Saint George's Respiratory Questionnaire Research Articles

Endobronchial valve treatment improves Chest-CT diaphragm configuration in COPD

This study investigated the impact of bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) on diaphragm configuration. We successfully analyzed the diaphragm index using a newly developed quantitative computed tomography (QCT) tool before and after EBV treatment in forty patients with severe emphysema. We evaluated whether changes in the diaphragm index were associated with improvements in forced expiratory volume in one second (FEV1), residual volume (RV), Saint Georges Respiratory Questionnaire (SGRQ), and 6-minute walking distance (6MWD) using Spearman’s rho. The EBV treatment influenced the diaphragm configuration only on the treated side, resulting in an increased diaphragm curvature. There were significant associations of relative diaphragm index changes on the treated lung side or the entire diaphragm with improvements in FEV1 and 6MWD. These findings provide valuable insights into how EBV treatment affects the diaphragm in COPD patients.

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<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.

Broncho-obstructive syndrome and the enzymes of cellular energy metabolism after coronavirus infection

Broncho-obstructive syndrome (BOS) after coronavirus infection is characterized by long-term, dry and painful cough which is hard for treatment, significantly reducing the quality of life of the patients. The goal of the study: to investigate the specific features of clinical manifestations of BOS diagnosed for the first time in patients belonging to different age groups in post-COVID-19 period and to estimate the degree of mitochondrial dysfunction by the imbalance of the enzymes of cellular energy metabolism. Materials and methods. 298 patients with BOS (age 18–78) were observed continuously for 2 years. Standard clinical, biochemical and functional examination was carried out, Saint George`s Respiratory Questionnaire (SGRQ) was used. Mitochondrial dysfunction was determined by the ratio of levels of two enzymes, lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH), in peripheral blood lymphocytes. Statistical data processing was performed in STATISTICA 10.1 program package. Results. The duration and severity of BOS manifestations increased with age, they were the most prominent in the age group older than 60 y/o. Bronchial asthma was diagnosed for the first time in 85 patients, most of them belonging to the group 18–25 y/o. In all the patients with BOS, the SGRQ coeffitient was above 50, and comorbidity was established in 82.4% of the patients. The longest duration of BOS (49.4±3.5 days) was established in the group older than 60 y/o (n = 86). LDH/SDH ratio decreased from 6 to 4.8–5.2 a.u. in all the age groups. Such changes should be taken into account in the patients from young age groups. Conclusion. The revealed low values of LDH/SDH ratio have not been shown in the available literature earlier. These values demonstrate the development of secondary mitochondrial dysfunction in post-COVID-19 period in both younger and older age groups, particularly, in patients with more severe progression of BOS. Estimation of this parameter would allow to revealthe personified characteristics for each patients, which is important for quantifying the efficacy and duration of the required antioxidant therapy.

Effectivity of Telemonitoring Toward Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Introduction: Chronic obstructive pulmonary disorder (COPD) is the third-leading cause of death worldwide. COPD treatment is essential to manage and attenuate the progression of symptoms. Home-based telemonitoring interventions showed several promises in increasing COPD patients’ quality of life (QoL) and outcomes. However, various results were obtained in recent studies, making a secondary research presence needed to establish clear risks and benefits. This study aimed to analyze the effect of telemonitoring on QoL among COPD patients. Methods: This study used the Preferred Reporting Items of Systematic Review and Meta-Analysis (PRISMA) reporting guidelines on several databases from February until April 2023. We performed screening and selection, followed by data extraction and quantitative analysis with Review Manager 5.4 Software. The risk of bias assessment was performed using the RoB 2.0 Cochrane tool. Results: Ten randomized controlled trials (RCTs), mostly low-risk of bias, were included. We found a reduction in Saint George's Respiratory Questionnaire (SGRQ) score (mean difference (MD) -1.13 [95% CI -4.23, 1.97; p = 0.47]) and Hospital Anxiety and Depression Scale (HADS) for anxiety (MD-0.16 [95% Cl -0.96, 0.63; p = 0.69]). There was no significant effect of HADS on depression and EuroQol-5 Dimension (EQ-5D). Conclusion: This study suggests that telemonitoring improves QoL in COPD patients, especially for SGRQ and HADS anxiety scores. We suggest a larger number of studies to evaluate the effect of telemonitoring on depression and anxiety. We also encourage the integration of telemedicine with the present care system to achieve the best beneficial outcome for patients.

