mMRC Score Research Articles

Sense of loneliness and meaning in life in chronic obstructive pulmonary disease patients. Preliminary studies.

Chronic obstructive pulmonary disease (COPD) interferes with everyday functioning but its impact on the loneliness and the meaning in life of the patients is unclear. to determine whether the COPD severity levels correlate with the sense of loneliness and dimensions of the sense of meaning in life. 144 patients with COPD during a period of absence of an infectious exacerbation were examined. The number of infectious exacerbations over the past year, the Modified Medical Research Council (mMRC) dyspnea score, the COPD Assessment Test (CAT) score were determined as well as the feelings of loneliness using the De Jong Gierveld Loneliness Scale (DJGLS) and the sense of meaning in life using the Life Attitude Profile-Revised (LAP-R) questionnaire. The age, the mMRC and CAT scores, the number of pack/years, as well as the number of infectious exacerbations during the year correlated positively with the feeling of loneliness. These variables (except for age) correlated negatively with the LAP-R scales apart from Existential Vacuum, which correlated positively. The subjects from the COPD severity group D (the most seriously ill people) had the highest level of loneliness, while it was the lowest in the subjects from group A (the least ill people). No statistical difference was observed between groups B and C. With the increase in the values of the selected parameters determining the severity of COPD the sense of meaning in life decreases and loneliness intensifies.

Diagnostic value of CT in patients with stable chronic obstructive pulmonary disease at high altitude: Observational study.

This research aims to explore the diagnostic value of computed tomography (CT) indicators in patients with stable chronic obstructive pulmonary disease (COPD) in a plateau of China, and to find out the correlation between CT indexes and lung function and symptoms. This study screened out 53 stable COPD patients and 53 healthy people through inclusion and exclusion criteria in Hongyuan county, Aba Prefecture, Sichuan Province, between July 2020 and December 2020, and then collected their baseline data, conducted lung function tests and chest CT scans, and collected COPD Assessment Test (CAT), modified Medical Research Council Dyspnea Scale (mMRC) scores. The CT indexes of the 2 groups were compared, binary logistic regression was used to analyze the influence of COPD, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the CT indexes for COPD. The Spearman test was used to understand the correlation analysis between the CT indexes and lung function, symptom score, and the number of acute exacerbations. Multiple linear regression was used to analyze the influencing factors of lung function. The percentage of low-attenuation areas less than -950 Hounsfield units (%LAA-950; t = -4.387,P = 0), percentage of wall area (WA%; t = -4.501, P = 0), and thickness-diameter ratio (TDR; t = -4.779, P = 0) in the COPD group were higher than those in the normal group. ROC shows that: %LAA-950 (P = .047) and TDR (P = .034) were independent influence in COPD in the plateau. %LAA-950 combined with TDR (AUC = 0.757, P < .001) had the value of diagnosis of COPD in the plateau. All 3 indexes are negatively correlated with lung function, and positively correlated with the symptoms and the number of acute exacerbations. Multiple linear regression analysis showed that the main factors for decrease of ratio of measurement to prediction of forced expiratory volume to the first second (FEV1%) included %LAA-950 (OR = -0.449, P < .001) and WA% (OR = -0.516, P < .001). CT indexes have a certain diagnostic value in patients with stable COPD at high altitude.

Long-Term High-Flow Nasal Therapy in Patients with Bronchiectasis of Different Severity: A Retrospective Cohort Study.

