mMRC Grade Research Articles

Breathlessness Predicts Mortality in Adults: A Systematic Review and Meta-Analysis.

Breathlessness is a commonly encountered symptom, and although its relationship with mortality is well established for many conditions, less clear is this relationship in healthy adults. This systematic review and meta-analysis examines whether breathlessness is associated with mortality in a general population. This is important in understanding the impact of this common symptom on a patient's prognosis.This review was registered with PROSPERO (CRD42023394104). Medline, EMBASE, CINAHL and EMCARE were searched for the terms 'breathlessness' and 'survival' or 'mortality' on January 24,2023. Longitudinal studies of >1,000 healthy adults comparing mortality between breathless and non-breathless controls were eligible for inclusion. If an estimate of effect size was provided, studies were included in the meta-analysis. Eligible studies underwent critical appraisal, data extraction and risk of bias assessment. A pooled effect size was estimated for the relationship between the presence of breathlessness and mortalityand levels of severity of breathlessness and mortality.Of 1,993 studies identified, 21 were eligible for inclusion in the systematic review and 19 for the meta-analysis. Studies were of good quality with a low risk of bias, and the majority controlled for important confounders. Most studies identified a significant relationship between the presence of breathlessness and increased mortality. A pooled effect size was estimated, with the presence of breathlessness increasing the risk of mortality by 43% (risk ratio (RR): 1.43, 95% confidence interval (CI): 1.28-1.61). As breathlessness severity increased from mild to severe, mortality increased by 30% (RR: 1.30, 95% CI: 1.21-1.38) and 103%, respectively (RR: 2.03, 95% CI: 1.75-2.35). The same trend was seen when breathlessness was measured using the modified Medical Research Council (mMRC) Dyspnoea Scale: mMRC grade 1 conferred a 26% increased mortality risk (RR: 1.26, 95% CI: 1.16-1.37) compared with 155% for grade 4 (RR: 2.55, 95% CI: 1.86-3.50). We conclude that mortality is associated with thepresence of breathlessness and its severity.The mechanism underlying this is unclear and may reflect the ubiquity of breathlessness as a symptom of many diseases.

EVALUATION OF PULMONARY FUNCTION TEST IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disease that affects the airways, alveoli, and pulmonary vasculature, leading to irreversible airflow limitation and loss of elastic recoil. This disease is highly prevalent in clinical practice, affecting approximately 10% of adults over 40 years of age, and it is expected to become the third leading cause of death by 2030. The study was conducted on 54 COPD patients diagnosed based on GOLD guidelines. The study observed a statistically significant association between Spirometric staging and the duration of symptoms.The mean value of FEV1/FVC,FEV1 in %,and 6MWD in meters decreased significantly as the grade of GOLD stage increased from stage II to stage III and stage IV. The study showed that COPD is associated with various comorbidities, including hypertension, diabetes mellitus, hypothyroidism, and coronary artery disease. The study concludes that FEV1, BMI, MMRC grading, and the 6-minute walk test are significant predictors of morbidity among COPD patients. The study recommends early detection and management of COPD to prevent its progression and associated morbidity.

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

BackgroundFrailty has been increasingly identified as a risk factor of adverse outcomes in chronic obstructive pulmonary disease (COPD). The prevalence and impact of frailty on health outcomes in people with COPD require clarification.MethodsPubMed, Embase, The Cochrane Library and Web of Science (January 1, 2002, to July 1, 2022) were comprehensively searched to identify studies related to frailty and COPD. Comparisons were made between people who did and did not have frailty for pulmonary function, dyspnea severity, 6-minute walking distance, activities of daily life, and mortality.ResultsTwenty studies (9 cross-sectional, 10 cohort studies,1 clinical trial) from Europe (9), Asia (6), and North and South America (4), Oceania (1) involving 11, 620 participants were included. The prevalence of frailty was 32.07% (95% confidence interval (CI) 26.64–37.49) with a range of 6.43–71.70% based on the frailty tool used. People with frailty had lower predicted forced expiratory volume in the first second (mean difference − 5.06%; 95%CI -6.70 to -3.42%), shorter 6-minute walking distance (mean difference − 90.23 m; 95%CI -124.70 to -55.76), poorer activities of daily life (standardized mean difference − 0.99; 95%CI -1.35 to -0.62), higher CAT(COPD Assessment Test) score(mean difference 6.2; 95%CI 4.43 to 7.96) and mMRC (modified Medical Research Council) grade (mean difference 0.93; 95%CI 0.85 to 1.02) compared with those who did not (P < 0.001 for all). Meta-analysis showed that frailty was associated with an increased risk of long-term all-cause mortality (HR 1.68; 95% CI 1.37–2.05; I2 = 0%, P < 0.001).ConclusionFrailty is prevalent in people with COPD and linked with negative clinical outcomes including pulmonary function, dyspnea severity, exercise capacity, quality of life and mortality.

