Medical Research Council Dyspnea Research Articles

Investigation of Factors Affecting Shuttle Walking Performance at Increased Speed for Patients with Chronic Obstructive Pulmonary Disease.

The aim of this study was to examine the factors affecting the shuttle walking test (SWT) in patients with chronic obstructive pulmonary disease (COPD). A total of 29 patients with COPD (the COPD group) and a healthy group (HG) of 34 women aged between 55 and 74 years were included in the study. After the pulmonary function profiles of the participants were assessed, and the SWT was performed. Walking distances, walking speeds, and SWT levels (SWT-L) were determined with the SWT. Before and after the SWT, the heart rate (HR), oxygen saturation level (SPO2), and Borg scale (perceived exertion (BSe) and dyspnea (BSd)) results were analyzed with a paired sample t-test. The dyspnea levels during activity of daily living were determined with the Medical Research Council (MRC) dyspnea scale, and the relationship between MRC dyspnea (MRCD) and walking distance, speed, and SWT-L was tested using multiple linear regression and Pearson correlation analysis. The walking distance, speed, and SWT-L were lower in the COPD group (p < 0.001) than in the HG. The HR values before and after the SWT changed significantly in the COPD group and the HG (p< 0.001), and the effect size was higher in the COPD group. Although the BSe and BSd results before and after the SWT in the COPD group increased significantly (p < 0.001), they did not change in the HG. There was a highly negative correlation between MRCD and walking distance, speed, and SWT-L in the COPD group (p = 0.002, p = 0.000, and p = 0.001, respectively), but no correlation was found in the HG. The results showed that the HR, perceived exertion, and dyspnea levels of women with COPD whose respiratory functions were lower than the HG were significantly affected on the SWT.

Predictors of Mortality in COVID-19-Positive Patients On and Off CPAP: A Review From a Tertiary Care Setting in the NHS.

IntroductionSince the first description of a coronavirus-related pneumonia outbreak in December 2019, the virus SARS-CoV-2 that causes the infection/disease coronavirus disease 2019 (COVID-19) has evolved into a pandemic, and as of today, millions have been affected.ObjectivesOur aim was to identify the predictors of mortality in COVID-19-positive patients on or off continuous positive airway pressure (CPAP).MethodologyThis was an observational study. Data were collected from February 2020 to April 2020 with patients admitted to the COVID-19 ward at The James Cook University Hospital, Middlesbrough, England. The inclusion criteria were COVID-19-positive patients confirmed through PCR tests on or off CPAP. Patients who had negative RT-PCR for COVID-19 and those who were intubated were excluded.ResultsA total of 56 patients diagnosed with COVID-19 (through RT-PCR) were included in the final analysis, among which 27 were on CPAP, while 29 did not require CPAP (NCPAP). The overall mean age of the patients was 66 ± 14 (range: 26-94) years. The mean age of CPAP and NCPAP patients was 63 ± 15 (range: 26-85) years and 68 ± 13 (range: 40-94) years, respectively. The ethnicity of 54 (96.4%) patients was White-Caucasian, while 2 (3.6%) were British-Asian. In the study sample, 16 (28.6%) patients expired, of which 11 (40.7%) were on CPAP, while 5 (16.7%) did not require CPAP during the disease course. Correlation analysis showed that overall higher age, Medical Research Council Dyspnoea (MRCD) score, performance status (PS), and consolidation affecting more than one quadrant of the lungs were significantly correlated with increased mortality. Among patients receiving CPAP, higher age, MRCD score, and PS were significant predictors of mortality. Among the NCPAP group, advancing age, respiratory rate, MRCD score, PS, increased creatinine levels, and consolidation affecting more than one quadrant of the lungs were the predictors of mortality.ConclusionEven with a small sample size, we can see that there are definitive predictors that are directly proportional to increased mortality in COVID-19 patients on CPAP, such as higher age, performance status, MRCD score, and increased lung involvement of consolidation in more than one quadrant, which can help us rationalize management.

