Saint George's Respiratory Questionnaire Research Articles

The Correlation between Functional Parameters (6-Minute Walk Test) and Life Quality of Silicosis Patients: Case Study in the Jerada City in Morocco

Introduction: Silicosis is pneumoconiosis secondary to the inhalation of mineral dust containing silica. It represents a real public health problem in the city of Jerada.Purposes: To assess the functional parameters of silicosis patients (based on the 6-minute walk test (6MWT)) and their impact on our patients' quality of life (Saint George's respiratory questionnaire (SGRQ) and hospital anxiety and depression scale (HAD)).Materials and methodology: This is a cross-sectional study of 147 patients with silicosis, designed to collect their socio-demographic data, to assess their respiratory function (6MWT) and their quality of life (SGRQ).Findings: The average age of our patients was 64.08 +/- 6.46 years [46 -81]. At 6MWT, the mean distance walked by our patients is 326.8 +/-168.47 m (30 - 835) or 59% of the predicted distance, with a median of 360m. The mean total Saint George score (SGT) was 68.02 +/- 19.54%. The means of the other Saint George scores were: symptoms (SGS): 45.95 +/- 23.66%, activities (SGA): 79.58 +/- 19.8%, and impact (SGI): 68, Results: The average age of our patients was 64.08 +/- 6.46 years [46 -81]. At 6MWT, the mean distance walked by our patients is 326.8 +/-168.47 m (30 - 835) or 59% of the predicted distance, with a median of 360m. The mean total Saint George score (SGT) was 68.02 +/- 19.54%. The means of the other Saint George scores were: symptoms (SGS): 45.95 +/- 23.66%, activities (SGA): 79.58 +/- 19.8%, and impact (SGI): 68.32 +/- 22.33%. We found a statistically significant relationship between dyspnea, quality of life, anxiety and walking distance.Conclusion: The study demonstrated that silicosis is a pulmonary disease which causes significant functional limitation and deterioration of life quality.

Reliability and validity of the Glittre-ADL test to assess the functional status of patients with interstitial lung disease.

The study objective was to investigated the reliability and validity of the ADL-Glittre test (TGlittre) to assess the functional status of patients with interstitial lung disease (ILD). Twenty-one individuals with ILD participated (age: 63 ± 11 years; DLCO: 51.0 ± 12.6%predicted), evaluated with body plethysmography, Saint George Respiratory Questionnaire, modified Medical Research Council dyspnea scale, six-minute walk test (6MWT) and monitoring of physical activity of daily living. Two TGlittre were performed, with an interval of 30 minutes between them. The TGlittre demonstrated high test-retest reliability, with an intraclass correlation coefficient of 0.90 (95%CI: 0.75–0.96; p < 0.001). Nineteen patients (90.5%) performed better on the second test (mean difference between TGlittre 1 and 2: −0.57 ± 0.96 minute; p = 0.001), with a learning effect of 11.6%. The time in TGlittre correlated with 6MWT (r = −0.70; p = 0.002) and with the total energy expenditure in physical activity of daily living (r = −0.52; p = 0.02). In %predicted, TGlittre and 6MWT also correlated (r = −0.50; p = 0.04). Correlations were observed between TGlittre and pulmonary function variables (r = −0.47 to −0.57; p = 0.01 to p = 0.04). There was no difference in the physiological response between TGlittre 1 and 2, and between TGlittre and 6MWT (p > 0.05). In conclusion, the TGlittre is reliable and valid for assessing functional status of patients with ILD.

Validation of a Spanish version of the Leicester Cough Questionnaire in cystic fibrosis.

Cough is a main symptom in cystic fibrosis (CF). We aim to validate a Spanish version of the Leicester Cough Questionnaire (LCQ-Sp) to measure the impact of cough in CF bronchiectasis. A prospective longitudinal multicentre study was performed. Internal consistency and score changes over a 15-day period in stable state were assessed to analyse reliability. Concurrent validity was analysed by correlation with Saint George’s Respiratory Questionnaire (SGRQ) and convergent validity by assessing the association with clinical variables. Changes in scores between stable state and the first exacerbation were assessed to analyse responsiveness. 132 patients (29.73 ± 10.52 years) were enrolled in four hospitals. Internal consistency was high for the total score and good for the three domains (Cronbach’s α 0.81–0.93). The test–retest reliability showed an intraclass correlation coefficient of 0.86 for the total score. The correlation between LCQ-Sp and SGRQ scores was −0.74. The LCQ-Sp score negatively correlated with sputum volume, and the mean score decreased at the beginning of exacerbations (16.04±3.81 vs 13.91±4.29) with a large effect size. The LCQ-Sp is a reliable, repeatable and responsive instrument to assess the impact of cough in CF bronchiectasis and is responsive to change in the event of exacerbations.

