Dyspnea Scale Research Articles

Impact of Pulmonary Rehabilitation on Recuperation of Moderate-to-Severe Coronavirus Disease 2019 Patients in Western India

Background: Coronavirus disease 2019 (COVID-19) virus has caused widespread Acute Respiratory Disease globally since 2020. Patients with evidence of lower respiratory illness either clinically or radiologically had moderate-to-severe illness. COVID respiratory and nonrespiratory symptoms (psychological and cognitive) noticed after 4–8 weeks of primary disease were called long COVID syndrome. Survivors of moderate-to-severe disease had a poor quality of life. The main objective of this retrospective study was to assess the role of outpatient pulmonary rehabilitation (PR) done in moderate-severe COVID-19 survivors who had symptoms after 4–8 weeks at Shaivam Lung Rehabilitation Centre, Ahmedabad. Methods: We analyzed the impact of PR on 30 patients' post-COVID-19 who were willing to participate during the ongoing pandemic. It was an outpatient 6–8 weeks of program designed to target respiratory and general muscle training, relaxation technique, nutritional counseling, occupational and psychological support. Patients were tested with of combination of self-assessment quality of life scale (adapted from short form 36 questionnaire), muscle training, dyspnea scale, and physical assessment. The standard objective assessment included oxygenation index (SpO2/FiO2 ratio), 6 min walk distance (6 MWD), Modified Medical Research Council (MMRC) score, manual muscle testing (MMT) along with pulmonary function testing. All these subjective and objective variables were tested pre- and post-PR program to assess the impact on defined parameters. Results: From December 2020 to March 2022, we studied the impact of PR on 30 out of 55 patients fitting into the inclusion criteria. Significant benefit was noted in subjective Short Form 36 (SF 36) score and objective (6 MWD, MMRC, oxygenation, MMT) quality of life post-PR program ( P < 0.001). Improvement in spirometry was not statistically significant, indicating structural chronicity of COVID pulmonary fibrosis. Conclusion: PR is safe, effective, and feasible on an outpatient basis in COVID-19 survivors of illness with poor quality of life. Further research is required to prove its widespread benefit in such patients.

Effectiveness and safety of normoxic allogenic umbilical cord mesenchymal stem cells administered as adjunctive treatment in patients with severe COVID-19

Inflammatory response in COVID-19 contributes greatly to disease severity. Mesenchymal Stem Cells (MSCs) have the potential to alleviate inflammation and reduce mortality and length of stay in COVID-19 patients. We investigated the safety and effectiveness of normoxic-allogenic umbilical cord (NA-UC)-MSCs as an adjunctive treatment in severe COVID-19 patients. A double-blind, multicentric, randomized, placebo-controlled trial involving severe COVID-19 patients was performed from January to June 2021 in three major hospitals across Java, Indonesia. Eligible participants (n = 42) were randomly assigned to two groups (1:1), namely the intervention (n = 21) and control (n = 21) groups. UC-MSCs dose was 1 × 106 /kg body weight on day D0, D3, and D6. The primary outcome was the duration of hospitalization. Meanwhile, the secondary outcomes were radiographical progression (Brixia score), respiratory and oxygenation parameters, and inflammatory markers, in addition to the safety profile of NA-UC-MSCs. NA-UC-MSCs administration did not affect the length of hospital stay of severe COVID-19 patients, nor did it improve the Brixia score or mMRC dyspnoea scale better than placebo. Nevertheless, NA-UC-MSCs led to a better recuperation in oxygenation index (120.80 ± 72.70 baseline vs. 309.63 ± 319.30 D + 22, p = 0.038) and oxygen saturation (97.24 ± 4.10% vs. 96.19 ± 3.75% in placebo, p = 0.028). Additionally, compared to the placebo group, the treatment group had a significantly smaller increase in PCT level at D + 22 (1.43 vs. 12.76, p = 0.011). No adverse effects, including serious ones, were recorded until D + 91. NA-UC-MSCs therapy is a very safe adjunct for COVID-19 patients. It improves the oxygenation profile and carries potential to suppress inflammation.

