Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score.

BACKGROUND: The objective of this study was to determine whether the concomitant presence of poor health status (COPD Assessment Test, CAT ≥ 10 points) and low exercise tolerance (6-Minute Walking Test, 6MWT < 350 m) is associated with worse clinical characteristics in patients with COPD. In addition, we aimed to develop a readily applicable diagnostic model to discriminate COPD patients with these conditions. METHODS: A cross-sectional multicenter study involving 208 stable COPD patients (FEV1/FVC < 0.7, smoking history of at least 10 pack-years, and chronic respiratory symptoms) was carried out. The outcome measures were the 6MWT, CAT score, 5-repetition sit-to-stand test (5STS) and modified Medical Research Council Dyspnea Scale (mMRC). Patients were categorized into three groups: no condition (6MWT ≥ 350 m and CAT < 10 points), one condition (6MWT < 350 m or CAT ≥ 10 points), and both conditions (6MWT < 350 m and CAT ≥ 10 points). RESULTS: A total of 26 patients (12,5%) presented both conditions. These patients experienced a higher degree of dyspnea (p = 0.001), smoking pack-years (p = 0.011), severe obstruction (p = 0.006), and time on 5STS (p = 0.001). The probability of having both conditions directly increased with the time spent on the 5STS (ß=0.188; p = 0.010) and the degree of dyspnea (ß=1.920; p < 0.001) (R2=0.413). The scoring system, using the 5STS and dyspnea as surrogate measures, demonstrated adequate calibration between the predicted and observed risk (linear R2=0.852). CONCLUSIONS: COPD patients with concurrent conditions have worse clinical status. The diagnostic model developed to discriminate these patients shows good internal validation.

Development of the ESEx index: a tool for predicting risk of recurrent severe COPD exacerbations.

Background: In chronic obstructive pulmonary disease (COPD), multiple recurrent severe exacerbations that require hospitalization can occur. These events are strongly associated with death and other clinical complications. Objectives: We aimed to develop a prognostic model that could identify patients with COPD that are at risk of multiple recurrent severe exacerbations within 3 years. Design: Prospective cohort. Methods: The derivation cohort comprised patients with stable, moderate-to-severe COPD. Multivariable logistic regression analyses were performed to develop the final model. Based on regression coefficients, a simplified index (ESEx) was established. Both, model and index, were assessed for predictive performance by measuring discrimination and calibration. Results: Over 3 years, 16.4% of patients with COPD experienced at least three severe recurrent exacerbations. The prognostic model showed good discrimination of high-risk patients, based on three characteristics: the number of severe exacerbations in the previous year, performance in the five-repetition sit-to-stand test, and in the 6-minute-walk test. The ESEx index provided good level of discrimination [areas under the receiver operating characteristic curve (AUCs): 0.913]. Conclusions: The ESEx index showed good internal validation for the identification of patients at risk of three recurrent severe COPD exacerbations within 3 years. These tools could be used to identify patients who require early interventions and motivate patients to improve physical performance to prevent recurrent exacerbations.

Pulmonary Oncocytoma Located at the Intermediate Bronchus Diagnosed by Bronchial Biopsy / Oncocitoma pulmonar localizado en bronquio intermediario diagnosticado mediante biopsia bronquial

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Ansiedad entre cuidadores de pacientes con Enfermedad Pulmonar Obstructiva Crónica tras el alta hospitalaria / Anxiety among caregivers of patients with Chronic Obstructive Pulmonary Disease after hospital discharge

Objetivo: Identificar los factores que influyen en cambios en la ansiedad de los cuidadores tres meses después del alta hospitalaria por exacerbación aguda de la Enfermedad Pulmonar Obstructiva Crónica (EPOC). Metodología: Estudio longitudinal. Participaron 87 cuidadores de pacientes hospitalizados por exacerbación aguda de EPOC. Se midió la ansiedad en el momento de la hospitalización y tres meses después del alta. Además, se midieron potenciales factores asociados a su cambio en cuatro dominios: Contexto del cuidado, demandas del cuidado, recursos y características del paciente. Utilizamos regresiones logísticas múltiples univariadas y multivariadas para determinar los cambios en la ansiedad tres meses después. Resultados: Presentaron ansiedad en el momento de la hospitalización el 57,5% de los cuidadores. De ellos, el 44% había remitido su ansiedad tres meses después del alta hospitalaria. Sin embargo, el 22% de los cuidadores quienes no habían presentado ansiedad en el momento de la hospitalización se mostraron ansiosos a los 3 meses. La gravedad de la EPOC y no recibir apoyo de otro cuidador disminuyó las probabilidades de remisión de la ansiedad. La sobrecarga moderadamente alta incrementa las probabilidades de presentar nuevos síntomas de ansiedad. Conclusiones: La percepción de los síntomas de la ansiedad es dinámica. Los cuidadores pueden recuperarse si reciben ayuda de otro cuidador o si el paciente al que cuidan no está en un estado severo de EPOC (AU)