Peripheral blood microbial signatures in current and former smokers

The human microbiome has a role in the development of multiple diseases. Individual microbiome profiles are highly personalized, though many species are shared. Understanding the relationship between the human microbiome and disease may inform future individualized treatments. We hypothesize the blood microbiome signature may be a surrogate for some lung microbial characteristics. We sought associations between the blood microbiome signature and lung-relevant host factors. Based on reads not mapped to the human genome, we detected microbial nucleic acids through secondary use of peripheral blood RNA-sequencing from 2,590 current and former smokers with and without chronic obstructive pulmonary disease (COPD) from the COPDGene study. We used the Genome Analysis Toolkit (GATK) microbial pipeline PathSeq to infer microbial profiles. We tested associations between the inferred profiles and lung disease relevant phenotypes and examined links to host gene expression pathways. We replicated our analyses using a second independent set of blood RNA-seq data from 1,065 COPDGene study subjects and performed a meta-analysis across the two studies. The four phyla with highest abundance across all subjects were Proteobacteria, Actinobacteria, Firmicutes and Bacteroidetes. In our meta-analysis, we observed associations (q-value < 0.05) between Acinetobacter, Serratia, Streptococcus and Bacillus inferred abundances and Modified Medical Research Council (mMRC) dyspnea score. Current smoking status was associated (q < 0.05) with Acinetobacter, Serratia and Cutibacterium abundance. All 12 taxa investigated were associated with at least one white blood cell distribution variable. Abundance for nine of the 12 taxa was associated with sex, and seven of the 12 taxa were associated with race. Host-microbiome interaction analysis revealed clustering of genera associated with mMRC dyspnea score and smoking status, through shared links to several host pathways. This study is the first to identify a bacterial microbiome signature in the peripheral blood of current and former smokers. Understanding the relationships between systemic microbial signatures and lung-related phenotypes may inform novel interventions and aid understanding of the systemic effects of smoking.

Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan

BackgroundWaitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.MethodsWe analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George’s Respiratory Questionnaire (SGRQ).ResultsAmong 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease.ConclusionsBoth mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients’ background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.

Association between patient-reported outcomes and exercise test outcomes in patients with COPD before and after pulmonary rehabilitation

BackgroundOver the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR).MethodsCorrelations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory- and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR.ResultsOverall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (ρ:-0.65; p<0.001). HRQoL related PROs showed weak correlations with exercise outcomes at baseline. Moderate correlations were found between St George’s Respiratory Questionnaire total score and 6MWD (r:-0.53; p<0.001) and maximal workload achieved during cardiopulmonary exercise testing (ρ:-0.48; p<0.001); and between Clinical COPD Questionnaire (CCQ) total score and 6MWD (r:-0.48; p<0.001) and maximal workload (ρ:-0.43; p<0.001). When significant, correlations between changes in exercise test outcomes and changes in PROs after PR were generally very weak or weak. The highest correlation was found between changes in CCQ total score and changes in 6MWD (ρ: − 0.36; p<0.001).ConclusionsPROs and exercise test outcomes, although significantly correlated with each other, assess different disease features in patients with COPD. Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a PR program.Trial registrationNetherlands Trial Register (NL3263/NTR3416). Registered 2 May 2012.

The association of patient-reported symptoms and clinical and lung function parameters in patients with chronic obstructive pulmonary disease in stable phase

ABSTRACT Objectives Few ‘real-life’ studies were conducted on the relationship between functional and clinical features in chronic obstructive pulmonary disease (COPD). We described the correlation between clinical and functional respiratory parameters in one-year follow-up observational study during stable phase COPD and regular inhalation therapy. Methods In 237 patients, the impact of respiratory symptoms was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, the COPD assessment test (CAT), and a self-assessment of patient’s perceived COPD severity (Mapel scale) at baseline (T0) and after one year (T1). Results Mean CAT and mMRC scores at T0 were 10.55 and 1.2, respectively. The majority of patients pointed out mild symptoms (values between 1 and 2 at Mapel scale). Mean CAT score at T0 did not differ after subdividing our population in the four spirometry GOLD stages. In the year of follow-up, FEV1 and hyperinflation indexes improved. CAT score was significantly associated with mMRC (p < 0.001), residual volume (RV) (p = 0.023), and RV/total lung capacity % (p = 0.011). Conclusion The impact of symptoms in COPD stable patients was related to hyperinflation indexes and mMRC. There was no correlation between significant changes in CAT score and other symptom evaluation scores after one year.

