Modified Medical Research Council Questionnaire Research Articles

Vaccination as a tool for influencing the course of chronic obstructive pulmonary disease in patients with diabetes mellitus

Introduction. Repeated exacerbations play a leading role in the progression of chronic obstructive pulmonary disease (COPD), contributing to an increase in the number of hospitalizations, a decrease in ventilation function of the lungs, and an increase in deaths.Aim. To analyze the clinical efficacy of pneumococcal disease vaccine prophylaxis in patients with COPD in combination with type 2 diabetes mellitus (DM) during 5 years of follow-up.Materials and methods. The study included patients (n = 113) with COPD and type 2 DM. The main parameters for evaluating the effectiveness of vaccination were the number of COPD exacerbations, including severe, requiring hospitalization of patients, the incidence of pneumonia, the dynamics of the severity of shortness of breath using the Modified Medical Research Council questionnaire – mMRC, the volume of forced exhalation in 1 second (FEV1), the dynamics of changes in laboratory indicators and prognostic indices BODEX, e-BODE, DOSE, ADO, CODEX. Pneumococcal conjugate 13-valent vaccine was used for vaccinoprophylaxis.Results. It has been established that vaccination against pneumococcal disease in patients with COPD and type 2 DM allows not only to significantly reduce the number of COPD exacerbations (by 2.7 times), reduce the frequency of episodes of community-acquired pneumonia (by 8 times) and significantly reduce the number of hospitalizations, but also stabilize the main functional indicators of the respiratory system while maintaining clinical effectiveness during the 5-year follow-up period. The dynamics of prognostic indices in the group of vaccinated patients reliably confirms the effectiveness of pneumococcal disease vaccine prophylaxis programs and the survival rate of patients with a combination of COPD and type 2 DM.Conclusion. The results of the study confirm that the vaccine prophylaxis of pneumococcal infection significantly reduces the risk of such undesirable events as exacerbations of COPD, pneumonia, hospitalization, and allows to stabilize the course of not only COPD, but also concomitant type 2 diabetes mellitus and thereby improve the prognosis for patients.

Pulmonary Hypertension and Left Ventricular Geometric Types in Sickle Cell Anemia

Pulmonary hypertension (PHT) is multifactorial in origin and a major cause of morbidity and mortality in the sickle cell populace. Its correlation with abnormal left ventricular geometric patterns has not been established. Subjects were sickle cell anemic patients of the hematology clinic of a tertiary hospital who gave informed consent. A modified Medical Research Council questionnaire was used to obtain the demographic, anthropometric, and clinical variables of the subjects. Blood samples were taken for hematologic and biochemical analysis. Spirometry, electrocardiography, and echocardiography were done for all subjects. SPSS version 25 was used for analysis. A p ≤0.05 was used for significance. In total 111 subjects with sickle cell anemia were recruited. Male:female ratio was 1:1.4. The prevalence of PHT was 8.1%. Those with PHT were older and had higher blood pressure, lower respiratory rate, higher body mass index, lower estimated glomerular filtration rate, and a higher prevalence of avascular necrosis of the head of femur, stroke, and chest pain. About 2/3 (66.7%) of those with PHT had concentric left ventricular hypertrophy (LVH) whereas none of those with eccentric LVH had PHT. Age, body mass index, systolic blood pressure, aortic root diameter, concentric LVH, serum creatinine, history of stroke, chest pain, and avascular necrosis of the head of femur correlated directly whereas eccentric LVH correlated inversely with PHT. Concentric LVH, relative systemic hypertension, history of chest pain, and respiratory rate were the independent correlates of PHT in subjects with sickle cell anemia. PHT is known to be of poor prognostic significance. Its association with relative systemic hypertension and concentric LVH suggests the need to initiate early treatment to reduce morbidity and mortality in this group.

Effect of Endurance Training in COPD Patients Undergoing Pulmonary Rehabilitation: A Meta-Analysis.

