mMRC Score Research Articles

Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial

Introduction Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR. Objective This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence. Methods A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients’ quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes. Results A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George’s Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028). Conclusions PDA supported recurring SDM intervention was helpful in maintaining older COPD patients’ PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients’ rehabilitation adherence and quality of life. Trial Registration Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

Diaphragmatic ultrasonography in patients with IPF: Is diaphragmatic structure and mobility related to fibrosis severity and pulmonary functional changes?

There is evidence to suggest that dyspnea and impaired exercise capacity are associated with respiratory muscle dysfunction in idiopathic pulmonary fibrosis (IPF) patients. We aimed to evaluate the functions of the diaphragm with ultrasonography (US) and to determine the correlation of the data obtained with the pulmonary function parameters of the patients, exercise capacity, and the extent of fibrosis radiologically. Diaphragmatic mobility, thickness, and thickening fraction (TF) were measured by ultrasonography in IPF patients and the control group. The correlation between these measurements, pulmonary function tests (PFT), six-minute walking test (6MWT), mMRC score, and total fibrosis score (TFS) was evaluated. Forty-one IPF patients and twenty-one healthy volunteers were included in the study. No difference was found between the patient and control groups in diaphragmatic mobility during quiet breathing (QB) on ultrasound (2.35 cm and 2.56 cm; p= 0.29). Diaphragmatic mobility during deep breathing (DB) was found to be lower in the patient group when compared to the control group (5.02 cm and 7.66 cm; p<0.0001). Diaphragmatic thickness was found to be higher during QB and DB in IPF patients (0.33 cm and 0.31 cm, p= 0.043; 0.24 cm and 0.22 cm, p= 0.045). No difference was found between the two groups in terms of thickening fraction (39.37%, 44.16%; p= 0.49). No significant correlation was found between US measurements and PFT, 6MWT, mMRC score, and TFS in IPF patients (p> 0.05). The functions of the diaphragm do not appear to be affected in patients with mild-to-moderate restrictive IPF. This study showed that there was no relationship between diaphragmatic functions and respiratory function parameters and the extent of fibrosis. Further studies, including advanced stages of the disease, are needed to understand the changes in diaphragmatic functions in IPF and to determine whether this change is associated with respiratory function parameters and the extent of fibrosis.

Hand-Schüller-Christian syndrome combined with empty sella syndrome: A case report and literature review.

Hand-Schüller-Christian syndrome (HCS) is a rare disease with little clinical awareness, but the condition is more dangerous, and it combines with empty sella syndrome (ESS) which is extremely rare. A 26-year-old male patient who had proptosis, headaches, and diabetes insipidus for more than 10 years, and chronic cough and wheeze for 8 years presented to our hospital due to an abrupt onset of chest pain for 2 days. Hand-Schüller-Christian syndrome is diagnosed based on the typical clinical manifestations of diabetes insipidus and bilateral proptosis, magnetic resonance imaging (MRI) pituitary imaging and pathology. Empty sella syndrome is diagnosed based on hormonal indicators, clinical manifestations and MRI pituitary scan results. Type 1 respiratory failure and severe pneumonia can be diagnosed based on the results of clinical examination, chest imaging (including chest x-ray and computed tomography), pathology and blood gas analysis. Left pneumothorax can be diagnosed with chest imaging. "Meropenem and Cefdinir" were given for antimicrobrial coverage, "Desmopressin acetate" for anti-diuretic treatment, "Forcodine" for cough relief, "Ambroxol and acetylcysteine" for phlegm reduction, and continuous closed chest drainage was performed. The patient discharged after cough, wheezing, headache and other symptoms improved, and vital signs were stable. The patient has been followed up once a month for 17 months ongoing after discharge. At present, symptoms such as cough, sputum, and wheezing have improved considerably, and the mMRC score of dyspnea is 2 points. The reexamination of the chest X-ray shows that the absorption of lung exudates is better than before, and there is no recurrence of pneumothorax. Consider whether isolated diabetic insipidus is related to HSC, and if so, conduct an MRI, a biopsy, and other examinations as soon as possible.

