St George's Respiratory Questionnaire Domain Research Articles

Baseline dependent minimally important differences for clinical outcomes of pulmonary rehabilitation in people with COPD

IntroductionMinimally important differences (MIDs) for common outcomes of pulmonary rehabilitation are well documented for people with chronic obstructive pulmonary disease (COPD). It is not known whether MIDs differ based on COPD disease characteristics. This study aimed to estimate MIDs for clinical outcomes of pulmonary rehabilitation dependent upon baseline characteristics. MethodsA database containing 2791 people with COPD was split into derivation (n=2245; age 66±9 years; 50% males; FEV1 47±20% predicted) and comparator (n=546; age 66±9 years; 47% males; FEV1 46±21% predicted) cohorts. MIDs were estimated using 0.5 x SD (symmetrically distributed) or 0.5 x IQR (non-symmetrically distributed) for: 6-minute walk test (6MWT), constant work rate test (CWRT), COPD assessment test (CAT), St. George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), and fat-free mass index (FFMI). MIDs were estimated based on baseline outcome scores, lung function, modified medical research council (mMRC) grade and FFMI. ResultsMID estimates were comparable to previously reported values. MIDs for SGRQ domains (Symptom=8.7 points, Activity=7.1 points, Impact=8.1 points) and FFMI were produced (0.36kg/m2). There was greater variation of change in 6MWT, SGRQ-activity, SGRQ-impact, HADS and FFMI on which the MIDs were determined when categorising for baseline values (all, p<0.05). Greater variation of change in 6MWT on which the MIDs were determined was evident with COPD disease severity grouping (p<0.05). The magnitude of change in 6MWT, CAT, CWRT, SGRQ-activity, and FFMI with baseline mMRC score categorisation resulted in greater variation on which the MIDs were determined (all, p<0.05). Baseline stratification for FFMI resulted in greater variation of change in CWRT (p<0.001) and HADS-depression (p = 0.043) on which MIDs were determined. DiscussionFindings suggest that baseline presentation should be considered for people with COPD when assessing the efficacy of pulmonary rehabilitation. However, clinical significance of the variation underpinning MIDs is yet to be determined.

Changes in health-related quality of life as a marker in the prognosis in COPD patients.

Chronic obstructive pulmonary disease (COPD) is understood as a complex, heterogeneous and multisystem airway obstructive disease. The association of deterioration in health-related quality of life (HRQoL) with mortality and hospitalisation for COPD exacerbation has been explored in general terms. The specific objectives of this study were to determine whether a change in HRQoL is related, over time, to mortality and hospitalisation.Overall, 543 patients were recruited through Galdakao Hospital's five outpatient respiratory clinics. Patients were assessed at baseline, and the end of the first and second year, and were followed up for 3 years. At each assessment, measurements were made of several variables, including HRQoL using the St George's Respiratory Questionnaire (SGRQ).The cohort had moderate obstruction (forced expiratory volume in 1 s 55% of the predicted value). SGRQ total, symptoms, activity and impact scores at baseline were 39.2, 44.5, 48.7 and 32.0, respectively. Every 4-point increase in the SGRQ was associated with an increase in the likelihood of death: “symptoms” domain odds ratio 1.04 (95% CI 1.00–1.08); “activity” domain OR 1.12 (95% CI 1.08–1.17) and “impacts” domain OR 1.11 (95% CI 1.06–1.15). The rate of hospitalisations per year was 5% (95% CI 3–8%) to 7% (95% CI 5–10%) higher for each 4-point increase in the separate domains of the SGRQ.Deterioration in HRQoL by 4 points in SGRQ domain scores over 1 year was associated with an increased likelihood of death and hospitalisation.

Effects of water-based Liuzijue exercise on peak exercise capacity, functional exercise capacity, and quality of life in people with COPD.

This study was conducted to investigate the effect of water-based Liuzijue exercise on peak exercise capacity, functional exercise capacity, and quality of life in people with COPD. The study included 50 participants randomly divided into three groups: a control group (CG = 17), a land-based Liuzijue exercise group (LG = 17), and a water-based Liuzijue exercise group (WG = 16). The LG and WG performed Liuzijue exercise in different environments, and the CG had no exercise intervention. All participants received prescribed medical treatment. Liuzijue exercise was performed according to the description of Health Qigong Liuzijue compiled by Chinese Health Qigong Association for 60minutes, two times per week, for 12weeks. After intervention, peak oxygen uptake and peak working rate were significantly improved in WG (P=.02). The results of the 6minutes walking test (6MWT) and 30 seconds sit-to-stand test were significantly improved in both WG and LG (P<.05), and significant difference was found between WG and CG in 6MWT (P=.03). The St. George's Respiratory Questionnaire (SGRQ) activity score increased significantly in the CG (P=.03), while all domains of SGRQ significantly decreased in both training groups (P<.01). All SGRQ scores showed a significant difference between LG and CG (P<.05) and, except for the activity score, between WG and CG (P<.05). Water-based Liuzijue exercise can effectively improve peak exercise capacity, functional exercise capacity, and quality of life in people with COPD, especially with respect to increasing peak VO2 and 6MWD.

