Medical Research Council Dyspnoea Score Research Articles

Efficacy of Pulmonary Exercises in Chronic Obstructive Pulmonary Disease

Objective: The aim of this study was to determine the effectiveness of pulmonary rehabilitation on respiratory parameters, aerobic exercise capacity, quality of life and psychological status of the patients with chronic obstructive pulmonary disease (COPD). The addition of aerobic exercise on pulmonary exercises was also evaluated to provide further improvements on these parameters. Methods: Sixty-five patients were randomly assigned to carry out pulmonary exercise, combined (respiratory plus aerobics) and, a control groups. Demographic characteristics were noted. Respiratory function tests, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) values and, exercise tolerance test (ETT) were assessed. Medical Research Council (MRC) dyspnea scale, body mass index (B), airway obstruction (O), dyspnea scale (D), exersice capacity (E) (BODE) index, Short Form 36 (SF-36), and Saint George Respiratory Questionnaire (SGRQ) obtained from each patient were recorded before the treatment, and after the 8-week treatment. Results: After the treatment significant increases were found in forced expiratory volume-one second (FEV1), FEV1/forced vital capacity (FVC) ratio, PImax, PEmax values in pulmonary and combined exercise groups, and FVC, vital capacity (VC) values in combined exercise group (p<0.05 for all parameters). Statistical differences were observed in both exercise groups regarding MRC Dyspnea score, Maksimum Equivalent Task (MET) values, SGRQ and some parameters of SF-36 (p<0.05 for all parameters). In the control group no noticeable difference was observed in any of the parameters. After treatment there was no difference between pulmonary and combined exercise group in any parameters (p<0.05). Conclusion: Both pulmonary and combined exercise programs improved exercise capacity, dyspnea, and the life quality of the COPD patients.

Spirometric abnormalities following treatment for pulmonary tuberculosis in Ilorin, Nigeria.

Pulmonary tuberculosis (PTB) contributes significantly to morbidity and mortality worldwide, and despite microbiological cure for the disease, many patients still demonstrate residual respiratory symptoms and spirometric abnormalities. The study aimed at identifying the prevalence, pattern and factors associated with spirometric abnormalities in patients successfully treated for PTB in Ilorin, Nigeria. This was a hospital-based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. A total of 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding 3 years had assessment of residual pulmonary symptoms, spirometry and plain chest radiograph. The prevalence of abnormal spirometry following treatment for PTB was 72.1% (confidence interval: 0.6682-0.7695), with restrictive pattern being the predominant abnormality (42.2%). Over half of the patients (56.5%) had at least one residual respiratory symptom. The significant predictors of abnormal spirometry were PTB retreatment (adjusted odds ratio [aOR] = 6.918; P = 0.012), increasing modified Medical Research Council dyspnoea scores (aOR = 7.935; P = 0.008) and increasing radiologic scores (aOR = 4.679; P ≤ 0.001) after treatment. There is significant residual lung function impairment in majority of the individuals successfully treated for PTB in Ilorin. This highlights the need for spirometric assessment and follow-up after treatment.

Effects of pulmonary rehabilitation on dyspnea and functional capacity on waiting list for lung transplantation: According to obstructive or restrictive pulmonary disease

BACKGROUND: Pulmonary rehabilitation (PR) has been shown to be effective on exercise capacity and dyspnea in lung transplantation (LTx) candidates. In this study, we aimed to investigate the efficacy of PR and to compare the outcomes in LTx candidates with obstructive and restrictive lung diseases. METHODS: Between January 2013 and May 2018, medical data of 86 patients who were on the waiting list for LTx were retrospectively analyzed. The patients were divided into two groups based on the diagnosis as obstructive patients (Group 1) and restrictive patients (Group 2). Six-minute walking test (6MWT), the Borg scale, and the modified Medical Research Council dyspnea scores were analyzed. RESULTS: A total of 65 patients completed the 8-week PR protocol (n = 42 in Group 1 and n = 23 in Group 2). Irrespective of the initial diagnosis, there was a significant (P CONCLUSION: PR has a positive effect on exercise capacity and dyspnea in patients with both obstructive and restrictive lung diseases who are on the waiting list for LTx. Our study results suggest that PR is effective in LTx candidates, irrespective of the initial diagnosis.