Effect of pulmonary rehabilitation in patients with post-tuberculosis sequelae with functional limitation

BackgroundPulmonary rehabilitation improves dyspnea, functional limitation and quality of life in patients with chronic respiratory disease especially Chronic obstructive pulmonary disease (COPD). Whether Pulmonary rehabilitation (PR) will have similar effect in patients with post-tuberculosis sequelae or not and whether the two morphological variants will respond similarly or not was the purpose of our study. MethodsAdult patients fulfilling the inclusion criteria of a diagnosis of post-tuberculosis sequelae with functional limitation (modified medical research council [mMRC] grade 1 or more) were recruited over a period of two years. A baseline health assessment in the different domains of health was done at the beginning and repeated just after the completion of the rehabilitation program at 6 weeks. Results26 patients completed the PR protocol of our study. Dyspnea improved from an mMRC grade of 1.5 to 0.7 post-PR (p < 0.001). 6MWD increased by 34 meters from a baseline value of 408.6 meters to 442.7 meters post-PR. (p-value 0.3) St. George's Respiratory Questionnaire (SGRQ) symptom score decreased by 13 points, SGRQ activity score decreased by 18 points, SGRQ impact score decreased by 18 and SGRQ total score decreased by 17 points with p-values of 0.037, 0.002, 0.004 and 0.002 for SGRQ symptom score, SGRQ activity score, SGRQ impact score, SGRQ total score respectively. Depression Anxiety Stress Scale (DASS) Stress score decreased by 6.7, DASS Anxiety score decreased by 6.6, and DASS Depression score decreased by 5.5 points. Intergroup comparison revealed both bronchiectasis predominant group and fibrosis predominant group responded similarly to PR. ConclusionPR improved parameters assessing dyspnea, quality of life and mental health indices significantly. Improvement in functional capacity was not statically significant. Both the morphological variants responded similarly to the PR.

Idiopathic pulmonary fibrosis in Soweto, South Africa: A descriptive study

Objectives: Idiopathic pulmonary fibrosis (IPF) is a specific form of age-related fibroproliferative interstitial pneumonia that is chronic, progressive, and carries a poor prognosis, with median survival of just 2.5–3.5 years from diagnosis. The exact etiology is unknown, but smoking is known to be risk factor. Symptoms and signs include progressive dyspnoea, cough, inspiratory “Velcro” crackles, and clubbing. At present, treatment options are limited; but include pulmonary rehabilitation, long-term domiciliary oxygen therapy, and the conditionally recommended pharmacological therapies pirfenidone and nintedanib. This study sought to describe the cohort of patients that attended the respiratory outpatient services at a tertiary-level hospital in South Africa during the period 2007– 2016. To the best of the authors’ knowledge, this is the first such descriptive study performed in Africa. Materials and Methods: This was a retrospective, descriptive, and record review, that included patients ≥18 years of age who fulfilled 2011 ATS/ERS/JRS/ALAT diagnostic criteria for IPF. Results: Data from 74 patients were used for analysis in this study, of which 60.8% were female. The mean age standard deviation was 64.4 (10.9) years and the majority (79.7%) were Black. Over half of the patients (40/74, 54.1%) were current or previous smokers, although there was no correlation between smoking history and age or baseline pulmonary function testing. All patients reported dyspnea, which was modified Medical Reseach Council (mMRC) Grade 3 or 4 in 80% of patients. High resolution computed tomography chest was reported as radiological usual interstitial pneumonia (UIP) in 72 patients (97.3%) and three patients underwent lung biopsy, all of which showed a UIP pattern. Fifty-eight patients (78.4%) had spirometry results available, with median forced vital capacity 67.3% of predicted; this was significantly higher in females. Median transfer factor of the lung for carbon monoxide was 39% predicted. Twenty-five patients (33.8%) received corticosteroids, of whom five (6.8%) received the prednisone-azathioprine-N-acetylcysteine regime. Three patients (4.1%) received nintedanib; two of whom showed slowing of decline in lung function, although no significant symptomatic improvement was reported. Mean duration of follow-up was 13.3 months, although females had significantly longer duration of follow-up than males. Conclusion: Despite a fairly small sample size and retrospective nature, this study contributes to the body of literature on IPF and highlights the need for additional studies in developing countries, particularly in Africa.

