mMRC Dyspnea Research Articles

Rehabilitation experience of a patient with severe form of COVID-19 at the pulmonological climatic resort of the Southern Coast of Crimea

Introduction. The increase in the number of patients with post-COVID syndrome determines the relevance of their rehabilitation in sanatorium and resort institutions, of both local and climate-therapeutic resorts.Aim. To identify the possibility for the rehabilitation of patients with severe forms of COVID-19 in the conditions of the climatic pulmonological resort of the South Coast of Crimea in the winter season.Materials and methods. Clinical-anamnestic, laboratory, functional and computed-tomographic results of the examination of the thorax of a patient who had a severe form of COVID-19. Rehabilitation was carried out 21 days complexly using climatotherapy, therapeutic exercise, respiratory, medication and physiotherapy. The effectiveness of treatment was assessed using a 6-minute step test, Borg scale, mMRC dyspnea scale, oxygen assessment chart, rating of health status, Hospital Anxiety and Depression Scale (HADS), Fatigue Assessment Scale (FAS), dyspnea assessment index (DDI/TDI), questionnaires of life quality EQ-5D and SF-36.Results. At the end of the rehabilitation course, general well-being improved, shortness of breath decreased, exercise tolerance increased, positive dynamics of spirographic parameters, Borg scale scores and a 6-minute step test were noted. The indicators of depression on the HADS scale normalized, positive dynamics was noted according to the SF-36 questionnaire of the psychological component of health. The severity of pain/discomfort and anxiety/depression according to the EQ-5D questionnaire decreased. The X-ray picture has improved. When determining the diffusion capacity of the lungs (DLCО), an increase of 30% from the initial value was revealed.Conclusion. Rehabilitation of a patient who had a severe form of COVID-19 with bilateral lung damage in the conditions of the climatic pulmonology resort of the South Coast of Crimea in the winter season is effective. To assess the lung function of patients who have undergone COVID-19, the most effective method can be considered the determination of lung diffusion capacity (DLCО). Spirogram indicators do not always objectively reflect the severity of the condition.

Assessment of small airway dysfunction by impulse oscillometry (IOS) in COPD and IPF patients.

Small airway dysfunction is a pathological component of chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF), and impulse oscillometry is an easy-to-administer, effort-independent non-invasive test reflecting small airway dysfunction. We aimed to compare the impulse oscillometry (IOS) measurements between COPD and IPF patients and investigate their correlation with severity of both diseases and other conventional parameters. This was a prospective, longitudinal study. We longitudinally evaluated the baseline demographic characteristics, COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scale, Pulmonary Function Test (PFT), Carbon Monoxide Diffusing Capacity (DLCO), Hemogram and Impulse Oscillometry measurements of the patients diagnosed with COPD and IPF. The study included 60 IPF patients and 48 COPD patients. The CAT and mMRC scores were higher in COPD patients. The majority of COPD patients were classified into Category B (46%), while 68% of IPF patients had Stage 1 GAP. The mean FEF 25-75%, which is typically considered to reflect small airway disease, was 93% in IPF patients, while it was significantly lower in COPD patients (29%). Impulse oscillometry measurements were consistent with spirometry parameters. IOS resistance and reactance values were significantly higher in COPD patients than in IPF patients. IOS is advantageous in COPD and IPF patients who cannot exhale due to severe dyspnea, as it is easy to administer and reflects small airway resistance better. Diagnosis of small airway dysfunction may be beneficial in the management of patients with IPF and COPD.

Incorporating Self-Efficacy Theory to Awake Prone Positioning in COVID-19 Patients: A Single-Center Perspective Study

Objective: This study sought to examine whether the inclusion of self-efficacy theory could increase the effectiveness of awake prone positioning in COVID-19 patients. Method: A total of 80 COVID-19 patients admitted to the respiratory department of our hospital between December 2022 and February 2023 were randomly allocated into either the intervention group (n=40) or the control group (n=40). The control group received routine respiratory medicine treatment and underwent awake prone positioning, whereas the intervention group received additional self-efficacy theory intervention alongside awake prone positioning. The patients’ oxygen saturation level (SpO2) and respiratory rate (RR) were closely monitored at three different time points: before awake prone positioning, 30 minutes and 1 hour after awake prone positioning. Furthermore, the patients’ Modified Medical Research Council (mMRC) dyspnea scale and self-efficacy scores were evaluated on the first, second, and third days of awake prone positioning. The cumulative duration of awake prone positioning and patient satisfaction were recorded on the third day of the intervention. Results: The data indicate that the intervention group demonstrated significant improvements in both SpO2 and RR compared to the control group, both at 1 hour and at the end of awake prone positioning (P＜0.05). Moreover, the intervention group experienced a substantial reduction in the dyspnea index compared to the control group on the second and third day (P＜0.05). The intervention group also reported higher self-efficacy scores, cumulative duration of awake prone positioning ventilation on the third day, and satisfaction levels compared to the control group on the first, second, and third day (P<0.05). Conclusions: The incorporation of self-efficacy theory to awake prone positioning improves the short-term outcomes of COVID-19 patients. This patient-centered approach has the potential to increase patients’ self-efficacy and satisfaction levels, emphasizing the importance of incorporating patient-centered care in healthcare practices.

