Modified Medical Research Council Dyspnea Research Articles

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

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

The Validity and Reliability of the Turkish version of Modified Medical Research Council Dyspnea Scale in Systemic Sclerosis Patients with Interstitial Lung Disease.

The aim was to investigate the validity and reliability of the Turkish version of the Modified Medical Research Council (mMRC) Dyspnea Scale in Systemic Sclerosis (SSc) patients with Interstitial Lung Disease. Thirty patients diagnosed with SSc according to the 2013 EULAR/ACR criteria were included. After recording the demographic data of the patients, dyspnea was evaluated with the Visual Analogue Scale (VAS), exercise capacity with the 6 Minute Walk Distance (6MWD), fatigue level with the Fatigue Severity Scale (FSS), disease activity with the Medsger Disease Severity Scale, skin involvement with the Modified Rodnan Skin Score, and dyspnea level with the mMRC Dyspnea Scale. The mMRC Dyspnea Scale was administered to the patients with SSc who did not receive any treatment for test-retest reliability at 1-week intervals. The observed scale range in mMRC (TR) was 0-4, and twelve out of the thirty patients (40%) were classified as having "moderate dyspnea." mMRC (TR) showed a significant moderate positive correlation with VAS dyspnea (rho: 0.718), a low negative correlation with 6MWD (rho: -0.445), and a low positive correlation with FSS (rho: 0.385). The weighted kappa statistic, used as an agreement scale for ordinal responses, was found to be 0.587 (indicating moderate agreement). The Turkish version of the mMRC Dyspnea Scale demonstrates validity and reliability in SSc patients with interstitial lung disease.

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

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

Comparison of exercise capacity and physical activity in patients with hyperthyroidism and controls

BackgroundHyperthyroidism impairs muscle mitochondrial metabolism and destroys many body systems. However, information is limited on how much physical and physiological outcomes are impaired in patients with newly diagnosed hyperthyroidism (NDH) and euthyroid. The comparison of pulmonary function, functional exercise capacity, respiratory muscle strength and endurance, physical activity levels (PAL), dyspnea, and quality of life (QoL) in patients and healthy controls was aimed. MethodSixteen patients with hyperthyroidism (evaluated twice at new diagnosis and euthyroid state) and healthy controls were compared. Pulmonary function was evaluated with a spirometer, functional exercise capacity with a 6-min walking test (6-MWT), respiratory muscle strength with a mouth pressure device and endurance with threshold loading test, PAL with metabolic holter, dyspnea with Modified Medical Research Council (MMRC) scale, and QoL with Quality of Life in Thyroid Patients Scale (ThyPRO). ResultsSix-MWT distance and respiratory muscle endurance significantly decreased, and MMRC dyspnea scale and ThyPRO scores were higher in patients with NDH and euthyroid compared to controls (p < 0.05). In addition, maximum inspiratory pressure and maximum expiratory pressure significantly decreased in patients with NDH compared to controls, and PAL was less active according to the number of steps in euthyroid patients (p < 0.05). The pulmonary function test was similar in both groups (p > 0.05). ConclusionExercise capacity, respiratory muscle strength and endurance, PAL, dyspnea, and QoL were affected in patients. Patients with hyperthyroidism should be evaluated at the onset of diagnosis, followed up, and referred to cardiopulmonary rehabilitation programs at the earliest. ClinicalTrials number: NCT04825964.

Validity and Responsiveness of the Manchester Fatigue Scale in Post-COVID

Objective: This study investigates the Manchester COPD Fatigue Scale's (MCFS) validity and responsiveness in individuals after hospitalization due to COVID-19.Methods: A longitudinal observational study included 53 adults diagnosed with COVID-19. Modified Medical Research Council dyspnea scale (mMRC), Six-Minute Step Test (6MST), Saint George's Respiratory Questionnaire (SGRQ), and Hospital Anxiety and Depression Scale (HADS) were assessed. The measurement properties tested were concurrent, convergent, discriminant validities, and responsiveness.Results: The MCFS showed concurrent, convergent, and discriminant validity, with moderate to strong significant correlations with fatigue (rs=0.57), symptoms (rs=-0.27), exercise performance (rs=0.39), depression (rs=0.67), and dyspnea (rs=0.44) measures. The instrument exhibited internal responsiveness with reduced fatigue scores three months after hospital discharge (median total score from 14.5 to 5.0,p&lt;0.001). External responsiveness was shown through associations between MCFS scores and dyspnea changes. Conclusion: The MCFS is a valid and responsive tool for physicians and researchers in effectively identifying, monitoring, and managing post-COVID-19 fatigue.

