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BACKGROUND: In chronic obstructive pulmonary disease (COPD), there are two known classifications for assessing what is called disease severity. One is the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, which is based on the post-bronchodilator value of FEV1 (% reference). The other is the STaging of Airflow obstruction by Ratio (STAR), with four grades of severity in subjects with an FEV1/FVC ratio <0.70: STAR 1 ≥0.60 to <0.70, STAR 2 ≥0.50 to <0.60, STAR 3 ≥0.40 to <0.50, and STAR 4 <0.40. PURPOSE: The aim of this study was to compare the staging of COPD using the GOLD and STAR classifications in clinical practice. METHODS: We reanalyzed data from our outpatient cohort study, which included 141 participants with COPD from 2015 to 2023. We compared mortality and COPD-specific health status between the GOLD 1 to 4 groups and the STAR 1 to 4 groups. RESULTS: By simple calculation, GOLD and STAR severity classes coincided in 75 participants (53.2%). The weighted Bangdiwala B value with linear weights was 0.775. The participants were observed for up to 95 months, with a median of 54 months. Death was confirmed in 29 participants (20.5%). In univariate Cox proportional hazards analyses, there was a significant difference in mortality between the GOLD 1 and GOLD 3 + 4 groups, with the GOLD 1 group used as the reference [hazard ratio 4.222 (95% CI 1.298-13.733), p = 0.017]. However, there was no statistically significant predictive relationship between STAR 1 and STAR 2, or between STAR 1 and STAR 3 + 4. St. George's Respiratory Questionnaire (SGRQ) Total and COPD Assessment Test (CAT) scores were significantly different between all GOLD groups, except for the CAT score between GOLD 1 and GOLD 2. The SGRQ Total and CAT scores were significantly different between STAR 1 and STAR 3 + 4, but not between STAR 1 and STAR 2. CONCLUSION: From the perspective of all-cause mortality and COPD-specific health status, the GOLD classification is more discriminative than STAR.
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Chronic obstructive pulmonary disease (COPD) can negatively affect patients' employment and work-life activities with a significant indirect economic impact. The current study aimed to measure unemployment, work productivity, activity impairment, and their associated factors among COPD patients. A cross-sectional study was conducted in the Chest outpatient clinic, Mansoura University Hospital, Egypt. COPD patients completed an interviewer-administered questionnaire including sociodemographic, occupational data, clinical history, medical research council (mMRC) dyspnea scale, the COPD assessment test (CAT), and work productivity and activity impairment Questionnaire (WPAI-COPD). A total 140 patients were included in the study and 22.1% of them gave up their jobs because of their COPD. Due to COPD, the mean percentage of daily activity impairment was 39.8 among all patients. The mean percentages of absenteeism, presenteeism, and overall work impairment among the 84 working patients were 0.07, 24.4, and 24.5. The CAT score was the significant predictor of all components of WPAI. In conclusion, COPD causes early retirement, high work productivity loss, and impaired daily activities. Higher CAT scores and increased disease severity significantly increase absenteeism, presenteeism, overall work, and activity impairment. Thus, timely diagnosis of COPD with appropriate management can help improve outcomes and lower the disease burden and economic impact.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Humans , Cross-Sectional Studies , Pulmonary Disease, Chronic Obstructive/epidemiology , Efficiency , Employment , Surveys and Questionnaires , Absenteeism , Severity of Illness Index , Quality of LifeABSTRACT
Background: The natural course of chronic obstructive pulmonary disease (COPD) is characterized by symptom exacerbation and quality-of-life reduction. Therefore, symptoms should be properly assessed. Some studies have demonstrated a weak correlation between cardiopulmonary exercise testing (CPET) parameters and symptoms in patients with COPD; however, data on Asian patients are lacking. We investigated the value of CPET parameters in assessing symptoms and quality of life in Asian patients with COPD. Methods: Of 681 patients who underwent CPET at Asan Medical Center between January 2020 and June 2022, we analyzed 195 patients with COPD in this retrospective study. A cycle ergometer was used for the incremental protocol. The modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) were administered to assess the patients' symptoms. Results: The mMRC grade was related to maximal oxygen uptake (VO2 max, L/min) (Spearman's correlation coefficient ρ=-0.295, P<0.001) and physiological dead space/tidal volume ratio at peak exercise (VD/VT peak) (ρ=0.256, P<0.001). The CAT score was significantly correlated with VO2 max (L/min) (Spearman's correlation coefficient ρ=-0.297, P<0.001) and VD/VT peak (ρ=0.271, P<0.001), but had no correlation with breathing reserve (ρ=-0.122, P=0.089). The optimal cut-off values of VO2 max and VD/VT peak for predicting the onset of clinically significant dyspnea were 1.099 L/min and 0.295, respectively. Conclusions: VO2 max and VD/VT peak comprehensively reflect the symptoms and health-related quality of life of patients with COPD.
