mMRC Score Research Articles

Role of inhaled corticosteroids in the exacerbation rate of moderate chronic obstructive pulmonary disease.

Our results present a small contribution to the current scientific discussion about the use of ICS in COPD treatment. Further prospective studies are needed to confirm the impact of ICS on the frequency of COPD exacerbations.

Feasibility, acceptability and effectiveness of integrated care for COPD patients: a mixed methods evaluation of a pilot community-based programme.

The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland. The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care. A process and outcome evaluation of the pilot phase of the programme was conducted by means of qualitative and quantitative methods. Reach (coverage, participation rates), dosage (interventions carried out), fidelity (delivered as intended) and stakeholders' acceptance of the programme were evaluated through data monitoring and conduct of focus groups with patients and healthcare professionals. Effectiveness was assessed with pre-post analyses (before and after the intervention). The primary outcome measures were; (1) generic and disease-specific quality of life (36-Item Short Form Health Survey, Chronic Respiratory Questionnaire); and (2) hospitalisations (all-cause and for acute exacerbations) in the past 12 months. Secondary outcomes included self-efficacy, number of exacerbations and exercise capacity. Finally, controlled pre-post comparisons were also made with patients from the Swiss COPD Cohort for three common outcome measures (dyspnoea [mMRC score], number of exacerbations and smoking status). During the first 2 years of the programme, eight series of group-based education sessions were delivered to 57 patients with COPD in three different locations of the canton of Valais. Coverage objectives were achieved and attendance rate at the education sessions was high (83.6%). Patients' and healthcare professionals' reported a high degree of satisfaction, except for multidisciplinarity and transfer of information. Exploration of the effectiveness of this pilot programme suggested positive pre-post results at 12 months, with improvements in terms of health-related quality of life, self-efficacy, exercise capacity, immunisation coverage and Patient Assessment of Chronic Illness Care score. No other outcome, including the number of hospital admissions, differed significantly after 12 months. We observed no differences from the control group. The evaluation demonstrated the feasibility and acceptability of the programme and confirmed the relevance of mixed method process evaluation to adjust and improve programme implementation. The introduction of multidisciplinary teams in a context characterised by fragmentation of care was identified as the main challenge in the programme implementation and could not be achieved as expected. Despite this area for improvement, patients' feedback and early effectiveness results confirmed the benefits of COPD integrated care programmes emphasising self-management education.

Vitamin D deficiency during chronic obstructive pulmonary disease exacerbations

BackgroundVitamin D deficiency is widespread and associated with increased risk of chronic diseases. The relation between chronic obstructive pulmonary disease (COPD) and vitamin D is complex owing to comorbidities, which are affected by vitamin D. Patients with low vitamin D showed higher risk for exacerbations.AimThe aim was to study the status of vitamin D in patients during exacerbation of chronic obstructive pulmonary disease (AECOPD).Patients and methodsThe study included 205 patients presented with AECOPD and 150 controls. Patients and controls were subjected to full clinical history and examination, pulmonary function testing, and vitamin D [hydroxyvitamin D, 25(OH)D] examination by Liaison 25 OH Vitamin D assay (direct competitive chemiluminescence immunoassay, DiaSorin Inc, Stillwater, Minnesota, USA) in serum. Symptom scoring was done using modified Medical Research Council (mMRC) and combined assessment of Global Initiative for Chronic Obstructive Lung Disease COPD classification, with division into groups A, B, C, and D. Data related to severity of exacerbation, site of care, and hospital days were gathered.StatisticsPearson’s χ2-test was used to compare the prevalence of categorical variables between patients with COPD and control groups. t-Test was used to compare differences in the levels of continuous variables between the two groups. R2-test was used to measure how close the data are to be fitted in the regression line.Results25(OH)D was significantly lower in patients with AECOPD than control group (mean: 39.5±32.5 vs. 56.3±43.7 nmol/l, P? 0.05). Vitamin D insufficiency (25–75 nmol/l) was significantly higher in patients than controls [115 (56.09%) patients vs. 51 (34%) controls, P<0.05]. Dyspnea score (mMRC) was higher in deficiency group (70.1% having two or more mMRC score) compared in insufficiency and sufficiency groups (51.3 and 51.5%, respectively). Patients with mild and moderate COPD (forced expiratory volume in first second >50%) showed higher 25(OH)D (69.4±23.1) than patients with severe and very severe COPD (forced expiratory volume in first second <50%) (47.4±28.3), with P value less than 0.05. Patients required hospitalization showed lower levels of 25(OH)D compared with patients treated at home (23±14.9 and 52±22.1, respectively), with P value less than 0.05. Hospital days were higher in deficiency group (3.78±3.51 days) compared with insufficiency group (1.68±2.33 days) or sufficiency group (1.3±1.7 days), with P value less than 0.05.ConclusionVitamin D is low in patients with COPD during AECOPD. The relationship is linear with lung function, disease severity groups and with previous exacerbation rate. Severe exacerbations requiring hospital admission and lengthy hospital stay were demonstrated in patients with low vitamin D.

