Dyspnea Score Research Articles

Effect of Dyspnea, Quality of Life, and Well-being in Postacute COVID-19 Patients: A Prospective Cohort Study

ABSTRACT Context: The persistence of respiratory symptoms beyond 4 weeks otherwise known as postacute COVID-19 symptoms has been reported to significantly affect the clinical outcome, quality of life (QOL), and well-being of patients’ postinfection. Aims: The study aims to determine the pattern of postacute COVID-19 dyspnea symptoms, QOL, and well-being and its association at month 1 and 6 following COVID-19 infection. Settings and Design: A prospective cohort study of two COVID-19 hospitals in Malaysia was conducted. Subjects and Methods: Patients were followed up from admission, discharge, and 6 months after. A standard questionnaire assessed demographics, Modified Medical Research Council (mMRC) dyspnea score, QOL EQ-5D-5L scale (mobility, ability to self-care, ability to perform usual activity, pain, and anxiety), and the World Health Organization (WHO)-5 well-being index. Statistical Analysis Used: Wilcoxon signed-rank, Kruskal–Wallis, and Pearson correlation tests were used. Results: The mMRC, ED-5D-5L, and WHO-5 scores worsened during admission and slowly resolved over the 6 months (n = 388). mMRC scores positively correlated with EQ-5D-5L scores for mobility, self-care, ability to perform usual activity, pain, and anxiety (visit 1 and 6, P = 0.00) during the 1st and 6th months. Higher mMRC and EQ-5D-5L scores indicate worsening dyspnea and QOL. mMRC demonstrated a negative correlation with WHO-5 scores (visit 1: r = −0.30 and visit 6: r = −0.39, P = 0.00), which indicated worsening dyspnea and lower mental well-being. A higher WHO-5 well-being index was associated with lower EQ-5D-5L scores (visit 1 and 6, P = 0.00), demonstrating lowered patient’s well-being with worsening QOL. Conclusions: As such, appropriate health-care support and monitoring of patients, postdischarge is essential to optimize patient outcome.

Effect of yoga-based exercises on functional capacity, dyspnea, quality of life, depression, anxiety, and sleep of infected healthcare workers during the COVID-19 pandemic: A prospective clinical trial.

The study aimed to investigate the effect of yoga-based exercises on functional capacity, dyspnea, quality of life, depression, anxiety, and sleep quality following coronavirus disease 2019 (COVID-19). Forty-one COVID-19-infected healthcare professionals (35 females, 6 males; mean age: 39.7±6.5 years; range, 28 to 55 years) who were actively working during the subacute period were included in the prospective controlled study between March 2021 and September 2021. The participants were divided into two groups: the yoga-based exercise group (YBEG; n=26) and the nonintervention group (n=15). Besides routine recommendations, the YBEG performed stretching, relaxation, isometric strengthening, breathing, and meditation exercises of 60 min twice a week for eight weeks. Clinical outcome was measured with flexibility tests (shoulder flexibility and sit and reach tests), hand grip strength, 6-min walk test, dyspnea score, Beck Depression and Anxiety Inventory, Short Form 36 (SF-36) quality of life, Pittsburgh sleep quality index (PSQI), and the International Physical Activity Questionnaire (IPAQ) before and after eight weeks in both groups. Beck anxiety scores, IPAQ scores, PSQI, SF-36 pain, and social functioning subparameters were positively statistically significant in the YBEG (p<0.05). The only parameter found to be insignificant in time and between groups was the SF-36 mental health subparameter (p>0.05). In addition, the YBEG had significant improvements in muscle strength, flexibility, functional capacity, physical activity level, quality of life, anxiety, depression levels, and sleep scores between before and after the eight-week intervention period (p<0.05). Yoga programs have led to an increase in functional capacity and physical performance, a decrease in anxiety and depression complaints, and an increase in the quality of life in healthcare professionals who were in the process of returning to work during the post-COVID-19.

Outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema

Background: This study aims to evaluate the outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema. Methods: Between February 2016 and March 2019, a total of 20 severe emphysema patients (19 males, 1 female; mean age: 65.2±5.2 years; range, 52 to 73 years) who underwent bronchoscopic lung volume reduction coil treatment were included. Each patient underwent pre- and post-treatment (6 and 12 months) pulmonary function tests, 6-min walking distance, modified Medical Research Council dyspnea scores, and diffusing capacity of the lung for carbon monoxide tests. Results: An mean number of 12.0±3.8 coils was placed in each lobe. There were significant improvements in the patients' pulmonary function tests and quality of life 12 months after the treatment. There was a significant difference in dyspnea as assessed by the modified Medical Research Council dyspnea scores 12 months after treatment compared to pre-treatment scores (p&lt;0.05). There was no change in the pulmonary function tests six months after treatment, while a significant improvement was seen at 12 months (p&lt;0.05). Conclusion: Bronchoscopic lung volume reduction coil treatment seems to be a promising modality for severe emphysema patients with significant improvements in the pulmonary function test results, modified Medical Research Council dyspnea scores, and 6-min walking distance.