A cross sectional pilot study to assess the role of phthalates on respiratory morbidity among patients with chronic obstructive pulmonary disease

BackgroundChronic Obstructive Pulmonary Disease (COPD) affects ∼16 million U.S. adults. Phthalates, synthetic chemicals in consumer products, may adversely impact pulmonary function and airway inflammation; however, their role on COPD morbidity remains unknown. ObjectiveWe examined associations between phthalate exposures and respiratory morbidity among 40 COPD patients who were former smokers. MethodsWe quantified 11 phthalate biomarkers in urine samples collected at baseline in a 9-month prospective cohort study in Baltimore, Maryland. COPD baseline morbidity measures included: health status and quality of life measures (CAT: COPD Assessment Test, CCQ: Clinical COPD Questionnaire, SGRQ: St. George's Respiratory Questionnaire; mMRC: Modified Medical Research Council Dyspnea Scale), and lung function. Information on prospective exacerbation data was monitored monthly during the 9-month longitudinal follow-up period. To examine associations between morbidity measures and phthalate exposures, we used multivariable linear and Poisson regression models for continuous and count outcomes, respectively, adjusting for age, sex, race/ethnicity, education, and smoking pack-years. ResultsHigher mono-n-butyl phthalate (MBP) concentrations were associated with increased CAT(β, 2.41; 95%CI, 0.31–4.51), mMRC (β, 0.33; 95%CI 0.11–0.55), and SGRQ (β, 7.43; 95%CI 2.70–12.2) scores at baseline. Monobenzyl phthalate (MBzP) was also positively associated with CCQ and SGRQ scores at baseline. Higher concentrations of the molar sum of Di (2-ethylhexyl) phthalate (DEHP) were associated with increased incidence of exacerbations during the follow-up period (incidence rate ratio, IRR = 1.73; 95%CI 1.11, 2.70 and IRR = 1.94; 95%CI 1.22, 3.07, for moderate and severe exacerbations, respectively). MEP concentrations were inversely associated with incidence of exacerbations during the follow-up period. ConclusionsWe found that exposure to select phthalates was associated with respiratory morbidity among COPD patients. Findings warrant further examination in larger studies given widespread phthalate exposures and potential implications for COPD patients should relationships observed be causal.

Abstract P544: Post-COVID-19: Predictors of Pulmonary Fibrosis

Introduction: From observational studies, it is known that some survivors of COVID-19 pneumonia have developed fibrotic pulmonary remodeling, restrictive lung abnormalities, associated with impaired exercise tolerance and poor quality of life at follow-up. Post-COVID-19 pulmonary fibrosis may be defined as the presence of persistent fibrotic changes identified on follow-up CT scans, such as traction bronchiectasis. It is important to identify the potential risk factors for the occurrence of pulmonary fibrosis in this context, although they have not yet been completely defined. Hypothesis: We hypothesize that lung fibrosis may be also a possible long-term consequence of COVID-19 pneumonia and the risk factors associated with the acute phase that enhance the risk of pulmonary sequelae, such as duration of hospitalization and intensive care stay, of high-flow oxygen support, and need for mechanical ventilation. Methods: We undertook a cohort study of COVID-19 survivors, that required supplemental oxygenation during the acute phase, who had been discharged from hospitals April 2020 to March 2022 in public hospitals of Curitiba/PR (BRAZIL). At 1-month and 6-month follow-up visit, survivors were interviewed with questionnaires symptoms, received a physical examination, sit-to-stand test, laboratory test ant chest CT scan was performed between two visits. The primary outcomes were persistent fibrotic changes, such as traction bronchiectasis, on follow-up chest CT. Multivariable adjusted logistic regression models were used to evaluate the risk factors of CT scan outcomes. Results: We followed 63 COVID-19 survivors with CT scan follow-up. The median age of patients was 52 years (±13.3) and 37 (58.7%) were women. The median CT scan follow-up time was 151 days (38-428). The median hospitalization time during acute phase was 13 (3-48) days. The proportion of patients with persistent dyspnoea, characterized by mMRC score of 1 or more, was 52 (82,5%). The proportion of patients with at least one fibrotic change on CT scan was 35 (55.6%), traction bronchiectasis was identified on 16 (25.4%). Hospitalization time during acute phase was associated with traction bronchiectasis, main persistent fibrotic change on CT scan (OR, 1.19; 95% CI:1.036, 1.207; p=0,004). Conclusion: In a follow-up, the duration of hospitalization COVID-19 acute phase was associated with higher odds of traction bronchiectasis on chest CT follow-up.

