mMRC Score Research Articles

A retrospective study on the efficacy of Ninjin’yoeito on fatigue in patients with interstitial pneumonia

IntroductionFatigue, caused by dyspnea associated with progression of interstitial pneumonia (IP), can negatively affect patients' quality of life (QOL). Ninjin’yoeito (NYT), a Chinese herbal medicine, is prescribed for general symptoms of fatigue and for fatigue associated with various respiratory diseases. However, there is a lack of integrated research on the effects of NYT in patients with IP. Therefore, we retrospectively investigated the efficacy of NYT in patients with IP and fatigue. Materials and methodsFrom the IP patients who had taken NYT, 19 who met the following inclusion criteria were included: (1) age of ≥20 years, (2) fatigue, and (3) history of NYT administration. The primary endpoint was fatigue, which was assessed using the Chalder Fatigue Scale (CFS). The secondary endpoints were loss of appetite and dyspnea, which were evaluated using the Simplified Nutritional Appetite Questionnaire (SNAQ) and modified Medical Research Council (mMRC) scores, respectively. All items were measured before and after 12 weeks of NYT administration. ResultsIn the enrolled 19 patients (male, 12; female, 7; mean age, 65.8 ± 12.7 years), the underlying diseases were idiopathic pulmonary fibrosis (n = 8), idiopathic pleuroparenchymal fibroelastosis (n = 5), connective tissue disease-related interstitial pneumonia (n = 2), chronic hypersensitivity pneumonitis (n = 3), and nonspecific interstitial pneumonia (n = 1). The CFS score decreased from 17.1 ± 6.8 before administration to 13.4 ± 5.7 after administration of NYT (p = 0.0389). The SNAQ score did not change markedly. The median mMRC score decreased from 3 to 2, however, the difference was not significant. ConclusionMany subtypes of IP are progressive, and a cure cannot be expected in cases of irreversible lung fibrosis. Therefore, a multifaceted approach to improve and maintain the QOL is needed in addition to the standard of care. This study showed that NYT can improve fatigue and help maintain the QOL in IP patients.

The COPD assessment test and the modified Medical Research Council scale are not equivalent when related to the maximal exercise capacity in COPD patients

IntroductionThe management and treatment of Chronic Obstructive Pulmonary Disease (COPD) are based on a cutoff point either of ≥ 10 on the COPD Assessment Test (CAT) or of ≥ 2 of the Medical Research Council (mMRC). Up to now, no study has assessed the equivalence between CAT and mMRC, as related to exercise tolerance in COPD. The aim of this study was to investigate as primary outcome the relationship between CAT and mMRC and maximal exercise capacity in COPD patients. We also evaluated as secondary outcome the agreement between CAT (≥ 10) and mMRC (≥ 2) to categorize patients according to their exercise tolerance. Material and methods118 consecutive COPD patients (39 females), aged between 47 and 85 years with a wide range of airflow obstruction and lung hyperinflation were studied. Maximal exercise capacity was assessed by cardiopulmonary exercise test. ResultsCAT and mMRC scores were significantly related to VO2 peak (p<0.01). CAT (≥ 10) and mMRC (≥ 2) have a high likelihood to be associated to a value of VO2 peak less than 15.7 and 15.6 mL/kg/min, respectively. The interrater agreement between CAT (≥ 10) and mMRC (≥ 2) was found to be fair (κ = 0.20) in all patients but slight when they were subdivided in those with VO2 peak < 15 mL/kg/min and in those with VO2 peak ≥ 15 mL/kg/min (κ = 0.10 and κ = 0.20 respectively). ConclusionThis study shows that CAT and mMRC are useful tools to predict exercise tolerance in COPD, but they cannot be considered as supplementary measures.

Swiss Experience in Therapy With Dual Bronchodilation in Chronic Obstructive Pulmonary Disease in Relation to Self-Reported Physical Functionality.