Two-year cardio-pulmonary follow-up after severe COVID-19: a prospective study

Short- and medium-term cardio-pulmonary sequelae after COVID-19 have been extensively studied. However, studies with longer follow-ups are required. This study aims to identify and characterise cardio-pulmonary sequelae, in patients hospitalised for SARS-CoV-2 pneumonia, at 24 months follow-up. This is a prospective, observational cohort study conducted on consecutive patients hospitalised for COVID-19 and acute respiratory failure. Patients were followed up at 24 months with complete pulmonary function tests (PFTs), 6-min walking test and a dyspnoea score (Modified Medical Research Council scale). A subgroup of patients with at least one clinical or functional sign suggestive of increased pulmonary pressures also underwent transthoracic echocardiography (TTE) to evaluate the presence of direct or indirect signs of pulmonary hypertension (PH). Ninety consecutive patients (74% men, median age 59.1 years) were enrolled in the study. In regard to PFTs, carbon monoxide diffusion capacity (DLCO) impairment was observed in 23 cases (26%), in all cases of mild entity. When considering the dyspnoea, 30 (34%) patients showed some degree of breathlessness. Forty patients underwent TTE. No patients had overt PH or chronic thromboembolic PH. However, all patients showed a hyperdynamic state of the right ventricle, and 8 (20%) patients had a decreased acceleration time on pulmonary valve, signs of increased pulmonary vasculature resistances and afterload elevation. At 24-month follow-up after severe COVID-19, DLCO and TTE prove to be the most sensitive tool to detect cardio-pulmonary sequelae. Dyspnoea is still present in about one-third of patients and requires a multidisciplinary approach.

The incidence of deep venous thrombosis in Parkinson’s disease

ABSTRACT Introduction Venous thromboembolism is one of the causes of sudden death in Parkinson’s Disease (PD). Few studies have investigated the correlation between PD and deep venous thrombosis (DVT). This study aimed to investigate the frequency of DVT in PD patients prospectively. Material and Method Demographic characteristics of 37 PD patients without known risk factors for DVT, disease duration, Hoehn-Yahr (H – Y) stage, oxygen saturation (SpO2) and heart rate values with pulse oximetry, use of assistive devices, waist and knee circumference measurements, and modified Medical Research Council (mMRC) dyspnea score was recorded. Both legs were evaluated for thrombus by Doppler venous ultrasound (US). Results With the H-Y stage of the disease duration, a positive correlation was determined between the H-Y stage and mMRC. Disease duration was negatively correlated with BMI and positively correlated with the need for assistance. Assistive device use was positively associated with age and mMRC. DVT was detected in only one patient. When our patients’ files were reviewed after 1.5 years, one patient was hospitalized with the diagnosis of submassive pulmonary embolism. Conclusion Attention should be paid to the development of DVT in elderly patients with advanced stages of PD, progression in the H-Y stage, use of assistive devices, and progression in dyspnea scoring. There is also a need for studies on the benefit of DVT prophylaxis in PD patients with a high risk of venous thromboembolism.

Frailty phenotype in chronic obstructive pulmonary disease patients: prevalence and relation to disease severity

Frailty is considered a high risk for falls, disability, hospitalization, and mortality in geriatric and certain chronic-disease populations. So, this study was planned to determine the prevalence of frailty phenotype in Chronic obstructive pulmonary disease (COPD) patients. Methods. 70 stable COPD patients were included in this study. Age, comorbidities (The FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale, BODE index, and modified Medical Research Council dyspnea score (mMRC) were recorded. In addition, each patient performed the Six-minute walk test (6-MWT) and underwent a pulmonary function test. Results. Frailty was detected in 37.3% of studied patients. However, 43.1% were classified as pre-frail. The presence of frailty was not significantly associated with the age of studied patients (p = 0.7). Comorbidities were significantly associated with frailty (p = 0.009). Also, the BODE index was significantly higher among patients with frailty (p &lt; 0.001). Frailty was significantly associated with forced expiratory volume in 1 second, residual lung volume/Total Lung Capacity, and GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification of COPD (p = 0.001; p = 0.003; p = 0.003 respectively). Frailty was significantly associated with 6-MWD and Borg scale difference (Lowest 6-MWD, highest Borg scale difference were detected in frail patients (p = 0.008; p = 0.001). Conclusion. Frailty is frequent among COPD patients. The presence of frailty is related to disease severity and functional impairment. Evaluation of frailty should be considered as a part of COPD assessment in clinical practice.

Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years.

The validated Incremental Shuttle Walk Test (ISWT) is widely used for evaluating maximal exercise capacity, with the distance-walked (IWSD) as the primary outcome. However, there are no normative reference values (NRV) and reference equations to predict ISWD for the Singaporean population. This study aims to establish the NRV and reference equations for ISWD in healthy Singaporeans aged 21 to 80 and investigate the determining variables during ISWT. This cross-sectional study recruited community-dwelling healthy subjects aged 21-80 from the community via convenience sampling. Each subject completed two trials of the ISWT according to the standard protocol. Variables measured during the trials included ISWD, pre-and post-test heart rate (HR), oxygen saturation, blood pressure (BP), modified Borg's dyspnoea score and Borg's rate of perceived exertion (RPE). 199 healthy Singaporean (females = 114, males = 85) participated in the study. The overall median ISWD was 660.0 metres (m) [interquartile range (IQR):440.0-850.0]. The age-stratified mean ISWD ranged from 430.0 m (IQR:350.0-450.0) (aged 60-80) to 480.0 m (IQR:438.0-650.0) (aged 40-59) to 780.0 m (IQR:670.0-960.0) (aged 21-39). Gender, age, weight, height and HR change (highest post-test HR minus pre-test HR) were the most significant variables (p < 0.001). IWSD (m) = 651.4(Height, m) +89.7(Gender, male = 1; female = 0) -6.31(Age, years) -3.61(Weight, kilograms) +2.54(HR change, beats per minute); R2 = 0.741. Previously published ISWT reference equations cannot accurately predict the ISWD in the Singaporean population. This study investigated the ISWD NRV and established reference equations for healthy Singaporeans aged 21-80. The information would be beneficial in setting performance benchmarks to guide physical assessment, intervention and rehabilitation.

Changes in diaphragm thickness and 6-min walking distance improvement after inspiratory muscle training in patients with chronic obstructive pulmonary disease: Clinical trial

AimInspiratory muscle training (IMT) improves respiratory muscle function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD), but the detailed mechanism is unclear. The purpose of this study is to elucidate the mechanism of functional improvement by IMT from P0.1, an index of respiratory central output, and thickness of diaphragm (Tdi), a noninvasive and reliable ultrasound examination. MethodsThis clinical trial study enrolled 13 elderly patients with COPD. IMT was performed using the POWER breathe® Medic Plus breathing trainer in combination with each participant's outpatient rehabilitation regimen. Starting at 20% of the maximal inspiratory pressure (PImax) and increasing to 50%, the participants performed 30 IMT repetitions twice a day for 2 months. P0.1 is the value of airway-occlusion pressure at 0.1 s after the start of inspiratory flow, and Tdi was measured at rest and maximal breathing. ResultsPImax and 6-min walking distance(6MWD) significantly increased after training. Tdi at resting inspiration and expiration, and maximal inspiration also significantly increased after training. In addition, the Borg Scale scores for dyspnea and leg fatigue and the respiratory rate of the 1-min recovery period after the 6MWD significantly decreased. There was no significant difference in P0.1. ConclusionsThese results suggest that the effects of IMT may be attributed to the improved peripheral factors rather than to the central factors in elderly COPD patients.

Systemic Determinants of Exercise Intolerance in Patients With Fibrotic Interstitial Lung Disease and Severely Impaired DLCO.

