Dyspnea Scale Research Articles

Связь системного воспаления с тяжестью обструктивного апноэ сна у мужчин пожилого возраста с хронической обструктивной болезнью легких

The combination of obstructive sleep apnea syndrome (OSA) and chronic obstructive pulmonary disease (COPD) is characterized by deep nocturnal hypoxemia and a higher risk of pulmonary hypertension. The study of the participation of blood cellular elements and indices of cellular reactivity in the inflammatory response in this comorbidity is relevant today. The purpose was to study the severity of systemic inflammation in elderly patients with chronic obstructive pulmonary disease depending on the obstructive sleep apnea syndrome severity. We examined 126 men (aged 67.3 ± 3.4 years) diagnosed with COPD 1–2 low risk of exacerbations. Depending on the presence of OSA, the patients were divided into 2 groups: group 1 — 32 people without OSA, group 2 — 94 people with OSA. Symptoms were assessed using the modified Medical Research Council (mMRC) dyspnea scale and the COPD assessment test (CAT). The severity of OSA syndrome was assessed by the frequency of respiratory events: mild – from 5 to 15 per hour; moderate — from 15 to 30 per hour; severe — more than 30 per hour. The indices were calculated: quantitative ratio of neutrophils (N) and lymphocytes (L) — NLR = N/L; ratio of platelets (P) to lymphocytes PLR = P/L, systemic inflammatory index (SII) = platelet × neutrophils / lymphocytes. It was found that as the severity of OSA increased, chronic systemic inflammation increased, which was determined by the ratio of neutrophils, lymphocytes, and platelets (NLR, PLR, SII).

What are the Barriers of Chronic Obstructive Pulmonary Disease (COPD) Patients in Smoking Cessation?

Smoking is the major determinant of developing chronic obstructive pulmonary disease (COPD). A substantial proportion of patients with COPD continue smoking although they have significant respiratory symptoms, exacerbation history and comorbidities. We aimed to find the associated factors and clinical features of the patients who maintain smoking. 200 current smokers and 132 former smokers with a spirometry-confirmed diagnosis of COPD were recruited from the outpatient department. Demographic characteristics, smoking backgrounds, treatment status, comorbidities, exacerbation history of the previous year, pulmonary function tests, blood biochemistry, dyspnea scales, symptom scores, and BECK anxiety scores were all recorded. No age and gender differences were found between current and former smokers. Compared to former smokers, current smokers were less qualified, had more cardiovascular diseases, more frequently exposed to tobacco smoke at home and at work place, more severe pulmonary function impairment, longer duration of COPD, longer time of smoking, earlier age of commencement in smoking, higher scores of BECK anxiety scores (BAI), higher levels of inflammatory markers in blood tests p<0.05. In multivariable analysis, lower values of FEV1%, higher scores of CAT and BAI, higher levels of platelet and CRP were found to decrease the likelihood of smoking cessation p<0.05. Additionally having diabetes, coronary artery disease and hypertension were inversely correlated with quitting smoking p<0.05. COPD is a systemic inflammatory disease. We found over half of the patients with COPD were currently smoking, despite the severity of their airflow limitation, symptoms and even the comorbidities. Furthermore, 2 out of 5 of the current smokers reported having moderate to severe anxiety. Dyspnea and inflammatory markers had negative effects on smoking cessation, and anxiety might be the cause that led these patients to keep smoking.

Effect of a 5A Model-based Self-management Program on Self-management Ability and Dyspnea Severity in the Elderly with Chronic Heart Failure: A Randomized Clinical Trial

Objectives Heart failure is one of the common chronic diseases in old age and is considered as a progressive and debilitating disorder. Nowadays, the use of supportive and non-pharmacological methods in disease management and empowerment of elderly patients is of increasing importance. This study was aims to assess the effect of a 5A model-based self-management program on self-management ability and dyspnea severity in the elderly with chronic heart failure. Methods &amp; Materials This is a randomized controlled clinical trial that was conducted on 75 eligible elderly people with heart failure (Class II or III) in Babol, Iran. They were randomly divided into two groups of intervention and control. The intervention group received the self-management training program based on the 5A model for 12 weeks. The control group received the usual training. The data before and immediately after the intervention were collected using the self-management ability scale (SMAS) and the five-item modified Medical Research Council (MMRC) dyspnea scale. The collected data was analyzed in SPSS software version 24. Results The mean age of patients was 68.026±3.956 in the intervention group and 69.595±4.079 in the control group. There were no statistically significant differences between the two groups in terms of demographic and clinical characteristics. After the intervention, the total SMAS score and severity of dyspnea in the intervention group were significantly higher than in the control group (P&lt;0.001). The difference was also significant in all subscales of SMAS between the two groups (P&lt;0.001). Conclusion Considering the positive effect of the 5A model-based self-management program on improving self-management ability and reducing the severity of dyspnea in the elderly with chronic heart failure, it can be used as a simple, low-cost, effective method, without the need to go to medical centers, to improve the quality of life of these patients.

