Hospital Respiratory Questionnaire Research Articles

Clinical study on the effect of Bi-level positive airway pressure therapy on COPD complicated with Anxiety and Depression.

To investigate the effect of bi-level positive airway pressure (BIPAP) therapy on chronic obstructive pulmonary disease (COPD) complicated with anxiety and depression. This is a retrospective study. One hundred patients with COPD complicated with anxiety and depression who were admitted to the Respiratory Department of The First Affiliated Hospital of Hebei North University from August 2021 to August 2022 were selected and randomly divided into two groups. Patients in the control group were given conventional symptomatic treatment, while those in the observation group were given BIPAP therapy in addition to the treatment in the control group. The two groups were compared and analyzed in terms of respiratory function indicators, the changes in the scores of St. George's Hospital Respiratory Questionnaire (SGRQ) and COPD assessment test (CAT), blood gas analysis indicators, the levels of serum neurokinin A (NKA), serum interleukin-6 (IL-6), and serum serotonin (5-HT), as well as the changes in the scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). After treatment, the levels of lung function indicators in both groups increased, SGRQ and CAT scores decreased, and pH levels remained unchanged. In addition, PaO2 levels increased, PCO2, 5-HT, NKA and IL-6 levels decreased, and HAMA and HAMD scores decreased. The improvement degree of each indicator in the observation group was superior to that in the control group. In the clinical treatment of COPD complicated with anxiety and depression, BIPAP boasts effective amelioration of lung function and relief of anxiety and depression symptoms, and its mechanism of action may have a close bearing on ameliorating the levels of 5-HT, NKA, and IL-6 in patients.

The double bronchodilation era: new capabilities in a new drug delivery device

A literature review presents the efficacy and safety of the new glycopyrronium bromide/formoterol fumarate (GP/FF) combination in the treatment of patients with chronic obstructive pulmonary disease according to the PINNACLE 1, 2, 3, 4 studies. There are 4 fixed LAMA/LABA combinations which used in world practice, as well as in Russia: vilanterol + umeclidinium bromide, glycopyrronium bromide + indacaterol, olodaterol + tiotropium bromide and aclidinium bromide + formoterol. The GP/FF combination also approved in Russia, is currently present in Global Initiative for Chronic Obstructive Lung Disease (GOLD). A new method of co-suspension delivery via the Aerosphere inhaler has been developed for this combination. The efficacy and safety in GP/FF MDI compared to its monocomponents and tiotropium bromide were assessed in phase III clinical trials PINNACLE 1, 2, 3, 4. The GP/FF combination showed an improvement in the morning and after 2 hours parameters of FEV1 compared to monocomponents and placebo. Data from PINNACLE studies showed an improvement in the quality of life associated with a decrease in compared with the baseline level of the overall score on the scale of the St. George’s Hospital Respiratory Questionnaire (SGRQ) in 24 weeks against those taking GP/FF in contrast to monocomponents and placebo. The use of GP/FF showed a significant reduction in theuse of salbutamol compared with placebo. A pooled analysis of PINNACLE 1, 2, 4 demonstrated that GP/FF improved lung functionand reduced the risk of COPD exacerbations compared with monocomponents and placebo. According to the results of the analysis, there was also no increase in the number of the most frequently recorded side effects.

A comparison between Qigong exercise and cycle ergometer exercise for the rehabilitation of chronic obstructive pulmonary disease: A pilot randomized controlled trial (CONSORT).