A risk-predictive model for obstructive sleep apnea in patients with chronic obstructive pulmonary disease.

Obstructive sleep apnea syndrome (OSA) is increasingly reported in patients with chronic obstructive pulmonary disease (COPD). Our research aimed to analyze the clinical characteristics of patients with overlap syndrome (OS) and develop a nomogram for predicting OSA in patients with COPD. We retroactively collected data on 330 patients with COPD treated at Wuhan Union Hospital (Wuhan, China) from March 2017 to March 2022. Multivariate logistic regression was used to select predictors applied to develop a simple nomogram. The area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to assess the value of the model. A total of 330 consecutive patients with COPD were enrolled in this study, with 96 patients (29.1%) confirmed with OSA. Patients were randomly divided into the training group (70%, n = 230) and the validation group (30%, n = 100). Age [odds ratio (OR): 1.062, 1.003-1.124], type 2 diabetes (OR: 3.166, 1.263-7.939), neck circumference (NC) (OR: 1.370, 1.098-1,709), modified Medical Research Council (mMRC) dyspnea scale (OR: 0.503, 0.325-0.777), Sleep Apnea Clinical Score (SACS) (OR: 1.083, 1.004-1.168), and C-reactive protein (CRP) (OR: 0.977, 0.962-0.993) were identified as valuable predictors used for developing a nomogram. The prediction model performed good discrimination [AUC: 0.928, 95% confidence interval (CI): 0.873-0.984] and calibration in the validation group. The DCA showed excellent clinical practicability. We established a concise and practical nomogram that will benefit the advanced diagnosis of OSA in patients with COPD.

Short-Term Vs. Long-Term Glucocorticoids in COPD Exacerbation: A Comparative Efficacy Study

The current study aims to evaluate the comparative efficacy of short-term and long-term glucocorticoid treatment in patients with COPD exacerbation. A randomized clinical trial will compare the effectiveness of short-term and long-term glucocorticoid treatments in COPD exacerbation. One hundred ninety patients will be recruited and randomized into two groups: a short-term glucocorticoid group and a long-term glucocorticoid group. The primary outcomes will be assessed at the end of the treatment period to determine the efficacy of the treatments. Secondary effects will include quality of life, length of hospitalization, and adverse events. The results of this study will provide insight into the comparative efficacy of short-term and long-term glucocorticoid treatments in COPD exacerbation. Objective: Comparative efficacy of short-term (5-days) versus long-term (10-days) glucocorticoids at equivalent doses in managing COPD patients with acute exacerbations. Materials and Methods: Pakistan Institute of Medical Sciences (PIMS), Islamabad, conducted this randomized clinical trial in the inpatient pulmonology department. This research took six months following ethical clearance. The experiment included 190 patients in two groups of 95. Patients in the two groups were randomly administered Tab—prednisolone 5mg (40mg/24 Hours) for five days or ten days. Using a carefully constructed pro-forma, postgraduate residents gathered data on five parameters (FEV1, FEV1/FVC, Arterial Blood Gases, mMRC Dyspnoea Scale, Sputum color and amount, presentation with identical symptoms within 30 days following discharge). Results: Patients averaged 58.13 ± 11.12. Long-term patients were 58.34 ± 11.53 years old, whereas short-term patients were 57.93 ± 10.752. The short-term group included 86 (90.53%) male and 9 (9.47%) female cases, whereas the long-term group had 89 (93.68%) male and 6 (6.32%) female cases. Sputum color was normal in all groups after therapy. Short-term and long-term therapy groups had mean FEV1 changes of 8.12±4.85 and 7.14± 1.75, respectively. Following treatment, short-term mMRC was significantly lower (2.14±0.32) than long-term (2.73±0.44), with p-value < 0.001. The short-term group mMRC mean change was 1.67±0.53 compared to the long-term group 1.07±0.26, p-value < 0.001. Sputum amounts changed by 2.63 ± 1.67 in the short-term and 2.49 ± 0.72 in the long-term groups. Both groups had similar mean sputum quantities before, after, and after treatment, with a p-value > 0.05. Both groups had the same ABG parameter mean change following therapy. One month after discharge, neither group relapsed. Conclusion: The efficacy of short-term (5-days) glucocorticoids is better than long-term (10-days) glucocorticoids at equivalent doses in terms of mMRC reduction. At the same time, the therapeutic effect was statistically the same in both groups regarding improvement in FEV1, sputum color, sputum quantity, all parameters of ABGs, and relapse rates. Keywords: COPD, exacerbation, glucocorticoids, efficacy