Background/Objectives: High-flow nasal therapy (HFNT) has been shown to reduce exacerbations of COPD and some evidence displays benefits in non-cystic fibrosis bronchiectasis (NCFB) patients. The present study aimed to compare the effectiveness of 12 months of home HFNT on the annual exacerbation rate between mild/moderate and severe NCFB patients, classified by the bronchiectasis severity index (BSI). Secondary outcomes were the evaluation of the dyspnea, pulmonary function, and sputum cultures in both groups. Methods: The study population included NCFB adult patients, with at least one severe exacerbation in the previous year on optimized therapy. NCFB exacerbations, dyspnea (mMRC score), pulmonary function test, and sputum cultures were assessed at baseline and after 12 months of HFNT. Results: A total of 86 NCFB patients were enrolled: 36 in the mild/moderate (BSI < 9) and 50 in the severe (BSI ≥ 9) group. A significant improvement in the annual exacerbation rate was found in both BSI ≥ 9 (p < 0.0001) and BSI < 9 cohorts (p < 0.0001), with a between-group difference of -1 (95% CI: -2 to 0) exacerbations per year (p = 0.0209). The change in the annual exacerbation rate was significantly correlated with BSI (ρ = -0.26, p = 0.0151) and with HFNT daily use (ρ = -0.22, p = 0.0460). The mMRC score significantly improved by -2 points (95% CI: -2 to -1) after treatment in both groups (p < 0.0001). The percentage of patients with P. aeruginosa colonization decreased from 34.9% to 27.9%. Conclusions: Long-term HFNT reduces the annual exacerbation rate in NCFB patients and its effectiveness increases alongside disease severity and daily use of HFNT.

Vitamin D status in patients with chronic obstructive pulmonary disease at Chris Hani Baragwanath Hospital, Johannesburg, South Africa

Background. There has been a growing interest in nutritional/lifestyle factors, including vitamin D, that may affect chronic obstructive pulmonary disease (COPD). Most data are from Caucasian populations and temperate climates, with minimal African data. Objectives. The primary objective was to determine the prevalence of vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) ≤20 ng/mL) and insufficiency (25(OH)D 21 - 29 ng/mL) among patients with COPD. Secondary objectives were to investigate the association between vitamin D and demographic/lifestyle factors, lung function parameters, markers of COPD severity and corticosteroid use. Methods. A prospective, cross-sectional study of 76 patients with COPD was conducted at a tertiary hospital in Johannesburg, South Africa. Patients were interviewed regarding demographic/lifestyle factors, COPD severity markers and corticosteroid therapy. The most recent spirometry result was recorded. Blood samples were taken for measurement of calcium, alkaline phosphatase and vitamin D levels. Patients were stratified according to vitamin D status (deficiency and non-deficiency (25(OH)D &gt;20 ng/mL, i.e. combined insufficiency and adequate levels)), and statistical analysis was performed to assess for associations. Results. The sample included 72% males and 63% black African patients. The prevalences of vitamin D deficiency and insufficiency were 48% (95% confidence interval (CI) 42 - 54) and 35% (95% CI 30 - 41), respectively. A Modified Medical Research Council (mMRC) dyspnoea score ≥2 was associated with a relative risk of 1.34 (95% CI 1.05 - 1.7) for vitamin D deficiency in univariate analysis. In multivariate regression analysis, only sunlight exposure (&lt;1 hour/day) was an independent predictor of vitamin D deficiency (odds ratio 2.4; 95% CI 1.3 - 4.5). Conclusion. There was a high prevalence of suboptimal vitamin D levels in this COPD sample population. A higher mMRC score was associated with an increased risk of vitamin D deficiency, while low sunlight exposure was the only independent predictor of vitamin D deficiency.

Chronic obstructive pulmonary disease and its treatment in the Russian Federation: Results of a cross-sectional assessment from the CORSAIR observational study

