mMRC Scale Research Articles

Changes in quality of life and dyspnoea after hospitalization in COVID-19 patients discharged at home.

BackgroundTo date, the effects of COVID-19 pneumonia on health-related quality of life (HRQoL) and dyspnoea are unknown.MethodsIn a real-life observational study, 20 patients with COVID-19-related pneumonia received usual care plus erdosteine (300 mg twice daily) for 15 days after hospital discharge following local standard operating procedures. At discharge (T0) and on Day 15 (T1), participants completed the St George’s Respiratory Questionnaire (SGRQ), the modified Medical Research Council (mMRC) scale of dyspnoea during daily activity, the BORG scale for dyspnoea during exertion, and Visual Analogue Scale (VAS) for dyspnoea at rest. Paired t-tests compared scores at T0 and T1.ResultsThe mean (SD) SGRQ total score decreased from 25.5 (15.5) at T0 to 16.9 (13.2) at T1 (p<0.01); 65% of patients achieved a clinically important change of ≥4 points. SGRQ domain scores (symptoms, activity, and impact) were also significantly reduced (all p<0.01). The mean (SD) VAS score decreased from 1.6 (1.7) to 1.4 (2.5); p<0.01. The mean mMRC score decreased significantly (p=0.031) and 30% of patients achieved a clinically important change of ≥1 point. The mean (SD) Borg score increased from 12.8 (4.2) to 14.3 (2.4); p<0.01.ConclusionThe present proof of concept study is the first to report HRQoL in patients with COVID-19. During 15 days after hospital discharge, patients reported significant improvements in HRQoL and dyspnoea at rest and during daily activities.

Bronchiectasis with accompanying bronchoobstruction: efficacy of nebulizer therapy

Objective. To investigate the efficacy and safety of the combination of salbutamol (Nebutamol®, “Yuria-Pharm”) and hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) in complex nebulizer therapy of bronchiectasis with concomitant bronchoobstruction.&#x0D; Materials and methods. As a result of initial screening, 74 patients with confirmed bronchiectasis using high-resolution computed tomography of thoracic organs were selected for further study of 45 patients who had &lt;90 % postbronchodilation forced expiratory volume in 1 sec (FEV1) at the first visit. Patients on the second visit (V2) were prescribed 14-day nebulizer therapy with the bronchodilator salbutamol at a dosage of 2 mg / 2 ml and mucolytic sodium chloride solution 3 % with sodium hyaluronate 30 mg and respiratory gymnastics. Inhalation of mucolytic was prescribed 20 min after inhalation of bronchodilators. Subjective assessment of the severity of cough and sputum was performed using the scales of V.M. Savchenko (2001), assessment of the severity of dyspnea – on a modified scale of dyspnea of the Medical Research Council (mMRC). The daily amount of sputum (DAS) was measured by laboratory scales of high accuracy (MOMERT Model 6000). The respiratory function (RF) was measured using computer spirometry MasterLab (Viasis, Germany). Indicators were evaluated before and 15 min after inhalation of 400 μg salbutamol using a metered aerosol inhaler through a spacer. Indicators such as DAS, the severity of cough and sputum according to the Savchenko questionnaire, the severity of shortness of breath according to the mMRC and RF were determined at the first (screening – V1), the third (day 14 – V3), the fourth (day 28 – V4) and the fifth (day 42 – V5) visits. The safety of this therapy was assessed by recording all adverse events and further processing of the data.&#x0D; Results and discussion. The average age of patients was 58 (43; 66) years, 14 of them (31.1 %) were men. A comparison of all clinical and laboratory characteristics of patients on four visits was performed using Friedman’s rank analysis of variance (ANOVA). Among patients, no statistically significant differences were found between visits in the severity of dyspnea on the mMRC scale (p=0.05), FEV1 (p=0.22) and the ratio of FEV1/FVCpost (p=0.61). However, there were statistically significant differences in such indicators: subjective assessment of the severity of cough on the scale of Savchenko (F29.3=22.5; p=0.00005) was statistically significantly lower by V3 compared with V1 (p=0.0003), on V4 in comparison with V1 (p=0.006), on V5 in comparison with V1 (p=0.008). Subjective assessment of the amount of sputum on the scale of Savchenko (F29,3=22,2; p=0,00009) was significantly higher before treatment than after: on V1 in comparison with V3 (p=0,0005), on V1 in comparison with V4 (p=0.0005) and on V1 in comparison with V5 (p=0.002). DAS was also lower after treatment (F29.3=26.4; p=0.00001): V3 compared to V1 (p=0.000013), V4 compared to V1 (p=0.000006) and on V5 in comparison with V1 (p=0,00005). The following side effects were identified during therapy: tachycardia – in 4 patients (8.9 %), throat irritation after inhalation – in 2 patients (4.4 %), heartburn – in 1 patient (2.2 %).&#x0D; Conclusions. The use of salbutamol in a dosage of 2 mg / 2 ml and a solution of sodium chloride 3 % with sodium hyaluronate 30 mg by inhalation for 14 days had statistically and clinically significant effectiveness in reducing DAS, subjective feelings of the patient regarding the severity of cough and sputum in patients with bronchial obstruction. The use of Nebutamol® and Lorde® gial in complex nebulizer therapy of bronchiectasis has shown its effectiveness and safety, which is confirmed by the results of the study.