Background:Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is associated with significant morbidity and mortality. Exercise training confers health benefits to people with COPD. The purpose of this study was to compare differences in the rehabilitation of COPD between Qigong exercise (QE) and aerobic exercise using a cycle ergometer (CE).Methods:This study was a randomized single-blind controlled trial. Twenty six participants were recruited and randomized to either the Qigong group or the cycle ergometer group. Both interventions lasted 12 weeks and comprised a 30 minutes supervised training session performed twice a week, that is, 24 sessions in total. The primary outcome measure was the endurance capacity measured by the six-minute walk test (6MWT). The secondary outcome measures were the results of the St. George's Hospital Respiratory Questionnaire (SGRQ) and the COPD assessment test (CAT).Results:Participants in the group that performed aerobic exercise using a cycle ergometer had significantly improved 6MWT (P = .005), SGRQ (P = .029), and CAT (P = .018) results. Participants in the Qigong exercise group had significant changes in 6MWT (P = .033). However, the differences in 6MWT and SGRQ were not statistically significant between the 2 groups. The changes in CAT scores before and after the intervention were significantly different between the 2 groups (P = .020). There were no reports of adverse events during the course of the trial.Conclusions:There was no difference in the primary outcome between groups. In particular, QE and cycle ergometer exercise had similar rehabilitation effects on the improvement of the cardiopulmonary endurance and quality of life of chronic obstructive pulmonary disease patients. In addition, cycle ergometer exercise may lead to a better trend of improvement in the quality of life and can improve the severity of the clinical symptoms of chronic obstructive pulmonary disease.Trial registration:ChiCTR-TRC-14004404.

Fixed airflow obstruction in patients with asthma

According to international guidelines in recent years, it has been proposed that bronchial asthma (BA) with fixed airflow obstructions (FAO) be identified as a separate phenotype.The aimof the study was the clinical and functional characterization and identification of risk factors for the formation of the phenotype BA with FAO.Materials.We examined adult outpatients with BA (n = 432) and a combination of BA and chronic obstructive pulmonary disease (COPD) without exacerbation (n = 58). Anamnesis collection, objective examination, spirometry with the assessment of obstruction reversibility (spirograph 2120 Vitalograph, UK), atopic status assessment (skin samples or specific IgE in serum) were performed. The level of eosinophils and neutrophils in peripheral blood was determined (by the impedance method on the automatic haemoanalyzer). Nitric oxide of exhaled air was measured by a chemiluminescent gas analyzer (Logan 4100, UK). BA control and quality of life of patients were evaluated using the Russian language versions of the Asthma Control Questionnaire (ACQ-5) and the St. George's Hospital Respiratory Questionnaire (St. George's Respiratory Questionnaire – SGRQ) respectively. Statistical analysis was carried out using parametric and non-parametric methods using the application program package Statistica 10. The value of bilateral p < 0.05 was considered statistically significant.Results.Among patients with BA without COPD, the incidence of FAO was 31%, with the most frequent (60%) FAO was found in severe BA and less often – in the mild (7%) and medium (36%) course of the disease. Among patients with a combination of BA and COPD, a severe course of the disease prevailed – 77%. Patients with FAO were older and had a longer duration of disease. The presence of FAO was accompanied by lower rates of pulmonary function, a higher frequency of positive markers of eosinophilic inflammation, worse indicators of control over BA and quality of life, a higher need for “emergency” drugs and drugs to support the treatment of BA, including biological therapy, increased use of healthcare resources. The risk factors for FAO in patients with BA include the debut of BA under 25 years of age (odds ratio (OR) – 1.6), sensitization to ticks of house dust (OR – 1.8), passive smoking (OR – 6.5), suffered during the life of pneumonia (OR - 3.0).Conclusion. The combination of BA + FAO can be considered as a separate phenotype of the disease with a more severe course and less favorable prognosis.

Comparative effectiveness of 3 Traditional Chinese Medicine treatment methods for idiopathic pulmonary fibrosis: A systematic review and network meta-analysis protocol.

