London Chest Activity Of Daily Living Research Articles

Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events

ObjectiveSevere acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can have a negative impact on functional capacity, symptoms and health-related quality of life (HRQOL). This study aimed to i) investigate the recovery of muscle strength, functional capacity, symptoms, and HRQOL in patients after a severe AECOPD; ii) compare with matched patients with stable COPD (SCOPD); and iii) assess whether these assessments at hospital discharge could discriminate patients’ risk for future events. MethodsThis observational study assessed patients with AECOPD during hospital discharge (T1) and one month after discharge (T2). Patients with SCOPD were assessed once. Quadriceps force, handgrip strength, short physical performance battery (SPPB), 6-min walk distance (6 MWD), COPD assessment test (CAT), London chest activity of daily living (LCADL), modified medical research council, checklist individual strength-fatigue, patient health questionnaire, and physical activity (Actigraph) were measured. Exacerbation-related readmission and mortality within six months and 1-year were collected. ResultsForty-four patients with AECOPD were matched with 44 patients with SCOPD. At T2, a significant improvement was found for the SPPB total score, 6 MWD, CAT score, and LCADL score. Compared to patients with SCOPD, a worse LCADL score was found at T2 in patients with AECOPD. Patients with AECOPD that were readmitted or died had a worse SPPB classification and five-repetition sit-to-stand test at T1. ConclusionPatients after severe AECOPD improved in functional capacity and HRQOL one month after hospital discharge, but ADL performance was still worse compared to SCOPD. Patients who were readmitted or died had significantly worse scores on functional tests at hospital discharge.

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

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

Relationship between patient functionality impairment and caregiver burden: is there a cut off point for the severe COPD patient?

ABSTRACT Background Chronic obstructive pulmonary disease (COPD) patients experience a progressive limitation of their functionality accompanying their clinical evolution. Concretely, severe COPD patients usually require the figure of a caregiver. Caregiver burden has yet to be explored in other similar chronic diseases. The objective is to propose a cutoff point in different functional impairment aspects, to predict the presence of caregiver burden. Methods Severe COPD patients were divided into two groups according to the caregiver burden, measured with the Zarit Burden Interview (ZBI). The patients were assessed with the London Chest Activity of Daily Living (LCADL) scale, the Functional Independence Measure (FIM), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Results 70 COPD patients and their caregivers were included in this cross-sectional study. The ROC curve indicated a cutoff point of 19 in the LCADL scale (AUC = 0.722). Dependence in daily life activities had a cutoff point of 123 in the FIM (AUC = 0.776). Social participation in activities of daily living had a cutoff point of 37 in the WHODAS 2.0 (AUC = 0.739). Conclusion Dyspnea related to functional status, dependence in daily life activities, and social participation in activities of daily living of severe COPD patients can predict caretaker burden.

Analysis of Autonomic Modulation in Patients with Chronic Obstructive Pulmonary Disease

The aim of this study was to analyze autonomic modulation and factors that may be associated in patients with COPD. We carried out a cross-sectional, observational study of a quantitative nature, from the recruitment of 11 individuals with COPD, assisted by a specialized hospital in the state of Ceará. For data collection, the following were used: an evaluation form containing demographic and clinical data, prepared by the researchers; a cardiofrequency meter to measure the heart rate during and after the walk test; the Duke Activity Status Index (DASI) questionnaire to assess the capacity functional scale, the London Chest Activity of Daily Living (LCADL) scale to check the level of dyspnea and the State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI) to analyze the level of anxiety. We identified the LCADL scale was significantly correlated with the BAI (r= 0.847; p=0.001). Also, we found that the DASI scale was negatively correlated with the BAI (r= -0.632; p=0.037), and it was verified that the lower the score, the greater the anxiety and the lower the performance in activities of daily living (ADLs). In this context, we observed that anxiety significantly impacts ADLs in the evaluated population.

