Determinants of cardiorespiratory fitness in patients with chronic obstructive pulmonary disease, focusing on activities parallel to daily living.

OBJECTIVE: The purpose of this study was to examine whether activities parallel to daily living (APDL) constitute a determinant index of cardiorespiratory fitness in patients with chronic obstructive pulmonary disease (COPD). METHODOLOGY: Four functional physical fitness parameters were investigated in 38 male patients (mean age 69.8 +/- 6.7 years) with moderate to severe COPD. The parameters measured were muscular strength (grip strength), muscular endurance strength (arm curl, keeping a half-squat position) and regulation (walking around two cones). In addition, cardiorespiratory fitness was measured using a 6-min walking distance test (6MWD) and peak oxygen uptake (VO(2peak)) was measured during bicycle ergometer testing. Maximal inspiratory pressure (MIP) and maximal expiratory pressure were measured so as to quantify respiratory muscle strength. RESULTS: There were significant correlations (P < 0.05) between the VO(2peak), muscular endurance, pulmonary function and respiratory muscle strength. There were also significant correlations of VO(2peak) to muscular endurance, muscular strength, muscular endurance strength and regulation. In stepwise multiple regression analysis, per cent predicted forced expiratory volume in 1 s and MIP appeared to be significant determinants of VO(2peak), showing a total variance of 56% (P < 0.05). For the 6MWD, the significant determinants were forced vital capacity, MIP and performance in the half-squat test, showing a variance of 59% (P < 0.05). CONCLUSION: The results suggest that cardiorespiratory fitness is strongly affected by MIP, pulmonary function and muscular endurance strength, as APDL depend on lower-limb use.

Time from finding abnormality on mass-screening to final diagnosis of lung cancer.

Mass-screening for lung cancer is rather a unique system in Japan. This study illustrates time from finding abnormality on mass-screening to final diagnosis of lung cancer. Among the 517 patients with lung cancer who were admitted to our hospital over a 10-year period up to December 2001, 83 (16.1%) were detected by mass-screening. We reviewed medical records of the 83 patients and determined the intervals from the mass-screening to the pathological diagnosis with clinical staging. Time from the mass-screening to the date of hospital visit was <2 months in 62 (74.7%) cases. Five (6.0%) patients visited hospital more than 6 months after the mass-screening. With respect to the interval, there was no statistical difference in gender (p=0.0680) and age (p=0.1532). Among 60 patients who were referred from outside, on average, patients visited our hospital 0.5 month after they first sought medical attention at nearby clinic, and at our hospital 0.5 month was required to make a pathological diagnosis of lung cancer with TNM staging. There was a statistical difference in survival between the patients who were diagnosed <4 months and the patients who were diagnosed >4 months from the screening (p=0.0487). The interval in most cases was acceptable. However, further improvements are still needed to minimize the delay and to maximize the benefits of early cancer detection.