Twelve-month follow-up after hospitalization for SARS-COV-2: Physiology improves, symptoms remain

ObjectivesPersistent symptoms on short-term follow-up after infection with COVID-19 are common, but long-term consequences have been insufficiently studied. The aim of this study was to characterize pulmonary function and ongoing symptoms 12 months after hospitalization with COVID-19. MethodsThis prospective multicenter study included 222 patients hospitalized with PCR-confirmed COVID-19 in the Central Denmark Region. Disease severity was stratified using WHO Clinical Progression Scale. Clinical characteristics, pulmonary function test (PFT), 6-minute walk test (6MWT), and patient-reported outcome measures were collected at follow-up 3 and 12 months after discharge. Outcome measures from follow-up 3 months after discharge have previously been published. ResultsA total of 179 (81%) patients completed the 12-month follow-up. Median age was 60 years (IQR 51, 69) and 58% were male patients. At 12-month follow-up 49.7% had a normal diffusion capacity for carbon monoxide (DLCO), while 39.4% had DLCO < 80%. The 6MWT distance increased significantly (29 m 95% CI 19, 40; p < 0.01). An mMRC score of 0 was reported by 51% and an mMRC ≥ 2 by 20%. The frequency and severity of fatigue, depression, and anxiety did not improve over time. ConclusionsThe study found that impaired DLCO percentage is common 12 months after hospitalization with SARS-CoV-2 and reduction in DLCO percentage is associated to dyspnea.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Efficacy and safety of bovhyaluronidase azoximer (Longidase) in patients with post-COVID syndrome: results of an open, prospective, controlled, comparative, multicenter clinical trial DISSOLVE

Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase®) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome.The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome.Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded.Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.

Associations of medication regimen complexity with medication adherence and clinical outcomes in patients with chronic obstructive pulmonary disease: a prospective study.

High medication burdens are common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore the associations of medication regimen complexity index (MRCI) with medication adherence and clinical outcomes among patients with acute exacerbations of COPD (AECOPD) after hospital discharge. Data were obtained from a nationwide cohort study of inpatients with AECOPD in China. MRCI scores were calculated using the medication list 30 days after discharge and separated into COPD-specific and non-COPD MRCI scores. Medication adherence was measured by the withdrawal rate of COPD or inhaled long-acting bronchodilators 6 months after discharge. Clinical outcomes included re-exacerbations and COPD-related readmissions during the 30-day to 6-month follow-up period. The associations of MRCI with medication withdrawal and clinical outcomes were evaluated using univariate and multivariate logistic regressions. Potential covariates included sociodemographic factors, year of COPD diagnosis, post-bronchodilator percentage predicted forced expiratory volume in 1 s, mMRC score, CAT score, and comorbidities. Among the 2853 patients included, the median total MRCI score was 7 [interquartile range (IQR), 7-13]. A high MRCI score (>7) was presented in 1316 patients (46.1%). Of the MRCI score, 91% were COPD specific. The withdrawal rates of the COPD and inhaled long-acting bronchodilators were 24.2% and 24.4%, respectively. Re-exacerbation and COPD-related readmission rates were 10.2% and 7.5%, respectively. After adjusting for covariates, patients with high total MRCI scores were less likely to discontinue COPD drugs [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.52-0.74] and inhaled long-acting bronchodilators (OR, 0.68; 95%CI, 0.57-0.81); conversely, these patients were more likely to experience re-exacerbation (OR, 1.64; 95% CI, 1.27-2.11) and readmission (OR, 1.57; 95% CI, 1.17-2.10). MRCI scores were relatively low among post-hospitalized patients with AECOPD in China. Higher MRCI scores were positively associated with adherence to COPD or inhaled medications, and risk of re-exacerbation and readmission. ClinicalTrials.gov identifier: NCT02657525.

Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema.

