Establishing Meaningful Change Thresholds in Patient-Reported Outcomes Among Patients With Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer in ALTA-1L Trial.

OBJECTIVES: An earlier study from the ALTA-1L trial of patients with anaplastic lymphoma kinase-positive non-small cell lung cancer demonstrated that brigatinib produces superior health-related quality of life (QoL) outcomes over crizotinib. This study aimed to derive meaningful change thresholds (MCTs) for European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and EORTC QLQ-LC13 to refine the earlier results. METHODS: Patients from the ALTA-1L trial were administered the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires. Responses were analyzed using anchor-based analysis, graphical analysis, distribution-based analysis, longitudinal responder analysis, and time to deterioration. RESULTS: The patient-reported outcome population comprised 262 patients who completed the EORTC QLQ-C30 at baseline and at least 1 follow-up timepoint. Both anchors (QLQ-C30 items for overall health and QoL) had correlations >0.40 or < -0.40 with all functioning domains, fatigue, pain, appetite loss, and all dyspnea scores. Within-group analysis for most scales found the derived MCT was consistent with a cutoff of 10 points for classifying individual-patient change, except for 3-item dyspnea. The probability of improvement/remaining stable was significantly greater in the brigatinib group over crizotinib for the EORTC QLQ-C30 emotional functioning, appetite loss, and constipation domains. CONCLUSIONS: This study derived MCTs for EORTC QLQ-C30 and QLQ-LC13 domains that may be applied in future studies and again demonstrated the superiority of brigatinib over crizotinib in health-related QoL outcomes in patients with non-small cell lung cancer.

Modified MRC assessment and FEV1.0 can predict frequent acute exacerbation of COPD: An observational prospective cohort study at a single-center in Japan.

INTRODUCTION: Acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) is a fatal event, leading to poor outcomes among COPD patients. However, exact frequency and poor prognostic factors are not well known in Japan. METHODS: and patients, To assess the frequency and risk factors of AE, we performed this prospective cohort study at the Kameda Medical Center in Japan between during 2011 and 2013. AE was defined as an acute worsening of respiratory symptoms according to the GOLD guideline. Furthermore, we compared the exacerbation-free time between the groups. RESULTS: A total of 330 patients (230 COPD patients and 100 smoking controls) were enrolled in the study. The mean age in the study was 73 years, and 94% of the patients were male. As for the frequency of AE, 0.17 times/patients/year was found in all patients. The frequency of AE increased as the COPD disease severity (p = 0.042 by Jonch-Heere terpla test). GOLD I patients had longer exacerbation-free time than GOLD II, and GOLD II grade COPD patients had longer exacerbation-free time than GOLD III grade COPD patients. In terms of risk factors for AE, logistic regression analysis showed that Modified Medical Research Council (mMRC) scale ≥3 and FEV1.0% <50% were independent poor prognostic factors for moderate grade of AE events, and mMRC scale ≥3 was independent poor prognostic factor for severe AE events. CONCLUSION: The frequency of AE increases as the disease severity becomes more severe. We found mMRC scale >3 and FEV1 <50% were risk factors for AE-COPD.

Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD.

BACKGROUND: COPD is a common but irreversible disease. Nevertheless, patients with COPD can maintain good quality of life through psychological resilience and effective self-management. However, limited studies have investigated the relationship between self-management behaviors and resilience in patients with COPD. Thus, the present study aimed to determine the factors associated with self-management behaviors and resilience among patients with COPD. METHODS: A total of 100 subjects with COPD were recruited from a medical center in northern Taiwan from February 2020 to January 2021. Each subject completed a questionnaire based on the 20-item COPD Self-Management Scale and 25-item Resilience Scale through a face-to-face interview. A multiple linear regression model that controlled for sociodemographic and clinical factors was used to examine the relationship between self-management behaviors and resilience. RESULTS: Analysis of our data indicated that differences in educational level, smoking status, religion, modified Medical Research Council dyspnea scale score, degree of COPD impacting wellbeing, number of COPD-related hospitalizations within 1 year, and self-reported comorbidities were associated with differences in self-management and resilience scores. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) D group had the lowest scores for self-management and resilience among GOLD groups A, B, C, and D. Self-management and resilience were positively correlated (r = 0.703, P < .001). In the linear regression model, a better self-management value was associated with a higher resilience score (ß = 0.749, P < .001), whereas an increasing resilience score was also associated with a better self-management score (ß = 0.461, P < .001). CONCLUSIONS: This study revealed that self-management and psychological resilience were positively correlated and associated in our linear regression model. Future work may focus on finding the causative relationship between self-management and resilience among patients with COPD.

