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Evans RA. The Rationale, Evidence, and Adaptations to Pulmonary Rehabilitation for Chronic Respiratory Diseases Other Than COPD. Respir Care 2024; 69:697-712. [PMID: 38806225 PMCID: PMC11147632 DOI: 10.4187/respcare.12089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Over the last 3 decades, pulmonary rehabilitation (PR) has become an integral part of the management of COPD. Many other chronic respiratory diseases have similar systemic manifestations including skeletal muscle impairment, commonly through deconditioning, and may benefit from PR. However, whereas many programs may accept patients with other respiratory diseases, the program may need several adaptations to optimally manage patients. This article uses the examples of interstitial lung disease including idiopathic pulmonary fibrosis, bronchiectasis, pulmonary hypertension, post lung transplantation, and post-COVID condition to highlight exemplar clinical problems. In addition, the rationale and latest evidence for PR are described alongside the adaptations to the program, including education needs of the delivery team and close integrated care with the wider clinical team. Finally, future directions for clinical care and research are discussed.
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Affiliation(s)
- Rachael A Evans
- National Institute for Health Research Biomedical Research Centre, Respiratory, Department of Respiratory Medicine, University of Leicester Glenfield Hospital, Leicester, United Kingdom.
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2
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Seo H, Cha SI, Park J, Lim JK, Lee WK, Park JE, Choi SH, Lee YH, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Pectoralis Muscle Area as a Predictor of Mortality in Patients Hospitalized with Bronchiectasis Exacerbation. Respiration 2024; 103:257-267. [PMID: 38499001 DOI: 10.1159/000538091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Data on factors related to mortality in patients with bronchiectasis exacerbation are insufficient. Computed tomography (CT) can measure the pectoralis muscle area (PMA) and is a useful tool to diagnose sarcopenia. This study aimed to evaluate whether PMA can predict mortality in patients with bronchiectasis exacerbation. METHODS Patients hospitalized due to bronchiectasis exacerbation at a single center were retrospectively divided into survivors and non-survivors based on 1-year mortality. Thereafter, a comparison of the clinical and radiologic characteristics was conducted between the two groups. RESULTS A total of 66 (14%) patients died at 1 year. In the multivariate analysis, age, BMI <18.4 kg/m2, sex-specific PMA quartile, ≥3 exacerbations in the previous year, serum albumin <3.5 g/dL, cystic bronchiectasis, tuberculosis-destroyed lung, and diabetes mellitus were independent predictors for the 1-year mortality in patients hospitalized with bronchiectasis exacerbation. A lower PMA was associated with a lower overall survival rate in the survival analysis according to sex-specific quartiles of PMA. PMA had the highest area under the curve during assessment of prognostic performance in predicting the 1-year mortality. The lowest sex-specific PMA quartile group exhibited higher disease severity than the highest quartile group. CONCLUSIONS CT-derived PMA was an independent predictor of 1-year mortality in patients hospitalized with bronchiectasis exacerbation. Patients with lower PMA exhibited higher disease severity. These findings suggest that PMA might be a useful marker for providing additional information regarding prognosis of patients with bronchiectasis exacerbation.
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Affiliation(s)
- Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Won Kee Lee
- Biostatistics, Medical Research Collaboration Center, Kyungpook National University, Daegu, Republic of Korea
| | - Ji-Eun Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun Ha Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Buran MM, Savci S, Tanriverdi A, Kahraman BO, Gunduz D, Sevinc C. Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis. J Bras Pneumol 2024; 50:e20230230. [PMID: 38422338 PMCID: PMC11095920 DOI: 10.36416/1806-3756/e20230230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES This study primarily aimed to investigate the clinical determinants of the Modified Incremental Step Test (MIST) in adults with non-cystic fibrosis bronchiectasis (NCFB). A secondary objective was to compare the cardiopulmonary responses after the MIST and Incremental Shuttle Walk Test (ISWT), two commonly adopted symptom-limited maximum field tests in chronic respiratory diseases. METHODS Forty-six patients with clinically stable bronchiectasis participated in this cross-sectional study. MIST and ISWT were performed to determine exercise capacity, while disease severity, fatigue, and quality of life were assessed using the Bronchiectasis Severity Index (BSI), the Fatigue Severity Scale (FSS), and St. George's Respiratory Questionnaire (SGRQ), respectively. Quadriceps muscle strength was evaluated using a hand-held dynamometer, walking speed with a wireless inertial sensing device, and the level of physical activity (steps/day) with a pedometer. RESULTS The BSI score, quadriceps muscle strength, daily step count, and the SGRQ total score explained 61.9% of the variance in the MIST (p < 0.001, R2 = 0.67, AR2 = 0.619). The BSI score (r = -0.412, p = 0.004), quadriceps muscle strength (r = 0.574, p = 0.001), daily step count (r = 0.523, p < 0.001), walking speed (r = 0.402, p = 0.006), FSS score (r = -0.551, p < 0.001), and SGRQ total score (r = -0.570, p < 0.001) correlated with the MIST. The patients achieved higher heart rates (HR), HR%, desaturation, dyspnea, and leg fatigue in the MIST compared to the ISWT (p < 0.05). CONCLUSIONS Disease severity, quadriceps muscle strength, physical activity level, and quality of life were determinants of MIST. The advantages of the MIST, including higher cardiopulmonary response than ISWT and greater portability, which facilitates its use in various settings, make MIST the preferred choice for investigating symptom-limited exercise capacity in patients with NCFB.
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Affiliation(s)
- Melike Mese Buran
- . Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Sema Savci
- . Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Aylin Tanriverdi
- . Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Çankırı Karatekin University, Çankırı, Turkey
| | - Buse Ozcan Kahraman
- . Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Damla Gunduz
- . Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Can Sevinc
- . Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Motta CP, Olimpio da Silva DL, da Costa LR, Galhardo GF, Lopes AJ. Performance during the Glittre-ADL test between patients with and without post-tuberculosis bronchiectasis: A cross-sectional study. PLoS One 2023; 18:e0290850. [PMID: 37656719 PMCID: PMC10473510 DOI: 10.1371/journal.pone.0290850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Post-tuberculosis bronchiectasis (PTBB) is gaining recognition as an important chronic lung disease, representing a neglected condition with a significant burden for the individual. Recently, the Glittre-ADL test (TGlittre) has been proposed for the assessment of functional capacity, which incorporates tasks of daily living demanding the upper and lower extremities. This study used TGlittre to compare patients with PTBB to patients with non-post-tuberculosis bronchiectasis (NPTBB) and evaluate the determinants of performance during TGlittre. METHODS This is a cross-sectional study in which 32 patients with PTBB and 29 with NPTBB underwent TGlittre. In addition, they completed Short Form-36 (SF-36), handgrip strength, quadriceps muscle strength (QMS) and pulmonary function tests (PFTs). RESULTS Both PTBB and NPTBB required much more time to perform the TGlittre compared to the predicted values, although they did not differ statistically from each other [152 (124-200) vs. 145 (117-179)% predicted, p = 0.41]. Regarding the PFTs, the PTBB participants showed significantly lower values than the NPTBB participants in forced vital capacity (FVC, 60 ± 14.5 vs. 78.2 ± 22.2% predicted, p<0.001) and total lung capacity [82 (66-95) vs. 93 (82-105)% predicted, p = 0.028]. In the PTBB group, FVC (p<0.001) and QMS (p = 0.001) were the only significant independent variables to predict TGlittre time, explaining 71% of the variability in TGlittre time. In the NPTBB group, maximal expiratory pressure (p = 0.002), residual volume/TLC (p = 0.001) and QMS (p = 0.032) were the significant independent variables for predicting TGlittre time, explaining 73% of the variability in TGlittre time. CONCLUSIONS PTBB patients have lower than expected performance on TGlittre, though similar to NPTBB patients. The PTBB patients had a greater reduction in lung volume than NPTBB patients. Furthermore, the performance on TGlittre in PTBB patients is largely explained by lung volume and QMS.