Sex differences and determinants of anxiety symptoms in patients with COPD initiating pulmonary rehabilitation

BackgroundAnxiety is common in patients with chronic obstructive pulmonary disease (COPD). However, there is little evidence available regarding gender differences, and severity of dyspnea in relation to anxiety in patients with COPD. AimsWe examined gender differences and the association of dyspnea with anxiety in a cohort of patients with COPD prior to entering a pulmonary rehabilitation (PR) program. MethodWe analyzed data from a prospective cohort of COPD patients who attended PR from 2013 to 2019 in Lytham, Lancashire, UK. Patients were aged 40 years or older with a post-bronchodilation forced expiratory volume in 1 s (FEV1) less than 80 % of the predicted normal value and FEV1/FVC (forced vital capacity) ratio less than 0.7. We assessed quality of life (QoL) using the Saint George's Respiratory Questionnaire (SGRQ), anxiety using the Anxiety Inventory for Respiratory disease (AIR), dyspnea using the modified Medical Research Council (mMRC) scale, and exercise capacity using the Incremental Shuttle Walk Test (ISWT). ResultsNine hundred ninety-three patients with COPD (mean age = 71 years, FEV1/FVC = 58 % predicted, 51 % male) entered the PR program. Of these, 348 (35 %) had anxiety symptoms (AIR ≥8); of these 165 (47 %) were male and 183 (53 %) female, (χ2 = 3.33, p = 0.06). On logistic multivariate analysis, the following variables were independently associated with elevated anxiety: younger age (p < 0.001), female sex (p = 0.03), higher SGRQ-total score (p < 0.001) and high FEV1/FVC (p < 0.002). Dyspnea was associated with anxiety r = 0.25, p < 0.001. ConclusionOver a third of COPD patients had clinically relevant anxiety symptoms with a higher prevalence in women than men. Anxiety was associated with younger age, female gender, and impaired QoL. Early recognition and treatment of anxiety in patients with COPD is worthy of consideration for those attending PR, especially women.

Evaluating performance on the Glittre-ADL test in men with long COVID 3 years after a SARS-CoV-2 infection

Background/objectiveMany COVID-19 survivors, especially those who have been hospitalized, have been suffering numerous complications that limit their activities of daily living, although changes that persist 3 years after infection are still not known. We aimed to investigate the impact of long COVID on the Glittre-ADL test (TGlittre) 3 years after acute infection in men who needed hospitalization and explore whether the performance on the TGlittre is associated with impairments in lung function, muscle strength, physical function and quality of life (QoL). MethodsCross-sectional study with 42 men with long COVID who took the TGlittre. They underwent pulmonary function tests and measurements of handgrip strength and quadriceps strength (QS). Additionally, they also completed the Saint George Respiratory Questionnaire (SGRQ) and Functional Independence Measure (FIM). ResultsThe mean age was 52 ± 10.6 years, while the mean time after diagnosis of COVID-19 was 37 ± 3.5 months. The mean TGlittre time was 3.3 (3.1–4.1) min, which was 10% greater than the time expected for normal individuals to complete it. The TGlittre time was correlated significantly with the QS (rs = −0.397, p = 0.009), pulmonary diffusion (rs = − 0.364, p = 0.017), FIM (rs = −0.364, p = 0.017) and the “activity” domain score of the SGRQ (rs = 0.327, p = 0.034). ConclusionFunctional capacity on exertion as measured by the TGlittre time is normal in most men with long COVID 3 years after hospitalization. However, this improvement in functional capacity does not seem to be reflected in muscle strength or QoL, requiring continued monitoring even after 3 years.

Bronchiectasis Severity Index and FACED scores in patients with allergic bronchopulmonary aspergillosis complicating asthma: do they correlate with immunological severity or high-attenuation mucus?