A case of renal cell carcinoma with microscopic pulmonary tumor embolism proven by surgical lung biopsy.

Pulmonary tumor embolism (PTE) is difficult to diagnose before death. We report the case of a 75-year-old man with microscopic PTE of renal cell carcinoma who was diagnosed by surgical lung biopsy. He visited our hospital because of dyspnea on exertion. Chest computed tomography (CT) showed multiple micronodules and ground glass opacities. Steroid therapy was started as therapeutic diagnosis for IgG4-related pulmonary disease. However, he was admitted our hospital due to progressive respiratory failure. Pathological findings of a lung biopsy obtained by video-assisted thoracic surgery showed PTE of renal cell carcinoma without embolization of large pulmonary arteries. He received palliative medicine and died four months after the surgical lung biopsy. In cases of multiple micronodules in chest CT findings and worsened respiratory symptoms, PTE should be considered in the differential diagnosis.

Improvements of lung volumes and respiratory symptoms after weight loss through laparoscopic sleeve gastrectomy.

PURPOSE: This study evaluated the improvement of respiratory function and airway volumes using spirometry and computed tomography (CT) in severely obese Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also evaluated the quality of life (QOL) of enrolled patients using questionnaires. METHODS: A total of 71 patients who underwent LSG at Iwate Medical University Hospital between October 2013 and September 2020 were enrolled. The changes and relationships between respiratory parameters including CT volumetry and weight-loss effects were evaluated. Improvements to QOL and bronchial asthma (BA) were also assessed before LSG and 1 year after LSG. RESULTS: The mean excess weight loss percentage (%EWL) and total weight loss percentage (%TWL) were measured at 55.1% and 26.1%, respectively. The attack frequency of BA significantly decreased (6.1/month vs. 1.5/month; P < 0.001), and the disease severity decreased according to severity classification (P = 0.032). Almost spirometric parameters, lung volume (LV) (4905.0 mL vs. 5490.3 mL; P < 0.001), and airway volume (AV) (108.6 mL vs. 119.3 mL; P = 0.022) significantly improved. The change of functional residual capacity (FRC) was correlated with both %EWL (ρ = 0.69, P < 0.001) and %TWL (ρ = 0.62, P < 0.001). The increase of LV (ρ = 0.79, P < 0.001) and AV (ρ = 0.69, P < 0.001) were correlated with the increase of FRC. Scores of QOL questionnaires dramatically became better owing to improvements in dyspnea. CONCLUSION: Weight loss effects and the reduction of body fat mass correlated significantly with increase in LV and AV. Improvements of respiratory functions after LSG contributes to QOL and BA symptoms.

The effectiveness of short-term pulmonary rehabilitation program in patients with comorbid asthma, chronic obstructive pulmonary disease and obesity.

The effectiveness of pulmonary rehabilitation (PR) has not yet been established in patients with asthma - chronic obstructive pulmonary disease overlap (ACO) depending on their nutritional status. We aimed to evaluate the effectiveness of a short-term PR program in patients with comorbid asthma, chronic obstructive pulmonary disease (COPD), and obesity. We included 40 ACO patients and divided them into 3 groups according to body mass index (BMI) and then subdivided them into PR (n=21) and control (n=19) groups. The COPD Assessment Test (CAT), the Asthma Control Test (ACT), and the modified Medical Research Council dyspnea scale (mMRS) were used to evaluate symptoms levels. BODE index (body mass index, forced expiratory volume in one second, dyspnoea, and 6-min walk distance) was used to evaluate the effectiveness of pulmonary rehabilitation. In addition, spirometry and bioimpedansometry were performed. All measurements were done before and after a 6-month PR program. A significantly lower decline in the BODE index was observed in overweight patients (decreased by 43.6% compared to baseline and lower by 40.7% compared to the control group). The six-minute walking test (6MWT) significantly increased in all groups (p<0.001). There was a decrease in total CAT score by 25.4% and by 31.2% in the overweight group (p<0.001). The BMI decreased more in the obese group (by 9.4% compared to baseline). Our study result showed that early use of PR program significantly improves functional capacity and BODE index, leads to dyspnea and CAT scores reduction and improvement in pulmonary function, cause a decrease in BMI, body fat percentage, and visceral fat level, and an increase in muscle mass in overweight and obese patients with ACO.

