SGRQ-C Score Research Articles

Assessing the impact of a respiratory care bundle on health status and quality of life of chronic obstructive pulmonary disease patients in Jordan: A quasi-experimental study.

This study aimed to evaluate the effectiveness of a respiratory care bundle, including deep breathing exercises, incentive spirometry, and airway clearance techniques, on the quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients in Jordan. A quasi-experimental study design and convenience sampling method was used to recruit 120 COPD patients, with 54 in the intervention group and 66 in the control group. The intervention group received additional respiratory care bundle training, while the control group received only discharge instructions and an education program. The St. George's Respiratory Questionnaire (SGRQ-C) was used to assess participants' QoL before and after the intervention. Independent t-tests, paired t-tests, and analysis of covariance (ANCOVA) analysis were used to analyze the data. The study found no significant differences between patients' characteristics, health status, and SGRQ-C scores between the two groups at baseline. After the intervention, there were statistically significant differences in all SGRQ-C subscales, which were lower in the intervention group compared to the control group. The paired t-test showed significant reductions in all SGRQ-C symptoms components (t = 7.62, P < .001), activity component (t = 7.58, P < .001), impact component (t = 7.56, P < .001), and total scores post-intervention (t = 7.52, P < .001) for the intervention group. The ANCOVA analysis showed significant differences in scores of SGRQ-C components and total scores (f = 11.3, P < .001) post-intervention between the two groups. The study's findings suggest that providing additional respiratory care bundle training for COPD patients can significantly improve their QoL, as measured by the SGRQ-C scores. The respiratory care bundle intervention was effective in reducing COPD symptoms and improving the QoL of COPD patients. Healthcare providers should consider implementing respiratory care bundles as part of COPD management to improve patients' outcomes.

Roles of Inflammatory Biomarkers in Exhaled Breath Condensates in Respiratory Clinical Fields.

Exhaled condensates contain inflammatory biomarkers; however, their roles in the clinical field have been under-investigated. We prospectively enrolled subjects admitted to pulmonology clinics. We collected exhaled breath condensates (EBC) and analysed the levels of six and 12 biomarkers using conventional and multiplex enzyme-linked immunosorbent assay, respectively. Among the 123 subjects, healthy controls constituted the largest group (81 participants; 65.9%), followed by the preserved ratio impaired spirometry group (21 patients; 17.1%) and the chronic obstructive pulmonary disease (COPD) group (21 patients; 17.1%). In COPD patients, platelet derived growth factor-AA exhibited strong positive correlations with COPD assessment test (ρ=0.5926, p=0.0423) and COPD-specific version of St. George's Respiratory Questionnaire (SGRQ-C) score (total, ρ=0.6725, p=0.0166; activity, ρ=0.7176, p=0.0086; and impacts, ρ=0.6151, p=0.0333). Granzyme B showed strong positive correlations with SGRQ-C score (symptoms, ρ=0.6078, p=0.0360; and impacts, ρ=0.6007, p=0.0389). Interleukin 6 exhibited a strong positive correlation with SGRQ-C score (activity, ρ=0.4671, p=0.0378). The absolute serum eosinophil and basophil counts showed positive correlations with pro-collagen I alpha 1 (ρ=0.6735, p=0.0164 and ρ=0.6295, p=0.0283, respectively). In healthy subjects, forced expiratory volume in 1 second (FEV1)/forced vital capacity demonstrated significant correlation with CC chemokine ligand 3 (CCL3)/macrophage inflammatory protein 1 alpha (ρ=0.3897 and p=0.0068). FEV1 exhibited significant correlation with CCL11/eotaxin (ρ=0.4445 and p=0.0017). Inflammatory biomarkers in EBC might be useful to predict quality of life concerning respiratory symptoms and serologic markers. Further studies are needed.

Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study.

Objectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-randomized cross-sectional study in Uasin Gishu County, Kenya was conducted. Individuals 12years and older completed questionnaires (including St. George's Respiratory Questionnaire for COPD, SGRQ-C), spirometry, and fractional exhaled nitric oxide (FeNO) testing. Prevalence ratios with 95% confidence intervals (CIs) were calculated. Multivariable models were used to assess correlates of airflow obstruction and high FeNO. Results: Three hundred ninety-two participants completed questionnaires, 369 completed FeNO testing, and 305 completed spirometry. Mean age was 37.5years; 64% were women. The prevalence of asthma, airflow obstruction on spirometry, and eosinophilic airway inflammation was 21.7%, 12.3% and 15.7% respectively in the population. Women had significantly higher SGRQ-C scores compared to men (15.0 vs. 7.7). Wheezing or whistling in the last year and SGRQ-C scores were strongly associated with FeNO levels >50ppb after adjusting for age, gender, BMI, and tobacco use. Conclusion: Airway disease is a significant health problem in Kenya affecting a young population who lack a significant tobacco use history.

Prevalence &amp; Impact of COPD on Quality of Life and Daily Life Activities- A Prospective Study

Introduction: Chronic obstructive pulmonary disease (COPD) is a major and increasing global health problem with enormous amount of expenditure of direct/indirect health-care costs. The prevalence of chronic obstructive pulmonary disease (COPD) varies from country to country, mainly due to the effects of cumulative exposure to smoking and the increased life span of the population. Quality of life (QOL) is an important domain for measuring the impact of chronic disease. Both general and disease-specific instruments have been used to measure QOL in patients with COPD. Among the disease specific questionnaires frequently used to evaluate the QOL of pulmonary patients is St. George’s Respiratory Questionnaire (SGRQ). Aim of the Study: The aim of this study was to determine the prevalence of chronic obstructive pulmonary disease (COPD) and study the impact of COPD on health-related quality of life (HRQL) and activities of daily living (ADL). Methods: This was a prospective observational study and was conducted in the Department of Medicine, LABAID Specialized Hospital, Dhaka, Bangladesh during the period from March, 2022 to December, 2022. We included 325 patients with chronic obstructive pulmonary disease (COPD) in our study. Result: In our study we found majority (52.61%) of our patients were aged more than 60 years and 58% were male compared to female (42%).We found the mean age was 61.73 ± 4.5 years. Among all patients 58.77% were smoker, 66.46% had previous history of COPD. Majority (38.15%) of our patients were severe, mild case was 18.15%, moderate was 33.54% and very severe case was 10.15% in this study. The mean SGRQ-C score was significantly higher in very severe group. The QoL was found higher in mild group. The four domains of LCADL were significantly higher in very severe group which indicates greatest impairment in this group. The mean vas score was seen higher in mild group. Conclusion: In our study, we found that patients with COPD have a lower ..........

Correlations Between Inflammatory Biomarkers in Tuberculosis-Associated Obstructive Pulmonary Disease Patients With Anxiety and Depression.

IntroductionTuberculosis-associated obstructive pulmonary disease (TOPD), anxiety, and depression are significant public health problems worldwide and their prevalence is common. These diseases interfere with physical, psychosocial, and economic well-being, resulting in unemployment, prolonged hospitalization, abstinence from working, and isolation.Subjects and methodsThis is a single-center, cross-sectional cohort, observational study conducted in a tertiary care hospital over six years to understand spirometry, laboratory profiles, as well as the impact on overall health, daily life, and perceived well-being in patients with TOPD.ResultThe sample size of the study was 73 patients. A total of 43 (58.5%) patients had depression with an average St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (SGRQ-C) score of 67.5, and 16 (21.9%) patients had anxiety with an average SGRQ-C score of 78.9. In the patients who scored higher on the Hamilton Depression Rating Scale (HAM-D), there was a significant correlation between Hamilton Anxiety Rating Scale (HAM-A) and HAM-D scores, as well as C-reactive protein (CRP) levels and WBC counts. In 16 (21.9%) of the patients with moderate to severe anxiety, there was a statistically significant negative correlation between higher HAM-A scores and lower WBC counts. Anxiety, depression, CRP level, WBC count, and serum fibrinogen did not show a significant correlation with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups-based assessment of TOPD severity. A high serum fibrinogen level did not correlate with a high HAM-D score, nor did a high CRP level correlate with a high HAM-A score.ConclusionPsychiatric comorbidities like depression are associated with increased inflammation in chronic diseases like TOPD, but no definitive biomarker has been identified and further studies are required to identify suitable biomarkers.