BackgroundMedical therapy in chronic obstructive pulmonary disease (COPD) usually includes inhaled dual bronchodilation leading not only to an improvement in symptoms but also to an increase in physical performance. However, it remains unknown whether responder rates to dual bronchodilation differ between the Swiss subgroup in comparison to participants of other European countries.MethodsThe non-interventional OTIVACTO trial investigated changes in self-reported physical functioning in COPD patients treated with tiotropium/olodaterol 5/5 µg fixed dose combination for 6 weeks. The cut-off between responder and non-responder was defined as a minimum increase of 10 points using the 10-question physical functioning questionnaire (PF-10) score. We searched for patterns of the responder patient group and compared the results of the whole dataset with the subgroup of Swiss participants.ResultsCompared to the total cohort (n = 7,608), the Swiss participants (n = 94) were predominantly > 65 years of age and had significantly more comorbidities. There were no significant differences according to COPD stage, smoking status, exacerbation rate in the last 12 months and modified Medical Research Council questionnaire (mMRC) score between the total cohort and the Swiss collective. There were no significant differences between the Swiss subgroup and the total cohort with regard to response to the medication in the PF-10 score. In the intragroup comparison, patients with high mMRC score showed significantly higher values in the PF-10 in both groups. The number of exacerbations had no influence on the PF-10 score in the Swiss subgroup but in the total cohort.ConclusionIn terms of age and number of comorbidities, significant differences were found between the overall patient population and the Swiss participants, having no influence on the success of the medication. The patients suffering from increased dyspnea benefited most from tiotropium/olodaterol treatment (Clinical Trials Registry NCT02720757).

The Effect of Non-Invasive Mechanical Ventilation on Respiratory and Inflammatory Parameters in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is an airway obstructive disease that is often caused by smoking. The disease is currently the third leading cause of death worldwide. The current therapeutic approach is based on Non-Invasive Ventilation (NIV) therapy, which can reduce mortality, the need for hospitalization in the intensive care unit, and to some extent therapeutic complications. Therefore, this study was performed to determine the effect of non-invasive ventilation along with routine treatments on respiratory markers, inflammation, and clinical status of patients with COPD. Methods: A total of 30 patients with COPD referred to Masih Daneshvari Hospital were divided into control and intervention groups. In the intervention group, 15 patients underwent non-invasive ventilation in addition to the usual treatments, and in the control group, the patients underwent only the usual treatments. After completing the mMRC (Modified Medical Research Council) questionnaire and evaluating FEV1 (Forced Expiratory Value in one score), 5 ml of blood samples were taken from these patients at the beginning of the study, on the seventh to tenth day, and also in the third month, and the results of this evaluation were compared between the two groups. Results: Based on the results of this study, the mMRC score of the intervention group was significantly lower than the control group in the first week (p=0.043) and three months after treatment (p=0.049). However, indices such as FEV1, and IL-8(Interleukin-8) did not change significantly in both groups. Conclusion: The use of non-invasive mechanical ventilation along with standard treatments can play a relative role in improving patient outcomes.

Effects of pain on depression, sleep, exercise tolerance, and quality of life in patients with nontuberculous mycobacterial pulmonary disease.

The experience and causes of pain in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) have not been clarified.This study aimed to determine the prevalence and severity of bodily pain (BP) in patients with NTM-PD. We also investigated the clinical indicators that contribute to pain.We used a retrospective cross-sectional study design. The participants were 114 NTM-PD patients (109 women) with a mean age of 65 years. The prevalence and severity of pain were measured using 2 items from the 36-Item Short Form Survey version 2 (SF-36), and the BP score was calculated. Functional limitation due to dyspnea was quantified using the Modified Medical Research Council Dyspnea Scale (mMRC), depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); health-related quality of life was assessed using the Leicester Cough Questionnaire (LCQ), and exercise tolerance was measured using the Incremental Shuttle Walk Test (ISWT).Pain was reported by 70.2% of the patients (n = 80), and of these, 35.7% (n = 25) reported moderate to very severe pain. NTM-PD patients with high levels of pain had significantly higher scores on the mMRC, CES-D, and PSQI scores, and significantly lower performance on the ISWT and LCQ. Multiple regression analysis identified ISWT, CES-D, and PSQI as independent factors that affected BP scores.Our findings suggest that pain significantly impacts daily life associated with reduced exercise tolerance, the presence of depressive symptoms, and poor sleep quality in patients with NTM-PD.