Background The efficacy of endurance training (ET) on patients with chronic obstructive pulmonary disease (COPD) has been controversial. This study was aimed at meta-analyzing the effect of ET in COPD patients undergoing pulmonary rehabilitation. Methods The literature retrieval was performed in databases to screen relevant literature. Inclusion criteria were as follows: (1) subjects—COPD patients; (2) inclusion of interventional and control groups; (3) intervention measures—the interventional group received whole-body ET and other lung rehabilitation training, while the control group did not receive intervention or other lung rehabilitation training; (4) outcome indicators which included at least one of the following—6MWD, modified Medical Research Council questionnaire (mMRC), and COPD Assessment Test (CAT); and (5) study type—randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the risk of bias. The chi-square test was used to evaluate the magnitude of heterogeneity. Subgroup analysis was used to explore the source of heterogeneity. A funnel plot and Egger's test were used to evaluate publication bias. Results The 6MWD in the ET group was significantly higher than that in the control group (MD = 47.20, 95% CI [28.60, 65.79], P < 0.00001). Significant heterogeneity (P < 0.00001, I2 = 76%) without publication bias (P > 0.05) was noted. Subgroup analysis showed that the 6MWD of the ET group was significantly larger than that of the control group without heterogeneity (P = 0.63, I2 = 0%; P = 0.59, I2 = 0%) in both the no training subgroup (MD = 79.26, 95% CI [72.69, 85.82], P < 0.00001) and other rehabilitation training group (MD = 23.64, 95% CI [6.70, 40.57], P = 0.006). The mMRC score (MD = −0.72, 95% CI [-1.09, -0.34], P = 0.002) and CAT (MD = −6.07, 95% CI [-7.28, -4.87], P < 0.00001) of the ET group were significantly lower than those of the control group. There was no heterogeneity (P = 0.32, I2 = 15%; P = 0.16, I2 = 41%). Conclusion ET can improve patients' motor function and reduce dyspnea. ET might be incorporated as an important part of lung rehabilitation training.

MEASUREMENT OF PATIENT-REPORTED OUTCOMES AT APPROXIMATELY ONE MONTH FOLLOWING A HOSPITAL OR ED DISCHARGE FOR COVID-19

TYPE: Abstract TOPIC: Chest Infections PURPOSE: To collect data for prolonged morbidity in COVID-19 infections using validated questionnaires. METHODS: An IRB-approved telephone survey was administered to 54 patients who were discharged from the hospital or ED for COVID-19 approximately one month earlier. PRO included the Modified Medical Research Council questionnaire (MRC, 0-4 scale), Short Fatigue Questionnaire (SFQ), Patient Health Questionnaire for Depression and Anxiety (PHQ– 4), the Cognitive Change Questionnaire (CCQ8), and the Medical Outcomes Study Short-Form General Health Survey (SF-20). Published thresholds for abnormality in these outcomes were utilized. RESULTS: Age was 50 ± 16 years; 54% were female, 81% were hospitalized while 19% were treated only in the ED. Higher dyspnea ratings (MRC >2) were present in 37%. Elevations in PRO at 32 ± 10 days were: PHQ anxiety (28%) and depression (19%), SFQ fatigue (57%), CCQ8 (19%). Mean ± SD values for the SF-20 health measures were as follows (range = 0 to 100, higher scores = greater functioning): Physical Functioning 69 ± 25, Role Functioning 53 ± 45, Social Functioning, 53 ± 41, Mental Health 71 ± 19, Health Perceptions 50 ± 30, Pain 61 ± 29. These scores were all lower (worse) compared to a cohort of Canadians (age range = 66-70) living at home (Carver et al., Age and Ageing, 1999; 28:169-174). CONCLUSIONS: Substantial abnormality in PRO remains at approximately one month after COVID-19 infection. CLINICAL IMPLICATIONS: Patients who have recovered from COVID-19 require follow-up care to address prolonged morbidity, and further analysis is needed to determine causation. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19

Confirmatory Evaluation of the Modified Medical Research Council Questionnaire for Assessment of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease in Portugal.

