Londrina Activities of Daily Living Protocol: validity, reliability, minimal detectable change, and standard error of measurement in adults with asthma.

INTRODUCTION: Asthma symptoms are dyspnea, chronic cough, wheezing, chest tightness, or chest discomfort, which can directly limit the activities of daily living (ADL), which is frequently reported by adults with asthma. Evaluating ADL with a reliable protocol at the usual speed is necessary. OBJECTIVES: To investigate the validity, reliability, minimal detectable change (MDC), and standard error of measurement (SEM) of the Londrina ADL Protocol (LAP) for adults with asthma. METHODS: Adults with asthma were evaluated with the LAP test. Spearman's correlation coefficient was used to verify validity with the 6-min walk test (6MWT), Glittre-ADL test, and London Chest Activity of Daily Living (LCADL). To test the reliability, the test was reapplied in at least 30 min; the Wilcoxon test and Intraclass Correlation Coefficient (ICC), SEM, MDC, and learning effect were performed. RESULTS: Fifty-three individuals were included (26% men, 43 ± 15 years, BMI 28 ± 8 kg/m2, FEV1 70 ± 24%predicted). For convergent validity, the LAP test was correlated with the 6MWT, Glittre-ADL, and LCADL scale (r = -0.49, 0.71, and 0.30, respectively; p < 0.03). There was a difference in test-retest (p < 0.0001) and reliability analysis shows ICC3 of 0.94, SEM of 14.88 s (22%), and MDC of 41.23 s (15%). Furthermore, the individuals performed the second test with -23 ± 19 (7.9%) s. CONCLUSION: The LAP test is valid and reliable for assessing limitations during ADL in adults with asthma. Considerable learning effect was observed, therefore, the best of two measures may avoid underestimation.

Characteristics of Skeletal Muscle Strength in Subjects With Interstitial Lung Disease.

OBJECTIVES: To investigate muscle strength and the prevalence of muscle weakness in adults with interstitial lung diseases (ILDs) compared to healthy subjects. DESIGN: Cross-sectional (description of clinical features). SETTING: Public referral center (University Hospital). PARTICIPANTS: One hundred and twelve adults with ILD (n=48, 60±10yr, 68% female) and healthy counterparts (control group, n=64, 57±10yr, 58% female) (N=112). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): Muscle strength and prevalence of muscle weakness in adults with ILD. Muscle strength was assessed via maximal isometric voluntary contraction of dominant upper and lower limb muscle groups. Data from the control group were used to generate reference equations. Muscle weakness was defined as a muscle strength value below the lower limit of normal calculated using data from the control group. Data were expressed as mean ± SD or median [interquartile range] according to the data distribution. RESULTS: Compared to the control group, adults with ILD had lower muscle strength for all muscle groups assessed (values presented as %predicted: pectoralis major 75[57-86]%; quadriceps 72[58-87]%; latissimus dorsi 76[57-103]%; deltoid 74[64-98]%; biceps brachii 78[64-91]%; triceps brachii 84[62-101]%; P≤.001 for all). Prevalence of muscle weakness in people with ILD was 40% for pectoralis major, 25% for latissimus dorsi, 16% for triceps brachii, 20% for biceps brachii, 27% for deltoid and 46% for quadriceps. CONCLUSIONS: Adults with ILD present a generalised reduction in peripheral Muscle strength, ranging between 20% to 46% of people depending on the muscle group assessed. and it was more prevalent in lower limb muscles.

Sarcopenia and sleep in individuals with chronic obstructive pulmonary disease.