Pulmonary fibrosis secondary to COVID-19

While death is the most feared outcome of COVID-19, other serious complications are increasingly being described. A 74-years-old man with hypertension, diabetes mellitus and a Modified Medical Research Council (mMRC) dyspnoea score of 1 was admitted to our institution with a 1-week history of dyspnoea, cough and severe hypoxia. Initial chest radiograph (A) showed bilateral, peripheral, lower lobe-predominant ground glass opacities. A diagnosis of COVID-19 was confirmed with positive SARS-CoV-2 RT-PCR on nasal swab. He received oral steroids and therapeutic doses of heparin. He initially required 60% facemask oxygen, which was weaned to nasal prong oxygen over two weeks. Seven weeks after admission and despite normalisation of all inflammatory markers, he remained dyspnoeic at rest and oxygen-dependent.Follow up chest radiograph (B) demonstrated worsening diffuse reticulonodular shadowing. Chest high-resolution computed tomography (C, D) demonstrated confluent pulmonary fibrosis with an apicobasal gradient bilaterally, diffuse peripheral inter- and intra-lobular septal thickening and significant traction bronchiectasis without honeycombing.Total lung capacity and diffusing capacity of the lungs for carbon monoxide were not performed due to infective risk but are expected to be decreased. The patient was given a trial of steroids and will be followed up in 6 weeks. He will likely require domiciliary oxygen. Due to the mMRC of 1 and short history, it is assumed that the fibrosis was not present prior to the COVID-19 diagnosis. The early use of antifibrotics may prevent this devastating complication, but it is difficult to predict who is likely to progress to pulmonary fibrosis.

Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in Subjects With Advanced COPD.

Severe exertional dyspnea is a commonly reported symptom in patients with COPD, especially in the advanced stages. Our objective was to assess the preliminary impact of comprehensive, individualized management provided by a specialized tertiary center clinic on exertional dyspnea and patient-centered outcomes in patients with advanced COPD. This retrospective analysis included 45 subjects with COPD who were evaluated in a newly established dyspnea clinic over 3 years. Those with severe exertional dyspnea (Medical Research Council dyspnea score of ≥4/5), despite optimal disease-targeted therapy were eligible for referral. We used the revised Edmonton Symptom Assessment System (ESAS-r) to assess symptoms. Responders were defined as those whose change from baseline to 2-months met the minimum clinically important difference of ≤-1 in ESAS-r score for shortness of breath. Subjects (mean ± SD age 70 ± 7 years) had an average FEV1 of 36 ± 18% predicted and a Medical Research Council dyspnea score of 4.7 ± 0.4. Responses to the intervention were variable and mean change in the ESAS-r score for shortness of breath in the total group was -0.32 ± 3.39, P = .53. Forty-seven percent of the subjects were identified as responders, and 42, 40, 40, and 33% met the minimum clinically important difference for improvement in ESAS-r scores for tiredness, anxiety, well-being, and depression, respectively. Responders had fewer emergency department annual visits in the 2 years after their first clinic visit compared with nonresponders (mean ± SD, 1.38 ± 1.63 vs 4.45 ± 5.52, P = .034). Although the impact of our specialized advanced dyspnea clinic was variable, as evaluated by the ESAS-r, it provided measurable additional clinically important benefit to almost half of the subjects with advanced COPD and severe refractory dyspnea.

ENDOBRONCHIAL VALVE TREATMENT OF SEVERE EMPHYSEMA IN PATIENTS WITH ALPHA-1 ANTITRYPSIN DEFICIENCY

ENDOBRONCHIAL VALVE TREATMENT OF SEVERE EMPHYSEMA IN PATIENTS WITH ALPHA-1 ANTITRYPSIN DEFICIENCY

IS THERE ANY ASSOCIATION BETWEEN INITIAL BODY MASS INDEX AND MAJOR OUTCOMES AFTER ENDOSCOPIC LUNG VOLUME REDUCTION USING ENDOBRONCHIAL VALVE PLACEMENT?