Efficacy of Enhanced External Counter Pulsation on Clinical Parameters and Health-Related Quality of Life in Coronary Heart Disease patients with Diabetes Mellitus

To assess the effect of Enhanced External Counter Pulsation (EECP) treatment on clinical parameters and health related quality of life (HRQoL) in Coronary Heart Disease (CHD) patients with Diabetes Mellitus. This was a pretest-posttest designed prospective study among 163 diabetic and non-diabetic coronary heart disease patients enrolled from SAAOL Heart Center, New Delhi, India. Patients were divided into two groups- diabetic CHD group and non-diabetic CHD group. EECP treatment was given to both the groups for 35 day. After EECP treatment physical and clinical profile along with HRQoL of study participants was assessed. The physical profile of study participants was assessed using Cooper’s 12 minutes’ walk test, Canadian Cardiovascular Society (CCS) angina scale and Medical Research Council (MRC) dyspnea scale and HRQoL was assessed through SF-36 (short form) and Seattle Angina Questionnaire (SAQ) scale. The follow-up of both groups was done at 6th and 12th months. Collected data were assessed through IBM, SPSS software v 21. Descriptive analysis with sample t-test for two independent groups and paired sample t-test for EECP effectiveness within the group was done. A significant improvement was observed in blood pressure; heart rate, lipid profile angina and MRC score in both the groups at 6th and 12 month follow-up. A significant reduction was observed in blood sugar fasting, blood sugar postprandial (PP) and glycosylated hemoglobin (HbA1c) in diabetic CHD patients. A significant improvement was also observed in all health domains of SF-36 &amp; SAQ scale HRQoL after EECP treatment. EECP therapy is an effective non-invasive method to treat diabetic and non–diabetic CHD patients. This therapy may improve both physical (physical functional capacity, angina, dyspnea) and clinical profile (lipid profile, lower the blood glucose level) in diabetic CHD patients. EECP may also improve clinical symptoms of CHD patients and lower the blood glucose level in diabetic CHD patients this may directly improve overall HRQoL of CHD patients with DM.

Técnica de uso de inhaladores y su impacto en la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar el impacto de la técnica de uso de los inhaladores en la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica (epoc). &lt;strong&gt;Métodos:&lt;/strong&gt; se realizó un estudio transversal analítico. Se incluyeron pacientes de 40 a 85 años, con diagnóstico de epoc&lt;strong&gt; &lt;/strong&gt;que utilizaran inhaladores, adscritos a la Unidad de Medicina Familiar (umf) no. 28 del Instituto Mexicano del Seguro Social (imss). La evaluación de la técnica de uso de inhaladores se realizó mediante una lista de cotejo, la medición de calidad de vida se hizo mediante el instrumento copd Assessment Test (cat), el apego al tratamiento se llevó a cabo mediante el test de Morinsky-Green, la estadificación del grado de severidad de epoc se ejecutó con la escala de disnea del Medical Research Council (mrc); se analizó el tiempo de evolución de la enfermedad, exacerbaciones, hospitalizaciones durante el último año, así como el uso de oxigenoterapia. &lt;strong&gt;Resultados:&lt;/strong&gt; se incluyó un total de 330 participantes, de los cuales 220 fueron mujeres (60.4%), con una mediana de 74 años, Rango Intercuartilar (ri) 66.83, con apego al tratamiento farmacológico en 313 pacientes (94.8%), de los cuales 129 mostraron una técnica adecuada de uso de inhaladores (39.1%). En los pacientes con alto y muy alto impacto en la calidad de vida se encontró mayor número de exacerbaciones y hospitalizaciones. Los factores de riesgo que impactan en la calidad de vida de estos pacientes fueron: técnica inadecuada de uso de inhaladores, que mostró un or de 5.35 (ic 95% 1.92-14.86), así como la edad e índice de masa corporal (imc). &lt;strong&gt;Conclusiones:&lt;/strong&gt; la inadecuada técnica de uso de los inhaladores, mayor edad e imc &amp;lt; 23 son variables que deterioran la calidad de vida de los pacientes con epoc. El uso correcto de los inhaladores debe ser una parte indispensable del tratamiento de los pacientes con epoc.&lt;/p&gt;