OBJECTIVE: To verify the relationship between sarcopenia and sleep in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Individuals with COPD were cross-sectionally assessed for lung function (spirometry), sleep (both subjectively [Pittsburgh Sleep Quality Index, PSQI] and objectively [Actiwatch sleep monitor]) and the presence of sarcopenia (handgrip strength by dynamometry). All tests were carried out in accordance with international standards. RESULTS: Twenty-nine individuals with COPD were analyzed (16 women; 69 ± 7 years; BMI 27 ± 5 kg/m2; FEV1 59 ± 19% predicted). Upon division in groups according to the presence or absence of sarcopenia, individuals with sarcopenia (in comparison to those without sarcopenia) had shorter sleep time (81 [75-85] vs. 86 [81-90] %; p = 0.043), lower sleep efficiency (77 [69-83] vs. 85 [75-87] %; p = 0.038), longer time awake after sleep onset (92 [71-120] vs. 58 [47-83] minutes; p = 0.0012) and more marked sleep fragmentation, represented by a higher number of sleep blocks/night (46 [41-49] vs. 34 [26-48]; p = 0.018), higher number of awake blocks/night (45 [40-49] vs. 34 [26-48]; p = 0.018) and shorter duration of sleep blocks/night (9 [8-10] vs. 14 [8-58] minutes; p = 0.043). There was no statistical difference when comparing the PSQI variables between the groups. However, handgrip strength was negatively associated with PSQI components 2 [R= -0.51, p = 0.005] and 5 [R= -0.39, p = 0.037]. CONCLUSION: Individuals with COPD and sarcopenia (as measured by handgrip strength) have worse objectively measured sleep outcomes. This was not the case regarding a self-reported perception of worse sleep quality, although there was weak-to-moderate association between handgrip strength and subjective sleep.

Do Functional Tests Estimate Physical Activity in COPD?

The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern.

Functional tests for adults with asthma: validity, reliability, minimal detectable change, and feasibility.

OBJECTIVE: To verify the validity, reliability, learning effect, Minimal Detectable Change (MDC), and feasibility of four functional tests (4-Meter Gait Speed [4MGS], Timed Up-and-Go [TUG], Sit-To-Stand [STS], and Short Physical Performance Battery [SPPB]) for adults with asthma. METHODS: In this cross-sectional study, fifty-two subjects with stable asthma underwent three sets of different functional tests protocols (4MGS, TUG, STS, SPPB) in a random order by two raters. For validation analysis, tests were compared with a sex-age matched control group without asthma and correlated with the Six Minute Walking Test (6MWT), and peripheral muscle strength, as well as with quality of life and asthma control questionnaires. Intra-rater and inter-rater reliability, MDC, and feasibility were verified. RESULTS: Adults with asthma presented worse results than controls in the functional tests, except for SPPB. All functional tests were significantly correlated with 6MWT (0.45 < r < 0.67) and peripheral muscle strength (0.32 < r < 0.63), but not with quality of life and asthma control (0.02 < r < 0.17). The tests presented good to excellent intra-rater Intraclass Correlation Coefficients (ICC ≥ 0.75 for all). In all tests, a considerable learning effect and variability of measurement was observed, therefore, the best of two measurements should be used. MDC ranged from 15 to 31% and all tests were performed in a short time, small space, and without clinical adverse events. CONCLUSION: Different protocols of 4MGS, TUG, STS, and SPPB are valid, reliable, and feasible to assess the functional capacity of adults with asthma. These tests are quick and practical new alternatives for assessing functional capacity in this population.

Reference Values for 7 Different Protocols of Simple Functional Tests: A Multicenter Study.

OBJECTIVES: To establish reference values and equations (ages 20-80y) for 7 simple functional tests based on a multicenter study. DESIGN: Cross-sectional data collection in 4 research centers across different regions of a continental dimension country. SETTING: Healthy subjects from general community were assessed in different research laboratories. PARTICIPANTS: Data collection of 296 volunteer subjects (N=296; 45% men; aged 50±18y, forced expiratory volume in the first second 95±13% pred, body mass index 26.9±4.5 kg/m2) aged 20-80 years; representing both sexes; with the ability to understand and perform all proposed assessments; and with no severe and/or unstable condition that could limit functional assessments occurred simultaneously in all centers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All participants randomly performed the following 7 functional tests twice: (1) the 4-meter gait speed test at usual walking speed; (2) the 4-meter gait speed test at maximal walking speed; (3) the Sit-to-Stand test performed with 5 repetitions; (4) the Sit-to-Stand test performed in 30 seconds; (5) the Sit-to-Stand test performed in 1 minute; (6) the Timed Up and Go test at usual speed; and (7) the Timed Up and Go test at maximal speed. Spirometry, quality of life, depression, anxiety, physical activity, and comorbidities were also assessed to better characterize the sample. The best performance of each test was used to propose reference values for men and women and reference equations for all. RESULTS: Participants similarly distributed by age groups from the 4 centers were included. All tests were correlated with age (0.34

Frequency and functional translation of low muscle mass in overweight and obese patients with COPD.