In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema. The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient's records, including the modified Medical Research Council (MRC) dyspnea score, the St. George's Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated. Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month's mMRC score was 2.62 (p=0.007), and the mean of the 12th month's mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients' preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients' preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756). It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ И ОЦЕНКА ПРОВОДИМОЙ ТЕРАПИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ НА ТРЕТЬЕМ УРОВНЕ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ В РЕСПУБЛИКЕ ТАТАРСТАН

Objective: to identify clinical data and treatment methods for COPD patients on the third level of medical care, and assess their correlations with exacerbations, the fatigue syndrome, and patient adherence to treatment. Materials and methods. We examined 330 patients with diagnosed COPD. We collected case records, assessed drugs and routes of administration, established results of clinical and laboratory studies, smoking status, and compliance. Results. GOLD-III and type D spirometry disorders prevailed. Frequent exacerbations were typical for patients with high mMRC and CAT scores and low FEV1 values. The proportion of adherent patients was 29.4%. Patients with frequent exacerbations, decreased FEV1, and pronounced symptoms were more adherent to treatment. COPD patients received short-acting bronchodilators (85.5%), ICS/LABA (54.5%), and dual long-acting bronchodilators (18.8%). The fatigue syndrome was established using the FAS questionnaire in 61.9% of patients. Patients with significant levels of fatigue were predominantly of the older age, often with FEV1 of 50% or less of the due value, more pronounced clinical symptoms by the CAT and mMRC scale, two or more exacerbation episodes, and concomitant diseases. Conclusion. COPD patients treated on the third level had lower adherence to treatment, poor skills in inhalation technique and control, and they excessively used short-acting bronchodilators. The present study confirmed the expediency of simultaneous use of two classifications of COPD and the necessity to assess fatigue levels during management of COPD patients.

Impact of Previous Pulmonary Tuberculosis on Chronic Obstructive Pulmonary Disease: Baseline Results from a Prospective Cohort Study.

Pulmonary tuberculosis (PTB) is a significant risk factor for COPD, and Xinjiang, China, has a high incidence of pulmonary tuberculosis. The effects of tuberculosis history on airflow restriction, clinical symptoms, and acute episodes in COPD patients have not been reported in the local population. Besides, the exact relationship between lung function changes in people with a history of tuberculosis and COPD risk is not clear. This study is based on the Xinjiang baseline survey data included in the Natural Population Cohort Study in Northwest China from June to December, 2018. Subjects' questionnaires, physical examination, and lung function tests were performed through a face-to-face field survey to analyze the impact of previous pulmonary tuberculosis on local COPD. Furthermore, we clarified the specific relationship between pulmonary function decline and the probability of developing COPD in people with a history of tuberculosis. A total of 3249 subjects were eventually enrolled in this study, including 87 with a history of tuberculosis and 3162 non-TB. The prevalence of COPD in the prior TB group was significantly higher than that in the control group (p-value = 0.005). First, previous pulmonary tuberculosis is an essential contributor to airflow limitation in the general population and patients with COPD. In all subjects included, pulmonary function, FEV1% predicted (p-value < 0.001), and FEV1/FVC (%) (p-value < 0.001) were significantly lower in the prior TB group than in the control group. Compared to non-TB group, FEV1% prediction (p-value = 0.019) and FEV1/FVC (%) (p-value = 0.016) were found to be significantly reduced, and airflow restriction (p-value = 0.004) was more severe in prior TB group among COPD patients. Second, COPD patients in the prior TB group had more severe clinical symptoms. Compared with no history of tuberculosis, mMRC (p-value = 0.001) and CAT (p-value = 0.002) scores were higher in the group with a history of tuberculosis among COPD patients. Third, compared with the non-TB group, the number of acute exacerbations per year (p-values=0.008), the duration of each acute exacerbation (p-values=0.004), and hospitalization/ patient/year (p-values<0.001) were higher in the group with a history of tuberculosis among COPD patients. Finally, a dose-response relationship between FEV1/FVC (%) and the probability of developing COPD in people with previous pulmonary TB was observed; when FEV1/FVC (%) was < 80.8, the risk of COPD increased by 13.5% per unit decrease in lung function [0.865(0.805, 0.930)]. COPD patients with previous pulmonary tuberculosis have more severe airflow limitations and clinical symptoms and are at higher risk for acute exacerbations. Furthermore, lung function changes in people with a history of tuberculosis were associated with a dose-response relationship with the probability of developing COPD.

Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study

We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

Dyspnea assessment in myotonic dystrophy type 1

In myotonic mystrophy type 1 (DM1), combining respiratory symptom screening and respiratory function testing, is crucial to identify the appropriate time for ventilatory support initiation. Dyspnea has been little investigated in DM1. To provide a multidimensional description of dyspnea, questionnaires assessing dyspnea were administered to 34 consecutive adult patients with DM1 (median (25th-75th centile) age of 36 (28–49), Vital Capacity (VC) of 74 (64–87)% of predicted value). Dyspnea scores were low whatever the questionnaire used: Multidimensional Dyspnea Profile score of 2(0–4.7)/50 for dyspnea sensory descriptor and of 0 (0–4.7)/60 for the emotional descriptor, Visual Analogue Scale score of 0 (0–0)/10 in sitting and supine position and Borg score after six-minute walk test (6MWT) of 2.2 (1.8–4.2)/10. Eleven patients (32%) reported disabling dyspnea in daily living (modified Medical Research Council (mMRC) score ≥ 2). In comparison with patients with mMRC score < 2, patients with mMRC score ≥ 2 had a more severe motor handicap (Muscular Impairment Rating score of 4.0 (4.0–4.0) vs 3.0 (2.0–3.5), p<0.01), a lower 6MWT distance (373 (260–424) vs 436 (346–499)m, p = 0.03) and a lower VC (64 (48–74)% vs 75 (69–89)%, p = 0.02). These data suggest that the mMRC scale might be an easy-to-use and useful tool to assess dyspnea in daily living in DM1 patients. However, the interest of integrating the mMRC dyspnea scale in clinical practice to guide therapeutic management of DM1 patients remains to be assessed in further studies.

Blood monocyte levels predict the risk of acute exacerbations of chronic obstructive pulmonary disease: a retrospective case–control study

Monocytes were critical cells in the innate immune system. Monocyte recruitment to the lungs is a crucial process of pathophysiology in chronic obstructive pulmonary disease (COPD). Current evidence on the association between the occurrence of acute exacerbations of COPD (AECOPD) and monocytes was unclear. This study aimed to examine whether blood monocytes are associated with the occurrence of AECOPD and to determine the specific blood monocyte level to predict AECOPD. A retrospective case–control study was conducted at Changhua Christian Hospital. A total of 444 eligible patients with COPD were included between January 2017 and December 2019. Restricted cubic splines were used to analyze the nonlinear relationships between continuous white blood cell values and the occurrence of AECOPD. The association between monocytes and the occurrence of AECOPD was assessed using the logistic, lasso, and ridge regression models. Restricted cubic splines revealed nonlinear associations among the monocyte level, the continuous value of the eosinophil-to-lymphocyte ratio, and the occurrence of AECOPD. The lowest risk of occurrence of AECOPD ranged from 7.4 to 10%; < 7.4% with an absolute count < 0.62 or > 10% indicated significant risk. No significant association was noted between the eosinophil-to-lymphocyte ratio categories in the tertiles (< 0.049, 0.049 to < 0.122, and ≥ 0.122) and the risk of AECOPD. A significantly higher risk was noted in the association of the occurrence of AECOPD with the CAT score; mMRC score; wheezing cough; preexisting chronic pulmonary disease; hypertension and malignancy; use of dual- and triple, and oral long-acting bronchodilators for COPD treatment; and WBC count. We reported a nonlinear relationship between monocytes and the occurrence of AECOPD. Patients with monocyte percentage of > 10% or < 7.4% with an absolute count < 0.62 had higher risk of occurrence of AECOPD. Overall, our study demonstrated the specific value of monocytes in identifying high risks of the occurrence of AECOPD; this value is an easy-to-obtain, inexpensive biomarker in patients with AECOPD and should be further investigated in future prospective clinical studies.