Background The utility of two disease-severity indices, namely bronchiectasis severity index (BSI) and FACED score in allergic bronchopulmonary aspergillosis (ABPA) remains unknown. Objective To correlate the BSI and FACED scores with immunological parameters (serum IgE [total and A. fumigatus-specific], A. fumigatus-specific IgG, blood eosinophil count), and high-attenuation mucus on chest computed tomography in ABPA. The secondary objectives were to evaluate the correlation between BSI and FACED scores and correlate the BSI/FACED scores with the bronchiectasis health questionnaire (BHQ) and Saint George’s Respiratory Questionnaire (SGRQ). Methods We included treatment-naïve ABPA subjects with bronchiectasis in a prospective observational study. We computed the BSI and FACED scores for each subject before initiating treatment. The subjects also completed two quality-of-life questionnaires (BHQ and SGRQ). Results We included 91 subjects. The mean (standard deviation) BSI and FACED scores were 3.43 (3.39) and 1.43 (1.27). We found no correlation between BSI or FACED with any immunological parameter or high-attenuation mucus. There was a strong correlation between BSI and FACED scores (r = 0.76, p < 0.001). We found a weak correlation between BSI and BHQ/SGRQ and FACED and SGRQ. Conclusion We found no correlation between BSI and FACED with immunological parameters in ABPA. However, we found a significant correlation between BSI and FACED and a weak correlation between SGRQ and BHQ. ABPA likely requires a separate disease-severity scoring system.

Influence of physical activity on the prognosis of COPD patients: the HADO.2 score - health, activity, dyspnoea and obstruction.

The aim of this study was to create a prognostic instrument for COPD with a multidimensional perspective that includes physical activity (PA). The score also included health status, dyspnoea and forced expiratory volume in 1 s (HADO.2 score). A prospective, observational, non-intervention study was carried out. Patients were recruited from the six outpatient clinics of the respiratory service of a single university hospital. The component variables of the HADO.2 score and BODE index were studied, and PA was measured using an accelerometer. The outcomes for the HADO.2 score were mortality and hospitalisations during follow-up and an exploration of the correlation with health-related quality of life at the moment of inclusion in the study. 401 patients were included in the study and followed up for three years. The HADO.2 score showed good predictive capacity for mortality: C-index 0.79 (0.72-0.85). The C-index for hospitalisations was 0.72 (0.66-0.77) and the predictive ability for quality of life, as measured by R2, was 0.63 and 0.53 respectively for the Saint George's Respiratory Questionnaire and COPD Assessment Test. There was no statistically significant difference between the mortality predictive capacity of the HADO.2 score and the BODE index. Adding PA to the original BODE index significantly improved the predictive capacity of the index. The HADO.2 score, which includes PA as a key variable, showed good predictive capacity for mortality and hospitalisations. There were no differences in the predictive capacity of the HADO.2 score and the BODE index.

Impact of telephone follow-up on COPD outcomes in pulmonary rehabilitation patients: A randomized clinical trial.

The educational component is a comprehensive part of Pulmonary Rehabilitation (PR), and telephone follow-up (TFU) is an alternative to reinforce face-to-face education. The objective was to determine the effect of telephone follow-up on educational needs, dyspnea, quality of life and functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients undergoing PR. Double-blind randomized controlled clinical trial in patients with COPD in a PR program in Cali-Colombia, allocation by randomization tables. All patients received 24 sessions of PR, which included face-to-face education sessions. In addition, the experimental group received telephone calls twice a week to reinforce the face-to-face educational content. The Lung Information Needs Questionnaire (LINQ) was used to measure disease knowledge, the Saint George's Respiratory Questionnaire to measure quality of life, the modified Medical Research Council (mMRC) scale to measure dyspnea, and the 6-minute walking test (6MWT) to measure functional capacity. Thirty-four patients were randomized and 31 were analyzed. PR group with conventional education (PRTE) n=15 and PR group with education plus telephone follow-up (PRTETFU) n=16. Significant improvement from baseline to endpoint in both groups: LINQ (PRTE 4±1.1, p=0.003, PRTETFU 5.8±10.6, p=0.000), mMRC (PRTE 1.6±0.3, p=0.000, PRTETFU 0.6±0.3, p=0.036) and functional capacity (PM6M: PRTE 45.9m±16.1, p=0.013, PRTETFU 62.8m±21.4, p=0.010). Analysis showed differences between groups for changes in LINQ knowledge domain after intervention, with greater improvement for PRTETFU (p=0.018). The TFU is an alternative to reinforce the education. This study demonstrated greater positive effects for the autonomous management of the pathology. Adding educational reinforcement through phone calls to patients with COPD during PR leads to improved knowledge and skills for managing the disease.