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BACKGROUND: Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD. METHODS: This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used. RESULTS: Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30-49% in 142 (38.0%), 50-79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30-49% predicted (p < 0.001), 50-79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121-0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = - 0.182, p < 0.001), mMRC (r = - 0.121, p = 0.020), and SGRQ-c scores (r = - 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407-0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001). CONCLUSIONS: In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak.
Subject(s)
Bronchodilator Agents , Pulmonary Disease, Chronic Obstructive , Humans , Bronchodilator Agents/therapeutic use , Cross-Sectional Studies , Lung , Pulmonary Disease, Chronic Obstructive/drug therapy , Forced Expiratory Volume , Patient Reported Outcome MeasuresABSTRACT
BACKGROUND: The omega-3 polyunsaturated fatty acids (PUFAs) have an anti-inflammatory effect, beneficial for allergies, asthma, chronic obstructive pulmonary disease (COPD), reduce cholesterol and triglyceride levels and blood inflammatory parameters [C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α)]. The aim of our cross-sectional study was to monitor omega-3 supplementation in patients with severe COPD and assess its association with quality of life, nutritional status, inflammatory parameters, lipid profile, comorbidities, exercise tolerance and inhaled medications. METHODS: Our questionnaire on dietary supplement habits and our validated self-completion questionnaires were filled in by 400 patients with COPD at the National Koranyi Institute of Pulmonology, Hungary, mean age 67 [61-73] years; forced expiratory volume in one second (FEV1) (ref%): 46 [34-58]; 47.5% male, 52.5% female. We used the disease-specific COPD Assessment Test (CAT) questionnaire to measure quality of life. RESULTS: More than half of the study participants (61%) did not consume fish or oilseeds at all. Nineteen patients (4.75%) took omega-3 supplementation regularly, mainly on medical advice (0.5 g/day). We observed significantly lower serum CRP levels [6.0 (1-7.3) vs. 9.7 (7.4-14.4); P=0.044], more favourable lipid profile [triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol] with higher mean body mass index (BMI) [28.1 (22.0-35.3) vs. 24.7 (24.5-30.1); P=0.118], better quality of life {CAT: 25 [21-30.5] vs. 26 [20-31]; P=0.519}, lower inhaled short-acting bronchodilators use [short-acting beta-agonists (SABAs): 6 (31.58) vs. 209 (54.86); P=0.047], lower number of exacerbations in the previous half year [0 (0-1) vs. 1 (0-2); P=0.023], and higher 6-minute walking distance (6MWD) {300 [177-387] vs. 251 [150-345]; P=0.120} in the group with omega-3 supplementation. CONCLUSIONS: PUFAs are anti-inflammatory and affect the immune system. Our study shows that omega-3 intake of COPD patients is insufficient, and there is an urgent need to develop new anti-inflammatory strategies because only one drug (such as corticosteroids) cannot ease the chronically progressive inflammatory process of COPD.
Subject(s)
Fatty Acids, Omega-3 , Pulmonary Disease, Chronic Obstructive , Adrenal Cortex Hormones/therapeutic use , Bronchodilator Agents/therapeutic use , C-Reactive Protein , Cholesterol/therapeutic use , Cross-Sectional Studies , Dietary Supplements , Exercise Tolerance , Fatty Acids, Omega-3/therapeutic use , Fatty Acids, Unsaturated/therapeutic use , Female , Humans , Interleukin-6 , Interleukin-8/therapeutic use , Lipoproteins, HDL/therapeutic use , Lipoproteins, LDL , Male , Nutritional Status , Pulmonary Disease, Chronic Obstructive/drug therapy , Quality of Life , Triglycerides , Tumor Necrosis Factor-alphaABSTRACT
Background: Chronic obstructive pulmonary disease (COPD) as one of the health-threatening problems imposes many economic costs on health systems. Today, there is a greater tendency to use complementary and alternative therapies in the treatment of diseases. This study aimed to evaluate the efficacy of a Persian herbal formulation in patients with COPD. Materials and Methods: This randomized clinical trial was conducted on 76 patients with mild-severe COPD assigned to 2 groups (in each group n=38) for 8 weeks. The interventional group received Compound Honey Syrup (CHS), consisting of combination of honey and extracts of five medicinal plants (i.e., ginger, cinnamon, saffron, cardamom, and galangal) and the control group received a placebo. The COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ), and lung function test were used before and after. Results: Seventy-six patients, 88.6% male and 55.7% under 60 years of age, completed the course of treatment. At the end of the study, the overall score of the CAT questionnaire was significantly different between the first and fourth week (P=0.029). Meanwhile the findings of SGRQ questionnaire were significantly different between the interventional and control groups at other times (P=0.001). FEV1 and FEV1/FVC were found to be significantly different between two groups in weeks 4 and 8 (P <0.05). At the end of the study, no side effects of CHS were reported. Conclusion: Based on the data presented herein, CHS could be effective as a complementary and safe drug in increasing the quality of life of with COPD.