Prevalence and clinical characteristics of blood eosinophilia in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective: To investigate the prevalence and clinical characteristics of peripheral blood eosinophilia (EOS) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: From July 2014 to June 2016, AECOPD patients in the Department of Respiratory Medicine of Affiliated Hospital of Chengdu University, were retrospectively stratified into two groups according to two standards of eosinophilic exacerbations (the peripheral blood eosinophil count ≥2% or ≥3% on admission). Demography, clinical symptoms, laboratory results, length of stay, total hospitalization expenses, and defined daily expenses were compared between groups. Results: A total of 559 cases with AECOPD were finally recorded, the prevalence of eosinophilia was 43.1% (241 cases by EOS≥2%) and 27.2% (152 cases by EOS≥3%), respectively. According to either standard, there were no significant differences in sexes, age, course of disease (P>0.05), and there were no significant differences in global initiative for chronic obstructive lung disease (GOLD) grades, parameters of pulmonary function, modified british medical research council (mMRC) scores, rate of antibiotic use, systemic glucocorticoids administration, and average daily expenses (P>0.05). According to 2% standard, leucocytes, neutrophils, monocytes, hs-CRP were lower than non-eosinophilic patients [(5.9±2.0)×10(9)/L vs (8.2±4.0)×10(9)/L, (3.9±1.6)×10(9)/L vs (6.5±3.8)×10(9)/L, (0.446±0.169)×10(9)/L vs (0.501±0.276)×10(9)/L, (25.8±35.9) vs (46.2±55.6) mg/L, all P<0.01]; basophils, lymphocytes were higher than non-eosinophilic patients [(0.043±0.025)×10(9)/L vs (0.029±0.021) ×10(9)/L, (1.3±0.6) ×10(9)/L vs (1.1±0.6) ×10(9)/L, both P<0.01]; length of stay, total hospital expense were shorter (or lower) than non-eosinophilic patients [(10.6±5.0) vs (11.6±5.8) d, (11 851±7 491) vs (14 254±10 751) RMB, both P<0.05]. According to 3% standard, leucocytes, neutrophils, monocytes, hs-CRP were lower than non-eosinophilic patients (all P<0.05), and basophil were higher than non-eosinophilic patients (P<0.01), but no significant differences were observed in lymphocytes, length of stay and total hospital expense (all P>0.05). Conclusion: Eosinophilia is of relative high prevalence in AECOPD patients, and basophil in eosinophilic patients is higher than non-eosinophilic patients.

Outcome of pulmonary rehabilitation in patients with COPD: Comparison between patients receiving exercise training and those receiving exercise training and CPAP