Effects of Ninjin'yoeito on Patients with Chronic Obstructive Pulmonary Disease and Comorbid Frailty and Sarcopenia: A Preliminary Open-Label Randomized Controlled Trial.

To present the preliminarily findings regarding the effects of a herbal medicine, Ninjin'yoeito, on comorbid frailty and sarcopenia in patients with chronic obstructive pulmonary disease (COPD). Patients with COPD (GOLD II or higher) and fatigue were randomly assigned to Group A (n = 28; no medication for 12 weeks, followed by 12-week administration) or B (n= 25; 24-week continuous administration). Visual analog scale (VAS) symptoms of fatigue, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) Dyspnea Scale were examined. Physical indices such asknee extension leg strength and walking speed, skeletal muscle mass index (SMI), and respiratory function test were also measured. VAS fatigue scales in Group B significantly improved after 4, 8, and 12 weeks compared to those in Group A (each p<0.001, respectively). Right and left knee extension leg strength in Group B significantly improved after 12 weeks compared to that in Group A (p=0.042 and p=0.037, respectively). The 1-s walking speed for continued to increase significantly over 24 weeks in Group B (p=0.016, p<0.001, p<0.001, p=0.004, p<0.001, and p<0.001 after 4, 8, 12, 16, 20, and 24 weeks, respectively); it also significantly increased after the administration of Ninjin'yoeito in Group A. In Group B, the SMI significantly increased at 12 weeks in patients with sarcopenia (p=0.025). The CAT scores in Group B significantly improved after 12 weeks compared to those in Group A (p=0.006). The mMRC scores in Group B also significantly improved after 8 and 12 weeks compared to those in Group A (p= 0.045 and p <0.001, respectively). The changes in %FEV1.0 in Group B were significantly improved at 12 and 24 weeks (p=0.039 and p=0.036, respectively). Overall, Ninjin'yoeito significantly improved patients' quality of life, physical activity, muscle mass, and possibly lung function, suggesting that Ninjin'yoeito may improve frailty and sarcopenia in patients with COPD.

Clinical Effectiveness of an Aquatic Exercise Program on Those With Visual Impairment: A Pilot Study

Background and Purpose: Visual impairments impact an individual’s ability to participate in certain activities, like exercise. Often, individuals with visual impairment have difficulty maintaining an active lifestyle, due to inopportunity and safety hazards. There is a lack of research on the use of aquatic exercise as a form of physical activity in those with visual impairments. The purpose of this study was to determine if this population can tolerate and benefit from an aquatic exercise program. Additionally, this study served to determine the effects of aquatic exercise on cardiovascular fitness, strength, and quality of life in individuals with visual impairment. Methods: This was a quasi-experimental study, evaluating participants with visual impairment aged 30 to 80 years, recruited from Northeast Sight Services in Exeter, PA. This study was reviewed and accepted by the Misericordia University Institutional Review Board. Eight participants were guided by physical therapy students and a primary researcher through a biweekly, 8-week aquatic exercise program at the Misericordia University Anderson Center Pool. This study utilized a pretest/post-test design to collect outcome measures. These included the 6-Minute Walk Test, 30-S Chair Stand Test, Modified Borg Ratings of Perceived Exertion (mRPE), the Modified Borg Dyspnea Scale, and the SF-36. Results: Paired t-tests and Cohen’s d were performed for the 6-Minute Walk Test (p = .04).953; Cohen’s d = 0.77, and the 30 Second Chair Stand Test (p = .02); Cohen’s d = 0.95 with large effect and significance. A Wilcoxon Signed Ranks and Cohen’s d were utilized for the mRPE 3 min, Cohen’s d = 0.27, Wilcoxon Signed Ranks 2.032 (p = .042), Borg RPE d = 1.054 and the SF-36 Cohen’s d = 2.3063. Discussion and Conclusion: This aquatic exercise program was tolerated well in this population and the results provide rehabilitation specialists an opportunity to promote health through aquatic programs for those with visual impairment. Furthermore, aquatic exercise was shown to be effective in improving lower extremity strength, cardiovascular endurance, and quality of life in participants, suggesting that aquatic exercise is a feasible intervention for this population.