Abstract Up-to-date data on patients with chronic obstructive pulmonary disease (COPD) in the Russian Federation are necessary to improve medical care effectiveness.This article presents the results of the retrospective part and the cross-sectional assessment of the CORSAIR study, which aimed to assess the distribution of COPD patients in the Russian population by symptom severity and exacerbation risk as per GOLD (2020) classification groups A, B, C, D.Methods. The observational multicenter study CORSAIR included a cross-sectional assessment with data collection during the previous 12 months (retrospective part) and subsequent follow-up for 12 months (prospective part). Data from 704 patients obtained at 18 study sites from August 2021 to November 2022 are presented. At the first visit, the physician recorded medical history, clinical data on the disease course, and COPD therapy, assessed compliance of treatment with national guidelines, and determined whether treatment change was needed considering the predominant treatable trait (dyspnea or exacerbation).Results. Upon inclusion, most patients had severe COPD symptoms (mMRC score ≥ 2; САТ score ≥ 10) and severe and very severe airflow obstruction (GOLD III and GOLD IV; FEV1 &lt; 50% оf predicted). More than half of the patients had at least one moderate or severe COPD exacerbation within the previous 12 months. As per the GOLD (2020) classification, 57.2% of patients belonged to Group B (severe symptoms and low risk of exacerbations) and 30.3% to Group D (severe symptoms and high risk of exacerbations). 58.8% of patients received treatment that was not compliant with national clinical guidelines in force at the study initiation. 31.7% of patients had not COPD control. Blood eosinophil count was above 300 cells/μL in 15.1% of patients.Conclusion. In most cases, patients had severe COPD symptoms with frequent exacerbations, and the prescribed treatment did not comply with national clinical guidelines. These data will be analyzed alongside the prospective study results.

Identifying abnormal exertional breathlessness in COPD: comparing mMRC and CAT with CPET

Chronic obstructive pulmonary disease (COPD) management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale and/or COPD Assessment Test (CAT). What is the ability of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD? Analysis of people aged ≥40 years with post-bronchodilator FEV1/FVC<0.70 and ≥10 smoking pack-years from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg 0-10) intensity rating > upper limit of normal (ULN) at the symptom-limited peak of CPET using normative reference equations. We included 318 people with COPD (40% women), age 66.5±9.3 years (mean±SD), FEV1 79.5±19.0%predicted; 26% had abnormally low exercise capacity (V'O2peak <lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC=0 and CAT<10, respectively. A mMRC≥2 and CAT≥10 was most specific (95%) to detect abnormal exertional breathlessness, but had low sensitivity of only 12%. Accuracy for all scale cut-offs or combinations was <65%. Compared with 'true negatives', people with abnormal exertional breathlessness but low mMRC and/or CAT scores ('false negatives') had worse self-reported and physiological outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to have any respiratory medication (37% versus 30%; mean difference 6.1%; 95% confidence interval -7.2 to 19.4; p=0.36). In COPD, mMRC and CAT have low concordance with CPET and fail to identify many people with abnormally high exertional breathlessness.

A Comparison of GOLD and STAR Severity Stages in Individuals with Chronic Obstructive Pulmonary Disease Undergoing Pulmonary Rehabilitation.

BackgroundAlongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD). Study QuestionWhat is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting? Study Design and MethodsMedical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR). ResultsA total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen’s κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (β=0.154; P=0.004). Interpretation.STAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.

Health-related quality of life measured with K-BILD is associated with survival in patients with idiopathic pulmonary fibrosis

BackgroundHealth-related quality of life (HRQoL) assessments and estimates of prognosis are needed for comprehensive care and planning of subsequent treatment in patients with idiopathic pulmonary fibrosis (IPF). We investigated HRQoL and its association with survival using a disease-specific tool in patients with IPF.MethodsThe patients were recruited from the real-life FinnishIPF study in 2015. HRQoL was assessed with the King’s Brief Interstitial Lung Disease (K-BILD) questionnaire every six months for 2.5 years. Dyspnoea was assessed with the modified Medical Research Council (mMRC) dyspnoea scale. Survival was registered until 31 December 2022. Patient survival according to the K-BILD total score was evaluated using the Kaplan‒Meier method. The Friedman test was used to compare the K-BILD total scores longitudinally, and the Mann‒Whitney U test was used to compare the mMRC groups. P values < 0.05 were considered statistically significant.ResultsThe median K-BILD total score (n = 245) was 51.6. At baseline, patients in the highest HRQoL quartile (K-BILD scores 58.9–100) had a longer median survival time (5.3 years) than did those with scores of 51.7–58.8 (3.1 years), 45.7–51.6 (2.3 years), and 0.0–45.6 (1.8 years). A decrease in the K-BILD total score of ≥ 5 units in the preceding 12 or 24 months showed a trend towards poorer survival, although statistical significance was not reached. Ninety-four patients survived more than 2.5 years and had available K-BILD data at all time points. The K-BILD total score remained higher in patients with a baseline mMRC of 0–1 than in those with a mMRC of 2–4, and the total score decreased only modestly in both groups (median of 3.3 and 4.8 units in patients with mMRC scores of 0–1 and 2–4, respectively).ConclusionsIn IPF, a reduced HRQoL is associated with impaired survival. A K-BILD total score less than approximately 50 units is associated with a median survival of approximately two years. In addition to assessing the treatment needs of patients with IPF using K-BILD, a decreased score may be useful for facilitating advance care planning and transplantation assessment.