Evaluation of primary and accessory respiratory muscles and their influence on exercise capacity and dyspnea in pulmonary arterial hypertension

BackgroundSkeletal and respiratory muscle disfunction has been described in pulmonary arterial hypertension (PAH), however, involvement of accessory respiratory muscles and their association with symptomatology in PAH is unclear. ObjectivesTo assess the primary and accessory respiratory muscles and their influence on exercise tolerance and dyspnea. Methods27 patients and 27 healthy controls were included. Serratus anterior (SA), pectoralis muscles (PM) and sternocleidomastoid (SCM) muscle strength were evaluated as accessory respiratory muscles, maximal inspiratory (MIP) and expiratory pressures (MEP) as primary respiratory muscles, and quadriceps as peripheral muscle. Exercise capacity was evaluated with 6-min walk test (6MWT), dyspnea with modified Medical Council Research (MMRC) and London Chest Activity of Daily Living (LCADL) scales. ResultsAll evaluated muscles, except SCM, and 6MWT were decreased in patient group (p < 0.01). SA was the most affected muscle among primary and accessory respiratory muscles (Cohen's-d = 1.35). All evaluated muscles significantly correlated to 6MWT (r = 0.428–0.525). A multivariate model including SA, SCM and MIP was the best model for predicting 6MWT (R = 0.606; R2 = 0.368; p = 0.013) and SA strength had the most impact on the 6MWT (B = 1.242; β = 0.340). None of the models including respiratory muscles were able to predict dyspnea, however PM and SA strength correlated to LCADL total (r = -0.493) and MMRC (r = -0.523), respectively. ConclusionSCM may be excessively used in PAH since it retains its strength. Considering the relationship of accessory respiratory muscles with exercise tolerance and dyspnea, monitoring the strength of these muscles in the clinical practice may help providing better management for PAH.

Reliability and validity of the Turkish version of Post-COVID-19 Functional Status Scale

Background/aimThe post-COVID-19 Functional Status (PCFS) has recently been developed for functional outcomes of COVID-19 upon discharge and in long term. The purpose of this study was to investigate the reliability and validity properties of the Turkish version of the PCFS in Turkish post-COVID-19 patients with hospitalized and nonhospitalized during infection.Materials and methods One hundred participants with post-COVID-19 were included in this cross-sectional study. Test-retest reliability of the Turkish version of PCFS assessed by intraclass correlation coefficient (ICC) and Cronbach’s alpha was calculated for internal consistency. For construct validity, correlation coefficients between the Turkish version of PCFS developed by translation-back translation method and modified Medical Research Council (mMRC) dyspnea scale (MMRC), London Chest Activities of Daily Living (LCADL) scale, Barthel Index (BI) were analyzed.Results For test-retest reliability analysis, ICC ranged between 0.734 and 0.880. The total ICC score was 0.821, indicating excellent reliability. The Cronbach’s alpha value of the PCFS test and retest scores were recorded as 0.821 indicating that the scale is quite reliable. The PCFS score was moderately correlated with the mMRC score (r = 0.534, p < 0.001) and weakly correlated with the LCADL self care (r = 0.311, p = 0.002), domestic (r = 0.277, p = 0.005), physical activity (r = 0.342, p < 0.001), leisure subscores (r = 0.434, p < 0.001) and total score (r = 0.399, p < 0.001).Conclusion The Turkish version of the PCFS scale is reliable scale that reflects activity limitation and functional status after COVID-19. The Turkish version of the PCFS will be a guide for rehabilitation professionals to understand functional limitation after COVID-19 and to direct interventions accordingly to functional status of the patients at discharge and in long term.

Occupational Competence and Activities of Daily Living Performance in Bronchial Asthma : Compétence professionnelle et performance des activités de la vie quotidienne pour la bronchite asthmatique.

Background. Activity restriction is one of the most common symptoms reported by people living with bronchial asthma. Purpose. The study aimed to determine occupational competence and values in people living with bronchial asthma and compare with the occupational competence and activities of daily living (ADL) of healthy controls. Methods. Twenty individuals with asthma and 20 healthy controls were enrolled. Occupational competence and values were assessed using the Occupational Self-Assessment (OSA) questionnaire. Restriction of ADL was determined using the London Chest ADL Scale. Findings. Occupational competence was lower, and all London Chest ADL scores were significantly higher in asthma individuals compared to controls (p < .05). The most affected parameters reported by asthma individuals on the OSA were the ability to concentrate, perform physical tasks, work toward goals, and use abilities effectively. Implications. Evaluating occupational competence in people living with bronchial asthma is important to identify their occupational problem areas and provide appropriate interventions.