P591Insights from Exercise Cardiac Magnetic Resonance Imaging (ExMR) With Cardiopulmonary Testing in HIV Patients

Abstract Background Cardiac magnetic resonance imaging in conjunction with exercise (exMR) and cardiopulmonary testing (CPET) to evaluate cardiopulmonary function has the potential of uncovering poorly understood mechanisms of dyspnea in patients that cannot be otherwise discerned with a single imaging modality. Purpose We prospectively evaluated the value of this technique in dyspneic patients with HIV without obvious cardiopulmonary etiologies to comprehensively assess mechanisms of dyspnea. Methods Thirty-six HIV patients with dyspnea without obvious cardiopulmonary causes [normal chest x-ray, normal resting LVEF and resting pulmonary artery (PA) pressures &lt;40 mm Hg on echo] and exercise limitation [Modified Medical Research Council (MMRC) dyspnea scale &gt;2] underwent testing using a novel combined exMR/CPET platform (Figure 1). Resting and exercise magnetic resonance imaging (MRI), including flow velocities across the pulmonary artery together with CPET was evaluated at pre and post peak stress. We analyzed the correlation between CPET and MRI pre and peak exercise variables. Results The mean age was 51 years; 60% were male; and mean absolute CD4 count was 718. Ventilator efficiency at peak exercise (Peak VO2) did not correlate with exMR parameters. Peak VE/VCO2 was negatively associated with peak LV and RV stroke volume (p values 0.002 &amp; 0.005 respectively). There was a positive relationship between peak petCO2and LV cardiac output (p=0.02), peak exercise RV stroke volume (p=0.003), peak exercise LV stroke volume (p=0.02). Absolute CD4 count was positively correlated with post exercise pulmonary artery velocity (p=0.045). We found no correlation between absolute CD8 count and CMR and CPET exercise parameters. Figure 1. MRI-CPET setting Conclusion HIV patients appear to have an impairment of ventilatory efficiency, exemplified by the association of VE/VCO2and PetCO2 with exMR parameters in the context of normal RV/LV contractile reserve and no evidence of Pulmonary arterial hypertension. A combined CPET/exMRI platform may provide new insight into cardiopulmonary function and the factors influencing exercise tolerance in symptomatic HIV patients. Acknowledgement/Funding 7R01HL125060-03

Effects of High-Dose Vitamin D Replacement on the Serum Levels of Systemic Inflammatory Biomarkers in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is associated with increased inflammatory responses to noxious particles, which can be further enhanced during Acute Exacerbation of COPD (AECOPD). Considering the important immunoregulatory function of vitamin D, high prevalence of Vitamin D Deficiency (VDD) in COPD patients and a negative link between vitamin D levels and inflammatory biomarkers, suggests the seemingly interesting mechanism of vitamin D effects on inflammation resolution during the conventional treatment of AECOPD. The admitted AECOPD patients with VDD were recruited and randomly allocated to receive either 300,000 IU of intramuscular vitamin D (n = 35) or placebo (n = 35). Primary outcomes included inflammation resolution dynamics, which were assessed by monitoring the serum levels of IL-6, IL-8, and hs-CRP. Symptom recovery was evaluated based on the modified Medical Research Council (mMRC) dyspnea scale on the 1st and 6th days of admission. Secondary outcomes included the length of hospital stay (LOS) and 30-day mortality rates. Inflammatory biomarkers were highest at Day 1. Baseline vitamin D levels were 11.25 ± 3.09 and 10.59 ± 3.90 ng/ml (P = 0.45), which reached 11.35 ± 3.16 and 18.17 ± 4.24 by Day 6 (P < 0.001) in the placebo and, vitamin-D groups, respectively. IL-6 levels significantly decreased in the vitamin-D vs. placebo group on the 6th day (P = 0.02); however, no significant differences were observed in IL-8 (P = 0.15) and hs-CRP (P = 0.24) levels, mMRC scale (P = 0.45), LOS (P = 0.20), and mortality rates (P = 0.61). Vitamin D replacement as adjunctive therapy may accelerate inflammation resolution in hospitalized AECOPD patients. Further studies were needed to establish vitamin D exact role on inflammation resolution in AECOPD.