Evaluación de la disnea y condición clínica en pacientes síntomáticos con enfermedad pulmonar obstructiva crónica en un programa de rehabilitacion pulmonar

Introduction: patients with chronic obstructive pulmonary disease (COPD) are characterized by dyspnea at rest and in activities of daily living. Objective: to describe the activities that cause greater dyspnea and clinical condition of patients with COPD in a pulmonary rehabilitation program at a clinic in Cali, Colombia. Material and Methods: descriptive cross-sectional study carried out using non-probabilistic sampling. It was approved by the institutional ethics committee. The variables included in the study were: age, sex, marital status, socioeconomic status, place of residence, health insurance, home oxygen use, emergency room visits and hospitalizations in the last year, GOLD classification, post-bronchodilator spirometry (FEV1, FVC, FEV1 / FVC in percentage of predicted), dyspnea mMRC, weight, height and body mass index (BMI), exposure to wood smoke, tobacco habit, situation or activity in which the greatest perception of dyspnea is triggered, functional capacity, anxiety / depression and health-related quality of life. Results: 59 participants were enrolled, 36 men (61%), with low socioeconomic status 2 (49.2%). 34 participants (57.6%) used home oxygen, emergency room visits (55.9%). Patients presented greater dyspnea in activities such as climbing stairs (20.3%) and when bathing (16.9%). Conclusions: patients with COPD had an advanced age with a predominance of males; activities involving the lower extremities and postural muscles such as stair climbing and bathing caused the greatest increase in perceived dyspnea in patients.

Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD.

COPD is characterized by progressive and irreversible air flow limitations. Single-inhaler therapies (SITTs) incorporating an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β2-agonist have been shown to effectively alleviate symptoms and improve lung function. Fluticasone-furoate/umeclidinium/vilanterol (F/U/V) and budesonide/glycopyrronium/formoterol (B/G/F) are available as SITT in Japan. However, the clinical differences between these 2 combinations and the predictors of their proper use have not been established. This study aimed to identify the subject characteristics that could predict the effectiveness of inhaler therapy. We assessed the pulmonary function test results of subjects with COPD before and one month after using F/U/V and B/G/F as SITT. Subjects with a difference of 100 mL or more in the FEV1 after treatment with pre-SITT were extracted and divided into the F/U/V effect and no-effect group and B/G/F effect and no-effect group to examine the factors associated with positive outcomes with each inhaler. F/U/V and B/G/F significantly improved the inspiratory capacity (IC), %IC, FVC, and %FEV1 when compared to pre-intervention values (P < .001, P = .001, P = .007, P = .009, respectively, for F/U/V; and P = .006, P = .008, P = .038, P = .005, respectively, for B/G/F). Factors associated with FEV1 improvement in F/U/V included lower %IC (odds ratio 0.97 [95% CI 0.94-0.99], P = .03) and a higher modified Medical Research Council (mMRC) dyspnea score (2.36 [1.27-4.70], P < .01). In addition, a higher %IC (1.03 [1.00-1.06], P = .02) and lower mMRC dyspnea score (0.55 [0.28-0.99], P = .041) were predictors for the effectiveness of B/G/F. Our results showed that SITT significantly improved the IC, %IC, FVC, and %FEV1 when compared to pre-intervention and that F/U/V was more effective in subjects with severe symptoms, whereas B/G/F was more effective in subjects with mild symptoms.