Introduction:The morbidity of idiopathic pulmonary fibrosis (IPF) was found in an increasing trend, progressive worsening of symptoms and deterioration in lung function tend to trigger off a lower quality of life (QoL). Only pirfenidone and nintedanib have been recommended in the guidelines, which can modify the disease process. However, no evidence was verified to significantly alleviate the main clinical manifestations of IPF. At present, Chinese herbal formula (CHF) is widely prescribed as an adjunct to western medicine to treat the disease, and have shown promising benefits on clinical symptoms and QoL. There are mainly 3 Traditional Chinese Medicine (TCM) treatment methods guiding the composition of CHFs, which are devoting to comfort the common symptoms of IPF. Nevertheless, the paucity of direct comparative evidence of them posed a challenge for clinicians to determine the relative merits options. Therefore, we formulate this protocol, which is described for a systematic review to investigate relative advantages among different TCM treatment method and provide more reliable evidence for clinical decision-making.Methods and analysis:A systematic literature search will be employed in 10 electronic databases. Inclusion criteria are randomized control trials of CHFs composed based on the 3 TCM treatment methods, which act as an adjuvant treatment with routine drugs, compared with routine drugs alone. The primary outcomes we focus on include St George's Hospital Respiratory Questionnaire (SGRQ) scores, TCM symptom (dyspnea, cough) scores. The research screening, data extraction, and methodological quality assessment will be conducted by 2 individuals separately, and dispute will be adjudicated by a third senior reviewer. We will employ network meta-analysis (NMA) in a Bayesian framework with vague priors and the surface under the cumulative ranking curve (SUCRA) to obtain the comprehensive rank for the 3 TCM treatment methods.Results:This systematic review will provide an evidence of CHFs composed under the guidance by 3 TCM treatment methods with routine drugs, compared with routine drugs alone for IPF, and will submit to a peer-reviewed journal for publication.Conclusion:The conclusion of this systematic review will provide evidence for relative advantages among the 3 TCM treatment methods.

Qigong exercise for Chronic Obstructive Pulmonary Disease Rehabilitation A Randomized Controlled Trial

PURPOSE: To compare the effects for chronic obstructive pulmonary disease (COPD) between Qigong exercise and the aerobics exercise using cycle ergometer. METHODS: Twenty-six participants (21 males and 5 females) with COPD were recruited and randomly assigned to either the Qigong group (N=13) or the cycle ergometer group (N=13). Both interventions lasted 12 weeks and comprised of 24 supervised training sessions with 30 min for each session and twice a week. All outcome measures were recorded at baseline and at the end of the study period. The primary outcome was the endurance capacity measured by six minute walk test. The secondary outcome was the St. George’s Hospital Respiratory Questionnaire (SGRQ). Paired t-tests were utilized to analyze for within-group comparisons between baseline and after three months. RESULTS: The data of ten participants in each group were analyzed due to 3 participants of losing follow up in each group. The six minute walk distance (6MWD) in Qigong group was 530±75.4m at baseline, and 560.9±60.9m after intervention. The 6MWD in cycle ergometer group was 520.6±35.6 and 549.6±26.9 after intervention. The result showed that there were significant differences between before and after intervention in each group (Qigong group t= -2.520, p <0.05, cycle ergometer group t= -3.747 , p <0.05), and was no significant difference between two groups after interventions. The SGRQ score in Qigong group was 27.8±11.8 at baseline and 22.5±8.9 after intervention. The SGRQ score in cycle ergometer group was 34.4±13 at baseline and 23.4±10.4 after intervention. The cycle ergometer group has significant difference between before and after intervention in (t = 2.601, p <0.05), but no significant difference between two groups after interventions. CONCLUSIONS: Both Qigong and cycle ergometer should improve the endurance capacity and quality of life of COPD patients through a 12 weeks training.