Effects of a Home-Based Pulmonary Rehabilitation Program in Patients with Chronic Obstructive Pulmonary Disease in GOLD B Group: A Pilot Study.

Patients with chronic obstructive pulmonary disease (COPD) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) B group can be included in pulmonary rehabilitation (PR) settings outside the hospitals. This study aimed to explore the feasibility of a home-based pulmonary rehabilitation (HBPR) program and assess its impact on patients with COPD in the GOLD B group. A real-world, pre–post intervention study was conducted with 12 weeks of HBPR (presential home visits and phone calls) using the self-management program Living Well with COPD. The 1-min sit-to-stand test (1MSTS), modified Medical Research Council Questionnaire (mMRC), COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activity of Daily Living (LCADL) were used to assess the impact. Pre–post differences and correlations between changes in outcomes were calculated. In 30 patients (71.6 years, FEV1 (%) 52.8), significant improvements (p < 0.05) were observed on 1MSTS (Pre 17.2, Post 21.2), mMRC (Pre 2.0, Post 1.0), CAT (Pre 16.3, Post 9.9), HADS (Pre 14.4, Post 9.6), and LCADL (Pre 21.0, Post 15.8), with no adverse events reported. When significant, correlations between changes in outcomes were moderate or strong (0.48 ≤ ρ ≤ 0.66). HBPR can be feasible and safe, and it shows the potential to significantly improve outcomes of patients with COPD in the GOLD B group.

The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD

The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = −0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = −0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.

The Relations of depression, anxiety and daily life activity patients with different levels of severity of chronic obstructive pulmonary disease

Introduction and aim: COPD is one of the leading causes of morbidity and mortality worldwide and it leads to economic and social burdens at significant and increasing levels. We aimed to investigate the relationship between daily living activities and depression, anxiety and disease levels in patients with COPD in our study. Materials and methods: Patients diagnosed with COPD were randomly enrolled to the study who admitted to the university polyclinics. Socio-demographic information form, mMRC dyspnea scale, COPD Assessment Test (CAT), London Chest Activity of Daily Living (LCADL) scale and Hospital Anxiety and Depression Scale (HADS) were applied. The collected data were evaluated by using statistical program. Results: In the study, 119 patients were enrolled, 94 participants were male (79%) and 25 were female (21%). Thirteen people (10.9%) who never smoked during their lifetime, 67 people (56.3%) who left the cigarette and 39 people (32.8%) were still smoking from the patients who participated in the study. There were 19 clinical cases (16%) and 100 (84%) normal cases for anxiety and 35 clinical cases (29.4%) and 84 (70.6%) normal cases for depression in the whole group. The correlation coefficient between the total score of daily living activity scale and anxiety was found as r: .289, and there is a weak level meaningful relationship between them (p<0.01). The correlation coefficient between daily life activity scale total score and depression was found as r: .259 and there is a weak level meaningful relationship between them (p<0.01). The correlation coefficient between total daily activity score and CAT total score was calculated as r: .552, and there is a moderate level meaningful relationship between them (p<0.01). Conclusion: In this study, it was concluded that activity of daily living in COPD patients was weakly correlated with depression and anxiety, and moderately correlated with disease level of severity. We believe that anxiety, depression, and severity of illness affects daily life activity in COPD patients, even if they are weak or moderate needed to be treated with a holistic approach.

Translation, cross-cultural adaptation and validation of the Pulmonary Rehabilitation Adapted Index of Self-efficacy (PRAISE) scale for Brazilian patients with chronic obstructive pulmonary disease