Therapeutic Effects of Respiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease

<h3>Research Objectives</h3> To investigate the improvement of cognition, lung function, clinical scores, and diaphragmatic muscle performance after respiratory muscle training in populations of chronic obstructive pulmonary disease (COPD) comorbid with mild cognitive impairment. <h3>Design</h3> This is a prospective randomized study with eight weeks of intervention. <h3>Setting</h3> Participants were recruited from a tertiary referral center, and they were instructed to perform training at home with telephonic supervision every week. <h3>Participants</h3> The inclusion criteria included: (1) a diagnosis of COPD, and (2) an mini mental state examination (MMSE) score between 23 and 27. The exclusion criteria were: (1) being unable to follow respiratory muscle training instructions or complete the questionnaires of our study due to cognitive impairment; (2) difficulty in completing cardiopulmonary exercise testing (CPET) due to high-risk cardiopulmonary diseases or orthopedic conditions; (3) a body mass index (BMI) of ≥30. Finally, 28 patients received both inspiratory and expiratory muscle training and 20 patients received inspiratory muscle training only. <h3>Interventions</h3> Participants were randomized into the full training (inspiratory plus expiratory muscle training) or the simple training group (inspiratory muscle training only) for a total of eight weeks. <h3>Main Outcome Measures</h3> Diaphragmatic thickness fraction and excursion examined through ultrasound; scores of MMSE, the COPD assessment test (CAT) and modified Medical Research Council (mMRC) scale; percentage of predicted FVC, FEV1, FEV1/FVC, DLCO, and DLCO/VA examined by pulmonary function test; dead space fraction (Vd/Vt) and minute ventilation to CO2 output (VE/VCO2) slope examined by CPET; and distance walked and changes in oxygen saturation and perceived exertion during six-minute walking test. <h3>Results</h3> Respiratory muscle training significantly improved the diaphragmatic thickness fraction and excursion, lung functions, MMSE, CAT and mMRC scores. The difference between the full training and simple training group was not significant. Patients with FEV1>30% had more improvement in diaphragmatic thickness than those with FEV1< 30%. <h3>Conclusions</h3> Expiratory muscle training could provide no further benefit to inspiratory muscle training. Additional study recruiting more patients with FEV< 30% could better validate our study results in clinical settings. <h3>Author(s) Disclosures</h3> Nothing to be disclosed.

Pre-operative Physical Performance Is Associated With Early Return to Work in Peri-operative Lung Cancer Patients.

Little is known about the factors related to return to work (RTW) in patients with peri-operative lung cancer (LC). This study aimed to investigate whether pre-operative physical performance is associated with early RTW in patients with peri-operative LC. A total of 59 patients who wished to resume work after lung resection surgery were included and were divided into three groups: early RTW (within 14 days after discharge), delayed RTW (within 15-90 days), and non-RTW (failure of RTW within 90 days). The early RTW group had significantly lower scores on the modified Medical Research Council dyspnea scale (mMRC) and significantly higher scores on the Euro Quality of Life 5-Dimension 3-Level (EQ-5D-3L) than the non-RTW group. Multivariate logistic regression analysis showed that EQ-5D-3L scores were significantly associated with early RTW, and mMRC scores and knee extensor strength tended to be associated with early RTW. Better pre-operative quality of life, mild dyspnea, and greater lower limb muscle strength tended to be associated with early RTW in patients with peri-operative LC.

Health-related quality of life in a multiracial Asian interstitial lung disease cohort.

Understanding health-related quality of life (HRQL) in patients with interstitial lung disease (ILD) provides insight into disease burden and treatment effects on patients' well-being. We examined HRQL in a multiracial Asian ILD cohort using the King's brief ILD (K-BILD) and EuroQol 5-dimension-3-level (EQ5D-3L) questionnaires and their associations with several clinical variables. This was a single-centre cross-sectional study of ILD patients in a university-affiliated tertiary public hospital in Singapore. All patients completed two self-administered HRQL questionnaires upon study entry, and their clinical information was retrieved from electronic medical records. Ninety-nine patients (56% male, 75% Chinese) were included. The median (interquartile range) age was 63 (54-72) years. The most common ILD diagnosis was connective tissue disease-related ILD (n=51, 52%), followed by idiopathic pulmonary fibrosis (n=27, 27%). The mean (standard deviation) scores for the EQ5D-3L utility value, EQ5D Visual Analogue Scale (VAS) and K-BILD total were 0.806 (0.284), 75.1 (12.8) and 63.9 (14.3), respectively. A moderate correlation was found between the EQ5D-3L and K-BILD total and domain scores. The HRQL scores also correlate moderately with the modified Medical Research Council dyspnoea scale (mMRC) scores. There was a weak-to-moderate correlation between HRQL and forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO) and Charlson comorbidity index. Multiple linear regression showed a significant association of K-BILD total [beta coefficient 0.244, 95% confidence interval (CI): 0.075-0.414; P=0.005], K-BILD 'breathlessness and activities' (beta coefficient 0.448, 95% CI: 0.192-0.703; P=0.001), and the 'psychological' domain (beta coefficient 0.256, 95% CI: 0.024-0.488; P=0.031) with DLCO %pred after adjustment for age, sex, BMI, race, smoking history, comorbidities, FVC %pred and ILD diagnosis. Non-Chinese race was a predictor of better K-BILD 'psychological' domain (beta coefficient 8.680, 95% CI: 0.656-16.704; P=0.034) after adjustment. HRQL is significantly impaired in ILD patients, and low DLCO is a strong predictor of this impairment.