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Affiliation(s)
- Cristiane Pires Motta
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | | | | | - Giselle Faria Galhardo
- Local Development Post-Graduation Programme, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Local Development Post-Graduation Programme, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
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Bhat A, Lee AL, Maiya GA, Vaishali K. Measurement properties of physical activity in adults with bronchiectasis: A systematic review protocol. F1000Res 2023; 12:801. [PMID: 37600906 PMCID: PMC10439356 DOI: 10.12688/f1000research.138593.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/22/2023] Open
Abstract
People with bronchiectasis reduce their physical activity (PA) due to muscle weakness, dyspnea, fatigue, reduced exercise capacity and frequent cough with expectoration. Patient-reported and objective physical assessment methods have been used to evaluate PA in people with bronchiectasis. In the literature, significant differences in the PA measured using patient-reported outcome measures when compared with the objective methods. Given the availability of many PA assessment tools, it is tedious for the clinician or researcher to choose an outcome measure for clinical practice or research. The evidence on validity and reliability in bronchiectasis are unclear. Objectives: To identify the PA assessment tools, describe and evaluate the literature on psychometric properties of instruments measuring and analyzing PA. Methods: The search will be conducted in PubMed/Medline, Cochrane Central Register of Controlled Studies, Scopus and EMBASE databases. The keywords, index terms and synonyms of the following words will be used: bronchiectasis, physical activity, and outcome measures. Published studies of adult with clinical and/ or radiologically diagnosed bronchiectasis, aged >18 years, any gender and studies that assessed PA and/or if there are reports on measurement properties of PA will be included in the review. Studies using qualitative research methods, narrative reviews, letters to editors and editorials will be excluded. The quality of the study will be assessed and data will be extracted. Any disagreement will be resolved in the presence of an author not involved in the screening or selecting studies. Discussion: By assessing the quality of studies on measurement properties, this review will help researchers choose the outcome measure to evaluate the effects of interventions on PA. This review will identify the suite of outcome measures of PA for people with bronchiectasis that can be used for research and clinical purpose.
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Affiliation(s)
- Anup Bhat
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Clayton, Frankston, Victoria, 3199, Australia
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Cakmak A, Kocaaga E, Sonbahar-Ulu H, Inal-Ince D, Vardar-Yagli N, Calik-Kutukcu E, Saglam M, Coplu L. Upper Extremity Exercise Capacity and Activities of Daily Living in Individuals With Bronchiectasis Versus Healthy Controls. Phys Ther 2023; 103:pzad012. [PMID: 37086209 PMCID: PMC10155809 DOI: 10.1093/ptj/pzad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/11/2022] [Accepted: 12/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the upper extremity exercise capacity and activities of daily living (ADL) in individuals with bronchiectasis and controls. METHODS Twenty-four individuals with bronchiectasis and 24 healthy controls were assessed for upper extremity exercise capacity (6-minute pegboard and ring test [6PBRT]) and ADL (Glittre ADL test). Energy expenditure was measured using a wearable metabolic monitor during the Glittre ADL test. RESULTS The mean [SD] 6PBRT score of individuals with bronchiectasis was significantly lower than the mean score of controls (196.50 [51.75] vs 243.00 [29.76] number of rings). The Glittre ADL test duration was significantly higher in individuals with bronchiectasis compared with controls (3.54 [1.53] vs 2.36 [0.18] minutes), despite similar energy expenditure during the Glittre ADL test between the groups (17.67 [5.28] kcal in individuals with bronchiectasis vs 18.13 [5.71] kcal in controls). The 6PBRT score and the Glittre ADL test duration were negatively correlated in individuals with bronchiectasis (r = -0.694). CONCLUSION The individuals with bronchiectasis had reduced upper extremity exercise capacity compared with healthy controls. Energy expenditure during ADL was similar between individuals with bronchiectasis and healthy controls, despite lower ADL performance in individuals with bronchiectasis. The upper extremity exercise capacity and ADL are related in individuals with bronchiectasis. Given this relationship, inclusion of upper extremity exercise training in pulmonary rehabilitation programs should be considered. IMPACT Considering the impairment of upper extremity exercise capacity and ADL in individuals with bronchiectasis highlights the need to tailor preventive strategies and preclude further unfavorable effects. LAY SUMMARY Bronchiectasis may reduce exercise capacity in your arms and reduce your ability to perform daily living activities. Physical therapists can evaluate your condition and create rehabilitation programs to help manage these impairments.
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Affiliation(s)
- Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Elif Kocaaga
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hazal Sonbahar-Ulu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Lutfi Coplu
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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7
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Liao Y, Wu Y, Zi K, Shen Y, Wang T, Qin J, Chen L, Chen M, Liu L, Li W, Zhou H, Xiong S, Wen F, Chen J. The effect of N-acetylcysteine in patients with non-cystic fibrosis bronchiectasis (NINCFB): study protocol for a multicentre, double-blind, randomised, placebo-controlled trial. BMC Pulm Med 2022; 22:401. [PMCID: PMC9639270 DOI: 10.1186/s12890-022-02202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
N-acetylcysteine (NAC), which is specifically involved in airway mucus clearance and antioxidation, is recommended by the treatment guideline for non-cystic fibrosis bronchiectasis (NCFB). However, there is little clinical evidence of its long-term efficacy concerning quality of life (QoL) and exacerbation in patients with NCFB. In addition, the influences of NAC on airway bacterial colonization, chronic inflammation and oxidative stress in NCFB are also unclear.
Methods
NINCFB is a prospective, multicentre, double-blind, randomised, placebo-controlled trial that will recruit 119 patients with NCFB and randomly divide them into an NAC group (n = 79) and a control group (n = 40). Participants in the NAC group will receive 600 mg oral NAC twice daily for 52 weeks, while patients in the control group will receive 600 mg placebo twice daily for 52 weeks. The information at baseline will be collected once participants are enrolled. The primary endpoints are the changes in St George’s Respiratory Questionnaire scores and the number of exacerbations in 52 weeks. The secondary endpoints are the 16S rRNA of sputum and the levels of inflammatory factors and oxidative stressors in sputum and serum. Other data related to radiography, lung function tests, number of oral and/or intravenous antibiotic therapies and adverse events (AEs) will also be analysed. Further subgroup analysis distinguished by the severity of disease, severity of lung function, airway bacterial colonization and exacerbation frequency will be performed.
Discussion
The objective of this study is to determine the long-term efficacy of NAC on QoL and exacerbation of NCFB and to explore the effectiveness of NAC for antibiosis, anti-inflammation and antioxidation in NCFB. The study results will provide high-quality clinical proof for the revision and optimization of treatment guidelines and for expert consensus on NCFB treatment.
Trial registration
The trial was registered on the Chinese Clinical Trial Register at April 11, 2020 (chictr.org.cn, ChiCTR2000031817).