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Purpose: This real-world study evaluated the effectiveness of different inhalation therapies in patients with symptomatic chronic obstructive pulmonary disease (COPD) in China and also explored the relevant factors that influence the effectiveness of inhalation therapy. Patients and Methods: We conducted a multicenter prospective longitudinal study that was carried out in 12 hospitals in China from December 2016 to June 2021. A face-to-face interview was conducted to collect data. Baseline data were collected at the first visit. Minimum clinically important difference (MCID) was defined as attaining a COPD assessment test (CAT) decrease ≥2. We mainly assessed the MCID and the incidence of exacerbations at the 6 months follow-up. Results: In 695 patients, the mean age was 62.5 ± 8.2 years, with a mean CAT score of 15.1 ± 6.0. Overall, 341 (49.1%) patients attained the MCID of CAT and the incidence of exacerbation during follow-up was 22.3%. Females were significantly more likely to attain MCID than male in COPD patients (adjusted odd ratio (aOR) = 1.93, adjusted 95% confidence interval (a95%CI) = 1.09-3.42, p = 0.024). Patients treated with LABA/LAMA or ICS/LABA/LAMA (ICS, inhaled corticosteroid; LABA, long-acting ß2-agonist; LAMA, long-acting muscarinic antagonist) were more likely to attain MCID than patients treated with LAMA (aOR = 3.97, a95%CI = 2.48-6.35, p < 0.001; aOR = 3.17, a95%CI = 2.09-4.80, p < 0.001, respectively). Patients treated with LABA/LAMA had a higher incidence of severe exacerbation than patients treated with ICS/LABA/LAMA (aOR = 1.95, a95%CI = 1.04-3.66, p = 0.038). Conclusion: The incidence of MCID in symptomatic COPD patients treated with inhalation therapy was nearly 50%. Patients treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID than patients treated with LAMA. Patients treated with LABA/LAMA had a higher incidence of severe exacerbations than with ICS/LABA/LAMA.
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INTRODUCTION: Chronic obstruction pulmonary disease (COPD) is a chronic airflow disorder along with decreasing health status. COPD assessment test (CAT) is commonly used to assess the health status of patients and their medical results. The aim of this study was to assess the therapeutic outcomes in patients with COPD using CAT in private hospitals in Yogyakarta. MATERIALS AND METHODS: This was a cross-sectional study involving 156 patients, aged >40 years who had completed the CAT questionnaire. CAT scores were categorized into four groups and consisted of eight items: cough, phlegm, chest tightness, breathlessness going up hills/stairs, activity limitations at home, confidence leaving home, sleep, and energy. The four categories were successful therapy (CAT scores <10), moderately successful CAT 10-19), less successful (CAT scores 20-30), and unsuccessful (CAT score >30). The study was conducted from April to August 2018 at two Private Hospitals in Yogyakarta followed by descriptive-analytical data processing and chi-square analysis. RESULTS: The therapeutic outcomes of COPD were 30.13% successful (CAT score: <10), 60.26% moderately successful (CAT score: 10-19), 9.62% less successful (CAT score: 20-30), and there were no patients with unsuccessful therapy. The majority of patients had moderate airflow severity. Exacerbation condition, severity level, and type of therapy showed a significant result (P < 0.05) toward therapy results with COPD measurement, and from eight CAT items, it was identified that 37.8% of respondents had breathlessness going up hills/stairs. CONCLUSION: CAT can assess the therapeutic outcomes and COPD patient's health status with moderately successful therapy (CAT score 10-19) in more than sixty percent of respondents.
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BACKGROUND: Self-management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory-related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital. AIM: This pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3-month follow-up. METHODS: The study was carried out in a randomised controlled design with follow-up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD-related readmissions was measured as the primary outcome. RESULTS: Compared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS-depression, but none in HADS-anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy. CONCLUSIONS: A personally tailored action plan introduced at or postdischarge combined with follow-up support is an effective self-management tool to support recovery and to reduce unnecessary readmissions. In future follow-up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.