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) present a progressive chronic airflow obstruction. Pulmonary Rehabilitation (PR) promotes the reversal of the extrapulmonary effects of the disease and improves the quality of life. Despite the physiological benefits, the major challenge of PR is to promote change in lifestyle. In this sense, it has been emphasized the study of psychological variables such as self-efficacy. Aim: To translate, cross-culturally adapt and validate the PRAISE scale for Brazilian COPD patients. Methods: The PRAISE scale was applied on the first day by two raters and 15-20 days later by one rater. Patients were assessed for self-efficacy with the General Self-Efficacy Scale (GSS) and the COPD Self-Efficacy Scale (CSES); functional limitation for activities of daily living with the London Chest Activity of Daily Living (LCADL) scale; anxiety and depression symptoms with the Hospital Anxiety and Depression Scale (HADS); quality of life with Saint George’s Respiratory Questionnaire (SGRQ); resilience with the Resilience Scale; and basic psychological needs with the Basic Psychological Needs in Exercise Scale (BPNES). The tests used were: Student’s t-test or Wilcoxon’s test (PRAISE score comparison); intraclass correlation coefficient (ICC), interrater reliability and test-retest and Cronbach’s alpha; and Spearman’s or Pearson’s correlation coefficient to assess validity. Results: The scale was pre-tested in 10 patients to evaluate translation accuracy and cross-cultural adaptation. Thirty-four patients with COPD took part (22 men; FEV1=42.2±15.7%pred). The interrater and test-retest ICCs were excellent (0.82 and 0.86, respectively), with no significant differences in test-retest reliability (p>0.05). Cronbach’s alpha interrater and testretest were 0.90 and 0.92, respectively (p<0.001). There were no floor and ceiling effects. The scale showed weak to moderate correlations with GSS, CSES, LCADL, HADS, SGRQ, Resilience Scale, and BPNES. Conclusions: The PRAISE scale proved to be valid and reliable for Brazilian patients with COPD.

Baseline Characteristics of Subjects with Chronic Obstructive Pulmonary Disease Associated to the Improvement in Activities of Daily Living after Exercise Training

This study aimed to identify baseline variables predicting improvement in ADLs following an exercise training program in subjects with COPD. Sixty-seven patients with COPD underwent assessment of spirometry, modified Medical Research Council scale, COPD Assesment Test (CAT), Six Minute Walk Test (6MWT), London Chest Activity of Daily Living (LCADL) scale and Glittre-ADL test (TGlittre). After 24 sessions, they were reassessed for limitation in ADLs (LCADL and TGlittre). The main outcome was the achieving of minimal important difference (MID) of TGlittre, LCADL and both (ADLs). The cut-off points to discriminate the subjects who achieved the MID of TGlittre, LCADL and ADLs were established using the ROC curve. A cut-off point of 3.7 min in baseline TGlittre was able to discriminate subjects who achieved the MID of TGlittre (AUC = 0.77). Subjects with baseline TGlittre ≥3.7 min were 6.92 (95%CI 2.2–20.9) times more likely to achieve the MID of TGlittre post-exercise training. A cut-off point of 32% in LCADL was able to discriminate subjects who achieved the MID of LCADL (AUC = 0.81) and in ADLs (AUC = 0.78). Subjects with baseline LCADL ≥32% were 12.3 (95% CI 2.50 − 60.7) times more likely to achieve the MID of LCADL. In conclusion, the baseline variables that best predict the improvement of individuals after exercise training are TGlittre and LCADL, showing that subjects with significant functional impairment are more likely to clinically significantly improve their ADLs.

Effects of neuromuscular electrical stimulation on exercise capacity and quality of life in COPD patients: a systematic review and meta-analysis.

Neuromuscular electrical stimulation (NMES) has been shown to produce benefits in the muscle function of chronic obstructive pulmonary disease (COPD) patients. The definite effectiveness of NMES, applied in isolation or concurrently with conventional pulmonary rehabilitation (PR) or exercise training, remains unclear. This review was to determine the effects of NMES on exercise capacity, functional performance, symptoms, and health-related quality of life (HRQoL) in COPD patients. Electronic databases (PubMed, Embase, Web of Science, the Cochrane Library) were searched for relevant randomized controlled trials (RCTs). Two investigators independently screened the eligible studies up to February 2020 that used NMES as the intervention group. The outcome measures were 6-min walking distance (6MWD), peak rate of oxygen uptake (VO2 peak), St George’s Respiratory Questionnaire (SGRQ), and symptoms of dyspnoea and fatigue. Data were extracted using a predefined table and papers were appraised using Downs and Black tool. We analyzed 13 RCTs with 447 COPD patients. In the analysis of 6MWD, pooled estimates showed a significant increase in the NMES group, compared with the control group (mean difference (MD) = 27.05, 95% confidence interval (CI): 8.46–45.63, P<0.001). There were also improvements in symptoms of dyspnea or leg fatigue, and reduction in London Chest Activity of Daily Living (LCADL) scores. No statistically significant difference was observed in VO2 peak, peak power, and SGRQ. NMES could improve exercise capacity and reduce perceived sensation of dyspnea during exercise in patients with COPD, but not to be recommended as an effective alternative training modality in the rehabilitation of stable COPD patients.