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.

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.

Investigation of the effect of kinesiotaping on the respiratory function and depression in male patients with chronic obstructive pulmonary disease: a prospective, randomized, controlled, and single-blind study

Objectives We aimed to investigate the effect of kinesiotaping (KT) on the respiratory parameters as measured by spirometry and depression in the chronic obstructive pulmonary disease (COPD) patients. Methods In this prospective, randomized, controlled, single-blind study 42 male patients with COPD diagnosis were randomized into two groups. In Group1 (n = 21) routine COPD medical treatment plus kinesiotaping and in Group2 (n = 21) only routine COPD medical treatment was given. KT was changed on every fifth day (for a total of three times and 15 days). The patients were assessed using Visual Analog Scale (VAS) for difficulty experienced by the patients during respiration, respiratory function test (RFT), modified medical research council (mMRC) dyspnea scale and beck depression inventory (BDI). The data were obtained before treatment and posttreatment. Results In Group 1; statistically significant improvement was found in all parameters except for FVC and FVC % following treatment compared to pretreatment values. Comparison of the difference scores (the amount of recovery between posttreatment and pretreatment) of the two groups showed significantly superior improvement in Group1 for all parameters except for FVC, FVC % and FEV1% following the treatment (p < .05). Conclusions The results of this study showed that supplementary kinesiotaping improved respiratory function and depression significantly compared to only routine medical treatment in COPD patients who were in stable condition.

Adaptação cardiovascular no Teste de Caminhada dos Seis Minutos em pacientes com DPOC: estudo transversal

OBJETIVO: Avaliar o comportamento da adaptação cardiovascular e da saturação periférica de oxigênio em indivíduos com DPOC submetidos no teste de caminhada dos seis minutos (TC6). MATERIAL E MÉTODOS: Trata-se de um estudo de corte transversal, que foram incluídas pessoas com diagnóstico de DPOC, confirmado pela espirometria e de ambos os sexos. A magnitude de sintomas foi avaliada pela escala de dispneia Medical Research Council (MRC) e questionário COPD Assessment Test (CAT). Aplicou-se o TC6 para avaliar a tolerância ao esforço. Para mensurar a frequência cardíaca máxima (FC máx) prevista para a idade foram utilizadas equações específicas para população brasileira. RESULTADOS: Avaliou-se 34 indivíduos com DPOC, 20 (58,8%) homens; relação VEF1/CVF foi 56,7% ± 10,2% pós broncodilatador (BD). Quatorze 14 (41,2%) indivíduos apresentaram impacto clínico moderado; 16 (47,2%) dos avaliados apresentou grau 2 na escala do MRC. As médias das distâncias percorridas no primeiro e segundo TC6 foram 383,5 ± 13,6; 408,6 ± 85,7 metros, correspondendo a 70, 75%; 75,10% em relação ao valor previsto (p=0,001). As médias da FC máx ao final do primeiro e segundo TC6, foram 94,1 ± 21,9; 92,3 ± 17,9 bpm e a FC pós percentual da FC máx prevista pré e pós TC6 foram 61,1% ± 17,7%; 59,7% ± 21,5% e 14 (41,2%) pacientes apresentaram dessaturação de O2 no primeiro TC6; 9 (26,5%) no segundo teste. CONCLUSÕES: Pacientes com DPOC, apresentam aumento da FC identificado pelo esforço submáximo, por meio do percentual da FC max. Indivíduos com maior comprometimento da função pulmonar apresentaram dessaturação de O2.

Role of chest ultrasonography in assessment of diaphragmatic mobility in chronic obstructive pulmonary disease patients on pulmonary rehabilitation program