BackgroundPulmonary rehabilitation (PR) using exercise training has been useful to increase the exercise capacity and life quality in patients with chronic obstructive pulmonary disease (COPD). However, airflow limitation which characterizes COPD usually worsens during exercise due to the lack of flow reserve and dyspnea hinders exercise maintenance. Non-invasive ventilation (NIV) has been a beneficial therapeutic tool for COPD patients to ameliorate their dyspnea and intensify their exercise. Thus, using NIV during exercise training program might have a synergistic effect in managing patients with COPD by increasing their physical activity, exercise intensity and capacity and their quality of life. ObjectiveTo study the effect of using NIV during PR by exercise training on dyspnea, exercise tolerance and quality of life as compared to effect of exercise alone in patients of COPD. Subjects and methodsThe present study was conducted on 24 stable male patients with COPD who were ex-smokers. Patients were divided into 2 groups; group 1 (Exercise gp) included 12 patients who had undergone exercise training only and group 2 (EX/CPAP gp) which included also 12 patients who had undergone exercise in addition to NIV using continuous positive airway pressure (CPAP). Baseline and after 1 month assessment of patients' pulmonary functions, arterial blood gases, dyspnea scale assessed with the Modified Medical Research Council (MRC), 6 minute walking test (6MWT), BODE index and COPD Assessment Test (CAT) score was done. ResultsGroup 2 (Ex/CPAP gp) showed a statistically significant improvement in 6MWD, BODE index, SaO2, PaCO2, Pimax, mMRC, and CAT score (p<.05). Group 1 (exercise group) showed a statistically significant improvement in 6MWD, Pimax, BODE index, mMRC and CAT score (p<.05). As regards comparison of group 1 to group 2, the % of improvement in 6MWD and BODE index was significantly more in group 2 than group 1 (p= .010 and <.001, respectively). No significant differences were found between both groups as regards blood gases, mMRC and CAT score. ConclusionAdding non-invasive ventilation to an exercise rehabilitation program in patients with stable COPD has shown to augment improvement in exercise performance.

MMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis.

This study was undertaken to investigate idiopathic pulmonary fibrosis (IPF) patients' health-related quality of life (HRQoL) and symptoms in a real-life cross-sectional study. Our secondary aim was to create a simple identification method for patients with increased need for palliative care by studying the relationship between modified Medical Research Council (mMRC) dyspnoea scale, HRQoL and symptoms.We sent a self-rating HRQoL questionnaire (RAND-36) and modified Edmonton Symptom Assessment Scale (ESAS) to 300 IPF patients; 84% of the patients responded to these questionnaires.The most prevalent (>80%) symptoms were tiredness, breathlessness, cough and pain in movement. An increasing mMRC score showed a linear relationship (p<0.001) to impaired HRQoL in all dimensions of RAND-36 and the severity of all symptoms in ESAS. Dimensions of RAND-36 fell below general population reference values in patients with mMRC score ≥2. The intensity of pain in movement (p<0.001) and at rest (p=0.041), and the prevalence of chest pain (p<0.001) had a positive linear relationship to increased mMRC score.An increasing mMRC score reflects impaired HRQoL and a high symptom burden. In clinical practice, the mMRC scale could be used for screening and identification of IPF patients with increased need for palliative care.

Positive end-expiratory pressure attenuates hemodynamic effects induced by an overload of inspiratory muscles in patients with COPD.

BackgroundInspiratory muscle training (IMT) using a Threshold® device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown.ObjectiveTo assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmH2O of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD.MethodsTwenty patients with COPD (forced expiratory volume in 1 second 53.19±24.71 pred%) and 15 age-matched healthy volunteers were evaluated using spirometry, MIP, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. The E- (fast-filling phase) and A- (atrial contraction phase) waves were evaluated at the tricuspid and mitral valves during inspiration and expiration in the following sequence: at basal conditions, using IMT, and using IMT + PEEP.ResultsPatients with COPD had reduced MIPs versus the control group. Ten patients had CAT scores <10 and 12 patients had mMRC scores <2. E-wave values at the mitral valve were significantly decreased with IMT during the inspiratory phase in both groups. These effects were normalized with IMT + PEEP. During the expiratory phase, use of IMT + PEEP normalized the reduction in E-wave values in the COPD group. During inspiration at the tricuspid valve, reduction in E-wave values during IMT was normalized by IMT + PEEP in COPD group. During the expiratory phase, the value of the E-waves was significantly reduced with overload of the inspiratory muscles in both groups, and these effects were normalized with IMT + PEEP. A-waves did not change under any conditions.ConclusionAcute hemodynamic effects induced by overloading of the inspiratory muscles were attenuated and/or reversed by the addition of PEEP in COPD patients.