Long-term quality of life and functional outcome after rib fracture fixation.

The primary aim of this study was to assess the long-term quality of life and functional outcome after rib fracture fixation for patients with multiple rib fractures or flail chest. Secondarily, this study sought to identify risk factors associated with the quality of life. A retrospective cohort study with a follow-up by questionnaire was performed at a level-1 trauma center in Switzerland. All adult patients with three or more rib fractures treated with rib fixation between 2010 and 2018 were eligible for inclusion. All outcomes were independently assessed for patients with multiple rib fractures and patients with a flail chest. The outcome measures were quality of life, level of dyspnea, return to work, implant irritation, and implant removal after a minimum of 12months of follow-up. Quality of life was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) and level of dyspnea was determined with the modified Medical Research Council dyspnea (mMRC) scale. The survey was completed by 74 out of 102 patients (73%) at a median follow-up of 26months (IQR 15-37). The median EQ-5D utility index score was 0.91 (0.89-1.0), which was equivalent to the reference population (0.902, p = 0.523). The vast majority of patients experienced 'no problems' or 'slight problems' in any of the EQ-5D-5L dimensions. The complication rate associated with rib fracture fixation was low, implant-related irritation was the most common long-term sequela and occurred in 31% of patients. In multivariable regression analyses, total length of stay on the intensive care unit (ICU-LOS) was independently associated with a worse quality of life. Patients who underwent rib fracture fixation for multiple rib fractures or flail chest after severe chest trauma experienced a good quality of life at least 1 year after surgery. A longer ICU-LOS was independently associated with impaired quality of life. In addition, there were no significant differences in the long-term quality of life and functional outcome between patients with multiple rib fractures and a flail chest. Implant-related irritation was the most important long-term sequela and occurred in one-third of patients.

Factors associated with discrepancies between poor dyspnea perception and abnormal lung function in 65 asthmatic patients.

Dyspnea is a subjective symptom of asthma whose perception is characterized by an interindividual variability. Poor dyspnea perception is usually associated with increased risk of exacerbation and may lead to inappropriate asthma management and under-treatment. We sought to identify factors associated with discrepancies between poor dyspnea perception and abnormal lung function in patients with moderate persistent asthma. 65 patients, who attended their scheduled follow-up pulmonology consultation at Ibn Sina Hospital (Rabat - Morocco), underwent interrogation including modified Medical Research Council (mMRC) scale for dyspnea, physical examination and spirometry. Two groups, those with mMRC < 2 (poor dyspnea perceivers) and those with mMRC scale ≥ 2 were compared. Poor dyspnea perception was found in 21 patients (32.3%). Associated factors were male sex (p : 0.03), low socio-economic income (p : 0.01), an onset of symptoms greater than 10 years (p : 0.01), BMI ≥ 25 Kg/m2 (p : 0.04) and depression (p : 0.04). The results revealed factors significantly associated with poor dyspnea perception despite an obstructive ventilatory disorder. These factors could usefully be considered to successfully manage asthma as well as the regular prescription of an objective test like spirometry.

Maximum Voluntary Ventilation and Its Relationship With Clinical Outcomes in Subjects With COPD.