Characteristics of Inhaler Technique in COPD Patients in a Specialized Center in Armenia, Colombia: A Cross-Sectional Study.

The aim of this research was to evaluate the technique of using inhaled drugs in patients with a confirmed history of COPD and describe errors in inhaler technique. Descriptive cross-sectional study was conducted in patients with a history of COPD using inhalation therapy, attending pulmonology consultation between August 2020 and April 2021 in Armenia, Colombia. A non-probabilistic sample of 80 adult participants was calculated, and the inhalation technique was evaluated (depending on the device used) using a scale validated for Colombia. Descriptive analysis of the qualitative variables was performed using frequencies and percentages. The Chi-Square test and Fisher's exact test (in corresponding cases) were used to look for association relationships between categorical variables. A total of 80 participants were evaluated, of which 66.3% (n = 53) were male, and 32.5% were older than 80 years. Clinically, 30.0% (n = 24) were classified as Modified Medical Research Council Dyspnea Scale (mMRC) grade 3, and 51.2% (n = 41) had at least one exacerbation per year. The main comorbidity was hypertension (40.3%). Pressurized metered-dose inhalers with spacer were the most used device at 22.7% (n = 39). Incorrect technique (at least one error in the steps of the inhalation technique used) was found in 48.7%. The most frequent error among all the techniques was the failure to perform pre-inspiratory exhalation. No significant differences were observed between the development of the technique and the characteristics of the participants. Nearly half of the patients who use inhalation devices make errors in the technique. Patient education and training of healthcare personnel represent a fundamental pillar in mitigating the incorrect use of these devices.

The effectiveness of an unsupervised home-based pulmonary rehabilitation with self-management program in patients with chronic obstructive pulmonary disease.

To assess the effectiveness of an unsupervised home-based pulmonary rehabilitation with self-management program in patients with chronic obstructive pulmonary disease (COPD). A few recent studies have shown that unsupervised home-based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. This study used a quasi-experimental design. Seventy-two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self-Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. The Medical Research Council dyspnea scale and COPD Self-Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. A short-term unsupervised home-based pulmonary rehabilitation with self- management program had significant benefits for patients with COPD. The long-term effects need to be confirmed.

Long-Term Clinical Outcomes of Patients with Chronic Obstructive Pulmonary Disease with Sarcopenia.

Sarcopenia with muscle wasting and weakness is a common occurrence among patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the clinical outcomes of sarcopenia in patients with COPD. We reviewed the electronic medical records of 71 patients with COPD between 1 January 2012, and 31 December 2018. We longitudinally analyzed clinical outcomes in patients with COPD with and without sarcopenia. Compared to the non-sarcopenia group COPD, the sarcopenia group showed a higher rate of acute exacerbation events of COPD (AE COPD, 84.6% vs. 31.0%, p = 0.001), all-cause mortality (30.8% vs. 5.2%, p = 0.022), and pneumonia occurrence per year (median [first quartile-third quartile]; 0.2 [0.0-1.6] vs. 0.0 [0.0-0.2], p = 0.025). Sarcopenia was an independent risk factor for AE COPD in Cox regression analysis (hazard ratio, 5.982; 95% confidence interval, 1.576-22.704). Hand grip strength was associated with the COPD Assessment Test (CAT) score and annual Charlson's comorbidity index score change. Total skeletal muscle mass index (SMMI) was associated with the modified medical research council dyspnea scale score, CAT score, body mass index, airflow obstruction, dyspnea, and exercise (BODE) index, and alanine transaminase. Trunk SMMI was significantly associated with AE COPD, while appendicular SMMI was associated with BODE index and annual intensive care unit admissions for AE COPD. Sarcopenia is associated with clinical prognosis, pneumonia occurrence, and the acute exacerbation of COPD requiring intensive care in patients with COPD. Therefore, it is important to carefully monitor sarcopenia development as well as recommend appropriate exercise and nutritional supplementation in patients with COPD.