SESSION TITLE: Monday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Body mass index (BMI) is has a higher risk of all-cause mortality. In chronic obstructive pulmonary disease (COPD) BMI is significantly lower in emphysema. COPD patients with BMI of <21.75 kg/m2 has a higher risk of death. Endoscopic lung volume reduction (ELVR) using endobronchial valve placement (EBV) is an innovative treatment for severe emphysema with optimal medical therapy. Associations between low BMI and outcomes after ELVR are not well-studied yet. We wanted to explore relations between initial BMI and changes in major outcomes after ELVR in patients with heterogeneous severe emphysema. METHODS: Data were collected at Thoraxklinik University of Heidelberg, Germany. Demography (age, gender, pack-year index, pulmonary function test); procedure (number of EBV, target lobe), changes after ELVR and complications were recorded. Group 1 and group 2 were created according to baseline BMI (G1>21kg/m2; G2< 0.005). Outcomes were the following: changes (d) in forced expiratory volume (dFEV1, % and ml), residual volume (dRV, % and ml), distance during 6-minute walking test (6MWD, m), Modified Medical Research Council dyspnea score (MMRC) and BODE index after treatment. Quantitative data was evaluated with non-parametric test (U-Mann Whitney) and qualitative data was evaluated with Fisher-exact test. Linear regression model was performed to explore baseline BMI and changes in BMI (dBMI) after ELVR (p-value < 0.005). RESULTS: 82 patients were included (G1= 63) and (G2 = 18). Average age was 62.5 years (28-81). Mean BMI in group 1 was 25.59 (21.54-35.6) compared to 19.54 (16.99-20.83) in G2. After treatment, mean change in BMI was -4.28 kg (-38, +48) and G2 reported an improvement of +8.82 kg (-25, +39) (p<0.006), BMI decreased 1.14 kg/m2 (-12.0, +13.4) in G1 and improved +4.389 kg/m2 (-2.7, +15) in G2 (p<0.0001). We found a statistical tendency between change in FEV1 (%) +3.80 in G2 (-4.2, +20.9) compared to +1.2 in G1 (-17.8, +10). In G1 d6MWD was +42.52 mts (-130, +318) and G2 +19.4 mts (-305, +250) (p=0.840). In G1 dMMRC was -0.30 pts (-3, +3), in G2 -0.066 pts (-4, +4) (p=0.272). In G1 dBODE was -0.62 pts (-6, +5), in G2 -0.833 pts (-5, +4) (p= 0.711). Linear regression analysis found an R2 value of 0.3786 in change of BMI (p<0.0001); an R2 value of 0.239 in change of weight (kg) (p<0.0001). In G2, 38.9% of patients had complications, in G1 26.98% (p=0.23). CONCLUSIONS: Baseline BMI is relevant in order to select candidates to ELVR using EBV. In patients with BMI < 21kg/m2, ELVR is associated with increased BMI and weight after treatment. We found correlation between initial BMI, change in BMI and weight after ELVR. CLINICAL IMPLICATIONS: These findings suggest a potential nutritional benefit in this population. The association between BMI and long-term outcomes should be further studied. DISCLOSURES: No relevant relationships by Sebastian Fernandez-Bussy, source=Web Response No relevant relationships by Daniela Gompelmann, source=Web Response Advisory Committee Member relationship with Pulmonx Please note: $1001 - $5000 Added 03/15/2019 by Felix Herth, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Spiration Please note: $1001 - $5000 Added 03/15/2019 by Felix Herth, source=Web Response, value=Consulting fee No relevant relationships by Anna Kornafeld, source=Web Response No relevant relationships by Gonzalo Labarca, source=Web Response

Tai Chi Movements for Wellbeing - evaluation of a British Lung Foundation pilot.