Brazilian version of the Clinical COPD Questionnaire, administered by interview: reliability and validity measurement properties.

ABSTRACTObjective:To test the reliability, validity, and interpretability of the Brazilian version of the Clinical COPD Questionnaire (CCQ) in patients with COPD. Methods:Fifty patients with COPD completed the CCQ by interview on two occasions. At the first visit, the CCQ was administered twice, by two different raters, approximately 10 min apart; the patients also underwent spirometry and were administered the COPD Assessment Test, the modified Medical Research Council scale, and Saint George’s Respiratory Questionnaire (SGRQ). At the second visit (1-2 weeks later), the CCQ was readministered. We tested the hypothesis that the CCQ total score would correlate positively with the total and domain SGRQ scores (r ≥ 0.5). Results:Of the 50 patients, 30 (60%) were male. The mean age was 66 ± 8 years, and the mean FEV1 was 44.7 ± 17.9% of the predicted value. For all CCQ items, Cronbach’s alpha coefficient (95% CI) was 0.93 (0.91-0.96). To analyze the interrater reliability and test-retest reliability of the CCQ, we calculated the two-way mixed effects model/single measure type intraclass correlation coefficient (0.97 [95% CI: 0.95-0.98] and 0.92 [95% CI: 0.86-0.95], respectively); the agreement standard error of measurement (0.65 for both); the smallest detectable change at the individual level (1.81 and 1.80, respectively) and group level (0.26 and 0.25, respectively); and the limits of agreement (−0.58 to 0.82 and −1.14 to 1.33, respectively). The CCQ total score correlated positively with all SGRQ scores (r ≥ 0.70 for all). Conclusions:The Brazilian version of the CCQ showed an indeterminate measurement error, as well as satisfactory interrater/test-retest reliability and construct validity.

A study of the psychometric properties of the Brazilian...Portuguese version of Bronchiectasis Health Questionnaire

Introduction and objectiveThe Bronchiectasis Health Questionnaire (BHQ) is a simple, repeatable, and self-reporting health status questionnaire for bronchiectasis. This study aims to cross-culturally adapt the BHQ into Brazilian Portuguese and evaluate its measurement properties. MethodsThe participants answered the Saint George...s Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) scale for dyspnea. The Brazilian-Portuguese version of the Bronchiectasis Health Questionnaire (BHQ-Brazil) was used at baseline (test) and after 14 days (retest). The psychometric analyses included internal consistency, test-retest reliability, and construct validity: factorial validity, convergent validity, and discriminative validity, agreement, and ceiling and floor effects. ResultsThe BHQ-Brazil demonstrated adequate internal consistency (Cronbach...s alpha...=...0.92) and substantial reliability (intraclass correlation coefficient...=...0.86; 95%CI: 0.79...0.90). The exploratory factorial analysis was considered suitable. All items presented a factorial load >0.40. The convergent validity of the BHQ-Brazil with mMRC was moderate (r...=......0.53, p...<...0.001), while concurrent validity with the SGRQ was strong (symptoms: r...=......0.72, activities: r...=......0.60, impact: r...=......0.60, total score: r...=......0.75, all p...<...0.001). The standard error of measurement was 4.81 points. The discriminative validity demonstrated that individuals with more pulmonary exacerbations, colonization by Pseudomonas aeruginosa, worst dyspnea, and a higher number of affected lung lobes presented the lowest quality of life. No floor or ceiling effects were observed. ConclusionThe BHQ-Brazil presents adequate measurement properties to evaluate the impact of bronchiectasis on health-related quality of life, and can be used in clinical and research settings.

Determination of the minimal important difference for Dyspnoea-12 questionnaire in patients with COPD, after pulmonary rehabilitation.