Kinesiophobia, Dyspnea, Pain, Fatigue, Depression, Anxiety, Stress, and Balance in Adolescent Volleyball Players Who Have Had COVID-19

Objectives: It is still unclear to what extent kinesiophobia, dyspnea, pain, fatigue, mood, and balance are affected in adolescent volleyball players who have had COVID-19. Therefore, present study aimed to comparatively investigate kinesiophobia, dyspnea, pain, fatigue, depression, anxiety, stress, and balance between adolescent volleyball players with and without post-COVID-19. Methods: Adolescent volleyball players between ages of 10-19 (n=40) were included in the study between May 2022 and August 2022 and divided into those who have had COVID-19 (n=18) and those who have never had COVID-19 (n=22). Measurements of kinesiophobia (Tampa Scale of Kinesiophobia), dyspnea perception in daily living activities (Modified Medical Research Council Dyspnea Scale), severity of pain and fatigue (Numerical Rating Scale), depression, anxiety, and stress levels (Short Form of Depression Anxiety Stress Scale), static balance (balance test on one leg), and dynamic balance (standing functional reach test) were performed in all volleyball players at once. Results: There was no statistically significant difference between groups in demographic characteristics, kinesiophobia, dyspnea, pain, fatigue, depression, stress, and balance values (p>0.05). However, anxiety scores of adolescent volleyball players who have not had COVID-19 were statistically significantly higher than those of adolescent volleyball players who have experienced COVID-19 (p<0.05). The incidences of anxiety (n=5, 27.8% versus n=11, 50%) were similar between groups (p>0.05). Conclusions: During the prolonged COVID-19 pandemic period, kinesiophobia, dyspnea, pain and fatigue perceptions, depression, stress, and balance levels were found to be similar in adolescent volleyball players regardless of their post-COVID-19 status. However, anxiety is more common in adolescent volleyball players without post-COVID-19. Therefore, underlying causes of anxiety observed in adolescent volleyball players without post-COVID-19 should be investigated.

Dyspnea Pada Penderita Asma Dengan Teknik Pernafasan Buteyko

Asthma is a chronic disease characterized by airway hyperactivity due to inflammation and reversible airflow obstruction. The most common triggers of asthma are allergies (food or inhalants such as dander, dust, pollen), exposure to cold temperatures, and upper respiratory infections. Non-pharmacological therapy can be carried out with the buteyko breathing technique which aims to reduce dyspnea, asthma attacks, wheezing, reduce symptoms of nasal congestion and stop coughing experienced by sufferers. The purpose of this study was to determine the effectiveness of buteyko exercise on dyspnea symptoms in asthma sufferers. The research method used was a pre-experimental one group pretest-posttest to see differences in the dyspnea scale in the intervention group before and after the buteyko exercise. The results of the pre-test and post-test statistics p = 0.025 <0.05 where there were differences in the dyspnea scale after being given buteyko exercises. Prior to the Buteyko exercise, it was shown that 4 respondents (40%) had mild dyspnea, 4 respondents (40%) had mild, 2 respondents (20%) were mild. After doing the buteyko exercise, it was shown that 7 respondents (70%) had mild dyspnea, 3 respondents (30%) had mild symptoms. Research shows that there is a decrease in the level of dyspnea after being given buteyko exercises with an average dyspnea scale decreasing (negative rank) with a result of 3.00. It was concluded that there were differences in the dyspnea scale after being given buteyko exercises, that there were significant results for a decrease in the dyspnea scale in asthma sufferers.

Investigation of Factors Affecting Shuttle Walking Performance at Increased Speed for Patients with Chronic Obstructive Pulmonary Disease.