A Randomized Comparative Clinical Study on Tamaka Shwasa (bronchial asthma) with Vamana and Virechana along with Shamana therapy

Introduction: Tamaka Shwasa (TS) is mentioned as one of the varieties among five types of Shwasa Roga as a “Swatantra Vyadhi” and has its own etiology, pathology, and management which resembles with bronchial asthma. Asthma affects about 6% of children and 2% of adults in India's 1.31 billion population. In TS, two treatment modalities Shodhana and Shamana have been explained. Hence, an attempt had been made to clinically compare the result of Vamana Karma and Virechana Karma along with the same Shamana drugs, i.e. Shrungyadi Churna with Guduchyadi Kashaya. Methodology: This study was an open comparative clinical trial with sample size 100 patients (50 in each group) for duration of 60 days. The intervention for Group I was Vamana Karma, whereas for Group II was Virechana Karma, followed by Shamana Chikitsa in both groups. Required hematological, radiological and routine examinations, pulmonary function tests, Asthma Control Questionnaire, St. George's Respiratory Questionnaire, and other parameters were assessed for the clinical evaluation. Results and Discussion: In both group, the parameters such as Asthma Control Questionnaire, SGRQ-C score, Peak expiratory flow rate (PEFR), Forced expiratory volume in one second (FEV1), Hemoglobin, Total leukocyte count, Eosinophils, Erythrocyte sedimentation rate and Absolute eosinophil count have shown significant (P &lt; 0.0001) improvement. In comparison to Group I (relief percentage range from 46% to 92.68%), Group II treatment has shown better results in the relief (60%–90%) of all the clinical parameters of Tamaka Swasa (Bronchial asthma). No significant adverse effects have been noted throughout the study. Conclusion: Both Vamana and Virechana along with administration of Shamana drugs have statistically highly significant effect in TS (Bronchial asthma). However, the Virechana shows better relief in clinical symptoms as compared to Vamana.

Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India.

Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.

HAND GRIP STRENGTH IS AN OBJECTIVE CORRELATE TO FUNCTIONAL IMPAIRMENT AND SYMPTOM BURDEN IN PATIENTS WITH COPD

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hand grip strength (HGS) is a simple to obtain marker of functional status and associated with all-cause mortality in the general population. The value of HGS in the clinical assessment of COPD patients is not well defined. We sought to define the associations of phenotypic features of COPD with hand grip strength. METHODS: We performed interim, cross-sectional analysis of the observational cohort of individuals who participated in COPD phenotyping study at UCLA (Funding: Amgen, Thousand Oaks, CA). One-hundred and seven patients with COPD completed questionnaires, spirometry, imaging, HGS measurement, and laboratory analysis. HGS was obtained from 3 sequential grip tests in each hand and highest single value was used. Values were normalized to previously reported norms for age and sex. The associations between grip strength with lung function, biomarkers, imaging, six-minute walk test (6MWT), symptom scores and quality of life indices were analyzed. 3-month follow-up including the number of reported exacerbations was available for 93 patients. RESULTS: After normalization, HGS was not associated with age, sex, height or BMI. In linear regression models, HGS was directly associated with percent predicted FEV1 (β = 0.24, p = 0.01), distance walked during 6MWT (β = 0.30, p < 0.01) and inversely associated with SGRQ-C score (β = -0.30, p < 0.01). Lower HGS was also associated with higher symptom burden by several other validated COPD-specific scores - CAT, BORG, VSAQ, with a trend towards higher mMRC (p = 0.57). Higher HGS was associated with better perceived health status and better health-related quality of life as quantified by SF-12 health survey. HGS was correlated with the presence of airway thickening by computed tomography but not presence, pattern or degree of emphysema. HGS was correlated with serum c-reactive protein, white blood cell count, eosinophil count but not fibrinogen, erythrocyte sedimentation rate, or neutrophil to lymphocyte ratio. HGS was not correlated with number of exacerbations in the year prior to enrollment or 3-month follow-up, forced vital capacity or use of supplemental oxygen. CONCLUSIONS: Hand grip strength is associated with functional limitation and COPD-specific symptoms but not correlated with number of exacerbations. CLINICAL IMPLICATIONS: Hand grip strength is a simple, objective measure which may aid in identifying those individuals most heavily impacted by COPD in the stable state of the disease. DISCLOSURES: Advisory Committee Member relationship with Astra Zeneca Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Advisory Committee Member relationship with GSK Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Consultant relationship with Grifols Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Theravance and Mylan Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Verona Pharma Please note: $1001 - $5000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Consultant relationship with GE Healthcare Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee no disclosure on file for Marissa Dembek; No relevant relationships by Brett Dolezal, source=Web Response No relevant relationships by Daniel Hoesterey, source=Web Response No relevant relationships by William LeMaster, source=Web Response no disclosure on file for Randy Nguyen