BACKGROUND: Cut offs for fat-free mass index (FFMI) and appendicular skeletal muscle mass index (ASMI) are available for diagnosing low muscle mass in patients with COPD. This study aimed to investigate: (1) the frequency of low muscle mass (FFMI and ASMI) applying different cut-offs and (2) the functional translation (clinical impact) of low muscle mass, in patients with COPD stratified into BMI categories. METHODS: Patients with COPD were assessed regarding body composition, exercise capacity, quadriceps muscle strength, symptoms of anxiety and depression, dyspnea and quality of life upon referral to pulmonary rehabilitation. The proportion of patients with low muscle mass was compared among BMI categories. Clinical outcomes between patients with normal and low muscle mass within each BMI category were compared. RESULTS: 469 patients with COPD were included for analyses. The frequency of patients classified as low FFMI varied significantly according to the choice of cut-off (32 to 54%; P < 0.05), whereas the frequency of patients with low ASMI was 62%. When applying age-gender-BMI-specific cut-offs, 254 patients (54%) were classified as low FFMI. The choice of the cut-off affected the frequency of patients with low muscle mass in all BMI categories. Overweight and obese patients with low muscle mass were more frequently males and presented worse pulmonary function, exercise capacity and muscle strength compared with overweight and obese patients with normal muscle mass. CONCLUSIONS: Approximately half of the overweight and obese patients with COPD have low muscle mass when applying age-gender-BMI-specific cut-offs. Low muscle mass is associated with worse functional outcomes in overweight and obese COPD patients.

Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19.

BACKGROUND: An increasing number of subjects are recovering from COVID-19, raising the need for tools to adequately assess the course of the disease and its impact on functional status. We aimed to assess the construct validity of the Post-COVID-19 Functional Status (PCFS) Scale among adult subjects with confirmed and presumed COVID-19. METHODS: Adult subjects with confirmed and presumed COVID-19, who were members of an online panel and two Facebook groups for subjects with COVID-19 with persistent symptoms, completed an online survey after the onset of infection-related symptoms. The number and intensity of symptoms were evaluated with the Utrecht Symptom Diary, health-related quality of life (HrQoL) with the 5-level EQ-5D questionnaire, impairment in work and activities with the Work Productivity and Activity Impairment questionnaire and functional status with the PCFS Scale. RESULTS: 1939 subjects were included in the analyses (85% women, 95% non-hospitalized during infection) about 3 months after the onset of infection-related symptoms. Subjects classified as experiencing 'slight', 'moderate' and 'severe' functional limitations presented a gradual increase in the number/intensity of symptoms, reduction of HrQoL and impairment in work and usual activities. No differences were found regarding the number and intensity of symptoms, HrQoL and impairment in work and usual activities between subjects classified as experiencing 'negligible' and 'no' functional limitations. We found weak-to-strong statistical associations between functional status and all domains of HrQoL (r: 0.233-0.661). Notably, the strongest association found was with the 'usual activities' domain of the 5-level EQ-5D questionnaire. CONCLUSION: We demonstrated the construct validity of the PCFS Scale in highly-symptomatic adult subjects with confirmed and presumed COVID-19, 3 months after the onset of symptoms.

Longitudinal changes in total and regional body composition in patients with chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: Low fat-free mass (FFM) is common in patients with chronic obstructive pulmonary disease (COPD) and contributes to morbidity and mortality. Few studies have evaluated longitudinal changes in body composition in patients with COPD compared with non-COPD controls. This study aimed to compare longitudinal changes in total and regional body composition between patients with COPD and non-COPD controls and investigate predictors of changes in body composition in COPD. METHODS: Patients with COPD and non-COPD controls participating in the Individualized COPD Evaluation in relation to Ageing (ICE-Age) study, a single-centre, longitudinal, observational study, were included. Subjects were assessed at baseline and after 2 years of follow-up. Among other procedures, body composition was measured by dual-energy X-ray absorptiometry scan. The number of exacerbations/hospitalizations 1 year before inclusion and during follow-up were assessed in patients with COPD. RESULTS: A total of 405 subjects were included (205 COPD, 87 smoking and 113 non-smoking controls). Patients with COPD and smoking controls presented a significant decline in total FFM (mean [95% CI]: -1173 [-1527/-820] g and -486 [-816/-156] g, respectively) while body composition remained stable in non-smoking controls. In patients with COPD, the decline in FFM was more pronounced in legs (-174 [-361/14] g) and trunk (-675 [-944/406] g) rather than in arms (54 [-19/126] g). The predictors of changes in total and regional FFM in patients with COPD were gender, number of previous hospitalizations, baseline values of FFM and BMI. CONCLUSION: Patients with COPD present a significant decline in FFM after 2 years of follow-up, this decline is more pronounced in their legs and trunk.