The aim of this study was to examine the factors affecting the shuttle walking test (SWT) in patients with chronic obstructive pulmonary disease (COPD). A total of 29 patients with COPD (the COPD group) and a healthy group (HG) of 34 women aged between 55 and 74 years were included in the study. After the pulmonary function profiles of the participants were assessed, and the SWT was performed. Walking distances, walking speeds, and SWT levels (SWT-L) were determined with the SWT. Before and after the SWT, the heart rate (HR), oxygen saturation level (SPO2), and Borg scale (perceived exertion (BSe) and dyspnea (BSd)) results were analyzed with a paired sample t-test. The dyspnea levels during activity of daily living were determined with the Medical Research Council (MRC) dyspnea scale, and the relationship between MRC dyspnea (MRCD) and walking distance, speed, and SWT-L was tested using multiple linear regression and Pearson correlation analysis. The walking distance, speed, and SWT-L were lower in the COPD group (p < 0.001) than in the HG. The HR values before and after the SWT changed significantly in the COPD group and the HG (p< 0.001), and the effect size was higher in the COPD group. Although the BSe and BSd results before and after the SWT in the COPD group increased significantly (p < 0.001), they did not change in the HG. There was a highly negative correlation between MRCD and walking distance, speed, and SWT-L in the COPD group (p = 0.002, p = 0.000, and p = 0.001, respectively), but no correlation was found in the HG. The results showed that the HR, perceived exertion, and dyspnea levels of women with COPD whose respiratory functions were lower than the HG were significantly affected on the SWT.

Isolated abnormal diffusing capacity for carbon monoxide (iso↓DLco) is associated with increased respiratory symptom burden in people with HIV infection.

An isolated reduction in the diffusing capacity for carbon monoxide (DLco; iso↓DLco) is one of the most common pulmonary function test (PFT) abnormalities in people living with HIV (PWH), but its clinical implications are incompletely understood. In this study, we explored whether iso↓DLco in PWH is associated with a greater respiratory symptom burden. Cross-sectional analysis. We used ATS/ERS compliant PFTs from PWH with normal spirometry (post-bronchodilator FEV1/FVC ≥0.7; FEV1, FVC ≥80% predicted) from the I AM OLD cohort in San Francisco, CA and Seattle, WA, grouped by DLco categorized as normal (DLco ≥lower limit of normal, LLN), mild iso↓DLco (LLN >DLco >60% predicted), and moderate-severe iso↓DLco (DLco ≤60% predicted). We performed multivariable analyses to test for associations between DLco and validated symptom-severity and quality of life questionnaires, including the modified Medical Research Council dyspnea scale (mMRC), the COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ), as well as between DLco and individual CAT symptoms. Mild iso↓DLco was associated only with a significantly higher SGRQ score. Moderate-severe iso↓DLco was associated with significantly higher odds of mMRC ≥2 and significantly higher CAT and SGRQ scores. PWH with moderate-severe iso↓DLco had increased odds of breathlessness, decreased activity, lower confidence leaving home, and less energy. Iso↓DLco is associated with worse respiratory symptom scores, and this association becomes stronger with worsening DLco, suggesting that impaired gas exchange alone has a significant negative impact on the quality of life in PWH. Additional studies are ongoing to understand the etiology of this finding and design appropriate interventions.

Outcome of Lung Functions in Covid-19 Patients at a Tertiary Care Center of Eastern Nepal

Background: Novel coronavirus infection has myriad clinical manifestations, such as headache, respiratory failure, and long coronavirus disease syndrome. A common cause for admission is pneumonia, and such patients have shown longer periods of respiratory symptoms and exercise intolerance after discharge. The study aimed to determine short-term and long-term lung function outcomes in coronavirus disease patients.&#x0D; Materials and Methods: The prospective, cross-sectional study was conducted in coronavirus disease facility of Birat Medical College Teaching Hospital. A structured proforma including symptoms, modified medical research council dyspnea scale, 6-minute walk test and portable spirometry were recorded during 3 months follow up.&#x0D; Results: A total of 58 coronavirus disease patients were admitted, 4 expired. Common symptoms were dyspnea (98.28%), fever (94.8%), dry cough (86.2%), myalgia (17.2%). Mean Forced expiratory volume in 1 second to forced vital capacity ratio was normal. The mean forced vital capacity was 46.52% at admission, 53.33% at 3 months. The mean forced expiratory flow at 25% to 75% of forced vital capacity was 56.91% at admission, 59.31% at 3 months. Mean values of forced expiratory volume predicted was 47.40% at admission, 51.69% at 3 months. Mean 6-minute walk test distance did not improve during follow-up (240.09m at 1 month, 239.35m at 3 months) and there was no improvement in oxygen saturation at 3 months compared to the first month.&#x0D; Conclusion: Short-term lung function outcome demonstrated persistent dyspnea and development of mixed airways disease in all the survivors. Long-term lung function outcome observed was persistence of dyspnea, mixed airways disease, and low exercise capacity.