Recent Inhaler Device Switch is Not Associated With Poor Inhaler Technique: Analysis of Inhaler Technique in the Adult Calgary COPD and Asthma Clinic

SESSION TITLE: Respiratory Care SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 08:45 AM - 10:00 AM PURPOSE: Inhaled medications are essential for the treatment of asthma and COPD. Poor inhaler technique is linked reduced asthma control, increased hospitalizations and exacerbation rates. Unfortunately, inhaler technique errors are common and rates of poor inhaler technique have not changed despite introduction of educational strategies. Previous research has identified risk factors associated with poor technique, such as, increased age, English as a second language (ESL), and multiple medical comorbidities. We hypothesized that with increasing types of devices available for use a recent device switch may be an emerging risk factor for persistently elevated inhaler error rates. METHODS: 95 adult newly referred patients to the COPD and Asthma Respiratory Education Program were assessed by a certified respiratory education. Baseline demographics and information on inhaler usage was obtained. Critical errors were defined a priori. A patient was categorized as having inadequate inhaler technique if a critical error was identified. RESULTS: The total rate of critical errors/inadequate inhaler technique amongst new referrals was 52.6% (95% CI 42.4%-62.9%). Lower MMRC score in patients with COPD (p=0.016) and ESL (p=0.031) were associated with inadequate inhaler technique. 39% of patients referred had a device switch in the last year. Patients with previously identified risk factors for poor inhaler technique such as increased age (p=0.064), vision impairment (0.027), no high school education (0.006), ESL (0.056), poor asthma control (0.041), and increased number of devices (0.005) were associated with a recent device switch. Overall, there was no evidence to suggest that recent device switch is associated with increased odds of inadequate technique (OR=0.92; 95% CI 0.37-2.28). Interestingly, patients with vision problems who had a recent device switch had lower odds of inadequate inhaler technique (OR = 0.06; 95% CI 0.001-0.74, p=0.007). CONCLUSIONS: This pilot study shows that rates of inhaler error remain unacceptably high. A recent device switch was associated with multiple previously identified risk factors for poor technique. However, a recent device switch itself does not seem to be a risk factor despite the fact that the patient is required to learn a new skill. In fact, in patients with specific risks (ex. visual impairment) a device switch may be protective. CLINICAL IMPLICATIONS: It is important to understand that inhaler error remains a critical issue in respiratory health. As there are increasing numbers of devices available patients are more likely to have a new inhaler device to learn. Further research to understand that role device selection to improve patient technique is needed. DISCLOSURE: The following authors have nothing to disclose: Julia Pritchard, Alex Scurfield, Brandie Walker No Product/Research Disclosure Information

Improvement of dyspnea after bariatric surgery is associated with increased Expiratory Reserve Volume: A prospective follow-up study of 45 patients

ObjectivesTo assess the effects of bariatric surgery in patients with obesity on dyspnea and to analyze the relationships between improvement of dyspnea after bariatric surgery and changes in pulmonary function, especially Expiratory Reserve Volume (ERV) which is the lung volume abnormality most frequently associated with obesity.MethodsForty-five patients (5 males/40 females, mean Body Mass Index = 46.2 ± 6.8 kg/m2) were evaluated before and 6 to 12 months after bariatric surgery. Dyspnea was assessed by the modified Medical Research Council (mMRC) scale. Pulmonary function tests, arterial blood gases and six-minute walk test were performed. Laboratory parameters including C-Reactive Protein (CRP) were analyzed.ResultsNinety percent of patients were dyspneic before surgery (mMRC scale ≥ 1) versus 59% after surgery (p<0.001). Mean mMRC score improved after bariatric surgery (1.5 ± 0.9 vs 0.7 ± 0.7, p<0.0001). Among patients with dyspnea before surgery (n = 38), a more marked increase in ERV after surgery was observed in patients with improvement of dyspnea compared to patients with no improvement of dyspnea (+0.17 ± 0.32 L vs +0.49 ± 0.35 L, p = 0.01). Multivariate analysis including age, variation of BMI, variation of CRP, variation of Total Lung Capacity and variation of ERV demonstraded that ERV was the only variable associated with improvement of the mMRc score after bariatric surgery (p = 0.04).ConclusionWeight loss associated with bariatric surgery improves dyspnea in daily living. This improvement could be partly related to increased ERV.

Imbalance of Endogenous Hydrogen Sulfide and Homocysteine in Chronic Obstructive Pulmonary Disease Combined with Cardiovascular Disease.