Association between body mass index and patient-reported-outcome questionnaire scores (CAT\u2122, ACT\u2122, mMRC dyspnoea scale, IPAQ) in Ukraine, Kazakhstan and Azerbaijan: results of the CORE study

BackgroundThe overweight/obese population (evaluated by a body mass index, BMI) represents a global health problem and contributes to the development of various chronic diseases. In this epidemiological study we evaluated this relationship by analyzing patient-reported questionnaires related to respiratory function, physical activity and BMI.MethodsIn 2013–2015, adult residents of selected cities were enrolled to this study in: Ukraine (M/F: 403/561), Kazakhstan (M/F = 348/597) and Azerbaijan (M/F: 389/544). Height was measured using a vertical measuring board, and body weight was measured by using portable digital scales. All participants were interviewed using CAT™, mMRC scale and IPAQ; respondents who also reported wheezing or whistling chest sounds during the previous 12 months additionally ACT™.Results45.4% of respondents in Ukraine, 47.6% in Kazakhstan and 54.9% of respondents in Azerbaijan were found to be overweight/obese (BMI ≥ 25 kg/m2). The mean CAT™ total score among this population versus those respondents with a normal weight was 5.2 versus 3.6 (Ukraine, p < 0.001), 4.2 versus 2.9 (Kazakhstan, p < 0.001) and 5.9 versus 4.3 (Azerbaijan, p < 0.001). The number of respondents without airflow limitations (mMRC score 0) among overweight/obese respondents versus normal weight respondents was 298 (68.2%) versus 456 (86.7%) in Ukraine, 261 (58.1%) versus 387 (78.2%) in Kazakhstan and 343 (67.1%) versus 345 (82.3%) in Azerbaijan. The ACT™ total score between overweight/obese respondents and normal weight respondents was not statistically different. IPAQ showed a tendency towards a higher proportion of “low activity” results (compared to “moderate” and “high”) in the overweight/obese subgroup (24.7% vs. 23.8% in Kazakhstan, 18.5% vs. 14.6% in Azerbaijan), and in Ukraine this difference was significant (12.4% vs. 5.2%, p < 0.001).ConclusionCAT™ and mMRC are widely used tools for respiratory function assessment. Despite CAT™ scores being close to a normal value (< 5), the relationship of both CAT™ and mMRC scores with being overweight/obese was demonstrated in the general adult population of three CIS countries. IPAQ may also be a useful instrument for measuring activity level however, more objective studies are required to evaluate the relationship between BMI and physical activity.

Clinical and Functional Features of Chronic Obstructive Pulmonary Disease in Russian Primary Health Care

Aim: To reveal the clinical and functional features in patients with COPD in Russian primary health care. Methods: At stage 1, COPD risk factors were assessed among persons with respiratory symptoms (n=525). Stage 2 included screening spirometry. At stage 3, patients with COPD were examined to determine clinical and functional features. The COPD group included 150 patients in age from 45 to 81 years (56.1±2.3 years). According to the GOLD classification, patients were divided into the following groups: group A – 59 patients (39.3%), group B – 30(20%), group C – 29(19%) and group D – 32(21.7%). Results: Mild to moderate COPD was registered in 62% of cases. 88(58.7%) had few symptoms of the disease (mMRC-0-1, CAT &lt;10 points), 62(41.3%) had many symptoms (mMRC-0-1, CAT ≥10 points). There is a correlation between the rate of exacerbations and severity of COPD (r=0,56, p&lt;0,05 ). Most of the patients without exacerbations belonged to group A (45.4%). There were no significant demographic differences between the groups in terms of age, gender, and smoking status (p&gt;0.05). 58.3% of COPD patients had a 1point mMRC score and 41.7% of patients had a score of more than 2. Conclusion: The study revealed a high prevalence of COPD between adults with mild to moderate severity. Keywords: COPD, spirometry, mMRC, CAT.