The authors of the international task force about the management of Dyspnoea recommend assessing sensory and affective components of dyspnoea. The Dyspnoea-12 questionnaire (D-12) allows to assess both components of dyspnoea. D-12 is valid and reliable but its sensitivity to pulmonary rehabilitation was not studied. The aim of this study was to estimate the minimal important difference (MID) for D-12 in COPD patients undergoing a pulmonary rehabilitation programme (PRP). Severe or very severe COPD patients undergoing a PRP were included. Dyspnoea was assessed using D-12, MMRC dyspnoea scale, London chest of Activity of Daily Living questionnaire (LCADL). Quality of life was assessed using Saint-George respiratory questionnaire (SGRQ) and COPD assessment Test (CAT); exercise capacity using 6-Minute walk Test (6MWT) and 1-minute sit to-stand test (1STST). The MID was evaluated using distribution and anchor-based methods. Sixty patients (age: 64.4±8.2; FEV1(%): 28.6±8.1) were included. At the end of the PRP, patients had significantly decreased their dyspnoea measured with D-12, MMRC, LCADL (D-12:23.9±8.9 to 17.6±9.4; MMRC: 3±0.7 to 2.2±1.1, LCADL: 38±13.9 to 31.6±11; p<0.0001). Using the distribution-based analysis, MID of -2.67 (standard error of measurement) or -4.45 (standard deviation) was found. According to methodology, we could only use SGRQ as anchor. With SGRQ as anchor, the receiver operating characteristic curve identified MID for the change in D-12 at -6.1 (sensibility: 58%, specificity: 79%). The correlation with SGRQ was modest (r=0.33), so the calculated MID should be interpreted with caution. D-12 is a good tool to assess the decrease of dyspnoea after PR. We propose MID of -6 points. However, Future estimates of MID for the D-12 should use anchors that are more strongly correlated with it.

A STUDY ON THE EFFECT OF EXACERBATIONS ON THE QUALITY OF LIFE OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim: The main aim of this study is to evaluate the effect of exacerbations on the quality of life of the patients with chronic obstructive pulmonary disease.&#x0D; Materials and Methods: Patients of both the genders and with an age of above 18 years of patients who were diagnosed with COPD were included in this prospective study. Modified British Medical Research Council (m-MRC) Dyspnoea Scale was used to establish functional impairment due to shortness of breath in the study participants. Saint George's Respiratory Questionnaire (SGRQ) was also used to assess the patient’s overall health and quality of life-based on self-report.&#x0D; Results: Among the 110 study participants, 87.3% were males and 12.7% were females. It was observed that majority of the patients were in the age group 51-60 years (43.6%). The most frequently observed co-morbidities were hypertension (22.7%) followed by diabetes mellitus (19.1%). Most of the patients were observed to be with m-MRC grade-3 (42.7%) followed by m-MRC garde-2 (39.1%). The SGRQ score was observed to be increased with increase in the frequency of exacerbations.&#x0D; Conclusion: Clinical Pharmacist should take the responsibility in providing effective evidence based therapeutic recommendations for the better management and well being of the COPD patients.

Validity of the Brazilian version of the COPD assessment test in patients with chronic obstructive pulmonary disease.

COPD Assessment Test (CAT) is a questionnaire defined as one of the main options in the assessment of the impact of Chronic Obstructive Pulmonary Disease on patients' life, according to the Global Initiative on Obstructive Lung Diseases. However, the Consensus-based Standards for the Selection of Health Measurement Instruments-COSMIN 2018 has recently determined a correlation coefficient greater than 0.70 and an optimal sample size must have a hundred subjects, hence, validity of the Brazilian version of this instrument is still not yet proven. To verify the validity of the Brazilian version of the Questionnaire CAT in patients with Chronic Obstructive Pulmonary Disease, comparing it to the Saint George's Respiratory Questionnaire (SGRQ) and correlate it with other outcomes. Observational transversal study with 101 COPD diagnosed subjects who underwent anthropometric data collection, life habits, CAT and SGRQ questionnaires, modified Medical Research Council (mMRC) dyspnoea scale. Spirometry, six-minute walking test (6MWT) and body mass index, Dyspnoea and exercise capacity (BODE). Each evaluative measure was compared to the total CAT score. The validity was considered for a significant Pearson correlation coefficient (r) greater than 0.7. It was observed a strong correlation between the total CAT score and the total SGRQ score (r=0.703; P<0.001), as well as moderate correlation with mMRC (r=0.518; P<0.001). SGRQ Symptoms (r=0.627; P<0.001). SGRQ Activity (r=0.636; P<0.001) and SGRQ Impact (r=0.655; P<0.001). There were similar correlations between CAT and other variables (6MWT, mMRC and BODE) and SGRQ and the same variables. The CAT questionnaire is a valid, reliable and easy-to-use instrument for assessing symptoms and can record the impact of COPD on the patient's quality of life.