Évaluation de la qualité de vie (QDV) des patients tunisiens atteints de bronchopneumopathie chronique obstructive (BPCO)

To test the Arabic version of the St. George's Hospital Respiratory Questionnaire (SGRQ) in stable Tunisian COPD patients. A correlation coefficient between the post-bronchodilator FEV1 and the "Total" score of SGRQ higher than "-0.40", and QOL scores lower in COPD with "mild to moderate airway obstruction" than in those with "severe to very severe airway obstruction" will be in favor of a possible application of the Arabic version of the SGRQ in Tunisians COPD patients. This is a prospective cross-sectional study including 50 clinically stable COPD patients. The Arabic version of the SGRQ was used. Four scores were calculated for the "Symptoms", "Activities", "Impacts" and "Total" components. Patients were divided into two groups according to the severity of their airway obstruction: "mild to moderate, n=30" and "severe to very severe, n=20". The correlation between the QOL "Total" score and postBD FEV1 was evaluated. The mean±SD of age, cigarette smoking and post-bronchodilator FEV1 were, respectively, 60±10, 61±36 pack-years and 55±20%. The correlation between the post-bronchodilator FEV1 and QOL "Total" score was significant at "-0.65". "Symptoms", "Activities", "Impacts" and "Total" scores were significantly less altered in patients with "mild to moderate airway obstruction" than among those with "severe to very severe airway obstruction" (respectively, 52±24 vs. 77±17, 66±28 vs. 87±18, 48±25 vs. 70±23 and 54±22 vs. 76±17). The application of the Arabic version of the SGRQ in stable COPD patients gives reliable results.

Effects of Feiwei granules in the treatment of idiopathic pulmonary fibrosis: a randomized and placebo-controlled trial

ObjectiveTo document the therapeutic effects of Feiwei granules (FGs) for idiopathic pulmonary fibrosis (IPF). MethodsOne hundred cases with IPF were randomized into the treatment group (80) and control group (20). Both groups were given basic treatment with prednisone. The treatment group was given FGs, and the control group was given Jinshuibao capsules (JCs). Treatment lasted for 6 months. The Medical Research Council Dyspnea Scale (MRCDS), the Saint George's Hospital Respiratory Questionnaire (SGHRQ), pulmonary function, the Traditional Chinese Medicine Syndrome Score (TCMSS), 6-min walking test (6MWT) and blood gas analyses were recorded before the study as well as 3 months and 6 months after treatment. ResultsFGs showed greater efficacy than the control in certain parameters between before the study and 6 months, and between 3 months and 6 months, in the MRCDS, some indicators in the SGHRQ, and the TCMSS. There were no significant differences between the treatment group and control group in the remainder of the indices evaluated. In the treatment group, there were significant differences in before and after treatment in the MRCDS, SGHRQ, TCMSS and 6MWT. ConclusionFGs were similar to JCs for IPF treatment.

EARLY AND LONG-TERM RESULTS OF VACCINATION: NEW TOOLS FOR SUSTAINABLE MANAGEMENT OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Adequate management of patients with chronic obstructive pulmonary disease (COPD) is not getting less relevant year by year. Sustainable management of the patient requires additional tools and methods as well as approaches to evaluating the effectiveness of treatment schemes. It is known that the ability of drugs to improve functional parameters does not always lead to an improvement in patients’ well-being or enhance their daily living. In this regard, it is especially important to evaluate the quality of life as a marker of treatment efficacy. The aim of the study was to evaluate the effect of vaccination on the quality of life in patients with COPD during a 3-year follow up. Material and Methods: 362 male patients diagnosed with COPD were included in the study. 13-valent conjugate pneumococcal vaccine Prevenar-13 (PCV13) and polyvalent Pnevmo23 pneumococcal vaccine (PPV23) were used in vaccination. The quality of life (QoL) evaluation was done using two questionnaires, the Russian version of the St. George Hospital Respiratory Questionnaire (SGRQ) and the universal COPD assessment test (CAT). Results and conclusions: vaccination with PCV13 and PPV23 had a positive impact on the quality of life in the first year after vaccination, but the effect of PPV23 decreased in the third year of follow-up. Quality of life questionnaires allow to focus on the right treatment strategy both in early and long-term follow up of patients with COPD.