The Glittre ADL-Test Differentiates COPD Patients with and without Self-Reported Functional Limitation

The Glittre ADL-test is based on important and common activities of daily living (ADLs), and it is an useful test to objectively distinguish patients with and without self-reported functional limitations. This study aims to analyze if difficulty to perform ADLs, as self-reported by patients with COPD, would reflect a worse Glittre ADL-test performance. In the first visit, patients were evaluated for clinical and nutritional status, spirometry, maximal cardiopulmonary exercise test on a treadmill. One week later, the patients performed two Glittre ADL-tests. Maximal voluntary ventilation (MVV) and the VEGlittre/MVV, VO2Glittre/VO2peak, and HRGlittre/HRpeak ratios were calculated to analyze the ventilatory, metabolic, and cardiac reserves. The London Chest Activity of Daily Living (LCADL) scale was only answered after the two Glittre ADL-test were performed. Patients were splited into two subgroups based on the anchor question of the LCADL: those with and those without self-reported ADL limitation. Sixty-two COPD patients were included (65.3 ± 8.6 years, FEV1 62 ± 22%pred). Those with ADL limitation (39 patients) completed the Glittre ADL-test with a significantly longer time (p = 0.002), as well as higher VEGlittre/MVV (p = 0.005) and lower oxygen pulse (p = 0.021) than those without ADL limitation. The time spent to perform the Glittre ADL-test was significantly associated with total LCADL score (ρ = 0.327, p < 0.05). A cutoff of 253 s was able to distinguish those patients without and with ADL limitation. COPD patients who self-reported ADL limitation according to the LCADL scale took a longer time to perform the Glittre ADL-test with higher VEGlittre/MVV and lower oxygen pulse than those without ADL limitation.

Do London Chest Activity of Daily Living Scale and St George's Respiratory Questionnaire Reflect Limitations During Activities of Daily Living in Patients With COPD?

It is unclear whether activities of daily living (ADL) and quality-of-life scales reflect real ADL limitations. The aim of the study was to assess the limitation during ADL simulation and to identify whether the London Chest Activity of Daily Living (LCADL) Scale and St George's Respiratory Questionnaire (SGRQ) are able to reflect the patient's real limitations during ADL simulation. Forty-eight patients with chronic obstructive pulmonary disease (age = 69 ± 8 y; forced expiratory volume in the first second of expiration [FEV1] = 1.37 ± 0.49 L) were assessed by SGRQ and LCADL Scale. Activities of daily living simulations were performed: showering (ADL1); lifting and lowering containers above the shoulder girdle (ADL2); and raising and lowering pots below the pelvic girdle (ADL3). SpO2 and ΔSpO2 in ADL2 were statistically lower than in ADL3. Ventilatory demand was statistically higher in ADL2 and ADL3 than in ADL1. Metabolic equivalent values were similar between the ADLs with values above 3.6. Oxygen desaturation was present in 41.7% (ADL1) and 33.3% (ADL2) of the patients. The LCADL% showed a moderate positive correlation with dyspnea in ADL3 and metabolic demand in ADL1. The SGRQ score presented a moderate positive correlation with dyspnea in all ADL simulations and metabolic demand in ADL1 and ADL3. Dyspnea in ADL3 and metabolic demand in ADL1 explained 33% of the variability in LCADL%. The dyspnea and metabolic demand in ADL3 explained 67% of the variability in SGRQ. Activities of daily living lead to oxygen desaturation and high ventilatory demand. London Chest Activity of Daily Living Scale reflected 33% and SGRQ reflected 67% of the functional limitation during ADL simulation, such as dyspnea and the metabolic demand during ADL.

