as a marker of pulmonary fibrosis severity.

Purpose – to determine changes in the trypsin-like blood activity and its relationship with acute phase indices of inflammation in patients with pulmonary fibrosis (PF) as a marker of course severity and prognosis of the disease. Materials and Methods: The study included 18 patients: 15 (83%) women and 3 (17%) men, mean age 53±2.5 years. The control group included 15 practically healthy persons. All the examined patients (n=18) were divided into two groups: with mild or moderately severe PF – 8 (44.4%) patients (group I), severe PF – 10 (55.6%) of patients (group II). Duration of the disease - from 1 month. up to 4 years. Patients underwent clinic-laboratory and anthropometric studies, a mMRC questionnaire was used, blood saturation was measured, lung radiography in 2 projections, echocardiography, and if necessary a high-resolution computer tomography etc were performed. Results and discussion: More than half of the patients were overweight (44,4%) or had obesity of І-ІІІ st. (27.8%). The severity of dyspnea according to mMRC scale was 3.0 (3.0-4.0) points in patients of group II and 2.5 (2.0-3.0) points in patients of group I. There was a decrease in C-reactive protein (CRP) in group I and a tendency to increase in patients of group II. When analyzing the indicator of trypsin-like blood activity (TLA), it was found that the median TLA at the beginning of the observation was twice as high as in healthy individuals, direct correlation was established between the level of TLA and the severity of the disease course. After treatment the level of TLA decreased in group I patients. In the severe course of PF, the average TLA level remained high. The progredient course of LF is characterized by severe clinical symptoms, a significant increase in TLA, CRP, reduced O2 saturation, a lack of response to treatment and an unfavorable prognosis. The TLA index can be used as a biochemical marker of the severity of PF along with the CRPindex, O2 saturation and the degree of dyspnoea.

Effect of cricothyroid and thyroarytenoid muscle botulinum toxin injection on patients with dyspnea caused by bilateral recurrent laryngeal nerve paresis

Objective: To discuss the clinical effect of small dose of botulinum toxin injection in cricothyroid muscle and thyroarytenoid muscle on patients with incomplete bilateral recurrent laryngeal nerve paresis. Methods: Six patients were selected with Ⅰor Ⅱ or Ⅲ degree of dyspnea diagnosed as bilateral recurrent laryngeal nerve injury by laryngeal electromyography, and small dose of botulinum toxin injection was performed in cricothyroid muscle and thyroarytenoid muscle as a treatment. Degree of dyspnea was assessed one month before and after the treatment, and the stroboscopic laryngoscope results, acoustic parameters and CT image of the patients were collected in the 6 patients. The relevant parameters were also collected one month before and after treatment, including the degree of dyspnea, stroboscopic laryngoscope results, acoustic parameters and CT image of the patients. The angle between bilateral vocal cords in stroboscopy at full inspiratory was calculated, acoustic parameters (F0, jitter, shimmer) were analysed, and vocal length, width and the vocal region were measured. Then, the paired t test was performed for statistical analysis between before and after one month injection, the one way analysis of variance was performed among vocal parameters in CT image. Result: Botulinum toxin injection was successfully completed in the 6 patients, followed without any serious complications. The degree of dyspnea was alleviated to some extent after treatment in all 6 patients; the angle between bilateral vocal cords at the end of a deep inspiration was significantly increased (t=2.44, P<0.05) after the treatment. The changes of F0 and jitter between before and after treatment were not statistically significant (t=0.72, t=1.42, P>0.05). Shimmer was significantly decreased after treatment (t=2.61, P<0.05). Vocal fold length, width and vocal region increased with F0, there was a statistically significant difference between different F0 before injection, and there was no statistically significant difference between different F0 after injection. The follow-up time was respectively seven months, 1 year, 1 year, 18 months, 22 months and 2 years respectively. Conclusion: Small dose of botulinum toxin injection in bilateral cricothyroid muscles and thyroarytenoid muscles can relieve the dyspnea caused by bilateral vocal cords paresis to some extent, accompanied without serious complications, despite the sound quality was slightly worse.

Diferencias de la rehabilitación pulmonar en pacientes con EPOC, con y sin indicación de oxígeno domiciliario a largo plazo

IntroductionPulmonary Rehabilitation in patients with COPD impacts exercise tolerance, health-related quality of life (HRQoL) and symptom reduction: However, it is not known whether there is differential behaviour in patients for whom home oxygen is indicated. The purpose of this study was to compare the effects of a pulmonary rehabilitation programme in terms of exercise tolerance, dyspnoea and HRQoL in two groups of patients with COPD: one with indication for home oxygen and the other without. MethodsProspective descriptive study that included 66 patients, 31 with home oxygen and 35 with no oxygen prescription. Body mass index, dyspnoea evaluated with the modified Medical Research Council scale (mMRC), 6-min walk distance (6MWD), anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) and HRQoL measured with the St. George Respiratory Questionnaire (SGRQ) were assessed at the beginning and end of the programme. ResultsThe HADS and SGRQ showed improvement in all the domains but there were no differences between either group. However, the body mass index, the mMRC, the 6MWD and the VO2e maintained their statistically significant difference in favour of the group without home oxygen (P<.05). ConclusionsThe patients without oxygen prescription performed better in the 6MWD, which can be attributed to the lower degree of dyspnoea in the activities of daily life and to greater limitation for patients with home oxygen.