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Cedeño de Jesús S, Almadana Pacheco V, Valido Morales A, Muñíz Rodríguez AM, Ayerbe García R, Arnedillo-Muñoz A. Exercise Capacity and Physical Activity in Non-Cystic Fibrosis Bronchiectasis after a Pulmonary Rehabilitation Home-Based Programme: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711039. [PMID: 36078768 PMCID: PMC9518172 DOI: 10.3390/ijerph191711039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Patients with chronic respiratory disease have low exercise capacity and limited physical activity (PA), which is associated with worsening dyspnoea, exacerbations, and quality of life. The literature regarding patients with non-cystic fibrosis bronchiectasis (non-CF BQ) is scarce, especially regarding the use of cardiopulmonary exercise tests (CPET) to assess the effects of home-based pulmonary rehabilitation programmes (HPRP). The aim was to evaluate the effect of an HPRP on the exercise capacity of non-CF BQ patients using CPET and PA using an accelerometer. METHODS Our study describes a non-pharmacological clinical trial in non-CF BQ patients at the Virgen Macarena University Hospital (Seville, Spain). The patients were randomised into two groups: a control group (CG), which received general advice on PA and educational measures, and the intervention group (IG), which received a specific 8-week HPRP with two hospital sessions. The variables included were those collected in the CPET, the accelerometer, and others such as a 6 min walking test (6MWT) and dyspnoea. The data were collected at baseline and at an 8-week follow-up. RESULTS After the intervention, there was a significant increase in peak VO2 in the IG, which was not evidenced in the GC (IG 66.8 ± 15.5 mL/min p = 0.001 vs. CG 62.2 ± 14.14 mL/min, p = 0.30). As well, dyspnoea according to the mMRC (modified Medical Research Council), improved significantly in IG (2.19 ± 0.57 to 1.72 ± 0.05, p = 0.047) vs. CG (2.07 ± 0.7 to 2.13 ± 0.64, p = 0.36). In addition, differences between the groups in walked distance (IG 451.19 ± 67.99 m, p = 0.001 vs. CG 433.13 ± 75.88 m, p = 0.981) and in physical activity (IG 6591 ± 3482 steps, p = 0.007 vs. CG 4824 ± 3113 steps, p = 0.943) were found. CONCLUSION Participation in a specific HPRP improves exercise capacity, dyspnoea, walked distance, and PA in non-CF BQ patients.
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Affiliation(s)
| | - Virginia Almadana Pacheco
- Respiratory Department, Virgen Macarena University Hospital, 41009 Seville, Spain
- Physical Medicine and Rehabilitation, Virgen Macarena University Hospital, 41009 Seville, Spain
| | | | | | - Rut Ayerbe García
- Respiratory Department, Virgen Macarena University Hospital, 41009 Seville, Spain
| | - Aurelio Arnedillo-Muñoz
- Respiratory, Allergology and Thoracic Surgery Department, Puerta del Mar University Hospital, 11009 Cadiz, Spain
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9
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Caglar Tosun BN, Zeren M, Barlik M, Demir E, Gulen F. Investigation of dynamic hyperinflation and its relationship with exercise capacity in children with bronchiectasis. Pediatr Pulmonol 2022; 57:2218-2226. [PMID: 35666051 DOI: 10.1002/ppul.26028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/07/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM Dynamic hyperinflation (DH) is a major contributor to exercise intolerance in patients with obstructive lung diseases. However, it has not been investigated in children with bronchiectasis (BE). We aimed to investigate dynamic ventilatory responses and their influence on functional exercise capacity in children with BE. METHODS Forty children with BE (mean forced expiratory volume in 1 s [FEV1 ] = 78 ± 19%pred) were included. Six-minute walk test (6MWT) was conducted using Spiropalm 6MWT® for evaluating dynamic ventilatory responses including inspiratory capacity (IC), minute ventilation (VE), breathing reserve (BR) and respiratory rate (RR). A decrease of ≥100 ml in IC during exertion was defined as DH. Also, spirometry was performed, and peripheral muscle strength were measured. RESULTS Twenty patients (50%) developed DH, and four patients (10%) were ventilatory limited (BR < %30) during 6MWT. There was a 176 [100-590] ml decrease in IC after exertion in patients with DH. DH did not correlate to clinical or functional indicators of the disease, except for an increase in RR (∆RR) during exertion. High ∆RR was associated with presence of DH (rpb = 0.390; p < 0.05). Clinical features, peripheral muscle strength, and Spiropalm 6MWT metrics including 6MWT distance did not differ between patients with and without DH. Univariate analysis revealed FVC% (R = 0.340), VEpeak (R = 0.565), quadriceps strength (R = 0.698) and handgrip strength (R = 0.711) were the only predictors of 6MWT distance (p < 0.05). CONCLUSION Although DH is common in children with BE, the severity of DH is rather low and may not seem to affect functional exercise capacity. However, peripheral muscle strength was a major contributor to functional exercise capacity.
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Affiliation(s)
- Beyza Nur Caglar Tosun
- Department of Physiotherapy and Rehabilitation, Graduate Education Institute, Izmir Bakircay University, Izmir, Turkey
| | - Melih Zeren
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Meral Barlik
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Esen Demir
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Gulen
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
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10
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Ucgun H, Gurses HN, Kaya M, Cakır E. Video game-based exercise in children and adolescents with non-cystic fibrosis bronchiectasis: A randomized comparative study of aerobic and breathing exercises. Pediatr Pulmonol 2022; 57:2207-2217. [PMID: 35669989 DOI: 10.1002/ppul.26026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Video game-based systems have been proposed to improve effectiveness and compliance with exercise training in children and adolescents with noncystic fibrosis bronchiectasis (NCFB). This study aimed to investigate the effects of aerobic and breathing video game-based exercises (VGE) on pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance in children and adolescents with NCFB. METHOD Thirty-nine children and adolescents aged between 8 and 18 years with NCFB were randomly allocated into three groups as "home-based chest physiotherapy group" (CP), "aerobic VGE given in addition to home-based chest physiotherapy group" (CP + aerobic VGE), and "breathing VGE given in addition to home-based chest physiotherapy group" (CP + breathing VGE). All three groups performed chest physiotherapy program twice a day for 7 days per week for 8 weeks. Pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance were assessed at baseline and after 8 weeks of training. RESULTS The improvement in maximum expiratory pressure and balance scores were significantly higher in both CP + aerobic and CP + breathing VGE groups. The significant improvement in maximum inspiratory pressure was greater in the CP + breathing VGE group. The changes in peripheral muscle strength and functional capacity were significantly higher in the CP + aerobic VGE group. CONCLUSIONS The present study showed that aerobic VGE provides additional benefits in improving peripheral muscle strength and functional capacity, while breathing VGE provides further increase in improving respiratory muscle strength. In addition, both aerobic and breathing VGE were effective in improving balance, but they were not superior to each other.