The Modified British Medical Research Council Questionnaire is considered an adequate and simple measure of breathlessness in chronic obstructive pulmonary disease. It is widely used in clinical practice in Portugal, but it still lacks confirmatory evaluation for the Portuguese setting. The aim of this study was to perform a cultural adaptation and validation of the Modified British Medical Research Council Questionnaire so that its most suitable version can be made available to researchers and clinicians in Portugal. We performed a cross-sectional descriptive study involving patients with chronic obstructive pulmonary diseaseaged 40 years or older. We applied the Modified British Medical Research Council Questionnaire and the previously validated Portuguese-language version of the clinical questionnaire for chronic obstructive pulmonary disease between January and June 2019.We determined the agreement between the two questionnaires with kappa agreement, with a 95% confidence interval, and we used Spearman correlation to find a correlation between two scores. The study included 65 patients managed in a hospital pulmonology clinic (aged 68 ± 7 years; with predicted FEV1 of 49.86%± 16.5%). The Modified British Medical Research Council scale correlated significantly with all the domains and the overall score of the clinical questionnaire for chronic obstructive pulmonary disease (0.46 < r < 0.68; p < 0.001). In bilingual patients, interclass correlation coefficient was 0.912 (p < 0.001). Our study showed that the Portuguese-language version of the Modified British Medical Research Council Questionnaire is feasible and externally valid when compared with a traditional and previously validated instrument. The Portuguese version of the Modified British Medical Research Council Questionnaire is a valid instrument for measurement of breathlessness in chronic obstructive pulmonary disease.

The relationship between sarcopenia and nesfatin-1 and ghrelin levels in patients with chronic obstructive pulmonary disease

Background and Aim: In this study, we aimed to investigate the relationship between the levels of adipocytokines anorexigenic nesfatin-1 and orexigenic ghrelin levels and body mass index (BMI), muscle mass, muscle strength and sarcopenia in patients with chronic obstructive pulmonary disease (COPD). &#x0D; Material and Method: The patients were divided into two groups according to the severity of COPD. Body mass index (BMI), body fat and muscle measurements were measured with bioelectrical impedance device. A hand-grip strength test was performed with a hand dynamometer to determine muscle strength. We used the mMRC (Modified Medical Research Council Questionnaire) questionnaire to measure the intensity of dyspnea during daily activities. A 6-minute walk test (6MWT) was used to test functional capacity and physical exercise tolerance. COPD Assessment Test (CAT) was performed to determine the health status. Serum nesfatin-1 and ghrelin levels were measured in all patients.&#x0D; Results: In a total of 90 patients (16 female and 74 male) were included in the study prospectively. There was not any significant difference regarding the Nesfatin-1, ghrelin and Nesfatin-1/ghrelin ratio between mild/moderate or severe COPD patients. Muscle strength was correlated positively with 6MWT, nesfatin-1 and ghrelin levels, but negatively correlated with CAT score and mMRC score. The number of patients in the advanced stage of COPD was higher in the sarcopenia group than in the non-sarcopenia group.&#x0D; Conclusion: There was a positive correlation between muscle strength and nesfatin-1 and ghrelin levels. However, muscle strength was negatively correlated with mMRC and CAT scores. Approximately 19% of COPD patients had sarcopenia. Serum nesfatin-1 and ghrelin levels were not different between sarcopenic and non-sarcopenic COPD patients.

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

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

Effects of a Home-Based Pulmonary Rehabilitation Program in Patients with Chronic Obstructive Pulmonary Disease in GOLD B Group: A Pilot Study.

Patients with chronic obstructive pulmonary disease (COPD) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) B group can be included in pulmonary rehabilitation (PR) settings outside the hospitals. This study aimed to explore the feasibility of a home-based pulmonary rehabilitation (HBPR) program and assess its impact on patients with COPD in the GOLD B group. A real-world, pre–post intervention study was conducted with 12 weeks of HBPR (presential home visits and phone calls) using the self-management program Living Well with COPD. The 1-min sit-to-stand test (1MSTS), modified Medical Research Council Questionnaire (mMRC), COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activity of Daily Living (LCADL) were used to assess the impact. Pre–post differences and correlations between changes in outcomes were calculated. In 30 patients (71.6 years, FEV1 (%) 52.8), significant improvements (p < 0.05) were observed on 1MSTS (Pre 17.2, Post 21.2), mMRC (Pre 2.0, Post 1.0), CAT (Pre 16.3, Post 9.9), HADS (Pre 14.4, Post 9.6), and LCADL (Pre 21.0, Post 15.8), with no adverse events reported. When significant, correlations between changes in outcomes were moderate or strong (0.48 ≤ ρ ≤ 0.66). HBPR can be feasible and safe, and it shows the potential to significantly improve outcomes of patients with COPD in the GOLD B group.