Background: Considerable studies showed associations between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), we evaluated the role of endogenous hydrogen sulfide (H2S)/homocysteine (Hcy) in patients with COPD combined with CVD.Methods: Fifty one stable patients with COPD were enrolled (25 COPD, 26 COPD + CVD). Lung function, sputum, peripheral blood samples, serum H2S, Hcy, high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) levels were measured. Dyspnea, symptoms and quality of life were quantified by modified Medical Research Council dyspnea scale (mMRC), COPD assessment test (CAT) and St. George’s Respiratory Questionnaire (SGRQ).Results: Compared with COPD group, waist circumference and body mass index (BMI) were higher in COPD + CVD group, mMRC, CAT and activity scores were also higher, high density lipoprotein cholesterol (HDL-C) was lower, total cells, neutrophils (%) in sputum and serum hs-CRP level were higher, whereas macrophages (% ) in sputum was lower. H2S and Hcy levels from COPD + CVD group were higher than those from COPD group, but H2S/Hcy ratio was lower. With increasing COPD severity, H2S level was decreased, however, Hcy level was increased. H2S level was positively correlated with FEV1/FVC, FEV1% predicted, lymphocytes (%) and macrophages (%) in sputum, but negatively correlated with smoking pack-years and neutrophils (%) in sputum. Hcy level was positively correlated with BMI and total cells in sputum. The ratio of H2S/Hcy was also positively correlated with FEV1/FVC, but negatively correlated with total cells in sputum.Conclusion: The imbalance of H2S/Hcy may be involved in the pathogenesis of COPD combined with CVD and provide novel targets for therapy.

Evaluation of symptoms and risks in stable chronic obstructive pulmonary disease patients with radiographic bronchiectasis

ObjectiveTo investigate the presence of previously undiagnosed radiographic bronchiectasis in stable chronic obstructive pulmonary disease (COPD) patients using high resolution computed tomography (HRCT) and to evaluate the effect of radiographic bronchiectasis on the symptoms and risks in stable COPD patients. MethodsFrom May 2012 to April 2014, there were 347 patients enrolled in COPD database. Data describing the general conditions, the frequency of acute exacerbations the year before, COPD assessment test, modified medical research council (mMRC) score, spirometric classification, and HRCT were collected. COPD patients were classified into two groups: COPD with bronchiectasis and COPD without bronchiectasis. The clinical characteristics of both groups were compared. ResultsBronchiectasis was presented in 18.4% (n = 64). The proportion of smokers, smoking index, and forced expiratory volume in 1 second predicted value were 62.5%, 27.3 ± 13.2, 48.2 ± 26.4, respectively, in the bronchiectasis group, which were lower than those of the group without bronchiectasis (82.0%, 32.6 ± 17.6, and 57.9 ± 18.8) (P < 0.05). Complications, COPD assessment test (CAT) and the rate of CAT≥10 in the bronchiectasis group were 2.8 ± 1.7,13.6 ± 7.4 and 26.6%, respectively, which were higher than those of the group without bronchiectasis (2.3 ± 1.5,11.3 ± 6.0, and 11.7%) (P < 0.05). The proportion of type D (high-risk more-symptoms) in the bronchiectasis group was 50.0%; it was significantly higher than that of 35.7% in the group without bronchiectasis (P < 0.05). ConclusionsCOPD with bronchiectasis is associated with more complications, symptoms, and risks. More attention should be paid to the treatment of COPD with bronchiectasis to reduce the frequency of exacerbation and improve the health status.

Our Experience on Silicone Y-Stent for Severe COPD Complicated With Expiratory Central Airway Collapse.

Expiratory central airway collapse (ECAC) is abnormal central airway narrowing during expiration. ECAC involves 2 different pathophysiological entities as tracheobronchomalacia and excessive dynamic airway collapse (EDAC). Although the exact cause is unknown, chronic obstructive pulmonary disease (COPD) is frequently accompanied by ECAC. Although there are various publications on the relationship between COPD and ECAC, there are very few data for stent placement in patients with tracheobronchomalacia accompanied severe COPD. We share our results for stenting in ECAC among patients with severe COPD. The data in this case series were collected retrospectively. The ECAC diagnosis was made during flexible bronchoscopy with severe COPD. Silicone Y-stents were placed via rigid bronchoscopy under general anesthesia. A total of 9 patients' (7 men) data were evaluated with an average age of 67±10.73 years. One patient experienced stent migration on the second day of stenting prompting stent removal. Another patient died 1 month after stenting. Consequently, we evaluated the follow-up data of remaining 7 patients. The changes in forced expiratory volume 1 was not significant for these 7 cases (P=0.51). The modified Medical Research Council (mMRC) score improvement was statistically significant (P=0.03). Functional status improvement was observed in 4 of 7 patients. Of the 7 patients, mean additional follow-up bronchoscopic interventions requirement was 2.2 times. Our study showed significant decrease in mMRC score with stenting for ECAC in severe COPD. For 2 patients, we experienced severe complications during short-term follow-up period after stenting. Additional follow-up bronchoscopic interventions were required.