BackgroundChronic obstructive pulmonary disease (COPD) affects all skeletal muscles including the diaphragm as an extra pulmonary complication. Diaphragmatic mobility improves by pulmonary rehabilitation (PR). Chest ultrasound can be used in assessment of diaphragmatic mobility.AimEvaluation of chest ultrasound as a simple, noninvasive tool in assessment of diaphragmatic mobility in COPD patients undergoing PR and its correlation with maximal inspiratory pressure (Pi MAX), 6-min walk test (6MWT) and clinical chronic obstructive pulmonary disease questionnaire (CCQ).Patients and methodsThis study was conducted upon 30 COPD male patients aged 54.50±8.81 years old. All patients were recruited in to a PR program including 16 sessions over 8 weeks. The program included upper limb exercise, lower limb exercise and inspiratory muscle training. Baseline spirometry, Pi MAX, modified medical research council (mMRC) dyspnea scale, CCQ, 6MWT and sonographic assessment of diaphragmatic excursion and thickness were done. Follow-up sonographic evaluation of the diaphragm, CCQ and mMRC every 2 weeks were done. Re-evaluation after the program by the same baseline parameters was done.ResultsThere was statistically significant improvement in diaphragmatic excursion and thickness after PR program as evidenced by chest ultrasound. There was also significant functional improvement evidenced by 6MWT and Pi MAX. Also, there was significant improvement in mMRC and CCQ, but PR did not significantly affect spirometric parameters as forced expiratory volume in first second (FEV1)%, FEV1 value in liter or FEV1/forced vital capacity.ConclusionChest ultrasound is a beneficial tool in diaphragmatic assessment in COPD patients undergoing PR.

The effect of changes to GOLD severity stage on long term morbidity and mortality in COPD

BackgroundThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV1). This allows patients to change to less severe COPD stages, a novel aspect of assessment not previously evaluated. We aimed to investigate the association between temporal changes in GOLD severity stage and outcomes in COPD patients.MethodsThis was a record-linkage study using patients registered with a Scottish regional COPD network 2000–2015. Annual spirometry & symptoms were recorded and linked to healthcare records to identify exacerbations, hospitalisations and mortality. Spirometry, modified Medical Research Council (mMRC) dyspnoea scale and acute exacerbations over the previous year were used to assign GOLD severity at each visit. A time-dependent Cox model was used to model time to death. Secondary outcomes were respiratory specific mortality and hospitalisations. Effect sizes are expressed as Hazard Ratios HR (95%CI).ResultsFour thousand, eight hundred and eighty-five patients (mean age 67.3 years; 51.3% female) with 21,348 visits were included. During a median 6.6 years follow-up there were 1530 deaths. For the secondary outcomes there were 712 respiratory deaths and 1629 first hospitalisations. Across 16,463 visit-pairs, improvement in COPD severity was seen in 2308 (14%), no change in 11,010 (66.9%) and worsening in 3145 (19.1). Compared to patients staying in GOLD stage A, those worsening had a stepwise increased mortality and hospitalisations.ConclusionsImproving COPD severity classification was associated with reduced mortality and worsening COPD severity was associated with increased mortality and hospitalisations. Change in GOLD group has potential as monitoring tool and outcome measure in clinical trials.

Clinical variables predicting the risk of a hospital stay for longer than 7\u2009days in patients with severe acute exacerbations of chronic obstructive pulmonary disease: a prospective study

BackgroundChronic obstructive pulmonary disease (COPD) patients may experience an acute exacerbation (AECOPD) that requires hospitalisation. The length of hospital stay (LHS) has a great economic impact on the health-care system. Knowing the predictors of prolonged LHS could help to identify possible interventions.MethodsWe performed a prospective study to identify the clinical predictors of prolonged LHS in patients hospitalised for AECOPD. We divided the study sample by LHS into normal (≤7 days) and prolonged LHS (> 7 days) groups. Outcomes were the need for non-invasive and invasive mechanical ventilation (NIMV and IMV), intensive care unit (ICU) admission, and the 3-year mortality.ResultsWe enrolled 437 patients, of which 213 and 224 had normal LHS and prolonged LHS, respectively. Patients with a prolonged LHS had more prior hospitalisations for AECOPD, a worse mMRC (modified Medical Research Council) dyspnoea score, a higher prevalence of long-term oxygen therapy and a higher rate of congestive heart disease. During the current admission, this group also tended to require NIMV, IMV and ICU admission and the mortality risks at 6 months, 1 year and 3 years were higher. In the multivariate regression analysis, an mMRC dyspnoea score ≥ 2 (odds ratio-OR 2.24; 95% confidence interval-CI 1.34 to 3.74; p = 0.002) and the presence of acute respiratory acidosis (OR 2.75; 95% CI 1.49 to 5.05; p = 0.001) predicted a prolonged LHS at admission.ConclusionsThe presence of an mMRC ≥2 and acute respiratory acidosis at admission independently increased the risk of a prolonged LHS for AECOPD.

