Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study.

BACKGROUND: The burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD). Physical activity has emerged as both functional outcome and non-pharmacological intervention in COPD patients, despite the lack of standardized measures or guidelines in clinical practice. This study aimed to explore in more depth the 24-h respiratory symptoms, the physical activity level (PAL) and the relationship between these two determinants in stable COPD patients. METHODS: This was a multinational, multicenter, observational, cross-sectional study conducted in ten European countries and Israel. Dedicated questionnaires for each part of the day (morning, daytime, night) were used to assess respiratory symptoms. PAL was evaluated with self- and interview-reported tools [EVS (exercise as vital sign) and YPAS (Yale Physical Activity Survey)], and physician's judgement. Patients were stratified in ABCD groups by 2013 and 2017 GOLD editions using the questionnaires currently recommended: modified Medical Research Council dyspnea scale and COPD Assessment Test. RESULTS: The study enrolled 2190 patients (mean age: 66.9 years; male: 70.0%; mean % predicted FEV1: 52.6; GOLD groups II-III: 84.5%; any COPD treatment: 98.9%). Most patients (> 90%) reported symptoms in any part of the 24-h day, irrespective of COPD severity. PAL evaluations showed discordant results between patients and physicians: 32.9% of patients considered themselves completely inactive, while physicians judged 11.9% patients as inactive. By YPAS, the overall study population spent an average of 21.0 h/week performing physical activity, and 68.4% of patients were identified as sedentary. In any GOLD ABCD group, the percentage of inactive patients was high. Our study found negative, weak correlations between respiratory symptoms and self-reported PAL (p < 0.001). CONCLUSIONS: Despite regular treatment, the majority of stable COPD patients with moderate to severe disease experienced daily variable symptoms. Physical activity level was low in this COPD cohort, and yet overestimated by physicians. With evidence indicating the negative consequences of inactivity, its adequate screening, a more active promotion and regular assessment of physical activity are urgently needed in COPD patients for better outcomes. TRIAL REGISTRATION: NCT03031769 , retrospectively registered, 23 Jan 2017.

Katayama syndrome disguised as eosinophilic asthma with acute systemic symptoms and pulmonary nodules.

Background: Katayama syndrome is an acute manifestation of schistosomiasis, a parasitic infection that manifests itself through a hypersensitivity reaction to migrating larvae and early egg deposition. Left undiagnosed and untreated, acute schistosomiasis can develop into chronic schistosomiasis which can lead to debilitating morbidity such as pulmonary hypertension. This case highlights that Katayama syndrome can also been seen in regions where the parasite is not endemic, as it occurs in travelers returning from endemic regions or in immigrants. Case presentation: We describe the case of a 26-year-old asthmatic male, who presented with systemic symptoms including fever, myalgia, night sweats as well as gastro-intestinal and pulmonary complaints since five days. At presentation, there was a raised blood eosinophil count and nodular lesions were seen on computed tomography. After considering diagnoses such as tuberculosis, vasculitis and hypereosinophilic syndrome, it was repeated history taking that revealed that the patient had suffered from swimmer's itch during a stay in Guinea. A stool sample showed microscopic presence of Schistosoma mansoni eggs, confirming the diagnosis of Katayama syndrome. The patient was treated with tapered corticosteroids to suppress the hypersensitivity reaction and praziquantel was added to cure the parasitic infection. This led to a complete resolution of the patients' symptoms and radiological abnormalities. Negative stool samples confirmed the eradication of the schistosomes. Conclusions: Swimmer's itch and Katayama syndrome are manifestations of acute schistosomiasis. It is important to recognize the syndrome, because early diagnosis and adequate treatment can prevent chronic disease and significant morbidity.

Correlation of symptoms and physical activity level in chronic obstructive pulmonary disease patients: results from the observational SPACE study.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and high symptom burden that interferes with physical activity and results in a vicious cycle of inactivity and symptom worsening. The aim of this multicenter, observational study was to determine the prevalence and severity of morning, daytime and night-time symptoms as well as patterns of physical activity levels (PALs) and their interrelation in Belgian COPD patients, enrolled in the multinational SPACE study (NCT03031769). METHODS: Socio-demographic, socio-economic and disease characteristics data were collected from patients' medical records as part of a routine visit to their primary care practice or pulmonologist. Dedicated questionnaires were used to evaluate respiratory symptoms for each part of the day. PAL was assessed by means of self- and interview-reported tools, and physician's judgment. Patients were also classified according to GOLD recommendations 2013 and 2017. RESULTS: Overall, 102 Belgian patients participated in the study (mean age 67 years, 60.8% males). Over 85% of patients experienced respiratory symptoms throughout the day and about one-third were considered as 'active' (PAL ≥150 minutes/week). Physician-assessed PALs were higher than self-reported PALs, categorizing fewer patients as 'inactive' (17.6% versus 42.2%, respectively). PALs and symptoms were weakly interrelated. Inactive patients were present in all GOLD classification groups. CONCLUSION: Stable Belgian COPD patients enrolled in the SPACE study presented 24-hour respiratory symptoms and insufficient PALs. Physicians tended to overestimate patients' physical activity. Inactive patients were present across all GOLD classification groups. New approaches are deemed necessary to objectively identify and activate sedentary patients.