Effectiveness of Autogenic Drainage in Improving Pulmonary Function in Patients with Cystic Fibrosis

The use of autogenic drainage (AD) in patients with cystic fibrosis (CF) has been officially approved; therefore, the purpose of this study was to compare the efficiency of the leading therapeutic techniques based on AD in patients with CF; Among patients with CF assessments were made of spirometric parameters, percent blood oxygen saturation, and the general feeling of the patients (Borg, VAS, and mMRC dyspnea scale) before and after therapy using AD, using AD in connection with a belt or a Simeox device and AD in combination with both a belt and Simeox device simultaneously. The best therapeutic effects were generated by the combination of AD with the belt and with the Simeox device. The greatest improvements were observed for FEV1, FVC, PEF, FET, saturation, and patient comfort. In patients <10.5 years of age, the increase in the level of FEV3 and FEV6 was significant in comparison to older patients. Due to their efficacy, therapies connected with AD should be applied not only in hospital departments but also during daily patient care. Given the particular benefits observed in patients <10.5 years of age, it is important to guarantee real accessibility to this form of physiotherapy, especially in this age group.

Efficacy and safety of bovhyaluronidase azoximer (Longidase) in patients with post-COVID syndrome: results of an open, prospective, controlled, comparative, multicenter clinical trial DISSOLVE

Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase®) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome.The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome.Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded.Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.

Value of incentive spirometry in routine management of COPD patients and its effect on diaphragmatic function

BackgroundIncentive spirometry (IS) is mostly used postoperatively to avoid pulmonary complications, but its effect on COPD patients and its effect on diaphragmatic functions are still not fully studied. The current study aimed to evaluate the value of IS on arterial blood gases, mMRC dyspnea scale, spirometry, and diaphragmatic functions by ultrasound in patients hospitalized for COPD exacerbation.Methods and patientsForty patients (37 males, 3 females) were admitted for COPD exacerbations and divided randomly into 2 groups: Group1 (G1) =20 patients (mean age 60.7±5.99) used incentive spirometry (IS) for 2 months with medical treatment. Group 2 as a control group (G2) = 20 patients (mean age 60.3±6.44) were given medical treatment only. ABG, spirometry, mMRC dyspnea scale, and diaphragmatic ultrasound functions were assessed on admission and after 2 months of treatment in the groups.ResultsThere were statistically significant differences between G1 and G2 after 2 months regarding PaCO2, FEV1/FVC (p=0.001 and 0.042, respectively), and Lt diaphragmatic excursion and diaphragm thickness ratio. There was a statistically significant increase in results of PaO2, PaCO2, FEV1/FVC, PEFR, and all diaphragmatic findings in group I before and after 2 months of IS but no difference in FVC and mMRC dyspnea scale.ConclusionIncentive spirometry in COPD patients seems to improve ABG, and spirometry functions together with improving diaphragmatic functions.Trial registrationClinicalTrials.gov NCT05679609. Retrospectively egistered on 10 January 2023

Impact of clinical factors on hospital stay and hospital readmission rate after acute exacerbation of COPD: a retrospective cross-sectional study

Background: Chronic obstructive pulmonary disease (COPD) is a condition with high morbidity and cost to health services due to a high number of exacerbations necessitating multiple and prolonged hospitalizations. The length of hospital stays and hospital readmission rate is related to patient age, sex, disease severity, current smoking status, comorbidities, dyspnea grade, carbon dioxide partial pressures, use of mechanical ventilation, previous exacerbation, long-term oxygen therapy, and inpatient diuretics use. The purpose of the study was to identify the differential effects of patient and treatment-related factors on the length of hospital stay and hospital readmission for COPD exacerbation-related admissions. Methods: A hospital-based retrospective cross-sectional study was conducted among 151 patients with acute exacerbation of COPD admitted at Civil Service Hospital, Kathmandu from August 2021 to March 2022. Ethical approval was taken from the Institutional Review Committee, Civil Service Hospital (Reference no. 18/ 2022). A convenience sampling method was followed. Data regarding different clinical factors were collected in a semi-structured questionnaire. The data were entered and analyzed through Microsoft Excel 365 and SPSS version 22.0 using a binary regression model. Results: Comorbidities, current smoking, dyspnea grade mMRC IV, mechanical ventilation, and long-term oxygen therapy were significantly associated with prolonged hospital stays for COPD exacerbation-related admissions. The corresponding odd ratio is (OR 3.4, 95% CI: 1.24–9.29); (OR 21.4, 95% CI: 6.17–74.57); (OR 2.5, 95% CI: 1.20–5.45); (OR 5.6, 95% CI: 1.20–26.35); (OR 2.4, 95% CI: 1.02–5.90), respectively. Conclusions: The effect of clinical factors such as comorbidities status, current smoking habits, higher grade of mMRC dyspnea scale, mechanical ventilation, and long-term oxygen therapy needed to be considered to optimize care for COPD patients needing hospital admissions and hence decrement in hospital costs.