What are the Prevalence of Abdominal Aortic Aneurysm in Patients with Chronic Obstructive Pulmonary Diseases and the Characteristics of These Patients?

To determine the prevalence of abdominal aortic aneurysm (AAA) in patients with chronic obstructive pulmonary disease (COPD) and to assess the characteristics of these patients. Stable COPD patients (age, >40 years) were included in the study between January 2014 and June 2014. Patients with acute exacerbations and a previous lung resection were excluded. Data regarding demographic characteristics were recorded. The modified Medical Research Council (mMRC) dyspnea scale was used to assess the severity of breathlessness. The COPD Assessment Test (CAT) was performed. Abdominal aortic diameter was measured using abdominal ultrasonography (AUS), and AAA was diagnosed as an aortic diameter of ≥30 mm at the renal artery level. In total, 82 patients were examined. AAA was detected in five (6.1%) patients. Diabetes mellitus, hypertension, and coronary artery disease were present in four patients with AAA. The average mMRC score was 3.2±0.4, and the mean CAT score was 18.4±6.0. Aneurysmal diameter was >50 mm in four patients and 37 mm in one patient. Statistically significant differences were found between patient with AAA and those without AAA with respect to the mean abdominal aortic diameters at the renal artery and iliac artery levels (p=0.012 and 0.002, respectively). Our findings suggest that AAA is associated with COPD, with a prevalence rate of 6.1%. AAA is usually asymptomatic until a clinical status of rupture, which is associated with a higher mortality risk. Early diagnosis of AAA is lifesaving. In COPD patients, AAA might be easily determined using AUS, which is a noninvasive and relatively cheap procedure.

Immediate salbutamol responsiveness does not predict long-term benefits of indacaterol in patients with chronic obstructive pulmonary disease

BackgroundThe purpose of this study was to evaluate the correlation between immediate responsiveness with the short-acting β2-agonist salbutamol and effects of treatment with the ultra-long-acting β2-agonist indacaterol in patients with chronic obstructive pulmonary disease (COPD).MethodsThe REVERBREZ study was a phase IV, multicentre, open-label study in which patients with moderate-to-severe COPD received indacaterol 150 μg once-daily for 5 months. The primary endpoint was the correlation between immediate response of forced expiratory volume in 1 s (FEV1) post-inhalation of salbutamol (400 μg) at study entry and the change from baseline in trough FEV1 after 1 month of indacaterol. Secondary endpoints included dyspnoea measured by the modified Medical Research Council (mMRC) grade and health-related quality of life measured by the clinical COPD questionnaire (CCQ).ResultsOf the 602 patients enrolled from 177 centres in France, 543 patients received at least one indacaterol dose, 512 patients completed 1 month of indacaterol treatment (primary endpoint), and 400 patients completed 5 months of treatment. At study entry, mean FEV1 values before and after salbutamol inhalation were 1.54 ± 0.50 L and 1.65 ± 0.53 L, respectively. Based on the magnitude of an immediate response of FEV1 after salbutamol inhalation at study entry, patients were classified into reversible (Rv, ≥12% and ≥200 mL from pre-salbutamol value; n = 106) and non-reversible (NRv, <12% or <200 mL from pre-salbutamol value; n = 431) groups. After 1 month of indacaterol treatment, mean absolute and relative difference in trough FEV1 were 100 mL and 9%, respectively. No significant correlation was found between the immediate FEV1 response to salbutamol at study entry and change from baseline in trough FEV1 after 1 month of indacaterol treatment (correlation coefficient = 0.056 [95% CI;−0.032, 0.144] for absolute response and 0.028 [95% CI;−0.06, 0.116] for relative response). At all subsequent visits, mMRC and CCQ scores, and FEV1 improved from baseline with no significant difference between the Rv and NRv groups.ConclusionsImmediate FEV1 response to salbutamol did not predict the long-term benefits observed with indacaterol treatment in patients with COPD. Patients considered reversible or non-reversible to salbutamol showed comparable improvements in lung function, dyspnoea and health-related quality of life.Trial registrationClinicalTrials.gov: NCT01272362. Date: January 5, 2011