The Value of Dyspnea and Spirometry in Detecting Relapse of Benign Tracheal Stenosis.

BACKGROUND: Benign tracheal stenosis may relapse after management. OBJECTIVES: This study aimed to assess the value of dyspnea and spirometry in detecting relapse of benign tracheal stenosis. METHODS: Patients with benign tracheal stenosis were evaluated post-management, at regular follow-up and emergency visits, with the Medical Research Council (MRC) dyspnea scale, spirometry, and flexible bronchoscopy. Patient visits were categorized and compared, in terms of change in clinical and functional parameters, in 2 groups: visits with relapse (case group) and visits with no relapse (control group). The ability of the MRC dyspnea scale and spirometry to predict relapse was evaluated. RESULTS: Thirty-five patients with benign tracheal stenosis were included. Mean follow-up duration was 3.2 years (standard deviation = 3.3). Spirometry data were analyzed from 43 relapse visits (23 patients) versus 90 nonrelapse visits. The MRC dyspnea score and most spirometric indices were associated with relapse. In the receiver operating characteristic analysis, forced expiratory volume in 1 s, forced expiratory flow when 25% of forced vital capacity has been expired, peak expiratory flow (PEF), and total peak flow were superior to the MRC dyspnea score in predicting relapse. Among spirometric indices, >10.8% of PEF reduction has been very sensitive and specific. CONCLUSIONS: This study supports the role of dyspnea and spirometry in monitoring benign tracheal stenosis, with spirometry predicting relapse even in clinically stable patients. PEF being a very sensitive index has the additional advantage of being assessed by peak flow meter and could potentially be used for remote monitoring.

The Relationship Between Clinical Phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stages/Groups in Patients With Chronic Obstructive Pulmonary Disease.

Background Chronic obstructive pulmonary disease (COPD) cannot be properly characterised by a single metric, forced expiratory volume in the first second (FEV1), due to its complexity and heterogeneity. The GOLD 2017 report contained the ABCD evaluation method to measure airflow limitation, symptoms, and/or exacerbation risk. Objective The purpose of this study was to explore the relationship between clinical characteristics and GOLD groups or stages in patients with COPD. Methods This cross-sectional observational study was conducted at the department of respiratory medicine, King George's Medical University, Lucknow, Uttar Pradesh, India, between 2019 and 2022. Here, stable COPD patients' demographics, clinical characteristics, and the number of exacerbations were compared between the groups following the GOLD 2022 report. An unpaired t-test with Welch's correction, chi-square test, Fisher's exact test, one-way ANOVA, and Kruskal-Wallis test were used for statistical significance. Results In this study, 349 stable COPD patients (256 males and 93 females) were selected. The GOLD 2017 categorization placed 78 (22.4%) patients in group A, 158 (45.3%) in B, 44 (12.6%) in C, and 69 (19.8%) in D. Further, we used GOLD 2017 to classify COPD patients into 16 subgroups (1A-4D). FEV1 (% predicted) decreased across groups A to D (p<0.0001). Groups C and D had a longer duration of illness, higher COPD assessment test (CAT) score, higher Modified Medical Research Council (mMRC) dyspnea scale, longer exacerbation history, and more COPD hospitalizations in the previous year than groups A and B. More symptomatic patients (B and D) exhibited lower FEV1 (% predicted) and more severe airflow limitation than less symptomatic patients (A and C) (p=0.0002). Symptomatic individuals exhibited higher CAT and mMRC dyspnea scores (p<0.0001). Groups C and D comprised older patients and those with longer disease duration, higher mMRC dyspnea scale and CAT, lower FEV1, and more severe airflow limitation (A and B). Conclusion The present study demonstrates the distribution of COPD patients' clinical phenotypes in an Indian population. We conclude that the combined COPD assessment according to the GOLD 2022 guideline provides a better understanding of COPD.