Stable COPD Picture through Exhaled Breath Condensate, Questionnaires and Tests. A Proof of Concept Study

Background: Changes in lung structures persist in stable Chronic Obstructive Pulmonary Disease (COPD), but their correlation with the clinical picture remains unclear. The purpose of this study was to assess the stable COPD picture via the relationship between exhaled breath condensate (EBC) particle concentration and the Saint George Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and six-minute walking test (6 MWT). Methods: 12 stable COPD and 12 healthy subjects participated in the study. The EBC was collected with Rtube and analyzed using the Accusizer FxNano. Particle concentration was measured and correlated with the findings of the tools used to assess the health status and functional profile of COPD. The results’ analysis was performed with the Spearman’s test and the Mann-Whitney U - test. Results: The COPD group presented a worse picture of health status and functional profile compared to the healthy group. Correlations were observed between components of the SGRQ and CAT. The two groups presented similar levels of EBC particle concentrations, but the number of small particles was higher in COPD subjects. A correlation of the EBC particle concentration with the activity and total score of the SGRQ was only observed in the healthy group. Conclusion: The total particle number was similar in the COPD and healthy groups. A few correlations between the EBC particles and tools used were also observed. The use of EBC particle concentration to monitor COPD status cannot be claimed with confidence because of the small sample size. Further research is necessary, particularly in large-scale groups.

Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease.

Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software. Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.

Current cough and sputum assessed by the cough and sputum assessment-questionnaire (CASA-Q) is associated with quality of life impairment in cystic fibrosis

BackgroundCough and sputum are major symptoms in cystic fibrosis (CF) that contribute to the impairment of quality of life.MethodsThis prospective single centre cross-sectional pilot study aimed to evaluate the results of a self-administered questionnaire assessing cough and sputum symptoms (2 domains), and their impact (2 domains) on daily activities in the previous week, named the Cough and Sputum Assessment Questionnaire (CASA-Q) in CF adult patients at stable state, and to analyse associations with clinical, functional, microbiological, radiological data, and two quality of life scales: the Cystic Fibrosis Questionnaire Revised (CFQ-R) and the Saint George Respiratory Questionnaire (SGRQ).ResultsForty-eight patients were included in this analysis (69% men; median age of 27.8 ± 8.1 years; median body mass index of 21.8 + 3.3 kg/m²; mean FEV1 of 64 ± 30% of the predicted value). The mean values of the CASA-Q domains were 58 ± 23 for cough symptoms, 77 ± 24 for cough impact, 62 ± 25 for sputum symptoms and 84 ± 21 for sputum impact. Impairment in CASA-Q cough and sputum domains was associated with dyspnea mMRC scale (p < 0.005 for all 4 domains of CASA-Q) and exacerbations in the previous year (p < 0.05 for CASA-Q symptoms domains). We also found correlations between all domains of the CASA-Q and quality of life questionnaires including SGRQ (p < 0.001) and to a lesser extend CFQ-R. We identified a clinical phenotype (female gender, ΔF508 heterozygous mutation, dyspnea mMRC scale) associated with an impairment of CASA-Q score and quality of life using a 2-step cluster analysis.ConclusionsCASA-Q allows the assessment of cough and sputum in CF adult patients and is associated with quality of life impairment. This simple easy-to-use tool could be used in routine clinical practice and in clinical studies to assess cough and sputum in CF patients.Trial RegistrationThe study was registered on ClinicalTrials.gov (NCT02924818, first posted on 5th October 2016).