&lt;p&gt;Patient-reported outcomes of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in individuals with COPD&lt;/p&gt;

Background: This study compared real-world patient-reported outcomes (PROs) measured by the Clinical COPD Questionnaire (CCQ), the London Chest Activities of Daily Living (LCADL) scale, and the Work Productivity and Activity Impairment (WPAI) questionnaire between individuals with COPD initiating LAMA/LABA fixed-dose combination (FDC) dual therapy versus either long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) monotherapy.Methods: Individuals with COPD aged ≥40 years initiating a LAMA/LABA FDC dual therapy or a LAMA or LABA monotherapy (index date = first prescription date) between January 1, 2016 and December 31, 2016 were identified from a large US administrative claims database. Individuals were excluded if they were prescribed an inhaled corticosteroid (ICS) or ICS/LABA two months prior to the index date or were diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma. The cohorts were propensity score matched (PSM) 1:1 for COPD severity using baseline measures. Each participant completed a survey.Results: Surveys were completed by 399 participants in the dual therapy cohort, and 718 participants in the monotherapy cohort. Following PSM, 379 participants remained in each cohort for analysis (monotherapy: 369 LAMA and 10 LABA). The dual therapy cohort reported fewer COPD-related symptoms (CCQ symptom score 2.75 vs 2.97, respectively, P=0.023), and, fewer limitations in leisure activities (LCADL leisure score 4.78 vs 5.17, respectively, P=0.021) versus the monotherapy cohort. No significant differences were found in the WPAI. A greater percentage of participants in the dual therapy cohort stayed on index therapy (63.1%) when compared with the monotherapy cohort (30.3%, P<0.0001).Conclusions: Only 30% of the participants prescribed monotherapy, usually with a LAMA, remained on index therapy alone at the time of survey administration. In the dual therapy cohort, 63% of the participants remained on the index medication and had fewer COPD-related symptoms and fewer limitations in leisure activities compared with participants in the monotherapy cohort.

Functional Status of Patients with COPD Assessed by London Chest Activity of Daily Living Scale: Gender Association and Validity of a Cutoff Point.

Whether the difference in the impact of chronic obstructive pulmonary disease (COPD) on the functional status of men and women stems from clinical distinctions or to the measuring instrument used is unclear. Like most instruments for assessing functional limitation in COPD, the interpretation of the results of the London Chest Activity of Daily Living (LCADL) scale is limited because a lack of a valid cutoff point to this scale. For that, this study sought to compare the functional status between men and women with COPD; and propose a cutoff point for LCADL capable of discriminating the prognosis of these individuals. A sample of 138 subjects with moderate-severe COPD was evaluated by the LCADL. The percentage of the individual maximum score was used to obtain a cutoff point capable of discriminating patients with the worse prognosis according to the BODE Index. The cutoff point was also tested in an independent sample (n = 70). Regarding the total score, domestic and leisure domains of the LCADL, men had better scores than women (P ≤ 0.01). The cutoff point found was 37% (area under the curve = 0.70, 95% confidence interval = 0.60-0.80, sensitivity = 0.55 and specificity = 0.74). Individuals who scored ≥ 37% had a worse prognosis and level of physical activities of daily living than those who scored below (P ≤ 0.02). When evaluated by the LCADL, men and women with COPD present difference in the functional status. The established cutoff point (37%) adequately discriminates individuals regarding the prognosis, contributing to improve the interpretation capacity of the LCADL.