Pilot study of home-based monitoring for early prediction of acute exacerbations in patients with fibrosing interstitial lung diseases

This study aimed to assess the potential of home monitoring using a monitoring application for the early prediction of acute exacerbations (AEs) in patients with fibrosing interstitial lung diseases (F-ILDs) by tracking symptoms, peripheral blood oxygen saturation (SpO2), and heart rate (HR). Data on symptoms, SpO2, and HR before and after a 1-min sit-to-stand test (1STST) were collected using an online home monitoring application. Symptoms were recorded at least 3 times a week, including cough intensity and frequency (Cough Assessment Test scale (COAT) score), breathlessness grade (modified Medical Research Council (mMRC) score), and SpO2 and HR before and after 1STST. Eighty-five patients with stable F-ILDs were enrolled. We observed a significant increase in COAT and mMRC scores, alongside a significant decrease in SpO2 before and after 1STST, 2 weeks before the first recorded AE. Furthermore, a combination of variables-an increase in COAT (≥ 4) and mMRC(≥ 1) scores, a decrease in SpO2 at rest (≥ 5%), and a decrease in SpO2 after 1STST (≥ 4%)- proved the most effective in predicting AE onset in patients with F-ILDs at 2 weeks before the first recorded AE. Home telemonitoring of symptoms, SpO2 holds potential value for early AE detection in patients with F-ILDs.

Effects of Heart Rate Variability (HRV) Biofeedback in Pulmonary Indicators and HRV Indices Among Patients with Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) exhibit reduced cardiac autonomic activity, linked to poor prognosis and exercise intolerance. While heart rate variability biofeedback (HRVB) can enhance cardiac autonomic activity in various diseases, its use in patients with COPD is limited. This study explored the impact of the HRVB on cardiac autonomic activity and pulmonary indicators in patients with COPD. Fifty-three patients with COPD were assigned to either the HRVB (n = 26) or the control group (n = 27), with both groups receiving standard medical care. The HRVB group also underwent one-hour HRVB sessions weekly for six weeks. All participants had pre- and post-test measurements, including the Six-Minute Walking Test (6MWT), lead II electrocardiogram (ECG) recording, Modified Medical Research Council Dyspnea Scale (mMRC), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. ECG data were analyzed for heart rate variability (HRV) as an index of cardiac autonomic activity. A two-way mixed analysis of variances demonstrated significant interaction effects of Group × Time in pulmonary indicators and HRV indices. The HRVB group exhibited significant post-test improvements, with decreased mMRC and BODE scores and increased 6MWT distance and HRV indices, compared to pre-test results. The 6MWT distance significantly increased and mMRC significantly decreased at post-test in the HRVB group compared with the control group. This study confirmed the efficacy of HRVB as an adjunct therapy in patients with COPD, showing improvements in exercise capacity, breathing difficulties, and cardiac autonomic activity.

Effects of the teach-back method on the health status of patients with chronic obstructive pulmonary disease: a real-world community-based cluster-randomized controlled trial.