Chinese medicine for residual symptoms of COVID-19 recovered patients (long COVID)-A double-blind, randomized, and placebo-controlled clinical trial protocol.

Coronavirus disease 2019 (COVID-19) is the current global pandemic of which residual symptoms exhibited by post-acute, rehabilitating patients include fatigue, dyspnoea, and insomnia. Chinese medicine (CM) has been widely used in China to treat different stages of COVID-19. While there are a significant number of clinical studies suggesting its efficacy and safety in its use during acute stage, there are very few randomized controlled trials focusing on the rehabilitation stage. Liujunzhi Decoction and Shashen Maidong Decoction are frequently recommended by official clinical guidelines in China to treat COVID-19 patients in rehabilitation stage. This double-blind, randomized, placebo controlled study aims to evaluate the efficacy and safety of the combination of the two formulae [named "COVID-19 Rehab Formula (CRF)"] in treating COVID-19 residual symptoms (long COVID). Eligible subjects will be randomly divided into treatment group and control group in 1:1 ratio. Treatment group will receive CRF along with certain pre-defined CM according to symptoms for 8 weeks, while control group will receive equivalent packs of placebo for 8 weeks. Data in terms of Fatigue Severity Score (FSS), self-reported COVID-19 long term symptom assessment, the modified British Medical Research Council (mMRC) Dyspnoea Scale, EuroQol Five-Dimension Five-Level (EQ-5D-5L) Questionnaire, pulmonary function test and adverse events will be collected and analyzed by SPSS 24. Blood test on liver and renal functions will also be conducted as safety measures. This study will evaluate the efficacy and safety of CRF in the treatment COVID-19 residual symptoms in a scientifically rigorous design. [ClinicalTrials.gov], identifier [NCT04924881].

An Elusive Case of Pleural Effusion

The incidence of distant metastasis in head and neck Squamous Cell Carcinoma (SCC) is relatively low. The most frequently involved sites for distant metastasis are lungs, followed by bone and liver. The most important predictive factors for distant metastasis appear to be site of the primary tumour (hypopharynx), advanced T- and N-classification, locoregional control and histologic grade. A 61- year-old male, chronic smoker, presented with complaints of grade 4 mMRC (Modified Medical Research Council) dyspnoea. He had left-sided buccal mucosal SCC (locally advanced) and was on palliative chemotherapy. He had undergone treatment for pulmonary tuberculosis seven years back. He was tachypneic and clinical examination revealed absent breath sounds in the left hemithorax. Chest radiograph showed a massive left pleural effusion which was found to be exudative after therapeutic thoracocentesis. Cytology tests were negative for malignant cells. Positron Emission Tomography (PET) scan showed uptake along the left pleura (SUV Max-5.06) and left buccal mucosa (SUV Max -4.1). Thoracoscopic frozen section pleural biopsy revealed metastatic squamous cell carcinomatous deposits in the pleura. On table pleurodesis was done with doxycycline. The patient was continued on palliation with no recurrent effusion. However, he succumbed to the disease after eight months. This case report describes a rare case of malignant pleural effusion from a primary buccal mucosal SCC without any concurrent lung involvement.