The precise mechanisms driving poor exercise tolerance in patients with fibrotic interstitial lung diseases (fibrotic ILDs) showing a severe impairment in single-breath lung diffusing capacity for carbon monoxide (DLCO < 40% predicted) are not fully understood. Rather than only reflecting impaired O2 transfer, a severely impaired DLCO may signal deranged integrative physiologic adjustments to exercise that jointly increase the burden of exertional symptoms in fibrotic ILD. Sixty-seven subjects (46 with idiopathic pulmonary fibrosis, 24 showing DLCO < 40%) and 22 controls underwent pulmonary function tests and an incremental cardiopulmonary exercise test with serial measurements of operating lung volumes and 0-10 Borg dyspnea and leg discomfort scores. Subjects from the DLCO < 40% group showed lower spirometric values, more severe restriction, and lower alveolar volume and transfer coefficient compared to controls and participants with less impaired DLCO (P < .05). Peak work rate was ∼45% (vs controls) and ∼20% (vs DLCO > 40%) lower in the former group, being associated with lower (and flatter) O2 pulse, an earlier lactate (anaerobic) threshold, heightened submaximal ventilation, and lower SpO2 . Moreover, critically high inspiratory constrains were reached at lower exercise intensities in the DLCO < 40% group (P < .05). In association with the greatest leg discomfort scores, they reported the highest dyspnea scores at a given work rate. Between-group differences lessened or disappeared when dyspnea intensity was related to indexes of increased demand-capacity imbalance, that is, decreasing submaximal, dynamic ventilatory reserve, and inspiratory reserve volume/total lung capacity (P > .05). A severely reduced DLCO in fibrotic ILD signals multiple interconnected derangements (cardiovascular impairment, an early shift to anaerobic metabolism, excess ventilation, inspiratory constraints, and hypoxemia) that ultimately lead to limiting respiratory (dyspnea) and peripheral (leg discomfort) symptoms. DLCO < 40%, therefore, might help in clinical decision-making to indicate the patient with fibrotic ILD who might derive particular benefit from pharmacologic and non-pharmacologic interventions aimed at lessening these systemic abnormalities.

Management of Moderate Ischemic Mitral Regurgitation in Patients Undergoing Surgical Revascularization

Abstract Background Chronic ischemic mitral regurgitation (IMR) is not uncommonly seen in association with patients diagnosed with coronary artery disease and represents a late sequel of chronic myocardial ischemia and infarction. It adversely affects cardiovascular mortality and morbidity especially in patients undergoing coronary artery bypass grafting (CABG) surgery. We aim to identify the optimal management of moderate IMR in patients undergoing coronary artery bypass grafts surgery (CABG), whether to address this pathology during revascularization surgery or not. Methods 100 patients diagnosed with Ischemic Heart Disease (IHD) associated with moderate IMR undergoing Coronary Artery Bypass Grafting (CABG). Patients were divided into two equal groups according to their Mitral valve intervention: Group A; 50 Patients with IMR planned for complete revascularization only and Group B; 50 patients planed for revascularization combined with mitral valve surgery. The two groups were compared demographically, for intraoperative and post-operative events. The primary end point was hospital mortality, secondary end points included post-operative improvement in the NYHA functional class, improvement of EF % and reduction of LV dimensions in post-operative echocardiography and finally, the incidence of neurological dysfunction in both groups. Results All the patients in both groups underwent CABG surgery using cardiopulmonary bypass machine. Patients in group B underwent combined Mitral valve surgery in the form of; Mitral valve replacement using a mechanical valve in 7 patients, Mitral valve repair with downsizing annuloplasty surgery using complete semi-rigid ring in 43 patients, of which 13 patients required additional chordal repair with artificial chordea. Group (A) patients were found to have statistically significant shorter total bypass time 72.2± 17.6 vs 113.5± 14.3 (p &amp;lt; 0.001), ischemic time 47.4 min ± 12.1 vs 79.7 min ± 12.3 (p &amp;lt; 0.001), mechanical ventilation duration 10.9 hours ±14.9 vs 14.9 hours ±12.1 (p &amp;lt; 0.001), total period of ICU stay was 46.1 hours ±21.2 vs 63.7 hours ±22.2 and ward stay 5.7 days ±2.3 vs 6.8 days ±2.9 vs (p &amp;lt; 0.001) in group A vs group B respectively. Hospital mortality was insignificant between the 2 groups [(5 patients in group A (10%) vs 4 patients in group B (8%) P = 0.84)]. One month post-surgery, all survivors showed improvement of their ejection fraction and reduction in left ventricular and left atrial dimensions in Transthoracic echo however, there were no statistical significant improvement when comparing patients in both groups. Both groups showed similar improvement in Dyspnea score at one month follow up. Neurological insults were comparable in both groups (none vs one patient in group A vs B simultaneously. Conclusion Addition of mitral-valve surgery to CABG in patients with moderate degree of Ischemic Mitral regurgitation did not show significant benefit on survival, post-operative NYHA class of the patients, the echocardiographic findings or stroke incidence during the short term follow up. On the contrary, it resulted in longer durations of cardiopulmonary bypass, aortic cross-clamp time and longer ICU stay. Longer term follow-up is required to identify its potential benefit.

Clinicoradiological outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease.