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Affiliation(s)
- Hikmet Ucgun
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.,Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Meltem Kaya
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Erkan Cakır
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Gurses HN, Ucgun H, Zeren M, Denizoglu Kulli H, Cakır E. Does the effect of comprehensive respiratory physiotherapy home-program differ in children with cystic fibrosis and non-cystic fibrosis bronchiectasis? Eur J Pediatr 2022; 181:2961-2970. [PMID: 35595860 DOI: 10.1007/s00431-022-04509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Bronchiectasis is a form of airway damage as a consequence of endobronchial infection and inflammation and may be present in different diseases. The underlying aetiologies include both cystic fibrosis (CF) and a group of non-cystic fibrosis diseases (NCFB) such as immunodeficiency, primary ciliary dyskinesia, or severe pulmonary infection. Although children with CF and non-cystic fibrosis bronchiectasis (NCFB) have many similar clinical features, their responses to exercise may be different. The aim of this study was to compare the efficacy of a comprehensive respiratory physiotherapy (CRP) home-program in children with CF and NCFB. Thirty children with CF and thirty children with NCFB were included in the study. Both groups performed the CRP home-program twice daily for 8 weeks. Pulmonary function, exercise capacity, and respiratory and peripheral muscle strength were assessed at baseline and after 8 weeks of training. Both groups experienced significant improvements in pulmonary function, exercise capacity, and respiratory and peripheral muscle strength (p < 0.001). Maximum expiratory pressure, exercise capacity, and peripheral muscle strength were further improved in NCFB group compared to CF (p < 0.05); however, there was a great variability in the improvements for each variable. CONCLUSION CRP is beneficial both for children with CF and NCFB and adherence to the program was high in both groups. WHAT IS KNOWN • Different physiotherapy approaches in the management of non-cystic fibrosis bronchiectasis have been based on the experience gained from the research studies performed in cystic fibrosis. • Although having similar pathophysiology, these two diseases show variation in some pulmonary and extrapulmonary features. WHAT IS NEW • The respiratory muscle strength and the efficacy of comprehensive respiratory physiotherapy have been compared for the first time in children with cystic fibrosis and non-cystic fibrosis bronchiectasis. • Comprehensive respiratory physiotherapy provides higher increases in children with non-cystic fibrosis bronchiectasis in exercise capacity and expiratory and peripheral muscle strength; however, there was a great variability in these improvements. Nevertheless, it can be concluded that both groups significantly benefited from the CRP program.
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Affiliation(s)
- Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No:189, 34060, Istanbul, Turkey. .,Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hilal Denizoglu Kulli
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Erkan Cakır
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Araújo AS, Figueiredo MR, Lomonaco I, Lundgren F, Mesquita R, Pereira EDB. Effects of Pulmonary Rehabilitation on Systemic Inflammation and Exercise Capacity in Bronchiectasis: A Randomized Controlled Trial. Lung 2022; 200:409-417. [PMID: 35543710 DOI: 10.1007/s00408-022-00540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Bronchiectasis is a chronic condition that is becoming a global health concern. OBJECTIVE To examine the effects of pulmonary rehabilitation (PR) on systemic inflammation, exercise capacity, and quality of life in participants with bronchiectasis. METHODS Participants were randomized to receive PR (outpatient, three weekly sessions for 3 months) or control intervention (usual care + airway clearance therapy + breathing exercises). Data on laboratory (fibrinogen level) and patient-centered outcomes such as physical fitness [6-min walk test (6MWT)] and quality of life were collected. RESULTS A total of 41 participants were evaluated (20 in the intervention group and 21 in the control group). The magnitude of change between baseline and the end of study was greater in the PR group than in the control group-the 6MWT distance increased by a mean of 54 m (54 vs 12 m; p < 0.01), fibrinogen showed a significant reduction (fibrinogen - 92.8 versus - 47.1 mg/dl; p < 0.01), and quality of life improved according to Saint George's Respiratory Questionnaire (SGRQ) (- 7.5 vs 3.2; p < 0.01), which exceeded the minimal clinically important difference of 4 points. CONCLUSION PR effectively improved physical fitness, quality of life, and the degree of systemic inflammation, as reflected by changes in 6 MWT, fibrinogen levels and SGRQ scores. This study supports the inclusion of people with bronchiectasis in supervised PR programs.
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Affiliation(s)
- Amanda Souza Araújo
- Department of Surgery, Federal University of Ceara, Fortaleza, Ceará, Brazil.,Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brasil
| | - Mara Rúbia Figueiredo
- Department of Surgery, Federal University of Ceara, Fortaleza, Ceará, Brazil.,Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brasil
| | - Isabella Lomonaco
- Department of Medicine, Federal University of Ceara, Fortaleza, Ceará, 60140000, Brazil
| | | | - Rafael Mesquita
- Department of Physiotherapy, Federal University of Ceara, Fortaleza, Ceará, Brazil
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13
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Vardar-Yagli N, Saglam M, Firat M, Cakmak A, Inal-Ince D, Calik Kutukcu E, Coplu L. Gait and functional balance in non-CF bronchiectasis. Physiother Theory Pract 2022:1-8. [PMID: 35189785 DOI: 10.1080/09593985.2022.2043965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The decline in ambulatory activities and negative alterations in gait characteristics may impair balance and increase fall risk in obstructive lung diseases. Few studies have evaluated balance and gait parameters in individuals with bronchiectasis. PURPOSE This study aimed to compare the gait parameters and functional balance in individuals with non-cystic fibrosis (CF) bronchiectasis and healthy subjects. METHODS This cross-sectional and retrospective study analyzed data from 22 individuals with non-CF bronchiectasis and 32 healthy controls recorded between July 2019 and July 2020. Functional balance was assessed using the Timed Up and Go (TUG) test. Gait parameters were evaluated using the Biodex Gait Trainer. Step cycle (s), gait speed (m/s), the number of steps per minute, and ambulation index were measured for 6 min. Results The TUG time (s) was significantly longer (p = .019, effect size = 0.66), and gait speed (m/s) (p ˂ 0.001, effect size = 2.47), step cycle (s) (p ˂ 0.001, effect size = 2.23), and ambulation index (p ˂ 0.001, effect size = 2.56) were significantly reduced in individuals with non-CF bronchiectasis compared with healthy controls. CONCLUSION Non-CF bronchiectasis is related to unfavorable changes in gait characteristics, such as slower gait speed and the decreased average step cycle. In addition, impairment in functional balance and mobility exists in a small percentage of adults with non-CF bronchiectasis. In comprehensive pulmonary rehabilitation, balance and gait evaluations should be included to prevent falls in adults with non-CF bronchiectasis.
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Affiliation(s)
- Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merve Firat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Lutfi Coplu
- Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Ankara, Turkey
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14
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Wang X, Balaña-Corberó A, Martínez-Llorens J, Qin L, Xia Y, Zha J, Maiques JM, Barreiro E. Respiratory and Peripheral Muscle Weakness and Body Composition Abnormalities in Non-Cystic Fibrosis Bronchiectasis Patients: Gender Differences. Biomedicines 2022; 10:334. [PMID: 35203543 PMCID: PMC8961780 DOI: 10.3390/biomedicines10020334] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
As demonstrated in COPD, bronchiectasis patients may experience respiratory and peripheral muscle dysfunction. We hypothesized that respiratory and peripheral (upper and lower limbs) muscle function and nutritional status may be more significantly altered in female than in males for identical age and disease severity. In mild-to-moderate bronchiectasis patients (n = 150, 114 females) and 37 controls (n = 37, 21 females), radiological extension, maximal inspiratory and expiratory pressures (MIP and MEP), sniff nasal inspiratory pressure (SNIP), hand grip and quadriceps muscle strengths, body composition, and blood analytical biomarkers were explored. Compared to the controls, in all bronchiectasis patients (males and females), BMI, fat-free mass index (FFMI), fat tissue, upper and lower limb muscle strength, and respiratory muscle strength significantly declined, and FFMI, fat tissue, and quadriceps muscle function were significantly lower in female than male patients. In patients with mild-to-moderate bronchiectasis, respiratory and peripheral muscle function is significantly impaired and only partly related to lung disease status. Quadriceps muscle strength was particularly weakened in the female patients and was negatively associated with their exercise tolerance. Muscle weakness should be therapeutically targeted in bronchiectasis patients. Body composition and peripheral muscle function determination should be part of the comprehensive clinical assessment of these patients.