Effects of core-postural stabilisation on fluoroscopy diaphragmatic measurement and dyspnea in chronic obstructive pulmonary disease: A randomized single-blinded clinical trial

BACKGROUND: While respiratory and core-postural stabilisation has recently gained a widespread acceptance to improve pulmonary function and dyspena, the therapeutic effects of and rationale underlying the use of respiratory and core-postural stabilisation in the management of patients with chronic obstructive pulmonary disease have not been investigated.OBJECTIVE: This study aimed to compare the effects of abdominal breathing and respiratory and core-postural stabilisation on diaphragmatic movement and pulmonary function.METHODS: Fourteen patients with moderate chronic obstructive pulmonary disease were randomly assigned to either the respiratory and core-postural stabilisation or abdominal breathing group. All patients underwent fluoroscopy-guided chest X-ray imaging and pulmonary function tests before and after the interventions; the modified Medical Research Council questionnaire was also administered before and after the interventions. Six sessions of either intervention were consistently provided. The obtained data were assessed using independent -tests and Wilcoxon signed-rank test with a significance threshold of 0.05.RESULTS: Respiratory and core-postural stabilisation was more effective in increasing diaphragmatic movements than abdominal breathing ( 0.05). Pulmonary function tests revealed more significant differences in the forced vital capacity (FVC(%)) only after respiratory and core-postural stabilisation ( 0.004). The Medical Research Council questionnaire score was significantly different within the Respiratory and core-postural stabilisation group ( 0.014).CONCLUSIONS: Our novel results suggest that the effects of respiratory and core-postural stabilisation breathing on diaphragmatic movement and pulmonary function were superior to those of abdominal breathing in patients with chronic obstructive pulmonary disease.

Association Between Self-Reported Dyspnea and Depressive Symptoms in New Mexico Uranium Workers.

New Mexico has the largest number of former uranium workers, mostly racial/ethnic minorities. Uranium workers are at risk for dyspnea secondary to mine dust exposure. The association between dyspnea and depressive symptoms has not been well examined in occupational minority cohorts. This study evaluated the associations between dyspnea (measured by the modified Medical Research Council Questionnaire) and depressive symptoms (measured by the Patient Health Questionnaire-2) in former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program. The subjects were mostly elderly, rural-residing, minority males. Dyspnea was commonly reported; however, depressive symptoms were uncommon. At baseline, former workers experiencing higher levels of dyspnea were more than 3 times likely to endorse depressive symptoms than those with no or mild dyspnea. Longitudinal analysis failed to determine an association between change in dyspnea and concomitant change in depressive symptoms. Dyspnea and depressive symptoms were associated cross-sectionally in former uranium workers.

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis

BackgroundPulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.MethodsA 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR.Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted.DiscussionThis study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases.Trial registrationThe trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666).

Soluble Urokinase-Type Plasminogen Activator Receptor and Arterial Stiffness in Patients with COPD

IntroductionSoluble urokinase-type plasminogen activator receptor (suPAR) is upregulated by inflammation and plays a role in the pathogenesis of atherosclerosis. Chronic obstructive pulmonary disease (COPD) is associated with enhanced systemic inflammation and increased risk for atherosclerosis, however, studies analysing the circulating suPAR levels in COPD are contradictory. The aim of the study was to investigate plasma suPAR concentrations together with markers of arterial stiffness in COPD.Materials and MethodsTwenty-four patients with COPD and 18 non-COPD, control subjects participated in the study. Plasma suPAR was measured, together with lung volumes, symptom burden, exacerbation history, markers of arterial stiffness and soluble inflammatory biomarkers, such as endothelin-1, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6).ResultsPlasma suPAR levels were higher in COPD (2.84 ± 0.67 ng/ml vs. 2.41 ± 0.57 ng/ml, p = 0.03) and were related to lung function measured with FEV1 (r = − 0.65, p < 0.01) and symptom burden determined with the modified Medical Research Council questionnaire (r = 0.55, p < 0.05). Plasma suPAR concentrations correlated with various measures of arterial stiffness in all subjects, but only with ejection duration in COPD (r = − 0.44, p = 0.03).ConclusionsPlasma suPAR levels are elevated in COPD and relate to arterial stiffness. Our results suggest that suPAR may be a potential link between COPD and atherosclerosis.