Assessment of mask use on oxygen saturation in adults and children with asthma.

Background: Mask use is recommended to reduce the transmission of severe acute respiratory syndrome coronavirus 2. The safety of mask use in adults and children with asthma is unknown. Objective: The objective of this study is to evaluate the effect of mask use on peripheral oxygen saturation (SpO₂) in those with and those without asthma. Methods: A two-stage cross-sectional study was performed. In the first stage, the SpO₂ concentration in adults and children with and without asthma was measured with the adults and children at rest during mask use. In the second stage, children years 6-17 performed a 6-minute walk test while wearing masks. The SpO₂ concentration was measured before the exercise and at 3 and 6 minutes into exercise. Subjective dyspnea was evaluated by using the Pediatric Dyspnea Scale (PDS). Results: In the first stage, SpO₂ levels in 393 subjects were analyzed. In the second stage, 50 pediatric subjects were included, 25 with and 25 without asthma. There was no difference in SpO₂ levels between those with and those without asthma in adults and children wearing masks while at rest, with median SpO₂ 98% in both groups. There was no difference in oxygen saturation or reported level of dyspnea between the children with asthma and children without asthma performing the 6-minute walk test while wearing masks. Median SpO₂ levels were at or near 99% in the asthma and non-asthma groups at all time points. Median PDS scores were similar between the asthma and non-asthma groups. Conclusion: Mask use did not affect SpO₂ in adults and children at rest or in children performing low-to-moderate intensity exercise. These findings were consistent in those with and without asthma.

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 years old (standard deviation [SD] 9.4), 55.3% female, forced expiratory volume in 1 second (FEV1) 44.3% (SD 19.4), and a modified Medical Research Council (mMRC) dyspnea scale of 2.69 (SD 0.84). Patients with high MLQ Presence (versus low score) had meaningfully better scores (beyond the minimal clinically important difference) across all Chronic Respiratory Questionnaire (CRQ) 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.

Clinical Characteristics and Frequency of Chronic Obstructive Pulmonary Disease Exacerbations in Korean Patients: Findings From the KOCOSS Cohort 2012-2021.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exert a substantial burden on patients and healthcare systems; however, data related to the frequency of AECOPD in the Korean population are limited. Therefore, this study aimed to describe the frequency of severe, and moderate or severe AECOPD, as well as clinical and demographic characteristics of patients with chronic obstructive pulmonary disease (COPD) in South Korea. Data from patients aged > 40 years with post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity ≤ 70% of the normal predicted value from the Korea COPD Subgroup Study database were analyzed (April 2012 to 2021). The protocol was based on the EXAcerbations of COPD and their OutcomeS International study. Data were collected retrospectively for year 0 (0-12 months before study enrollment) based on patient recall, and prospectively during years 1, 2, and 3 (0-12, 13-24, and 25-36 months after study enrollment, respectively). The data were summarized using descriptive statistics. Data from 3,477 Korean patients (mean age, 68.5 years) with COPD were analyzed. Overall, most patients were male (92.3%), former or current smokers (90.8%), had a modified Medical Research Council dyspnea scale score ≥ 1 (83.3%), and had moderate airflow limitation (54.4%). The mean body mass index (BMI) of the study population was 23.1 kg/m², and 27.6% were obese or overweight. Hypertension was the most common comorbidity (37.6%). The mean blood eosinophil count was 226.8 cells/μL, with 21.9% of patients having ≥ 300 cells/μL. A clinically insignificant change in FEV1 (+1.4%) was observed a year after enrollment. Overall, patients experienced a mean of 0.2 severe annual AECOPD and approximately 1.1 mean moderate or severe AECOPD. Notably, the rates of severe AECOPD remained generally consistent over time. Compared with patients with no exacerbations, patients who experienced severe exacerbations had a lower mean BMI (21.7 vs. 23.1 kg/m²; P < 0.001) and lower lung function parameters (all P values < 0.001), but reported high rates of depression (25.5% vs. 15.1%; P = 0.044) and anxiety (37.3% vs. 16.7%; P < 0.001) as a comorbidity. Findings from this Korean cohort of patients with COPD indicated a high exacerbation burden, which may be attributable to the unique characteristics of the study population and suboptimal disease management. This highlights the need to align clinical practices with the latest treatment recommendations to alleviate AECOPD burden in Korea. ClinicalTrials.gov Identifier: NCT05750810.