Associations between depression and anxiety index and frequency of acute exacerbation in chronic obstructive pulmonary disease.

Comorbidities of chronic obstructive pulmonary disease (COPD) influence clinical characteristics and prognosis. This study compared the clinical characteristics and exacerbation rate of COPD according to the presence of depression or anxiety. This study used data from The Korea COPD Subgroup Study (KOCOSS) cohort, a nationwide prospective cohort from 54 medical centers, between April 2012 and 2019. Depression and anxiety were diagnosed with the Beck Depression Inventory and Beck Anxiety Inventory. Negative binomial regression analysis was performed to analyze the frequency of exacerbations in depressed patients and anxiety. Differences in lung function trajectory according to presence of depression/anxiety were analyzed using a linear mixed model. In all, 2147 patients were enrolled. Depressed patients or anxiety had lower lung function, higher modified Medical Research Council (mMRC) grade, St. George Respiratory Questionnaire (SGRQ) score, and COPD assessment test score, and higher rates of exacerbation in the past year than those without depression/anxiety. Depressed patients had a higher frequency of moderate to severe exacerbations [Incidence Rate Ratio (IRR): 1.57, CI: 1.17-2.11, p = 0.002] and those with anxiety had higher frequencies of moderate to severe (IRR: 1.52, CI: 1.03-2.27, p = 0.038) and severe exacerbations (IRR: 2.13, CI: 1.09-4.15, p = 0.025) during 1-year follow-up compared to those without these comorbidities. The differences in the change in annual forced expiratory volume in 1 seconds (FEV1) over 3 years according to the presence of depression or anxiety were not statistically significant. Depressed and anxious patients showed increased respiratory symptoms and exacerbation rate as well as reduced health-related quality of life, whereas there were no significant differences in changes in lung function between groups with and without depression/anxiety.

Efficacy of Pulmonary Rehabilitation in Pulmonary Tuberculosis Sequelae with Cystic Bronchiectasis and Pulmonary Hypertension

Cystic bronchiectasis, also known as saccular bronchiectasis (a severe type of bronchiectasis), is a condition that occurs as a complication and sequelae after pulmonary Tuberculosis (TB). There is chronic permanent dilation of bronchi that occurs after destructive changes in elastic and muscular layers of bronchial walls which further leads to the ballooning of bronchi and difficulty in clearing secretions with recurrent infection of the respiratory tract. Pulmonary hypertension is another major complication after bronchiectasis which affects pulmonary circulation. A 44-year-old female reported to the physiotherapy department with cystic bronchiectasis and pulmonary hypertension. The positive symptoms were chronic cough with mucoid sputum, low-grade fever, chest pain, breathlessness (modified Medical Research Council (mMRC) grade III), and easy fatiguability. The goals were set and inpatient Pulmonary Rehabilitation (PR) started with the aim of reducing burdening of symptoms and promoting the Quality of Life (QoL). The therapeutic interventions were splinted coughing techniques, deep breathing exercises, thoracic expansions, postural correction exercises, dyspnoea relieving positions, strength training, and pacing techniques. After rehabilitation the ventilation along with strength improved, dyspnoea was reduced, and exercise tolerance was increased.