Correlation of Self-Reported Breathlessness with Post Exercise Dyspnea in Obesity

Background: Dyspnea in obesity is common and dyspnea questionnaires are mostly validated for chronic respiratory diseases. The study aims to assess how modified Medical Research Council (mMRC) dyspnea scale correlates with post exercise dyspnea Borg scale in 6-minute walk test of the obese population. Methods: We performed a retrospective observational study on 342 obese patients with 6 MWT tests from February 2008 to November 2014 at a single tertiary hospital. Linear regression analysis was used to assess the relationship between mMRC and Borg dyspnea score. Fractional polynomial regression was used to analyze the relationship of mMRC and Borg scores with BMI. Results: MMRC dyspnea score was a strong predictor of post exercise dyspnea Borg score in the obese population in a univariate regression model (coefficient = 0.764, p ≤ 0.001). When adjusted to age, BMI, 6 MWT distance and PFT parameters in a multivariate regression model, the relationship remained statistically significant (coefficient = 0.587, p ≤ 0.001). The relationship was stronger in obese group with no airflow obstruction. Conclusion: In obese population, pre-exercise mMRC dyspnea score correlates significantly with post exercise dyspnea Borg score regardless of airflow obstruction. This is the first validity study regarding mMRC scale in assessing dyspnea in the obese population.

A Randomized Controlled Study of the Yi Qi Gu Biao Pill in the Treatment of Frequent Exacerbator Phenotype in Chronic Obstructive Pulmonary Disease (Lung and Spleen Qi Deficiency Syndrome).

Objective To evaluate the efficacy and safety of Yi Qi Gu Biao (YQGB) pill in treating frequent exacerbator phenotype in chronic obstructive pulmonary disease (lung and spleen qi deficiency syndrome) (FEPCOPD). Methods This prospective, randomized, double-blind, controlled study assessed 112 cases (64 included) of FEPCOPD treated at the outpatient department in our hospital in January–August 2016. The patients were randomly divided into YQGB and placebo (Pb) and treated for three months. Lung function, CAT, mMRC, and TCM symptom scores (TCMs) were observed. Results Compared with Pb, YQGB showed decreased wheezing symptom scores (WSs) and TCMs at one month and decreased CAT and TCMs at three months. From one to three months, CAT, cough, sputum, WSs, and TCMs in YQGB were lower than pretreatment values. But in Pb, CAT was lower than pretreatment values after one month; CAT, sputum, and TCMs were lower than pretreatment values after two months; CAT, cough, sputum, WSs, and TCMs were lower than pretreatment values after three months. Conclusion Yi Qi Gu Biao pill can improve wheezing, health status, and TCMs in FEPCOPD and also can shorten the durations of cough, sputum, and wheezing. This trial is registered in the Clinical Trials Registry of China: ChiCTR-IOR-15007542 (on 8 December 2015).

Characteristics of chronic obstructive pulmonary disease patients with depressive disorder

Introduction/Objective. The origin of depressive disorder in chronic obstructive pulmonary disease (COPD) patients is still not completely known and probably is caused by various factors. The aim of this study is to establish the most important characteristics of COPD patients who have depressive disorder. Methods. Eighty-nine COPD patients and 65 demographically-matched referents without COPD were included. All the patients underwent lung function examination, and gas exchange, nutritional status, dyspnoea level by the modified Medical Research Council (mMRC) scale and exercise tolerance were also assessed, as well as depressive disorder by Hospital Anxiety and Depression Scale (HADS) and Geriatrics Depression Scale (GDS) and quality of life by St. George?s Respiratory Questionnaire (SGRQ). Results. Depressive disorder has been found in 30.3% of COPD patients evaluated by HADS and 25.3% of COPD patients evaluated by GDS. When COPD subjects were stratified by forced expiratory volume in 1 second (FEV1) categorization, all subgroups were more likely to have depressive disorder, according to HADS and GDS, relative to referents with the odds ratio highest (3: 95% confidence interval 1.6?4.9) among those with the FEV1 &lt; 30%. COPD patients with depressive disorder (HADS) compared to non-depressed patients had (differences in mean values) higher intensity of smoking [6.9 (0.5?10.1)], lower body mass index [-4.9 (-7.2?5.4)], lower value of FEV1% [-8.3 (-16.3?1.2)] , higher value of total lung capacity (%) [17.8 (2.3?28.4)], higher mMRC score (1.07 (-1?3.0), and higher SGRQ ? giving a total score of 32.9 (24.1?40.3). Conclusion. Evaluation of depressive disorder should be considered in every patient with COPD, especially in patients with greater degree of airflow limitation and lung hyperinflation, dyspnoea level and malnourished.