Daily living activities, exercise capacity, cognition, and balance in COPD patients with and without frailty.

Information on the interaction between frailty and chronic obstructive pulmonary disease (COPD) is limited. This study aimed to compare activities of daily living (ADL), exercise capacity, balance, and cognition in COPD patients with and without frailty. Twenty frail and 28 non-frail COPD patients aged 55 years and over were included. Frailty was determined according to Fried et al. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale. Respiratory and peripheral muscle strength were measured. Functional capacity was assessed using a 6-min walk test (6MWT); ADL performance was evaluated using the Glittre ADL test. The balance was evaluated using the functional reach test (FRT). Cognitive function was assessed using the Montreal Cognitive Evaluation (MoCA) Test. Quality of life was measured using the COPD Assessment Test (CAT). The mMRC and CAT scores were higher in the frail patients as compared with the non-frail patients (p < 0.05). The maximal inspiratory pressure, handgrip strength, 6MWT distance, and FRT score were lower in the frail patients as compared with the non-frail patients (p < 0.05). The duration for the Glittre ADL test was longer in the frail patients than the non-frail patients (p < 0.05). There was no significant difference between MoCA scores between groups (p > 0.05). Frail COPD patients have increased dyspnea perception, impaired muscle strength, and functional capacity, ADL performance, balance, and quality of life. Whether pulmonary rehabilitation programs for patients with frail COPD need to be adapted with new rehabilitation strategies, including components of frailty, needs further investigation.

Identification of Inflammation-Related Biomarker Lp-PLA2 for Patients With COPD by Comprehensive Analysis.

PurposeChronic obstructive pulmonary disease (COPD) is a complex and persistent lung disease and lack of biomarkers. The aim of this study is to screen and verify effective biomarkers for medical practice.MethodsDifferential expressed genes analysis and weighted co-expression network analysis were used to explore potential biomarker. Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and Gene set enrichment analysis (GSEA) analysis were used to explore potential mechanism. CIBERSORTx website was used to evaluate tissue-infiltrating immune cells. Enzyme-linked immunosorbent assay (ELISA) was used to assess the concentrations of the Lp-PLA2 in serum.ResultsTen genes were selected via combined DEGs and WGCNA. Furthermore, PLA2G7 was choose based on validation from independent datasets. Immune infiltrate and enrichment analysis suggest PLA2G7 may regulate immune pathway via macrophages. Next, Lp-PLA2(coded by PLA2G7 gene) level was upregulated in COPD patients, increased along with The Global Average of COPD (GOLD) stage. In additional, Lp-PLA2 level was significant correlate with FEV1/FVC, BMI, FFMI, CAT score, mMRC score and 6MWD of COPD patients. Finally, the predictive efficiency of Lp-PLA2 level (AUC:0.796) and derived nomogram model (AUC:0.884) in exercise tolerance was notably superior to that of the sit-to-stand test and traditional clinical features.ConclusionLp-PLA2 is a promising biomarker for COPD patients and is suitable for assessing exercise tolerance in clinical practice.

PARC/CCL18 is Associated with Inflammation, Emphysema Severity and Application of Inhaled Corticosteroids in Hospitalized COPD Patients.