Effect of Long-Term Oxygen Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Clinical Study

Introduction: Long-Term Oxygen Therapy (LTOT) has the potential to improve the mortality and morbidity in Chronic Obstructive Pulmonary Disease (COPD) patients. Aim: To assess the effect of LTOT on the Quality of Life (QoL) in stable COPD patients with severe resting hypoxemia. Materials and Methods: This was a prospective observational study conducted in a tertiary care teaching hospital in Kozhikode, Kerala, on stable COPD patients with severe hypoxemia who were newly initiated on home LTOT for ≥15 hours per day. Health Related Quality of Life (HRQoL), modified Medical Research Council (mMRC) grade of dyspnoea, frequency of exacerbations and adherence to treatment on LTOT were studied. Total of 60 patients were followed-up for one year. Significance of mean was tested using paired t-test and association between qualitative variables was tested using Chi-square test. The p-value &lt;0.05 was considered statistically significant. Results: Out of all, 7 patients died during the study period and 53 patients were included in the final analysis. The mean total St.George’s Respiratory Questionnaire (SGRQ) scores at 3, 6 and 12 months improved to 53.73±13.2, 53.97±13.22 and 54.63±13.16, respectively, from a baseline score of 72.51±8.88. At the end of 12 months of LTOT, 22 (41.51%) patients did not have exacerbations and 31 (58.49%) patients had exacerbations. There was no statistically significant improvement in dyspnoea after one year of LTOT. Among the 53 patients, who completed one year follow-up, 36 (67.92%) participants were adherent and remaining 17 (32.07%) participants were non adherent to LTOT. Conclusion: LTOT improves the HRQoL in stable COPD patients with severe hypoxemia. Use of domiciliary oxygen for at least 15 hours per day can reduce the number of COPD exacerbations.

Supervised hospital based pulmonary rehabilitation outcome in long COVID-experience from a tertiary care hospital.

Some patients suffer from various multisystem symptoms even after active process of COVID-19 illness has settled lasting more than four weeks called as long COVID. Pulmonary rehabilitation therapy is the proposed option in those patients. This study aims to study the impact of pulmonary rehabilitation on outcome of long COVID patients through improvement in mMRC dyspnea scale, oxygen saturation, cough score, six-minute walk distance and biomarkers of inflammation. A retrospective observational study was carried out from the data of electronic medical records among 71 Long COVID patients. Parameters like Spo2, MMRC scale, cough score, six-minute walking distance along with blood levels of D-dimer, C-reactive protein (CRP), leucocyte count at the time of admission and after three weeks of pulmonary rehabilitation were collected. The outcome among the patients was divided into full recovery and partial recovery group. Statistical analysis was done using SPSS software version 19.0. Among 71 cases in our study 60 (84.50%) where male with mean age was 52.7 ± 13.23 years. Biomarkers like CRP and d-Dimer were elevated in 68 (95.7%) and 48 (67.6%) patients, respectively, at the time of admission. After 3 weeks of pulmonary rehabilitation mean SPO2, cough score, 6MWD showed significant improvement and normalization of biomarkers in recovered group of 61 out of 71 which was statistically significant. Significant improvement of oxygen saturation, mMRC grade, cough score, six-minute walk distance and normalization of biomarkers were marked following pulmonary rehabilitation. Thus, pulmonary rehabilitation therapy should be offered to all long COVID cases.

Petals of rose: Application of rapid on-site evaluation in bronchoscopy

In present day scenario, procedures that are minimally invasive like FNAs and Core needle biopsies are on the rise. Rapid on-site evaluation (ROSE) is a laboratory service that assesses the cytomorphologic features from FNA smears or biopsy contact imprints in the biopsy room and can provide on the spot input and suggestions for the clinician through immediate cytological examination of the biopsy sample. ROSE also allows for a preliminary diagnosis, allowing for the requirement of additional material for ancillary studies. We are presenting two cases which highlights the merits of ROSE in cytological diagnosis. In the first case, a thirty four year old male patient came with complaints of productive cough, breathlessness and fever. Bronchoscopic needle aspiration and biopsy was done with Rapid Onsite Evaluation. ROSE revealed two non-caseating epithelioid granulomas on the 4th pass. Bronchoscopic lymph node biopsy was non- contributory. With other clinical and biochemical parameters, diagnosis of Sarcoidosis was made. This case study underscores the significance of ROSE in arriving at the diagnosis. In the other case, a fifty seven year old male patient came to hospital with productive cough and breathlessness (MMRC grade II). CT chest revealed features suggestive of bronchogenic carcinoma. ROSE was performed along with bronchial brush cytology in which presence of atypical cells with increased nuclear cytoplasmic ratio, nuclear hyperchromatism and nuclear molding was noted. On histopathological examination, it was diagnosed as a case of non-small cell carcinoma of lung – poorly differentiated type. This case proves the advantage of ROSE in avoiding repeated invasive procedures for the patient.