Interstitial lung disease (ILD) is relatively common in patients with lung cancer with an incidence of 7.5%. Historically pre-existing ILD was a contraindication to radical radiotherapy owing to increased radiation pneumonitis rates, worsened fibrosis and poorer survival compared with non-ILD cohorts. Herein, the clinical and radiological toxicity outcomes of a contemporaneous cohort are described. Patients with ILD treated with radical radiotherapy for lung cancer at a regional cancer centre were collected prospectively. Radiotherapy planning, tumour characteristics, and pre- and post-treatment functional and radiological parameters were recorded. Cross-sectional images were independently assessed by two Consultant Thoracic Radiologists. Twenty-seven patients with co-existing ILD received radical radiotherapy from February 2009 to April 2019, with predominance of usual interstitial pneumonia subtype (52%). According to ILD-GAP scores, most patients were Stage I. After radiotherapy, localised (41%) or extensive (41%) progressive interstitial changes were noted for most patients yet dyspnoea scores (n = 15 available) and spirometry (n = 10 available) were stable. One-third of patients with ILD went on to receive long-term oxygen therapy, which was significantly more than the non-ILD cohort. Median survival trended towards being worse compared with non-ILD cases (17.8 vs 24.0 months, p = 0.834). Radiological progression of ILD and reduced survival were observed post-radiotherapy in this small cohort receiving lung cancer radiotherapy, although a matched functional decline was frequently absent. Although there is an excess of early deaths, long-term disease control is achievable. For selected patients with ILD, long-term lung cancer control without severely impacting respiratory function may be possible with radical radiotherapy, albeit with a slightly higher risk of death.

Parenteral treprostinil induction for rapid attainment of therapeutic doses of oral treprostinil

RationaleOral treprostinil slows disease progression and improves exercise capacity in pulmonary arterial hypertension; however, titration can be prolonged. Published data suggests prostacyclin-naïve patients achieve total daily oral treprostinil doses of about 6 mg by Week 16, while those on prior parenteral treprostinil reach higher doses at the same timepoint. ObjectivesEXPEDITE (NCT03497689), a single-arm, multicenter study, assessed the efficacy of rapid parenteral treprostinil induction to quickly reach higher doses of oral treprostinil for the treatment of pulmonary arterial hypertension. MethodsParenteral treprostinil was titrated for 2–8 weeks, followed by cross-titration of oral treprostinil. The primary endpoint was percentage of patients reaching ≥12 mg daily of oral treprostinil at Week 16. Secondary endpoints included clinical changes from baseline to Week 16. ResultsTwenty-nine prostacyclin-naïve patients were included in efficacy analyses. At Week 16, the mean daily oral treprostinil dose was 16.4 mg; 79% of patients met the primary endpoint. From baseline to Week 16, median REVEAL Lite 2 score improved (decreased) from 6 to 3.5 (p = 0.0006). Statistically significant improvements were also seen in World Health Organization Functional Class, N-terminal-pro brain natriuretic peptide levels, 6-minute walk distance, right atrial area, Borg Dyspnea Score, and emPHasis-10 score. Favorable trends were seen in risk stratification, echocardiography parameters, disease symptoms, and treatment satisfaction. ConclusionShort-course parenteral treprostinil induction resulted in oral treprostinil doses over twice those reported in de novo initiations and may be a useful approach to quickly achieve the therapeutic benefits of oral treprostinil.

Measure of lung dielectric proprieties in patients with Idiopathic Pulmonary Fibrosis: correlation with clinical, radiological and pulmonary functional parameters

BackgroundDielectric properties of biological tissues are biophysical parameters; in lung they change with amount of air, blood and parenchyma. Remote Dielectric Sensing (ReDS™) technology measures dielectric properties of lung tissues quantifying the content of fluids inside the scan volume. We aimed to evaluate the reliability of ReDS™ measure in Idiopathic Pulmonary Fibrosis (IPF) patients and in healthy volunteers, and to investigate the correlation of ReDS™ score with clinical, radiological and functional parameters. MethodsWe conducted a prospective observational study, including 52 patients with diagnosis of IPF and 17 healthy volunteers; for each patient we recorded: complete functional evaluation, dyspnoea score (mMRC scale), Usual Interstitial Pneumonia (UIP) Computed Tomography (CT) pattern (UIP definite or probable) and ReDS™ measure (expressed in %). ResultsReDS™ measure was reported as correct both in patients and controls, the firsts with higher scores (33.8% vs 29.1%, p = 0.003). In IPF patients we observed a significant inverse correlation with ReDS™ score and Forced Vital Capacity (FVC), Vital Capacity (VC) and Total Lung Capacity (TLC) measures and, when we considered only patients with UIP definite CT pattern, the correlation was inverse with FVC, VC, TLC, DLCO. In IPF patients the higher was mMRC dyspnoea index, the higher was ReDS™ score. No significant correlations were observed between ReDS™ score and functional parameters in healthy controls. DiscussionWe demonstrated a correlation of ReDS™ scores with some functional (mainly indicative or diagnostic for restriction) and clinical parameters in IPF patients; the score was correlated with density of tissues possibly quantifying tissue fibrosis in IPF patients.