BackgroundPulmonary and activation-regulated chemokine (PARC) also named CC-chemokine ligand 18 (CCL18) is a lung-predominant inflammatory protein that is found in serum. The relationship of PARC/CCL18 with the chronic obstructive pulmonary disease (COPD) is not fully understood. The aim of the present study is to analyze the expression of PARC/CCL18 in COPD.MethodsNinety-eight hospitalized COPD patients and 60 healthy volunteers from January 2019 to December 2019 were recruited in this retrospective study. Gender, age, height, weight, disease duration, smoking status, blood cell classification and count, length of hospital stay (LOS), symptom score, including COPD Assessment Test (CAT) score, modified British Medical Research Council (mMRC) score, lung function and therapy were recorded and serum PARC/CCL18 was analyzed by ELISA. The correlation between symptom score, blood cell classification and count, CRP, lung function parameters and serum levels of PARC/CCL18 and ROC curves of PARC/CCL18 levels and inhaled corticosteroids (ICS) were accessed.ResultsIt was found that serum PARC/CCL18 level in hospitalized COPD population was significantly higher than that in healthy people (p=0.003). COPD patients with emphysema had significantly higher serum level of PARC/CCL18 than those without emphysema (p=0.049). Total lung capacity (TLC) and residual volume (RV)/TLC had positive correlation with serum level of PARC/CCL18 (p=0.001, 0.020, respectively). Furthermore, serum PARC/CCL18 level was predictive for the application ICS (p=0.003) and related to C-reactive protein (p <0.0001) in hospitalized COPD patients.ConclusionPARC/CCL18 is associated with the severity of inflammation and emphysema in COPD. Furthermore, PARC/CCL18 is a predictor of ICS application in the treatment of hospitalized COPD patients.

EVALUATION OF THE RELATIONSHIP BETWEEN VITAMIN D LEVELS IN COPD PATIENTS WITH ACUTE RESPIRATORY FAILURE

COPD with the development of inflammation in the alveoli as a result of exposure of harmful gases to the bronchi and bronchioles in the lungs, irreversible airflow restriction and respiratory symptoms occur. In our study;It is aimed to evaluate the serum D vitamin level in COPD patients with acute respiratory failure and to investigate the effect of vitamin D in COPD stages. This study is a prospective cross-sectional study. The study was conducted with a total of 75 COPD patient groups and 65 control groups. GOLD score, CAT score and Mmrc score were used in the study. Kruskal-Wallis H test and Mann-Whitney U test were used for statistical analysis.The results were evaluated in terms of p &amp;lt;0.05 significance level. According to the results of our study, vitamin D level in acute exacerbation was lower in patients with acute obstructive pulmonary disease than in the control group. According to the results obtained in our study, when CAT scores, Mmrc scores, vitamin D levels and gold scores,which are the measured assessment for chronic obstructive pulmonary disease patients, are evaluated; With increasing vitamin D deficiency, patient clinics become more severe. We believe that patients diagnosed with COPD add vitamin D to their treatment protocols according to their vitamin D levels and their vital activities will increase while reducing the severity of COPD.

The effect of pulmonary rehabilitation on smoking and health outcomes in COPD patients.

Although several positive effects of pulmonary rehabilitation (PR) are known in COPD patients, the results of PR in smoker COPD patients are unclear. We aimed to compare the effect of PR on smoking behaviour and health outcomes between COPD patients who are smoker and ex-smoker. In our study; 62 COPD patients (31 of them active smoker and 31 of them were ex-smoker) who completed in an 8-week outpatient PR programme were included. Pulmonary function test, blood gas analysis, mMRC Dyspnoea Scale, 6-minute walk test, St. George's Respiratory Questionnaire, SF-36 Quality of Life Questionnaire and Hospital Anxiety Depression Scale were performed. Smoking behaviour and nicotine dependence of the study group was evaluated. At baseline assessment; TLCO was found to be lower in the currently smoking group (p=0.042) and significantly increased after PR (p=0.012). FEV1 , PaO2 , arterial saturation, 6-min walk distance and quality of life improved in both groups (p<0.05). Anxiety score decreased in both groups; depression score decreased only in the ex-smoker group. When comparing changes between groups; mMRC score was observed to be decreased more in the smoker group (p=0.01). At the end of the programme, nicotine dependence score and the daily number of cigarettes were significantly decreased in the smoker group (p<0.001), also 2 patients completely quit smoking. Smoker COPD patients benefited from the PR programme at least as much as the patients who do not smoke. Furthermore, nicotine dependence and amount of cigarette decreased in smoker patients. Therefore, COPD patients who smoke should be referred to the PR programmes.