TO STUDY THE IMPACT OF MODIFIED PULMONARY REHABILITATION PROGRAMME ON IMPROVEMENT OF MORBIDITIES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS

Background : Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. It is characterized by slow emptying of the lung during forced expiration and measured by FEV1/FVC ratio. Objectives: To assess the difference in the patient's level of symptoms (MMRC Grading), psychological assessment (PHQ9),objective parameters (6 Minute Walk Test, Spirometry) after giving modied pulmonary rehabilitation. Material and Methods:An analytical study was carried out on 150 participants attending our hospital who were enrolled after their informed and written consent, Demographic data, history, physical examination, and psychological assessment were conducted of all the patients. The total duration of the study is of 18 months. Out of that one patient is followed for 12 weeks during which during the rst 6 weeks of the study patients were given pharmacotherapy as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and for the next 6 weeks patients were given pharmacotherapy with pulmonary rehabilitation. Results: Out of 150 patients , the majority of the patients presented with MMRC grade 2 or 3 at the initiation of study and at the end of the study, their grades were improved. The value of spirometry testing, 6 Minute walk test, and the PHQ9(Psychological assessment) score was also improved at the end of the study as compared to the initiation of the study. Conclusion: Pulmonary rehabilitation plays a sentinel role in management of COPD and it increases the survival of COPD patients

Qualitative validation of the modified Medical Research Council (mMRC) dyspnoea scale as a patient-reported measure of breathlessness severity

IntroductionThe modified Medical Research Council (mMRC) dyspnoea scale is a measure of breathlessness severity recommended by guidelines and utilised as an inclusion criterion or endpoint for clinical trials. No studies have been conducted to validate the categorical descriptors against the dyspnoea severity grade. MethodsThis study utilised cognitive interviews (Think Aloud method) to assess the content validity of the mMRC scale among 16 participants (13 with cardiac/respiratory disease). Participants were recruited to achieve representation across a variety of demographic factors. Interviews were conducted remotely via video conferencing and participants were presented with all 5 mMRC descriptors on screen in random order then asked to rank the statements “in order from the best breathing to the worst breathing”. ResultsMean age of participants was 57 years (range 22–84 years). Eleven had multimorbidity (≥2 comorbidities) including COPD, asthma, lung cancer, lung infection, interstitial lung disease, heart failure, depression, and anxiety. Length of time with breathlessness ranged between 2 weeks and >25 years. The median rank of the mMRC grade descriptors was concordant for mMRC grades 0, 1 and 4 but not grades 2 and 3. Even so, substantial heterogeneity was found in the distribution of responses for mMRC grade 0. ConclusionOur study found substantial heterogeneity in participant grading of the mMRC descriptors, particularly for grades 0, 2 and 3, indicating that mMRC might not be a good discriminator of difference or change in dyspnoea severity. This study demonstrates the importance of content validation even for long-established PROs like mMRC.

Evaluation of the Individual Activity Descriptors of the mMRC Breathlessness Scale: A Mixed Method Study.