What is the Prevalence of Persistent Symptoms in Older Adults after Covid-19 Infection? A Cohort Study

Aim: To compare the prevalence of persistent symptoms between older and younger adults infected with COVID-19 at 6-8 weeks following infection (baseline) and at 6-12 months (follow-up). Methods: A cohort study from the post-COVID service at Alfred Hospital, Melbourne, Australia. Participants completed standardized surveys at 6-8 weeks following infection (younger = 870, and older = 311), and 6-12 months later (younger = 84, and older = 37). The measurements included dyspnoea (Modified Medical Research Council Dyspnoea Scale – mMRC), fatigue (Fatigue Assessment Scale - FAS), anxiety and depression (Hospital Anxiety and Depression Scale - HADS), post-traumatic stress disorder (The Impact of Events Scale-Revised - IES-R) and quality of life (QoL) (Euroqol-5D questionnaire - EQ-5D). Results: At baseline, older adults had a lower prevalence of dyspnoea (mMRC: 21% vs. 31%, p&lt;0.01), depression (HADS-D: 9% vs 26%, p&lt;0.01), anxiety (HADS-A: 16% vs 36%, p&lt;0.01), extreme fatigue (FAS: 9% vs 39%, p&lt;0.01), post-traumatic stress (IES-R: 12% vs 27%, p&lt;0.01) and reported better QoL (EQ-5D-5L-VAS: 69±18 vs 57±22, p&lt;0.01) compared to younger adults, At follow-up, older adults continued to report a lower prevalence of symptoms than younger adults for anxiety (HADS-A: 17% vs 36%, p=0.03), extreme fatigue (FAS: 9% vs 44%, p&lt;0.01), and better QoL (EQ-5D-VAS, 66±23 vs 56±21, p=0.03). Conclusion: Older adults experience fewer short-and long-term COVID-19 symptoms. Future research should focus on developing targeted interventions tailored to different age groups.

Evaluation of exercise capacity in chronic obstructive pulmonary disease patients with pulmonary hypertension

Abstract Background Chronic obstructive pulmonary disease (COPD) is ordinarily associated with social and economic burden. Pulmonary hypertension attributed to COPD varies greatly among studies; and accounts for worse quality of life and hence increased morbidity and mortality. Aim This study aimed to evaluate impact of pulmonary hypertension on exercise capacity, and possible predictors for exercise intolerance among COPD patients. Methods Patients suffering from COPD (73 patients) were grouped according to echocardiographic assessment for the presence of pulmonary hypertension into two groups. The assessment included full clinical history, mMRC dyspnea scale, COPD assessment test, arterial blood gases before and after exercise testing, and assessment of resting pulmonary function test. Also transthoracic echocardiography, cardiopulmonary exercise testing (CPET) using incremental treadmill exercises protocol was done for all participants. Results A total of 39 (53.4%) COPD patients have pulmonary hypertension. COPD patients with pulmonary hypertension had significantly lower parameters of pulmonary function tests either pre or postbronchodilator; significantly lower pH, PaO2 and SaO2 either before or after CPET. It was found that all parameters of metabolic response during exercise were significantly lower among COPD-PH patients (P&lt;0.001). Pulmonary artery systolic pressure (PASP) showed significant negative correlations with peak VO2 (r=−0.514, P&lt;0.001), VO2/kg (r=−0.443, P&lt;0.001), oxygen pulse (% predicted) (r=−0.459, P&lt;0.001), oxygen saturation post exercise (r=−0.427, P&lt;0.001). Also PASP showed significant positive correlation with VE/VO2 (at peak) (r=0.374, P=0.001), VE/VCO2 (at peak) (r=0.609, P&lt;0.001). Predictors of poor exercise capacity among COPD patients included in the study were COPD-PH group (OR=8.84, 95%CI= 1.79–43.65), PASP (OR=1.11, 95% CI=1.02–1.15), forced expiratory volume (FEV1)% (OR=0.89, 95% CI=0.84–0.95) and mMRC (OR=3.10, 95% CI=1.13–8.47), CAT assessment (OR=1.37, 95% CI=1.14–1.65), MVV L/min (OR=0.91, 95% CI=0.86–0.96) and mean PAP (OR=1.16, 95% CI=1.11–1.29). Conclusion Pulmonary hypertension in patients with COPD is negatively correlated with exercise capacity, specifically peak VO2 percent predicted. Furthermore, pulmonary hypertension had a significant impact on gas exchange. Assessment of pulmonary hypertension using echocardiography among COPD patients is a valuable tool for predicting exercise impairment.