Rehabilitation and functional outcomes of COVID-19 patients in a rehabilitation hospital in Qatar.

Patients recovering from severe COVID-19 infections have experienced prolonged cognitive, physical, and psychological sequelae, including cardiorespiratory and motor deconditioning, neurological deterioration, anxiety, and depression. The impact of rehabilitation post-acute COVID-19 infection was recognized in the literature, but studies assessing and quantifying specific functional outcomes were lacking. This study aims to describe the characteristics and quantify the changes in functional outcomes of patients admitted to Qatar Rehabilitation Institute (QRI) for inpatient rehabilitation (IPR) post-COVID-19 infection during a 10-month period in 2021. This is a retrospective observational cohort study, which included individuals over 18 years of age with a documented COVID-19-positive diagnosis who were admitted to QRI for IPR due to COVID-19 complications. Data was collected by the investigators from January 1, 2021, until October 30, 2021. A total of 243 patients were included in this study. The changes in functional rehabilitation outcomes were assessed and quantified at both the patient's baseline (on admission to QRI) and after completion of IPR (on discharge). The duration of the IPR program varied based on each patient's baseline assessment. Patients were given a total of 8-12 weeks to achieve their rehabilitation goals and were discharged once those goals were met. Several validated tools were utilized in this study including Functional Independence Measure (FIM), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Modified Medical Research Council (mMRC) Dyspnea Scale, Mini-Mental State Examination (MMSE), and Right- and left-Hand Grip Strength. In addition, patients' diet, the need for respiratory support, and the presence of a tracheostomy tube before and after IPR were also recorded. In total, 84.4% of the included patients were males (n = 205); with a mean age of 52.44 ± 12.99 years. The most commonly reported comorbidities were type 2 diabetes (62.1%) and hypertension (49.8%) with 83.5% of patients experiencing critical illness neuromyopathy. The average patients' length of stay in QRI was 33.92 ± 27.72 days. A statistically significant improvement in all functional outcome scales was noted following the completion of the IPR program (p = 0.001). The number of patients requiring modification to their diet or feeding via nasogastric tube (NGT) significantly decreased by 35% and 93%, respectively (p = 0.001). Patients requiring respiratory support decreased by 98% (p = 0.001) and the need for a tracheostomy tube among patients was reduced by 95% (p = 0.001). IPR following COVID-19 infection was associated with significant functional, motor, and cardiorespiratory improvement. Dedicating clinics for post-COVID-19 rehabilitation would ensure improved patient outcomes and enhanced recovery.

The impact of the COVID-19 pandemic on university students

Introduction/Objective. Our study aims to investigate the effects of COVID-19 pandemic on dyspnea, exercise capacity and mood in university students. Method. A total of 120 university students were included in this prospective study. The students' scores of desire to exercise, hopelessness (Beck Hopelessness Scale), fatigue severity (Fatigue Severity Scale), shortness of breath (Modified Medical Research Council (mMRC) Dyspnea Scale), and pain (Visual Analogue Scale) before and after the onset of the SARS-CoV-2 pandemic were determined using scales, face-to-face and online surveys. The Shapiro-Wilk, Mann-Whitney U, Wilcoxon Signed Rank test and the chi-square tests were used. In the data analysis, a p-value of less than .05 was considered statistically significant. Results. A total of 120 subjects were included in the study, 95 of whom (79.2%) identified as female. The mean age of the participants was 22.8±5.3 (18-45) years. It was observed that the scores for hopelessness, shortness of breath, pain, and fatigue in the group with a history of SARS-CoV-2 infection increased significantly (p&lt;0.05) compared to the pre-pandemic period. Conversely, the desire to exercise exhibited a notable decline (p&lt;0.05). Conclusion. In university students, increased hopelessness, fatigue, shortness of breath and decreased desire to exercise after the COVID-19 pandemic may have developed secondary to post-COVID syndrome and immobility due to lockdown.