King's Sarcoidosis Questionnaire (KSQ) - Validation study in Serbian speaking population of sarcoidosis patients.

Sarcoidosis is a multiorgan, multisystem chronic disease of unknown etiology and unpredictable course. Health status is reduced in sarcoidosis and assessing it is a difficult multitask effort due to many faces this disease might have. Recently, a new questionnaire for assessing health status in sarcoidosis was developed by a group of authors from England-King's Sarcoidosis Questionnaire (KSQ). The benefit of KSQ is the ability to develop the best care plan for the patient, as well as to differentiate the efficacy of the administered treatment. The aim of this study was to validate the KSQ in Serbian speaking population of sarcoidosis patients. The test itself is a modular, multi-organ health status measure for patients with sarcoidosis for use in clinic and the evaluation of therapies. The correlation of KSQ with different clinical course of sarcoidosis (acute vs chronic disease) and with the clinical outcome status (COS) in sarcoidosis was also investigated. A total of 159 biopsy positive sarcoidosis patients participated in this study. The average age of the participants was 49.67, majority was female (67.3%) and majority had only pulmonary form of sarcoidosis (71.7%). KSQ - new disease-specific health status instrument, was compared with 5 other already existing instruments already used and validated in sarcoidosis (Saint George Respiratory Questionnaire- SGRQ, Daily Activity List -DAL, Fatigue Assessment Scale- FAS, Medical Research Council dyspnea scale-MRC, Borg Dyspnea Scale and 15D as general questionnaire. KSQ has significant correlation with other quality of life questionnaires already used in sarcoidosis. Translated version of KSQ shows significant internal reliability, similar to the original KSQ. Serbian version of KSQ has significant correlation with different clinical course of sarcoidosis and with COS as well. The translated version of KSQ is reliable sarcoidosis specific instrument for assessing health status in these patients.

Clinical significance of normalized airflow obstruction in patients with chronic obstructive pulmonary disease

BackgroundThere is ongoing debate regarding the diagnostic criteria for chronic obstructive pulmonary disease (COPD); recent studies have focused on the early COPD detection and management. Here, we compared clinical features and prognosis in patients with FEV1/FVC<0.70 at baseline, according to normalized airflow obstruction status during follow-up. MethodsWe used the Korea COPD Subgroup Study (KOCOSS) cohort database, a prospective nationwide observational COPD study. Normalized obstruction (NO) was defined as FEV1/FVC ≥0.7 in the 2-year follow-up period, whereas fixed obstruction (FO) was defined as FEV1/FVC <0.7. Demographic and clinical data, 1-year exacerbation risk and difference in FEV1 decline over 2 years were compared between NO and FO groups. ResultsAmong the 670 COPD patients with post-bronchodilator FEV1/FVC <0.7 in this study, 95 (14.2%) displayed NO. Compared with the FO group, the NO group had higher FEV1, and DLCO, body mass index, as well as lower Saint George Respiratory Questionnaire, Beck Depression Index, and Beck Anxiety Index. Blood eosinophil count, IgE level, and FeNO did not significantly differ between two groups. There was no significant difference in exacerbation frequency between the two groups, but the NO group had a significant increase in FEV1 compared with the FO group during follow-up. ConclusionTransient airflow obstruction in the NO group may represent a clinical manifestation of early COPD; close monitoring is needed for such patients.

Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD.

To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity. The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: "amount" domain = 0.87 (95% CI, 0.73-0.94) and "difficulty" domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = -0.63). The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

Effectiveness of Paced Breathing Guided by Biofeedback on Clinical and Functional Outcomes Patients with Chronic Obstructive Pulmonary Disease: An Uncontrolled Pilot Study.