In breathless individuals with respiratory disease, pulmonary rehabilitation (PR) can improve exercise capacity, symptoms and ability to cope with their condition. However, access is often limited, and adherence can be poor. Thus, there is interest in developing alternative and complementary forms of exercise intervention and tai chi may be effective in this context. The British Lung Foundation worked in collaboration with 'Tai Chi Movements for Wellbeing' Training to train leaders to run community-based tai chi groups in the UK. Leaders received funding to run 3 months of once-a-week classes consisting of a 12 movement sequence of tai chi. Participants completed a questionnaire survey to evaluate the service at the start of their first session and again after 3 months. Ten tai chi groups recruited 128 participants, 65% women, mean (standard deviation (SD)) age 70.1 (7.4) years at baseline. Seventy individuals completed the follow-up questionnaire at 3 months. Participants demonstrated an improvement in Medical Research Council (MRC) Dyspnoea Score pre 3 (interquartile range (IQR) = 1.8), post 2 (IQR = 1), p = .013 and disease burden; chronic obstructive pulmonary disease (COPD) assessment test score pre 19.4 (8.7), post 17.9 (9.4), mean change -1.5 (confidence interval (CI): -2.89 to -0.127), p = .033. Those who completed the programme had a worse baseline COPD assessment test (CAT) score and were more likely to have participated in maintenance exercise previously. Qualitative feedback suggested that participants felt the classes had helped with breathlessness and relaxation. Establishing a tai chi for wellbeing programme for people with respiratory disease is feasible, with a reasonable level of compliance, and is perceived to be helpful by participants.

Outcome of Regular Inhaled Treatment in GOLD A Chronic Obstructive Pulmonary Disease Patients

Background: The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends regular bronchodilator therapy in all group A patients with chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to evaluate whether regular inhaled treatment in group A patients with COPD improves their health outcomes, including exacerbations and symptoms. Methods: We recruited patients from 2 Korean prospective cohorts. Eligible COPD patients had a modified Medical Research Council (mMRC) dyspnea score of <2, a St. George’s Respiratory Questionnaire for COPD (SGRQ-C) total score of <25, and had no more than 1 exacerbation and no hospitalizations during the previous year. Incidence rates of exacerbations and changes in symptom scores were analyzed. Results: After propensity score matching, there were 107 patient pairs, with and without regular inhaled treatment, who were followed up for mean times of 2.6 and 3.1 years, respectively. The incidence rates of exacerbations in those with and without regular treatment were not significantly different (incidence rate ratio 1.24 [95% CI 0.68 to 2.25]). Significant differences in favor of regular treatment were observed at 6 and 12 months for the SGRQ-C total scores (mean between-group difference –4.7 [95% CI –7.9 to –1.6] and –4.8 [95% CI –7.9 to –1.7], respectively). Regular treatment with a long-acting bronchodilator was also associated with significantly better scores on the SGRQ-C (mean between-group difference –5.0 [95% CI –8.6 to –1.4]) compared to no regular treatment at 12 months of follow-up. Conclusions: Regular inhaled treatment in group A patients with COPD was associated with a symptomatic benefit but not with a reduction of exacerbation rates.

Gait characteristics and their associations with clinical outcomes in patients with chronic obstructive pulmonary disease

BackgroundAbnormalities of spatiotemporal gait parameters are frequently observed in chronic obstructive pulmonary disease (COPD). However, associations of gait parameters with clinical outcomes and their implementation into clinical practice have not been established. Research questionTo investigate gait abnormalities and their association with clinical outcomes of COPD. MethodsThis study included 34 male outpatients with COPD and 16 community-dwelling healthy men aged ≥65 years. The subjects underwent a ten-metre walk test wearing an accelerometer. Data on gait speed, step length, cadence, walk ratio, acceleration magnitude, and standard deviation of step time (step time SD) were collected. Forced expiratory volume in 1-second, modified Medical Research Council dyspnoea score, six-minute walk distance (6MWD), quadriceps muscle strength (QMVC), and physical activity (daily steps and time spent in moderate to vigorous physical activity per day) were measured in the COPD group as clinical outcomes of COPD. We tested group differences in gait parameters, associations between gait parameters and COPD clinical outcomes, and predictive capability of gait parameters for reductions in 6MWD, QMVC, and daily steps in COPD. ResultsAll gait parameters except walk ratio deteriorated in COPD. Step time SD and gait speed were significant independent predictors of 6MWD in COPD (B=−0.440, p = 0.001, B = 0.339, p = 0.007, respectively). Step length was a significant independent predictor of QMVC (B=−0.609, p < 0.001) and daily steps (B=−0.453, p = 0.006). Step length was a significant predictor of muscle weakness and physical inactivity, and step time SD was significant in predicting poor 6MWD in COPD. SignificanceSignificant associations between gait abnormalities measured by an accelerometer and deficits in extra-pulmonary features of COPD were observed. An accelerometer-based gait analysis could be an alternative approach to assessing gait abnormalities and screening of functional decline in COPD.