Subject(s)
Patient Discharge , Pulmonary Disease, Chronic Obstructive , Aftercare , Humans , Patient Readmission , Pilot Projects , Pulmonary Disease, Chronic Obstructive/therapy , Quality of LifeABSTRACT
OBJECTIVE: To investigate the concentration of CX3CL1 in serum of patients with chronic obstructive pulmonary disease (COPD), and to evaluate the associations between the CX3CL1 level and systemic inflammation, small airway obstruction, and COPD assessment test (CAT) scores in COPD patients. METHODS: Enzyme-linked immunosorbent assay were utilized to detect the CX3CL1 protein in serum separately from 64 patients with COPD and 53 healthy controls. RESULTS: Compared with healthy non-smokers, healthy smokers and COPD non-smokers, serum CX3CL1 protein levels were significantly elevated in COPD smokers (258.33⯱â¯56.27â¯pg/mL versus 177.32⯱â¯43.21â¯pg/mL, 185.64⯱â¯47.03â¯pg/mL, and 226.55⯱â¯51.79â¯pg/mL, Pâ¯<â¯0.05). Correlation analysis indicated that serum CX3CL1 in COPD smokers was negatively correlated with FEV1/FVC (justified râ¯=â¯-0.319, Pâ¯<â¯0.001), FEV1/Pre (justified râ¯=â¯-0.476, Pâ¯<â¯0.001), FEV3/FVC (justified râ¯=â¯-0.354, Pâ¯<â¯0.001), MMEF25-75/Pre (justified râ¯=â¯-0.428, Pâ¯<â¯0.001), but positively correlated with CRP (justified râ¯=â¯0.331, Pâ¯<â¯0.001) and MMP-12 (justified râ¯=â¯0.352, Pâ¯<â¯0.001). However, our results showed no significant correlation between serum CX3CL1 of COPD smokers and the diffusing capacity of the lung for carbon monoxide (DLCO) (justified râ¯=â¯0.0397, Pâ¯=â¯0.6025), but a positive correlation with COPD assessment test (CAT) scores (justified râ¯=â¯0.367, Pâ¯<â¯0.001). Finally, through multivariate linear analysis, statistical results demonstrated age (ßâ¯=â¯-0.2694, Pâ¯=â¯0.005), FEV1/Pred (ßâ¯=â¯-0.2653, Pâ¯=â¯0.003), CRP (ßâ¯=â¯0.1427, Pâ¯=â¯0.0478) and MMP-12 (ßâ¯=â¯0.430, Pâ¯<â¯0.001) are independent parameters associated with CX3CL1. CONCLUSION: The results demonstrated that elevated circulating CX3CL1 level is associated with the systemic inflammation, small airway obstruction, and CAT scores in COPD patients, suggesting that CX3CL1 may play crucial roles in the pathogenesis of COPD. Blocking CX3CL1 might prevent the progression of chronic obstructive pulmonary disease.
Subject(s)
Airway Obstruction/blood , Biomarkers/blood , Chemokine CX3CL1/blood , Pulmonary Disease, Chronic Obstructive/blood , Aged , Airway Obstruction/complications , C-Reactive Protein/metabolism , Cross-Sectional Studies , Disease Progression , Female , Humans , Inflammation/metabolism , Leukocyte Elastase/blood , Male , Matrix Metalloproteinase 12/blood , Middle Aged , Pulmonary Disease, Chronic Obstructive/complications , Respiratory Function Tests , SmokersABSTRACT
OBJECTIVES: A wide range of electronic devices can be used for data collection of patient-reported outcome (PRO) measures in subjects with chronic obstructive pulmonary disease (COPD). Although comparisons between electronic and paper-based PRO measures have been undertaken in asthmatics, it is currently uncertain whether electronic questionnaires work equally as well as paper versions in elderly subjects with COPD. The aim of this study was to compare the responses to paper and electronic versions of the Evaluating Respiratory Symptoms in COPD (E-RS) and the COPD Assessment Test (CAT). DESIGN: A randomised cross-over design was used to compare the responses to paper and electronic versions of the two tools. The interval between the two administrations was 1 week. SETTING: Electronic versions were self-administered under supervision using a tablet computer at our outpatient clinic (secondary care hospital in Japan) while paper questionnaires completed at home were requested to be returned by mail. It was intended that half of the patients completed the electronic versions of both questionnaires first, followed by the paper versions while the other half completed the paper versions ï¬rst. PARTICIPANTS: Eighty-one subjects with stable COPD were included. RESULTS: The E-RS total scores (possible range 0-40) were 6.8±7.4 and 5.0±6.6 in the paper-based and electronic versions, respectively, and the CAT scores (possible range 0-40) were 10.0±7.4 and 8.6±7.8. In both questionnaires, higher scores indicate worse status. The relationship between electronic and paper versions showed significant reliability for both the E-RS total score and CAT score (intraclass correlation coefficient=0.82 and 0.89, respectively; both p<0.001). However, both the E-RS total and CAT scores were significantly higher in the paper versions (p<0.05). CONCLUSIONS: In both cases, the two versions of the same questionnaire cannot be used interchangeably even though they have both been validated.