Safety and efficacy of airway stenting in patients with malignant oesophago-airway fistula.

Close anatomical relationships between the oesophagus and the bronchial tree can lead to the formation of oesophageal fistula particularly in patients with advanced lung or oesophageal carcinoma. Stenting is a most often used treatment in such patients, but data regarding the relative value of unilateral (US) vs. double stenting (DS) are scarce. Retrospective analysis of hospital records of patients with oesophageal fistula who underwent stenting between 2008 and 2016. In those in whom airway stenosis was >30%, double stenting (oesophagus and bronchial tree) was performed, whereas in those with lesser airway stenosis unilateral stenting (i.e., oesophagus only) was performed. In all patients, the degree of dysphagia, the degree of dyspnoea and the quality of life were assessed before and after the stenting. There were 46 patients, analysed, including 26 who underwent DS and 20 patients who underwent US. Both, DS and US resulted in significant improvement of dysphagia (2.72 vs. 1.2, P=0.0001 and 2.65 vs. 1.0, P=0.0001), dyspnoea (2.89 vs. 0.34, P=0.0001 and 1.71 vs. 0.09, P=0.0001) and performance score (53.2 vs. 66.3, P=0.0001 and 54.3 vs. 62.38, P=0.0001). Neither fistula type, nor stenting method, weight loss and gain, and BMI, had an effect on survival (P=0.34). Disease progression and recurrence of fistula requiring re-intervention occurred in 9 patients (19.5%). Double and unilateral stenting is an effective measure to alleviate dysphagia and dyspnoea in patients treated with malignant oesophageal fistula. In those with airway stenosis of ≤30%, stenting of the oesophagus only, instead of DS, is a safe method of treatment.

Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD

PurposeIt is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery.Patients and methodsWe retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared.ResultsSeventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; −34.52 cmH2O vs −43.25 cmH2O, P<0.01; −34.67 cmH2O vs −48.18 cmH2O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH2O vs 46.05 cmH2O, P<0.01; 37.78 cmH2O vs 45.72 cmH2O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV1; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV1 (96 L vs 1.09 L, P<0.05) and FEF25–75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF25–75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group.ConclusionPRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF25–75 in COPD patients.

Quality of Life and Psychological Disorders of Patients with Chronic Pulmonary Obstructive Disease (COPD) Admitted for Exacerbation

We aimed to verify how many patients with COPD admitted due to exacerbation had psychological disorders such as anxiety-depression and had their quality of life affected according to specific questionnaires; as well as to know the relation of these parameters with the degree of dyspnea and affectation of their COPD descriptive study of patients admitted for COPD at a pulmonology service between January and June of 2014 was carried out.

Analysis of compliance dynamics in patients with chronic obstructive pulmonary disease on the background of vaccination against pneumococcal infection.

The analysis of the dynamics of compliance in patients with chronic obstructive pulmonary disease (COPD) on a background of vaccination. A total of 394 male patients are covered by this study. The main endpoints of observation are as follows: 1. To evaluate the effectiveness It's important the dynamics of scores for mMRC, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia cases. 2. To assess compliance it's necessary to conduct a test for adherence to the Moriska-Green questionnaire. For vaccine prophylaxis, 13-valent conjugated pneumococcal vaccine Prevenar-13 and a 23-valent polysaccharide vaccine Pnevmo23 were used. The dynamics of changes in the parameters studied was evaluated within 4 years of the therapy initiation. The inclusion of vaccine prophylaxis of PCV13 in the patient management plan allows to reduce a degree of dyspnea and stabilize the main functional parameters of the respiratory system not only in the short term, but also for at least next 4 years. PCV13 vaccination of can be considered as a basic therapy along with bronchodilator therapy. The use of vaccine prophylaxis PCV13 significantly increases the compliance and adherence of patients to a therapy. The use of vaccine prophylaxis PKV13 significantly increases patients ' compliance and adherence to the therapy.

Comparison of Efficiency of Pleurodesis Between Video Assisted Thoracoscopic Surgery (VATS) and Standard Thoracostomy.

Background:Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions.Aim:Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy.Methods:From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months.Results:Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2.Conclusion:Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.

Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study

BackgroundClinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level.MethodsEPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics.ResultsA total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient’s characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance.ConclusionTo be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.