Previous studies have reported that maximum voluntary ventilation (MVV) may be better associated with commonly used outcomes in COPD than FEV1 and may provide information on respiratory mechanics. In this study, we aimed to investigate the relationship between MVV and clinical outcomes in COPD and to verify whether MVV predicts these outcomes better than FEV1. We conducted a cross-sectional study involving individuals with COPD. Lung function was assessed with spirometry; maximum inspiratory and expiratory pressures (PImax and PEmax, respectively) were assessed with manuvacuometry; and functional exercise capacity was assessed with the 6-min-walk test (6MWT). Dyspnea was assessed with the modified Medical Research Council (mMRC) scale; functional status was assessed with the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-m); and health status was assessed with the COPD Assessment Test (CAT). Correlations were verified with the Spearman coefficient, and stepwise multiple linear regression models investigated the predictors of clinical outcomes. Our study included 157 subjects: 82 males; median (interquartile range) age 66 (61-73) y; FEV1 46 (33-57) % predicted; 6MWT 86 (76-96) % predicted; PFSDQ-m total score 34 (14-57); and CAT total score 13 (7-19). Moderate correlations were found between MVV and PImax (r = 0.40), 6MWT (r = 0.50), mMRC (r = -0.56), and total scores on the PFSDQ-m (r = -0.40) and the CAT (r = -0.54). In the regression models, MVV was a predictor of almost all clinical outcomes, unlike FEV1. MVV correlates moderately with clinical outcomes commonly used in the evaluation of individuals with COPD, and MVV is a better predictor of respiratory muscle strength, functional exercise capacity, and patient-reported outcomes than FEV1.

Obesity in patients with chronic obstructive pulmonary disease: prerequisites for the isolation of a separate phenotype

Chronic Obstructive Pulmonary Disease (COPD) is highly lethal and has a pronounced impact on the patient's quality of life (QoL), representing a serious public healthcare problem. According to various studies, the prevalence of obesity in COPD, which can have a significant effect on the course of the disease, reaches 50%. The aim of the study was to assess the disease course characteristics, symptom severity, QoL, concomitant diseases, and lung function in obese COPD patients. Materials. Patients included in the study (n = 176) of COPD patients (GOLD II – IV, group D) were divided into 2 groups: 1 st (n = 88: 71 men, 17 women; mean age 62.40 ± 8.83 years) – normal weight COPD patients; 2 nd (n = 88: 64 men, 24 women; mean age 62.94 ± 5.96 years) – obese COPD patients. The number of COPD exacerbations in the last 12 months has been estimated. Visual analogue scale (VAS) was used to assess the severity of coughing, sputum production, shortness of breath, general weakness. Modified shortness of breath severity scale (Medical Research Council – mMRC), COPD Assessment Test (CAT) and the Chronic obstructive pulmonary disease control Questionnaire (CCQ) were also used, spirometry, 6-minute step test (6-MST) was performed, QoL was assessed using the SF-36 questionnaire, and BODE index was determined. Results. It was shown that the frequency of exacerbations of COPD for the previous year, which did not require hospitalization, and hospitalizations to the inpatient department for exacerbation of COPD, in patients of the 1st group was significantly higher and was 1.21 ± 0.83 and 0.96 ± 0.42 (p = 0.016) and 1.82 ± 0.94 and 1.5 ± 0.81 cases (p = 0.0145) respectively. In patients of the 2 nd group the dyspnea severity, sputum production and general weakness according to VAS and the dyspnea according to mMRC scale were significantly lower. In patients of the 2 nd group reliably higher indices of the forced expiratory volume in the 1 st second (FEV1), forced vital capacity (FVC) and Tiffno index were noted. Patients of the 1 st group also have higher index BODE – 6.23 ± 2.81 and 4.53 ± 2.11 respectively (p = 0.0000). Conclusion . It was found that patients with COPD with obesity have low indices of symptom severity at relatively high values of FEV1, FVC, relatively low risk of acute COPD and hospitalization, and low BODE index at frequent combination with diabetes mellitus and hypertension.

Predictors of patient adherence to COPD self-management exacerbation action plans

ObjectiveIdentifying patient characteristics predicting categories of patient adherence to Chronic Obstructive Pulmonary Disease (COPD) exacerbation action plans. MethodsData were obtained from self-treatment intervention groups of two COPD self-management trials. Patients with ≥1 exacerbation and/or ≥1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as ‘self-initiating prednisolone treatment ≤2 days from the onset of a COPD exacerbation’. Predictors of adherence categories were identified by multinomial logistic regression analysis using patient characteristics. Results145 COPD patients were included and allocated to four adherence categories: ‘optimal treatment’ (26.2 %), ‘sub optimal treatment’ (11.7 %), ‘significant delay or no treatment’ (31.7 %), or ‘treatment outside the actual exacerbation period’ (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0–4) increased the risk of ‘significant delay or no treatment’ (OR 1.64 (95 % CI 1.07−2.50)). Cardiac comorbidity showed a borderline significant increased risk of ‘treatment outside the actual exacerbation period’ (OR 2.40 (95 % CI 0.98−5.85)). ConclusionMore severe dyspnoea and cardiac comorbidity may lower adherence to COPD exacerbation action plans. Practice implicationsTailored self-management support with more focus on dyspnoea and cardiac disease symptoms may help patients to better act upon increased exacerbation symptoms and improve adherence to COPD exacerbation action plans.