Subject(s)
Patient Reported Outcome Measures , Pulmonary Disease, Chronic Obstructive/physiopathology , Aged , Aged, 80 and over , Cross-Over Studies , Cross-Sectional Studies , Female , Humans , Male , Paper , Pulmonary Disease, Chronic Obstructive/psychology , Reproducibility of ResultsABSTRACT
OBJECTIVES: We hypothesised that chronic obstructive pulmonary disease (COPD)-specific health status measured by the COPD assessment test (CAT), respiratory symptoms by the evaluating respiratory symptoms in COPD (E-RS) and dyspnoea by Dyspnoea-12 (D-12) are independently based on specific conceptual frameworks and are not interchangeable. We aimed to discover whether health status, dyspnoea or respiratory symptoms could be related to smoking status and airflow limitation in a working population. DESIGN: This is an observational, cross-sectional study. PARTICIPANTS: 1566 healthy industrial workers were analysed. RESULTS: Relationships between D-12, CAT and E-RS total were statistically significant but weak (Spearman's correlation coefficient=0.274 to 0.446). In 646 healthy non-smoking subjects, as the reference scores for healthy non-smoking subjects, that is, upper threshold, the bootstrap 95th percentile values were 1.00 for D-12, 9.88 for CAT and 4.44 for E-RS. Of the 1566 workers, 85 (5.4%) were diagnosed with COPD using the fixed ratio of the forced expiratory volume in one second/forced vital capacity <0.7, and 34 (2.2%) using the lower limit of normal. The CAT and E-RS total were significantly worse in non-COPD smokers and subjects with COPD than non-COPD never smokers, although the D-12 was not as sensitive. There were no significant differences between non-COPD smokers and subjects with COPD on any of the measures. CONCLUSIONS: Assessment of health status and respiratory symptoms would be preferable to dyspnoea in view of smoking status and airflow limitation in a working population. However, these patient-reported measures were inadequate in differentiating between smokers and subjects with COPD identified by spirometry.
Subject(s)
Dyspnea/epidemiology , Health Status , Patient Reported Outcome Measures , Pulmonary Disease, Chronic Obstructive/physiopathology , Smoking/epidemiology , Adult , Aged , Cross-Sectional Studies , Dyspnea/etiology , Female , Forced Expiratory Volume , Health Status Indicators , Humans , Japan , Male , Middle Aged , Occupational Health , Pulmonary Disease, Chronic Obstructive/diagnosis , Smoking/adverse effects , Spirometry , Surveys and Questionnaires , Vital Capacity , WorkABSTRACT
OBJECTIVES: Minimal clinically important differences (MCIDs) are used as fixed numbers in the interpretation of clinical trials. Little is known about its dynamics. This study aims to explore the impact of baseline score, study setting, and patient characteristics on health status MCIDs in chronic obstructive pulmonary disease (COPD). STUDY DESIGN AND SETTING: Baseline and follow-up data on the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and St. George's Respiratory Questionnaire (SGRQ) were retrospectively analyzed from pulmonary rehabilitation (PR) and routine clinical practice (RCP). Anchor- and distribution-based MCID estimates were calculated and tested between settings, gender, age, Global initiative for Obstructive Lung Disease (GOLD) classification, comorbidities, and baseline health status. RESULTS: In total, 658 patients were included with 2,299 change score measurements. MCID estimates for improvement and deterioration ranged for all subgroups 0.50-6.30 (CAT), 0.10-0.84 (CCQ), and 0.33-12.86 (SGRQ). Larger MCID estimates for improvement and smaller ones for deterioration were noted in patients with worse baseline health status, females, elderly, GOLD I/II patients, and patients with less comorbidities. Estimates from PR were larger. CONCLUSION: Baseline health status and setting affected MCID estimates of COPD health status questionnaires. Patterns were observed for gender, age, spirometry classification, and comorbidity levels. These outcomes would advocate the need for tailored MCIDs.