Automated O2 Titration Alone or With High-Flow Nasal Cannula During Walking Exercise in Chronic Lung Diseases.

Exercise-induced O2 desaturation contributes to dyspnea and exercise intolerance in various respiratory diseases. This study assessed whether automated O2 titration was superior to fixed-flow O2 to improve exertional dyspnea and walking exercise endurance. We also aimed at evaluating possible additive effects of high-flow nasal cannula coupled with automated O2 titration on these outcomes. Subjects with chronic respiratory diseases and exercise-induced desaturation performed a 3-min constant-speed shuttle test (CSST) and an endurance shuttle walking test (ESWT) with either (1) fixed-flow O2, (2) automated O2 titration targeting an SpO2 of 94% (± 2%), and (3) automated O2 titration + high-flow nasal cannula according to a randomized sequence. The main outcome was Borg dyspnea score at the end of the 3-min CSST. Secondary outcomes included endurance time and dyspnea during ESWT and oxygenation status during exercise. Ten subjects with COPD, 10 with interstitial lung disease, 5 with pulmonary hypertension, and 3 with cystic fibrosis completed the study. Compared to fixed-flow O2, automated O2 titration did not reduce dyspnea at the end of the 3-min CSST. Endurance time during the ESWT was prolonged with automated O2 titration (mean difference 298 [95% CI 205-391] s, P < .001), and dyspnea at isotime was reduced. No further improvement was noted when high-flow nasal cannula was added to automated O2 titration. Compared to fixed-flow O2, O2 flows were higher with automated O2 titration, resulting in better oxygenation. Automated O2 titration was superior to fixed-flow O2 to alleviate dyspnea and improve exercise endurance during the ESWT in subjects with a variety of chronic respiratory diseases. Adding high-flow nasal cannula to automated O2 titration provided no further benefits.

SABR for Early Non-Small Cell Lung Cancer: Changes in Pulmonary Function, Dyspnea, and Quality of Life

The aim of this study is to report pulmonary function tests (PFTs), clinician-reported and patient-reported QoL outcomes on a cohort of NSCLC patients treated with SABR. 119 patients with NSCLC were treated with SABR in the prospective cohort SSBROC study of patients with T1-T2N0M0 NSCLC. PFTs and quality of life measures were obtained at baseline pre-treatment and 6 monthly. Here we report on the 6- to 18-month time points. ANCOVA methods adjusting for baseline analysed potential predictors on outcomes of PFT and patient-reported dyspnoea at 18 months. The only statistically significant decline in PFTs was seen in FEV1 at 18 months post-SABR with a decline of -0.11L (p = 0.0087, 95% CI -0.18 to -0.02). Of potential predictors of decline, only a 1 unit increase in smoking pack years resulted in a -0.12 change in DLCO (p = 0.026, 95% CI -0.02 to -0.23) and a 0.003 decrease in FEV1 (p = 0.026, 95% CI -0.006 to -0.0004). For patient reported outcomes, statistically significant worsening in both QLQC30 and QLQLC13 dyspnoea scores occurred at the 18-month time point, but not earlier. No potential predictors of worsening dyspnoea were statistically significant. There was no statistically significant decline in clinician-reported outcomes or global QoL scores. We found a statistically significant decline in FEV1 at 18 months post-treatment. Smoking pack years was a predictor for decline in DLCO and FEV1 at 18 months. Worsening of patient-reported dyspnoea scores was observed, consistent with the expected progression of lung co-morbid disease.