King's Brief Interstitial Lung Disease questionnaire: responsiveness and minimum clinically important difference.

Health status is increasingly used in clinical practice to quantify symptom burden and as a clinical trial end-point in patients with interstitial lung disease (ILD). The King's Brief Interstitial Lung Disease (KBILD) questionnaire is a brief, validated 15-item, disease-specific, health-related quality of life questionnaire that is increasingly used in clinical trials, but little data exist regarding the minimum clinically important difference (MCID). Using pulmonary rehabilitation as a model, we aimed to determine the responsiveness of KBILD and provide estimates of the MCID.KBILD scores, Chronic Respiratory Questionnaire (CRQ) scores, Medical Research Council (MRC) Dyspnoea score and incremental shuttle walk test (ISWT) distance were measured in 209 patients with ILD (105 with idiopathic pulmonary fibrosis (IPF)) before and after an outpatient pulmonary rehabilitation programme. Changes with intervention and Cohen's effect size were calculated. Anchor-based (linear regression and receiver operating characteristic plots) or distribution-based approaches (0.5 sd and standard error of measurement) were used to estimate the MCID of KBILD domain and total scores.KBILD, CRQ, MRC Dyspnoea and ISWT improved with intervention, and the effect sizes of KBILD domain and total scores ranged from 0.28 to 0.38. Using anchor-based estimates, the MCID estimates for KBILD-Psychological, KBILD-Breathlessness and activities, and KBILD-Total were 5.4, 4.4 and 3.9 points, respectively. Using distribution-based methods, the MCID estimate for KBILD-Chest symptoms was 9.8 points. The MCID estimates for KBILD in IPF patients were similar.In patients with ILD and IPF, KBILD is responsive to intervention with an estimated MCID of 3.9 points for the total score.

The prognostic significance of weight loss in chronic obstructive pulmonary disease-related cachexia: a prospective cohort study.

BackgroundCachexia is an important extra‐pulmonary manifestation of chronic obstructive pulmonary disease (COPD) presenting as unintentional weight loss and altered body composition. Previous studies have focused on the relative importance of body composition compared with body mass rather than the relative importance of dynamic compared with static measures. We aimed to determine the prevalence of cachexia and pre‐cachexia phenotypes in COPD and examine the associations between cachexia and its component features with all‐cause mortality.MethodsWe enrolled 1755 consecutive outpatients with stable COPD from two London centres between 2012 and 2017, stratified according to European Respiratory Society Task Force defined cachexia [unintentional weight loss >5% and low fat‐free mass index (FFMI)], pre‐cachexia (weight loss >5% but preserved FFMI), or no cachexia. The primary outcome was all‐cause mortality. We calculated hazard ratios (HRs) using Cox proportional hazards regression for cachexia classifications (cachexia, pre‐cachexia, and no cachexia) and component features (weight loss and FFMI) and mortality, adjusting for age, sex, body mass index, and disease‐specific prognostic markers.ResultsThe prevalence of cachexia was 4.6% [95% confidence interval (CI): 3.6–5.6] and pre‐cachexia 1.6% (95% CI: 1.0–2.2). Prevalence was similar across sexes but increased with worsening Global Initiative for Chronic Obstructive Pulmonary Disease spirometric stage and Medical Research Council dyspnoea score (all P < 0.001). There were 313 (17.8%) deaths over a median (interquartile range) follow‐up duration 1089 (547–1704) days. Both cachexia [HR 1.98 (95% CI: 1.31–2.99), P = 0.002] and pre‐cachexia [HR 2.79 (95% CI: 1.48–5.29), P = 0.001] were associated with increased mortality. In multivariable analysis, the unintentional weight loss feature of cachexia was independently associated with mortality [HR 2.16 (95% CI: 1.31–3.08), P < 0.001], whereas low FFMI was not [HR 0.88 (95% CI: 0.64–1.20), P = 0.402]. Sensitivity analyses using body mass index‐specific, age‐specific, and gender‐specific low FFMI values found consistent findings.ConclusionsDespite the low prevalence of cachexia and pre‐cachexia, both confer increased mortality risk in COPD, driven by the unintentional weight loss component. Our data suggest that low FFMI without concurrent weight loss may not confer the poor prognosis as previously reported for this group. Weight loss should be regularly monitored in practice and may represent an important target in COPD management. We propose the incorporation of weight monitoring into national and international COPD guidance.