Daily life physical activity in patients with chronic stage IV sarcoidosis: A multicenter cohort study.

Background and objectivesLittle is known about the consequences of chronic sarcoidosis on daily life physical activity (DLPA). The aim of this prospective study was to measure DLPA in patients with chronic sarcoidosis and to determine its relationship to clinical and functional parameters.MethodsFifty‐three patients with chronic sarcoidosis and 28 healthy control subjects were enrolled in this multicenter prospective study. Two markers of DLPA (number of steps walked per day [SPD]) and total daily energy expenditure (TEE) were assessed for five consecutive days with a physical activity monitor. Pulmonary function, aerobic capacity (maximal oxygen uptake [VO2max]), exercise capacity (6‐min walk test [6MWT]), and quality of life (self‐reported questionnaires) were also evaluated. Comparisons of DLPA parameters between the two groups were performed using an analysis of covariance adjusted for age, sex, and body mass index (BMI). Relationships between DLPA parameters and patient characteristics were assessed in multivariable linear regression models.ResultsPatients with sarcoidosis walked significantly fewer SPD than did the control subjects (6395 ± 4119 and 11 817 ± 3600, respectively; P < 0.001 after adjustment for age, BMI, and sex). TEE was not significantly different between patients with sarcoidosis and healthy controls (median [interquartile range]: 2369 [2004‐2827] and 2387 [2319‐2876] kcal/day, respectively, P = 0.054 adjusted for age, BMI, and sex). SPD showed significant positive correlations with 6MWT distance (Pearson's correlation, r = 0.32, 95% confidence intervals [95%CI] = 0.06, 0.55; P = 0.019), VO2max (r = 0.44, 95%CI = 0.17, 0.65; P = 0.002), and Visual Simplified Respiratory Questionnaire score (r = 0.44, 95%CI = 0.19, 0.64; P = 0.001), and a significant negative correlation with modified Medical Research Council questionnaire score (r = −0.38, 95%CI = −0.60, −0.10; P = 0.009). TEE was significantly correlated with BMI (r = 0.38, 95%CI = 0.13, 0.59; P = 0.004), forced expiratory volume in 1 second (r = 0.55, 95%CI = 0.33, 0.71; P < 0.001), total lung capacity (r = 0.44, 95%CI = 0.18, 0.64; P = 0.001), and forced vital capacity (r = 0.56, 95%CI = 0.34, 0.72; P < 0.001). In multivariable analysis, SPD remained associated only with VO2max.ConclusionPatients with chronic sarcoidosis appear to have reduced DLPA mainly because of compromised VO2max.

Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study

Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, the effect of aspirin on COPD morbidity is unknown. Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV1/FVC< 70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring ED visit or hospitalization). Aspirin users were matched one-to-one with nonusers, based on propensity score. The association of aspirin use with total, moderate, and severe AECOPD was investigated using zero-inflated negative binomial models. Linear or logistic regression was used to investigate the association with baseline respiratory symptoms, quality of life, and exercise tolerance. Among 1,698 participants, 45%reported daily aspirin use at baseline. Propensity score matching resulted in 503 participant pairs. Aspirin users had a lower incidence rate of total AECOPD (adjusted incidence rate ratio [IRR], 0.78; 95%CI, 0.65-0.94), with similar effect for moderate but not severe AECOPD (IRR, 0.86; 95%CI, 0.63-1.18). Aspirin use was associated with lower total St. George's Respiratory Questionnaire score (β, -2.2; 95%CI, -4.1 to -0.4), reduced odds of moderate-severe dyspnea (modified Medical Research Council questionnaire score≥ 2; adjusted odds ratio, 0.69; 95%CI, 0.51-0.93), and COPD Assessment Test score (β, -1.1; 95%CI, -1.9 to -0.2) but not 6-min walk distance (β, 0.7 m; 95%CI, -14.3 to 15.6). Daily aspirin use is associated with reduced rate of COPD exacerbations, less dyspnea, and better quality of life. Randomized clinical trials of aspirin use in COPD are warranted to account for unmeasured and residual confounding. ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov.