Inhaled Maintenance Therapy in the Follow-Up of COPD in Outpatient Respiratory Clinics. Factors Related to Inhaled Corticosteroid Use. EPOCONSUL 2021 Audit

ObjectiveThe aim of this analysis was to describe the patterns of inhaled maintenance therapy according to risk level and to explore the determinants associated with the decision to prescribe inhaled corticosteroids (ICS) in addition to bronchodilator therapy according to risk level as strategy in the follow-up of COPD in daily clinical practice. MethodsEPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021 and January 31, 2022. Results4225 patients from 45 hospitals in Spain were audited. Risk levels were analyzed in 2678 patients. 74.5% of patients were classified as high risk and 25.5% as low risk according to GesEPOC criteria. Factors associated with the prescription of ICS in low-risk COPD were symptoms suggestive of asthma [OR: 6.70 (3.14–14.29), p<0.001], peripheral blood eosinophilia>300mm3 [OR: 2.16 (1.10–4.24), p=0.025], and having a predicted FEV1%<80% [OR: 2.17 (1.15–4.08), p=0.016]. In high-risk COPD, factors associated with triple therapy versus dual bronchodilator therapy were a mMRC dyspnea score of ≥2 [OR: 1.97 (1.41–2.75), p<0.001], symptoms suggestive of asthma [OR: 6.70 (3.14–14.29), p<0.001], and a predicted FEV1%<50% [OR: 3.09 (1.29–7.41), p<0.011]. ConclusionsInhaled therapy in the follow-up of COPD does not always conform to the current guidelines. Few changes in inhaled therapy are made at follow-up visits. The use of ICS is common in COPD patients who meet low-risk criteria in their follow-up and triple therapy in high-risk COPD patients is used as an escalation strategy in patients with high clinical impact. However, a history of exacerbations and eosinophil count in peripheral blood were not factors predicting triple therapy.

Pulmonary Rehabilitation for Chronic Lung Diseases.

Chronic Obstructive Pulmonary Disease (COPD) is now the main cause of disability in the developed world. The advance of COPD is related to increasing breathlessness, disability, and periodic hospitalizations. An aging population in the developed world and increasing cigarette consumption in developing countries expand the global impact of this condition. The disorder associated with COPD leads to a decrease in physical activity and failure of functional independence.&#x0D; The aim of this study was to evaluate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity.&#x0D; The mean FEV1/FVC was 59.4± 14.1%, and the mean FEV1 was 64.8± 23.0% as expected. Most topics had mild to moderate COPD. The PImax and PEmax were normal. These subjects had no previous participation in home-based or hospital-based PR. All the subjects had normal maximal V˙O2 and work rate before PR.&#x0D; After PR there were still considerable improvements in maximal V˙O2 (mean increase of 101.3 mL/min, p &lt;0.001) and work rate (mean increase of 8.2 watts, p&lt;0.001). Ventilation, heart rate, and mean blood pressure were constant following PR. The maximum oxygen pulse at maximum exercise was significantly increased with PR (p&lt;0.02). The SpO2 and end-tidal PCO2 at peak exercise did not significantly improve after PR.&#x0D; Although dyspnea scores at rest were low and did not improve significantly with PR, dyspnea at end-exercise was significantly improved after PR (p=0.01). PR should be the responsibility of the clinical management of patients with COPD, even for those with normal exercise capacity. However, the benefits of disease progression, hospitalization, and survival for these patients remain unknown.&#x0D; The main role in the management of any chronic disease, including lung disease, is to improve the quality of life (QL) in patients.&#x0D; Conclusion; Although strongly recommended by scientific societies pulmonary rehabilitation programs still need to be more widely implemented. PR programs have shown a high level of evidence of benefits in chronic respiratory patients, particularly those with COPD.

Spontaneous physical functional recovery after hospitalization for COVID-19: insights from a 1 month follow-up and a model to predict poor trajectory.

Long COVID syndrome has emerged as a new global healthcare challenge, with impaired physical performance being a prominent debilitating factor. Cardiopulmonary rehabilitation is a mainstay of management of symptomatic post-COVID patients, and optimization of candidate selection might allow for more effective use of available resources. In order to study the natural dynamics and to identify predictors of physical functional recovery following hospitalization for COVID-19, 6 min walk test was performed pre-discharge in 176 patients (40% hypertensive, 53% female, mean age 53.2 ± 13.5 years) with re-evaluation at 1 month. Six min walk distance and the reached percent of predicted distance (6MWD%) were suboptimal at both visits-396 ± 71 m (68.7 ± 12.4%) pre-discharge and 466 ± 65 m (81.8 ± 13.6%) at 1 month. Associated changes included significant oxygen desaturation (2.9 ± 2.5 and 2.3 ± 2.2%, respectively) and insufficient increment of heart rate during the test (24.9 ± 17.5 and 28.2 ± 12.0 bpm) that resulted in low reached percent of individual maximum heart rate (61.1 ± 8.1 and 64.3 ± 8.2%). Automatic clusterization of the study cohort by the 6MWD% changes has allowed to identify the subgroup of patients with poor "low base-low increment" trajectory of spontaneous post-discharge recovery that were characterized by younger age (38.2 ± 11.0 vs. 54.9 ± 12.1, p < 0.001) but more extensive pulmonary involvement by CT (43.7 ± 8.8 vs. 29.6 ± 19.4%, p = 0.029) and higher peak ESR values (36.5 ± 9.7 vs. 25.6 ± 12.8, p < 0.001). Predictors of poor recovery in multivariate logistic regression analysis included age, peak ESR, eGFR, percentage of pulmonary involvement by CT, need for in-hospital oxygen supplementation, SpO2 and mMRC dyspnea score pre-discharge, and history of hypertension. COVID-19 survivors were characterized by decreased physical performance pre-discharge as assessed by the 6 min walk test and did not completely restore their functional status after 1 month of spontaneous recovery, with signs of altered blood oxygenation and dysautonomia contributing to the observed changes. Patients with poor "low base-low increment" trajectory of post-discharge recovery were characterized by younger age but more extensive pulmonary involvement and higher peak ESR values. Poor post-discharge recovery in the study cohort was predictable by the means of machine learning-based classification model that used age, history of hypertension, need for oxygen supplementation, and ESR as inputs.