Long-term health-related quality-of-life data in subjects with a history of wheezing in early childhood.

Background: Wheezing in early childhood has implications for respiratory morbidity in later life. Objectives: We evaluated respiratory health-related quality of life (HRQoL) in young adults ages 17-20 years with a history of early childhood wheezing. Methods: Between 1992 and 1993, 100 children ages < 24 months were treated in the hospital for a lower respiratory tract infection with wheezing, and we followed up this cohort. In 2010, 49 of the patients (cases) and 60 population-based controls attended a clinical follow-up. St. George's Respiratory Questionnaire (SGRQ) was used to evaluate respiratory HRQoL, expressed as symptom, activity, impact, and total scores. Results: The median (interquartile range) SGRQ symptom scores were higher (13.7 [3.8-29.1]) in the 49 subjects (cases) with early childhood wheezing compared with the 60 population controls (7.8 [0.0-18.3]; p = 0.019). However, there were no between-group differences in total scores or in other SGRQ domains. Current asthma was a major risk factor for reduced HRQoL. In univariate analyses, the median symptom scores were 20.2 in those with asthma and 7.8 in those without asthma (p < 0.001), and, in multivariate analyses, the odds ratio (OR) was 8.7 for high total scores (95% confidence intervals, 2.1-36.6). Other factors associated with reduced HRQoL were current allergy (OR 4.4 for symptom scores), overweight (OR 3.3 for activity scores), tobacco smoking (OR 4.3 for symptom scores), and female sex (OR 3.2 for impact score). Furthermore, we performed post hoc analyses by excluding those with asthma and those who smoked, and found no significant differences on SGRQ scores between the subjects (cases) and the controls. Conclusion: Hospitalization for wheezing in early childhood mainly had indirect effects on HRQoL by increasing the risk of asthma.

Is the Leicester Cough Questionnaire useful for nontuberculous mycobacterial lung disease?

Although the incidence of nontuberculous mycobacterial lung disease (NTM-LD) is increasing worldwide, there is no established standard of care leading to eradication. Therefore, research on health-related quality of life (HRQOL) is important for patients with NTM-LD. HRQOL is commonly evaluated using the St. George's Respiratory Questionnaire (SGRQ), developed for chronic obstructive pulmonary disease (COPD). However, NTM-LD differs from COPD in that few patients complain of dyspnea or wheezing, and cough and sputum are their main symptoms. The Leicester Cough Questionnaire (LCQ) is an HRQOL questionnaire dedicated to cough, but few studies have used it for NTM-LD. This study evaluated HRQOL in patients with NTM-LD using the SGRQ and LCQ and clarified the usefulness of the LCQ. Information on age, height, weight, lung function, percent ideal body weight, laboratory data, radiological scores, exercise capacity, SGRQ, and LCQ were collected from the medical records of 81 patients. Correlations between SGRQ and LCQ domains were assessed using Spearman's rank correlation coefficients. Multivariate analysis was performed with SGRQ and LCQ total scores. Statistically significant correlations were observed between all domains, and the correlation between the total scores was -0.67 (p<0.01). Multivariate analysis with total scores as the dependent variable showed that the explanatory variables were lung function (p<0.05) and radiological score (p<0.05) in the SGRQ, and radiological score (p<0.05) and C-reactive protein level (p<0.05) in the LCQ. The LCQ, which evaluates an inflammatory response involved in the diagnosis of NTM-LD, may be useful to assess HRQOL in patients with NTM-LD.

The Effect of Treatment during A Haze/Post-Haze Year on Subsequent Respiratory Morbidity Status among Successful Treatment Tuberculosis Cases.