Handgrip strength is associated with dyspnoea and functional exercise capacity in male patients with stable COPD.

<sec id="st1"> <title>SETTINGS</title> Handgrip strength (HGS) is widely used to evaluate nutrition and adverse outcomes in several diseases. However, the relationship between HGS and the parameters of chronic obstructive pulmonary disease (COPD) are not known. </sec> <sec id="st2"> <title>OBJECTIVE</title> To evaluate HGS in male patients with stable COPD, and to assess its correlation with dyspnoea and functional exercise capacity. </sec> <sec id="st3"> <title>DESIGN</title> We recruited 116 male out-patients with stable COPD from a general hospital in China between February and December 2017. For each patient, we recorded demographic characteristics and measured pulmonary function, dyspnoea, exercise capacity, body composition and HGS. </sec> <sec id="st4"> <title>RESULTS</title> HGS had a significantly positive correlation with muscle mass, lung function, and 6-min walking distance (6MWD) and a negative correlation with the modified Medical Research Council dyspnoea score. Multiple linear regression analysis showed that combining age, fat-free mass (FFM), 6MWD and duration of COPD accounted for 43.1% of the total variance in HGS. </sec> <sec id="st5"> <title>CONCLUSION</title> HGS was correlated with dyspnoea and exercise capacity. Aging and disease could alter upper limb muscle strength in COPD patients. Hence, HGS might be a simple method for assessing muscle function and for identifying patients with a noticeable reduction in HGS, who will need early, multidisciplinary intervention. </sec>.

Long-Term Outcome of Metallic Stenting for Central Airway Involvement in Relapsing Polychondritis

Placement of uncovered self-expandable metallic stents was found to successfully alleviate critical airflow limitation in patients with relapsing polychondritis (RP) with central airway involvement by several reports. However, the long-term outcome of airway metallic stenting in patients with RP remain unclear. We retrospectively analyzed patients with RP who underwent airway metallic stenting with the use of fiberoptic bronchoscopy between September 1, 2009, and October 1, 2017, in Shanghai. Outcome measurements, including modified Medical Research Council (mMRC) dyspnea score, 6-minute walk distance (6MWD), spirometry, and bronchoscopic findings, as well as adverse events after stent placement, were collected. A total of 27 patients were included; the median patient age was 58 years (range: 41 to 74 years), and 19 weremen (70.4%). Nineteen uncovered self-expandable metallic stents were placed in the trachea and 39 in the main bronchi. The median follow-up time was 50.5 months (range: 6 to 100 months). The baseline forced expiratory volume in 1 second (FEV1) percentage predicted (%pred), FEV1/forced vital capacity (FVC), and peak expiratory flow (PEF) was 24.2 ± 3.7, 27.2 ± 5.6, and 0.99 ± 0.21 L/min, respectively. One day after the procedure, improvement from baseline in FEV1 %pred, FEV1/FVC, and PEF was 17.9± 8.9 (p= 0.001), 19.8 ± 10.9 (p= 0.002), and 0.69 ± 0.44 L/min (p= 0.001), respectively. Changes in the following variables were also statistically and clinically significant: 6MWD of 193.7 ± 83.4 m; mMRC dyspnea score of-1.2 ± 0.4 points (both p < 0.05). The improvements were maintained at 5 years: a mean change in FEV1 %pred, FEV1/FVC, PEF, 6MWD, and mMRC score was 19.5 ± 6.7, 13.9 ± 5.0, 0.82± 0.40 L/min, 134.7 ± 66.2 m, and-0.83 ± 0.29 points, respectively. Cough, foreign body sensation, mucus production, and granulomas were common adverse events,occurring in 48.1% (13 of 27), 40.7% (11 of 27), 29.6% (8 of 27), and 25.9% (7 of 27) of the subjects. However, noneof those complications were severe enough to requireurgent bronchoscopic interventions. Airway metallic stenting in patients with RP with central airway involvement resulted in long-term clinical benefits in lung function, exercise tolerance, and dyspnea with an acceptable safety profile.