Pro-Resolving Inflammatory Effects of a Marine Oil Enriched in Specialized Pro-Resolving Mediators (SPMs) Supplement and Its Implication in Patients with Post-COVID Syndrome (PCS).

This study aimed to evaluate the eicosanoid and pro-resolutive parameters in patients with Post-COVID Syndrome (PCS) during a 12-week supplementation with a marine oil enriched in specialized pro-resolving mediators (SPMs). This study was conducted on 53 adult patients with PCS. The subjects included must have had a positive COVID-19 test (PCR, fast antigen test, or serologic test) and persistent symptoms related to COVID-19 at least 12 weeks before their enrolment in the study. The following parameters were evaluated: polyunsaturated fatty acids EPA, DHA, ARA, and DPA; specialized pro-resolving mediators (SPMs), 17-HDHA, 18-HEPE, 14-HDHA, resolvins, maresins, protectins, and lipoxins. The eicosanoids group included prostaglandins, thromboxanes, and leukotrienes. The development of the clinical symptoms of fatigue and dyspnea were evaluated using the Fatigue Severity Scale (FSS) and the Modified Medical Research Council (mMRC) Dyspnea Scale. Three groups with different intake amounts were evaluated (daily use of 500 mg, 1500 mg, and 3000 mg) and compared to a control group not using the product. In the serum from patients with PCS, an increase in 17-HDHA, 18-HEPE, and 14-HDHA could be observed, and a decrease in the ratio between the pro-inflammatory and pro-resolutive lipid mediators was detected; both differences were significant (p < 0.05). There were no differences found between the three treatment groups. Fatigue and dyspnea showed a trend of improvement after supplementation in all groups. A clear enrichment in the serum of the three monohydroxylated SPMs could be observed at a dosage of 500 mg per day. Similarly, a clear improvement in fatigue and dyspnea was observed with this dosage.

Characterizing pulmonary rehabilitation referrals from primary care

BackgroundSupporting referral to pulmonary rehabilitation (PR) from primary care for people with chronic lung disease could improve equity of access. Understanding who is referred to PR from primary care, and by whom, could inform development of strategies to increase awareness of and referral to PR for people with chronic respiratory disease. We aimed to quantify the proportion of patients referred to PR from primary care in an Australian metropolitan setting; and to identify characteristic features of patients and referrers. MethodsA retrospective, single-site, audit of referrals was undertaken. Corresponding patient medical records were reviewed for referral details, patient demographics and baseline PR assessment measures. ResultsBetween January 2020 and December 2023 658 referrals to PR were received of which 6.2 % (n = 41) originated from a primary care source (98 % general practice; 2 % allied health). People referred to PR from primary care were typically diagnosed with COPD (71 %), were female (59 %), had moderate disease severity (mean(SD) forced expiratory volume in 1 s 70(26) %predicted) and had mild symptoms (53 % modified Medical Research Council dyspnoea score 0 or 1) and modest functional impairment (6-min walk distance 410(121) meters). Just 4 of 36 primary care practitioners referred more than one patient. ConclusionIn this audit the proportion of people referred to PR from primary care was very low. Processes to support the referral of more patients from primary care to PR, across the spectrum of chronic respiratory disease, remain a priority for improving access to this well-established treatment.

Alternative Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Moving Cupping along Meridians.