The purpose of this study was to evaluate the respiratory morbidity status within the two to three years among successful (completed/cured) treatment of tuberculosis cases during a haze year (2015) and a post-haze year (2016). The study was conducted among 133 cases of a 2015 group and 103 cases of a 2016 group between January to March 2018 in Pekanbaru city, Indonesia. The St George Respiratory Questionnaire (SGRQ) was used to assess respiratory morbidity status. A higher score corresponds to worse respiratory morbidity. Based on a directed acyclic graph, quantile regression models were constructed to assess the associations between haze/post-haze year and the SGRQ (symptom, activity, impact, and total) domains score. The subsequent respiratory morbidity status of tuberculosis (TB) cases was poorer among respondents treated during a haze year (2015). Among SGRQ domains, only the activity domain score showed significant difference, in which the median for the 2015 group was 23.7 (inter-quartile range (IQR); 17.2, 30.9) compared to 18.4 (IQR; 11.9, 24.8) for the 2016 group. The effect was limited to the 2015 group who were exposed by an average PM10 index ≥ 55 during TB treatment. This raises concern for monitoring and improving the quality of life of TB patients treated during a haze year.

A Comparative Study of Respiratory Quality of Life among Firefighters, Traffic Police and Other Occupations in Malaysia

Background:Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations.Objective:To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia.Methods:We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL.Results:We recruited 706 participants—211 firefighters, 198 traffic police, and 297 from general population. Smokers had significantly higher scores than non-smokers in all SGRQ domains. Regardless of smoking status, the "occupationally exposed group" had higher symptoms score than the "occupationally unexposed group," who had higher activity and impact scores. Smoking status, comorbidity status and monthly income were significant independent predictors of SGRQ total score.Conclusion:In comparison with the general population, firefighters and traffic police reported poorer RQoL; smoking further deteriorated their respiratory health. There is a need to strengthen preventive health measures against occupational disease and smoking cessation among firefighters and traffic police.

Improvements in Health-Related Quality of Life with Lung Transplantation: A Prospective Multicenter Cohort Study

Purpose Lung transplant improves health-related quality of life (HRQL) for many recipients. However, with increasing lung disease severity and higher acuity candidates, it is not clear the early trajectory of improvement and the specific early clinical factors that might be associated with this improvement. Understanding post transplant HRQL trajectories and clinical factors that influence those trajectories is an unmet need. Methods As part of a prospective multi center cohort study, lung transplant recipients completed the Short Form-36 (SF-36) and the St George's Respiratory Questionnaire (SGRQ) pre-transplant and at 1, 3, 6, 9 and 12 months post-transplant. A longitudinal repeated measures linear mixed model was constructed with separate slopes prior to and post day 91 due to evidence of time-varying associations. The impact of key clinical factors on HRQL changes was modeled in secondary analyses. Results For the SF-36 physical component score and all SGRQ domains, lung transplant recipients had large improvements in the first 3 months post-transplant that remained mostly stable over the remainder of the first year. In particular, younger patients, patients with cystic fibrosis and patients with worse pre-transplant HRQL had the greatest improvements in the early period after transplant. The mean SF-36 mental component score was in the normal range pre-transplant and remained stable post-transplant. Conclusion Lung transplant recipients have dramatic and sustained improvement in HRQL by SF-36 and SGRQ domains with the greatest improvements evident within 3 months that may differ by age, native lung disease pre-transplant HRQL.

Acceptance of Illness Associates with Better Quality of Life in Patients with Nonmalignant Pulmonary Diseases.

Chronic nonmalignant pulmonary diseases impose a heavy burden on patients, generate health-care costs, and contribute to poor health-related quality of life. It has been found that a wide range of factors negatively affects quality of life, but the role of acceptance of illness needs to be further investigated. The aim of the study was to evaluate the relationship between acceptance of illness and quality of life in patients with chronic nonmalignant pulmonary diseases. The study encompassed 200 patients of the mean age 58±16years who were mainly diagnosed with asthma (n=72; 36%), COPD (n=52; 26%), and obstructive sleep apnea (n=38; 19%). The patients answered the Acceptance of Illness Scale (AIS) and the St. George's Respiratory Questionnaire (SGRQ). Sociodemographical and clinical data were collected. The level of acceptance of illness significantly associated with each of the SGRQ domains. The greater the acceptance of illness, the lowest was the SGRQ score. The mean total score of SGRQ was 44.6±24.9 and that of AIS was 26.1±8.2. Higher AIS scores significantly associated with lower SGRQ scores, i.e., with better quality of life (p<0.001 for each domain). We conclude that in patients with chronic nonmalignant pulmonary diseases, acceptance of illness plays an important role and is closely related to the general level of quality of life. Interventions aimed at improving acceptance of illness may be considered to improve quality of life.

Evaluation of the psychometric properties of the St George's Respiratory Questionnaire in patients with severe asthma

PurposeLimited data exist on the quantitative validity of the St George's Respiratory Questionnaire (SGRQ) in asthma populations. This study evaluated the psychometric properties of the SGRQ in patients with severe asthma. MethodsThis was a post-hoc analysis of pooled data from MENSA (N = 576; NCT01691508) and SIRIUS (N = 135; NCT01691521), two randomized, placebo controlled trials of mepolizumab in patients with severe asthma. Patients completed the SGRQ at Baseline and Exit (MENSA Week 32; SIRIUS Week 24). Distributional characteristics, internal consistency reliability, test-retest reliability, convergent and discriminant validity, known-groups validity and responsiveness were assessed. ResultsInternal consistency reliability was acceptable for the total and domain scores at Baseline and Exit (Cronbach's α was 0.92 and 0.94 at Baseline and Exit, respectively, for the total score). Test-retest reliability was demonstrated (intraclass correlation coefficients >0.7) for total score and the Activity and Impacts domains. Convergent and discriminant validity were demonstrated with measures associated or not associated with respiratory-related health status. Known groups validity based on baseline FEV1% predicted, Asthma Control Questionnaire (ACQ)-5 score, exacerbations and eosinophil counts was demonstrated for the SGRQ total and domain scores. Responses to therapy based on clinician-rated response, patient-rated response, ACQ-5 change score and exacerbations generally correlated with improvements in SGRQ scores. ConclusionsThis analysis demonstrated that the SGRQ has acceptable psychometric properties in patients with severe asthma, exceeding the thresholds for adequate reliability, validity and responsiveness. The SGRQ appears to be a good instrument for identifying response to therapy in patients with severe asthma.

Psychometric validation of a Hindi version of a chronic obstructive pulmonary disease (COPD) assessment test in patients in northern India.

We aimed to validate a Hindi version of a chronic obstructive pulmonary disease (COPD) assessment test (CAT) for assessing the health status of patients in northern India. Of the 178 patients studied, 171 with COPD self-completed CAT twice at a 4-week interval. The patients also self-completed the Hindi versions of the abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref) and St George's Respiratory Questionnaire (SGRQ) at the initial assessment. Baseline clinical details and spirometric data were recorded. Acceptability, validity, internal consistency, test-retest reproducibility and responsiveness were assessed using standard tools. The study population of 178 had 167 (93.8%) males and 1 59 (89.3%) smokers. One hundred and twenty- seven (71.3%) patients completed the second assessment, of whom the condition of 19 had worsened. Each of the eight CAT items correlated strongly with the total CAT score (Pearson coefficients 0.59-0.73). The total CAT score correlated well with the dyspnoea grade, SGRQ domain scores and the physical domain score of WHOQOL-Bref. Cronbach's alpha coefficient had a high value of 0.83. The intraclass correlation coefficient for 101 patients with stable disease between the two assessments was high (0.83), but the effect size in the 19 patients who recovered from an exacerbation was moderate (0.45). The Hindi version of CAT has good validity and reliability and can be used to quantify the health impact of COPD among patients in northern India.

Pulmonary rehabilitation and whole-body vibration in chronic obstructive pulmonary disease

The Whole-Body Vibration (WBV) has been described as an alternative therapeutic resource for patients with Chronic Obstructive Pulmonary Disease (COPD) with similarity to the Pulmonary Rehabilitation Program (PRP). The aim of the study was to compare PRP to WBV on functional capacity and quality of life in patients with COPD. Twenty individuals with COPD were assigned to PRP and WBV, who were evaluated regarding their lung function, functional capacity and quality of life through spirometry, 6-minute walk test (6MWT) and St. George Respiratory Questionnaire (SGRQ), respectively. The main results for the WBV group were, there were improvements in the walked distance on the 6MWT and in the symptoms and total domains of the SGRQ. For the PRP group, we observed improvement in the activity, impact and total domains of SGRQ. We could conclude that the WBV group increased the walked distance in regard to the PRP group and both programs improved the quality of life.

The Influence of Lung Volume Reduction with Intrabronchial Valves on the Quality of Life of Patients with Heterogeneous Emphysema—A Prospective Study

A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used - bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (-12.8; p < 0.001) and in domains and the differences were for: "symptoms" (-8.5; p < 0.001), "activity" (-13.9; p < 0.001) and "influence on life"(-13.5; p < 0.002). The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.

Home-Based Pulmonary Rehabilitation for Subjects With COPD: A Randomized Study.

The aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test. Twenty-nine subjects with COPD (FEV1 = 62.4 ± 10.7% of predicted, 62.4 ± 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. The control group included 15 subjects (FEV1 = 54 ± 26.2% of predicted, 65.3 ± 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. The home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise. The 2 groups were similar regarding age, FEV1, and FVC. The home-based pulmonary rehabilitation group increased by 65 m in the 6MWT (P < .05) and 316.6 ± 81.8 m in the endurance test (P < .05) and decreased by > 4 units in all SGRQ domains. The control group showed no difference in any variable. This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.

Validation of St George Respiratory Questionnaire (SGRQ) into Indonesian version for Tuberculosis Patients in Indonesia

Tuberculosis (TB) is one of the disease as the highest contributor to the disease burden in Indonesia. Tuberculosis can affect the patients’ quality of life, such as psychological, physical, and social functioning. St. George's Respiratory Questionnaire (SGRQ) is a special instrument which was widely used to measure the patients’ quality of life with respiratory disease. The objective of this study was to validate the Indonesian version of the SGRQ as instrument to collect data. A descriptive cross section design with 61 subjects was conducted at the Pulmonary Clinics and Primary Health Centers in the region of Yogyakarta within 3 months. The validation process included the known group validity, convergent and discriminant validity and factor analysis. There were 14 items question numbers which did not meet the criteria for convergent validity and 9 items which did not meet the criteria for discriminant validity. Known group validity analysis on gender showed that of the three domains of SGRQ, the activity domain gave statistically significant result. The factor analysis showed the result of Kaiser Meyer Olkin analysis (KMO) was less than 0.5. With a few modifications, the Indonesian version of SGRQ is valid and reliable for measuring quality of life in tuberculosis patients.

Reliability and Validaty of St George Respiratory Questionnaire (SGRQ) into Indonesian Version

Tuberculosis (TB) is one of the disease as the highest contributor to the disease burden in Indonesia. Tuberculosis can affect the patients’ quality of life, such as psychological, physical, and social functioning. St. George's Respiratory Questionnaire (SGRQ) is a special instrument which was widely used to measure the patients’ quality of life with respiratory disease. The objective of this study was to validate the Indonesian version of the SGRQ as instrument to collect data. A descriptive cross section design with 61 subjects was conducted at the Pulmonary Clinics and Primary Health Centers in the region of Yogyakarta within 3 months. The validation process included the known group validity, convergent and discriminant validity and factor analysis. There were 14 items question numbers which did not meet the criteria for convergent validity and 9 items which did not meet the criteria for discriminant validity. Known group validity analysis on gender showed that of the three domains of SGRQ, the activity domain gave statistically significant result. The factor analysis showed the result of Kaiser Meyer Olkin analysis (KMO) was less than 0.5. With a few modifications, the Indonesian version of SGRQ is valid and reliable for measuring quality of life in tuberculosis patients.

Reliability and Validaty of St George Respiratory Questionnaire (SGRQ) into Indonesian Version

Tuberculosis (TB) is one of the disease as the highest contributor to the disease burden in Indonesia. Tuberculosis can affect the patients’ quality of life, such as psychological, physical, and social functioning. St. George's Respiratory Questionnaire (SGRQ) is a special instrument which was widely used to measure the patients’ quality of life with respiratory disease. The objective of this study was to validate the Indonesian version of the SGRQ as instrument to collect data. A descriptive cross section design with 61 subjects was conducted at the Pulmonary Clinics and Primary Health Centers in the region of Yogyakarta within 3 months. The validation process included the known group validity, convergent and discriminant validity and factor analysis. There were 14 items question numbers which did not meet the criteria for convergent validity and 9 items which did not meet the criteria for discriminant validity. Known group validity analysis on gender showed that of the three domains of SGRQ, the activity domain gave statistically significant result. The factor analysis showed the result of Kaiser Meyer Olkin analysis (KMO) was less than 0.5. With a few modifications, the Indonesian version of SGRQ is valid and reliable for measuring quality of life in tuberculosis patients.

İnterstisyel akciğer hastalıklarında pulmoner rehabilitasyon

Interstitial lung diseases are characterised by dyspnea on exertion, low quality of life, cough and exercise intolerance. The aim of this study was to evaluate the effects of comprehensive pulmonary rehabilitation in patients with interstitial lung disease. Data from patients who were referred to pulmonary rehabilitation with the diagnosis of interstitial lung diseases were included to this study. Ten patients with interstitial lung disease participated to our outpatient, 8 weeks, comprehensive pulmonary rehabilitation programme. Dyspnea was assessed with the Medical Research Council (MRC) scale; health related quality of life was assessed with the St.George's Respiratory Questionnaire (SGRQ). Exercise capacity was measured using the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT); anxiety and depression were assessed with the hospital anxiety depression scale (HADS). All parameters were recorded before and after pulmonary rehabilitation programme. Dyspnea sensation, anxiety and depression scores decreased after pulmonary rehabilitation (p: 0.023, p: 0.026, p: 0.039 respectively). Also impact domains of SGRQ significantly reduced (Z= 1.988; p= 0.047).The difference between median values of ISWT results before and after pulmonary rehabilitation was 60 meters. Although it was not statistically significant (Z= 1.863; p= 0.063), the level of increment was higher than the minimaly important clinical differance for ISWT. Our results showed that comprehensive pulmonary rehabilitation programmes were benefical for patients with interstitial lung diseases and it should be regarded as a standard care in this population from the early stages.

The modified Medical Research Council dyspnoea scale is a good indicator of health-related quality of life in patients with chronic obstructive pulmonary disease

Health-related quality of life (HRQoL) is an important patient-centred outcome in chronic obstructive pulmonary disease (COPD). The aim of the current study is to compare the discriminative capacity of the modified Medical Research Council (mMRC) dyspnoea scale and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric classification of COPD on HRQoL, as well as determine other factors that are simple and determinative of HRQoL. In this cross-sectional observational study, a total of 328 patients with COPD were enrolled from the pulmonology outpatient clinic. HRQoL was measured using the St George's Respiratory Questionnaire (SGRQ) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). HRQoL scores were compared between the four GOLD stages and the five grades of the mMRC scale. Significant differences were determined using analysis of variance with Scheffe post-hoc test. Multiple linear regression was applied to explore the major determinants of HRQoL and exclude confounding factors. Significant differences were found in many more domains of the two questionnaires between mMRC grades than between GOLD stages. In the multiple linear regression model, the mMRC scale was the only factor that remained determinative of all the domains of SGRQ and WHOQOL-BREF. Patients with chronic productive cough, sleep disorders and frequent exacerbations had poorer HRQoL, as reflected by higher scores in SGRQ or lower scores in WHOQOL-BREF. The mMRC dyspnoea scale is a concise and practical tool to assess the HRQoL of patients with COPD in daily clinical practice.

Pretreatment with inhaled procaterol improves symptoms of dyspnea and quality of life in patients with severe COPD

BackgroundThe clinical efficacy of short-acting β2-agonists administered before performing daily activities in chronic obstructive pulmonary disease (COPD) is unclear. The aim of this study was to investigate the clinical effect of supplementary inhaled procaterol hydrochloride in patients with COPD.MethodsThirty outpatients with moderate to severe COPD (Stage II–IV) regularly using inhaled tiotropium bromide alone and with dyspnea during daily activities were enrolled. Subjects self-administered 20 μg of inhaled procaterol before daily activities no more than four times daily. Dyspnea symptom scores, St George’s Respiratory Questionnaire (SGRQ) activity domains, impulse oscillometry system parameters, and pulmonary function tests were recorded at the beginning and end of the 2-week study.ResultsAt baseline, more than 80% of subjects reported dyspnea when walking up a slope (100.0%), climbing stairs (100.0%), gardening (93.3%), walking on flat ground (90.0%), bathing (86.7%), getting on a bus or train (83.3%), and changing clothes (80.0%). After 2 weeks, subjects with Stage III symptoms had significantly improved dyspnea scores on walking up a slope (P = 0.047), climbing stairs (P = 0.014), gardening (P = 0.034), walking on flat ground (P = 0.006), getting on a bus or train (P = 0.039), and changing clothes (P = 0.045). Both symptom and activity SGRQ domains improved significantly in subjects with Stage III symptoms (P = 0.036 and P = 0.028, respectively). Resistance of small airways and low-frequency reactance area values improved significantly in subjects with Stage III symptoms (P = 0.003 and P = 0.004, respectively). No significant changes were found in pulmonary function tests.ConclusionUse of supplementary inhaled procaterol before performing daily activities improved dyspnea symptoms in subjects with Stage III COPD.