CXCR2 antagonist for patients with chronic obstructive pulmonary disease with chronic mucus hypersecretion: a phase 2b trial

BackgroundOral CXC chemokine receptor 2 (CXCR2) antagonists have been shown to inhibit neutrophil migration and activation in the lung in preclinical and human models of neutrophilic airway inflammation. A previous study with danirixin, a reversible CXCR2 antagonist, demonstrated a trend for improved respiratory symptoms and health status in patients with COPD.MethodsThis 26-week, randomised, double-blind, placebo-controlled phase IIb study enrolled symptomatic patients with mild-to-moderate COPD at risk for exacerbations. Patients received danirixin 5, 10, 25, 35 or 50 mg twice daily or placebo in addition to standard of care. Primary end-points were the dose response of danirixin compared with placebo on the incidence and severity of respiratory symptoms (Evaluating Respiratory Symptoms in COPD [E-RS:COPD] scores) and safety. Secondary end-points included the incidence of moderate-severe exacerbations, health status (COPD Assessment test, CAT) and health-related quality of life HRQoL (St. George Respiratory Questionnaire-COPD, SGRQ-C).ResultsA total of 614 participants were randomized to treatment. There were no improvements in E-RS:COPD, CAT or SGRQ-C scores in participants treated with any dose of danirixin compared to placebo; a larger than expected placebo effect was observed. There was an increased incidence of exacerbation in the danirixin-treated groups and an increased number of pneumonias in participants treated with danirixin 50 mg.ConclusionsThe robust placebo and study effects prohibited any conclusions on the efficacy of danirixin. However, the absence of a clear efficacy benefit and the observed increase in exacerbations in danirixin-treated groups suggests an unfavorable benefit-risk profile in patients with COPD.Trial registrationThis study was registered with clinicaltrials.gov, NCT03034967.

The Difficulty Of Improving Quality Of Life In COPD Patients With Depression And Associated Factors.

ObjectivesDepression is a major comorbidity that affects clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). COPD patients with depression are hospitalized more frequently, and show more acute exacerbations, decreased physical and social activities, and higher mortality compared to their non-depressed counterparts. In the present study, we investigated the clinical impact of depressive symptoms and associated clinical factors in Korean patients with COPD by evaluating multicenter cohort data.Materials and methodsPatients with COPD enrolled in the Korean COPD Subtype Study, a multicenter observational study, from December 2011 to October 2014 were selected for evaluation. The initial evaluation of all patients included pulmonary function tests, 6 min walk distance (6MWD), the COPD Assessment Test (CAT), and the COPD-specific version of the St. George’s Respiratory Questionnaire (SGRQ-C). Significant depression was defined as a Beck Depression Inventory-II (BDI-II) score ≥17.ResultsAmong the 270 study patients, 19.6% had significant depression. The depressed group showed a higher proportion of females (41.4%), lower body mass index (BMI), and lower education level compared to the non-depressed group (p = 0.002, p = 0.008, and p = 0.019, respectively). The depressed group had significantly higher CAT and SGRQ-C scores, as well as a lower 6MWD, compared to the non-depressed group based on 6 month-interval serial measurements over 3 years. The total SGRQ-C score and the symptoms, activity, and impact domain scores were significant predictors of depression (area under curves [AUCs] of 0.699 [0.613–0.786], 0.670 [0.581–0.758], 0.680 [0.589–0.770], and 0.689 [0.603–0.776], respectively). From CAT score domains, sleep and energy scores were significant predictors of depression (AUCs of 0.619 [0.522–0.715] and 0.595 [0.504–0.685], respectively). SGRQ-C score, low BMI, and decreased 6MWD were significantly associated with depression in a multivariable analysis.ConclusionA considerable proportion of patients with COPD had depression, and a high SGRQ-C score, low BMI, and low 6MWD were significantly associated with depression. As improving quality of life in this subgroup is difficult, physicians should be more active in screening patients with significant depression.