To investigate the effectiveness of paced breathing guided by biofeedback on clinical and functional outcomes of patients with chronic obstructive pulmonary disease (COPD). An uncontrolled pilot study comprising a training with paced breathing guided by biofeedback (three sessions of 35min per week) was conducted over four weeks (12 sessions). Assessments included respiratory muscle strength (using a manovacuometer), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), dyspnea (Baseline Dyspnea Index), functionality (Timed Up and Go Test), health status (COPD Assessment Test) and health-related quality of life (Saint George's Respiratory Questionnaire). The sample consisted of nine patients with a mean age of 68.2 ± 7.8years. After intervention, patients significantly improved in health status and health-related quality of life, assessed using the COPD Assessment Test (p < 0.001) and Saint George's Respiratory Questionnaire (p < 0.001); anxiety (p < 0.001); and depression (p = 0.001). Patients also significantly improved in dyspnea (p = 0.008), TUG (p = 0.015), CC Score (p = 0.031), and maximum inspiratory (p = 0.004) and expiratory pressures (p < 0.001). An intervention with paced breathing guided by biofeedback promoted positive results on dyspnea, anxiety, depression, health status and perceived health-related quality of life in patients with COPD. Moreover, gains in respiratory muscle strength and functional performance were observed, affecting the performance of daily activities.

Three-Month Variability of Commonly Evaluated Biomarkers in Clinically Stable COPD.

Clinical decisions in chronic obstructive pulmonary disease (COPD) treatment often utilize serially assessed physiologic parameters and biomarkers. To better understand the reliability of these tests, we evaluated changes in commonly assessed biomarkers over 3 months in patients with clinically stable COPD. We performed an observational prospective cohort study of 89 individuals with clinically stable COPD, defined as no exacerbation history within 3 months of enrollment. Biomarkers included lung function and functional performance status, patient-reported outcomes of symptoms and health status, and blood markers of inflammation. The correlation between testing at baseline and at 3-month follow-up was reported as the intraclass correlation coefficient (ICC). "Outliers" had significant variability between tests, defined as >1.645 standard deviations between the two measurements. Differences in clinical features between outliers and others were compared. Participants with COPD (n = 89) were 70.5 ± 6.7 years old, 54 (61%) male, had a 40 pack-year smoking history with 24.7% being current smokers, and postbronchodilator forced expiratory volume in one second (FEV1) 62.3 ± 22.7% predicted. The biomarkers with excellent agreement between the initial and the follow-up measurements were FEV1 (ICC = 0.96), Saint George's Respiratory Questionnaire (SGRQ) (ICC = 0.98), COPD Assessment Test (CAT) (ICC = 0.93) and C-reactive protein (CRP) (ICC = 0.90). By contrast, parameters showing less robust agreement were 6-minute walking distance (ICC = 0.75), eosinophil count (ICC = 0.77), erythrocyte sedimentation rate (ICC = 0.75) and white blood cell count (ICC = 0.48). Individuals with greater variability in biomarkers reported chronic bronchitis more often and had higher baseline SGRQ and CAT scores. Our study evaluated the stability of commonly assessed biomarkers in clinically stable COPD and showed excellent agreement between baseline and three-month follow-up values for FEV1, SGRQ, CAT and CRP. Individuals with chronic bronchitis and more symptomatic disease at baseline demonstrated greater variability in 3-month interval biomarkers.

Dyspnea-induced Limitation (DYSLIM), a new self-administered concise questionnaire to evaluate dyspnea-related activity limitation in chronic respiratory diseases