One-Year Safety and Efficacy Study of Arformoterol Tartrate in Patients With Moderate to Severe COPD

BACKGROUND:Arformoterol tartrate (arformoterol, 15 μg bid) is a nebulized long-acting β2-agonist approved for maintenance treatment of COPD.METHODS:This was a multicenter, double-blind, randomized, placebo-controlled study. Patients (aged ≥ 40 years with baseline FEV1≤ 65% predicted, FEV1> 0.50 L, FEV1/FVC ≤ 70%, and ≥ 15 pack-year smoking history) received arformoterol (n = 420) or placebo (n = 421) for 1 year. The primary assessment was time from randomization to respiratory death or first COPD exacerbation-related hospitalization.RESULTS:Among 841 patients randomized, 103 had ≥ 1 primary event (9.5% vs 15.0%, for arformoterol vs placebo, respectively). Patients who discontinued treatment for any reason (39.3% vs 49.9%, for arformoterol vs placebo, respectively) were followed for up to 1 year postrandomization to assess for primary events. Fewer patients receiving arformoterol than placebo experienced COPD exacerbation-related hospitalizations (9.0% vs 14.3%, respectively). Twelve patients (2.9%) receiving arformoterol and 10 patients (2.4%) receiving placebo died during the study. Risk for first respiratory serious adverse event was 50% lower with arformoterol than placebo (P= .003). Numerically more patients on arformoterol (13; 3.1%) than placebo (10; 2.4%) experienced cardiac serious adverse events; however, time-to-first cardiac serious adverse event was not significantly different. Improvements in trough FEV1and FVC were greater with arformoterol (least-squares mean change from baseline vs placebo: 0.051 L,P= .030 and 0.075 L,P= .018, respectively). Significant improvements in quality of life (overall St. George's Hospital Respiratory Questionnaire and Clinical COPD Questionnaire) were observed with arformoterol vs placebo (P< .05).CONCLUSIONS:Arformoterol demonstrated an approximately 40% lower risk of respiratory death or COPD exacerbation-related hospitalization over 1 year vs placebo. Arformoterol was well-tolerated and improved lung function vs placebo.TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT00909779; URL:www.clinicaltrials.gov

Clinical characteristics and quality of life in women with COPD: an observational study.

BackgroundThe impact of COPD on patient’s quality of life is well established, but gender differences have received little attention.MethodsTo describe factors associated with the health-related quality of life by gender: A cross-sectional observational study (NCT01007734) was conducted in COPD patients followed by pulmonologists. The first patient included had to be a woman. Data concerning the patient, COPD and their management were collected by the physician. The patient had to fill in several questionnaires: Saint-George Hospital respiratory Questionnaire (SGRQ-C), and motivation to quit smoking.ResultsFour hundred and thirty patients were included: mean age 63.9 ± 11.3 years; 57.4% were women. Women were significantly younger than men (61.9 vs. 66.6) and their tobacco use was lower (37.1 vs. 40.4 PY). Cardiovascular comorbidities were more frequent in men while osteoporosis, anxiety and depression were frequent in women. The frequency of cough, sputum and the severity of dyspnea did not differ significantly between genders. Lung function impairment was less severe in women than in men (mean FEV1 52% predicted normal vs. 47. 8%). Anxiety score was higher (score 9.8 vs. 7.1) and quality of life (SGRQ-C) more impaired in women (scores 50.6 vs. 45.4; p < 0.02) than in men. Moreover, in multivariate analysis, chronic sputum was associated with higher SGRQ-C scores in women but not in men.ConclusionsThis study underlines that despite less airflow limitation, quality of life is more impacted by chronic sputum in women than in men.