The emerging role of mycophenolate mofetil in interstitial lung diseases.

INTRODUCTION: Mycophenolate mofetil (MMF), initially approved to prevent rejection in solid organ allograft, is now being increasingly used for other conditions. Over the last decade, MMF has emerged as a useful therapy for a variety of immune-mediated diseases. AREAS COVERED: There has been a growing interest in the clinical use of MMF in the treatment of ILDs due to its versatile anti-inflammatory, immunomodulatory, anti-fibrotic and anti-proliferative properties. In this focussed review, we summarize the available literature using the Pubmed, Science Direct and EMBASE databases published until June 2021 on the efficacy and tolerability of MMF in various ILDs. EXPERT OPINION: Other than idiopathic pulmonary fibrosis (IPF) and its broader category of progressive fibrosing ILD, there have been no drugs approved by relevant regulatory agencies for the treatment of the multiple other forms of ILD. Though results are limited, immunosuppressants such as MMF have shown promise as an effective and well-tolerated steroid-sparing agent, providing hope that the limited treatment armamentarium for ILDs can be expanded.

Clinical characteristics of patients with chronic obstructive pulmonary disease assessed using GOLD 2016 and GOLD 2018 classifications: a cross-sectional study in China.

BACKGROUND: In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) removed spirometry as a criterion for classifying GOLD risk groups (A-D, low-high risk). METHODS: In this cross-sectional observational study in China, we used the GOLD 2016 (spirometry included) and 2018 (spirometry eliminated) criteria for classifying GOLD risk groups to describe: the proportion of patients with chronic obstructive pulmonary disease (COPD) in each GOLD risk group; disease severity; demographics and comorbidities. Patients aged ≥40 years with a clinical COPD diagnosis for ≥1 year were included. During a single study visit, patients completed the COPD assessment test, modified Medical Research Council (mMRC) dyspnea scale assessment, and spirometry tests. Demographics, medical history, and treatment data were recorded. RESULTS: In total, 838 patients were included. Most patients were male (86.4%), ≥65 years old (58.6%), and current or former smokers (78.5%). By GOLD 2016, the highest proportion of patients were Group D (42.8%), followed by B (28.2%). By GOLD 2018, the highest proportion of patients were Group B (57.3%), followed by A (25.5%). A total of 296 patients (35.3%) were reclassified, either from Group C to Group A or from Group D to Group B. Overall, 36.2% of patients were receiving treatment concordant with GOLD 2016 recommendations; 34.1% were not receiving any inhaled medication. CONCLUSIONS: The distribution of COPD severity shifted from a high-risk category (by GOLD 2016) to a low-risk category (by GOLD 2018). The high proportion of patients not receiving maintenance medication reflects a high level of under-treatment of the disease.

Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan.

BACKGROUND: Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation. METHODS: We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ). RESULTS: Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease. CONCLUSIONS: Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings.

CONTEXT: The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest. OBJECTIVES: To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer. METHODS: A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested. RESULTS: The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74-0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33-0.36, respectively). CONCLUSION: The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.

Pain is a common problem in patients with ILD.

