The relation between inspiratory muscle strength and bacterial colonization and other clinical factors in patients with non-cystic fibrosis bronchiectasis.

Introduction: This study aimed to investigate whether inspiratory muscle strength was associated with bacterial colonization and other clinical outcomes and whether bacterial colonization was associated with clinical outcomes in patients with non-cystic fibrosis bronchiectasis (NCFB). Materials and Methods: Eighty-six patients were enrolled in a cross-sectional study. Patients were divided into two groups according to the presence of inspiratory muscle weakness and bacterial colonization. Parameters were compared between groups. Result: Bronchiectasis etiologies were post-infectious, Kartagener's syndrome, and primary ciliary dyskinesia. The median value of MIP was -68, and MEP was 89 cm H2O in all patients. Although the ratio of bacterial colonization was similar to patients without inspiratory muscle weakness, the inspiratory muscle weakness group had a higher number of females, lower FEV1, FVC, ISWT, CRQ, higher MRC, E-FACED, SGRQ, number of hospitalization (p<0.05). When colonized and non-colonized patients were compared, MIP, and MEP were similar in spite of adjusted BMI, age, and sex. FEV1, FVC, ISWT, and ESWT were lower, and E-FACED scores (p<0.05) were higher in colonized patients. Conclusions: Although inspiratory muscle strength was not associated with bacterial colonization in NCFB patients, it is an important factor that could be linked to disease severity, pulmonary functions, quality of life, and exercise capacity. Bacterial colonization was also associated with severe disease, deteriorated pulmonary functions, and exercise capacity.

Relationship between exercise capacity and impulse oscillometry parameters after COVID-19 infections.

BACKGROUND: After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse oscillometry (IOS) parameters and exercise capacity by using incremental and endurance shuttle walk tests (ISWT, ESWT) and investigate the factors and parameters which might have an effect on both IOS parameters and exercise capacity tests. METHOD: The patients who had a history of COVID-19 were enrolled into cross-sectional study according to inclusion criteria. The IOS parameters, ISWT, ESWT, smoking status, time since COVID-19 diagnosis, length of hospital stay, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), body mass index (BMI), fat-free mass index (FFMI), dyspnea, hospital anxiety-depression and fatigue severity scores were recorded. RESULTS: The study comprised 72 patients, 71% of whom were male, with a mean age of 54 ± 10 years. After COVID-19 diagnosis, the median duration was 3 (min: 1, max: 5) months and 51 (71%) of the patients were hospitalized. The FEV1 and FVC values were in normal range. The area of reactance (AX), resonance frequency (Fres), reactance at 20 Hz (X20) and the difference between resonance at 20 and 5 Hz (R5-20) correlated with both ISWT and ESWT. The FEV1 correlated with all IOS parameters (p < 0.05). Reactance correlated with FFMI (p = 024, r = 0.267), different according to hospitalization (p = 0.02). CONCLUSION: In COVID-19 survivors, there could be correlations between IOS parameters and exercise capacity; and between these parameters and FEV and FVC. Furthermore, small airway disease with normal spirometric functions could be related to decreased exercise capacity in COVID-19 survivors regardless of concomitant diseases, BMI, smoking status and time since COVID-19 diagnosis.

Electrocardiogram parameters for predicting future arrhythmia in patients with stable chronic obstructive pulmonary disease.

Introduction: Arrhythmia is one of the common comorbidities in chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate arrhythmia predictors by using ECG in non-hypoxemic patients with stable COPD in outpatient clinics. Materials and Methods: Fifty patients with COPD and 21 age-sex matched healthy controls were enrolled. Exclusion criteria were having history of exacerbation in the last two months, any cardiac symptoms, comorbidities, hypoxemia for COPD patients, and additionally, history of smoking for healthy controls. Twelve-lead ECGs were obtained from all patients. Result: Mean was 55 ± 4 year in all participants. Median Medical Research Council (MRC) score of COPD patients was 2 and median value of FEV1 was 49%. Median heart rate of COPD patients was 77/min with normal sinus rhythm, significantly faster than healthy controls. P-min, QTcmin, Tp-edisp, Tp-e/QT were significantly different from the control group. In patients with COPD, whilst significant correlations between pulmonary functions and Qtcmin, Qtc-max, p-min were found, there were no significant differences between groups of spirometric stages. Smoking and mMRC dyspnea scale were not correlated with ECG findings. Conclusions: This study showed that non-hypoxemic COPD patients with decreased pulmonary functions, without cardiac symptoms and comorbidities, could have risks for atrial, ventricular arrhythmias regardless of dyspnea, smoking.