The effects of a respiratory rehabilitation programme on body composition

Abstract Objective Analysis of the respiratory rehabilitation effects on body composition, performed for 10 patients with respiratory pathology. Materials and method In our pilot study were included patients with respiratory disease, for which bioelectrical impedance analysis was performed before and after an outpatient respiratory rehabilitation (RR) programme. The RR programme consisted of 20 sessions of exercise for lower limb (cycling and walking on a treadmill) and upper limb (weights). Results Ten patients followed the rehabilitation programme (five patients with chronic obstructive pulmonary disease, two with bronchiectasis, one with cystic fibrosis, one with lung cancer and one with idiopathic pulmonary fibrosis). Following the rehabilitation, they presented an important decrease in total body fat distribution (average total body fat distribution before RR – 31.38% and after RR – 27.09%, p = 0.000) and also segmental body fat distribution; we found an increase of total muscle mass after RR programme (average total muscle mass distribution before RR – 53.03 kg and after the RR – 56.84 kg, p = 0.000) and segmental muscle mass. The average body weight of the patients measured before and after the rehabilitation programme remained relatively constant in absolute value (81.8 kg and 81.3 kg after RR), probably by decreasing fat mass and increasing muscle mass. The RR programme had also a positive effect on increasing exercise tolerance (with 88.5 m at 6-min walk test) and dyspnoea improvement (decrease of mMRC scale with 1.5 points). Conclusion The RR programme has modified the body composition by increasing muscle mass and decreasing fat mass in the respiratory patients, with positive effects on symptoms and exercise tolerance.

RESPIRATORY MUSCLE TRAINING WITH THERABAND VERSUS INCENTIVE SPIROMETER AMONG INDIVIDUALS WITH BRONCHIAL ASTHMA

Objective: To determine and compare the effects of Theraband exercises with Incentive Spirometer exercise in improving respiratory muscle strength among bronchial asthma.&#x0D; Methods: In this study, 30 Individuals with Bronchial asthma were taken and assessed for FEV1/FVC, Maximum voluntary ventilation (MVV) using a computerized spirometer, dyspnea level graded using MMRC scale and diaphragm muscle strength assessed using manual muscle testing (MMT) as pre-test then the individuals were randomly allocated in two groups: Group A and Group B. Group A (n=15) received Theraband exercise and Group B (n=15) were treated with incentive spirometer for a total period of 4 w following which the outcome measures were repeated for post-test.&#x0D; Results: Based on the obtained statistics, both the groups showed significant improvement within groups when comparing pre and post-test measures. On comparing the mean values of the post-test between the groups, theraband exercises showed clinically higher significant results than incentive spirometer exercises.&#x0D; Conclusion: From the result, it shall been concluded that both theraband exercises and incentive spirometer exercises shows improvement in MVV, FEV1/FVC, reduced dyspnea and increased respiratory muscle strength. Hence, theraband exercises are effective compared to the incentive spirometer.

Pulmonary function test in patients with idiopathic pulmonary fibrosis: data from the National Registry for Moscow and Moscow region

The purpose of the work was to evaluate the frequency and severity of lung functional disorders, the relationship between respiratory function (RF) and clinical symptoms in patients with idiopathic pulmonary fibrosis (IPF). Materials and Methods . The National Registry registered IPF patients ( n = 127; 90 (71%) men, 37 (29%) women; average age 69.5 ± 8.5 years), by March 2019 lived in Moscow and Moscow region; at the time of inclusion in the register the duration of the disease was 3.3 ± 3.1 years (22 (17%) < 1 year). The diagnosis of IPF is based on the clinical picture of the disease, the results of high-resolution computed tomography and/or histological examination of the material obtained by surgical lung biopsy. The data of the complex RF examination (spirometry, Body plethysmography, lung diffusion capacity by carbon monoxide – DL CO ), 6-minute walking test (6-MWT) and dyspnea evaluation according to the modified dyspnea scale (Modified Medical Research Council – mMRC) at the moment of inclusion in the register are analyzed. Results . Average value of forced vital capacity (FVC) was 78 ± 22% debt, ratio of forced expiratory volume for 1 s/FVC – 83 ± 9%, total lung capacity (TLC) – 77 ± 17% debt, DL CO – 47 ± 18% debt. DL CO , TLC, FVC were reduced in 97.5, 63 and 59% of patients respectively. In patients with a disease duration of less than 1 year, DL CO was significantly higher than that of less than 1 year. The median distance covered by the 6-MWT was 317.5 m, dyspnea according to the mMRC scale – 2 points. Statistically significant correlations between RF values and shortness of breath, tolerance to physical activity have been revealed. Conclusion . In patients with IPF, included in the National Register, restrictive disorders of pulmonary ventilation were detected in the majority of cases, reduced DL CO – in 97.5%. Statistically significant higher DL CO values are noted for a disease duration of less than 1 year.