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

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

A follow-up study of respiratory and physical function after discharge in patients with redetectable positive SARS-CoV-2 nucleic acid results following recovery from COVID-19

ObjectiveThe aim of this study was to evaluate the respiratory and physical function of patients who retested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA during post-coronavirus disease 2019 (COVID-19) rehabilitation. MethodsA total of 302 discharged COVID-19 patients were included. Discharged patients were followed up for 14 days to 6 months. The modified Medical Research Council (mMRC) dyspnea scale, Borg rating of perceived exertion, and manual muscle testing (MMT) scores on day 14 and at 6 months after discharge were compared between the redetectable positive (RP) and non-RP (NRP) groups. Prognoses of respiratory and physical function were compared between patients who recovered from moderate and severe COVID-19. ResultsOf the study patients, 7.6% were RP. The proportion of patients who used antiviral drugs was significantly lower in the RP group than in the NRP group. There were no differences in mMRC, Borg, or MMT scores within the RP and NRP groups. The mMRC, Borg, and MMT scores were worse for patients with severe disease when compared to those with moderate disease at both follow-up time points. ConclusionsCOVID-19 patients who did not take antiviral drugs were more likely to be RP after discharge. The recovery of respiratory and physical function was not related to re-positivity during rehabilitation, but was related to disease severity during hospitalization.

Analysis of the clinical efficacy and safety of bronchial thermoplasty in the treatment of patients with severe asthma and asthma-chronic obstructive pulmonary disease overlap

Objective: To investigate the clinical efficacy and safety analysis of bronchial thermoplasty (BT) in the treatment of severe asthma and asthma-chronic obstructive pulmonary disease overlap. Methods: The clinical data of 49 patients with asthma-COPD overlap who received BT in the University of Chinese Academy of Sciences Shenzhen Hospital from January 2016 to December 2018 and 50 patients with severe asthma who received BT in the same period were retrospectively analyzed. Patients were divided into overlap group and asthma group, and the baseline data of two groups were recorded. The pulmonary function before and after treatment (including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1 as a percentage of predicted value (FEV1% pred)), hormone consumption, asthma control test (ACT) score, asthma quality of life questionnaire (AQLQ) score, asthma control questionnaire (ACQ) score, the overlap group before and after treatment COPD assessment test (CAT) score, modified British Medical Research Council (mMRC) score and postoperative respiratory adverse events in the next 3 weeks were comparatively analyzed. Results: The general baseline characteristics of the two groups are compared. The patients in the overlap group were older than those in the asthma group, and the course of disease and smoking history were longer than those in the asthma group. The inhaled hormone dosage in asthma group was greater than those in the overlap group ((64±11) years vs (48±11) years; 10.00 (10.00, 25.00) years vs 9.00 (1.75, 20.00) years; 20.00(2.00, 40.00) years vs 0 (0, 10.00) years; 320 (320, 640) μg/d vs 960 (320, 960) μg/d) (all P<0.05). The predicted values of lung function indexes FVC, FEV1, FEV1% pred in the overlap group before treatment were all lower than those in the asthma group (1.98 (1.43, 2.43) L vs 2.54 (2.02, 3.15) L; 0.92 (0.61, 1.26) L vs 1.69(1.17, 2.16) L; (50±16) L vs (65±14) L) (all P<0.05). There were no significant differences in ACT, ACQ, and AQLQ scores between the two groups before treatment (all P>0.05). Within 3 months after treatment, except for no significant improvement in FEV1% predicted value and inhaled hormone dosage in the overlap group (all P>0.05), other indexes in both groups were improved compared with those before treatment (all P<0.05). After 1 year of treatment, all indexes of the two groups were significantly improved than those before treatment, and all indexes of the asthma group were better than those of the overlap group (all P<0.05). In terms of respiratory adverse events occurring within 3 weeks after the operation, the incidence of cough and bloody sputum in the overlap group was higher than that in the asthma group, while the incidence of sputum and short-term wheezing was lower than that in the asthma group (all P<0.05). There were no statistically significant differences in the incidence of chest tightness, chest pain, segmental atelectasis and pneumonia between the two groups (all P>0.05), and the postoperative adverse reactions could be effectively controlled in a short period of time. Conclusion: BT treatment could not only improve the lung function, clinical symptoms and quality of life of asthmatic patients, but was also effective for asthma-COPD overlap patients. However, BT treatment had more benefits for asthmatic patients without serious adverse events occurred.

Adherence to Treatment Recommendations for Chronic Obstructive Pulmonary Disease - Results from the Swedish National Airway Register.

IntroductionSwedish guidelines adhere to the international GOLD document regarding management of chronic obstructive pulmonary disease (COPD). Based on data from the Swedish National Airway Register (SNAR) the aim was to evaluate adherence to guidelines of pharmacological treatment of COPD in Swedish primary and secondary care.MethodsDuring a period of 18 months, data on symptoms (CAT, mMRC), lung function, exacerbation history and pharmacological treatment from 15,595 COPD patients from 853 primary care and 125 secondary care clinics were collected from SNAR. Patients with a co-diagnosis of asthma were excluded. Patients were divided into four treatment groups: no pharmacological treatment, short-acting bronchodilators alone, long-acting bronchodilators alone and ICS alone or in combination with bronchodilators.ResultsOf the patients, 29% were in GOLD group A, 58% in group B, 2% in group C and 11% in group D. CAT score was ≥10 and mMRC score was below 2 in 30.9% of the patients and mMRC score was ≥2 and CAT score <10 in 4.2% of the patients. In 61.4% of the patients, no exacerbation was registered during the last year. Long-acting bronchodilators were prescribed for 78% and ICS for 46% of all patients. In groups A, B, C and D, respectively, 21%, 11%, 11% and 5% did not receive any inhaler therapy; 67%, 81%, 81% and 90% received long-acting bronchodilators; 33%, 46%, 55% and 71% received any ICS containing therapy and 19%, 34%, 39% and 61% received triple therapy.DiscussionData from the SNAR indicate that only a minority of COPD patients were untreated. There was a liberal use of ICS containing drug combinations in subjects who do not have an indication for ICS. A considerable proportion of subjects at high risk of exacerbations did not receive ICS treatment.

Sociodemographic and Clinical Variables Related to the Overburden of the Informal Caregivers of Patients Hospitalized for Chronic Obstructive Pulmonary Disease Exacerbations.

ObjectiveTo increase our knowledge of the patient variables related to the overburden of the caregivers of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs).MethodologyThis was a cross-sectional study of patients with severe COPD who have informal caregivers. We performed a multivariate analysis of sociodemographic (economic situation, care, dependence, social risk, and use of social services) and clinical (degree of dyspnea, previous hospitalizations, disease impact, pulmonary function, and comorbidity) factors and related these to the burden of informal caregivers, as evaluated using the Zarit scale.ResultsThe study included 91 patients, age 72.6±8.7 years and 80 were male (89.7%); the mean modified Medical Research Council dyspnea scale (mMRC) score was 2.5±0.8; mean FEV1 was 39.5 ± 13.2%; and 70 patients (76.9%) were dependent for basic activities. Of the informal caregivers, 90 (90.9%) were women, 49 (49.4%) were partners or spouses, and 29 (29.6%) were daughters. The mean Zarit questionnaire score was 51.4±14.2, with 63 of carers (69.2%) perceiving some overburden, and 34 (37.4%) describing the overburden as mild–moderate. The variables related to informal caregiver overburden in the multivariate study were the previous use of social resources [OR = 8.1 (95% CI = 1.03–69.9); p = 0.04], degree of mMRC dyspnea 3–4 [OR =4.7 (95% CI = 1.7–13.2); p = 0.003], and two or more admissions for AEPOC in the previous year [OR = 4.5 (95% CI = 1.7–13.2); p = 0.003]. Of the informal caregivers of patients who had presented two or more of these variables, 92.3% perceived an overburden.ConclusionThe variables associated with overburden are easily accessible in patient medical records, or can be obtained by interviewing patients or their relatives. This information would allow to detect and assess the overburden of informal caregivers to provide an early warning of this problem.