СТАНДАРТИ ЛІКУВАННЯ ПАЦІЄНТІВ НА ХРОНІЧНЕ ОБСТРУКТИВНЕ ЗАХВОРЮВАННЯ ЛЕГЕНЬ, 2024 РІК: МІСЦЕ ТІОТРОПІУМА БРОМІДУ

Updated GOLD 2024 guidelines emphasized the problem of insufficient or inaccurate diagnosis of COPD, leading to inappropriate therapy of these patients. This trend is also widespread in Ukraine, despite the significant improvement in diagnosis and available treatment options. The aim of the study was to determine the effectiveness of tiotropium bromide (Spiriva® HandiHaler® "Boehringer Ingelheim Pharma GmbH", Germany) for the initial and follow-up treatment of patients. We evaluated the effect of the drug on the clinical and functional status of patients and adherence to therapy. Materials and methods. We enrolled 20 patients with newly diagnosed COPD (group 1) and 10 patients already receiving treatment with previously diagnosed COPD (group 2). In all group 2 patients the diagnosis was established in 2022-2023. In this study the diagnosis and initiation of treatment has been done according to GOLD 2024 recommendations. In 1 month of treatment the effectiveness of treatment based on the change of symptoms (mMRC dyspnea scale and CAT score) and treatment compliance were assessed. Results. Standard clinical examination was performed to confirm or revise of COPD diagnosis. In group 1 GOLD 2 airflow limitation were observed in 75 % (n = 15) of patients, GOLD 3 — in 25 % (n = 5); 25 % (n = 5) patients were classified as group A, and 75 % (n = 15) of patients — as group В. In group 2 there were prevalent the patients with more severe airflow limitation: GOLD 2 — 40 % (n = 4), GOLD 3 — 60 % (n = 6). All patients from this group were allocated to group B due to symptoms intensity. The analysis of CAT responses structure has demonstrated that the questions 1 to 4 evaluating such symptoms as cough and dyspnea collected more points. All patients received inhalation therapy with tiotropium bromide DPI once daily and Berodual H MDI as needed. In group 1 post-treatment CAT score demonstrated a significant change in comparison with visit 1 score (13,5 (SD 1,4) vs 11 (SD 1,0), р = 0,001). Conclusion. Overall, during the study period we observed a significant improvement in compliance, which was reflected in the decrease in the frequency of use of short-acting bronchodilators. The use of tiotropium bromide as an initial or follow-up therapy right after 1 month of treatment significantly reduced the clinical manifestations of the disease. Key words: chronic obstructive pulmonary disease, GOLD 2024, tiotropium bromide.

DETERMINATION OF MALNUTRITION, FRAILTY, POLYPHARMACY, MULTIMORBIDITY, AND MORTALITY RISK IN HOSPITALIZED ELDERLY COVID-19 PNEUMONIA CASES WITH AND WITHOUT POSSIBLE SARCOPENIA

Introduction: To evaluate elderly COVID-19 pneumonia hospitalizations via the presence of possible sarcopenia, hand grip strength measurements, malnutrition, frailty, polypharmacy, multimorbidity, mortality risk and 30th-day mortality after discharge. Materials and Method: This observational study included geriatric patients in the COVID ward of Gaziosmanpasa Training and Research Hospital between March 1, 2022, and April 30, 2022. SARC-F screening test, hand grip strength measurement, CALL score for mortality risk, KATZ Index of Independence in activities of daily living, Mini Nutritional Assessment-Short Form, BORG dyspnea scale, and Frail scale were administered. 30th-day mortality after discharge was recorded during follow-up using phone calls. Results: Distribution of 75 cases aged 76.6±8.2 years was as follows: 65.3% (n =49) possible sarcopenia, 49.3% (n =37) malnutrition, 49.3% (n =37) polypharmacy,70.7% (n =53) multimorbidities. 30th-day after-discharge mortality was 24.0% (n =18). The length of hospital stay, activities of daily living, frailty, D-dimer level, albumin, and oxygen requirement were significant in the possible sarcopenia group compared to non-sarcopenia group (p =0.003, p = 0.012, p =0.012, p =0.007, p =0.004, and p =0.015, respectively). Impaired hand grip strength was related to a higher CALL risk score (r =-0.343; p =0.003), higher drug use and disease counts (r =-0.387, p =0.001 and r =-0.321; p =0.005), prolonged length of hospital stay (r=-0.315; p=0.006), and higher oxygen requirement (r =-0.240, p =0.038). Conclusion: COVID-19 pneumonia hospitalizations of geriatric patients are significantly accompanied by possible sarcopenia. The measurement of hand grip strength was emphasized to determine associations with the length of hospital stay, malnutrition, and 30th-day discharge mortality of hospitalized COVID-19 pneumonia in the elderly. Keywords: Pneumonia; COVID-19; Sarcopenia; Frail Elderly; Malnutrition; Mortality.