Maintenance of pulmonary rehabilitation benefits in patients with COPD: is a structured 5-year follow-up program helpful?

Background/aim: Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD), but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program. Materials and methods: COPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George's respiratory questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the forced midexpiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study. Results: Thirty-three COPD patients with a mean age of 58 ± 8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47 ± 16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p < 0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p = 0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p = 0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p < 0.001) and year 3 (p = 0.005/0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years. Conclusion: Structured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Long-term randomized controlled studies are needed to verify these results.

The narrative review of chronic obstructive pulmonary disease management in Turkey: medical treatment, pulmonary rehabilitation and endobronchial volume reduction.

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. In Turkey, the prevalence of COPD has been shown at rates of 9.1% to 19.1%, and COPD was found to be the third leading cause of mortality and eighth leading cause of disability. In several national multicentral studies, a high rate of non-adherence to pharmacologic treatment according to GOLD was found to be high, and the most commonly prescribed treatment was the triple regimen. The most important non-pharmacologic treatment of COPD is pulmonary rehabilitation (PR), which is also highly recommended in Turkey, but it is also underutilized, like in other countries. Awareness of healthcare professionals and patients should increase in Turkey. The recommendations in content and modality of programs are similar to international guidelines. Another non-pharmacologic treatment is endobronchial volume reduction (EBVR). Although there is limited number of studies about EBVR, in national reports, the importance of patient selection, method, close follow-up after intervention, and applications in experienced centers are emphasized to decrease the economic burden of this expensive treatment. There is still great need for further randomized studies about pharmacologic and non-pharmacologic treatment and additionally, a close collaboration between healthcare professionals, physicians, professional societies of pulmonology, planners of reimbursement system, patients, patient advocacy groups and the general public should be established.

Pleuroparenchymal fibroelastosis: from diagnosis to pulmonary rehabilitation.

Pleuroparenchymal fibroelastosis (PPFE) is an uncommon disease of which diagnosis should be established multidisciplinary fashion and has no effective medical therapy. Pulmonary rehabilitation (PR) can be applied, but lung transplantation is the only therapeutic option. There have been few reported cases or studies showing the efficacy of PR in patients with PPFE in the literature. We present our multidisciplinary PR programme including confirmation of the diagnosis and a structured follow-up programme in two PPFE patients. In both cases, after multidisciplinary PR the diagnoses were confirmed and body composition, quality of life, exercise capacity and psychological status improved and some improvements preserved for 6-12 months. They underwent lung transplantation about 2 years after PR. Patients with PPFE should be directed and encouraged to participate in comprehensive multidisciplinary PR programmes. Long-term structured follow-up programmes could preserve the improvements, increase adherence and save time while waiting on the transplant list.

Hospital-at-home for chronic obstructive pulmonary disease exacerbation: Will it be an effective readmission avoidance model?

OBJECTIVES: Hospital-at-home (HAH), a pioneering health care model, is an accepted alternative to hospital treatment for patients with a chronic obstructive pulmonary disease (COPD) exacerbations. The aim of the present study was to analyze the effectiveness of HAH for patients with COPD exacerbations. METHODS: Two hundred six patients with COPD exacerbations who were admitted to our emergency room (ER) received the HAH model between January 2008 and March 2010. The number of patient's hospitalization, admission to emergency room, unscheduled outpatient attendance, and the length of stay in hospital (day) were recorded before and after a one-year period of HAH. RESULTS: After a one-year follow-up period of the HAH program, the number of patient who had hospitalization, admission to ER, unscheduled outpatient attendance rates was decreased 41.3%, 54.4%, 49.5% respectively. The decreases for all parameters were found to be statistically significant (P < 0.001). Additionally the total number of length of stay in hospital (day) after a one-year period after HAH was decreased (46.5%). CONCLUSION: Integrated care services, including home care units where HAH models are performed, are necessary to improve the health of patients with COPD, as well as to better manage their condition in terms of disease burden. Physicians should consider this form of management, especially because there is increasing pressure on inpatient bed requirement in Turkey.

Efficacy of pulmonary rehabilitation for bronchiectasis and related factors: which patients should receive the most treatment?

INTRODUCTION: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. RESULTS: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = -0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = -0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = -0.563) and ΔSGRQ (p < 0.001, r = -0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = -0.176) and Δanxiety (p = 0.007, r = -0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = -0.267) and ΔSGRQ (p < 0.001, r = -0.648). CONCLUSIONS: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program.