Quality of life of patients with chronic obstructive pulmonary disease with different risk of exacerbations

Aim. To study the quality of life (QoL) in patients with COPD depending on the exacerbation risk category and the phase of the disease in correlation with respiratory symptoms. Materials and methods . The study involved 53 patients with COPD who were divided into two groups. The group 1 included the patients of the low risk category of exacerbations (n=22), the group 2 had the patients in the high risk category (n=31). The frequency of exacerbations per year, the severity of respiratory symptoms, QoL using the CAT test and the mMRC scale were included in this analysis. Results. The level of QoL (according to the CAT test) in group 1 during exacerbation is significantly worse by 16.5% (p<0.05) than with stable COPD. In group 2, QoL was significantly lower than in group 1 at both points of the study (p <0.001). In most patients of group 1, the severity of dyspnea by mMRC was <2 points, in group 2 it was ≥ 2 points. Moreover, in group 1, the indicator was significantly lower than in group 2 (p<0.001). In patients of both groups during exacerbation, positive associations were found between the CAT test, severity of cough (r=0.31; p<0.05) and sputum (r=0.31; p<0.05). It was revealed that the risk of frequent symptoms with stable COPD in group 2 was significantly higher than in group I (RR=0.33; 95% CI [0.18-0.61]) and it increased in the period of exacerbation by 19% (RR=0.52; 95% CI [0.34-0.79]). Conclusion. Based on the data obtained, it was found out that QoL in patients with COPD is associated with a risk category of exacerbations and a phase of the disease. Regardless of the risk category, QoL, according to the CAT test, is associated with the severity of respiratory symptoms. The risk of frequent symptoms is increased in patients with COPD of the high risk category both during exacerbation and during the stable course of the disease, and is significantly higher than in patients of the low risk category.

Evaluation of severity of chronic obstructive pulmonary disease using bronchial obstruction, dyspnea, exercise index and global initiative for chronic obstructive lung disease classification and it’s correlation with physical quality of life measured by St. George’s respiratory disease questionnaire score

Background: The Global initiative for chronic Obstructive Lung Disease (GOLD) criteria classified chronic obstructive pulmonary disease (COPD) by severity into four stages. Recently, Body mass index (BMI), Bronchial Obstruction, Dyspnea, Exercise (BODE) index, was proposed to provide useful prognostic information of COPD patients. Health-related quality of life (HRQOL) is measured by St. George’s Respiratory disease Questionnaire (SGRQ). Study was undertaken to assess correlations between BODE index and GOLD classification with SGRQ score.Methods: Fifty five COPD patients were included. Spirometry was performed in all patients. Modified Medical Research Council (mMRC) scale was used to label severity of dyspnea. Six-minute walking distance (6 MWD) was performed. BODE index was calculated by giving points to BMI, forced expiratory volume in one minute (FEV1), 6 MWD, and mMRC. SGRQ was used to determine HRQOL. Correlation analysis was done using Pearson’s method.Results: Mean symptoms, mean activity, mean impacts and mean total SGRQ score were significantly higher in patients having mMRC scale 0-1, patients who could walk ≤149 meters, and in patients who had GOLD III and IV class. Lesser the FEV1, higher the mMRC grade, and lesser the 6 MWD, worse was the quality of life. BODE index (r = 0.72) and GOLD classification (r =0.59) were significantly and positively correlated with symptoms score, activity score, impacts score and total SGRQ score.Conclusions: BODE index correlated better than the Gold classification with SGRQ score implying that apart from the airflow limitation, functional impairment measured by the 6MWT and mMRC also affect HRQOL.

Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study.