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Affiliation(s)
- Xuejie Wang
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Ana Balaña-Corberó
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Juana Martínez-Llorens
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Liyun Qin
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Yingchen Xia
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jianhua Zha
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - José María Maiques
- Radiology Department, Imatge Mèdica Intercentres, Parc de Salut Mar, Hospital del Mar, 08003 Barcelona, Spain;
| | - Esther Barreiro
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Parc de Recerca Biomèdica de Barcelona (PRBB), 08003 Barcelona, Spain; (X.W.); (A.B.-C.); (J.M.-L.); (L.Q.); (Y.X.); (J.Z.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
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15
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Lee JH, Lee WY, Yong SJ, Kim WJ, Sin S, Lee CY, Kim Y, Jung JY, Kim SH. Prevalence of depression and its associated factors in bronchiectasis: findings from KMBARC registry. BMC Pulm Med 2021; 21:306. [PMID: 34579692 PMCID: PMC8475377 DOI: 10.1186/s12890-021-01675-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND With the emergence of bronchiectasis as a common respiratory disease, epidemiological data have accumulated. However, the prevalence and impact of psychological comorbidities were not sufficiently evaluated. The present study examined the prevalence of depression and its associated factors in patients with bronchiectasis. METHODS This study involved a multicenter cohort of bronchiectasis patients recruited from 33 pulmonary specialist hospitals. The baseline characteristics and bronchiectasis-related factors at enrollment were analyzed. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). RESULTS Of the 810 patients enrolled in the study, 168 (20.7%) patients had relevant depression (PHQ-9 score ≥ 10), and only 20 (11.9%) patients had a diagnosis of depression. Significant differences were noted in the depressive symptoms with disease severity, which was assessed using the Bronchiectasis Severity Index and E-FACED (all p < 0.001). Depressive symptoms inversely correlated with quality-of-life (r = - 0.704, p < 0.001) and positively correlated with fatigue severity score (r = 0.712, p < 0.001). Multivariate analysis showed that depression was significantly associated with the modified Medical Research Council dyspnea scale ≥ 2 (OR 2.960, 95% CI 1.907-4.588, p = < 0.001) and high number of exacerbations (≥ 3) in the previous year (OR 1.596, 95% CI 1.012-2.482, p = 0.041). CONCLUSIONS Depression is common, but its association with bronchiectasis was underrecognized. It negatively affected quality-of-life and presented with fatigue symptoms. Among the bronchiectasis-related factors, dyspnea and exacerbation were closely associated with depression. Therefore, active screening for depression is necessary to optimize the treatment of bronchiectasis. TRIAL REGISTRATION The study was registered at Clinical Research Information Service (CRiS), Republic of Korea (KCT0003088). The date of registration was June 19th, 2018.
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Affiliation(s)
- Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Korea
| | - Sooim Sin
- Department of Internal Medicine, Kangwon National University Hospital, Gangwon-do, Chuncheon-si, Korea
| | - Chang Youl Lee
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Youlim Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Korea.
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16
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Pinto-Bernal MJ, Cifuentes CA, Perdomo O, Rincón-Roncancio M, Múnera M. A Data-Driven Approach to Physical Fatigue Management Using Wearable Sensors to Classify Four Diagnostic Fatigue States. SENSORS (BASEL, SWITZERLAND) 2021; 21:6401. [PMID: 34640722 PMCID: PMC8513020 DOI: 10.3390/s21196401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023]
Abstract
Physical exercise contributes to the success of rehabilitation programs and rehabilitation processes assisted through social robots. However, the amount and intensity of exercise needed to obtain positive results are unknown. Several considerations must be kept in mind for its implementation in rehabilitation, as monitoring of patients' intensity, which is essential to avoid extreme fatigue conditions, may cause physical and physiological complications. The use of machine learning models has been implemented in fatigue management, but is limited in practice due to the lack of understanding of how an individual's performance deteriorates with fatigue; this can vary based on physical exercise, environment, and the individual's characteristics. As a first step, this paper lays the foundation for a data analytic approach to managing fatigue in walking tasks. The proposed framework establishes the criteria for a feature and machine learning algorithm selection for fatigue management, classifying four fatigue diagnoses states. Based on the proposed framework and the classifier implemented, the random forest model presented the best performance with an average accuracy of ≥98% and F-score of ≥93%. This model was comprised of ≤16 features. In addition, the prediction performance was analyzed by limiting the sensors used from four IMUs to two or even one IMU with an overall performance of ≥88%.
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Affiliation(s)
- Maria J. Pinto-Bernal
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá 111166, Colombia; (M.J.P.-B.); (M.M.)
| | - Carlos A. Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá 111166, Colombia; (M.J.P.-B.); (M.M.)
| | - Oscar Perdomo
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia;
| | | | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá 111166, Colombia; (M.J.P.-B.); (M.M.)
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17
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King L, White H, Clifton I, Spoletini G, Ispoglou T, Peckham DG. Nutritional status and intake in patients with non-cystic fibrosis bronchiectasis (NCFB) - a cross sectional study. Clin Nutr 2021; 40:5162-5168. [PMID: 34461590 DOI: 10.1016/j.clnu.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity. METHODS A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested. RESULTS In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI. CONCLUSION BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.
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Affiliation(s)
- Linsey King
- University Leeds, Clinical Science Building, Beckett Street, Leeds, LS97TF, UK; Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
| | - Helen White
- Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
| | - Ian Clifton
- Leeds Teaching Hospitals Trusts, Beckett Street, Leeds, LS97TF, UK
| | - Giulia Spoletini
- Leeds Teaching Hospitals Trusts, Beckett Street, Leeds, LS97TF, UK
| | | | - Daniel G Peckham
- University Leeds, Clinical Science Building, Beckett Street, Leeds, LS97TF, UK; Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
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18
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Detailleur S, Vos R, Goeminne P. The Deteriorating Patient: Therapies Including Lung Transplantation. Semin Respir Crit Care Med 2021; 42:623-638. [PMID: 34261186 DOI: 10.1055/s-0041-1730946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this review paper, we discuss the characteristics that define severe bronchiectasis and which may lead to deterioration of noncystic fibrosis bronchiectasis. These characteristics were used to establish the current severity scores: bronchiectasis severity index (BSI), FACED, and E-FACED (exacerbation frequency, forced expiratory volume in 1 second, age, colonization, extension and dyspnea score). They can be used to predict mortality, exacerbation rate, hospital admission, and quality of life. Furthermore, there are different treatable traits that contribute to severe bronchiectasis and clinical deterioration. When present, they can be a target of the treatment to stabilize bronchiectasis.One of the first steps in treatment management of bronchiectasis is evaluation of compliance to already prescribed therapy. Several factors can contribute to treatment adherence, but to date no real interventions have been published to ameliorate this phenomenon. In the second step, treatment in deteriorating patients with bronchiectasis should be guided by the predominant symptoms, for example, cough, sputum, difficulty expectoration, exacerbation rate, or physical impairment. In the third step, we evaluate treatable traits that could influence disease severity in the deteriorating patient. Finally, in patients who are difficult to treat despite maximum medical treatment, eligibility for surgery (when disease is localized), should be considered. In case of end-stage disease, the evaluation for lung transplantation should be performed. Noninvasive ventilation can serve as a bridge to lung transplantation in patients with respiratory failure.