Subject(s)
Health Status , Minimal Clinically Important Difference , Pulmonary Disease, Chronic Obstructive/therapy , Aged , Female , Germany , Humans , Male , Middle Aged , Netherlands , Observational Studies as Topic , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/rehabilitation , Randomized Controlled Trials as Topic , Retrospective Studies , Spirometry , Treatment OutcomeABSTRACT
Objetivo: Correlacionar a sensação de dispneia obtida pela escala Medical Research Council modificada (mMRC) com as variáveis respiratórias e o tempo de internação em portadores de doença pulmonar obstrutiva crônica (DPOC) hospitalizados. Material e Métodos: Estudo transversal de caráter observacional e descritivo; no qual participaram do estudo pacientes interna-dos na Santa Casa de Misericórdia (SCM) de Goiânia-GO e Hospital Geral de Goiânia Dr. Alberto Rassi (HGG), com diag-nóstico de DPOC. Foram coletados sinais vitais, dados antro-pométricos e aplicada a escala de mMRC. Resultados: Foram avaliados 28 participantes, com média de idade de 74,10±12,46 anos; a média de mMRC foi de 3,10±1,19, comprometimento moderado, não ocorrendo diferença de mMRC entre homens e mulheres (p=0,503), além de não ter sido encontrada cor-relação entre o mMRC com a FR (r= -0,035 p=0,864), SpO2 (r=-0,228 p=0,222) e o tempo de internação (r=0,140 p=0,486). No entanto, em relação a necessidade de internação em uni-dade de terapia intensiva e o tempo de internação na unidade houve correlação significativa (r-0,457 p<0,01 e r 0,388 p<0,04, respectivamente). Conclusão: Não se encontrou relação da sensação de dispneia com as variáveis respiratórias e o tempo de internação total, porém foi possível verificar uma correlação entre o mMRC e a necessidade de internação e o tempo de internação em unidade de terapia intensiva. (AU)
Objetive:To correlate the dyspnea syndrome with the modified Medical Research Council scale (mMRC) with the respiratory and temporal variables of hospitalization in patients with hospitalized chronic obstructive pulmonary disease (COPD). Method: Cross-sectional observational and descriptive studyin which participated patients from the Santa Casa de Misericórdia (SCM) of Goiânia-GO and the General Hospital of Goiânia Dr. Alberto Rassi (HGG), with the diagnosis of COPD. Vital signs and anthropometric data were collected and the mMRC scale was applied. Results: Twenty-eight participants were evaluated, with a mean age of 74.10 ± 12.46 years; the mean mMRC was 3.10 ± 1.19, there was moderate impairment, no difference of mMRC between men and women (p = 0.503), nor was it found among mMRC with FR (r = -0.035 p = 0.864), SpO2 (r = -0.228 p = 0.222) and length of stay (r = 0.140 p = 0.486), which means that intensive care unit stay and length of stay in the domestic unit are important (r-0,457 p<0,01 e r 0,388 p<0,04 respectively). Conclusion: No differences between dyspnea syndrome and respiratory variables and total hospitalization time were found, but it was possible that they occurred between the MRC and the need for hospitalization and length of stay in intensive care therapy. There is a moderate influence of the dyspnea syndrome to direct the attention to the individuals under hospitalization, in order to minimize the progression of the disorder and greater impairment in the general state of health. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Severity of Illness Index , Pulmonary Disease, Chronic Obstructive/physiopathology , Dyspnea/diagnosis , Symptom Assessment/methods , Length of Stay , Cross-Sectional Studies , Dyspnea/physiopathology , Intensive Care UnitsABSTRACT
BACKGROUND: The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant. Although the recall period can influence questionnaire scores, it is unclear if it influences the MCID. This study is the first to examine longitudinally the impact of the recall period of an anchor question and its design on the MCID of COPD health status tools using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and the St. George's Respiratory Questionnaire (SGRQ). METHODS: Moderate to very severe COPD patients without respiratory co-morbidities were recruited during 3-week Pulmonary Rehabilitation (PR). CAT, CCQ and SGRQ were completed at baseline, discharge, 3, 6, 9 and 12 months. A 15-point Global Rating of Change scale (GRC) was completed at each follow-up. A five-point GRC was used as second anchor at 12 months. Mean change scores of a subset of patients indicating a minimal improvement on each of the anchor questions were considered the MCID. The MCID estimates over different time periods were compared with one another by evaluating the degree of overlap of Confidence Intervals (CI) adjusted for dependency. RESULTS: In total 451 patients were included (57.9 ± 6.6 years, 65% male, 50/39/11% GOLD II/III/IV), of which 309 completed follow-up. Baseline health status scores were 20.2 ± 7.3 (CAT), 2.9 ± 1.2 (CCQ) and 50.7 ± 17.3 (SGRQ). MCID estimates for improvement ranged - 3.1 to - 1.4 for CAT, - 0.6 to - 0.3 for CCQ, and - 10.3 to - 7.6 for SGRQ. Absolute higher - though not significant - MCIDs were observed for CAT and CCQ directly after PR. Significantly absolute lower MCID estimates were observed for CAT (difference - 1.4: CI -2.3 to - 0.5) and CCQ (difference - 0.2: CI -0.3 to -0.1) using a five-point GRC. CONCLUSIONS: The recall period of a 15-point anchor question seemed to have limited impact on the MCID for improvement of CAT, CCQ and SGRQ during PR; although a 3-week MCID estimate directly after PR might lead to absolute higher values. However, the design of the anchor question was likely to influence the MCID of CAT and CCQ. TRIAL REGISTRATION: RIMTCORE trial # DRKS00004609 and #12107 (Ethik-Kommission der Bayerischen Landesärztekammer).