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition characterized by persistent and progressive airflow obstruction, resulting in chronic respiratory symptoms like dyspnea, cough, and sputum production, accompanied by wheezing, chest tightness, fatigue, and reduced physical activity. Under the influence of various factors, patients with COPD often experience acute exacerbations, which have a significant negative impact on the prognosis, quality of life, and life span of patients. As a branch of cupping therapy, moving cupping along meridians is an essential complementary therapy of the traditional Chinese medicine system. Cupping plays a unique role in treating and preventing many diseases by stimulating the local skin with negative pressure. This article elaborately describes the procedure of moving cupping along meridians therapy in the treatment of AECOPD. The effectiveness and feasibility of moving cupping along meridians therapy in relieving symptoms and enhancing the quality of life is demonstrated by comparing the changes in the 36-item Short-Form (SF-36) health survey questionnaire, the modified Medical Research Council dyspnea scale (mMRC), and the COPD Assessment Test (CAT) score before and after the treatment. As a cost-effective complementary treatment, the protocol for the moving cupping along meridians treatment described in this article is expected to provide a reference for non-pharmacological treatment options for AECOPD.

Assessment of quality of life in IPF Patients: a multicenter observational study.

This study aimed to examine how dyspnea, cough, sleep disruption, anxiety, depression, and physiological factors affect the quality of life in newly diagnosed, untreated IPF patients. This study is a multicenter observational study. Patients not receiving antifibrotic treatment were included. To assess patients' quality of life, Leicester Cough Questionnaire (LCQ), St. George's Respiratory Questionnaire (SGRQ), Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Borg Dyspnea Index (BDI), Modified Medical Research Council Dyspnea Scale (MMRC) score, Composite Physiological Index (CPI), Gender Age and physiology (GAP) score, and Pittsburgh Sleep Quality Index (PSQI) were administered. Among 88 patients (mean age: 67.6±8.5 years), 81.9% were diagnosed with IPF through HRCT, 14.8% through surgery, and 3.4% via cryobiopsy. The average disease duration was 2.2±2.9 years. Over 50% experienced moderate to severe depression, and 40% had moderate to severe anxiety. In the IPF group, 13.6% had possible usual interstitial pneumonia (UIP), and 81.8% had definite UIP pattern. No significant differences were found between UIP groups in various scores. Anxiety and depression correlated negatively with respiratory function and positively with MMRC score and BDI. Sleep quality scores had similar correlations. Patients with good sleep quality had better respiratory parameters (p=0.013), lower MMRC (p=0.004), BDI (p=0.026), and CPI (p=0.047). -Conclusion: A notable number of IPF patients in follow-up show symptoms of anxiety and depression. Moreover, declining respiratory function not only diminishes sleep quality but also elevates dyspnea scores.

The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial.

Lung diseases have profound effects on the aging population. We aimed to hypothesize and investigate the effect of remote pulmonary telerehabilitation and motor imagery (MI) and action observation (AO) methods on the clinical status of elderly chronic obstructive pulmonary disease (COPD) patients. Twenty-six patients were randomly assigned to pulmonary telerehabilitation (PtR) or cognitive telerehabilitation (CtR) groups. The programs were carried out 3 days a week for 8 weeks. The 6-min walk test (6MWT), modified Medical Research Council dyspnea score, blood lactate level (BLL), measurement of peripheral muscle strength (PMS), and electromyography activation levels of accessory respiratory muscles were the main outcomes. There was a statistically significant improvement (p < 0.05) in both groups in the 6MWT distance and in secondary results, except for BLL. Generally, in the mean muscle activity obtained from the electromyography measurement after the program, there were statistically significant increases in the PtR group and decreases in the CtR group (p < 0.05). There was a statistically significant increase in PMS in both groups. An active muscle-strengthening program has the same benefits as applying the muscle-strengthening program to the patient as MI and AO. CtR can be a powerful alternative rehabilitation method in respiratory patients who cannot tolerate active exercise programs.