Correlations of IL-1β and vitamin D with CAT score in patients with acute exacerbation of chronic obstructive pulmonary disease.

This study was to analyze the correlations of IL-1β and vitamin D (VitD) with chronic obstructive pulmonary disease assessment test (CAT) score in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). For this purpose, a total of 65 patients with chronic obstructive pulmonary disease (COPD) treated in our hospital between June 2020 and June 2022 were enrolled and assigned to a research group, and 40 healthy individuals who underwent physical examination in our hospital over the same time spanning were enrolled into the control group. The 65 COPD patients were further grouped into a stability group (30 cases) and an exacerbation group (35 cases). The two groups were compared in the levels of 25-hydroxyvitamin D (25(OH)D), interleukin-1β (IL-1β) and blood gas indexes (arterial carbon dioxide partial pressure (PaCO2) and arterial partial pressure of oxygen (PaO2). The modified Medical Research Council Dyspnea Scale (mMRC) and the CAT were adopted for evaluation of the stability group and exacerbation group. The correlations of IL-1β and 25(OH)D with mMRC and CAT scores were analyzed. The diagnostic value of IL-1β and VitD in patients in different stages was analyzed through receiver operating characteristic (ROC) curves. Results showed that the control group showed greatly lower IL-1β and PaCO2 levels and higher 25(OH)D and PaO2 levels than the research group (all P<0.05). The stability group got greatly lower mMRC and CAT scores than the exacerbation group (both P<0.05). IL-1β had positive correlations with mMRC and CAT scores, while 25(OH)D had negative correlations with them (P<0.05). According to ROC curve-based analysis, IL-1β and 25(OH)D had areas under the curves of 0.814 and 0.583, respectively, in diagnosing the acute exacerbation period, and had specificities of 56.67% and 43.33%, respectively and sensitivities of 97.14% and 74.29%, respectively. In conclusion, patients with COPD have increased IL-1 β and VitD deficiency, so VitD can be properly supplemented during treatment, and the levels of inflammatory factors should be paid close attention to at all times. IL-1 β and VitD can be regarded as novel ideas for the diagnosis and treatment of COPD, which may further improve the effect of COPD prevention and treatment.

Effects of Buteyko Breathing Technique versus Diaphragmatic Breathing on Exercise Capacity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition characterized by decreased respiratory function and reduced quality of life. Pulmonary rehabilitation techniques, specifically Buteyko Breathing Technique (BBT) and Diaphragmatic Breathing Technique (DBT), have been suggested to improve these aspects in COPD patients. However, comparative efficacy of these techniques remains uncertain. Objective: This study aimed to compare the effectiveness of BBT and DBT on exercise capacity and quality of life in patients with COPD. Methods: In a randomized clinical trial (WHO Registry of IRCTs: NCT05947227), 48 COPD patients (aged 40-65 years) were enrolled and randomly assigned to either BBT or DBT groups. Both groups underwent respective breathing technique training as part of pulmonary rehabilitation over a 10-month period at Jinnah Hospital, Lahore. Key measurements included the 6-minute walk test (6MWT) for exercise capacity and the St. George Respiratory Questionnaire (SGRQ) for quality of life assessment. The Modified Borg Dyspnea Scale was used to categorize dyspnea severity. Data were analyzed using SPSS software (Version 25), with parametric and non-parametric tests applied for comparative analysis. Results: Both groups showed improvement post-intervention, but DBT demonstrated superior outcomes. Quality of life scores improved from an average of 85.33 (SD=1.110) to 76.06 (SD=4.503) in the DBT group, compared to 87.16 (SD=4.55) to 83.10 (SD=5.76) in the BBT group (p=0.000). Similarly, 6MWT distances showed significant improvement in the DBT group. The DBT group also exhibited a more considerable enhancement in activity scores and dyspnea reduction compared to the BBT group. Conclusion: While both BBT and DBT are effective in improving exercise capacity and quality of life in COPD patients, DBT shows a more significant improvement. These findings suggest that DBT could be a more favorable technique in pulmonary rehabilitation for COPD patients.

Effectiveness of adequate chicken egg white consumption on dyspnea degree and exacerbation incidence in stable COPD patients practicing strength and endurance exercises.