PurposeThe modified-Medical Research Council (mMRC) breathlessness scale consists of five grades that contain of a description of different activities. It has wide utility in the assessment of disability due to breathlessness but was originally developed before the advent of modern psychometric methodology and, for example contains more than one activity per grade. We conducted an evaluation of the mMRC structure.Patients and MethodsCognitive debriefing was conducted with COPD patients to elicit their understanding of each mMRC activity. In a cross-sectional study, patients completed the mMRC scale (grades 0–4) and an MRC-Expanded (MRC-Ex) version consisting of 10-items, each containing one mMRC activity. Each activity was then given a 4-point response scale (0 “not at all” to 4 “all of the time”) and all 10 items were given to 203 patients to complete Rasch analysis and assess the pattern of MRC item severity and its hierarchical structure.ResultsCognitive debriefing with 36 patients suggested ambiguity with the term “strenuous exercise” and perceived severity differences between mMRC activities. 203 patients completed the mMRC-Ex. Strenuous exercise was located third on the ascending severity scale. Rasch identified the mildest term was “walking up a slight hill” (logit −2.76) and “too breathless to leave the house” was the most severe (logit 3.42).ConclusionThis analysis showed that items that were combined into a single mMRC grade may be widely separated in terms of perceived severity when assessed individually. This suggests that mMRC grades as a measure of individual disability related to breathlessness contain significant ambiguity due to the combination of activities of different degrees of perceived severity into a single grade.

Metabolic Syndrome and Its Correlates Among Female Chronic Obstructive Pulmonary Disease Patients at a Rural Tertiary Health Care Center in Northern India.

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease that is thought to result from chronic inflammation that may affect other organ systems. Similarly, metabolic syndrome includes central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), hyperglycemia, and hypertension. The prevalence of metabolic syndrome and its associated factors among female COPD patients in northern India needs to be evaluated.Aim and objectives: To find the prevalence of metabolic syndrome and its correlates among female chronic obstructive pulmonary disease patients at a rural tertiary health care center in northern India.Materials and methods: A cross-sectional study was conducted between January 2019 and June 2020 at a rural tertiary health care center in northern India. The female patients who presented with symptoms of COPD and fulfilled the inclusion criteria were included and classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) guideline while the clinical diagnosis of metabolic syndrome was made according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP: ATP III) criteria.Results: A total of 210 female COPD patients were included, the mean age of patients who had metabolic syndrome was 63.38±10.54 years. Metabolic syndrome was diagnosed in 60.48% of patients. There was a significant difference between female COPD patients with and without metabolic syndrome regarding body weight, BMI (body mass index), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP), blood sugar, serum triglyceride, serum HDL-C. Whereas no significant difference was found between patients with and without metabolic syndrome group regarding smoking exposure, biomass fuel exposure, duration of biomass fuel exposure, mMRC (modified Medical Research Council) grading of breathlessness, GOLD grading of airflow limitation, route and duration of corticosteroid used. In our study, we also found a significant association between the severity of airflow limitation of COPD with the duration of biomass fuel exposure and BMI. Also, there was a significant association between biomass fuel exposure and the presence of cough in female COPD patients.Conclusion: Metabolic syndrome is a prevalent entity in female COPD patients among the northern Indian population. Body weight, BMI, waist circumference, SBP, DBP, fasting blood sugar, serum triglyceride, and serum HDL-C have a significant impact on developing metabolic syndrome in female COPD patients. Duration of biomass fuel exposure and BMI also have a significant impact on the severity of airflow limitation in female COPD patients. So early detection and treatment of parameters of metabolic syndrome are important to reduce complications.

Status of Vitamin D among Patients Admitted with Acute Exacerbation of COPD in Cox’s Bazar Medical College Hospital