Objective: To identify the factors that influence changes in caregivers anxiety status three months after discharge for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methodology: Longitudinal study. Participants included 87 caregivers of patients hospitalized for acute exacerbation of COPD. Anxiety was measured at the time of hospitalization and three months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. We used multiple univariate and multivariate logistic regressions to determine changes in anxiety three months later. Univariate and multivariate multiple logistic regressions were used to determine changes in anxiety three months later. Results: A total of 57.5% of caregivers reported anxiety at the time of hospitalization. Of these, 44% had a remission of their anxiety three months after discharge. However, 22% of caregivers who had not experienced anxiety at the hospitalization became anxious at 3 months. The severity of COPD and not receiving help from another caregiver decreased the likelihood of remission of anxiety. Moderately high overload increases the likelihood of experiencing anxiety symptoms. Conclusions: The perception of anxious symptoms is dynamic. Caregivers are likely to recover from anxiety when they receive help from another caregiver and if the patient they are caring for does not have severe COPD (AU)

Creación del cuestionario SAQ-COPD (Spanish Physical Activity Questionnaire in COPD) para la medida de la actividad física de pacientes con EPOC en la práctica clínica / Creation of the SAQ-COPD Questionnaire to Determine Physical Activity in COPD Patients in Clinical Practice

Introducción: Aunque la actividad física (AF) es una dimensión clínica relevante en la EPOC, no existen instrumentos útiles en la práctica clínica habitual. Objetivo: Crear un nuevo cuestionario específico, sencillo y de fácil aplicación que detecte el déficit de AF. Método: Se creó un panel multidisciplinar de expertos en EPOC y se revisó el estado de la cuestión sobre AF, sus determinantes y métodos de medida. Se consensuó la metodología de selección de dimensiones e ítems específicos por rondas, definiendo las dimensiones e ítems sobre los que formar la versión preliminar. La estructura del cuestionario fue definida de acuerdo con su aplicabilidad en la práctica clínica. Los acuerdos se alcanzaron por consenso de los miembros. Resultados: Se revisaron un total de 148 ítems, de los que solo fueron seleccionados directamente 3. Se definió que el cuestionario debía evaluar la intensidad (baja, moderada o intensa), cantidad y frecuencia de AF, así como la inactividad o sedentarismo. También ofrece información sobre el perfil del paciente con baja actividad e incluye una medida de impacto, definido como la percepción del paciente respecto a sus expectativas de actividad, lo que abarca su experiencia personal, características de su entorno y personalidad. El cuestionario queda dividido en 2bloques: una herramienta destinada a cuantificar la AF y una parte informativa, solo para los pacientes con baja AF, destinada a definir su perfil e impacto. Conclusión: El SAQ-COPD es un cuestionario específico, breve y sencillo, para evaluar la AF en pacientes con EPOC, que se ha definido para que sea aplicable en la práctica clínica

Physical activity (PA) is a significant clinical dimension in COPD, but no useful tools are available to determine this variable in routine clinical practice. Objective: To create a simple, easy-to-use, specific questionnaire to detect PA deficits. Method: A multidisciplinary panel of COPD experts was formed to review PA, its determinants, and measuring methods. The methodology for selecting specific dimensions and items was agreed in rounds, and the aspects to be included in the preliminary version were determined. The questionnaire structure was defined according to applicability of these aspects in clinical practice. Agreements were reached by consensus of the members. Results: A total of 148 items were reviewed, of which only 3 were directly selected. It was decided that the questionnaire should evaluate the intensity (low, moderate, or intense), amount, and frequency of PA, and inactivity or sedentary lifestyles. It also gathers information on the profile of inactive patients, and includes a measure of impact, defined as the patient's perception of their expectations regarding activity, their personal experience, characteristics of their environment, and their personality. The questionnaire is divided into 2blocks, one aimed at quantifying PA, and the other at collecting data for defining the profile and impact in patients with low PA only. Conclusion: The SAQ-COPD is a simple, short, specific questionnaire, designed to evaluate PA in COPD patients in clinical practice