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Affiliation(s)
- Stephanie Detailleur
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Pieter Goeminne
- Department of Respiratory Diseases, AZ Nikolaas, Sint-Niklaas, Belgium
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19
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José A, Holland AE, Selman JPR, de Camargo CO, Fonseca DS, Athanazio RA, Rached SZ, Cukier A, Stelmach R, Dal Corso S. Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial. ERJ Open Res 2021; 7:00021-2021. [PMID: 34084777 PMCID: PMC8165366 DOI: 10.1183/23120541.00021-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. Methods Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. Results After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4–143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. Conclusion HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up. Home-based pulmonary rehabilitation (HBPR) delivers improvements in functional capacity, peripheral muscle strength and QoL in people with bronchiectasis. HBPR is safe, well tolerated and can be considered an alternative rehabilitation programme.https://bit.ly/2Q2Bout
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Affiliation(s)
- Anderson José
- Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Anne E Holland
- Physiotherapy, Alfred Health, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Institute for Breathing and Sleep, Monash University, Melbourne, Australia
| | - Jessyca P R Selman
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo-SP, Brazil
| | | | | | - Rodrigo A Athanazio
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
| | - Samia Z Rached
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
| | - Alberto Cukier
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo-SP, Brazil
| | - Simone Dal Corso
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo-SP, Brazil
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Sami R, Zohal M, Khanali F, Esmailzadehha N. Quality of life and its determinants in patients with noncystic fibrosis bronchiectasis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:27. [PMID: 34345238 PMCID: PMC8305753 DOI: 10.4103/jrms.jrms_665_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/22/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
Background: Promoting quality of life (QoL) in patients with bronchiectasis, as a chronic disease, is a part of therapeutic principles. This study aimed to investigate QoL and its determinants in patients with noncystic fibrosis (CF) bronchiectasis. Materials and Methods: This cross-sectional study was conducted on 62 patients (38.7% male, mean age: 44) with non-CF bronchiectasis and involvement of ≥2 lobes in Qazvin, Iran. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ). The relationships of QoL subscales with clinical (cough, dyspnea, and sputum volume) and paraclinical (spirometry, computerized tomography scan, sputum microbiology, and 6-min walk test [6-MWT]) were assessed using Pearson's correlation coefficient and multiple linear regression analyses. Results: The mean SGRQ total score was 53.1 (standard deviation 19.8) out of 100. The level of dyspnea (r = 0.543, P < 0.001), cough (r = −0.594, P < 0.001), 6-MWT (r = −0.520, P < 0.001), sputum volume (r = 0.423, P = 0.002), and number of exacerbations (r = 0.446, P = 0.009) had significant correlation with SGRQ total score. In multiple regression analysis, forced expiratory volume in 1 s was an independent predictor of the symptom (β = −0.22, P = 0.048) and activity (β = −0.43, P = 0.03) subscales, whereas cough was an independent predictor of the symptom subscale (β = −2.1, P = 0.002). Conclusion: In patients with non-CF bronchiectasis, the extent of lung impairment has a lower effect on the QoL than clinical symptoms. It seems that the QoL can be improved through the proper treatment of clinical symptoms and rehabilitation for promoting 6-MWT.
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Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Metabolic Diseases Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammadali Zohal
- Metabolic Diseases Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Khanali
- Metabolic Diseases Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Neda Esmailzadehha
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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21
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Abstract
BACKGROUND Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which reduce exercise tolerance and impair quality of life. Exercise training in isolation or in conjunction with other interventions is beneficial for people with other respiratory diseases, but its effects in bronchiectasis have not been well established. OBJECTIVES To determine effects of exercise training compared to usual care on exercise tolerance (primary outcome), quality of life (primary outcome), incidence of acute exacerbation and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis. SEARCH METHODS We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, and the World Health Organization trials portal, from their inception to October 2020. We reviewed respiratory conference abstracts and reference lists of all primary studies and review articles for additional references. SELECTION CRITERIA We included randomised controlled trials in which exercise training of at least four weeks' duration (or eight sessions) was compared to usual care for people with stable bronchiectasis or experiencing an acute exacerbation. Co-interventions with exercise training including education, respiratory muscle training, and airway clearance therapy were permitted if also applied as part of usual care. DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors for missing data. We calculated mean differences (MDs) using a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included six studies, two of which were published as abstracts, with a total of 275 participants. Five studies were undertaken with people with clinically stable bronchiectasis, and one pilot study was undertaken post acute exacerbation. All studies included co-interventions such as instructions for airway clearance therapy and/or breathing strategies, provision of an educational booklet, and delivery of educational sessions. The duration of training ranged from six to eight weeks, with a mix of supervised and unsupervised sessions conducted in the outpatient or home setting. No studies of children were included in the review; however we identified two studies as currently ongoing. No data were available regarding physical activity levels or adverse events. For people with stable bronchiectasis, evidence suggests that exercise training compared to usual care improves functional exercise tolerance as measured by the incremental shuttle walk distance, with a mean difference (MD) between groups of 87 metres (95% confidence interval (CI) 43 to 132 metres; 4 studies, 161 participants; low-certainty evidence). Evidence also suggests that exercise training improves six-minute walk distance (6MWD) (MD between groups of 42 metres, 95% CI 22 to 62; 1 study, 76 participants; low-certainty evidence). The magnitude of these observed mean changes appears clinically relevant as they exceed minimal clinically important difference (MCID) thresholds for people with chronic lung disease. Evidence suggests that quality of life improves following exercise training according to St George's Respiratory Questionnaire (SGRQ) total score (MD -9.62 points, 95% CI -15.67 to -3.56 points; 3 studies, 160 participants; low-certainty evidence), which exceeds the MCID of 4 points for this outcome. A reduction in dyspnoea (MD 1.0 points, 95% CI 0.47 to 1.53; 1 study, 76 participants) and fatigue (MD 1.51 points, 95% CI 0.80 to 2.22 points; 1 study, 76 participants) was observed following exercise training according to these domains of the Chronic Respiratory Disease Questionnaire. However, there was no change in cough-related quality of life as measured by the Leicester Cough Questionnaire (LCQ) (MD -0.09 points, 95% CI -0.98 to 0.80 points; 2 studies, 103 participants; moderate-certainty evidence), nor in anxiety or depression. Two studies reported longer-term outcomes up to 12 months after intervention completion; however exercise training did not appear to improve exercise capacity or quality of life more than usual care. Exercise training reduced the number of acute exacerbations of bronchiectasis over 12 months in people with stable bronchiectasis (odds ratio 0.26, 95% CI 0.08 to 0.81; 1 study, 55 participants). After an acute exacerbation of bronchiectasis, data from a single study (N = 27) suggest that exercise training compared to usual care confers little to no effect on exercise capacity (MD 11 metres, 95% CI -27 to 49 metres; low-certainty evidence), SGRQ total score (MD 6.34 points, 95%CI -17.08 to 29.76 points), or LCQ score (MD -0.08 points, 95% CI -0.94 to 0.78 points; low-certainty evidence) and does not reduce the time to first exacerbation (hazard ratio 0.83, 95% CI 0.31 to 2.22). AUTHORS' CONCLUSIONS This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.