Dyspnea as a side effect of subthalamic nucleus deep brain stimulation for Parkinson's disease

Bilateral subthalamic nucleus deep brain stimulation for Parkinson's disease improves limb function. Unpublished observations from our clinic noted that some subthalamic nucleus deep brain stimulation patients complain of post-operative dyspnea. Therefore, we designed a prospective, longitudinal study to characterize this in greater depth. We used specific questionnaires to assess dyspnea in patients with electrodes in the subthalamic nucleus (n=13) or ventral intermediate thalamus (n=7). St. George's Hospital Respiratory Questionnaire symptom subscale scores were greater in subthalamic nucleus patients (median=18.60, interquartile range=40.80) than ventral intermediate thalamus patients (median = 0.00, interquartile range=15.38) at greater than 6 months post-operatively (p<0.05). Several of the subthalamic nucleus patients exhibited functional impairments as judged by the St. George's Hospital Respiratory Questionnaire impact subscale, the Medical Research Council Dyspnoea Scale, and the Dyspnoea-12 Questionnaire. There was no correlation between limb function ratings, stimulation parameters, or precise electrode position and dyspnea severity. We have shown, for the first time, that dyspnea can be a side effect of subthalamic nucleus deep brain stimulation, and that this dyspnea may be highly disabling.

Personality Traits of Patients with Chronic Obstructive Pulmonary Disease Who Exhibit Depression

[Purpose] The objective of this study was to examine the differences in personality traits based on the presence of depression in chronic obstructive pulmonary disease (COPD) patients. [Subjects and Methods] The current study involved 39 subjects with COPD. Personality traits of subjects were compared with the presence of depression and effectors of depression, including personality traits, were reviewed. [Results] Fourteen subjects (35.9% of the total) were classified as having depression (Center for Epidemiologic Studies Depression Scale (CES-D)≥16). Subjects who exhibited depression also displayed differences in items of the Yatabe-Guilford personality inventory and demonstrated high values for all St. George's Hospital Respiratory Questionnaire (SGRQ) items. Additionally these personality traits and SGRQ items were partially correlated with CES-D score. Effectors for CES-D were "Nervousness" "Sense of cooperation", and "Symptoms" of SGRQ. [Conclusion] Subjects who exhibited depression displayed traits such as a sense of inferiority, nervousness, lack of cooperation, inactivity, thinking introversion, excessive punctuality and unsociability. Therefore, in COPD patients, consideration of personality traits can be linked to early detection and appropriate treatment of depression via methods such as group cognitive behavioral therapy in respiratory rehabilitation.

Self efficacy measurement and goal attainment after pulmonary rehabilitation.

Little is known about self-efficacy in COPD and its role as a mediator of goal attainment after rehabilitation. We hypothesized that higher baseline self efficacy may facilitate goal attainment. 48 COPD patients completed pulmonary rehabilitation, self-efficacy was measured using the COPD Self Efficacy Scale (CSES). Personal goals were used as self reported outcome. Relationships were evaluated between CSES and St George's Hospital Respiratory Questionnaire (SGRQ); depression; using Brief Assessment Schedule Cards (BASDEC), London Chest Activity of Daily Living Scale (LCADL) and exercise tolerance; using Six-Minute Walking Distance (6MWD) and muscle strength. 74 Stable COPD patients, mean FEV1 1.2 (0.6) 1, age 68.1 (10.2) years were recruited. 51 patients completed rehabilitation and 48 of those CSES and reported goal attainment. 94 goals were documented. Baseline self efficacy did not differ according to whether goal was achieved or not. Relationships were evident between CSES and SGRQ (r = -0.53), 6MWD (r = 0.36), BASDEC (r = -0.31), LCADL (r = -0.33) (all p < or = 0.01), but not FEV1, pack years or muscle strength. There was a significant improvement in CSES scores pre to post rehabilitation, mean difference (95% CI) 0.27 (0.04 to 0.51). Self efficacy, using the CSES, improves with rehabilitation but baseline self efficacy does not appear to influence goal attainment.