Dyspnea and poorer physical performance are conditions that may be related and be present among the elderly. However, few studies have evaluated associations between these variables. To determine whether there is an association between dyspnea and physical performance among community-dwelling older adults of both sexes (age 60 years and over). Cross-sectional study conducted in the city of Macapá, state of Amapá, Brazil. Socioeconomic and health data were collected using a structured form. Frailty syndrome was assessed based on the frailty phenotype proposed by Fried et al. Dyspnea was measured using the modified Medical Research Council (mMRC) scale and physical performance was measured using the Short Physical Performance Battery (SPPB). Data were analyzed using a linear regression model. A total of 411 subjects (70.15 ± 7.25 years) were evaluated, most of them females (66.4%). It was observed from the mMRC scale that 30.9% (n = 127) of the subjects had some dyspnea symptoms: grade 1 was most frequent. The physical performance score from the SPPB was 9.22 ± 2.01. Higher dyspnea scores were associated with poor physical performance, both in the crude analysis (β = -0.233; P = 0.028) and after adjustment for frailty condition (β = -0.148; P = 0.002) and for the socioeconomic and health variables (age, sex, number of diseases, smoking habit and frailty status) (β = -0.111; P = 0.025). Higher dyspnea score was independently associated with poor physical performance among community-dwelling older adults.

Performance difference on the six-minute walk test on tracks of 20 and 30 meters for patients with chronic obstructive pulmonary disease: validity and reliability

BackgroundFunctional capacity assessment is important in patients with chronic obstructive pulmonary disease (COPD). It can be performed by the six-minute walk test (6MWT) on a 30-meter track. However, such space is not always available in clinical settings. ObjectivesTo compare the performance between the 6MWT on a 30- (6MWT30) and 20-meter (6MWT20) track; to evaluate the validity and reliability of the 6MWT30 and the 6MWT20; and to determine for which patients track length has the greatest impact on performance. MethodsPatients with COPD randomly performed two 6MWT30 and two 6MWT20 on two different days and were also assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale. ResultsThirty patients (23 men; mean ± standard deviation FEV1%pred: 45.6 ± 12.1) participated in the study. They walked a greater distance on the 6MWT30 than on the 6MWT20 [mean difference: 22.1 m (95% CI: 12, 32 m)]. The longer the 6MWT30 distance, the greater the difference between the 2 tests (r = 0.51; p = 0.004). The 6MWT20 showed high reliability [ICC: 0.96 (95% CI: 0.77, 0.99)] and the results were associated with the distance walked on the 6MWT30 (r = 0.86), CAT (r = −0.53), and mMRC (r = −0.62). Patients who walked ≥430 m in the 6MWT30 presented a difference between the tests greater than those who walked <430 m (34.5 ± 23.3 m vs. 12.6 ± 24.1 m; respectively; p = 0.01). ConclusionsPerformance was higher on the 6MWT30, with the difference increasing as performance improved. Therefore, the 6MWT20 is valid and reliable to evaluate functional capacity but should not be considered interchangeable with the 6MWT30, especially for the less disabled patients with COPD.

Dual use of bronchodilators versus monotherapy, and its impact on pulmonary rehabilitation in COPD patients

IntroductionLong-acting bronchodilators are the therapy with the best evidence for treating stable chronic obstructive pulmonary disease (COPD). Long-acting combinations of β2 agonists and anticholinergics (LABA-LAMA) are recommended in advanced stages when monotherapy has not generated the desired effects. Pulmonary Rehabilitation (PR) is an effective non-pharmacological strategy. The aim of this study was to compare the results obtained in patients with COPD who received monotherapy versus dual bronchodilator therapy in terms of functional aerobic capacity, symptoms and quality of life. Materials and methodsProspective non randomized intervention study; the patients were divided into two groups: in one group patients were treated with LAMA (Tiotropium Bromide, 5 μg every 24 h) and in the other group patients were treated with LABA + LAMA (Indacaterol/Glycopyrronium, 110/50 μg once a day). After receiving the concept of pulmonology, patients were intervened with 8 weeks of PR. The study was approved by the committee of the Clinica Neumológica del Pacifico in Cali and the Institución Universitaria Escuela Nacional del Deporte, Colombia. To determine the differences, t pair test for intragroup, and t-test was performed for intergroup analysis. For all tests, a p-value <0.05 was considered as statistically significant. Results53 patients participated in this study, of which 20 were assigned to the LAMA group and 33 to the LAMA + LABA group. Patients in both groups presented changes in the distance of the 6MWT, in the VO2e, dyspnea and in all the SGRQ domains. Regarding the comparison between groups, there were found no differences in the variables at the beginning of the PR and significant differences (p < 0.05) at the end of the 8 week-period in favor of the LABA + LAMA group, in symptoms with the mMRC scale, functional aerobic capacity with the 6 min walking test and in health related quality of life specifically in the symptoms domain, where the dual therapy group obtained better results. ConclusionThe addition of LABA to the treatment with LAMA showed better response results compared with the monotherapy in patients with COPD who attended PR.