Subject(s)
Health Status , Pulmonary Disease, Chronic Obstructive/rehabilitation , Quality of Life , Aged , Female , Humans , Male , Middle Aged , Minimal Clinically Important Difference , Pulmonary Disease, Chronic Obstructive/physiopathology , Surveys and Questionnaires , Time FactorsABSTRACT
BACKGROUND: Although, the variable pattern of asthmatic symptoms is well recognized, little is known about the respiratory symptoms variability in patients of chronic obstructive pulmonary disease (COPD). The present study evaluated the variability of the respiratory symptoms in a day and their influence on the daily activities in a cohort of Chinese COPD patients. METHODS: An observational cross-sectional study was conducted in 11 medical centers of China. Participants were outpatient ≥40 years old with stable COPD, post-bronchodilator forced expiratory volume in 1 second (FEV1) <80% predicted. Overall, data of 1,032 eligible patients were valid for final analysis. RESULTS: Mean post bronchodilator FEV1 (predicted %) was 46.5%. Cough, expectoration and dyspnea were the most commonly observed symptoms (73.6%, 68.8% and 61.4%, respectively). Daily symptom variability was experienced by 50.2% of symptomatic patients. The wake up time in the morning was the worst and the most troublesome time during the day (39.3%), followed by the nighttime (21.3%). The morning activities were most affected by COPD symptoms. Multivariate analyses revealed that COPD assessment test (CAT) scores was the only factor correlated with patients' symptom variability [odds ratio (OR) =0.463, P<0.0001]. CONCLUSIONS: Patient-perceived symptoms vary during the day in Chinese COPD patients. They experience the greatest increase in respiratory symptoms early in the morning. This variation should be considered as a potential new target in the long-term COPD management.
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Objective Osteoporosis, which is now recognized as a major comorbidity of chronic obstructive pulmonary disease (COPD), must be diagnosed by appropriate methods. The aims of this study were to clarify the relationships between bone mineral density (BMD) and COPD-related clinical variables and to explore the association of BMD with the updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification in men. Methods We enrolled 50 Japanese men with clinically stable COPD who underwent dual-energy X-ray absorptiometry (DEXA), pulmonary function testing, and computerized tomography (CT) and who had completed a questionnaire (COPD assessment test [CAT]). We determined the association between the T-score and other tested parameters and compared the BMD of patients in each GOLD category. Results Twenty-three of the 50 patients (46.0%) were diagnosed with osteopenia, and 7 (14.0%) were diagnosed with osteoporosis. The BMD findings were significantly correlated with the CAT score, forced expiratory volume in 1 second percentage predicted (FEV1% predicted), low attenuation volume percentage (LAV%), and percentage of cross-sectional area of small pulmonary vessels (%CSA) on CT images. Notably, the median T-score of the GOLD category D participants was significantly lower than that of the participants in each of the other categories (A [-0.98], B [-1.06], C [-1.05], and D [-2.19], p<0.05). Conclusion Reduced BMD was associated with airflow limitation, extent of radiographic findings, and a poor quality of life (QOL) in patients with COPD. The BMD of GOLD category D patients was the lowest of all of the patients evaluated, and category D patients may benefit from active intervention for osteoporosis.