Prognostic value of the post-exercise heart rate recovery and BHDE-index in chronic obstructive pulmonary disease

BackgroundThe BODE index, consisting of body mass index (B), airflow obstruction (O), dyspnea score (D), and exercise capacity (E), can predict outcomes in COPD. However, when spirometry was restricted to prevent cross-infection such as COVID-19 pandemic, a modified index would be needed. Because cardiovascular dysfunction is associated with poor clinical outcomes in COPD, we conducted a novel BHDE-index by replacing spirometry with post-exercise heart rate recovery (HRR, H) and evaluated its predictive performance in this observational study.MethodsFrom January 2019 to December 2019, enrolled patients were analyzed as a derivation cohort for the setup of the model. This model was verified in another group of patients generated between January 2020 and December 2020, as the validation cohort. The post exercise HRR was defined as the difference of heart rate immediately after and 1 min after test cessation.ResultsA total of 447 patients with COPD were enrolled. Patients with abnormal HRR were older, with more severe airway obstruction, severe airway symptoms, faster resting heart rate, shorter 6-min walk distance and higher frequency of severe acute exacerbation in previous one year. The prediction performance of the BHDE-index for one-year severe COPD exacerbation was similar to that of the BODE-index in both the derivation and validation groups [area under the receiver operating characteristic curve (AUROC) 0.76 vs. 0.75, p = 0.369; AUROC 0.74 vs. 0.79, p = 0.05]. The prediction performance for 1 year mortality was also similar between BHDE-index and BODE-index in both cohorts [AUROC 0.80 vs. 0.77, p = 0.564; 0.76 vs. 0.70, p = 0.234]. Univariate and multivariate analyses also showed that the BHDE-index was an independent and important predictor of annual severe COPD exacerbation in the derivation and validation cohorts.ConclusionsThe BHDE-index is a good and easy-to-perform prediction model for the risk of severe acute exacerbation and 1-year mortality in COPD wherever spirometry results are unavailable.

Comparison of Exercise Capacity, Physical Activity Level and Peripheral Muscle Strength in Systemic Lupus Erythematosus Patients with Healthy Individuals

Abstract Background This study investigated physical activity, peripheral muscle strength, exercise capacity, sleep, fatigue, anxiety and depression in patients with systemic lupus erythematosus (SLE). Material and Methods Twenty-six patients with SLE, median age 32.5 (25–43) years, and 29 healthy individuals, median age 30 (23–32) years, were included. Exercise capacity (6-minute walk test (6MWT)), peripheral muscle strength (dynamometer), physical activity (Mi Band 4 smart band), fatigue (Fatigue Severity Scale (FSS)), anxiety and depression (Hospital Anxiety Depression scale (HAD)), quality of life (SLE-specific QOL scale (SLEQoL)) and sleep (Pittsburgh Sleep Quality Index (PSQI)) were assessed. Results Demographic characteristics were similar in both groups. 6MWT distance, peripheral muscle strength, physical activity level, SLEQoL and PSQI scores were significantly lower, while FSS and HAD scores were higher in patients with SLE (p&lt;0.05). Moreover, pre-test and post-test heart rates, dyspnea and fatigue severity scores were higher in patients with SLE than in healthy individuals (p&lt;0.05). Conclusion Patients with SLE had lower exercise capacity, muscle strength, physical activity, quality of life and sleep quality, along with more common fatigue, anxiety and depression. Strategies need to be developed to improve these symptoms in patients with SLE for a favourable outcome.