Pulmonary rehabilitation improves sleep efficiency measured by actigraphy in poorly sleeping COPD patients

Chronic insomnia is reported by up to 50% of chronic obstructive pulmonary disease (COPD) patients. This may be attributable to several factors including nocturnal dyspnea, reduced physical activity, and less time outside. Pulmonary rehabilitation (PR) is recommended in COPD to improve both physical and psychological conditioning. The aim of this study was to assess the effect of PR on sleep efficiency (SE, measured by actigraphy) in COPD patients. COPD eligible for PR were prospectively included. Baseline and post PR (30 sessions) assessments included incremental and maximal exercise testing, 6-min walking distance test (6MWT), actigraphy, and questionnaires [Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety Depression scale, St George Respiratory, and modified Medical Research Council dyspnea scale]. Sixty-one patients were included, and 31 patients completed the study protocol (68% of males, age 63 ± 9 y, FEV1 44.2 ± 12.3%). After PR, SE remained unchanged, p = 0.07, as well as PSQI score (p = 0.22), despite improvements in exercise capacity (incremental exercise test, 6MWT) and dyspnea. However, SE improved significantly in the poor sleeper subgroup (SE < 85%, n = 24, p = 0.02), whereas the PSQI remained unchanged. The present study shows, in COPD patients included in a PR program, that improvement in exercise capacity was disappointingly not associated with a better SE assessed by actigraphy. Subjective sleep quality was also unchanged at the end of PR program. However, SE improved significantly in the poor sleeper subgroup (SE < 85%). Further studies are required to better characterize the origin of sleep disturbances in COPD and the potential benefit of some (non-)pharmacologic interventions.

Reliability and validity of the London Chest Activity of Daily Living scale for adults with asthma

Introduction Dyspnea during activities of daily living (ADL) is frequently reported by adults with asthma. However, instruments that specifically assess that in people with asthma have not yet been validated. Objectives To investigate the validity and reliability, including standard error of measurement (SEM) and Minimum Detectable Change (MDC), of the London Chest Activity of Daily Living (LCADL) scale for adults with asthma. Methods Adults with asthma answered the LCADL scale which was performed twice by the same rater. Spirometry, 6-min walk test (6MWT), St George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea scale, Asthma Quality of Life questionnaire (AQLQ), Asthma Control Test (ACT), and Glittre-ADL test were assessed. For statistical analyses, Spearman correlation, Wilcoxon test, Intraclass Correlation Coefficient (ICC), Cronbach’s alpha coefficient, SEM, MDC were performed. Results Seventy participants were included (30% men, 44 ± 15 years old, BMI 27[23-31]kg/m2, FEV1 80 ± 17%predicted). For convergent validity, the LCADL scale was moderately correlated with SGRQ, AQLQ, and Glittre-ADL (r = 0.57, −0.46, and 0.41 respectively; p < 0.0001). The LCADL scale correlated weakly with the mMRC scale, ACT, and spirometry measures (-0.23<r < 0.39; p < 0.001). Weak to strong correlations between the domains of the LCADL scale and the domains of the SGRQ were observed (0.26<r < 0.73; p < 0.001). There was no difference between the test-retest of the scale (p = 0.65) and reliability analysis shows an ICC3 of 0.71, a Cronbach’s alpha coefficient of 0.87, an SEM of 6.23 points, and an MDC of 17.27 points. Conclusion The LCADL scale is valid and reliable for assessing dyspnea during ADL in adults with asthma.

EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AS AN INDICATION FOR COMPUTERIZED ELECTROACUPUNCTURE: RESULTS OF PROSPECTIVE CLINICAL STUDIES

The purpose of the study is to evaluate the effect of the phase (exacerbation / remission) of chronic obstructive pulmonary disease (COPD) on the effectiveness of computerized electroacupuncture (CEAP).&#x0D; Materials and Methods. COPD patients took part in a two-stage study. During the first study phase, 80 COPD patients were randomized into two equal groups, regardless of the disease phase. Group I patients underwent a 5-day CEAP combined with standard pharmacotherapy, group II patients received isolated pharmacotherapy. The second study phase involved 33 patients with COPD exacerbation (Group O) and 32 patients with COPD remission (Group P). These patients underwent standard pharmacotherapy and a 5-day CEAP. The treatment effectiveness was evaluated according to the dynamics of respiratory function and the mMRC dyspnea scale.&#x0D; Results. At the first phase, the parameters of respiratory function and mMRC questionnaire did not have any significant changes in both comparison groups. However, in patients with COPD exacerbation, the rate of a positive clinical response was higher than in patients in remission (59 % and 17 %, respectively). During the second phase, in Group O, CEAP was accompanied by an increase in respiratory function and a decrease in dyspnea severity (mMRC questionnaire). In group P, the parameters did not change significantly.&#x0D; Conclusion. CEAP is more effective in COPD treatment if it is used during the exacerbation phase.

Effect of physiotherapy and its frequency on the outcome of COVID-19 patients regarding acute care setting at isolation unit of Ain Shams University

Abstract Background Severe acute respiratory syndrome coronavirus 2 is a new strain of coronavirus that started in 2019 and causes a pandemic disease called coronavirus disease 2019 (COVID-19). The present report result was 80% of cases are asymptomatic or mild; 15% of cases are severe; and 5% are critical needing ICU and mechanical ventilation. Physiotherapy (PT) provides airway clearance techniques and improves physical fitness. Aim The aim of this study is to assess the effect of PT and the frequency of PT session on the outcome of patients with COVID-19 infection at an isolation unit of Ain Shams University. Patients and methods This is randomized controlled clinical trial that was applied on 264 confirmed adult patients with COVID-19, who were admitted to isolation units at Ain Shams University Hospitals over 6 months since March 2021 with 134 females and 130 males in the age range from 31 to 82 years. The breathing method was room air, oxygen mask and nasal cannula, HFNC, and ventilated patients (both invasive and noninvasive). The patients were divided randomly into two groups: one group received two sessions of PT per day and the other group received one session of PT per day. Results The patients were divided clinically into mild, moderate, severe, and severe-critical patients. In mild cases, the range of incentive spirometer (ml) after one daily PT became 2300–2800 ml, and for twice daily PT it became 2300–3300 ml with highly statistical difference (P=0.005) before and after one or two PT sessions. Regarding 6-min walking test (m) the range became 420–740 m for one PT session per day and 420–880 m for two PT sessions per day with significant statistical difference (P=0.010). In moderate cases, the SPO2 (%) became 88–98% after one daily PT session and 90–98% after twice daily PT sessions with significant statistical differences between the one and two PT (P=0.032) sessions. Regarding the incentive spirometer (ml) at the moderate group, after one daily PT session it became 1200–2500 ml and for twice daily PT it became 1500–2500 ml with significant statistical differences between one and two PT sessions (P=0.032). Conclusion Patients with mild and moderate COVID-19 infection had significant improvement in SPO2 (oxygen saturation), dyspnea scale, and incentive spirometer after receiving two daily sessions of PT compared with patients who received one daily PT session. There was no difference in both groups for severe and severe-critical cases.

Different Case Finding Approaches to Optimise COPD Diagnosis: Evidence from the RADICALS Trial.

Diagnosis of COPD in primary care is hindered by underuse of spirometry. Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting. We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants' FEV1 and FEV6 were measured using a handheld spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George's Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD. FEV1/FEV6 <0.70 alone showed significant association (p<0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 <0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70). Handheld micro-spirometers can facilitate case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.

Value of cardiopulmonary exercise testing in the assessment of symptoms and quality of life in Asian patients with chronic obstructive pulmonary disease.