Nonadherence to treatment and quality of life among patients with chronic obstructive pulmonary disease.

Objectives:Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases. Assessment of medication nonadherence and quality of life (QOL) is important in such chronic diseases. The aim of the study was to describe treatment nonadherence and QOL of COPD patients and their associated factors.Materials and Methods:A cross-sectional study was performed in Mansoura Chest Hospital on 133 already diagnosed inpatient cases of COPD from March to August 2017. Data were collected using two validated questionnaires, Morisky Medication Adherence Scale to assess medication adherence and St George's Respiratory Questionnaire for COPD patients (SGRQ-c) to assess QOL.Results:About 45% of studied group were nonadherent to prescribed medications. Logistic regression analysis showed that duration of disease is the only independent risk factor for nonadherence. The scores on SGRQ-c indicated sever QOL affection in COPD. SGRQ-c scores show significant impairment with the presence of comorbidities, hospital admission, and frequency of exacerbations.Conclusions:Nonadherence to treatment was affected mainly by the duration of disease. QOL impairment in COPD is influenced by broad range of factors suggesting the importance of QOL assessment in those patients. No association was found between nonadherence to treatment and QOL.

Manometry Optimized Positive Expiratory Pressure (MOPEP) in Excessive Dynamic Airway Collapse (EDAC).

Positive expiratory pressure(PEP) breathing modalities are commonly prescribed in obstructive lung diseases, however practical methods of airway pressures(AP) quantification for therapeutic efficacy are lacking. Excessive dynamic airway collapse(EDAC) is characterized by expiratory central airway collapse leading to dyspnea and poor quality of life(QoL), with limited therapeutic options. To measure AP and exertional dyspnea in EDAC patients during normal breathing and with use of pursed-lip breathing(PLB), nasal PEP device(nPEP), and oral-PEP valve(oPEP) during rest and exercise using an Esophageal Manometer. EDAC patients exercised on a bicycle ergometer sequentially using normal breathing, PLB, nPEP, and oPEP for five-minute intervals. AP's were measured by continuous topographic upper airway manometry. Pre- and post-exercise BORG dyspnea scores were recorded and QoL measured with the St. George's respiratory questionnaire(SGRQ-C). The most effective and patient-preferred PEP modality was prescribed for daily activities and SGRQ-C repeated after one week. Three women with symptomatic EDAC participated. Expiratory laryngopharyngeal AP's during exercise with normal breathing, PLB, nPEP and oPEP in patient-1 were 1.7, 14, 4.5, and 7.3 mmHg, in patient-2; 2.3, 8, 8.3, and 12 mmHg, and in patient-3; 1, 15, unobtainable, and 9 mmHg, respectively. Maximal reduction in BORG scores occurred with PLB in patient 1 and with oPEP in patients 2 and 3. After 1 week mean SGRQ-C scores declined by 17-points. Upper airway manometry directly measures laryngopharyngeal pressures during rest and exercise and can be used to select and optimize PEP breathing techniques to improve respiratory symptoms in EDAC patients.

Health-related quality of life of chronic obstructive pulmonary disease patients: Results from a community based cross-sectional study in Aligarh, Uttar Pradesh, India.

Background:Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. It is an incurable disease with improvement in quality of life (QOL) as a major focus area for management. This study assesses the QOL of COPD patients and the factors affecting it.Materials and Methods:All 124 patients diagnosed with COPD in a larger cross-sectional study to determine the prevalence of COPD were assessed for their QOL using St. George's respiratory questionnaire for COPD patients (SGRQ-C). Spirometry was performed to assess lung function and diagnose COPD. Chronic lung disease (CLD) severity index was used to assess the severity of symptoms and the Medical Research Council questionnaire was used to assess the severity of dyspnea. Sociodemographic data regarding the patients were also recorded.Results:Patients with COPD showed significantly reduced health-related quality of life (HRQOL). CLD estimate for severity of lung disease and the Medical Research Council assessment for dyspnea and the duration of illness showed a highly significant positive correlation with HRQOL. There was a statistically significant negative correlation between lung function and SGRQ-C score. Increasing age, increased quantum of smoking, and lower socioeconomic status were correlated with poorer HRQOL. No association between QOL and education, body mass index (BMI), and gender was observed.Conclusion:This study showed that Indian patients with COPD had reduced HRQOL. Poor lung function, increased disease duration and smoking, and worsening symptoms impacted HRQOL negatively.