Results of health-improving treatment of patients with a new COVID-19 coronavirus infection in a phthisiopulmonological sanatorium

The results of sanatorium treatment of 102 patients (aged 18 to 79 years, 30 men and 72 women) who have had a new coronavirus infection (COVID-19) are presented in the article. Materials and methods. A 21-day health im-proving program was developed to restore the functions of external respiration, increase mobility, achieve psych-oemotional stability, and restore patients’ daily activities. Exercise tolerance (6-minute walking test, Borg scale, mMRC scale), hypoxia tolerance (Genchi and Stange func-tional tests), peripheral muscles’ strength (MRC scale), ox-ygen saturation, anxiety and depression intensity (HADS Hospital Anxiety and Depression Scale), quality of life (EQ-5D), and nutritional status were evaluated, as well as in-dicators of external respiratory function of patients upon admission and discharge from the sanatorium. Results.In the result of such therapy clinical and laboratory indi-cators improved (patients rarer complained of weakness (down from 73% to 3.9%), shortness of breath during exercise (from 58 to 14.7%), manifestations of angiodis-tonic syndrome (from 39 to 3%), and ESR level (from 40 to 13.7%). During the 6-minute walk test, there was a sig-nificant increase in the distance traveled compared to the test at admission in all observation groups. 83 out of 90 test subjects (92.2%) co vered a longer distance covered. On average, the distance increased 14% in patients with mild COVID, the average increase was 81 meters, 12% (47 meters) in patients with moderate severity, and 21% (112 meters) in those who had severe infection. Psych-oemotional state evaluated by the Hospital Anxiety and Depression Scale showed a decrease in the average level of anxiety from 4.9 to 3.6, and depression — from 4.3 to 3 points. The average quality of life score (EQ-5D ques-tionnaire) at discharge was 7.3 points compared to 8.9 at admission. Conclusion. The authors demonstrated the effectiveness of the sanatorium-resort care in achieving psychoemotional stability and restoring daily activities in COVID-19 recovalescents

Handgrip strength and its relation to isokinetic dynamometry in COPD

Abstract Introduction: Muscle dysfunction is one of the major changes found in chronic obstructive pulmonary disease (COPD) and associated with loss of functionality, morbidity and mortality. Objective: correlate two strength assessment methods: manual dynamometry for handgrip strength and isokinetic dynamometry for quadriceps strength in patients with COPD, and assess the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE), quality of life and muscle strength. Method: twenty-five patients with moderate to very severe COPD were evaluated by pulmonary function parameters, anthropometric variables, functional capacity, via the six-minute walk test, dyspnea, applying the modified Medical Research Council (mMRC) scale, BODE, quality of life, using the Saint George's Respiratory Questionnaire (SGRQ), handgrip strength with manual dynamometer and quadriceps force using an isokinetic dynamometer. Muscle strength was assessed with a manual portable dynamometer and isokinetic dynamometer. For statistical analysis, ANOVA with Bonferroni’s post-test, the chi-squared test and Pearson's correlation coefficient were used. Results: There was a strong correlation between the strength measurements and the two instruments (torque and quadriceps extension power with right handgrip strength: r = 0.74; p &lt;0.001). The patients classified as very severe exhibited worse performance in the strength tests when compared to the moderate group, albeit with no statistically significant difference. Conclusion: In muscle strength measurements, a strong correlation was detected between the isokinetic dynamometer for quadriceps and the manual dynamometer for handgrip strength. These findings indicate that, in clinical practice, the manual dynamometer for handgrip strength could be used to assess peripheral muscle strength in patients with COPD.