Lack of physical exercise and inadequate nutritional intake in chronic obstructive pulmonary disease (COPD) patients could lead to low muscle mass and function, which causes reduced respiratory function, increased incidence of exacerbations, exercise intolerance, increased visits to health facilities, and low health status. Therefore, physical exercise and good nutritional intake are the main foundations of a comprehensive pulmonary rehabilitation program for COPD patients. The aim of the study was to determine the effect of chicken egg white supplementation on dyspnea degree and the incidence of exacerbations in stable COPD patients who perform physical exercise independently at home. A quasi-experimental study was conducted in 38 stable COPD patients based on the Global Initiative for Chronic Lung Disease (GOLD) 2021 classification criteria. The patients were divided into two groups: the control group who did smartphone application-assisted physical exercises and the intervention group who did the same physical exercises plus chicken egg white supplementation for 12 weeks. Performed physical exercises included both strength and endurance training. The degree of dyspnea was assessed with modified Medical Research Council (mMRC) dyspnea scale and the incidence of exacerbations was assessed by direct interviews at the beginning and at the end of the intervention. A Fisher's exact test was used to assess the association between the intervention with dyspnea degree and exacerbation incidence. In the intervention group, chicken egg white supplementation for 12 weeks lowered the dyspnea degree by 3.16 times than the control (relative risk 3.16 with p=0.001). Furthermore, the incidence of exacerbations was also reduced by 1.8 times compared to the control group (relative risk 1.8, p=0.001). This study highlights a significant improvement in dyspnea degree and exacerbation incidence in COPD patients with the combination of protein supplementation and physical exercise. Therefore, adding chicken egg white intake could be beneficial for stable COPD patients practicing physical exercises.

Burden of Uncontrolled Severe Asthma With and Without Elevated Type-2 Inflammatory Biomarkers

Many patients with asthma have type-2 airway inflammation, identified by the presence of biomarkers, including history of allergy, high blood eosinophil (EOS) count, and high fractional exhaled nitric oxide levels. To assess disease burden in relation to type-2 inflammatory biomarker status (history of allergy, blood EOS count, and fractional exhaled nitric oxide level) in patients with uncontrolled and controlled severe asthma in the NOVEL observational longiTudinal studY (NOVELTY) (NCT02760329). Asthma diagnosis and severity were physician-reported. Control was defined using Asthma Control Test score (uncontrolled <20, controlled ≥20) and/or 1 or more severe physician-reported exacerbation in the previous year. Biomarker distribution (history of allergy, blood EOS count, and fractional exhaled nitric oxide level), symptom burden (Asthma Control Test score, modified Medical Research Council dyspnea scale), health status (St George's Respiratory Questionnaire score), exacerbations, and health care resource utilization were assessed. Of 647 patients with severe asthma, 446 had uncontrolled and 123 had controlled asthma. Among those with uncontrolled asthma, 196 (44%) had 2 or more positive biomarkers, 187 (42%) had 1 positive biomarker, 325 (73%) had low blood EOS, and 63 (14%) were triple-negative. Disease burden was similarly high across uncontrolled subgroups, irrespective of biomarker status, with poor symptom control (Asthma Control Test score 14.9-16.6), impaired health status (St George's Respiratory Questionnaire total score 46.7-49.4), clinically important breathlessness (modified Medical Research Council grade ≥2 in 47.3%-57.1%), and 1 or more severe exacerbation (70.6%-76.2%). Type-2 inflammatory biomarkers did not differentiate disease burden in patients with severe asthma. Patients with low type-2 inflammatory biomarker levels have few biologic therapy options; their needs should be addressed.

Investigation of the Effects of Remote Online Exercise Training in Individuals Self-Isolating at Home Due to COVID-19 Disease: A Randomized Controlled Study

Objective: Effectiveness of a 4-week telerehabilitation program including thoracic expansion exercises (TEE), non-specific general body exercises (NSGBE), and physical activity recommendations (PAR) which started at quarantine in individuals with acute mild-COVID-19 was investigated in current study. Methods: This is a randomized controlled study which was performed between May 2021 and February 2022. Adult individuals with acute mild-COVID-19 were randomly grouped as training (TG) (telerehabilitation program under supervision for 3 days/week) and control (CG) (home program including TEE and PAR). Dyspnea (Modified Borg Scale and Modified Medical Research Council Dyspnea Scale), chronic fatigue (Checklist Individual Strength Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), balance (Berg Functional Balance Scale) and lower body strength (a 30-s chair stand test) were evaluated remotely in the individuals before and after a 4-week follow-up. Results: Baseline characteristics and balance scores were similar between groups (p&gt;0.05). After 4-week from baseline, there were no significant differences in dyspnea, chronic fatigue, anxiety, depression, balance, and lower body strength between the groups (p&gt;0.05). However, as dyspnea, chronic fatigue, anxiety, and depression scores decreased, lower body strength increased significantly within TG after follow-up (p&lt;0.05). Dyspnea, chronic fatigue, and anxiety scores decreased while lower body strength increased significantly within CG after follow-up (p&lt;0.05). Conclusion: Dyspnea, severe fatigue, anxiety, and depression are commonly observed in individuals with mild-COVID-19 in the acute period. In these individuals, dyspnea perception, chronic fatigue, anxiety, depression, and functional performance improve after a 4-week light-intensity online tele-program applied either supervised or unsupervised. Mild exercises and PAR are safe and effective in these individuals.