Handgrip Strength as a Reflection of General Muscle Strength in Chronic Obstructive Pulmonary Disease.

Muscle dysfunction is one of the main features in individuals with chronic obstructive pulmonary disease (COPD). Handgrip strength (HS) has been used as a representation of general muscle strength in various populations, and a few studies found correlation between HS and other measures of upper and lower limbs' muscle strength in the general population, although this was not yet studied in depth in COPD. The aims of this study were to verify if HS is cross-sectionally well correlated with upper and lower limbs' muscle strength in individuals with COPD, and to identify a new cutoff for handgrip weakness in this population. HS was assessed by a dynamometer, whereas other muscle strength assessments comprised maximal voluntary contraction (MVC) of the quadriceps femoris and 1-repetition maximum (1RM) of biceps and triceps brachii, pectoralis major, latissimus dorsi and quadriceps femoris. Additional assessments included pulmonary function and volumes, body composition and exercise capacity. Fifty individuals with COPD were studied (65 ± 7 years; FEV1 51 ± 14%pred). HS showed moderate-to-strong correlations with all 1-RM assessments (0.62

Energy expenditure per minute in different activities and body positions and its association with the classification as physically active or inactive in daily life in individuals with COPD.

Objective: To describe and compare energy expenditure (EE)/minute walking and in different body postures in individuals with COPD; and to investigate if EE/minute walking is a predictor of their classification as physically active or inactive. Methods: Physical activity (PA) in daily life was objectively assessed using two PA monitors for 7 days and data were analyzed on a minute-by-minute basis. Predominant minutes were separated into walking, standing, sitting, and reclined, and EE/minute (a reflection of PA intensity) was then calculated in each of these four activities and postures. Participants were classified as active and inactive according to the criteria proposed by the American College of Sports Medicine (ACSM). Results: 43 individuals were evaluated (65±8 years; FEV1 50±14% predicted). A binary logistic regression model yielded that, regardless of the time spent walking/day, EE/minute walking was a significant predictor of the classification as physically active (OR=18.2 [2 - 165]; p=0.01), together with BMI (OR=0.68 [0.5 - 0.9]; p=0.008) (model: Chi-square = 22.431, p< 0.05; R2 [Nagelkerke] = 0.556). In the active group, significantly higher EE/minute was observed for walking and standing in comparison both to sitting and reclined. However, in the inactive group, there were significant differences in EE/minute only when comparing walking versus reclined and standing versus reclined. Conclusion: In individuals, with COPD, EE/minute walking is a significant predictor of being classified as physically active, independently of the time spent walking/day. Each additional kilocalorie/minute spent walking increases in 18 times the chances to be classified as physically active in daily life.

Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?

PURPOSE: This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS: Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS: The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION: High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

The Gini Coefficient: A New Approach to Assess Physical Activity Inequality in COPD.

Increasing physical activity (PA) is a complex and challenging task in patients with chronic obstructive pulmonary disease (COPD). However, some questions are raised regarding the evaluation of PA in these patients: Have all aspects of PA evaluation in patients with COPD already been explored in the scientific literature and clinical practice? What is the clinical importance of assessing PA inequality? PA inequality is defined as the Gini coefficient (Ginicoef) of the PA distribution of a population and is already shown to have implications for public health in the general population. It is a simple tool that might allow a better understanding of PA disparities among different COPD populations, although to our knowledge there is no previous investigation of PA inequality in patients with COPD using the Ginicoef. In this perspective study we have provided examples of the Ginicoef use in different scenarios. Future studies might try to apply it in order to identify subpopulations with higher PA inequality, and perhaps are therefore more prone to benefit most from interventions specifically tailored to promote PA. In summary, we propose the quantification of PA inequality with the Ginicoef as a tool that might allow us to see PA even more comprehensively than we already do, expanding our perspective on PA in patients with COPD.

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care.

The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory and critical care medicine. This review summarises studies focussing on pulmonary rehabilitation and exercise training, physical activity, chronic respiratory failure and palliative respiratory care published in 2017.