Correlation of CAT, CCQ and mMRC Scores in Patients of COPD with Exacerbation and after Treatment

Introduction: Chronic Obstructive Pulmonary Disease (COPD), a globally prevalent disease holds a huge stake among all pulmonary patients being admitted throughout the year. Various disease specific and health related quality of life questionnaires such as the Constructed Response Question (CRQ) and St. George’s Respiratory Questionnaire (SGRQ) are readily available, although, attributing to their complex structure, they can’t be used in a widespread manner. Some new scores like COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) were developed to ease-off this dilemma. However, there is a need to justify usage of these patient-friendly simplified scores by objectifying their inter-score reliability and correlation with disease severity and progression using statistical analysis. Aim: To analyse efficacious use of CAT, CCQ score and modified Medical Research Council (mMRC) scale in assessing health status of COPD with exacerbation. Additionally, it was also targeted to assess the inter-score correlation and reliability. Materials and Methods: A total of 180 confirmed cases of COPD with exacerbation were included in this study and subjected to requisite biochemical parameters, assessment scores at their admission, after 1 week and then after 4-6 week (at stabilisation) and spirometry. 136 patients were followed-up to 4-6 weeks and studied. Quantitative and qualitative variables thus obtained were compared statistically to find out correlation, if any. A p-value of &lt;0.05 was considered significant. Results: Mean difference between CAT score at exacerbation and at 1 week and CAT score at exacerbation and at 4-6 weeks were statistically significant. The changes in CCQ scores from exacerbation to 1 week and 6 weeks were also found to be statistically significant. Similar pattern was also observed in assessing timescale variability of mMRC score. There was good correlation between CAT, CCQ and mMRC scores at exacerbation, 1 week and it continually intensified as patients progressed towards a more stable state (4-6 weeks). Similar pattern was also observed with significant progressive positive correlation between change in CAT, CCQ and mMRC scores from exacerbation to 1 week and from exacerbation to 4-6 weeks. Conclusion: These score have a high correlative reliability when used to assess health status among various stages of disease from exacerbation towards a stable state. Similarly, correlation between change of individual score from exacerbation towards recovery state was also high.

Quality of life in patients with pleural effusions of various etiologies

The aim of the study was to analyze the most significant factors affecting quality of life in patients with pleural effusions of various etiologies. Materials and methods. Quality of life was assessed in 135 patients with pleural effusions of various etiologies 3–5 days after thoraco-scopy with pleural biopsy. In particular, the participants completed the SF-36 (Short Form-36) Health Survey; further, the degree of dyspnea was assessed before and after surgery using the Modified Medical Research Coun-cil (mMRC) scale. Results. Participants were divided into three groups: first, 65 subjects (48.1%) with malignant pleural effusions (MPE); second, 58 subjects (43%) with inflammatory effusions; and third, 12 subjects (8.9%) with transsudative ones. The volume of effusion in the first group was 1340.3±981.1 ml (M±σ); in the second group, 770.1± 607.0 ml; and in the third group, 1524.0± 991.9 ml. The degree of dyspnea in the second group was less pronounced, and decreased post-surgery from 2.2±1.0 points (M±σ) to 1.0± 1.0; while in the first group, from 2.8±1.0 points to 1.49±0.8 points; and in the third group, from 2.91 ±0.83 points to 1.64±0.67 (p=0.013). In patients with inflammatory pleurisy, physical function-ing, general health and vitality levels were significantly higher. Patients with MPE demonstrated a significant-ly steeper decline of physical, mental and emotional health status compared to patients with pleurisy of an-other etiology. The indicators of the physical, psycho-logical and emotional components were higher in men than in women, with a more pronounced difference in case of cancer. Conclusions. Quality of life of patients with pleural effusions is decreased due to the physical component as a result of respiratory failure caused by lung compression, and it improves after draining and fluid removal. Physical health and viability indices in malignant and transsudative effusions are significantly worse than in inflammatory pleurisy.

Validation of Serbian version of chronic obstructive pulmonary disease assessment test

Background/Aim. The Chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a simple and reliable tool designed to measure overall COPD related health status and complement physician assessment in routine clinical practice. Objective of this study was to evaluate the validity of the Serbian version of CAT. Methods. Study included 140 outpatients in the stable COPD, recruited from two centres: Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, and Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. All patients completed pulmonary function testing ? spirometry, the CAT and the modified Medical Research Council (mMRC) dyspnea scale at baseline visit. The CAT test-retest reliability was tested in 20 patients by the same investigator (physician). Results. We demonstrated that Serbian version of CAT had high internal consistency with Cronbach?s alpha 0.88. Test-retest analysis showed good correlation between CAT scores in two time points (Spearman?s ? = 0.681, p &lt; 0.01). In our study the CAT correlated moderately to mMRC scale (? = +0.57), weakly to FEV1 (? -0.214), was positively related to number of exacerbations, but did not showed exact regularity with change in the Global Initiative for Chronic Obstructive lung disease (GOLD) stage. Conclusion. The Serbian version of CAT is a reliable, simple and easy-to-use tool that can be used in everyday clinical practice to assess the health status of COPD patients in Serbia.