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Affiliation(s)
- Annemarie L Lee
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
| | - Carla S Gordon
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
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McCreery JL, Mackintosh KA, Mills-Bennett R, McNarry MA. The Effect of a High-Intensity PrO2Fit Inspiratory Muscle Training Intervention on Physiological and Psychological Health in Adults with Bronchiectasis: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063051. [PMID: 33809595 PMCID: PMC8001489 DOI: 10.3390/ijerph18063051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023]
Abstract
Bronchiectasis is characterised by airflow obstruction and hyperinflation resulting in respiratory muscle weakness, and decreased exercise capacity. Inspiratory muscle training (IMT) is potentially an alternative treatment strategy to enhance respiratory muscle strength and endurance. Therefore, the aim was to investigate the effects of IMT on those with bronchiectasis. Eighteen participants (10 bronchiectasis) took part in an eight-week, three times a week IMT programme at 80% sustained maximal inspiratory pressure (SMIP). Lung function, respiratory muscle strength and endurance, exercise capacity, physical activity and self-determination theory measures were taken. Participants also took part in a semi-structured interview to assess their perceptions and experience of an IMT intervention. After eight weeks of IMT, bronchiectasis and healthy participants exhibited significant increases in MIP (27% vs. 32%, respectively), SMIP (16% vs. 17%, respectively) and inspiratory duration (36% vs. 30%, respectively). Healthy participants exhibited further improvements in peak expiratory flow and maximal oxygen consumption. Bronchiectasis participants reported high levels of perceived competence and motivation, reporting higher adherence and improved physical ability. Eight weeks of IMT increased inspiratory muscle strength and endurance in those with bronchiectasis. IMT also had a positive effect on perceived competency and autonomy, with bronchiectasis participants reporting improved physical ability and motivation, and high adherence.
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Affiliation(s)
- Jessica L McCreery
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea SA18EN, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea SA18EN, UK
| | - Rebekah Mills-Bennett
- Physiotherapy Department, Glangwili Hospital, Dogwili Rd Carmarthen, Carmarthen SA312AF, UK
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea SA18EN, UK
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23
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Sami R, Zohal M, Mohammadi N. Clinical Determinants of the Six-Minute Walk Test (6MWT) in Stable Non-Cystic Fibrosis Bronchiectasis Patients. TANAFFOS 2020; 19:385-391. [PMID: 33959177 PMCID: PMC8088139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The six-minute walk test (6MWT) is a suitable tool for the assessment of functional capacity in patients with chronic pulmonary diseases. This study aimed to assess the clinical determinants of the six-minute walk distance (6MWD), exercise-induced desaturation (EID), and pretest saturation of arterial oxygen (SataO2) in patients with diffuse non-cystic fibrosis (CF) bronchiectasis. MATERIALS AND METHODS In this cross-sectional study, a total of 57 clinically stable patients with diffuse non-CF bronchiectasis were enrolled. Anthropometric measurements (body mass index [BMI], mid-arm muscle circumference [MAMC], and triceps skinfold thickness [TSF]), spirometric indices (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), imaging assessment (CT scan), and bacteriological sputum studies were performed, and then, 6MWT was carried out. RESULTS The mean 6MWD was measured to be 447.11±94.59 m. The average walked distance in patients with severe, moderate, and mild bronchiectasis was 427.73±92.07, 439.63±102.65, and 485.87±80.47 m, respectively, with no significant difference. The pretest SataO2 was 88.92±5.59%, 93.75±3.36%, and 94.87±2.88% in the severe, moderate, and mild bronchiectasis groups (P<0.001). A significant inverse correlation was observed between the distance walked and BMI (r=-0.434, P=0.001). CONCLUSION The predictors of 6MWD in stable non-CF bronchiectasis patients were FVC, SataO2 at rest, BMI, and MAMC. The FEV1, FEV1/FVC, and BMI were independent predictors of SataO2 at rest. The extension of bronchiectasis was the only predictor of EID during the test.
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Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadali Zohal
- Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran,,Correspondence to: Zohal MA Address: Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Email address:
| | - Navid Mohammadi
- Department of Community Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran,, Preventive Medicine and Public Health Research Center (PMPHRC), Iran University of Medical Sciences, Tehran, Iran
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24
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Zeren M, Gurses HN, Denizoglu Kulli H, Ucgun H, Cakir E. Sit-to-stand test in children with bronchiectasis: Does it measure functional exercise capacity? Heart Lung 2020; 49:796-802. [PMID: 33010517 DOI: 10.1016/j.hrtlng.2020.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests. METHODS Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO2 and dyspnea responses to tests were recorded. RESULTS Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT (r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls (r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65±5.28 vs 26.55±3.56 repetitions) and 6MWT (538±85 vs 596±54 m) were significantly lower in BE group compared to healthy controls (p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE (p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference (p = 0.466), indicating both tests had similar discriminative properties. CONCLUSIONS 30s-STST is found to be a valid alternative measurement for functional exercise capacity in children with BE.
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Affiliation(s)
- Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey.
| | - Hilal Denizoglu Kulli
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Chest Diseases, Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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25
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Dik J, Saglam M, Tekerlek H, Vardar-Yagli N, Calik-Kutukcu E, Inal-Ince D, Arikan H, Eryilmaz-Polat S, Dogru D. Visuomotor reaction time and dynamic balance in children with cystic fibrosis and non-cystic fibrosis bronchiectasis: A case-control study. Pediatr Pulmonol 2020; 55:2341-2347. [PMID: 32533804 DOI: 10.1002/ppul.24903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Extrapulmonary involvement such as balance and reaction time is unclear in cystic fibrosis (CF) patients. The aim of this study was to evaluate visuomotor reaction time (VMRT) and dynamic balance in children with CF and non-CF bronchiectasis compared to healthy children. DESIGN/METHODS Demographic and clinical characteristics were recorded. All children were evaluated with pulmonary function test (PFT) using a spirometer, incremental shuttle walk test (ISWT) for exercise capacity, Fitlight Trainer for VMRT, and functional reach test (FRT) for dynamic balance. RESULTS Fourteen children with CF (10.71 ± 2.94 years, 7 females), 17 children with non-CF bronchiectasis (12.75 ± 2.81 years, 8 females), and 21 healthy children (11.36 ± 3.28 years, 11 females) were included. Children with CF had longer total VMRT (P = .027), poorer FRT performance (P = .001), and shorter ISWT distances (P = .03) compared to the children with non-CF bronchiectasis and controls. Although total VMRT was longest in the CF group, there was no significant difference in mean VMRT among the CF, non-CF bronchiectasis, and control groups (P > .05). CONCLUSION Dynamic balance and VMRT show greater impairment in children with CF than in children with non-CF bronchiectasis compared to healthy controls. Our findings suggest that VMRT and dynamic balance should be taken into consideration for assessments and exercise programs in pulmonary rehabilitation.