Traditional Chinese medicine tonifying kidney therapy (Bu shen) for stable chronic obstructive pulmonary disease: Protocol for a systematic review and meta-analysis.

Background:Traditional Chinese medicine (TCM) is commonly used to combine with pharmacotherapy for stable chronic obstructive pulmonary disease (COPD) in China and other Asian countries such as South Korea and Japan. The objective of this systematic review is to evaluate the efficacy and safety of tonifying kidney therapy (Bushen, TK) for stable COPD.Methods:Randomized controlled trials (RCTs) of TK for stable COPD were searched from 4 databases including Pubmed, the Cochrane library, CBM (China Biology Medicine disc, CBMdisc), CNKI (China National Knowledge Infrastructure) from inception to December 2017. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias in included studies. RevMan 5.3 software was used for meta-analysis. The primary outcomes analyzed in this meta-analysis were effectiveness, TCM Syndrome Score, dyspnea (modified Medical Research Council questionnaire [mMRC]), COPD health status (COPD Assessment Test [CAT]), exercise capacity (6-min walk distance in meters [6mWD]), and respiratory-specific quality of life (St George's Respiratory Questionnaire [SGRQ]). Second outcomes analyzed for this meta-analysis were lung function (forced expiratory volume in 1 second [FEV1], FEV1%, forced vital capacity [FVC], FEV1/FVC), the frequency of acute exacerbation, T-lymphocyte subsets (CD4, CD8, CD4/CD8), and immunoglobulin (IgA, IgG, and IgM). The summary results will be pooled using the random-effects model or fixed-effects model according to the heterogeneity of the included studies.Result:This systematic review will provide an evidence of TK for stable COPD, and will submit to a peer-reviewed journal for publication.Conclusion:The conclusion of this systematic review will provide evidence to judge whether TK is an effective intervention for stable COPD patients.PROSPERO registration number:PROSPERO CRD 42018090328.

Effect of dyspnea on frailty stages and related factors in Taiwanese men with COPD.

PurposeChronic obstructive pulmonary disease (COPD) impacts health-related quality of life in men more than in women. In patients with dyspnea, frailty is more likely to develop and aggravate disability. Despite this, few studies have addressed frailty in men with COPD. The present study investigated the effects of dyspnea and its related factors on frailty in men with COPD.Patients and methodsThis cross-sectional observational study selected 125 participants by voluntary sampling at the thoracic outpatient clinics of two medical centers in Taiwan. The modified Medical Research Council questionnaire was used as the basis to classify dyspnea. Data were collected using questionnaires and analyzed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corporation., Armonk, NY, USA).ResultsThere were 85.90% and 26.70% patients with COPD assessed in the unfit stage among the dyspnea and non-dyspnea groups, respectively. Additionally, the number of medication use and the COPD Assessment Test (CAT) scores were correlated with the period from fitness to unfitness among the dyspnea group and non-dyspnea group.ConclusionCOPD with dyspnea was more common in the unfit stages. The total number of medication use and CAT scores were significantly related to frailty.

Exploratory mixed methods study of respiratory physiotherapy for patients with lower respiratory tract infections

ObjectivesTo assess the outcomes of respiratory physiotherapy for patients with lower respiratory tract infections (LRTI). DesignParallel group mixed-methods study. SettingPatients were recruited from a general hospital. Respiratory physiotherapy took place in a community setting. ParticipantsFifty-four patients aged ≥18 years and diagnosed with LRTI completed the study. Twenty-seven patients were allocated to the control group {CG: 10 male, mean age 53.3 [standard deviation (SD) 17.4] years} and 27 patients were allocated to the experimental group [EG: 10 male, mean age 58.6 (SD 17.2) years]. InterventionThe CG received conventional medical treatment and the EG received conventional medical treatment plus respiratory physiotherapy for 3 weeks. Outcome measuresPatients in both groups undertook the 6-minute walk test (6MWT), modified Borg scale (MBS), modified Medical Research Council questionnaire (mMRC), and Breathlessness, Cough and Sputum scale (BCSS) before and after the intervention. A telephone follow-up survey was performed 3 months after the first hospital visit. Interviews were conducted immediately after the intervention in the EG. ResultsIn the EG, the distance walked in the 6MWT increased by more than the minimally important difference (P=0.001), and significantly more than the CG {EG: mean change 76m [standard deviation (SD) 63], 95% confidence interval (CI) 51 to 101; CG: mean change 27m (SD 56), 95% CI 5 to 49; mean difference between groups: 49m 95% CI 16 to 82; partial η2=0.15}. No differences in the MBS, mMRC and BCSS were found between the two groups. The EG reported high levels of satisfaction with the intervention (27/27; 100%) and with the physiotherapist (20/27; 74%). The intervention improved patients’ symptoms (19/27; 70%) and their self-management skills to control/prevent future LRTI (19/27; 70%). Health service use was significantly less in the EG (P=0.04). ConclusionsRespiratory physiotherapy appears to be effective for the management of patients with LRTI. ClinicalTrial.gov Registration NumberNCT02053870.