The teach-back method (TBM), also known as the "show-me" method, is a technique for verifying patients' understanding of health-related information that has been recommended for improving health literacy. However, the research on TBM effect on the outcomes of chronic obstructive pulmonary disease (COPD) patients is limited. Therefore, the aim of this study was to examine the effect of a TBM intervention on the health status of COPD patients. This real-world community-based cluster-randomized controlled trial enrolled 1,688 patients with COPD from 18 communities in China. Participants received either TBM plus usual care (UC) or UC only. General practitioners were trained in TBM before the intervention. The primary outcomes were depression and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes were health-related quality of life and dyspnea, as measured by the COPD Assessment Test (CAT). Dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Data on acute exacerbations and deaths were extracted from medical records. Lung function was expressed as the forced expiratory volume in 1 second as a percentage of the predicted value [FEV1 (% pred)]. In total, 336 of the 853 COPD patients in the intervention group (TBM plus UC) had comorbid depression, compared with 329 of the 835 in the control group (UC only). The TBM group showed a significantly greater improvement in HADS depression and anxiety subscale scores (HADS-D and HADS-A, respectively) than the UC group at12 months (t =8.34, P<0.001; t=12.18, P<0.001). The CAT and mMRC scores were significantly lower in the TBM than UC group at 12 months (t=8.43, P<0.001; t=7.23, P<0.001). The numbers of acute exacerbations and deaths were significantly lower in the TBM than UC group at 12 months (mean MCF values were 0.35 and 0.56, respectively [difference of 0.22; 95% confidence interval (CI): -0.41, -0.02; χ2=9.63, P<0.001]. The FEV1 (% pred) was significantly higher in the TBM than UC group at 12 months (t=7.45, P<0.001). General practitioners can use TBM interventions to effectively reduce anxiety, depression, and dyspnea symptoms, decrease the frequency of exacerbations and likelihood of death, and improve health-related quality of life and pulmonary function in patients with COPD. The trial was registered on the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958).

The health and economic burden of breathlessness, Australia, 2019: a national survey.

To examine the impact of breathlessness on quality of life, health care use, productivity loss, and economic costs in Australia. National internet-based survey of Australian adults drawn from a web-based survey panel (National Breathlessness Survey). Australian adults (18 years or older), nationally representative by age group, gender, state of residence, and postcode-based socio-economic status (Index ofRelative Socioeconomic Disadvantage quintile), 13-30 October2019. Quality of life assessed with the EQ-5D 5-level version (EQ-5D-5L) and visual analogue scale (EQ-VAS), health care use, productivity loss, and societal cost, each by severity of breathlessness (modified Medical Research Council [mMRC] dyspnoea scale; mMRC grade 1: mild breathlessness; mMRC grades 2-4: clinically important breathlessness). Of 10 072 adults who completed the survey, mild breathlessness was reported by 3044 respondents (30.2%), and clinically important breathlessness by 961 (9.5%). The mean EQ-VAS score was 74.8 points (95% confidence interval [CI], 74.3-75.3 points) and the mean EQ-5D-5L score 0.846 (95% CI, 0.841-0.850) for respondents with mMRC grade 0 breathlessness; for each measure, the mean value declined with increasing severity of breathlessness (trends: each P < 0.001). Respondents with clinically important breathlessness were more likely than those with mild breathlessness to report non-urgent general practitioner visits, urgent general practitioner visits, and specialist visits (exception: mMRC scores of 4) during the preceding year. Among the 2839 respondents of working age, the likelihood of being employed declined with increasing breathlessness severity (mMRC grades 4 v 1: adjusted odds ratio, 0.34; 95% CI, 0.22-0.53). Adjusted mean annual societal cost per person was $1413 (95% CI, $1326-1501) for respondents with mMRC grade 1 breathlessness, $2065 (95% CI, $1766-2365) at mMRC grade 2, $1795 (95% CI, $1371-2218) at mMRC grade 3, and $2075 (95% CI, $1389-2762) at mMRC grade 4. Breathlessness imposes major burdens on individuals, the health care system, and the economy.

Small Airways Dysfunction and Lung Hyperinflation in Long COVID-19 Patients as Potential Mechanisms of Persistent Dyspnoea.