The natural course of chronic obstructive pulmonary disease (COPD) is characterized by symptom exacerbation and quality-of-life reduction. Therefore, symptoms should be properly assessed. Some studies have demonstrated a weak correlation between cardiopulmonary exercise testing (CPET) parameters and symptoms in patients with COPD; however, data on Asian patients are lacking. We investigated the value of CPET parameters in assessing symptoms and quality of life in Asian patients with COPD. Of 681 patients who underwent CPET at Asan Medical Center between January 2020 and June 2022, we analyzed 195 patients with COPD in this retrospective study. A cycle ergometer was used for the incremental protocol. The modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) were administered to assess the patients' symptoms. The mMRC grade was related to maximal oxygen uptake (VO2 max, L/min) (Spearman's correlation coefficient ρ=-0.295, P<0.001) and physiological dead space/tidal volume ratio at peak exercise (VD/VT peak) (ρ=0.256, P<0.001). The CAT score was significantly correlated with VO2 max (L/min) (Spearman's correlation coefficient ρ=-0.297, P<0.001) and VD/VT peak (ρ=0.271, P<0.001), but had no correlation with breathing reserve (ρ=-0.122, P=0.089). The optimal cut-off values of VO2 max and VD/VT peak for predicting the onset of clinically significant dyspnea were 1.099 L/min and 0.295, respectively. VO2 max and VD/VT peak comprehensively reflect the symptoms and health-related quality of life of patients with COPD.

The Impact of COVID-19 on the Mental Health and Musculoskeletal Pain in Post-COVID-19-Recovered Patients

Background: The COVID-19 pandemic is having worldwide impact including mental and physical health. The objective of this study is to evaluate the mental health and musculoskeletal pain in postrecovered patients. Methods: A 4-week exercise program including warm-up exercises, strengthening exercises, relaxation exercises, deep breathing exercises, and cool down exercises was designed for this interventional study. A total of 100 corona-recovered patients were selected from the physiotherapy department of the hospital. All the patients were instructed to come to the department for postassessment and then the data were analyzed. Results: The significant results were seen in the following variables on the basis of comparison between week 1 and week 4: Visual Analog Scale score (week 1: 2.11 ± 1.77 and week 4: 0.79 ± 1.21), modified Borg Dyspnea Scale (week 1: 2.07 ± 1.65 and week 4: 0.79 ± 1.21), Warwick–Edinburgh Mental Well-being Scale (week 1: 42.5 ± 4.6 and week 4: 59.4 ± 6.7), and Cornell Musculoskeletal Discomfort Scale (week 1: 8.32 ± 6.1 and week 4: 1.68 ± 2.42). Conclusions: The study concluded that there was significant reduction of physical and mental health status of patients with history of COVID-19.

Assessment of efficacy and safety of endoscopic lung volume reduction with one-way valves in patients with a very low FEV1.

Endoscopic lung volume reduction (ELVR) with one-way valves produces beneficial outcomes in patients with severe emphysema. Evidence on the efficacy remains unclear in patients with a very low forced expiratory volume in 1 s (FEV1) (≤20% predicted). We aim to compare clinical outcomes of ELVR, in relation to the FEV1 restriction. All data originated from the German Lung Emphysema Registry (Lungenemphysem Register), which is a prospective multicentric observational study for patients with severe emphysema after lung volume reduction. Two groups were formed at baseline: FEV1 ≤20% pred and FEV1 21-45% pred. Pulmonary function tests (FEV1, residual volume, partial pressure of carbon dioxide), training capacity (6-min walk distance (6MWD)), quality of life (modified Medical Research Council dyspnoea scale (mMRC), COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ)) and adverse events were assessed and compared at baseline and after 3 and 6 months. 33 patients with FEV1 ≤20% pred and 265 patients with FEV1 21-45% pred were analysed. After ELVR, an increase in FEV1 was observed in both groups (both p<0.001). The mMRC and CAT scores, and 6MWD improved in both groups (all p<0.05). The SGRQ score improved significantly in the FEV1 21-45% pred group, and by trend in the FEV1 ≤20% pred group. Pneumothorax was the most frequent complication within the first 90 days in both groups (FEV1 ≤20% pred: 7.7% versus FEV1 21-45% pred: 22.1%; p=0.624). No deaths occurred in the FEV1 ≤20% pred group up to 6 months. Our study highlights the potential efficacy of one-way valves, even in patients with very low FEV1, as these patients experienced significant improvements in FEV1, 6MWD and quality of life. No death was reported, suggesting a good safety profile, even in these high-risk patients.