СТАН СЕРЦЕВО-СУДИННОЇ СИСТЕМИ У ХВОРИХ ІЗ ЗАДИШКОЮ, ЯКІ ПЕРЕНЕСЛИ ПНЕВМОНІЮ, АСОЦІЙОВАНУ З COVID-19

The aim of this study is to determine the contribution of cardiovascular system impairment to the development of dyspnea in post-acute COVID-19 pneumonia patients. Materials and methods. A total of 108 patients with dyspnea in the post-acute phase of COVID-19 (at 47 (38; 62) days after the onset of symptoms) were examined. These patients had experienced COVID-19associated pneumonia between April and November 2021. 21 patients were excluded due to comorbidities that could be a potential cause of dyspnea in the post-COVID-19 period. Thus, a group of 87 patients was formed, with an average age of 56 (49; 65) years, including 42 (48.3%) males. Patients were divided into three subgroups based on the severity of their acute COVID-19 illness: subgroup 1 (35 patients) — moderate, subgroup 2 (37 patients) — severe and subgroup 3 (15 patients) with critical. Investigation methods included clinical examinations, the mMRC dyspnea questionnaire, chest CT scans (both anamnestic and during examination), spirometry, ECG, echo-Doppler, serum NT-proBNP levels. Results. Patients in subgroups 1 and 2 in the post-acute phase of COVID-19 had less pronounced dyspnea compared to patients in subgroup 3 (1 (1; 2) and 2 (1; 3) vs. 3 (2; 4), respectively) (p &lt; 0.001). Residual changes on chest CT scans were more frequently observed in subgroup 3 than in subgroups 1 and 2 (15 (100%) vs. 7 (20.0%) and 20 (54.1%), respectively) (p &lt; 0.001). Obstructive ventilation disorders were only observed in subgroups 1 and 2 (in 15 (42.9%) and 6 (16.2%) patients, respectively), while restrictive disorders were found in subgroups 2 and 3 (in 14 (37.8%) and 12 (80.0%) patients, respectively). Clinically significant rhythm or conduction disturbances were not detected on ECG in any patient. According to echo-Doppler, subgroup 1 had diastolic dysfunction of the left ventricle (LV) in 3 (8.5%) patients; subgroup 2 had diastolic dysfunction of both the LV and right ventricle (RV) in 5 (13.5%) and 4 (10.8%) patients, respectively; and subgroup 3 had diastolic dysfunction of both the LV and RV in 4 (26.7%) patients. Mild pulmonary hypertension was observed only in subgroups 2 and 3 (in 13 (35.1%) and 14 (93.3%) patients, respectively). Elevated NT-proBNP levels were found in 22.9% of patients, with no significant differences between subgroups (p &gt; 0.05). Conclusions. The severity of dyspnea in the post-acute phase of COVID-19 is related to the duration of lung involvement and the severity of the acute illness. In patients with moderate-severity acute COVID-19, dyspnea in the post-acute phase is primarily due to residual respiratory system changes (in 20.0% of patients) and mild obstructive ventilation disorders (in 42.9% of patients). Cardiovascular system involvement in these patients is mainly detected by elevated serum NT-proBNP levels (in 22.9% of patients), which may serve as a marker for the heart failure onset, necessitating consultation with a cardiologist. In patients with severe- acute COVID-19, dyspnea in the post-acute phase is due to residual morphological lesions in the respiratory system based on chest CT findings (in 54.1% of patients) and cardiovascular pathology (in 45.9% of patients). Therefore, managing this patient cohort in the post-acute phase requires collaboration between pulmonologists and cardiologists, especially when dyspnea does not correlate with morphological lesions in the respiratory system on chest CT. In patients with critical acute COVID-19, dyspnea in the post-acute phase is consistently caused by both residual morphological lesions in the respiratory system (in 100% of patients) and cardiovascular pathology (in 93.3% of patients). This substantiates the imperative for joint management by pulmonologists and cardiologists.

Obesity, Charlson comorbidity index, and neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: relationship to disease severity.

Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory lung disease with high mortality and morbidity rates. Obesity, various comorbid diseases, and inflammation often coexist in chronic obstructive pulmonary disease (COPD), exhibiting a complex interaction with disease severity. The aim of the study was to examine the relationship between COPD markers and obesity, the Charlson Comorbidity Index (CCI), and neutrophil/lymphocyte ratio (NLR). Eighty male patients with stable COPD admitted to the pulmonology unit were included in the study. The presence of comorbidities was investigated in obese and non-obese individuals with COPD. Pulmonary function tests and the mMRC dyspnea scale were examined, and CCI scores were calculated. 60.9 % with mild/moderate COPD, and 64.7 % with severe COPD had a comorbid disease. The incidence of hypertension and diabetes was significantly higher in obese patients. The obesity rate was 41.3 % in patients with mild/moderate COPD (FEV1 ≥ 50) and 26.5 % in those with severe COPD (FEV1 < 50). There was a positive and significant correlation between CCI value and BMI and mMRC dyspnea scale. NLR was significantly higher in patients with FEV1 < 50 and mMRC ≥ 2. As a result, it is essential to screen obese patients with COPD, who are among the groups with the highest incidence of comorbidities, in terms of such diseases that exacerbate the symptoms of their disease. Findings may support the potential applicability of simple blood count indices (such as NLR) in the clinical assessment of disease in stable COPD patients (Tab. 4, Fig. 1, Ref. 46).