Reticulation, ground glass opacities and post-infection bronchiectasis are present three months following hospitalisation in patients recovering from SARS-CoV-2 infection and are associated with the severity of acute infection. However, scarce data exist on small airways impairment and lung hyperinflation in patients with long COVID-19. To evaluate small airways function and lung hyperinflation in previously hospitalised patients with long COVID-19 and their association with post-COVID-19 breathlessness. In total, 33 patients (mean ± SD, 53 ± 11 years) with long COVID-19 were recruited 149 ± 90 days following hospital discharge. Pulmonary function tests were performed and lung hyperinflation was defined as RV/TLC ≥ 40%. Small airways function was evaluated by measuring the closing volume (CV) and closing capacity (CC) using the single-breath nitrogen washout technique (SBN2W). CC was 115 ± 28% pred. and open capacity (OC) was 90 ± 19. CC was abnormal in 13 patients (39%), CV in 2 patients (6.1%) and OC in 9 patients (27%). Lung hyperinflation was present in 15 patients, whilst the mean mMRC score was 2.2 ± 1.0. Lung hyperinflation was associated with CC (r = 0.772, p = 0.001), OC (r = 0.895, p = 0.001) and mMRC (r = 0.444, p = 0.010). Long COVID-19 patients present with small airways dysfunction and lung hyperinflation, which is associated with persistent dyspnoea, following hospitalisation.

Descriptive Study on the Relationship between Dyspnea, Physical Performance, and Functionality in Oncology Patients.

Cancer is a leading cause of morbidity and mortality globally. Dyspnea, affecting up to 60% of cancer patients, exacerbates physical and psychological distress, reducing quality of life. This study aims to explore the relationship between dyspnea and factors such as age, sex, clinical diagnosis, and treatment lines in cancer patients, with the goal of improving understanding and management of this debilitating symptom to enhance patient care and quality of life. This study employed an observational, cross-sectional, and descriptive approach to investigate patients with oncological disease at the University Hospital of Salamanca between March 2021 and April 2024. A convenience sample was selected, including patients over 18 years old with a pathological diagnosis of cancer, experiencing any degree of dyspnea, and who consented to participate by signing the informed consent. Exclusion criteria included lack of consent and clinical conditions that prevented an interview. The studied variables encompass sociodemographic (age, gender, diagnosis, tumor stage, number of treatment lines) and clinical aspects (daily activities, degree of dyspnea, functional capacity, physical performance), evaluated using the Barthel Index, the mMRC Dyspnea Scale, the ECOG Scale, and the Short Physical Performance Battery (SPPB). Data were collected through semistructured interviews and medical records, and analyzed using specialized software. This research has ethical approval CEiM Code 2023 12 1472, Reference 2024/01. The mean age was 66.82 years. Lung cancer was predominant (60.2%), with most patients in stage 3 (65.7%) and receiving three treatment lines (68.7%). Higher age, advanced disease stage, and more treatment lines correlated with lower Barthel and SPPB scores, and higher ECOG and mMRC scores, indicating worse functionality, physical performance, and greater dyspnea. No significant correlations were found between gender or pathological diagnosis and the studied variables. Advanced age, higher disease stage, and more treatment lines are associated with decreased functionality, poorer physical performance, and increased dyspnea in cancer patients. Gender and specific cancer diagnosis do not significantly affect these relationships. Addressing dyspnea is crucial to improving the quality of life and physical performance in this population. Future studies should explore additional factors like treatment types and nutritional status.

Effects of home-based telerehabilitation-assisted inspiratory muscle training in patients with idiopathic pulmonary fibrosis: A randomized controlled trial.