The Association of Serum Vitamin D Levels with Lung Function, Symptom Severity, and Exacerbations in Stable COPD Patients

Background: Chronic obstructive pulmonary disease (COPD) is a significant health burden associated with a decrease in quality of life. Patients with the disease often have a deficiency of Vitamin D, a fat-soluble vitamin important for respiratory health. A previous study suggested an association between low vitamin D levels and poor lung function, as well as increased exacerbation, and more severe COPD symptom. Therefore, this study aimed to assess serum vitamin D levels in stable COPD patients and explore association with lung function, symptom severity, and frequency of exacerbation. Methods: This was a cross-sectional study conducted from May to July 2023 at Lung Polyclinic of Dr. Zainoel Abidin Regional General Hospital (RSUDZA) Banda Aceh. A total of 30 subjects selected based on specific inclusion and exclusion criteria were included. Results: The results showed that the mean serum vitamin D level was 26.25 ng/mL, with 56.7% of subjects showing vitamin D insufficiency. Statistical analysis showed p-values of 0.58, 0.637, 0.12, and 0.98 for lung function, exacerbation, COPD Assessment Test (CAT), and Modified Medical Research Council (mMRC) dyspnoea scale respectively, indicating no significant association between vitamin D levels and these outcomes. Potential confounding factors include unassessed variables such as medication use, educational background, and psychological status. Conclusion: This study found no significant association between serum vitamin D levels and lung function, symptom severity, or frequency of exacerbation in stable COPD patients. Further studies with a larger sample size and extended follow-up are needed to confirm these results and explore additional influencing factors.

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

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

Psychometric properties of computerized adaptive testing for chronic obstructive pulmonary disease patient-reported outcome measurement

BackgroundComputerized adaptive testing (CAT) is an effective way to reduce time, repetitious redundancy, and respond burden, and has been used to measure outcomes in many diseases. This study aimed to develop and validate a comprehensive disease-specific CAT for chronic obstructive pulmonary disease (COPD) patient-reported outcome measurement.MethodsThe discrimination and difficulty of the items from the modified patient-reported outcome scale for COPD (mCOPD-PRO) were analyzed using item response theory. Then the initial item, item selection method, ability estimation method, and stopping criteria were further set based on Concerto platform to form the CAT. Finally, the reliability and validity were validated.ResultsThe item discrimination ranged from 1.05 to 2.71, and the item difficulty ranged from − 3.08 to 3.65. The measurement reliability of the CAT ranged from 0.910 to 0.922 using random method, while that ranged from 0.910 to 0.924 using maximum Fisher information (MFI) method. The content validity was good. The correlation coefficient between theta of the CAT and COPD assessment test and modified Medical Research Council dyspnea scale scores using random method was 0.628 and 0.540 (P < 0.001; P < 0.001) respectively, while that using MFI method was 0.347 and 0.328 (P = 0.007; P = 0.010) respectively. About 11 items (reducing by 59.3%) on average were tested using random method, while about seven items (reducing by 74.1%) on average using MFI method. The correlation coefficient between theta of the CAT and mCOPD-PRO total scores using random method was 0.919 (P < 0.001), while that using MFI method was 0.760 (P < 0.001).ConclusionsThe comprehensive disease-specific CAT for COPD patient-reported outcome measurement is well developed with good psychometric properties, which can provide an efficient, accurate, and user-friendly measurement for patient-reported outcome of COPD.

Comparison of functionality, physical activity, cardiac and respiratory parameters between patients with mood disorders and healthy controls