The MRC Dyspnoea Scale and mortality risk prediction in pulmonary arterial hypertension: A retrospective longitudinal cohort study

AbstractRisk stratification models in pulmonary arterial hypertension (PAH) rely on World Health Organisation Functional Class (WHO FC). A high proportion of patients are classified as WHO FC III, a heterogenous group which limits the stratification abilities of risk models. The Medical Research Council (MRC) Dyspnoea Scale may allow a more precise assessment of functional status and improve current risk models. We investigated the ability of the MRC Dyspnoea Scale to assess survival in PAH and compared performance to WHO FC and the COMPERA 2.0 models. Patients with Idiopathic, Hereditary or Drug‐induced PAH who were diagnosed between 2010 and 2021 were included. The MRC Dyspnoea Scale was retrospectively applied as derived from a combination of patient notes, 6MWD tests results and WHO functional status using a purpose‐designed algorithm. Survival was assessed using Kaplan–Meier analyses, log rank testing and Cox proportional hazard ratios. Model performance was compared with Harrell's C Statistic. Data from 216 patients were retrospectively analyzed. At baseline, of 120 patients classified as WHO FC III, 8% were MRC Dyspnoea Scale 2, 12% Scale 3, 71% Scale 4 and 10% Scale 5. The MRC Dyspnoea Scale performed well compared to the WHO FC and COMPERA models at follow up (respectively, C‐statistic 0.74 vs. 0.69 vs. 0.75). It was possible to use the MRC Dyspnoea Scale to subdivide patients in WHO FC III into groups which had distinct survival estimates. We conclude that at follow‐up, the MRC Dyspnoea Scale may be a valid tool for the assessment of risk stratification in pulmonary arterial hypertension.

Safety and feasibility of oesophageal ultrasound for the work-up of thoracic malignancy in patients with respiratory impairment.

Biopsying lung tumours with endobronchial access in patients with respiratory impairment is challenging. However, fine needle aspiration with the endobronchial ultrasound-endoscope via the oesophagus (EUS-B-FNA) makes it possible to obtain tissue samples without entering the airways. Safety of EUS-B-FNA in these patients has not earlier been investigated prospectively. Therefore, this study aimed at assessing feasibility and safety of EUS-B-FNA from centrally located tumours suspected of thoracic malignancy in patients with respiratory insufficiency. The study is a prospective observational study. Patients with indication of EUS-B-FNA of centrally located tumours and respiratory impairment defined as modified Medical Research Council (mMRC) dyspnoea scale score of ≥3, saturation ≤90% or need of continuous oxygen supply were included prospectively in three centres. Any adverse events (AEs) were recorded during procedure and 1-hour recovery. AEs were defined as hypoxemia (saturation <90% or need for increased oxygen supply) or any kind of events needing intervention. Late procedure-related events were recorded during 30-day follow-up. Between April 1, 2020 and January 30, 2021, 16 patients were included. No severe AEs (SAEs) occurred, but AEs were seen in 50% (n=8) and 13% (n=2) of the patients during procedure and recovery respectively. AEs included hypoxemia corrected with increased oxygen supply and in two cases reversal of sedation. Late procedure-related events were seen in 13% (n=2) and included prolonged need of oxygen and one infection treated with oral antibiotics. In this cohort, EUS-B-FNA of centrally located tumours was safe and feasible in patients with respiratory impairment, when examined in the bronchoscopy suite. A variety of mostly mild and manageable complications may occur, a few even up to 30 days post-procedure.