Difference Between Slow and Forced Vital Capacity and Its Relationship with Dynamic Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease.

The aim of the study was to investigate the relationship between slow and forced vital capacity (SVC-FVC) difference with dynamic lung hyperinflation (DH) during the 6-min walking test (6MWT) in subjects with chronic obstructive pulmonary disease (COPD). Twenty-four subjects with COPD (12 males; 67 ± 6 years; forced expiratory volume in first second [FEV1] 56 ± 18% predicted) performed lung function tests by spirometry and plethysmography. DH was assessed by serial measurements of inspiratory capacity (IC) performed during the 6MWT and defined as ∆IC ≥ 150 mL or 10%. IC decrease significantly during the 6MWT (ΔCI: - 0.48 ± - 0.40 L; P < 0.0001), and 18 individuals (75%) presented DH. There was significant difference when comparing IC measured at rest with the other serial IC measurements (P < 0.0001). Correlation between the SVC-FVC difference and DH during the 6MWT was r = - 0.38; P = 0.06. The SVC-FVC difference presented only weak correlation with the development of DH during the 6MWT in patients with COPD.

Functional Status of Patients with COPD Assessed by London Chest Activity of Daily Living Scale: Gender Association and Validity of a Cutoff Point.

PURPOSE: Whether the difference in the impact of chronic obstructive pulmonary disease (COPD) on the functional status of men and women stems from clinical distinctions or to the measuring instrument used is unclear. Like most instruments for assessing functional limitation in COPD, the interpretation of the results of the London Chest Activity of Daily Living (LCADL) scale is limited because a lack of a valid cutoff point to this scale. For that, this study sought to compare the functional status between men and women with COPD; and propose a cutoff point for LCADL capable of discriminating the prognosis of these individuals. METHODS: A sample of 138 subjects with moderate-severe COPD was evaluated by the LCADL. The percentage of the individual maximum score was used to obtain a cutoff point capable of discriminating patients with the worse prognosis according to the BODE Index. The cutoff point was also tested in an independent sample (n = 70). RESULTS: Regarding the total score, domestic and leisure domains of the LCADL, men had better scores than women (P ≤ 0.01). The cutoff point found was 37% (area under the curve = 0.70, 95% confidence interval = 0.60-0.80, sensitivity = 0.55 and specificity = 0.74). Individuals who scored ≥ 37% had a worse prognosis and level of physical activities of daily living than those who scored below (P ≤ 0.02). CONCLUSION: When evaluated by the LCADL, men and women with COPD present difference in the functional status. The established cutoff point (37%) adequately discriminates individuals regarding the prognosis, contributing to improve the interpretation capacity of the LCADL.

Association between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios and Coronary Artery Calcification Score among Asymptomatic Patients: Data from a Cross-Sectional Study.

INTRODUCTION: Atherosclerosis is a low-grade inflammatory disease. Among markers of inflammation, importance has been given to the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). The objective of this study was to examine the association between these hematological indices of inflammation and coronary atherosclerotic calcification in clinically asymptomatic patients. METHODS: This study had clinical and laboratorial data collected from consecutive asymptomatic patients that underwent computed tomography coronary artery calcium (CAC) scoring. Risk factors, NLR, and PLR were evaluated at different categories of CAC scoring. Statistical tests included chi-square, linear regression, and logistic regression. Patients (N = 247; age 60.4 ± 8.0 years and 60.7% men) were allocated into four categories according to the CAC score. RESULTS: Respective age, sex (male), NLR, and PLR distribution within groups were as follows: CAC = 0 (n = 98; 52.5 ± 13.6 years, 55%, 2.0 ± 1.0, and 121.5 ± 41.5), CAC 1-100 (N = 64; 61.3 ± 11.0 years, 60%, 2.2 ± 1.2, and 125.6 ± 45.6), CAC 101-400 (N = 37; 64.2 ± 11.6 years, 67%, 2.6 ± 1.3, and 125.4 ± 55.9), and CAC > 400 (N = 48; 69.3 ± 11.1 years, 66%, 3.3 ± 2.0, and 430.1 ± 1787.4). The association between risk factors and CAC score was assessed. Hypertension status and smoking status were similar within groups, while the presence of diabetes (P = 0.02) and older age (P ≤ 0.001) was more prevalent in the CAC > 400 group. LDL cholesterol was greater in the higher CAC score groups (P = 0.002). Multivariate logistic regression of the quartile analysis showed that age and NLR were independently associated with CAC > 100 (OR (CI), P value): 2.06 (1.55-2.73, P = 0.00001) and 1.82 (1.33-2.49, P = 0.0002), respectively. CONCLUSION: Within asymptomatic patients, NLR provides additional risk stratification, as an independent association between NLR extent and CAD extent was identified. Moreover, PLR was not an inflammation marker for CAD severity.