Patients with COPD who underwent pulmonary rehabilitation in Turkey: prevalence, distribution, and mortality

Background: Pulmonary rehabilitation (PR) is an effective, evidenced-based treatment. Despite its proven effect, it is still underused. The aim of this study was to present the number of patients with chronic obstructive pulmonary disease (COPD) who underwent PR, general mortality percentages, the rate of patients prescribed PR by pulmonologists, and the distribution of institutions where PR was performed between 2008 and 2016 in Turkey. Materials and methods: The documents were obtained from Turkish Institution of Social Insurance. Ages, sexes, and numbers of patients with COPD who underwent PR between 2008 and 2016 were recorded. The number of patients with COPD who had been prescribed PR by physicians and the type of hospitals in which these patients underwent PR were identified. The general annual and the general total mortality rates between 2008 and 2016 among patients with COPD who underwent PR in 2008 were also determined. Results: The mean age ranges of patients with COPD who underwent PR were 67.4 ± 12.3 to 72.0 ± 13.2 years, and 62.2% (n = 60,852) of patients were male. The number of patients increased progressively from 3,214 to 18,664. The rate of patients prescribed PR programs between 2008 and 2016 was between 0.32% and 0.59% among all registered patients with COPD. Between 52.0% and 94.8% (5,488/10,549 and 16,792/17,707 patients, respectively) of the programs were prescribed by a pulmonologist, and 62.9% (n = 62,613) of patients received PR in secondary public hospitals. The general annual mortality rates were between 6.2% and 11.1% (115/1,855 and 358/3,214 patients) in patients who underwent PR in 2008, and the general total mortality rate was 52.8% (1,696/3,214 patients) over the 9-year period in the same patient group. Conclusion: PR was still an underutilized approach in Turkey between 2008 and 2016. The awareness of PR should be increased in our country. In order to achieve this, we think that PR should be within the scope of health policies.

Comparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients.Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables.Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity (p = 0.003), quality of life (p = 0.045), FEV1 (p = 0.001), lower pack-year smoking (p < 0.001) than outpatient PR.After home PR, exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea(p < 0.05), anxiety (p < 0.001), depression (p < 0.001) were improved except endurance shutte test. Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar.Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.

Use of i-BODE index to determine efficacy of pulmonary rehabilitation in COPD patients.

INTRODUCTION: Pulmonary rehabilitation (PR) is well-proven approach on improving dyspnea, exercise intolerance which are two components of BODE index. But, PR is known to have minimal effect on pulmonary function which is another component of BODE index. There are few studies evaluating PR efficacy by using i-BODE index. Our aim was to evaluate efficacy of PR in patients with chronic obstructive pulmonary disease (COPD) with i-BODE index and to investigate changes in i-BODE index according to GOLD 2011 combined assessment. MATERIALS AND METHODS: A total of 228 stable COPD patients who completed a comprehensive 8 week duration PR program were enrolled into this retrospective study. RESULT: The patients were with mean age of 63.3 ± 8.6 years and mean FEV1% was 38.6 ± 16.2%. According to combined assessment of COPD, 23 patients were group A, 30 patients were B, 31 patients were C and 144 patients were D. Baseline i-BODE scores correlated with body compositions, pulmonary function, dyspnea, exercise capacity, psychological status, quality of life, and age. i-BODE index score decreased from 4.7 ± 2.2 to 3.5 ± 1.8 after PR (p<0.001), improved by 26%. Significant improvements were found in dyspnea, quality of life and i-BODE index in more symptomatic patients (group B and D). CONCLUSIONS: This study highlights that changes in i-BODE scores after PR significantly correlated with improvements in dyspnea, exercise capacity and quality of life. i-BODE score could be a better predictor of efficacy of PR than some individual variables such as BMI or FEV1. Significant improvements in dyspnea sensation, quality of life and i-BODE index could be seen symptomatic patients in after PR.

The Efficacy of Outpatient Pulmonary Rehabilitation After Bilateral Lung Transplantation.