Background: Acute exacerbations of COPD (AECOPD) are common and strongly affect disease severity and relative healthcare costs. Vitamin D deficiency is frequent among COPD patients and its role in disease exacerbations is widely debated. Method: This study was carried out in the medicine department of Cox’s Bazar medical college. A total of 50 patients admitted with AECOPD were selected consecutively who had given consent and agreed to carry out 25 (OH) D level assays during the period from January 2021 to December 2021. Inclusion criteria were patients with confirmed cases of COPD. At the enrolment visit, patients were subjected to full clinical history and examination, and pulmonary function testing. Vitamin D [25 hydroxyvitamin D, 25(OH) D] assay was done by Automated Immunoassay Analyzer Model “MINI-VIDAS” using Biomerieux reagent in ELFA (Enzyme linked fluorescence assay) Technology. Vitamin D deficiency was defined as 25(OH) D &lt;=20ng/ml, Vitamin D insufficiency was recognized as 21-29 ng/ml and Vitamin D level &gt;30 ng/ ml was recognized as sufficient. Results: Among 50 patients 38 were males and 12 were females. The mean age of patients in this study was 72.2±13.8 years. The mean 25(OH) D level was 22.026±6.0519 ng/ml (95%CI 8.1-40.2). The mean level of vitamin D in males was (22.06±6.08 ng/ml) and in females (21.93±6.24ng/ml) (P= 0.948). Associated comorbidities are present in 54% of patients, among which Hypertension (HTN) contributes in 26%, Diabetes Mellitus (DM) in 18%, coronary artery disease (CAD) in 8%, and cerebrovascular disease (CVD) in 2%. The majority of the participants were former smokers (60%), and the mean pack-year of smoking was 22.09±6.14. In this study, vitamin D levels did not differ among various smoking groups. It was 21.9±8.1 ng/ml in non-smokers, 21.4±5.1 ng/ml in current smokers, and 22.3±6.1 ng/ml in ex-smokers groups (P= 0.904). 56% of the patients belong to low socioeconomic conditions in this study, and 42% were from lower-middle-class families. Most of the patients (86%) were from rural areas, followed by 10% from urban areas and 2% from slum areas. Regarding vocational status, 70% were retired, 10% were housemakers, farmers 6%, and the rest were service holders or business people with mean vitamin D levels of 22.2±5.9 ng/ml, 20.1±8.6 ng/ml, 24.3±2.8 ng/ml and 21.4±6.5 ng/ml respectively. The majority (44%) of patients had mMRC Grade -2 dyspnea, followed by 40% in Grade- 1, 10% in Grade-3, and only 6% of patients had Grade- 4 dyspnea. In the study, only 12% of the patients had sufficient levels of serum vitamin D. The majority had an insufficient level of serum vitamin D (52%) and 36% had a deficient level of serum vitamin D. Conclusion: This study finds a high prevalence of hypovitaminosis D (88%) in AECOPD patients. Vitamin D deficiency and insufficiency are more prevalent in females. In this study, vitamin D levels did not differ between smoking groups. J MEDICINE 2022; 23: 121-125

Profile of chronic obstructive pulmonary disease (COPD) patients in Oksibil Regional Public Hospital at 2020

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by persistent respiratory symptoms and airflow limitation due to blocked airways and/or alveolar abnormalities caused by harmful particles or gases. COPD is the third leading cause of death in the world.&#x0D; Objective: To determine the profile of COPD patients at Oksibil Regional Public Hospital.&#x0D; Methods: This study implemented a descriptive study design. Sample acquisition was done with total sampling. All COPD patients from January until December 2020 were included in this study.&#x0D; Result: This study obtained a total of 50 patients with COPD, with dominant of men aged &gt; 60 years and worked as farmers. Most of patients have history of smoking, and those who use furnace or firewood. Most of patients with CAT score ≥ 10, with mMRC grades of 2-4. Based on the history of exacerbations, it was obtained that most with ≥ 2 times per year or minimum of one time with hospitalization. Based on the GOLD category, patients with the GOLD D category were the most numerous and the main symptom that made the patients come for treatment was shortness of breath.&#x0D; Conclusion: Most COPD patients were more than 60 years old with smoking risk factors and GOLD D category.

To assess activity-related dyspnea in chronic obstructive pulmonary disease patients

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world. COPD is a growing global health concern affecting over 300 million people worldwide and contributing to ~3 million deaths every year. COPD being a respiratory disorder affects the daily routine activities of people and causes immobilization and makes them bedridden due to dyspnea causing activity limitation. This study aimed to assess this activity-related dyspnea in COPD. MATERIALS AND METHODS: This cross-sectional study was conducted among COPD patients. Patients were assessed based on a detailed history, thorough clinical examination, chest X-ray, sputum for Ziehl–Neelsen staining, and electrocardiogram to fulfill the inclusion and exclusion criteria. Furthermore, spirometry, Modified Medical Research Council (mMRC) Dyspnea scale, COPD assessment test (CAT) score, and Borg’s scale were used to assess the activity-related dyspnea grading. RESULTS: Among 110 participants, the mean age was 57.51 ± 10.86 years with equal gender distribution. The majority of participants (33.6%) showed mMRC grade II dyspnea and medium range CAT category and obstructive pattern on spirometry (92.7%). Hence, there was a linear correlation between the CAT score and the mMRC dyspnea score. CONCLUSION: Based on our findings, we can conclude that these patients’ activities of daily living should be examined, and patients should be directed by a complete multidisciplinary team to offer them better advice to prevent, diagnose, and early treatment of dyspnea.