Antiplatelet therapy in the primary prevention of cardiovascular disease in patients with chronic obstructive pulmonary disease: protocol of a randomised controlled proof-of-concept trial (APPLE COPD-ICON 2)

IntroductionThe antiplatelet therapy in the primary prevention of cardiovascular disease in patients with chronic obstructive pulmonary disease (APPLE COPD-ICON2) trial is a prospective 2×2 factorial, double-blinded proof-of-concept randomised controlled trial...

Clinical features of patients with bronchiectasis of different types

Objective To investigate the clinical features of patients with bronchiectasis of different types. Methods One hundred and twenty two patients with bronchiectasis at stable stage were recruited from January 2014 to July 2015. The patients were typed as cystic bronchiectasis (n=45) or non-cystic bronchiectasis (n=77) by high resolution CT (HRCT), expectoration bronchiectasis (n=80) or dry brochiectasis (n=42) by clinical symptoms, bacterial colonization (n=42) or non-bacterial colonization (n=80) by sputum culture. The modified British Medical Research Council (mMRC) dyspnea scale, Leicester Cough Questionnaire (LCQ), St George′s Respiratory Questionnaire (SGRQ) and pulmonary function test were used to assess the clinical features, and the episodes of exacerbations and hospitalization, and mortality during 1-year follow-up were documented. Results mMRC dyspnea scale(1.90±0.94 vs. 2.90±1.09, t=-5.040), LCQ (16.20±4.60 vs. 11.20±2.20, t=8.114), SGRQ (36.80±13.10 vs. 52.06±22.10, t=-4.780), FEV1% pred (68.45±26.50 vs. 52.22±20.60, t=3.458), FVC% pred (72.20±26.32 vs. 63.10±21.42, t=2.058), FEV1/FVC (75.14±20.52 vs. 58.12±19.82, t=4.546 ), diffusing capacity of the lung for carbon monoxide (DLCO) (76.24±28.40 vs. 54.32±21.20, t=4.400), episodes of exacerbations (Z=-8.272 ) and hospitalization during 1-year follow-up [6(14.29%) vs. 29(36.25%), χ2=6.495] in patients with dry bronchiectasis were significantly better than those in patients with expectoration bronchiectasis (all P 0.05) among patients with different types of bronchiectasis. Conclusion Patients with cystic, bacterial colonization and expectoration types of bronchiectasis seem to have more severe symptoms, more episodes of exacerbations and hospitalizations than those of non-cystic, non-bacteria colonization and dry types of bronchiectasis. Key words: Bronchiectasis; Phenotype; Respiratory function tests; Bacteriology

Impact of Symptoms Duration in Chronic Obstructive Pulmonary Disease is There Any Meaningful Link?

Aim: To examine the relationship of duration of symptoms with the disease outcomes in patients with COPD. Background: COPD patients have varying degree of symptoms. We hypothesized that duration of symptoms may be useful to understand the disease progression. Methods: This observational study carried out in England. The patients were recruited and followed up between September 1999 and December 2002 and then 2007-2008, respectively. Patient’s demographics were recorded. Medical Research Council Dyspnoea (D) score were used to measure degree of breathlessness and spirometry were utilized to evaluate the severity of disease. Patients were asked about the COPD symptoms and for how long they have these symptoms including shortness of breath, cough, and the duration of their symptoms. Results: A total of 269 subjects were recruited. Of those 227 were with the diagnosis of COPD and 42 as non COPD or control group. The data is normally distributed. The study results show that there is a strong correlation between duration of symptoms and physiological variables both at baseline and at follow up. These include age (p=0.04), pack years (p=0.02), MRC score (p=0.04) and FEV1 (p<0.001).When GOLD stages of severity were used to explore the relationship; it becomes evident that patients with higher GOLD stage had longer duration of symptoms. Conclusion: These findings indicate the possible role of considering duration of symptoms as a useful marker of disease progression and its relationship with other disease outcomes in chronic obstructive pulmonary disease patients.