Background The cardiorespiratory effect in mental illnesses has recently received much attention. However, the cardiovascular and pulmonary effects of mood disorders have not been clearly demonstrated. Aims This study aims to compare individuals with mood disorders and healthy people in terms of exercise capacity, functionality, respiratory muscle strength, pulmonary function, dyspnoea and physical activity level. Method This cross-sectional study involved 30 patients with mood disorders and 35 age- and gender-matched healthy individuals. Exercise capacity (6-Minute Walk Test (6MWT), 3-Minute Step Test (3MST)), functionality (vertical jump test, functional reach test), respiratory parameters (respiratory muscle strength, pulmonary function test), dyspnoea (Modified Medical Research Council Dyspnoea Scale) and physical activity level (Short-Form International Physical Activity Questionnaire (IPAQ)) were evaluated. Results 6MWT results (P &lt; 0.001) and functional test scores (vertical jump test, P = 0.006; functional reach test, P &lt; 0.001) were significantly lower, and heart rate recovery after 3MST (P &lt; 0.001) was higher in mood disorder patients. Although patients' respiratory parameters were lower than healthy individuals, only measured and predicted respiratory muscle strength (P &lt; 0.001), peak expiratory flow rate litres (P &lt; 0.001), forced vital capacity predicted (P = 0.010) and forced expiratory volume in 1 s predicted (P = 0.002) values were statistically significantly different. Dyspnoea with activities was higher in patients (P &lt; 0.001). Patients spent more time sitting (IPAQ, P &lt; 0.001), but overall physical activity levels were similar between the two groups (P &gt; 0.05). Conclusions Patients with mood disorders had decreased exercise capacity and pulmonary function, lower functionality scores and respiratory muscle strength, and increased dyspnoea. Exercise-based rehabilitation protocols are recommended for the management of risk factors affecting the mood disorder patients' cardiorespiratory status.

Sleep Quality and Its Predictors among Dyspnea, Fatigue and Exercise Capacity in Pulmonary Arterial Hypertension.

Poor sleep quality is an overlooked symptom in patients with pulmonary arterial hypertension (PAH), however it may significantly contribute to disease burden. The aim of this study was to assess the sleep quality of patients with PAH and investigate its association with dyspnea, fatigue, and exercise capacity. Forty-five patients were included. Sleep quality of the patients was assessed by the Pittsburgh Sleep Quality Index (PSQI), dyspnea levels were assessed by the UCSD-Shortness of Breath Questionnaire (UCSD-SOBQ), Baseline Dyspnea Index (BDI), Modified Medical Research Council (MMRC) dyspnea scale and Modified Borg Dyspnea scale, fatigue levels were evaluated with the Fatigue Severity Scale and Borg Rating of Perceived Exertion, and functional exercise capacity was evaluated with the 6-minute walk test (6MWT). Among the patients with PAH, 64% had poor sleep quality (PSQI > 5). PSQI score was significantly correlated with MMRC scale (r = -0.561), UCSD-SOBQ (r = 0.497), BDI (r = -0.468), and 6MWT (r = -0.412) (p < 0.05). There was no significant relationship between sleep quality and fatigue. A regression model including MMRC and 6MWT could explain 32% of variance in PSQI (p < 0.05), and MMRC score was an independent predictor for PSQI (p < 0.05). In addition, MMRC score had a greater influence on PSQI than 6MWT (β = 0.548 vs. 0.019). Poor sleep quality is common in patients with PAH and is associated with poor exercise capacity and dyspnea. Patients with severe dyspnea are particularly at higher risk of poor sleep quality. Consideration of sleep-related complaints and underlying mechanisms when planning symptomatic treatments for these patients may help provide better management for PAH.

Exploring prevalence and risk factors association of osteoporosis among chronic obstructive pulmonary disease patients: a cross-sectional study in western Rajasthan

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition with progressive respiratory symptoms and systemic complications, including osteoporosis. It is characterized by decreased bone mass represents significant health risks among COPD patients. However, associated risk factors were partially understood requires further exploration. Methods: Study conducted at a tertiary care hospital in western Rajasthan, India, we aimed to assess the prevalence and risk factors association of osteoporosis among COPD patients. A cross-sectional study was conducted from January 2023 to December 2023, involving 102 COPD patients by Convenience sampling categorized according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA), and demographic and clinical data were collected. Results: Our findings revealed high prevalence of osteoporosis (48%) among COPD patients, showed significant associations with advancing age, female sex, underweight status, and more severe COPD stages. Female gender, older age, underweight status, higher Modified Medical Research Council (mMRC) dyspnea scores, and advanced GOLD stages were identified as significant risk factors for osteoporosis. Conclusions: These results underscore the importance of early screening and management of osteoporosis in COPD patients to mitigate its adverse effects on quality of life and morbidity. Implementing routine BMD measurements using DEXA in COPD management protocols can facilitate timely diagnosis and intervention, ultimately improving patient outcomes. Further research is warranted to elucidate the mechanistic links between COPD and osteoporosis and to explore targeted therapeutic strategies for mitigating bone loss and fracture risk in this vulnerable population.