Questionnaires in Multidimensional Assessment of Chronic Obstructive Pulmonary Disease: Two Sides of the Same Coin

In recent decades, the diagnosis of chronic obstructive ulmonary disease (COPD) has been veering from simple oneimensional schemes to more complex strategies based on ultidimensional approaches or on phenotypes. The latest update f the GOLD1 strategy recommends the use of three questionnaires or the assessment of the patient’s situation: the COPD Assessment est (CAT),2 the modified Medical Research Council (MRC) dyspnea cale,3 and the Clinical COPD Questionnaire (CCQ).4 The inclusion of hese three different questionnaires in the GOLD strategy to assess he impact of the disease in patients has provoked an interesting ebate on the multidimensional assessment of the disease. In order to verify the equivalence of these questionnaires, sevral authors have conducted observational studies, describing a eality that was intuitively perceived by the clinician: the results f these questionnaires, while individually valid in assessing the mpact of the disease, are not superimposable. In this respect, some tudies have highlighted a lack of agreement between CAT and RC,5 while others report the discrepancies between the MRC nd the St. George’s respiratory questionnaire.6 The differences are educed by changing the cutoff for the MRC questionnaire in the OLD classification. Thus, Jones et al.7 suggest that if patients with nd without dyspnea (MRC grade 0) are separated, the distribuion of patients over the various GOLD types is very similar to that btained using CAT with the current cutoff values. The idea behind these studies is that if the classification perentages with both scales in a given patient cohort agree, then they ould all be used interchangeably for categorizing COPD patients. owever, as Jones et al.7 point out, concordance in the distribuion of GOLD types does not necessarily mean that patients who btain the same scores on the different questionnaires using these ew cutoff values will be exactly the same. In this respect, it should

Impact of pulmonary rehabilitation in subjects with mild COPD.

Pulmonary rehabilitation (PR) is a core component of the management of patients with moderate-to-very-severe COPD. However, as impairments in quadriceps muscle strength and health-related quality of life (HRQOL) are already present in patients with mild COPD, there is a need to investigate whether PR could also be beneficial to these patients. Thus, this study assessed the impact of PR on patients with mild COPD. A quasi-experimental study was conducted. Twenty-six participants (67.8 ± 10.3 years old; FEV1 83.8 ± 6.4% of predicted) enrolled in a 12-week PR program with exercise training and psychoeducation. Lung function was assessed by spirometry, dyspnea with the Modified Medical Research Council questionnaire, functional balance with the Timed Up and Go test, muscle strength with 10-repetition maximum testing, exercise tolerance with the 6-min walk test, emotional state with the Depression Anxiety Stress Scales, and HRQOL with the St George Respiratory Questionnaire (SGRQ). Significant effects were observed on participants' dyspnea (P = .003, effect size [ES] = 0.7), functional balance (P < .001, ES = 0.8), shoulder flexor/knee extensor strength (P < .001, ES = 1.2-1.3), and exercise tolerance (P < .001, ES = 0.5). With the exception of the SGRQ impact score, the symptom (P < .001, ES = 0.6), activity (P = .02, ES = 0.4), and total (P = .005, ES = 0.3) scores improved significantly after PR. The PR program had no significant effect on participants' lung function and emotional state. Patients with mild COPD benefit from PR and could therefore be routinely included in these programs. Studies with more robust designs and with long-term follow-ups are needed to inform guidelines for PR in mild COPD.

COPD management: role of symptom assessment in routine clinical practice.

Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients’ everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed.