Impact of pulmonary rehabilitation on psychosocial morbidity in patients with severe COPD.

STUDY OBJECTIVE: To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe COPD. DESIGN: A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis. SETTING: A tertiary-care respiratory service. PATIENTS: Forty patients (mean age, 65 +/- 8 years [+/- SD]) with severe chronic flow limitation (FEV(1), 35 +/- 13%) without respiratory failure (Pao(2), 72 +/- 9 mm Hg; Paco(2), 42 +/- 5 mm Hg) were randomized either to a control group or to a PR group (PRG). INTERVENTIONS: Sixteen weeks of PR that included breathing retraining and exercise. MEASUREMENTS: At baseline and 16 weeks, we evaluated psychosocial morbidity using two questionnaires (the Millon Behavior Health Inventory [MBHI] and the Revised Symptom Checklist [SCL-90-R]) and measured 6-min walk distance (6WMD) and HRQL using the Chronic Respiratory Questionnaire (CRQ). RESULTS: We found differences in favor of the PRG in the following MBHI domains: introversive, forceful, and sensitive personality styles (all p

Are oxygen-conserving devices effective for correcting exercise hypoxemia?

BACKGROUND: Correction of exercise hypoxemia in advanced lung diseases is crucial and often challenging. However, oxygen-conserving devices have been introduced in the market with limited evidence of effectiveness. In the present study the efficacy of 2 oxygen-conserving devices, a pulse demand oxygen delivery (DOD) system and pendant reservoir cannula (PRC), were evaluated in subjects with COPD and interstitial lung disease (ILD). METHODS: A cross-sectional, crossover study included 28 COPD and 31 ILD subjects with oxygen desaturation on the 6-min walk test (average S(pO2) < 88%). Each subject underwent 3 walk tests with DOD, PRC, and continuous oxygen flow by standard nasal cannula (CFNC), in random order, taking average S(pO2) ≥ 90% as the resaturation criterion. RESULTS: Exercise desaturation was corrected in 79%, 79%, and 86% of COPD subjects with CFNC, DOD, and PRC, respectively, and in 77%, 61%, and 81% of ILD subjects with CFNC, DOD, and PRC, respectively. When compared to CFNC, the oxygen-conserving devices showed similar efficacy, except a lower performance for the DOD in the ILD subjects (P = .01). CONCLUSIONS: Although these oxygen-conserving devices corrected exercise hypoxemia in most COPD and ILD subjects, correction was not achieved in about 20% of the severe COPD subjects, regardless of the device, and in nearly 40% of the ILD subjects with the DOD device. These findings underscore that individualized adjustment of oxygen flow is needed for optimal correction of exercise hypoxemia, especially with a DOD in an ILD patient. (ClinicalTrials.gov NCT01086891).

[The validity and sensitivity to change of the Spanish self-administered version of the chronic respiratory questionnaire (CRQ-SAS)]. / Validez y sensibilidad al cambio de la versión española autoadministrada del cuestionario de la enfermedad respiratoria crónica (CRQ-SAS).

INTRODUCTION: The interviewer-administered chronic respiratory questionnaire (CRQ-IA) is widely used and has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS) in Spanish has not been validated. The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SAS in patients with COPD. MATERIAL AND METHODS: We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs. IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 questionnaire, pulmonary function tests, and six-minute walk test. RESULTS: The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a range of correlations, for the change scores, between 0.46 (P=.05) and 0.71 (P=.01). Regarding sensitivity to change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [P=.02], emotional factor 0.62 [P=.04], control of the disease 0.83 [P=.06]). CONCLUSIONS: The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. The correlations of the CRQ-SAS with other tools provide construct validity and show good sensitivity to change.

Validez y sensibilidad al cambio de la versión española autoadministrada del cuestionario de la enfermedad respiratoria crónica (CRQ-SAS) / The Validity and Sensitivity to Change of the Spanish Self-Administered Version of the Chronic Respiratory Questionnaire (CRQ-SAS)

Introducción: El cuestionario de la enfermedad respiratoria crónica con entrevistador (CRQ-IA) ha demostradoexcelentes propiedades de medida de la calidad de vida relacionada con la salud (CVRS) en pacientescon enfermedad pulmonar obstructiva crónica (EPOC). La validación en español de la versión estandarizadaautoadministrada (CRQ-SAS) no se ha realizado. El objetivo de este estudio fue evaluar la validez yla sensibilidad a los cambios, de la versión española del CRQ-SAS en pacientes con EPOC.Pacientes y métodos: Aleatorizamos a 40 pacientes con EPOC (33 en tratamiento con rehabilitación respiratoriay 7 con oxígeno líquido) a uno de los dos métodos de administración del CRQ (SAS vs. IA) antesy 8 semanas después de la intervención. Los pacientes completaban el cuestionario SF-36, pruebas defunción pulmonar y prueba de los 6 min de marcha.Resultados: El CRQ-SAS ha demostrado una buena validez de constructo longitudinal en todas las áreascon un rango de correlaciones, para las puntuaciones del cambio, entre 0,46 (p = 0,05) y 0,71 (p = 0,01).En cuanto a la sensibilidad a los cambios, se observa un cambio mínimo clínicamente significativo en lamayoría de áreas (fatiga 0,71 [p = 0,02], factor emocional 0,62 [p = 0,04], control de la enfermedad 0,83[p = 0,06]).Conclusiones: La versión española del CRQ-SAS resulta ser válida para evaluar la CVRS de los pacientescon EPOC. Las correlaciones con otros instrumentos aportan validez de constructo y se demuestra unabuena sensibilidad a los cambios(AU)

Introduction: The interviewer-administered chronic respiratory questionnaire (CRQ-IA) is widely usedand has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patientswith chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS)in Spanish has not been validated.The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SASin patients with COPD.Material and methods: We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs. IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 questionnaire, pulmonary function tests, and six-minute walk test. Results: The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a rangeof correlations, for the change scores, between 0.46 (P=.05) and 0.71 (P=.01). Regarding sensitivityto change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [P = .02],emotional factor 0.62 [P=.04], control of the disease 0.83 [P=.06]).Conclusions: The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. Thecorrelations of the CRQ-SAS with other tools provide construct validity and show good sensitivity tochange(AU)