MRC Dyspnoea Grade Research Articles

Differential response to pulmonary rehabilitation in COPD: multidimensional profiling.

The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD.

P119 Is A Practice Incremental Shuttle Walk Test Needed For Patients With Chronic Obstructive Pulmonary Disease Admitted To Hospital For An Acute Exacerbation?

Introduction The Incremental Shuttle Walk Test (ISWT) assesses exercise capacity in patients with Chronic Obstructive Pulmonary Disease (COPD). Guidelines suggest 2 ISWTs should be performed. However, in patients who have been admitted with an acute exacerbation, it is unknown if 2 ISWTs are required. Objective To investigate if a practice ISWT is needed for inpatients with an acute exacerbation of COPD. Methods Patients admitted to hospital with an acute exacerbation completed 2 ISWTs, prior to discharge. Patients gave written informed consent ([ISRCTN84599369][1]) and were included if they used the same oxygen and mobility aid (if any) between tests. Results 37 inpatients with COPD (19 male) were included: mean (SD) 67.89(8.02) years with BMI 24.66(6.60), FEV1 was 1.07(0.44)l[41.94(13.72)% predicted], FEV1/FVC 47.11(11.70)%, median (inter-quartile range) MRC dyspnoea grade 4(3–5), resting Borg breathlessness 2(0.5–3) and 11 had never exercised. Participants achieved ISWT1 92.16(97.67)m, post-HR 108.64(14.33), post-SaO2 90.33(3.89), post-Borg breathlessness 4(3–5) and post-Rated Perceived Exertion (RPE) 13(13–15). There was a statistically significant increase of 14.59(29.12)m for ISWT2 (p < 0.05) but no significant differences in HR, SaO2, Borg or RPE. Bland Altman plot ([Figure 1a][2]) shows acceptable agreement between the ISWTs. When calculating Endurance Shuttle Walk Test (ESWT) level at 85% VO2 peak as estimated from ISWT1 and ISWT2, there was a significant increase of one level (p < 0.05). Multiple regression explained 92.1% of the variance ( F (9–18)p 0.05). Conclusions There was a small but statistically significant increase between ISWTs, which was below the minimal clinically important difference. However, this difference changed the ESWT level for some patients which would have had consequences for exercise prescription. This exploratory work has shown that we can predict the difference between ISWTs using a multiple regression equation which could substitute the need for a second ISWT; this needs to be confirmed prospectively. A practice ISWT is therefore not necessarily needed in this patient group. ![Abstract P119 Figure 1a][3] Abstract P119 Figure 1a Bland Altman Plots showing agreement between ISWT1 and ISWT2 and 1b predicted ISWT2 and actual ISWT2 [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN84599369 [2]: #F1 [3]: pending:yes

P136 Multidimensional prognostic index for exacerbations of COPD

Introduction and ObjectivesPrognostic assessment of COPD exacerbations is currently limited by models that only take into account short term prognostic factors. We developed a multidimensional tool for COPD exacerbations, predicting...

S75 Is a practice incremental shuttle walk test always necessary and is it influenced by MRC dyspnoea grade?

IntroductionThe Incremental Shuttle Walk Test (ISWT) is a common assessment tool used to assess exercise capacity in patients with Chronic Obstructive Pulmonary Disease (COPD). Healthcare professionals conducting this test will...

Sujets à risque de BPCO en population générale : disproportion entre la fréquence des symptômes, leur perception et la connaissance de la maladie

Chronic obstructive pulmonary disease (COPD) is markedly under-diagnosed, which may relate to under-reporting of symptoms and poor awareness of the disease. A survey was conducted in a sample of the French general population aged 40-75 years (n=2758) to assess respiratory symptoms and level of knowledge of the disease in subjects with or at-risk of COPD (n=860, 31%). The high frequency of dyspnoea (MRC dyspnoea grade > or =1: 40%) contrasted with that of subjects spontaneously reporting respiratory problems (9%). Among these, 72% reported limitations in daily-life activities but only 14% considered that they were severely affected by their respiratory status. A very low proportion of subjects knew the term COPD (8%) and only 66% of these associated COPD with a respiratory disease. There is a wide gap between the high number of subjects at risk of COPD in the general population and the frequency of breathlessness in these subjects on one hand, and the poor knowledge of the disease, poor perception of symptoms, and under-diagnosis and under-use of spirometry on the other. Increasing awareness of COPD in the population is needed.

Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade

It is not clear whether the benefits of pulmonary rehabilitation (PR) apply equally to patients with Chronic Obstructive Pulmonary Disease (COPD) with different levels of starting disability. We have therefore investigated the effect of pulmonary rehabilitation stratified by the MRC dyspnoea scale in patients with COPD. This is a retrospective, observational study of data collected from 450 consecutive patients with COPD attending outpatient PR: 247 male, mean (SD) age 69.5 (8.9) yrs and FEV(1) 44.6 (19.7)% predicted. The Incremental Shuttle Walk Test (ISWT) was performed before and after the seven-week course 395 patients (88%) completed the programme. The mean (SD) baseline ISWT performance was 167 (113)m. The distribution of baseline MRC grades was 2 - 15.4%, 3 - 24.9%, 4 - 27.3% and 5 - 32.4%. The mean (95% CI) improvement in ISWT after PR for each MRC scale grade was highly significant (p<0.0005); 2 - 66 (50-83)m, 3 - 63 (50-75)m, 4 - 59 (49-70)m, and 5 - 54 (43-64)m. Patients with COPD, of all MRC dyspnoea grades, benefit comparably from pulmonary rehabilitation achieving both statistically and clinically meaningful improvements in exercise performance. MRC grade should therefore not be used to exclude patients from pulmonary rehabilitation.