Efficacy and safety of fluticasone furoate/vilanterol or tiotropium in subjects with COPD at cardiovascular risk.

BackgroundFluticasone furoate/vilanterol (FF/VI) is a novel, once-daily, inhaled corticosteroid/long-acting β2-agonist combination approved for the treatment of COPD and asthma. We compared the safety and efficacy of FF/VI and tiotropium (TIO) in subjects with moderate-to-severe COPD with greater risk for comorbid cardiovascular disease (CVD).MethodsThis randomized, blinded, double-dummy, parallel-group study compared a once-daily morning dose of FF/VI 100/25 mcg delivered via ELLIPTA™ with TIO 18 mcg via HandiHaler® for 12 weeks in subjects with diagnosed COPD, forced expiratory volume in 1 second (FEV1) 30%–70% predicted, and CVD or CVD risk. The primary endpoint was change from baseline in 24-hour weighted mean FEV1 on Day 84. Other efficacy endpoints included time to onset of bronchodilation, trough FEV1, other spirometry measures, rescue medication use, symptoms, quality of life (St George’s Respiratory Questionnaire-COPD [SGRQ-C]), and health status (COPD Assessment Tests [CAT]) measures. Safety endpoints included cardiovascular monitoring, cortisol excretion, COPD exacerbations, and adverse events, including prespecified drug effects.ResultsBoth FF/VI and TIO improved the 24-hour weighted mean FEV1 from baseline after 12 weeks with no significant difference between treatments. Other endpoints favored FF/VI for time to onset of bronchodilation, rescue medication use, dyspnea, SGRQ-C and CAT scores, or favored TIO for change from baseline in forced vital capacity and inspiratory capacity. Pneumonia occurred more frequently in the FF/VI group, and two TIO-treated subjects died following cardiovascular events. Other safety measures were similar between groups, and cardiovascular monitoring did not reveal increased CVD risk.ConclusionBoth FF/VI and TIO were efficacious in improving lung function in subjects with COPD and comorbid CVD or CVD risk factors, with minor differences in efficacy and safety profiles.

Factors Associated With Acute Exacerbation in COPD Patients With Mild-to-Moderate Airflow Limitation

SESSION TITLE: COPD Posters III SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: The aim of this study was to compare the clinical characteristics of patients with mild-to-moderate airflow limitation according to the experience the acute exacerbation. METHODS: The patients included in the present study were from the Korean COPD Subtype Study (KOCOSS) cohort. The patients were recruited from 37 referral hospitals in Korea. The definition of COPD was adopted by the GOLD guideline. We obtained the clinical data from the medical record and compared the clinical, spirometric data according to the development of exacerbation during the follow-up period RESULTS: A total of 570 patients with mild-to-moderate airflow limitation were enrolled. A total of 9.3% had FEV1>80% of predicted value. The mean CAT score was 13.9 ± 6.9. The mean SGRQ-c was 30.4 ± 6.5. There were 114 patients (20%) who had experienced one year before enrollment. A total of 17.4% and 14.2% of patients had history of measles and pneumonia, respectively. When adopting 2011 GOLD classification, 24.9% and 74.7% of the patients were classified as GOLD A and B, respectively. During the first 2 years of follow-up period, 17.5% of patients experienced acute exacerbation. SGRQ-c and CAT score were significantly higher in patients with exacerbation than patients without exacerbation (36.3 ± 2.0 vs. 25.6±1.5, 16.6±79 vs. 12.1±6.0, respectively). Patient with exacerbation had allergic rhinitis, hyperlipidemia more frequently, which is statistically significant. A total of 83.3% of patients with history of exacerbation at enrollment experienced exacerbation during the follow-up period. A total 22.0% and 24.1% of the patients with exacerbation had history of pneumonia and measles, which is higher than that of patients without exacerbation (p=0.014 and 0.044, respectively). CONCLUSIONS: A total of 17.5% of mild to moderate COPD patients experienced acute exacerbation during 2 years of follow up. Development of acute exacerbations is associated with poor quality of life, hyperlipidemia, allergic rhinitis, history of acute exacerbation, history of pneumonia and history of measles CLINICAL IMPLICATIONS: A subsequent number of patients with mild-to-moderate airflow limitation experienced exacerbations. Presence of co-morbidities, quality of life and past medical history should be assessed meticulously in order to differentiate patients with high risk of exacerbation. DISCLOSURE: The following authors have nothing to disclose: Yong Il Hwang, Chang Youl Lee, Sunghoon Park, Joo Hee Kim, Yong Bum Park, Seung Hun Jang, Kwang Ha Yoo, Chin Kook Rhee, Hyoung Kyu Yoon, Ki-Suck Jung No Product/Research Disclosure Information