Different Clusters in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Two-Center Study in Brazil.

BackgroundChronic obstructive pulmonary disease (COPD) has a functional definition. However, differences in clinical characteristics and systemic manifestations make COPD a heterogeneous disease and some manifestations have been associated with different risks of acute exacerbations, hospitalizations, and death.ObjectiveTherefore, the objective of the study was to evaluate possible clinical clusters in COPD at two study centers in Brazil and identify the associated exacerbation and mortality rate during 1 year of follow-up.MethodsWe included patients with COPD and all underwent an evaluation composed of the Charlson Index, body mass index (BMI), current pharmacological treatment, smoking history (packs-year), history of exacerbations/hospitalizations in the last year, spirometry, six-minute walking test (6MWT), quality of life questionnaires, dyspnea, and hospital anxiety and depression scale. Blood samples were also collected for measurements of C-reactive protein (CRP), blood gases, laboratory analysis, and blood count. For the construction of the clusters, 13 continuous variables of clinical importance were considered: hematocrit, CRP, triglycerides, low density lipoprotein, absolute number of peripheral eosinophils, age, pulse oximetry, BMI, forced expiratory volume in the first second, dyspnea, 6MWD, total score of the Saint George Respiratory Questionnaire and packs-year of smoking. We used the Ward and K-means methods and determined the best silhouette value to identify similarities of individuals within the cluster (cohesion) in relation to the other clusters (separation). The number of clusters was determined by the heterogeneity values of the cluster, which in this case was determined as four clusters.ResultsWe evaluated 301 COPD patients and identified four different groups of COPD patients. The first cluster (203 patients) was characterized by fewer symptoms and lower functional severity of the disease, the second cluster by higher values of peripheral eosinophils, the third cluster by more systemic inflammation and the fourth cluster by greater obstructive severity and worse gas exchange. Cluster 2 had an average of 959±3 peripheral eosinophils, cluster 3 had a higher prevalence of nutritional depletion (46.1%), and cluster 4 had a higher BODE index. Regarding the associated comorbidities, we found that only obstructive sleep apnea syndrome and pulmonary thromboembolism were more prevalent in cluster 4. Almost 50% of all patients presented an exacerbation during 1 year of follow-up. However, it was higher in cluster 4, with 65% of all patients having at least one exacerbation. The mortality rate was statistically higher in cluster 4, with 26.9%, vs 9.6% in cluster 1.ConclusionWe could identify four clinical different clusters in these COPD populations, that were related to different clinical manifestations, comorbidities, exacerbation, and mortality rate. We also identified a specific cluster with higher values of peripheral eosinophils.

The St. George's Respiratory Questionnaire in Pulmonary Sarcoidosis.

The Saint George's Respiratory Questionnaire (SGRQ) is a frequently used tool to assess health status in pulmonary disease patients. However, its performance characteristics in sarcoidosis patients are not well characterized. Data from a clinical trial of 138 symptomatic adults with sarcoidosis were used to examine the performance characteristics of SGRQ. Data were available at both baseline and week 24. Other assessments included FVC, FEV1, ATS dyspnea score, Borg's CR 10 dyspnea score, 6-min walk distance (6MWD), and Short Form-36 Physical Component Summary (SF-36 PCS) score. Baseline SGRQ was 46.8, indicating impaired health status. At baseline, SGRQ total score correlated significantly with % predicted FVC, FEV1, ATS dyspnea score, Borg's CR 10 dyspnea score, 6MWD, and SF-36 PCS (r = - 0.37, - 0.32, 0.57, 0.40, - 0.55, and - 0.80, respectively, p < 0.001). Change from baseline in SGRQ score also statistically significantly correlated with change from baseline in these parameters at week 24: r = - 0.25, - 0.20, 0.30, 0.22, - 0.20, - 0.45, respectively (p < 0.05). The SGRQ correlated with other outcome measures in sarcoidosis initially and with treatment. Improvement in FVC % predicted correlated with improvement in SGRQ. These data suggest the SGRQ may function as a reliable endpoint in clinical sarcoidosis trials.