Clinical Efficacy of the Transdermal Tulobuterol Patch in Patients with Chronic Obstructive Pulmonary Disease: A Comparison with Slow-Release Theophylline

There is insufficient evidence for the efficacy of a transdermal tulobuterol patch (TP), although combination therapy with bronchodilators is recommended for chronic obstructive pulmonary disease (COPD). A randomized, controlled crossover study was conducted to evaluate the clinical efficacy and safety of the TP in 16 patients with COPD. Slow-release theophylline was used as a control drug. Following a 2-week run-in period, patients were randomly allocated to two groups by the envelope method; they then received the TP and theophylline for 4 weeks each by the crossover method. Pulmonary function tests, peripheral blood examination, and electrocardiography were performed before and after each treatment period. Patients recorded in diaries their symptom scores, numbers of administrations of inhaled beta(2) agonists, and presence/absence of adverse reactions. Patients receiving TP exhibited significant improvement in the number and ease of sputum expectoration and in cough frequency score and wheezing severity score compared with baseline (p<0.05); the corresponding improvement in patients receiving theophylline was non-significant. Assessment of quality of life by the St. George's Hospital Respiratory Questionnaire revealed that treatment with TP was associated with significant improvement in symptoms, impact, and total scores compared with baseline (p<0.05); theophylline gave only a non-significant improvement in total score. Neither drug caused significant changes in the results of physiological examinations or in pulse or blood pressure. There was no difference in safety between the treatments. Treatment of COPD patients with TP is more effective than with theophylline.

Persistent Impact of Cigarette Smoking on Asthma

Objective. In the present study we assessed the impact of former cigarette smoking on asthma control and treatment effectiveness. Methods. A total of 104 patients with uncontrolled asthma were included in the study. The group of former smokers consisted of 33 subjects, whereas the never smokers group consisted of 71 subjects of similar age and gender. Spirometry, classification of asthma severity, and control were assessed according to Global Initiative for Asthma (GINA) guidelines. Quality of life was measured with the use of the Saint George Hospital Respiratory Questionnaire (SGHRQ). Results. Asthma was more severe in the group of former smokers both before and after treatment; p < 0.001. Severe asthma (OR 7.8 CI 2.8-21.9) and cigarette smoking (OR 3.5 CI 1.3-9.2) were associated with difficulties in asthma control achievement. Total quality of life significantly improved in the group of non-smokers; p = 0.02, whereas in former smokers this effect was not significant; p > 0.05. Conclusion. Cigarette smoking has a persistent, dose-dependent, negative impact on the response to treatment in patients with uncontrolled asthma even after smoking cessation. Smoking cessation should remain the ultimate goal in treatment of asthmatic patients. More efforts should be undertaken to decrease smoking initiation, especially in teenagers.

The relationship between inflammatory markers and disability in chronic obstructive pulmonary disease (COPD)

To examine relationships between markers of systemic inflammation and functional status in patients with chronic obstructive pulmonary disease (COPD). 41 COPD patients were stratified using the Medical Research Council (MRC) dyspnoea scale. Six-minute walking distance (6MWD), Quadriceps (% body weight) (QBW), St George's Hospital Respiratory Questionnaire (SGRQ), London Chest Activity of Daily Living Scale (LCADL), C-reactive protein (CRP), interleukin 6 (IL6), tumour necrosis factor alpha, and neopterin were measured. Relationships between variables and differences in inflammatory markers between MRC categories were tested. Inflammation increased with MRC grade and was significantly different across grades; CRP (p=0.002) and IL6 (p=0.04). Relationships were evident between CRP, 6MWD, LCADL and SGRQ, r=-0.47, 0.50, 0.43 (all p<0.01) respectively, and between IL6, QBW and LCADL, rho=-0.36, 0.51 (p<0.05). Measures of systemic inflammation, and in particular CRP, may prove to be useful markers in the assessment of COPD severity in primary care.

Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD)

Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality in this patient group. In a multicentre study conducted at four university hospitals (Reykjavik, Uppsala, Tampere and Copenhagen) hospitalised patients with COPD were investigated. Patient height, weight and lung function was recorded. Health status was assessed with St. George's Hospital Respiratory Questionnaire. After 2 years, mortality data was obtained from the national registers in each country. Of the 261 patients in the study 19% where underweight (BMI <20), 41% were of normal weight (BMI 20-25), 26% were overweight (BMI 25-30) and 14% were obese. FEV(1) was lowest in the underweight and highest in the overweight group (p=0.001) whereas the prevalence of diabetes and cardio-vascular co-morbidity went the opposite direction. Of the 261 patients 49 (19%) had died within 2 years. The lowest mortality was found among the overweight patients, whereas underweight was related to increased overall mortality. The association between underweight in COPD-patients, and mortality remained significant after adjusting for possible confounders such as FEV(1) (hazard risk ratio (95% CI) 2.6 (1.3-5.2)). We conclude that COPD patients that are underweight at admission to hospital have a higher risk of dying within the next 2 years. Further studies are needed in order to show whether identifying and treating weight loss and depletion of fat-free mass (FFM) is a way forward in improving the prognosis for hospitalised COPD patients.

Home-based exercise training in chronic obstructive pulmonary disease

The role of rehabilitation programmes in chronic obstructive pulmonary disease (COPD) patients is to lower dyspnoea, improve exercise tolerance and quality of life. We have developed a short-course, home-based, rehabilitation programme of physical exercise for lower limb muscles, based on walking at patients' fastest pace. The aim of the study was to investigate the effectiveness of such a programme regarding the exercise tolerance, pulmonary functions and quality of life. Twenty-nine individuals with stable COPD (22 males, 7 females), with a mean age of 59.6 +/- 8.9 years participated in the study. Subjects were assessed before and after the 8-week rehabilitation programme using the six-minute walking test (6MWT), Borg breathlessness score, oxygen saturation, St. George's Hospital Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Scale (HADS) and spirometry. The 6MWT distance improved significantly from 337 to 362 m, representing 8.3% (25 m) improvement over baseline. SGRQ activity, impact and total scores improved significantly after the rehabilitation programme (p < 0.01) and quality of life, too. Anxiety and depression scores were significantly lower than the baseline (p < 0.01), as well as dyspnoea sensation (p < 0.01). Pulmonary function improved after an eight-week exercise programme, too (p < 0.01). This short-term and simple home-based exercise programme improved health status in COPD. It also improved exercise tolerance, breathlessness sensation and quality of life in COPD patients.

A influência de bactérias patogênicas na transportabilidade do escarro e na qualidade de vida de portadores de bronquiectasia

INTRODUCTION: Patients' quality of life may be related to their clinical status and level of infection, and to the infecting microorganism. OBJECTIVE: To analyze the bacteriological profile of sputum from patients with bronchiectasis and to determine the effect of such bacteria on in vitro transport and patients' quality of life. METHODS: Patients with bronchiectasis were evaluated by means of quality-of-life questionnaires and sputum bacterial culturing and in vitro transport. RESULTS: Nineteen patients with bronchiectasis (mean age: 38.6 ± 16 years) were included in the study. A group of 10 patients with potentially pathogenic bacteria (group I) was compared with a group of 9 patients with nonpathogenic bacteria (group II). Group I presented lower relative transport velocity and greater displacement per cough maneuver than did group II (p < 0.05). Using the St. George's Hospital respiratory questionnaire, group I presented poorer quality of life in the impact domain (p < 0.05). Using the World Health Organization's Quality-of-Life brief questionnaire, group I also presented poorer quality of life in the physical domain. Regarding sputum color, the darker the sputum was, the lower the relative mucociliary transport velocity was (r = -0.695; p = 0.007) and the greater the displacement per cough maneuver was (r = 0.756; p = 0.001). CONCLUSION: Patients with bronchiectasis and potentially pathogenic bacteria in sputum present poorer quality of life and worse mucociliary transport in the frog palate, but better sputum displacement in the cough mechanism, in comparison with patients without potentially pathogenic bacteria.