Dyspnea assessment in myotonic dystrophy type 1

In myotonic mystrophy type 1 (DM1), combining respiratory symptom screening and respiratory function testing, is crucial to identify the appropriate time for ventilatory support initiation. Dyspnea has been little investigated in DM1. To provide a multidimensional description of dyspnea, questionnaires assessing dyspnea were administered to 34 consecutive adult patients with DM1 (median (25th-75th centile) age of 36 (28–49), Vital Capacity (VC) of 74 (64–87)% of predicted value). Dyspnea scores were low whatever the questionnaire used: Multidimensional Dyspnea Profile score of 2(0–4.7)/50 for dyspnea sensory descriptor and of 0 (0–4.7)/60 for the emotional descriptor, Visual Analogue Scale score of 0 (0–0)/10 in sitting and supine position and Borg score after six-minute walk test (6MWT) of 2.2 (1.8–4.2)/10. Eleven patients (32%) reported disabling dyspnea in daily living (modified Medical Research Council (mMRC) score ≥ 2). In comparison with patients with mMRC score < 2, patients with mMRC score ≥ 2 had a more severe motor handicap (Muscular Impairment Rating score of 4.0 (4.0–4.0) vs 3.0 (2.0–3.5), p<0.01), a lower 6MWT distance (373 (260–424) vs 436 (346–499)m, p = 0.03) and a lower VC (64 (48–74)% vs 75 (69–89)%, p = 0.02). These data suggest that the mMRC scale might be an easy-to-use and useful tool to assess dyspnea in daily living in DM1 patients. However, the interest of integrating the mMRC dyspnea scale in clinical practice to guide therapeutic management of DM1 patients remains to be assessed in further studies.

Efficacy of vitamin D supplementation on COPD and asthma control: A systematic review and meta-analysis.

The role of vitamin D (VD) in the management of chronic obstructive pulmonary disease (COPD) and asthma remains largely undetermined. In the present meta-analysis, we aimed to comprehensively investigate the efficacy of VD in the treatment of COPD and asthma according to the latest update. The PubMed, Embase, and Cochrane Library databases were searched from their inception to June 2, 2022. Randomized controlled trials (RCTs) comparing the efficacy of VD with placebo against COPD or asthma were included. A total of 11 RCTs consisting of 1183 COPD patients and 19 RCTs consisting of 2025 asthmatic patients were finally included. As for pulmonary function, FEV1/FVC was not changed significantly, while FEV1% was improved in the VD group. In the asthma subgroup, FEV1% was not changed significantly, while FEV1/FVC was improved in the VD group. For the questionnaire and rating scale, the mMRC (modified Medical Research Council) dyspnoea scale score for COPD and ACT (Asthma Control Test) score for asthma were not significantly changed, while the SGRQ (St. George's Respiratory Questionnaire) score for COPD was improved in the VD group. For inflammation indicators, IL-6 and IL-10 were statistically equivalent between the VD and placebo groups, while IgE, IL-5, and IL-10 (baseline VD deficiency subgroup) were improved in the VD group. The exacerbation, length of hospital stays, and mortality were statistically equivalent between the two groups. VD supplementation improved the indicators of asthma and COPD, especially in pulmonary function, SGRQ scores, IL-5, and IgE. The protocol could be found at PROSPERO with the registration number of CRD42020218058.

Prevalence of adverse events during ticagrelor versus clopidogrel treatment and its association with premature discontinuation of dual antiplatelet therapy in East Asian patients with acute coronary syndrome.

Clinical evidence raises the issues regarding the high risk of adverse events and serious bleeding in East Asian patients receiving standard-dose ticagrelor treatment. We sought to evaluate the association between adverse events and their associations with premature discontinuation of dual antiplatelet therapy (DAPT). We enrolled East Asian patients presented with acute coronary syndrome who took DAPT with 90-mg ticagrelor (n = 270) or 75-mg clopidogrel (n = 674). During 1-month treatment, antiplatelet effect was evaluated with the VerifyNow P2Y12 assay, and the occurrence of Bleeding Academic Research Consortium (BARC) bleeding and modified Medical Research Council (mMRC) dyspnea was assessed with the dedicated questionnaire. During 1-month follow-up, patients on ticagrelor showed the higher risks of bleeding (any BARC type: 45.6% vs. 23.6%; odds ratio [OR], 2.71 and BARC 1 or 2 type: 45.2% vs. 22.1%; OR, 2.90, respectively) and dyspnea (26.3% vs. 13.6%; OR, 2.25) compared with those on clopidogrel. In a receiver-operating characteristics curve analysis to predict bleeding risk, ticagrelor showed a lower cutoff of low platelet reactivity (LPR) (P2Y12 reaction unit [PRU] ≤ 20) than clopidogrel (PRU ≤ 110). Early occurrence of bleeding episode was significantly associated with LPR phenotype (OR, 2.68), not type of P2Y12 inhibitor. In multivariate analysis, type of P2Y12 inhibitor (ticagrelor vs. clopidogrel: OR, 2.19) and bleeding episode (OR, 2.94) were independent predictors for dyspnea occurrence. During 1-year follow-up, DAPT with ticagrelor showed a higher risk of premature discontinuation compared to DAPT with clopidogrel (27.8% vs. 4.7%; adjusted HR, 8.84), which risk appeared frequent during the first month (14.4%) during DAPT with ticagrelor. Early occurrence of bleeding and dyspnea synergistically increased a risk of DAPT non-adherence, irrespective of type of P2Y12 inhibitor. This analysis is the first evidence to show the different cutoff of low platelet reactivity during the reversible (ticagrelor) versus irreversible P2Y12 inhibitor (clopidogrel). Early occurrence of bleeding and dyspnea is very common during standard-dose ticagrelor treatment in East Asian patients, which show a close association with premature DAPT discontinuation. [https://www.clinicaltrials.gov], identifier[NCT046 50529].