EFFICIENT RESULTS OF PHYSIOTHERAPY REHABILITATION IN HYDRO PNEUMOTHORAX

Hydro pneumothorax is a rare variant type of pneumothorax. It occurs when both free fluid and air are within the pleural space. The goal of treating a hydropneumothorax is to relieve the pressure on your lung, allowing it to re-expand. Treatment options may include observation, needle aspiration, chest tube insertion, non-surgical repair or surgery along with a very important role of physiotherapy. A 54-year male patient came to the hospital with complaints of breathlessness (MMRC grade II), dry cough, and high-grade fever for one month. The patient had a history of alcohol consumption and tobacco chewing for 10 years. Laboratory investigations showed a WBC count 18,600/ml. Complete blood count gave normal results. The arterial blood gases revealed PO2 as 69. Chest X-ray which showed fairly large opacities with the fluid level in right side. The costophrenic angle on the right side is obliterated. Multiple, small patchy opacities are also seen in the left lower zones. Along with these findings, there was a contralateral mediastinal shift. Physiotherapy intervention included patient education, breathing retraining, airway clearance techniques, positioning, walking program with supplemented oxygen and psychological support. Outcome measures have shown improvement in functional independence and performance of activities of daily living. Physiotherapy management showed efficient results in improving lung function, quality of life, inducing relaxation, and early return to pre-disease life in patient with hydro pneumothorax.

Intensive Intervention Improves Outcomes for Chronic Obstructive Pulmonary Disease Patients: A Medical Consortium-Based Management.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Strategies involving multidimensional approaches for the treatment of COPD are needed. This study aimed to evaluate the efficiency of medical consortium-based management for COPD. Patients were grouped in accordance with whether the hospitals they went to were under the medical consortium. We enrolled 141 COPD patients in the management group and 147 COPD patients in the control group. There was no predetermined sex and disease severity inclusion or exclusion criteria. Patients in the control group were managed by standard care, while patients in the management group were managed with intensive medical intervention jointly by specialists in the hospital and general practitioners and healthcare workers in community health centers. There was no difference in the basal demographics between the two groups. The basal condition of the management group was worse than that of the control group, demonstrated by a higher CAT score and a lower pulmonary function index. Half-year intensive intervention decreased CAT score from 17.28 to 15.62 and the Barthel ADL index from 73 to 60 in the management group, which was associated with better pulmonary rehabilitation, pursed-lip breathing, oxygen usage, and medicine regularity. The benefits became more obvious after one-year intensive intervention in the management group. There was a difference in mMRC grades and smoking cessation between the two groups. This study shows that a one-year intensive intervention improves the patients' health status and pulmonary function, suggesting that our medical consortium-based management is effective in the treatment of COPD.

Association of geriatric syndromes in older adults with chronic obstructive pulmonary disease.

BackgroundGeriatric syndromes (GS) are multi‐factorial conditions that make older adults vulnerable to morbidities and poor outcomes. The main objective was to observe the frequency of GS in older patients with COPD.MethodsA case‐control study was conducted in the Geriatric department of a tertiary care hospital in India to evaluate geriatric syndromes including falls, cognitive impairment, frailty, functional impairment, urinary incontinence, malnutrition, and depression in patients with COPD and controls without COPD. The factors having a significant association with the occurrence of these GS in COPD patients were observed.ResultsIn this study, 150 cases and 150 controls were included. The mean age of the participant was 65.85±5.54, with 76% males. Functional impairment, cognitive impairment, frailty, urinary incontinence, and malnutrition were significantly higher in COPD patients. The independent variables which increased the odds of geriatric syndromes were dyspnoea (≥2 mMRC grade) (AOR:3.54,95% CI:1.06‐11.8) and low socioeconomic status (AOR: 4.14, 95% CI: 1.03‐16.54), while male gender showed inverse association (AOR: 0.08,95% CI: 0.01‐0.99).ConclusionGeriatric syndromes are common in older COPD patients, and assessment for them should be done routinely in these patients.