Cluster analysis identifying patients with COPD at high risk of 2-year all-cause mortality.

The objective of the article is to identify clusters of patients with COPD according to factors known to be associated with mortality and to verify whether clusters' assignment is associated with 2-year mortality. Patients ( n = 141) were evaluated by bioelectrical impedance, maximal inspiratory pressure (MIP), one-repetition maximum test of the quadriceps femoris (1RMQF) and BODE index (body mass index; airflow obstruction (spirometry); dyspnea (modified Medical Research Council scale); and exercise capacity (6-minute walk test (6MWT) distance). Vital status was retrospectively checked 2 years after the assessments, and time to death was quantified for those deceased in this period. K-means analysis identified two clusters. Patients in cluster one (CL I, n = 69) presented an impaired clinical status in comparison to cluster two (CL II, n = 72). Receiver operating characteristics curves identified the cutoffs discriminating patients composing CL I: forced expiratory volume in the first second <44%pred; 6MWT <479 m; 1RMQF <19 kg; and maximum inspiratory pressures <73 cmH2O (area under the curve range 0.750-0.857). During the follow-up, 19 (13%) patients deceased, 15 in CL I (22%) and 4 in CL II (0.06%) ( p = 0.005). CL I was associated with a higher risk of 2-year mortality (hazard ratio (95% confidence interval): 4.3 (1.40-12.9), p = 0.01). A cluster of patients with COPD highly associated with 2-year mortality was statistically identified, and cutoffs to identify these subjects were provided.

Oxygen Desaturation in Daily Life and During a Laboratory-Based Protocol of Activities of Daily Living in COPD: Is There Relationship?

PURPOSE: To analyze the relationship between oxygen desaturation episodes during a laboratory-based ADL protocol and in real-life routine in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Twenty patients with stable COPD (12 men, 70 ± 7 years, FEV1% 54 ± 15 predicted) with no indication for long-term oxygen therapy (LTOT) were submitted to assessments including ADL performance by the Londrina ADL Protocol (LAP) and level of physical activity in daily life, both while submitted to simultaneous activity and pulse oximeter monitoring. RESULTS: Episodes of desaturation ≥ 4% (ED ≥ 4%) during the LAP were correlated both with ED ≥ 4% in daily life (r = 0.45) and number of episodes of SpO2 under 88% (ED < 88%) in daily life (r = 0.59). ED < 88% during the LAP was also correlated with ED < 88% in daily life (r = 0.51), explaining 43% of its variance. CONCLUSION: In stable patients with COPD and no indication of LTOT, episodes of desaturation during a lab-based ADL protocol are moderately related to episodes of desaturation in daily (real) life, especially those episodes under 88%.

Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy.

Chronic obstructive pulmonary disease (COPD) has systemic consequences that lead to reduced physical activity in daily life (PADL). Little is known about PADL and its associations in individuals with COPD on home-based long-term oxygen therapy (LTOT). The objective of the study was to determine whether there is an association between severe physical inactivity and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on home-based LTOT using electric oxygen concentrators and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV1: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale - FSS), dyspnea (Medical Research Council - MRC scale), functional status (London Chest ADL scale [LCADL] and Timed Up and Go [TUG] test) and functional exercise capacity (Six-Minute Step test [6MST] and Sit-to-Stand test [STST]). PADL was markedly low (1444 ± 1203 steps/day) and associated with daily duration of LTOT (r = -0.50), fatigue (r = -0.36), LCADL (r = -0.41), 6MST (r = 0.48), and STST (r = 0.53) (p < .05 for all). Multiple linear regression revealed that daily duration of LTOT and STST explained 39% of the variability of PADL. Longer daily duration of LTOT, fatigue, worse functional status and exercise capacity were all associated with physical inactivity in individuals with COPD on LTOT, whereas daily duration of LTOT and the STST were determinants of reduced physical activity.