Efectividad de un programa de reacondicionamiento físico sobre la calidad de vida en personas adultas mayores con enfermedad pulmonar crónica

Resumen: Este trabajo corresponde a un análisis observacional descriptivo, de un programa de reacondicionamiento fisco para adulto mayor con enfermedad pulmonar crónico, desarrollado en el Hospital Nacional de Geriatría y Gerontología, entre enero 2012 y mayo 2018. Con un total de 53 practicantes. Los problemas pulmonares crónicos impactan negativamente en la calidad de vida a causa de los síntomas y la baja capacidad física. Hay limitada evidencia a nivel nacional de la efectividad del ejercicio sobre la calidad de vida de la persona adulta mayor con enfermedad pulmonar crónica. El propósito de este análisis fue conocer la efectividad de un programa de reacondicionamiento físico sobre la calidad de vida en adultos mayores con enfermedad pulmonar crónica. Se analizó la calidad de vida relacionada con la salud por medio del cuestionario Saint George’s (SGRQ) el CAT-Assessment Test y el índice BODE pre y post programa. Para el análisis estadístico se utilizó la prueba de t de student para medidas pariadas. Los resultados se expresan como promedio ± desviación estándar, nivel de significancia establecido en Pp≤0,05. Se identificaron diferencias estadísticamente significativas en el SGRQ (t= 5,42; p&lt;0,01), el CAT-Assessment Test (t= 2,30; p&lt;0,05), el índice BODE mostró diferencias estadísticamente significativas en la puntuación total (t= 5,16; p&lt;0,01) y la mortalidad global al año (t= 4,01; p&lt;0,01). Se concluye que en las personas adultas mayores con enfermedad pulmonar crónica el Programa de Reacondicionamiento Físico para Adulto Mayor con Enfermedad Pulmonar Crónica; produjo mejoras en la calidad de vida relacionada con la salud.

Assessment of Quality of Life Among Patients After Lung Transplantation: A Single-Center Study

IntroductionLung transplantation (LTx) is the only effective method of treatment to improve the health and quality of life (QoL) of patients with end-stage lung diseases. After LTx, medical examination accompanied by quality of life assessment should be performed on routine follow-up visits. The aim of the study was to assess the QoL of patients after LTx. Material and methodsThe study group consisted of 60 patients (29 women and 31 men); 20 patients received single lung transplantation (SLT), and 40 received double lung transplantation (DLT). To determine the patient’s QoL, the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Test–BREF (WHOQOL-BREF), and the Saint George Respiratory Questionnaire (SGRQ) were used. Spirometry and the 6-minute walk test were analyzed to examine efficiency of transplanted organs. ResultsIn SGRQ there are differences between patients with cystic fibrosis and interstitial lung disease in symptom domain (20.28% vs 39.26%, P = .025) and total score (19.38% vs 32.47%, P = .028). As reported in the GHQ, men had worse overall results than women in sten scale (5.22 points vs 4.69 points). Patients after SLT achieved similar scores in every questionnaire. ConclusionStudies assessing QoL should be an important addition to lung function tests and an integral part of control during postoperative follow-up visits. This study is one of the important contributions to understanding of how essential QoL is after LTx. The authors of this study realize that their work does not cover the whole issue, and further studies in this area are warranted.

Predictive factors over time of health-related quality of life in COPD patients

BackgroundHealth-related quality of life (HRQoL) should be seen as a tool that provides an overall view of the general clinical condition of a COPD patient. The aims of this study were to identify variables associated with HRQoL and whether they continue to have an influence in the medium term, during follow-up.MethodsOverall, 543 patients with COPD were included in this prospective observational longitudinal study. At all four visits during a 5-year follow-up, the patients completed the Saint George’s Respiratory Questionnaire (SGRQ), pulmonary function tests, the 6-min walk test (6MWT), and a physical activity (PA) questionnaire, among others measurements. Data on hospitalization for COPD exacerbations and comorbidities were retrieved from the personal electronic clinical record of each patient at every visit.ResultsThe best fit to the data of the cohort was obtained with a beta-binomial distribution. The following variables were related over time to SGRQ components: age, inhaled medication, smoking habit, forced expiratory volume in one second, handgrip strength, 6MWT distance, body mass index, residual volume, diffusing capacity of the lung for carbon monoxide, PA (depending on level, 13 to 35% better HRQoL, in activity and impacts components), and hospitalizations (5 to 45% poorer HRQoL, depending on the component).ConclusionsAmong COPD patients, HRQoL was associated with the same variables throughout the study period (5-year follow-up), and the variables with the strongest influence were PA and hospitalizations.