An Assessment of Cognitive Dysfunction among COPD Patients

Introduction: The brain, in particular, may be vulnerable to the systemic effects of COPD. Cognitive dysfunction is associated with increased mortality and disability; however, it remains poorly understood in COPD. The hypoxemia seen in some patients with COPD seems to be a crucial factor for cognitive impairment, because it affects the oxygen dependent enzymes that are important in the synthesis of neurotransmitters such as acetylcholine. Methods and Material: 40 COPD patients were subjected to SMMSE questionnaire, and then statistical analysis were conducted between their FEV1 and SMMSE questionnaire score, and between MMRC dyspnea scale score and SMMSE score. Results: Mild cognitive impairment was found in COPD patients and there was significant positive correlation was found between SMMSE score with FEV1, and significant negative correlation between SMMSE score and MMRC score. Conclusion: Cognitive impairment was significantly correlated with severity of disease in COPD patients. For early identification of cognitive dysfunction of COPD patients by SMMSE will defiantly helpful to physician to assess the cognitive function.

Persistent disabling breathlessness in chronic obstructive pulmonary disease.

ObjectiveTo determine the prevalence, change in breathlessness status over time, and risk factors for disabling and persistent disabling breathlessness in relation to treatments in chronic obstructive pulmonary disease (COPD).Materials and methodsLongitudinal analysis of data from the Swedish National Register of COPD with breathlessness measured using modified Medical Research Council (mMRC) scores at two subsequent visits. Prevalence of disabling breathlessness (mMRC ≥2 at baseline) and persistent disabling breathlessness (disabling breathlessness at baseline and follow-up) was investigated in relation to COPD treatment. Risk factors for disabling breathlessness, change from non-disabling to disabling breathlessness, and persistent disabling breathlessness were analyzed using multiple logistic regression.ResultsA total of 1,689 patients were included in the study with a median follow-up of 12 months (interquartile range: 4 months). Prevalence of disabling breathlessness was 54% at baseline. Persistent disabling breathlessness was present in 43% of patients despite treatment and in 74% of patients despite combined inhaled triple therapy and physiotherapy. Risk factors for disabling breathlessness or change to disabling breathlessness were higher age, lower lung function, frequent exacerbations, obesity, heart failure, depression, and hypoxic respiratory failure (all P<0.05). Persistent disabling breathlessness was associated with lower lung function and ischemic heart disease (all P<0.05).ConclusionDisabling breathlessness is common in COPD despite treatment, which calls for improved symptomatic treatments and consideration of factors influencing disabling breathlessness. Factors influencing disabling breathlessness should be considered for COPD management.

Umbilical cord derived stem cell (ModulatistTM) transplantation for severe chronic obstructive pulmonary disease: a report of two cases

Chronic obstructive pulmonary disease (COPD) is a chronic disease affecting the airway of the respiratory system. COPD cases have rapidly increased in recent years, with the disease becoming the fourth leading cause of death worldwide. Stem cell transplantation is a new approach to treat COPD. In this study we report in two cases the use of transplanted stem cells to treat COPD. Umbilical cord derived stem cells (ModulatistTM) were used in the study. ModulatistTM was prepared according to previous published studies. Two patients with late stage COPD (stage IV) were transfused with Modulatist at a dose of 106 cells/kg. Patients were evaluated by the COPD assessment test (CAT) score as well as the Modified Medical Research Council Dyspnea Scale (mMRC) score, before and after transplantation (1, 3 and 5 months post transplantation). Results showed that ModulatistTM transplantation significantly improved sever COPD, especially after 3 months. At that time point, the two patients receiving ModulatistTM showed a significantly improvement, from late-stage of COPD (stage IV) to stage I. Although these initial results suggest that ModulatistTM transplantation is a promising therapy, more clinical studies in COPD patients are warranted to evaluate efficacy.