There are few studies that have used inspiratory muscle training (IMT) as an intervention for patients with isolated idiopathic pulmonary fibrosis (IPF). This study aimed to investigate and interpret the effects of home-based telerehabilitation-assisted IMT in patients with IPF. Twenty-eight participants with IPF took part in the study. Lung function tests, functional exercise capacity by 6-min walk distance (6MWD), dyspnoea perception by modified medical research council dyspnoea scale (mMRC), and inspiratory muscle strength by maximal inspiratory pressure (MIP) were assessed. IMT was performed twice a day, 7 days/week, for 8 weeks. The intervention group (n = 14) performed IMT at 50% of their baseline MIP while the control group (n = 14) performed IMT without applied resistance. Loading intensity was progressed by keeping the load at 4-6 on a modified Borg scale for the highest tolerable perceived respiratory effort for each patient. Dyspnoea based on mMRC score (p < 0.001, η2 effect size = 0.48) significantly decreased within the intervention group compared with the control group. There were significant increases in the intervention group compared to the control group based on 6MWD (p < 0.001, η2 effect size = 0.43), MIP (p = 0.006, η2 effect size = 0.25) and MIP % predicted (p = 0.008, η2 effect size = 0.25). The findings of this study suggest that an 8-week home-based telerehabilitation-assisted IMT intervention produced improvements in inspiratory muscle strength, leading to improvements in functional exercise capacity and dyspnoea.

Assessment of exercise tolerance using cardiopulmonary exercise test in patients with chronic obstructive pulmonary disease and secondary pulmonary arterial hypertension treated with Sildenafil versus those receiving only standard-of-care

BackgroundPulmonary arterial hypertension (PAH) is a common complication of chronic obstructive pulmonary disease (COPD), which can lead to shorter survival and poor clinical outcomes. Patients suffering from PAH display a cardiopulmonary exercise testing (CPET) profile with several atypical factors, such as decreased work rate, limited ability to do aerobic activities, and ventilatory insufficiency.ObjectivesTo assess and compare exercise tolerance by CPET in COPD patients with secondary PAH receiving cGMP-specific phosphodiesterase type-5 (PDE-5) inhibitor (sildenafil) versus those who are receiving standard-of-care only.Patients and methodsThis is a prospective, cross-sectional research in which a total of 30 COPD patients with mild to severe obstruction and secondary PAH were recruited; all patients were treated with standard-of-care treatment for COPD; moreover, half of the recruited patients were also on sildenafil 60 mg/day for at least 3 months at the time of recruitment (sildenafil users) as specific therapy for PAH while the other half were not (non-users). All patients underwent CPET to assess their exercise capacity.ResultsNo significant statistical differences were observed between sildenafil users and non-users in all CPET parameters except in respiratory exchange ratio (RER) during both exercise and recovery with sildenafil users showing a lower RER in both phases compared to non-users (p = 0.02, 0.01, respectively). Also, resting diastolic blood pressure (DBP) was significantly lower in sildenafil users (p = 0.02). In addition, sildenafil users did not exhibit significant differences compared to non-users in terms of Modified Medical Research Council (mMRC) score, COPD assessment test (CAT) score, or spirometric parameters.ConclusionOur findings suggest that there were no significant differences in overall exercise capacity, nor in symptoms or spirometric parameters between COPD patients with secondary PAH receiving sildenafil and those who were not.

Association between swallowing dynamics, tongue pressure and pulmonary function in patients with idiopathic pulmonary fibrosis

BackgroundSwallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF).MethodsPatients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax).ResultsThe sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea.ConclusionPatients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.

The use of antibiotics in the early stage of acute exacerbation of chronic obstructive pulmonary disease in patients without obvious signs of infection: a multicenter, randomized, parallel-controlled study.