4433 SGRQ score is associated with treatment status for patients with non-tuberculous mycobacterial lung disease

OBJECTIVES/GOALS: The Saint Georges Respiratory Questionnaire (SGRQ) is used as a patient reported outcome tool for clinical research in COPD and bronchiectasis. We established a registry and biospecimen repository of bronchiectasis patients with and without NTM and report associations between clinical phenotype and SGRQ scores. METHODS/STUDY POPULATION: Patients were recruited in a cross-sectional format from the Bronchiectasis, Cystic Fibrosis, and NTM clinics at our institution. All patients provided at least one sputum sample in the six months prior to inclusion. Clinical and epidemiologically relevant data was obtained, and blood specimens were processed and preserved. Patients were grouped based on clinical phenotype and differences in SGRQ scores were analyzed using ANOVA or Student’s t-test. Descriptive statistics are reported as means and standard deviations, p&lt;0.05 considered significant. RESULTS/ANTICIPATED RESULTS: 72 NTM patients completed the SGRQ including 39 patients not on treatment (Colonized), 29 patients on NTM directed antibiotics, and 4 patients whose infection was cured in the past year. Among patients on treatment, 14 were treatment refractory (positive cultures beyond 12 months of therapy). The mean age of all NTM patients was 59.5±17.6 and 80.5% were female. Mean SGRQ Total scores were significantly higher among patients receiving treatment compared to patients considered colonized (35.7± 22.0 colonized group versus 48.8± 15.8 treatment group, p = 0.011). The SGRQ subdomain scores including Impacts (26.2± 26.2 colonized group versus 42.5± 17.0 treatment group, p = 0.01) and Activities (41.7± 31.8 colonized group versus 59.3± 24.5 treatment group, p = 0.018) were also significantly different between groups. DISCUSSION/SIGNIFICANCE OF IMPACT: We developed a cross sectional cohort of NTM patients and assessed associations between clinical phenotype and SGRQ score. Preliminary data suggests that female sex, treatment status, and therapeutic duration are associated with higher SGRQ scores. We intend to continue to assess the potential for specific SGRQ questions to be used for quantifying disease symptom severity for NTM patients.

THU0616-HPR EXPIRATORY FLOW ACCELERATOR (EFA) IN SYSTEMIC SCLEROSIS PATIENTS WITH MUCUS HYPERSECRETION, PRODUCTIVE COUGH AND DYSPNOEA: PRELIMINARY RESULTS FROM A HOME-BASED AIRWAY CLEARANCE TECHNIQUE DAILY PROGRAM

Background:Systemic sclerosis (SSc) is a chronic disease with frequent lung involvement. As mucociliary clearance is impaired, mucus retention and frequent pulmonary infections, increase morbidity and mortality (1).Airway clearance techniques (ACT) enhance removal of mucus from the airways. Expiratory flow accelerator (EFA) is a new technology that promotes deep and gentle drainage of the bronchial secretions, through the Venturi effect. No respiratory effort is required and no negative pressure is generated, avoiding risk of bronchial collapse (2).Objectives:The aim of this study was to describe the effectiveness of EFA in improving pulmonary symptoms in SSc patients.Methods:SSc patients with daily productive cough, frequent pulmonary exacerbations, exertional dyspnea and/or reduced physical activity were selected. All of them underwent a home-based ACT program with EFA. A Respiratory Physiotherapist (RT) trained each patient to use the device 3 times a day, 15 minutes each session. Every subject compiled the Saint George’s Respiratory Questionnaire (SGRQ) and scleroderma Health Assessment Questionnaire (SHAQ) at baseline, 30, 90 and 180 days from the beginning. Statistical analysis has been carried out with General linear model for repeated measures. A value of p&lt;0.05 was considered statistically significant.Results:8 patients were enrolled (M:F=1:7), median age 54 (IC95% 46-69) years. Interstitial lung disease affected the majority of them (7/8). SGRQ total score and SHAQ domain for respiratory symptoms decreased over time (p= 0.003 and p= 0.005). In particular, there was an improvement in two SGRQ domains: activities (p= 0.013) and symptoms (p= 0.005) (fig.1).Figure 1Conclusion:This is the first study to investigate the effect of EFA technology on airway clearance in SSc patients. The observations suggest the importance of a daily ACT program with EFA in improving respiratory symptoms. This technology appear to be extremely promising in SS patient management as it is well tolerated and it has the potential to slow down the pulmonary disease progression by limiting bronchial infections.