Assesment on health-related quality of life in elderly patients with stable chronic obstructive pulmonary disease

Objective To assess the health-related quality of life in elderly patients with stable chronic obstructive pulmonary disease(COPD). Methods The patients were collected from the outpatient department, a tertiary hospital in ShaanXi Province. The demographic characteristics such as age, gender, weight and height were collected. Spirometry was performed for every patient after salbutamol 400 μg was inhaled. 6-minute walk test was done according to the guidelines which developed by American Thoracic Society in 2002. Four questionnaires, including COPD Assessment Test (CAT), Clinical COPD Questionnaire-week Version (CCQ), St George's Respiratory Questionnaire for COPD Patients (SGRQ-C) and Chronic Respiratory Questionnaire-Self Administered Standardized Activities-First Administration Version (CRQ-SAS), were answered by every participant. Results Totally 90 participants were enrolled between September 2013 and September 2014. 75 cases(83.3%) were male and 70 cases (77.8%) were smokers or ex-smokers, the mean age was (67.8±9.7)years, and the mean educational history was (8.9±3.0)years. The mean body mass index was (23.3±3.6) kg/m2, and the mean post-brochodilator FEV1 was (51.2±18.7)% predicted. The average 6-minute walk distance was (424.5±99.1) meters. The average scores of CAT and CCQ were(20.4±6.9) and (2.4±0.8), respectively. The mean SGRQ-C score was (38.5±16.2). The symptoms, activity and impacts average scores of SGRQ-C were (64.3±18.8), (45.1±21.3) and (25.7±16.1). For CRQ-SAS, the average scores of dyspnea, fatigue, emotional function and mastery were (2.9±1.3), (2.9±1.1), (3.0±1.1) and (2.9±1.1), respectively. There was a weak correlation between FEV1 and each questionnaire scores. There was a moderate correlation between 6-minute walk distance and SGRQ-C, CCQ and CRQ-SAS. However, there was a weak correlation between CAT and 6-minute walk distance. For 6-minute walk distance, activity score of SGRQ-C, impacts score of SGRQ-C and history of coronary artery disease were independent influencing factors. For BODE index, activity and impacts score of SGRQ-C were independent influencing factors. Conclusions CAT, CCQ, SGRQ-C and CRQ-SAS are suitable to assess health-related quality of life for elderly patients with stable COPD, among four questionnaires, SGRQ-C is the best one. Key words: Pulmonary disease, chronic obstructive; Quality of life

A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD

We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease (COPD). A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Ireland. Patients had at least two of: emergency department admissions, hospital admissions or emergency general practitioner (GP) contacts in the 12 months before the study. Exclusion criteria were patients who had any respiratory disorder other than COPD, or were cognitively unable to learn the process of monitoring. Patients were randomised to receive six months of home telemonitoring with usual care, or six months of usual care. The primary outcome measure was disease-specific quality of life, as measured by the St George’s Respiratory Questionnaire for COPD patients (SGRQ-C). Of 100 patients completing the study, 48 patients were randomised to telemonitoring and 52 patients were randomised to the control group. The SGRQ-C scores improved significantly in the intervention group compared to usual care (P = 0.001). The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group (P = 0.01). There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group (P = 0.029). There were no significant between group differences in EQ-5D scores, HADS depression scores, GP activity, emergency department visits, hospital admissions or exacerbations. The total cost to the health service of the intervention over the 6-month study period was £2039, giving an estimated ICER of £203,900. In selected patients with COPD, telemonitoring was effective in improving health-related quality of life and anxiety, but was not a cost-effective intervention.