Efficacy of Vaccine Prophylaxis for Pneumococcal Infection in Patients with Chronic Obstructive Pulmonary Disease with Various Comorbidity Indix

Actuality. Modern medicine shows a sharp growth of patients with comorbid and concurrent chronic diseases, involving not only the mature and older persons but also the young people. Combined diseases of the circulatory and respiratory systems are the main cause of death, disability of the population and major labor losses. The aim of this work was to study the vaccine prophylaxis effectiveness for chronic obstructive pulmonary disease (COPD) patients having the different Charlson comorbidity index. Material and methods: This study covered 174 patients with COPD and IHD. All patients were subject to the complex clinical research, including the medical assessment, patient complaints, medical history, physical and instrumental examinations and pathology tests Assessment of respiratory function and general Body plethysmography were performed Degree of dyspnea was assessed using a scale provided by Medical Research Center. Number of COPD exacerbations, hospitalizations and pneumonia development cases were analyzed. Modified Charlson comorbidity index was calculated for all patients Results and conclusions: Among the patients with comorbidity the severe manifestations of chronic obstructive pulmonary disease correspond to the more pronounced functional classes of angina pectoris. With the comorbidity index growth the number of exacerbations, hospitalizations and pneumonia cases were increasing. Vaccine prophylaxis is the most effective for the patients having the lower comorbidity indices and shows a tendency to stabilize these indicators for the patients having the moderate & high levels of comorbidity, and therefore, are to be recommended for all COPD and CVD patients. Changes in clinical and functional parameters of respiratory function for COPD patients are statistical-significantly different for the patients having the low and high levels of comorbidity.

Extent of jugular venous distension and lower extremity edema are the best tools from history and physical examination to identify heart failure exacerbation

We aimed to identify the best tools from history and physical examination that predict severity of heart failure (HF) exacerbation among patients with an ejection fraction (EF)≤ 30%. Patients enrolled in the ESCAPE trial were divided into tertiles according to the combined value of pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) which we used as amarker of volume loading of both pulmonary and systemic compartments. Variables of congestion from history and physical examination were examined across tertiles. There were significant differences across tertiles (tertile1: PCWP+ RAP< 31 mm Hg, tertile2: PCWP+ RAP 31-42 mm Hg and tertile3: PCWP + RAP > 42 mm Hg) with respect to baseline B‑type natriuretic peptide (P= 0.016), blood urea nitrogen (P= 0.022), sodium (P= 0.015), left ventricular ejection fraction (P= 0.005), and inferior vena cava diameter during inspiration (P< 0.001) and expiration (P< 0.001). With respect to variables of congestion from history and physical examination, we found significant differences across tertiles predominantly in signs of right sided failure, specifically, the frequency of jugular venous distension (JVD, P< 0.001) and JVD> 12 cmH2O (p< 0.001), lower extremity edema (P= 0.001) and lower extremity edema of at least grade 2+ (P= 0.029), and positive hepatojugular reflux (HJR, P= 0.022) but no differences in patients' symptoms such as degree of dyspnea, orthopnea or fatigue. With regards to post-discharge outcomes, there was asignificant difference across tertiles in all-cause mortality (P= 0.029) and rehospitalization for HF (P= 0.031) at 6 months following randomization. Receiver operator characteristic curves showed that admission PCWP + RAP had an area under the curve of 0.623 (P= 0.0075) and 0.617 (P= 0.0048), respectively, in predicting 6‑month all-cause mortality and rehospitalization for HF. The presence and extent of JVD and lower extremity edema, and a positive HJR are better than other signs and symptoms in identifying severity of HF exacerbation among patients with EF≤ 30%.

Effects of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: A randomised controlled trial.

We conducted a randomised controlled trial to assess the effects of daily breathing pattern changes to stable patients with COPD excluding the confounding factors of inspiratory muscle mobilization, by ensuring the load intensities of two inspiratory training devices were equal. Sixty patients with COPD were randomised to three groups: resistive-IMT group (T-IMT, 21 patients), threshold-IMT (R-IMT, 19 patients), and a control group (20 patients). Inspiratory load intensity for both methods was set at 60% of maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, which, along with health-related quality of life (HRQoL), degree of dyspnoea, and exercise capacity, were conducted before and after 8 weeks of daily IMT. At 8 weeks, there was no significantly difference of MIP between the R- and T-IMT groups (P>0.05). Chronic Respiratory Disease Questionnaire and Transition Dyspnea Index scores improved significantly after each training program compared with controls (P<0.05), and R-IMT was significant better (P<0.05). R-IMT was better than T-IMT in performance of exercise (P<0.05). In summary, in clinically stable patients with COPD, 8 weeks of R-IMT was superior to 8 weeks of equal-intensity T-IMT in improving HRQoL, degree of dyspnoea, and exercise capacity.