Health-related quality of life associates with change in FEV1 in COPD: results from the COSYCONET cohort

BackgroundForced expiratory volume in one second (FEV1) characterizes the pathophysiology of COPD and different trajectories of FEV1 decline have been observed in patients with COPD (e.g. gradual or episodic). There is limited information about the development of patient-reported health-related quality of life (HRQL) over the full range of the natural history of COPD. We examined the longitudinal association between change in FEV1 and change in disease-specific and generic HRQL.MethodsWe analysed data of 1734 patients with COPD participating in the COSYCONET cohort with up to 3 years of follow-up. Patients completed the Saint George’s Respiratory Questionnaire (SGRQ) and the EQ-5D Visual Analog Scale (EQ VAS). Change score models were used to investigate the relationship between HRQL and FEV1 and to calculate mean changes in HRQL per FEV1 change categories [decrease (≤ − 100 ml), no change, increase (≥ 100 ml)] after 3 years. Applying hierarchical linear models (HLM), we estimated the cross-sectional between-subject difference and the longitudinal within-subject change of HRQL as related to a FEV1 difference or change.ResultsWe observed a statistically significant deterioration in SGRQ (total score + 1.3 units) after 3 years, which was completely driven by the activity component (+ 4 units). No significant change was found for the generic EQ VAS. Over the same period, 58% of patients experienced a decrease in FEV1, 28% were recorded as no change in FEV1, and 13% experienced an increase. The relationship between HRQL and FEV1 was found to be approximately linear with decrease in FEV1 being statistically significantly associated with a deterioration in SGRQ (+ 3.20 units). Increase in FEV1 was associated with improvements in SGRQ (− 3.81 units). The associations between change in FEV1 and the EQ VAS were similar. Results of the HLMs were consistent and highly statistically significant, indicating cross-sectional and longitudinal associations. The largest estimates were found for the association between FEV1 and the SGRQ activity domain.ConclusionsDifference and change in FEV1 over time correlate with difference and change in disease-specific and generic HRQL. We conclude, that deterioration of HRQL should induce timely re-examination of physical status and lung function and possibly reassessment of therapeutic regimes.Trial registrationNCT01245933. Date of registration: 18 November 2010.

Força muscular, funcionalidade e distância percorrida em pacientes com doença pulmonar obstrutiva crônica

INTRODUÇÃO: O status funcional do indivíduo com Doença Pulmonar Obstrutiva Crônica (DPOC), considerado um indicador preditivo de agravo do quadro clínico e qualidade de vida dessa população. OBJETIVO: Analisar a força muscular, morbidade, qualidade de vida e distância percorrida em pacientes com DPOC e comparar com o grupo não DPOC. MÉTODOS: Foram avaliados 58 voluntários, 29 do grupo DPOC, classificados em GOLD II e 29 o grupo não DPOC, com os seguintes parâmetros mensurados: função pulmonar; variáveis antropométricas; força muscular; morbidade mediante o índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE); qualidade de vida com o questionário do Saint George's Respiratory Questionnaire (SGRQ); capacidade pulmonar através da distância percorrida no teste de caminhada de seis minutos. Para análise estatística, realizado o teste de Shapiro Wilk e os testes de Mann-Whitney ou t de Student, assim como o teste de correlação de Pearson, para valores de p &lt; 0,05. RESULTADOS: A idade média total foi de 61±7 anos, a força de extensores de joelho (p:0,0004), com valores de força menores para o grupo DPOC 110,61±41,69; em comparação com do grupo não DPOC 156,31±44,09, destaca-se ainda a força de flexores de cotovelo (p 0,004), com 96,34±26,15 para grupo DPOC, em comparação ao grupo não DPOC 118,19±34,71. Na distância percorrida do TC6M o grupo DPOC percorreu uma média de 274± 107,86 e o grupo não DPOC 384,98±100,47 (p&lt;0,05). O BODE apresentou correlação de (r = -0,79) com a distância percorrida no TC6M e de (r =0,72) com o Saint George total. CONCLUSÕES: Os pacientes com DPOC apresentaram redução da força muscular de membros superiores, extensores de joelho e da distância percorrida, ao comparar com o grupo não DPOC.