Informing the management of the post-COVID condition: insights from the Western Australian experience comparing those who tested positive and negative to early COVID-19 strains.

ObjectiveThis study aimed to compare the relative physical recovery and symptoms after SARS-CoV-2 infection between groups confirmed positive or negative to early strains of COVID-19.MethodsA prospective, longitudinal cohort study compared outcomes of metropolitan adults polymerase chain reaction-tested for COVID-19 between March and November 2020 in Western Australia. Control matching was attempted: inpatients (gender, age) and ambulatory clinic (gender, age, asthma, chronic pulmonary disease). One-year follow-up involved three repeated measures: physical function (grip strength and 1-min sit-to-stand) and patient-reported outcomes (Fatigue Severity Scale, modified Medical Research Council dyspnoea scale and Euroqol-5D-5L).ResultsThree hundred and forty-four participants were recruited (154 COVID+, age 54±18years, 75 females [49%]); 190 COVID-, age 52±16years, 67 females [35%]) prior to national vaccination roll-out. No between-group differences in physical function measures were evident at any time point. Fatigue (OR 6.62, 95% CI 2.74-15.97) and dyspnoea (OR 2.21, 95% CI 1.14-4.30) were higher in the COVID+ group at second assessment (T2). On Euroqol-5D-5L, no between-group differences were evident in the physical function domains of self-care, mobility or usual activities at any time point. However, COVID+ participants were less likely to report an absence of anxiety or depression symptoms at T2 (OR 0.41, 95% CI 0.19-0.89).ConclusionsNeither statistical nor clinically meaningful differences in physical function were evident between COVID+ and COVID- participants to 12-months after acute illness. Symptoms of fatigue, dyspnoea, anxiety or depression were more prevalent in the COVID+ group til ~8months after illness with between-group differences no longer evident at 1 year.

Short-term intermittent hypoxia exposure for dyspnea and fatigue in post-acute sequelae of COVID-19: A randomized controlled study

BackgroundPost-acute sequelae of COVID-19 (PASC) is incurring a huge health and economic burden worldwide. There is currently no effective treatment or recommended drug for PASC. MethodsThis prospective randomized controlled study was conducted in a hospital in China. The effect of intermittent hypoxia exposure (IHE; 5-min hypoxia alternating with 5-min normal air, repeated five times) on dyspnea and fatigue was investigated in patients meeting the NICE definition of PASC. Patients were computationally randomized to receive normoxia exposure (NE) and routine therapy or IHE and routine therapy. Six-minute walk distance (6MWD) and spirometry were tested before and after the interventions; the Borg Dyspnea Scale (Borg) and the modified Medical Research Council Dyspnea Scale (mMRC) were used to assess dyspnea; and the Fatigue Assessment Scale (FAS) and the Chalder Fatigue Scale-11 (CFQ-11) were used to assess fatigue. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300070565). FindingsNinety-five participants (33 males and 62 females) were recruited between March 1, 2023 and December 30, 2023. Forty-seven patients in the IHE group received 10.0 (9.0, 15.0) days of IHE, and 48 patients in NE group received 10.0 (8.0, 12.0) days of NE. 6MWD, forced vital capacity (FVC), FVC %pred, forced expiratory volume in 1 s (FEV1), FEV1 %pred, tidal volume (VT), and dyspnea and fatigue scales markedly improved after IHE (p < 0.05), and improvements were greater than in the NE group (all p < 0.05). Furthermore, participants in IHE group had better subjective improvements in dyspnea and fatigue than those in the NE group (p < 0.05). Compared with <10 days of IHE, ≥10 days of IHE had a greater impact on 6MWD, FVC, FEV1, FEV1 %pred, VT, FAS, and CFQ-11. No severe adverse events were reported. InterpretationIHE improved spirometry and 6MWD and relieved dyspnea and fatigue in PASC patients. Larger prospective studies are now needed to verify these findings.