Study on clinical, subclinical characteristics, serum immunoglobulins concentration during and after of acute exacerbation of chronic obstructive pulmonary disease

Objective: To describe the clinical, subclinical characteristics and serum immunoglobulin concentrations during and after of acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD). Subject and method: A prospective observational study. 127 cases were enrolled: 30 healthy persons in control group and 97 patients with AE of COPD, being treated at 103 Military Hospital from October 2015 to August 2017. Result: Severe and very severe dyspnea accounted for the highest proportion, average mMRC score of 3.2 ± 0.7. Life-threatening AE accounted for 43.3%. Increased number of leukocytes was 54.6%. Disorders of blood glucose and kidney function were common, increasing serum PCT levels by 54.6%, and CRP by 68%. Increased pCO2 was 47.4% and respiratory acidosis was 33% in arterial blood gas in AE. The serum concentration of IgG, IgG1 during and after of AE were lower than the control group. The serum concentration of IgA in COPD patients were higher than control group (p&lt;0.001). Conclusion: Severe clinical symptoms accounted for a high proportion in AE and life-threatening AE accounted for 43.3%. Leukocytosis, increased serum PCT and CRP levels were common in AE. Serum IgG concentrations during and after of AE were significantly lower than in the control group.

The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature

Background: Sarcoidosis is a heterogeneous multisystemic disorder of unknown etiology. Dyspnea and fatigue are two of the most common and debilitating symptoms experienced by subjects with sarcoidosis. There is limited evidence regarding the short- and long-term impact of pulmonary rehabilitation (PR) on exercise capacity and fatigue in these individuals. Objective: To evaluate the benefit of PR in subjects with pulmonary sarcoidosis at different severity stages and to review the current literature about PR in sarcoidosis. Methods: PR included a 12-week training program of a twice-weekly 90-min workouts. Fifty-two subjects with stable pulmonary sarcoidosis were recruited. Maximal exercise capacity, defined as VO₂max, was measured using the cardiopulmonary exercise test (CPET). Pulmonary function tests, 6-min walking distance (6MWD), St. George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) and Hospital Anxiety and Depression Scale (HADS) questionnaires were given before and after PR and following 6 months (follow-up). Results: The PR program significantly increased the VO₂max (1.8 ± 2.3 mL/kg/min, p = 0.002), following 12 weeks. mMRC and SGRQ scores were also improved (−0.3 ± 0.8, p = 0.03, and −3.87 ± 10.4, p = 0.03, respectively). The impact of PR on VO₂max was more pronounced in subjects with pulmonary parenchymal involvement. The increase in VO₂max correlated with initial disease severity (indicated by FEV1/FVC, p = 0.01). Subjects with FEV1/FVC <70% showed greater improvement in 6MWD. 6MWD also improved in those with a transfer coefficient of the lung for CO (KCO) above 80% predicted (p < 0.05). At 6-month follow-up, the VO₂max, 6MWD, and SGRQ scores remained stable, thus suggesting lasting effects of PR. Conclusion: PR is a promising complementary therapeutic intervention for subjects with sarcoidosis. Further study is needed to validate these findings.

Evaluation of the Application Effect of Online Mindfulness-Based Cognitive Therapy in the Health Management of Elderly Patients with COPD during the Novel Coronavirus Pneumonia Epidemic

"The aim of this paper is to evaluate the effectiveness of the application of online mindfulness-based cognitive therapy to elderly patients with chronic obstructive pulmonary disease during the lockdown period due to the COVID-19 epidemic. From January 23, 2020 to March 30, 2020, one hundred and thirteen elderly patients with stable COPD were selected as participants of the research, and a WeChat group was used for mindfulnessbased cognitive therapy. CAT and mMRC were used to compare the symptoms and health status of patients before and after the epidemic lockdown. After the epidemic lockdown, the cough symptoms, energy status, total score and mMRC score in the CAT questionnaire were lower than before the epidemic lockdown, and the difference was statistically significant (p&lt;0.05). During the epidemic lockdown, the use of WeChat groups to conduct mindfulness-based cognitive therapy for elderly patients with chronic obstructive pulmonary disease can help alleviate panic, improve patients' self-management behavior, and enhance the quality of life and health of patients."