Prevalence of metabolic syndrome in patients with chronic obstructive pulmonary disease: An observational study in South Indians

Background and aimsMetabolic syndrome (MetS) has a significant association with airflow obstruction and physical inactivity, which are the relevant extra-pulmonary markers of chronic obstructive respiratory disease (COPD). This study aimed to estimate the prevalence of MetS and its correlation with comorbidities and health related quality of life (HRQoL) in South Indian patients with COPD. MethodsA cross-sectional study was conducted among the 76 COPD patients. Pulmonary function test (PFT) and parameters for MetS such as waist circumference, blood pressure, fasting blood glucose, triglycerides (TGs) and high density lipoprotein cholesterol (HDL-C) levels of COPD patients were measured. HRQoL was calculated using Saint George Respiratory Questionnaire (SGRQ). Results54% of COPD patients were presented with MetS especially in stage II and III. TGs and HDL-C were significantly associated with the severity of COPD (p < 0.05), while waist circumference, TGs and HDL-C were significantly (p < 0.05) correlated with PFT. Symptom, activity, impact and total scores of SGRQ was increased statistically (p < 0.05) in COPD patients with MetS than without MetS. ConclusionAccording to our findings, screening the grade II and III COPD patients for the presence of MetS is a reasonable option. The results of this study should be confirmed with a larger sample of population.

Validity and Reliability of the Turkish Version of the London Chest Activity of Daily Living Scale in Obstructive Lung Diseases.

The London Chest Activity of Daily Living Scale (LCADL) is a simple, useful, and comprehensive measure of dyspnea perception in activities of daily living. This study was conducted to determine the validity and reliability of the Turkish version of the LCADL. A total of 64 patients with obstructive lung disease (24 chronic obstructive pulmonary disease, 20 asthma, and 20 bronchiectasis patients) were included. The Turkish LCADL was evaluated for interobserver reliability, test-retest reliability, and criterion validity. Two different observers applied the scale with an interval of 10 minutes to assess interobserver reliability. The second observer applied the scale twice at an interval of 10-15 days to assess test-retest reliability. Criterion validity was assessed using the 6-minute walk test (6MWT), Nottingham Health Profile (NHP), and Saint George Respiratory Questionnaire (SGRQ). The interobserver reliability of the scale was very high (rs=0.985, p<0.050). Cronbach's alpha coefficient for total score was 0.976 and intraclass correlation coefficient was 0.953. These results indicate that the Turkish LCADL has high reliability. The correlation between LCADL and 6MWT was moderate 0.503 (p=0.002). The LCADL total score was weakly correlated with NHP total score (rs=0.370, p=0.040) and SGRQ total score (rs=0.367, p=0.004). The Turkish version of the LCADL scale is reliable and valid in obstructive lung disease. The LCADL scale will be beneficial in existing pulmonary rehabilitation programs aiming to improve functional status. We believe that using the Turkish LCADL scale as an outcome measure in pulmonary rehabilitation programs will serve as an indicator of rehabilitation efficacy for individual patients.

Efficacy of Pulmonary Exercises in Chronic Obstructive Pulmonary Disease

Objective: The aim of this study was to determine the effectiveness of pulmonary rehabilitation on respiratory parameters, aerobic exercise capacity, quality of life and psychological status of the patients with chronic obstructive pulmonary disease (COPD). The addition of aerobic exercise on pulmonary exercises was also evaluated to provide further improvements on these parameters. Methods: Sixty-five patients were randomly assigned to carry out pulmonary exercise, combined (respiratory plus aerobics) and, a control groups. Demographic characteristics were noted. Respiratory function tests, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) values and, exercise tolerance test (ETT) were assessed. Medical Research Council (MRC) dyspnea scale, body mass index (B), airway obstruction (O), dyspnea scale (D), exersice capacity (E) (BODE) index, Short Form 36 (SF-36), and Saint George Respiratory Questionnaire (SGRQ) obtained from each patient were recorded before the treatment, and after the 8-week treatment. Results: After the treatment significant increases were found in forced expiratory volume-one second (FEV1), FEV1/forced vital capacity (FVC) ratio, PImax, PEmax values in pulmonary and combined exercise groups, and FVC, vital capacity (VC) values in combined exercise group (p&amp;lt;0.05 for all parameters). Statistical differences were observed in both exercise groups regarding MRC Dyspnea score, Maksimum Equivalent Task (MET) values, SGRQ and some parameters of SF-36 (p&amp;lt;0.05 for all parameters). In the control group no noticeable difference was observed in any of the parameters. After treatment there was no difference between pulmonary and combined exercise group in any parameters (p&amp;lt;0.05). Conclusion: Both pulmonary and combined exercise programs improved exercise capacity, dyspnea, and the life quality of the COPD patients.