Background and aimFew questionnaires are available for routine assessment of dyspnea. The study aimed to design a self-administered questionnaire assessing the impact of chronic dyspnea on daily activities, named DYSLIM (Dyspnea-induced Limitation). MethodsThe development followed 4 steps: 1: selection of relevant activities and related questions (focus groups); 2: clinical study: internal and concurrent validity vs. modified Medical Research Council (mMRC), Baseline Dyspnea Index (BDI) and Saint George Respiratory Questionnaire (SGRQ); 3: item reduction; 4: responsiveness.Eighteen activities (from eating to climbing stairs) were considered with 5 modalities for each: doing the task slowly, taking breaks, seeking assistance, changing habits, and activity avoidance. Each modality was graded from 5 (never) to 1 (very often). Validation study included 194 patients: COPD (FEV1 ≥ 50% pred: n = 40; FEV1 < 50% pred: n = 65); cystic fibrosis (n = 30), interstitial lung disease (n = 30), pulmonary hypertension (n = 29). Responsiveness was evaluated by post-pulmonary rehabilitation data in 52 COPD patients. ResultsAcceptability was high and short term (7 days) reproducibility was satisfactory (Kappa mostly above 0.7). Concurrent validity was high vs. mMRC (Spearman correlation coefficient, r = 0.71), BDI (r = - 0.75) and SGRQ (r = - 0.79). The reduced questionnaire with 8 activities (from cleaning to climbing stairs) and 3 modalities (slowly, seeking help, changing habits) showed a comparable validity and was chosen as the final short version. Effect size of rehabilitation was good for both the full (0.57) and short (0.51) versions. A significant correlation was also found between changes of SGRQ and DYSLIM post rehabilitation: r = - 0.68 and r = - 0.60 for full and reduced questionnaires, respectively. ConclusionThe DYSLIM questionnaire appears promising for the evaluation of dyspnea-induced limitations in chronic respiratory diseases and seems suitable for use in various contexts.

Cross-sectional validation of the COPD Assessment Test (CAT) among chronic obstructive pulmonary disease patients in rural Uganda.

Measuring quality of life is a key component in the management of Chronic Obstructive Pulmonary Disease (COPD). The COPD assessment test (CAT), an easy to administer and shorter instrument than the standard Saint George's respiratory questionnaire (SGRQ), could be an alternative tool for measuring the quality of life of COPD patients in rural Uganda. A cross-sectional study was conducted between June and August 2022, consecutively recruiting 113 COPD patients aged > 40 years from the Low-Dose Theophylline for the management of Biomass-associated COPD (LODOT-BCOPD) study. Upon obtaining consent, participants answered an interviewer administered social demographic, CAT and SGRQ questionnaire. Internal consistency for both SGRQ and CAT was determined using Cronbach's alpha coefficient and values > 0.7 were considered acceptable while correlations were determined using Spearman's rank correlation. Limits of Agreement were visualised using Bland Altman and pair plots. Of the 113 participants, 51 (45.1%) were female. The mean age was 64 ± 12 years, 19 (16.8%) had history of smoking while majority (112 (99.1%)) reported use of firewood for cooking. There was a strong correlation of 0.791 (p < 0.001) between the CAT and SGRQ total scores with a high internal consistency of CAT, Cronbach's alpha coefficient of 0.924 (0.901-0.946). The agreement between the absolute CAT scores and the SGRQ scores was good with a mean difference of -0.932 (95% Confidence Interval: -33.49-31.62). In summary, CAT has an acceptable validity and can be used as an alternative to the SGRQ to assess the quality of life of COPD patients in rural Uganda.

Evaluation the Effect of Sublingual Glutathione on the Quality of Life in COPD Patient by Using Saint George respiratory questionnaire

Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder of the airways associated with airway narrowing with airflow obstruction leading to difficulty in breathing impair daily activity and cause poor quality of life. Patients and methods: Fifty patients whom diagnosed with COPD are divided into two groups, 1st control group includes 25 patients assigned to receive conventional therapy of Formoterol fumarate 12 microgram inhaler twice daily, and 2nd interventional group also includes 25 patients assigned to receive conventional therapy with (300 mg/ 2 times daily) sublingual glutathione for two months. Saint George respiratory questionnaire (SGRQ) were measured before and after first and second months after treatment in both study groups. Aim of the study: This study was object to assess the changes in quality of life by using SGRQ following sublingual glutathione supplements therapy in COPD patients. Results and conclusion: After two months treatment , the mean values of SGRQ showed a significant increase compared to pre-treatment levels in both groups (P&lt;0.01). There was highly significant improvement in SGRQ in both COPD patients groups after 2 months of treatment with much significant improvement in intervention group which may indicate the beneficial effects of adding glutathione sublingually administered supplements in COPD patients conventional therapeutic regiment.