Physical Inactivity in Pulmonary Sarcoidosis

PurposeReduced physical activity in many chronic diseases is consistently associated with increased morbidity. Little is known about physical activity in sarcoidosis. The aim of this study was to objectively assess physical activity in patients with pulmonary sarcoidosis and investigate its relationship with lung function, exercise capacity, symptom burden, and health status.MethodsPhysical activity was assessed over one week in 15 patients with pulmonary sarcoidosis and 14 age-matched healthy controls with a tri-axial accelerometer (ActivPal™) and the International Physical Activity Questionnaire (IPAQ). All participants underwent pulmonary function tests, 6-min walk test (6MWT) and completed the Fatigue Assessment Scale (FAS), Medical Research Council (MRC) Dyspnoea Scale and the King’s Sarcoidosis Questionnaire (KSQ).ResultsPatients with sarcoidosis had significantly lower daily step counts than healthy controls; mean (SD) 5624 (1875) versus 10,429 (2942) steps (p < 0.01) and a trend towards fewer sit-to-stand transitions each day (p = 0.095). Only two patients (13%) self-reported undertaking vigorous physical activity (IPAQ) compared to half of healthy individuals (p < 0.01). Daily step count was significantly associated with 6MWT distance in sarcoidosis (r = 0.634, p = 0.01), but not with forced vital capacity (r = 0.290), fatigue (r = 0.041), dyspnoea (r = −0.466) or KSQ health status (r = 0.099–0.484). Time spent upright was associated with fatigue (r = −0.630, p = 0.012) and health status (KSQ Lung scores r = 0.524, p = 0.045), and there was a significant correlation between the number of sit-to-stand transitions and MRC dyspnoea score (r = −0.527, p = 0.044).ConclusionPhysical activity is significantly reduced in sarcoidosis and is associated with reduced functional exercise capacity (6MWD). Fatigue, exertional symptoms and health status were more closely associated with time spent upright and the number of bouts of physical activity, as compared to step counts. Further studies are warranted to identify the factors that determine different physical activity profiles in sarcoidosis.

The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer

BackgroundInternational research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in...

Pulmonary rehabilitation in patients with mustard gas lung disease: a study protocol for a randomized controlled trial

BackgroundMore than 60,000 people have health problems due to chemical weapons exposure during the Iran–Iraq war. Respiratory consequences of mustard gas exposure are common and disabling; medical interventions have limited effect. Patients complain of cough, sputum, breathlessness and exercise limitation. We hypothesized that patients with this condition would benefit from pulmonary rehabilitation.MethodsWe outline the protocol for an assessor-blind, two-armed, parallel-design randomized controlled clinical trial (IRCT2016051127848N1). Sixty patients with respiratory disease due to documented sulfur mustard gas exposure will be randomized to either take part in a 6-week pulmonary rehabilitation programme or receive usual care. Inclusion criteria include forced expiratory volume in 1 second < 80% predicted and Medical Research Council dyspnoea score ≥ 3. The primary endpoint will be the change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Lung function, physical activity, the strength and endurance of the quadriceps muscle, and quality of life will also be compared. Outcomes will be assessed at 6 weeks and 12 months. Health care utilization will also be assessed.DiscussionIf the study confirms that rehabilitation is effective for patients with mustard gas lung disease this should prompt provision of the intervention to this patient group.Trial registrationIranian Registry of Clinical Trials, IRCT2016051127848N1. Registered on 24 May 2016.

B-type natriuretic peptide predicts deterioration in functional capacity following lung resection.