PURPOSE: Pulmonary rehabilitation (PR) is advocated in the pre- and post-lung transplantation (LTx) periods. However, there is limited literature on the benefit of PR post-LTx. The aim of this study was to investigate the efficacy of an outpatient, multidisciplinary, comprehensive PR program in bilateral LTx recipients in the early period after LTx. METHOD: Twenty-three LTx recipients were referred to the PR center. Change in incremental and endurance shuttle walk tests, hand and quadriceps strength, respiratory muscle strength (maximum inspiratory/expiratory pressure), dyspnea (Medical Research Council score), quality of life (St George's Respiratory Questionnaire, Chronic Respiratory Questionnaire), and psychological status (Hospital Anxiety Depression Scale) were compared pre- and post-PR. RESULTS: Seventeen of 23 (74%) recipients completed PR, comprising 15 male and 2 female patients whose median age was 51 yr. The initiation of the program was 75 ± 15 d after LTx. The incremental shuttle walk test distance was predicted as 23% before PR and it increased to 36% after PR (P < .001); the endurance shuttle walk test distance also increased (P < .01). Significant improvement was seen in upper and lower extremity strength, and St George's Respiratory Questionnaire and Chronic Respiratory Questionnaire scores and Hospital Anxiety Depression Scale scores reflected less anxiety and depressive symptoms. Furthermore, body mass and fat-free mass indices, maximum inspiratory pressure, and maximum expiratory pressure improved significantly. There was no significant change in forced expiratory volume in the first second of expiration, forced vital capacity, or Medical Research Council scores. CONCLUSION: This study demonstrated that patients who attended PR within 3 mo of bilateral LTx showed improvements in exercise capacity, respiratory muscle strength, quality of life, body composition, and psychological status.

Influenza and pneumonia vaccination rates in patients hospitalized with acute respiratory failure.

Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded.Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations.Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients.

[Oral nutritional supplement in patients with COPD who completed PR program: six months and one year follow ups]. / Pulmoner rehabilitasyon programini tamamlayan KOAH tanili olgularda oral nütrisyonel destek; alti ay ve bir yillik takipleri.

INTRODUCTION: Oral nutritional supplement (ONS), an important part of multidisciplinary pulmonary rehabilitation (PR) program, is indicated according to body composition abnormalities in the patients with chronic obtructive pulmonary disease (COPD). We evaluated efficacy of oral nutritional supplement (ONS) during 5-8 months in patients with COPD who completed PR program. MATERIALS AND METHODS: The data of 41 patients with stable COPD were recorded after the approval had been taken. Patients were grouped according to ONS duration. Group 1 consisted of patients who took ONS during 2 months, group 2: 5 months, group 3: 8 months. In all patients, pulmonary function tests, quality of life, exercise capacity and body composition datas were recorded before and after PR program, at 3rd, 6th month and in 20 patients 1 year follow-up visit. RESULT: In all groups, improvements after PR in exercise capacity, dyspnea, and body composition sustained at 3 and 6 month. Quality of life was protected in group 1 during six month, in other groups it was over values before PR despite loss at 6. month. All improvements after PR were similiar between groups. In 20 patients with one year follow up, while the improvements in dyspnea and body composition were preserved, both exercise capacity and quality of life decreased, exercise capacity was lower than values before PR. CONCLUSIONS: In patients with COPD, after multidisplinary PR program, the improvements in dyspnea, exercise capacity, quality of life were maintained during six months regardless of body composition and ONS duration. Furthermore, while the improvements in body composition, dyspnea, quality of life were protected, exercise capacity was found to be lower than baseline.

The Comparison of Clinical Variables in Two Classifications: GOLD 2017 Combined Assessment and Spirometric Stage of Chronic Obstructive Pulmonary Disease.

BACKGROUND: There are limited number of studies that investigate clinical variables instead of chronic obstructive lung disease (COPD) management according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 classification. The aim of the study was to investigate whether there was a difference between GOLD 2017 classification and spirometric stage in clinical variables in patients with COPD. The data of 427 male patients with stable COPD were investigated retrospectively. METHODS: Patients were allocated into combined assessment of GOLD 2017 and spirometric stage. Age, amount of smoking, pulmonary function, modified Medical Research Council (mMRC), incremental shuttle walk test (ISWT), Hospital Anxiety-Depression Scale (HADS), St. George's Respiratory Questionnaire (SGRQ), body mass index (BMI), and fat free mass index (FFMI) were recorded. RESULTS: Seventy-three (17%) patients were in group A, 103 (24%) constituted group B, 38 (9%) were included in group C, and 213 (50%) comprised group D according to the combined assessment of GOLD 2017. Twenty-three patients (5%) were in stage 1, 95 (22%) were in stage 2, 149 (35%) were in stage 3, and 160 (38%) were in stage 4 according to spirometric stage. According to GOLD 2017, age, amount of smoking, mMRC, BMI, FFMI, SGRQ, HADS, forced vital capacity, forced expiratory volume in 1 second (FEV1), and ISWT were significantly different between groups. Ages, amount of smoking, FFMI, BMI, HADS of group A were different from B and D. Smiliar values of FEV1 were found in A-C and B-D. A and C had smiliar ISWT. According to spirometric stage, BMI, FFMI of stage 4 were statistically different. mMRC, ISWT, and SGRQ of stages 3 and 4 were different from other stages, amongst themselves. FEV1 was correlated with mMRC, SGRQ, anxiety scores, BMI, FFMI, and ISWT. CONCLUSION: This study showed that the GOLD ABCD classification might not represent the severity of COPD sufficiently well in terms of lung function or exercise capacity. The combination of both spirometric stage and combined assessment of GOLD 2017 is important, especially for estimating clinical variables.