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality. In some acute exacerbations of COPD (AECOPD) in patients with no obvious signs of infection, early antibiotic treatment seems to clinically improve the disease, but more studies are needed to determine the prognostic impact of antibiotic treatment in AECOPD patients with no obvious signs of infection. To clarify the impact of antibiotic treatment on the short-term and long-term prognoses of AECOPD patients without obvious signs of infection. The impact of the two treatment methods on the prognosis of patients was compared at 30, 90, 180, and 360days after discharge. A multicenter, randomized, parallel-controlled clinical trial was conducted in a department of respiratory and critical care medicine in Central China. All patients met the inclusion criteria for AECOPD, and the patients were randomly assigned to the antibiotic group or the nonantibiotic group at a 1:1 ratio. Patients in the antibiotic group were given moxifloxacin 400mg/day intravenously for 7days. Patients in the nonantibiotic group were intravenously injected with the same amount of normal saline as the amount of moxifloxacin given to those in the antibiotic group for 7days. There were 406 patients in the antibiotic group and 410 patients in the nonantibiotic group. During the short-term and long-term follow-ups, the acute exacerbation frequency, intensive care unit (ICU) treatment rate, mortality, and mMRC and CAT scores were not significantly different between the two groups (p > 0.05). At the 180- and 360-day follow-ups, the forced expiratory volume in 1s (FEV1%) and peak expiratory flow (PEF) were not significantly different between the two groups (p > 0.05). The 30-day readmission rate was significantly lower in the antibiotic group than in the nonantibiotic group (p < 0.05). The time from discharge to the first acute exacerbation was not significantly different between the two groups (p > 0.05). The length of the first hospital stay after discharge was significantly lower in the antibiotic group (5.84days) than in the nonantibiotic group (6.75days) (p < 0.05). At the 30-day follow-up, the acute exacerbation frequency, age, C-reactive protein (CRP) level, and sputum viscosity were significantly greater in the nonantibiotic group than in the antibiotic group (p < 0.05). In addition, according to the receiver operating characteristic (ROC) analysis, the frequency of acute exacerbations at the 30-day follow-up was significantly greater in COPD patients aged >62.5years, with a CRP level >12.56mg/L or with a sputum viscosity >III, in the nonantibiotic group than in those in the antibiotic group, suggesting that the short-term prognosis was poor. Patients who are >62.5years of age, have a CRP concentration >12.56mg/L, or have a sputum viscosity >III without obvious signs of infection should be treated with antibiotics to improve their short-term prognosis. (https://www.chictr.org.cn), (ChiCTR1800018921).

The Impact of Early Pulmonary Rehabilitation on Dyspnea, Quality of Life, and Symptoms in Moderate to Severe COVID-19 Pneumonia Patients

Introduction: COVID-19 pneumonia leads to dyspnea, persistent symptoms and poor quality of life. Inpatient pulmonary rehabilitation (PR) has limited evidence of effectiveness. Therefore, we aimed to determine the effect of a comprehensive inpatient PR program on dyspnea symptoms and quality of life in patients with COVID-19 pneumonia. Methods: A group pretest-posttest design was conducted in patients with COVID-19 pneumonia. Comprehensive PR was administered during hospitalization. Baseline dyspnea index (BDI), Transitional dyspnea score (TDI), Modified Medical Research Council score (mMRC), and St. George’s Respiratory Questionnaire (SGRQ) were assessed at baseline, 4th week and 12th week after discharge. Results: In total, 28 patients were included (9 with oxygen supplementation, 19 without oxygen supplementation). The mean BDI at baseline was 7.82 ± 2.13. TDI scores at the 4th and 12th weeks were 5.14 ± 1.90 and 6.61 ± 1.59, respectively, with a significant difference observed between the 4th and 12th weeks (p &lt; 0.001). Median mMRC scores at baseline, 4th week, and 12th week were 2(1.25 - 3), 1 (1 - 2) and 1 (0 - 1), respectively, showing a significant improvement between baseline vs 4th week, baseline vs 12th week, and 4th week vs 12th week (p &lt; 0.001). The total SGRQ score exhibited a median (IQR) of 11.34 (7.88 - 8.58) at the 4th week and 6.93 (4.43 - 13.03) at the 12th week, demonstrating a statistically significant improvement (p &lt; 0.001). No adverse events were reported during inpatient PR. Conclusion: Inpatient PR provides a safe and feasible profile, reduces dyspnea symptoms, and improves the quality of life in patients with moderate to severe COVID-19 pneumonia. HIGHLIGHTS COVID-19 pneumonia results in dyspnea and persistent symptoms, impacting quality of life. Early pulmonary rehabilitation, from inpatient to a 12-week outpatient program for moderate and severe cases, is safe and improves dyspnea, quality of life, and patient reported symptoms. GRAPHICAL ABSTRACT

Airway collapse hinders recovery in bronchoscopy therapy for postintubation tracheal stenosis patients.

Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. ChiCTR2100053991.