Doença Pulmonar Obstrutiva Crônica: atividade de vida diária e qualidade de vida

INTRODUÇÃO: A qualidade de vida (QV) é um instrumento relevante para o contexto funcional na doença pulmonar obstrutiva crônica (DPOC), a escala London Chest Activity of Daily Living (LCADL) avalia a atividade de vida diária (AVD) em pacientes com DPOC. OBJETIVO: avaliar a capacidade em realizar AVD e a QV dos pacientes com DPOC que buscam serviço público de reabilitação pulmonar (RP). MÉTODOS: Pesquisa transversal, realizada de 2014 até 2017, 27 pacientes diagnósticados DPOC leve a grave de acordo os critérios GOLD, de ambos os sexos, estáveis, sem exacerbações recentes. Foi utilizado ANOVA para analisar diferença entre as médias de LCADL e Saint George's Respiratory Questionnaire (SGRQ) em seguida o teste pos- HOC de Turkey para delimitar o impacto de cada preditor separadamente. Utilizou-se o teste de Spearmann para correlacionar LCADL e SGRQ. RESULTADOS: Encontrada limitação leve para todos os domínios da escala LCADL 22,7 ± 8,4 pontos com 30,2% de limitação. A QV é impactada em todos os domínios (31,2 ± 11,6 pontos) de forma moderada a grave com 41,6% de redução. A dispnéia e a fadiga interferem de forma correlata na AVD, r = 0,78 (p &lt; 0,05). O escore LCADL correlaciona-se diretamente com a QV, r =0,59 (p &lt; 0,05). CONCLUSÃO: Os pacientes apresentam limitação na atividade de vidade diária e impacto na qualidade de vida, além de forte correlação entre o índice de dispneia da escala LCADL e seus domínios.

Validation of the French version of the London Chest Activity of Daily Living scale and the Dyspnea-12 questionnaire.

IntroductionEighty percent of COPD patients experience dyspnea during activities of daily life (ADL). To the best of our knowledge, the Modified Medical Research Council (MMRC) dyspnea scale is the only validated scale designed to quantify dyspnea during ADL available in the French language. Two other instruments are only available in English versions: the London Chest Activity of Daily Living (LCADL) scale that allows a specific evaluation of dyspnea during ADL and the Dyspnea-12 questionnaire that evaluates the affective (emotional) and sensory components of dyspnea in daily life. The aim of this study was to translate and validate French versions of both LCADL and Dyspnea-12 questionnaires and to determine the reliability of these versions for the evaluation of dyspnea in severe to very severe COPD patients.MethodsBoth translation and cultural adaptation were based on Beaton’s recommendations. Fifty consecutive patients completed the French version of LCADL and Dyspnea-12 and other questionnaires (MMRC, Saint George’s Respiratory Questionnaire [SGRQ], Hospital Anxiety and Depression [HAD]), at a 2-week interval. Internal consistency, validity, and reliability of LCADL and Dyspnea-12 were evaluated.ResultsThe French version of LCADL and Dyspnea-12 demonstrated good internal consistency with Cronbach’s α of, respectively, 0.84 and 0.91. LCADL was correlated significantly with item activity of SGRQ (ρ=0.55, p<0.001), total score of SGRQ (ρ=0.63, p<0.001), item impact of SGRQ (ρ=0.57, p<0.001), and HAD-depression (HAD-D) (ρ=0.47, p=0.001); and Dyspnea-12 was correlated significantly with MMRC (ρ=0.39, p<0.001), HAD-anxiety (ρ=0.64, p<0.001), and HAD-D (ρ=0.64, p<0.001). The French version of LCADL and Dyspnea-12 demonstrated good test–retest reliability with, respectively, intraclass coefficient =0.84 (p<0.001) and 0.91 (p<0.001).ConclusionThe French versions of LCADL and Dyspnea-12 questionnaires are promising tools to evaluate dyspnea in severe to very severe COPD patients.

Changes and Clinical Consequences of Smoking Cessation in Patients With COPD: A Prospective Analysis From the CHAIN Cohort

Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real life are still low among patients with COPD. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of patients with COPD. CHAIN (COPD History Assessment in Spain) is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS). No specific smoking cessation intervention was carried out. Factors associated with and clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses. One thousand and eighty-one patients with COPD were included (male, 80.8%; age, 65.2 [SD 8.9] years; FEV1, 60.2 [20.5]%). During the 2-year follow-up time (visit 2, 906 patients; visit 3, 791 patients), the majority of patients maintained the same smoking habit. Decision tree analysis detected chronic expectoration as the most relevant variable to identify persistent quitters in the future, followed by an LCADL questionnaire (cutoff 9 points). Total anxiety HADS score was the most relevant clinical impact associated with giving up tobacco, followed by the LCADL questionnaire with a cutoff value of 10 points. In this real-life prospective COPD cohort with no specific antismoking intervention, the majority of patients did not change their smoking status. Our study also identifies baseline expectoration, anxiety, and dyspnea with daily activities as the major determinants of smoking status in COPD. ClinicalTrials.gov; No. NCT01122758; URL: www.clinicaltrials.gov.