Rehabilitación pulmonar y componente educativo individual/grupal con seguimiento telefónico en pacientes con enfermedad pulmonar obstructiva crónica (EPOC)

Introduction: chronic obstructive pulmonary disease (COPD) causes progressive dyspnea in patients. Components of pulmonary rehabilitation (PR) include physical exercise, education, and behavior change. Adding telephone educational follow-up could cause additional improvements. Objective: to determine the changes in dyspnea, functional capacity and health-related quality of life in patients with COPD who underwent PR; in turn, to determine the changes in the educational needs of the patients who received individual/group educational component and telephone follow-up. Methods: patients with COPD were linked to a PR program with an individual/group educational component and telephone follow-up in a clinic in the city of Cali-Colombia. Dyspnea was assessed according to the modified Medical Research Council scale (mMRC), the distance covered in the 6-minute walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ) and education needs with the Lung Information Needs. Questionnaire (LINQ) before and after completing the program. Results: 22 patients were linked to the study, a greater number of men with 68.2%, mean age 64.9 years; there were changes in dyspnea mMRC 0.91±0.29; p=0.002, distance traveled 51.37±21.22; p=0.007, SGRQ domains symptoms, activities and total (p&lt;0.05), as well as the knowledge, self-care, exercise and total domains of the LINQ. Conclusion: COPD patients who underwent PR presented improvements in the distance traveled, dyspnea and quality of life; additionally, the individual/group educational component and telephone follow-up caused improvements in patient education.

Pulmonary involvement: A potential independent factor for quality of life in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic multi-systemic autoimmune disease. SLE patients may experience a wide range of physical, psychological, and social perception of well-being influenced by the patient illness that are not always fully captured by descriptions of the disease's physiological consequences alone. Nowadays, patients with SLE have a better survival than decades ago, nevertheless still experience a low health related quality of life (HRQoL). Assessing disease activity in SLE is crucial to the physician as it forms the basis for treatment decisions, moreover careful evaluation for respiratory involvement should be routinely considered. More chronic lung disease related to SLE can have a significant negative effect on patient well-being and physical performance status and are detrimental to quality of life. The aim of this study was to evaluate quality of life changes in SLE patients using Lupus QoL scale, assessing their correlation with different disease aspects particularly pulmonary manifestations and predictors for worse QoL. Total of 60 SLE patients, who fulfilled the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, were enrolled in this study. Disease activity was measured by systemic lupus erythematosus disease activity index (SLEDAI) and quality of life was assessed by Lupus QoL. Pulmonary evaluation included pulmonary function tests parameters (PFTs), mMRC dyspnea scale, HRCT score, and pulmonary damage index. Lupus QoL had a strong significant correlations with PFTs FEV1, FVC, and DLCO (r = 0.79, 0.78, 0.76, p < .001), respectively}, while Lupus QoL had strong negative correlations with both mMRC dyspnea scale and HRCT score (r = -0.96, -0.85, p < .001), respectively, and moderate negative correlation with neuropsychiatric lupus (NPSLE) (r = -0.61, p < .001). Weak negative correlations were found between Lupus QoL, photosensitivity, alopecia, Raynaud's and renal affection (r = -0.29, -0.30, -0.30, 0.38, p = .03, .02, .02, .002), respectively. NPSLE and pulmonary involvement were the most consistent predictors of low HRQoL [contributing 36% and 18% of the variance of Lupus QoL], respectively. Lupus QoL is negatively correlated with different SLE clinical parameters particularly pulmonary manifestations. Neuropsychiatric, pulmonary, renal affection, and SLEDAI are the best determinants for worse Lupus QoL.