Following lung resection, there is a decrease in the functional capacity and quality of life, which is not fully explained by changes in pulmonary function. Previous work demonstrates that B-type natriuretic peptide (BNP) is associated with short- and long-term complications following lung resection, leading to the suggestion that cardiac dysfunction may contribute to functional deterioration. Our aim was to investigate any relationship between BNP and subjective and objective indices of functional deterioration following lung resection surgery. Twenty-seven patients undergoing lung resection had serum BNP measured preoperatively, on postoperative day (POD)1 and POD2, and at 2 months postoperatively. The functional deterioration was assessed using 6-min walk tests and the Medical Research Council dyspnoea scale. 'Deterioration in functional capacity' was defined as either an increase in the Medical Research Council dyspnoea score or a significant decrease in the 6-min walk test distance. BNP increased over time (P < 0.01) and was significantly elevated on POD1 and POD2 (P < 0.02 for both). Seventeen patients demonstrated functional deterioration 2 months postoperatively. At all perioperative time points, BNP was significantly higher in patients showing deterioration (P < 0.05 for all). Preoperative BNP was predictive of functional deterioration at 2 months with an area under the receiver-operating characteristic curve of 0.82 (P = 0.01, 95% confidence interval 0.65-0.99). This study has demonstrated, using subjective and objective measures, that preoperative BNP is a predictor of functional deterioration following lung resection. BNP may have a role in preoperative risk stratification in this population, allowing therapy in future to be targeted towards high-risk patients with the aim of preventing postoperative cardiac dysfunction. NCT01892800.

Personalised anti-inflammatory therapy for bronchiectasis and cystic fibrosis: selecting patients for controlled trials of neutrophil elastase inhibition.

BackgroundNeutrophil elastase (NE) has been linked to lung neutrophil dysfunction in bronchiectasis and cystic fibrosis (CF), making NE inhibition a potential therapeutic target. NE inhibitor trials have given mixed result perhaps because not all patients have elevated airway NE activity.MethodsWe tested whether a single baseline sputum NE measurement or a combination of clinical parameters could enrich patient populations with elevated NE activity for “personalised medicine”. Intra- and interindividual variations of total and active NE levels in induced sputum from patients with CF or bronchiectasis were monitored over 14 days. Patients with established CF and bronchiectasis (n=5 per group) were recruited. NE was measured using three different methods: one total and two active NE assays. Subsequently, we analysed the association between clinical parameters and NE from a large bronchiectasis cohort study (n=381).ResultsAll three assays showed a high degree of day-to-day variability (0–233% over 14 days). There were strong correlations found between all assays (p<0.0001). Despite high day-to-day variability, patients could be stratified into “high” or “low” groups based on moderate cut-off levels. In the bronchiectasis cohort study, factors most associated with high sputum NE levels were: Pseudomonas aeruginosa infection (β-estimate 11.5, 95% CI −6.0–29.0), sputum colour (β-estimate 10.4, 95% CI 4.3–16.6), Medical Research Council dyspnoea score (β-estimate 6.4, 95% CI 1.4–11.4) and exacerbation history (β-estimate 3.4, 95% CI 1.4–5.3). Collectively, P. aeruginosa infection, sputum colour and exacerbation frequency provided the greatest specificity for “high” NE (98.7%, 95% CI 7.0–99.6%).ConclusionThese results show that patients with bronchiectasis and CF can be effectively divided into “high” or “low” groups, based on sputum NE assays or clinical inclusion criteria.

Endobronchial coils in treatment of advanced emphysema: A single center experience.

This study aims to present our experience with endobronchial coils in patients who underwent endobronchial lung volume reduction due to advanced emphysema. The study included 46 patients (45 males, 1 female; mean age 61.7±8 years; range, 43 to 80 years) who underwent endobronchial lung volume reduction with endobronchial coils for advanced emphysema. Patients" age, gender, pulmonary function tests, post-treatment morbidity, mortality, pre- and post-treatment (6 months) six-minute walking distance, modified Medical Research Council dyspnea scores, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores were recorded. Patients had an average of 65 pack/year smoking history. An average of 11 (range, 9-15) coils were placed per lobe (right upper lobe=35, left upper lobe=19, right lower lobe=2, left lower lobe=4). Mean follow-up duration was 12.6 months (±5.6 months). Post-treatment forced expiratory volume in one second, residual volume and six-minute walking distance values were improved with statistical significance. Also, significant improvement was seen in quality of life, quantified by modified Medical Research Council, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores. While no immediate major postoperative complications occurred, three patients developed chronic obstructive pulmonary disease exacerbation, two developed pneumonia, and one developed recurrence of previous neurologic disorder within 30 days. Endobronchial coil administration provides lower morbidity and mortality compared to lung volume reduction surgery as well as significant improvement in pulmonary functions and quality of life in selected patients with advanced emphysema.