Prevalence and early outcome of bronchiectasis as an atypical presentation in COVID-19 patients

IntroductionBronchiectasis was considered as an uncommon radiological feature of corona virus disease 2019 (COVID-19) infection. The clinical course and outcome of COVID-19 bronchiectasis overlap is still a point for research. The aim of this study was to evaluate the prevalence, course, and outcome of bronchiectasis as an atypical presentation of COVID-19 infection.MethodsA cross-sectional study has been conducted from July 2021 to February 2022 and included 425 COVID-19 swab-positive patients who were examined by high resolution computed tomography of the chest during acute phase (4 weeks) of the infection.ResultsFourteen (3.3%) patients newly developed bronchiectasis-de novo. Patients with de novo bronchiectasis had significantly higher cough score, frequency of colored sputum and mMRC score, respiratory distress (p < 0.001) and respiratory failure (p = 0.02) than patients with no bronchiectasis. They also had the higher frequency of ICU’s admission (p = 0.02), need to non-invasive (p = 0.01), and invasive mechanical ventilation (p = < 0.001), duration of mechanical ventilation, ICU’s stay and overall hospital stay (p < 0.001). As for the outcome, death rate was also statistically significantly higher among those with De novo bronchiectasis than those without bronchiectasis (p = 0.04).ConclusionBronchiectasis is an uncommon presentation among COVID-19 patients. However, bronchiectasis increases disease burden in COVID-19 patients. It may have a negative impact on the outcome.Trial registrationClinicalTrials.gov. NCT04910113. Registered June 2, 2021.

Effect of Liuzijue on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: study protocol for a multicenter, non-randomized, prospective study

BackgroundTraditional Chinese exercise as a new pulmonary rehabilitation technique has been increasingly used and achieved good results in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD). The aim of this study is to investigate the protective effects of Liuzijue on exercise tolerance, lung function, and quality of life in patients with COPD.MethodsThis study is a multicenter, non-randomized, prospective study. Patients will be divided into a control group (CG) and a Liuzijue group (LG) based on their willingness to learn Liuzijue. None of the outcome assessors will know the grouping of patients. Participants in this study will be collected from stable COPD patients who are outpatients or inpatients in 3 centers in China since September 2021. Patients will meet the diagnostic criteria for GOLD stage I-II COPD (FEV1% ≥ 0.5 and FEV1/FVC < 0.7) and be aged 40 years or older. Patients voluntarily will take part in the clinical study and sign an informed consent form. All participants will follow their existing medication. For LG patients, Liuzijue training has been added. Patients will practice Liuzijue for more than 30 minutes a day, more than 5 days a week, and adhere to the training for 3 months. Outcome indicators are 6-minute walk test (6MWT), lung function (FEV1%, FEV1/FVC, MMEF, PEF), modified British Medical Research Council (mMRC) score, COPD assessment test score (CAT), acute exacerbations and changes in drug treatment.DiscussionThis study quantified the effect of Liuzijue on the pulmonary rehabilitation of COPD patients in the stable phase of the disease, and provided a basis for the use of Liuzijue in COPD patients.Trial registrationChinese clinical trial registry, ChiCTR2100048945. Date: 2021-07-19. http://www.chictr.org.cn/showproj.aspx?proj=129094