Fatores determinantes da qualidade de vida numa população de doentes com doença pulmonar obstrutiva crónica

Objectives: To test the association between quality of life (QoL) and gender, age, body mass index, marital status, employment status, forced expiratory volume in 1 second, anxiety, depression and dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Type of study: Observational, cross-sectional study. Location: Manuel Rocha Peixoto Family Health Unit and Gualtar Family Health Unit, Braga, Portugal. Population: Patients over 40 years of age, diagnosed with COPD or chronic bronchitis, registered in the Gualtar and Manuel Rocha Peixoto Family Health Units. Methods: Demographic data were collected and the Portuguese versions of the Hospital Anxiety and Depression Scale, the Medical Research Council Dyspnoea Questionnaire and the COPD-specific Saint George’s Respiratory Questionnaire (SGRQ-C) were administered. The diagnosis of COPD was confirmed by spirometry, determining the forced expiratory volume in 1 second. A bivariate analysis of the study variables and QoL was performed. Statistically significant associations were tested by multiple linear regression. Results: Sixty-five patients were included in the study. In the bivariate analysis, depression, anxiety and dyspnoea were related to all domains of the SGRQ-C. Gender and employment status also showed a significant bivariate correlation with “Activity”, “Impact of disease” and the total SGRQ-C score. In the multiple linear regression analysis, gender and anxiety were not found to be significant predictors of outcomes. In the regression analysis, depression was a significant predictor for “Symptoms” and “Impact”, employment status and dyspnoea were significant predictors for “Activity” and employment status, depression and dyspnoea were significant predictors for the SGRQ-C score. Conclusion: Employment status, depression and dyspnoea should be considered in intervention strategies to improve QoL in patients with COPD.

Clinical characteristics and quality of life in women with COPD: an observational study.

BackgroundThe impact of COPD on patient’s quality of life is well established, but gender differences have received little attention.MethodsTo describe factors associated with the health-related quality of life by gender: A cross-sectional observational study (NCT01007734) was conducted in COPD patients followed by pulmonologists. The first patient included had to be a woman. Data concerning the patient, COPD and their management were collected by the physician. The patient had to fill in several questionnaires: Saint-George Hospital respiratory Questionnaire (SGRQ-C), and motivation to quit smoking.ResultsFour hundred and thirty patients were included: mean age 63.9 ± 11.3 years; 57.4% were women. Women were significantly younger than men (61.9 vs. 66.6) and their tobacco use was lower (37.1 vs. 40.4 PY). Cardiovascular comorbidities were more frequent in men while osteoporosis, anxiety and depression were frequent in women. The frequency of cough, sputum and the severity of dyspnea did not differ significantly between genders. Lung function impairment was less severe in women than in men (mean FEV1 52% predicted normal vs. 47. 8%). Anxiety score was higher (score 9.8 vs. 7.1) and quality of life (SGRQ-C) more impaired in women (scores 50.6 vs. 45.4; p < 0.02) than in men. Moreover, in multivariate analysis, chronic sputum was associated with higher SGRQ-C scores in women but not in men.ConclusionsThis study underlines that despite less airflow limitation, quality of life is more impacted by chronic sputum in women than in men.

Impact of emphysema and airway wall thickness on quality of life in smoking-related COPD

Limited data are available as to the relationship between computed tomography (CT) derived data on emphysema and airway wall thickness, and quality of life in subjects with chronic obstructive pulmonary disease (COPD). Such data may work to clarify the clinical correlate of the CT findings. We included 1778 COPD subjects aged 40-75 years with a smoking history of at least 10 pack-years. They were examined with St George's Respiratory Questionnaire (SGRQ-C) and high-resolution chest CT. Level of emphysema was assessed as percent low-attenuation areas less than -950 Hounsfield units (%LAA). Airway wall thickness was estimated by calculating the square root of wall area of an imaginary airway with an internal perimeter of 10mm (Pi10). In both men and women, the mean total score and most of the subscores of SGRQ-C increased with increasing level of emphysema and increasing level of airway wall thickness, after adjusting for age, smoking status, pack years, body mass index and FEV1. The highest gradient was seen in the relationship between the activity score and the emphysema level. The activity score increased by 35% from the lowest to the highest emphysema tertile. The relationship between level of emphysema and the total SGRQ-C score became weaker with increasing GOLD (Global initiative for Chronic Obstructive Lung Disease) stages (p<0.001), while the impact of gender was limited. In subjects with COPD, increasing levels of emphysema and airway wall thickness are independently related to impaired quality of life.