BACKGROUND: As it is less known about the prevalence and characteristics of pain in the patients with interstitial lung disease (ILD), this paper aims at determining the characteristics of the pain in the patients with ILD. METHODS: Subjects with ILD and health controls with the matched ages and genders completed Short Form McGill Pain Questionnaire (SF-MPQ) and part of the Brief Pain Inventory (BPI) Short Form to elicit the characteristics of the pain. The patients with ILD were also assessed through Pulmonary Function Test, Six Minutes Walking Test (6MWT), modified Medical Research Council Dyspnea Scale (mMRC) for state of the illness and measured health-related quality of life (HRQoL) by Short Form-36 (SF-36) and psychological associations by Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 63 subjects with ILD and 63 healthy controls (HC) were recruited in our study. The prevalence of the pain was 61.9% in ILD versus 25.3% in HC (P = 0.005) and the median score of the pain rank index (PRI) in ILD was higher than that in HC (P = 0.014). Chest (46.1%) accounted for the highest of overall pain locations in subjects with ILD. Associated clinical factors for pain intensity in the patients with ILD included exposure history of risk factors of ILD, with a longer distance of 6MWD (≥ 250 m), and a higher mMRC score (2-4). The patients with ILD and pain are more likely to suffer impaired HRQoL (P = 0.0014) and psychological problems (P = 0.0017, P = 0.044). CONCLUSION: The pain is common in those with ILD and the pain intensity is associated with exposure history, 6MWD, and mMRC score. The patients with ILD and pain were possibly to suffer depression, anxiety, and impaired HRQoL.

Secondary organizing pneumonia associated with sertraline: A case report.

Cryptogenic organizing pneumonia is a rare idiopathic interstitial lung disease, with a well-defined clinical-radiological and pathological entity. It may also be secondary to several causes. Rapid clinical and imaging improvement is usually obtained with corticosteroid therapy. We report here, to the best of our knowledge, a unique case of organizing pneumonia associated with Sertraline, a selective serotonin reuptake inhibitor, commonly used in antidepressant therapy.

Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial.

Although the beneficial effect of exercise on the health of Chronic Obstructive Pulmonary Disease (COPD) patients has been widely demonstrated, that of Tai Chi Qigong (TCQ), as an alternative exercise, has been inconclusive. Therefore, this study aimed to evaluate the effects of combined center-and home-based TCQ on functional capacity and lung function in patients with mildly and moderately severe COPD. A total of 50 patients, with a mild and moderate degree of COPD, were recruited and randomly assigned to either the TCQ (n = 25) or control group (n = 25). The TCQ group completed 12-week center-and 12-week home-based training. The control group attended a meeting class once a week for 12 weeks. Outcome measures were assessed at baseline, and the 6th, 12th and 24th week. The primary outcomes were functional capacity (6-min walk test; 6MWT) and lung function. The secondary outcomes were dyspnea score and quality of life. The TCQ group demonstrated significant improvement in functional capacity at week 12 and 24 (p < 0.05) and dyspnea score and quality of life at week 6, 12 and 24 (p < 0.05) when compared to baseline. Functional capacity, forced expiratory volume in 1st second (FEV1), dyspnea score, and quality of life were significantly better in the TCQ group from week 6 to week 24 when compared to the control group (p < 0.05). Combined center-and home-based TCQ training for patients with mildly and moderately severe COPD is effective in improving functional capacity, dyspnea score, and quality of life.

Body plethysmography for measuring airway resistance in patients with bilateral vocal fold immobility.

OBJECTIVE: This study investigated the reliability of body plethysmography in comparison to spirometry in objectively measuring upper airway functions. METHODS: The study population consisted of 53 participants, 23 patients with BVFI after endolaryngeal laser posterior cordectomy and 30 healthy volunteers. All of them had body plethysmography (airway resistance, Raw), spirometry (ratio of forced expiratory flow at 50% to forced inspiratory flow at 50%, FEF50/FIF50 and peak inspiratory flow, PIF), 6 min-walking-test (6MWT) and Medical Research Council (MRC) dyspnea scale measurements. The tests were repeated and reliability was evaluated using intraclass correlation (ICC) and Spearman correlation. RESULTS: The reliability of Raw was high with ICC of 0.92, comparable to the spirometry measurements: FEF50/FIF50(ICC = 0.72) and PIF (ICC = 0.97). The mean of Raw was significantly higher in patient group. A strong significant correlation between Raw and MRC dyspnea scale (r = 0.79; p<0.05) and a moderate negative correlation between Raw and 6MWT (r = 0.4; p<0.05) was demonstrated. CONCLUSION: Body plethysmography (Raw) is a reliable tool in objective measurement of upper airway resistance that reflects the patient's perception of breathlessness. A larger number of participants are necessary to confirm this finding.