Patient-reported outcome measures in severe asthma: an expert consensus

Objective The study aimed to reach a consensus on the most relevant patient-reported outcomes (PROs), the corresponding measures (PROMs), and measurement frequency during severe asthma patient follow-up. Methods Two Delphi rounds were conducted. The questionnaire was developed based on a systematic literature review, a focus group with patients, and a nominal group with experts. It assessed PROs’ relevance and the appropriateness (A) and feasibility (F) of PROMs using a Likert scale (1=totally agree; 9=totally disagree). The consensus was established when ≥75% of participants agreed (1-3) or disagreed (7-9). Results Sixty-three professionals (25 hospital pharmacists, 14 allergists, 13 pulmonologists, and 11 nurses) and 5 patients answered the Delphi questionnaire. A consensus was reached on all PROs regarding their relevance. Experts agreed on the use of ACT (A:95.24%; F:95.24%), mini AQLQ (A:93.65; F:79.37%), mMRC dyspnea scale (A:85.71%; F:85.71%), TAI (A:92.06%; F:85.71%), MMAS (A:75.40%; F:82%), and the dispensing register (A:96.83%; F:92.06%). Also considered suitable were: SNOT-22 (A:90.48%; F:73.80%), PSQI (A:82.54; F:63.90%), HADS (A:82.54; F:64%), WPAI (A:77.78%; F:49.20%), TSQM-9 (A:79.37; F:70.50%) and knowledge of asthma questionnaire (A:77%; F:68.80%); however, their use in clinical practice was considered unfeasible. Panelists also agreed on the appropriateness of EQ-5D, which was finally included despite being considered unfeasible (A: 84.13%; F:67.20%) in clinical practice. Agreement was reached on using ACT, TAI, mMRC, and a dispensing register every three months; mini-AQLQ and MMAS every six months; and EQ-5D every twelve months. Conclusion This consensus paves the way toward patient-centered care, promoting the development of strategies supporting routine assessment of PROs in severe asthma management.

Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease.

Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software. Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.

Individualised monitoring programme for pulmonary rehabilitation of patients with chronic obstructive pulmonary disease-study protocol for a randomised controlled trial.

Chronic obstructive pulmonary disease (COPD) is characterised mainly by exertional dyspnoea, which may lead to activity reduction. Pulmonary rehabilitation (PR) is considered capable of mitigating these impairments. However, access to PR is limited to specialised centres, especially during the coronavirus disease 2019 pandemic. Moreover, low-cost home rehabilitation programmes have non-individualised prescriptions, which might lead to inconsistent clinical effects in patients with COPD. Therefore, it is important to develop new, low-cost protocols involving individualised prescriptions and staff supervision. This is a descriptive protocol for a randomised controlled study at the Grade III A Hospital in Tianjin. The sample size was calculated according to a described formula. Fifty-six participants will be selected and randomly allocated into two groups: (I) control (traditional PR training, medication, and nursing interventions); and (II) intervention [PR training in the hospital and at home by the Cardiopulmonary Rehabilitation System Management Platform (CSM)]. The protocol will be performed twice a week for 8 consecutive weeks in the outpatient clinic, and the training will be performed by the application of the CSM system in the final 6 months of the trial. The study will assess lung function and physical fitness and analyse the scores of the modified Medical Research Council Dyspnoea Scale, the COPD assessment test, the International Classification of Functioning, Disability, and Health, and the 6-minute walk test before and after the training protocol. Comparison of differences will be performed using repeated measures analysis of variance, a linear mixed effects analysis, or a non-parametric test, which will include only participants who completed all outcome measures and followed the intervention protocol. The study results will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals. The new, low-cost supervised rehabilitation programmes are expected to present positive results, making PR programmes more accessible and effective for patients with COPD. The study was registered in the Chinese Clinical Trial Registry: ChiCTR2000040723.