Relation between upper-limb muscle strength with exercise capacity, quality of life and dyspnea in patients with severe chronic obstructive pulmonary disease.

INTRODUCTION: In chronic obstructive pulmonary disease (COPD), skeletal muscle weakness is characterized by reduced muscle strength, reduced muscle endurance and the presence of muscle fatigue especially in lower limbs. There has been little research into the upper limb skeletal muscles. OBJECTIVES: In this study, we aimed to investigate the relation of upper limb muscle strength with pulmonary function, exercise capacity, quality of life (QoL) and dyspnea sensation. METHODS: Eigthy-eight patients (89.8% male; age: 64.2 ± 8.7 years) with COPD (FEV1 = 34.2% ± 15.2%) were evaluated. Tests included hand grip strength and actual 1-repetition maximum (1RM) test for upper limb strength. Dyspnea sensation was assessed with medical research council (MRC) scale. St. George Respiratory Questionary (SGRQ) was used to evaluate patients health related QoL. Exercise capacity was evaluated with incremental shuttle walk test and endurance shuttle walk test. RESULTS: Upper limb muscle strength correlated with exercise capacity but no correlations were found with pulmonary functions.There were negative correlations with all the domains of SGRQ both actual 1RM and handgrip strength. MRC scores revealed a negative correlation with upper limb muscle strength. CONCLUSION: In our study, we showed that upper limb muscle strength correlated with exercise capacity, QoL, dyspnea sensation. Identifying patients who have greater reductions in strength will allow early interventions with a multidisciplinary manner.

Efficacy of a multidisciplinary pulmonary rehabilitation outpatient program on exacerbations in overweight and obese patients with asthma.

BACKGROUND: Even though many studies have investigated the effectiveness of weight loss interventions, the efficacy of pulmonary rehabilitation (PR) has not yet been proven in obese patients with asthma. The aims of this study were to investigate the efficacy of PR on asthma exacerbations in the first year after PR and to evaluate the efficacy of PR in exercise capacity, quality of life, psychosocial symptoms and control of asthma in overweight patients. METHODS: The exercise capacity, health-related quality of life scores, psychosocial symptoms, asthma control test (ACT) data, number of emergency admissions and hospitalizations of 35 overweight patients with asthma who completed a 1-year multidisciplinary PR program were recorded and analyzed. RESULTS: Of the participants 30 were female, the mean age was 45 ± 9 years, 13 (37%) patients were overweight and 22 (63%) were obese. The average number of emergency admissions (from 1.2 ± 1.1 to 0.3 ± 0.8) and hospitalizations (from 0.6 ± 0.9 to 0.0 ± 0.1) decreased significantly 1 year after PR (both p<0.001). After PR, statistically significant improvements in exercise capacity as measured by the incremental shuttle walking test (ISWT) from 281 ± 104 m to 339 ± 95 m (p < 0.001), the endurance shuttle walking test (ESWT) from 13.3 ± 7.4 min to 17.5 ± 4.5 min (p = 0.005), quality of life measured by the St. George's respiratory questionnaire (SGRQ total from 64 ± 14 to 28 ± 10, p < 0.001), dyspnea sensation with the Medical Research Council (MRC) scale (from 2.6 ± 0.6 to 2.1 ± 0.4, p <0.001) and hospital anxiety depression scores (HADS, anxiety score from 9.9 ± 1.6 to 7.1 ± 2.1, depression score from 9.4 ± 1.9 to 7.2 ± 2.3, both p < 0.001) were found. A reduction in body mass index (BMI) was found in obese patients only, but the fat-free mass index (FFMI) improved in both overweight and obese patients (from 19.00 ± 1.90 to 19.45 ± 2.04, p = 0.01). The mean ACT score increased significantly (from 18 to 21 points, p < 0.001). The number of patients with poorly controlled asthma decreased from 21 (60%) to 10 (28%). CONCLUSION: This study showed that comprehensive multidisciplinary PR was associated with a decreased number of emergency admissions and hospitalizations for asthma exacerbations in 1 year, and improvements of dyspnea sensation, quality of life, exercise capacity, and psychosocial status in overweight and obese patients.