Office-Based Steroid Injections for Idiopathic Subglottic Stenosis: Patient-Reported Outcomes, Effect on Stenosis, and Side Effects.

OBJECTIVE: Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects. METHODS: Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t-tests compared values at baseline versus follow-up tracheoscopy. RESULTS: DI decreased (t = 3.938, P = 0.0013), as did MMRC (t = 2.179, P = 0.0457). There was no change in VHI-10 (t = 1.354; P = 0.1957) scores. Airway stenosis decreased (t = 4.331; P = 0.0006); this was not correlated with change in DI (r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2). CONCLUSION: Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis.

The Impact of Upper Limb Training with Breathing Maneuver in Lung Function, Functional Capacity, Dyspnea Scale, and Quality of Life in Patient with Stable Chronic Obstructive of Lung Disease.

BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429). CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients.

Correlation of the modified Medical Research Council dyspnea scale with airway structure assessed by three-dimensional CT in patients with chronic obstructive pulmonary disease.

BACKGROUND: Dyspnea is a common symptom in chronic obstructive pulmonary disease (COPD). The modified Medical Research Council (mMRC) dyspnea scale is a widely used questionnaire to assess dyspnea. However, the relationship of the mMRC dyspnea scale with morphological airway structures in COPD remains unclear. We evaluated the correlation between the mMRC dyspnea scale and imaging-based airway structures in patients with COPD. METHODS: The wall area (WA) and airway inner luminal area (Ai) of third-to sixth-generation bronchi and the percentage of low attenuation area with less than -950 HU (%LAA) of the lungs were measured using three-dimensional computed tomography in patients with COPD. WA and Ai were corrected by body surface area (BSA). RESULTS: Forty-two clinically stable patients with COPD were enrolled. The median (range) mMRC dyspnea scale was 2 (0-3). The mMRC dyspnea scale score was significantly correlated with WA/BSA of fifth- and sixth-generation bronchi (Spearman correlation coefficient ρ = 0.386, p = 0.012; ρ = 0.484, p = 0.001, respectively). Partial rank correlation analysis showed that the mMRC dyspnea scale score was significantly correlated with WA/BSA of sixth-generation bronchi, independent of the confounding factors of age, body mass index, %predicted forced expiratory volume in 1 s, %LAA, and Ai/BSA (ρ = 0.481, p = 0.003). However, the %LAA and Ai/BSA were not correlated with this dyspnea scale. CONCLUSION: Bronchial WA assessed by three-dimensional computed tomography may be used as an assessment tool for dyspnea in patients with COPD.

Italian version of Dyspnoea-12: cultural-linguistic validation, quantitative and qualitative content validity study.

BACKGROUND: Dyspnoea-12 is a valid and reliable scale to assess dyspneic symptom, considering its severity, physical and emotional components. However, it is not available in Italian version due to it was not yet translated and validated. For this reason, the aim of this study was to develop an Italian version Dyspnoea-12, providing a cultural and linguistic validation, supported by the quantitative and qualitative content validity. METHODS: This was a methodological study, divided into two phases: phase one is related to the cultural and linguistic validation, phase two is related to test the quantitative and qualitative content validity. Linguistic validation followed a standardized translation process. Quantitative content validity was assessed computing content validity ratio (CVR) and index (I-CVIs and S-CVI) from expert panellists response. Qualitative content validity was assessed by the narrative analysis on the answers of three open-ended questions to the expert panellists, aimed to investigate the clarity and the pertinence of the Italian items. RESULTS: The translation process found a good agreement in considering clear the items in both the six involved bilingual expert translators and among the ten voluntary involved patients. CVR, I-CVIs and S-CVI were satisfactory for all the translated items. CONCLUSIONS: This study has represented a pivotal step to use Dyspnoea-12 amongst Italian patients. Future researches are needed to deeply investigate the Italian version of  Dyspnoea-12 construct validity and its reliability, and to describe how dyspnoea components (i.e. physical and emotional) impact the life of patients with cardiorespiratory diseases.