Subject(s)
Bone Density , Osteoporosis/etiology , Osteoporosis/physiopathology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/physiopathology , Absorptiometry, Photon , Aged , Asian People , Cross-Sectional Studies , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
Objective To observe the effect of early pulmonary rehabilitation (PR) on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods AECOPD patients (n=97) were randomly distributed into two groups:control group (n=39) and rehabilitation group (n=58). Patients in both groups were assessed when symptom im?proved from acute phase (baseline, T1). Then patients in control group only received pharmaco-therapy and rehabilitation ed?ucation without PR. When symptom was relieved and stable (T2), they were given 12 weeks PR (T3). On the other hand, pa?tients in rehabilitation group underwent a 12-week PR after T1 directly (T2). The lung function parameters, 6 min walking distance (6MWD), MRC scores and CAT scores were observed and analyzed in two groups. Results Until the end of the 12-weeks observation, the value of lung function showed no statistic differences between two groups(either T1 in control group vs T1 in PR group or T2 in PR group vs T2 and T3 in control group. In control group, the value of 6MWD scores of T3 was bet?ter than that of T1 and T2, in PR group(F6MWD=8.762,FMRC=4.432,FCAT=10.266,P<0.05)while MRC, CAT value in T3 of control group were higher than those in T1 and T2 of PR group. At T1, parameters does not demonstrate significant difference between these two groups. Value of 6MWD was higher while MRC and CAT were lower in T2 of PR group than that in T2 and T3 of control group. Conclusion Early pulmonary rehabilitation could improve the mobility and qulity of life, as well as ameliorate the severity of dyspnea in AECOPD patients.
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INTRODUCTION: In the therapy of chronic obstructive pulmonary disease (COPD), it is a major goal to improve health-related quality of life (HRQOL). Patients with COPD often suffer from exertional dyspnea and adopt a sedentary lifestyle, which could be associated with poorer HRQOL. The aim of this study was to investigate the independent association of objectively measured daily physical activity and functional capacity with HRQOL in patients with COPD. METHODS: In this cross-sectional study conducted at the University Hospital Basel, Switzerland, 87 stable patients (58.6% male, mean age: 67.3 ± 9.6 yrs) with COPD in GOLD grades I (n = 23), II (n = 46), III (n = 12) and IV (n = 6) were investigated. To assess HRQOL, the COPD assessment test (CAT) was completed. Patients performed spirometry and 6-min walk test. Physical activity was measured by the SenseWear Mini Armband on 7 consecutive days. By performing a multiple linear regression analysis, independent predictors of CAT score were identified. RESULTS: Age (ß = -0.39, p = 0.001), average daily steps (ß = -0.31, p = 0.033) and 6-min walk distance (ß = -0.32, p = 0.019) were found to be independent predictors of CAT score, whereas physical activity duration above 3 METs (p = 0.498) and forced expiratory volume in 1 s in% of predicted (p = 0.364) showed no significant association. CONCLUSIONS: This study showed that average daily steps and functional capacity are independent determinants of HRQOL in patients with COPD. This emphasizes the importance to remain active and mobile, which is associated with better HRQOL.
Subject(s)
Exercise Tolerance/physiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality of Life , Walking/physiology , Accelerometry , Age Factors , Aged , Cross-Sectional Studies , Exercise Test , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Monitoring, Physiologic , Vital CapacityABSTRACT
BACKGROUND: COPD is a major cause of morbidity in smokers. The COPD assessment test (CAT) is a validated test for evaluation of COPD impact on health status. CAT is not a diagnostic test and pulmonary function test (PFT) still remains the most important diagnostic test. However, its predictive value for evaluation of disease impact is weak. The purpose of this study was to determine the relationship between CAT score and PFT in COPD patients. MATERIALS AND METHODS: We evaluated 105 patients with stable COPD. Demographic data were obtained at baseline. Severity of airflow obstruction was assessed by standard spirometry and classified by the Global initiative for Obstructive Lung Disease (GOLD) criteria. Then, the impact of COPD on health status was assessed using CAT. The CAT scores were categorized into four groups. We statistically compared the relationship between CAT score, COPD stages, CAT groups and PFT. RESULTS: The mean age of patients and mean period of smoking (p/y) were 59.60±11.93SD and 35.43±15.33 SD yrs, respectively. The mean FEV1%predicted was 71.01±26.70SD. The mean CAT score was 19.61±8.07 SD. The correlation between the severity of smoking and GOLD classification was significant (p=0.006). There was a significant association between the FEV1%predicted and total CAT score (r= -0.55, p< 0.001). The correlation between mean FEV1%predicted and mean score of CAT groups 1, 2, 3, and 4 was statistically significant (p<0.001). CONCLUSION: The relationship between CAT score and FEV1%predicted suggests that CAT is linked to severity of airflow limitation and GOLD classification in stable COPD patients. Health status as measured by CAT worsens with severity of airflow limitation.