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Affiliation(s)
- Jan Dik
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Haluk Tekerlek
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Atilim University, Ankara, Turkey
| | - Sanem Eryilmaz-Polat
- Faculty of Medicine, Department of Pediatric Chest Diseases, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Faculty of Medicine, Department of Pediatric Chest Diseases, Hacettepe University, Ankara, Turkey
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26
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Cakmak A, Inal-Ince D, Sonbahar-Ulu H, Bozdemir-Ozel C, Ozalp O, Calik-Kutukcu E, Saglam M, Vardar-Yagli N, Arikan H, Selcuk ZT, Coplu L. Physical activity of patients with bronchiectasis compared with healthy counterparts: A cross-sectional study. Heart Lung 2019; 49:99-104. [PMID: 31530430 DOI: 10.1016/j.hrtlng.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A few studies have implied that patients with bronchiectasis have a more inactive lifestyle than healthy counterparts do. The main objective of this study was to compare physical activity (PA) levels subjectively and objectively between patients with bronchiectasis and healthy individuals using an accelerometer and a questionnaire. METHODS The study included 41 patients with bronchiectasis aged 18-65 years and 35 healthy age- and sex-matched control subjects. The PA level was assessed objectively using a multisensorial PA monitor, the SenseWear Armband (SWA), and subjectively with the International Physical Activity Questionnaire (IPAQ). All participants performed the incremental shuttle walk test (ISWT) for the assessment of exercise capacity. Pulmonary function, dyspnea, severity of bronchiectasis, respiratory and peripheral muscle strength, and quality of life were assessed. RESULTS The pulmonary function test parameters, respiratory and peripheral muscle strength, exercise capacity, step count, moderate- and vigorous-intensity PA duration were significantly lower in patients with bronchiectasis than in the healthy control group (p < 0.05). Sedentary, moderate, vigorous, and total PA duration measured using the SWA were higher than those obtained using the IPAQ (p < 0.05). CONCLUSIONS Patients with bronchiectasis have a reduced PA level compared with healthy counterparts. The IPAQ (based on the subjective estimation of PA) outcomes differed from the SWA outcomes, reinforcing the necessity for a disease-specific PA questionnaire. IPAQ underestimates the physical activity level compared with objective measurements.
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Affiliation(s)
- Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey.
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Hazal Sonbahar-Ulu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Ozge Ozalp
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Cyprus International University, Lefkosa, Cyprus
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Hulya Arikan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100 Samanpazari, Ankara, Turkey
| | - Ziya Toros Selcuk
- Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Ankara, Turkey
| | - Lutfi Coplu
- Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Ankara, Turkey
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Hoffman M, Augusto VM, Eduardo DS, Silveira BMF, Lemos MD, Parreira VF. Inspiratory muscle training reduces dyspnea during activities of daily living and improves inspiratory muscle function and quality of life in patients with advanced lung disease. Physiother Theory Pract 2019; 37:895-905. [DOI: 10.1080/09593985.2019.1656314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mariana Hoffman
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Physiotherapy Discipline, La Trobe Clinical School, La Trobe University, Melbourne, Australia
| | - Valéria M. Augusto
- Department of Internal Medicine, UFMG, 271, Centro, Belo Horizonte, Brazil
| | - Daisy S. Eduardo
- Advanced Lung Disease and Pre Lung Transplantation Ambulatory Clinics, UFMG, 271, Centro, Belo Horizonte, Brazil
| | - Bruna M. F. Silveira
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcela D. Lemos
- Laboratory of Cardiorespiratory Assessment and Research, Department of Physical Therapy, UFMG, Belo Horizonte, Brazil
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28
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Cordova-Rivera L, Gibson PG, Gardiner PA, Hiles SA, McDonald VM. Extrapulmonary associations of health status in severe asthma and bronchiectasis: Comorbidities and functional outcomes. Respir Med 2019; 154:93-101. [PMID: 31229944 DOI: 10.1016/j.rmed.2019.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Severe asthma and bronchiectasis are heterogeneous diseases that contribute to disability beyond the pulmonary system. The magnitude of the impact that these extrapulmonary features has on health-related quality of life (HRQoL) is unknown. METHODS We analysed the cross-sectional relationships between HRQoL (St. George's Respiratory Questionnaire; SGRQ) and extrapulmonary characteristics, including physical activity (steps/day), anxiety and depression, isometric leg strength, systemic inflammation, and several comorbidities in adults with severe asthma (n = 70) and bronchiectasis (n = 61). RESULTS Participants with severe asthma and bronchiectasis had similar SGRQ total scores (mean scores 43.7 and 37.8 for severe asthma and bronchiectasis; p > 0.05), and similar pulmonary and extrapulmonary characteristics. The associations between extrapulmonary variables and HRQoL did not differ according to diagnosis (all interactions p > 0.05). Greater anxiety and depressive symptoms, fewer steps/day and greater systemic inflammation were statistically associated with poorer HRQoL in both diseases (p < 0.05). Lower isometric leg strength in severe asthma, and greater Charlson Comorbidity Index in bronchiectasis were also associated with poorer HRQoL (p < 0.05). In the multivariable regression model performed in the combined disease groups, anxiety and depression, steps/day, systemic inflammation and isometric leg strength remained independently associated with HRQoL. Associations between extrapulmonary characteristics and SGRQ domains were stronger for the activity and impact domains, than symptoms. CONCLUSION In severe asthma and bronchiectasis, extrapulmonary features including physical activity and leg strength have a significant impact on HRQoL, especially within the activity and impact domains. These features should be considered as part of the assessment of these conditions, and they may represent additional treatment targets to improve HRQoL.
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Affiliation(s)
- Laura Cordova-Rivera
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
| | - Paul A Gardiner
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Australia; Mater Research Institute, The University of Queensland, South Brisbane, Australia.
| | - Sarah A Hiles
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
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29
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Lanza FC, Castro RAS, de Camargo AA, Zanatta DJM, Rached S, Athanazio R, Cukier A, Stelmach R, Dal Corso S. COPD Assessment Test (CAT) is a Valid and Simple Tool to Measure the Impact of Bronchiectasis on Affected Patients. COPD 2018; 15:512-519. [PMID: 30468091 DOI: 10.1080/15412555.2018.1540034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The COPD assessment test (CAT) is a short questionnaire developed to help patients and clinicians to assess the impact of symptoms in routine clinical practice. We aimed to validate and to test the reproducibility of CAT in patients with bronchiectasis and correlate with the severity of dyspnea, aerobic and functional capacity, and physical activity in daily life. This is a cross-sectional study, patients with bronchiectasis underwent spirometry, cardiopulmonary exercise test (CPET), incremental shuttle walk test (ISWT), Saint George`s Respiratory Questionnaire (SGRQ), and received pedometer. CAT was applied twice (CAT-1 and CAT-2, 7 to 10 days apart). The severity of bronchiectasis was assessed by E-FACED and bronchiectasis severity index (BSI). A total of 100 patients were evaluated (48 ± 14 years, 59 women, FVC: 67 ± 22% pred, FEV1: 52 ± 25% pred). According to CAT, 14% patients presented low, 40% medium, 32% high, and 14% very high impact. The higher the CAT, the worse the severity of bronchiectasis, dyspnea, quality of life, performance on the CPET, and smaller the distance walked (DW) on the ISWT and number of steps (NS) per day. There was significant correlation between CAT and SGRQ, E-FACED, BSI, NS, ISWT, oxygen uptake, and workload at CPET. CAT-1 and CAT-2 presented similar values: 21 (13-26) and 19 (13-26), respectively. The CAT is a valid and reproducible instrument in patients with bronchiectasis presenting good correlation with clinical, functional, and quality of life measurements. This easy-to-use, easy-to-understand, quick, and useful tool may play an important role to assess the impact of bronchiectasis on both daily medical practice and clinical trial settings.
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Affiliation(s)
- Fernanda C Lanza
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Rejane A S Castro
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Anderson A de Camargo
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Drielly J M Zanatta
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Samia Rached
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Rodrigo Athanazio
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Alberto Cukier
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Rafael Stelmach
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Simone Dal Corso
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
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Pulmonary Rehabilitation Only Versus With Nutritional Supplementation in Patients With Bronchiectasis. J Cardiopulm Rehabil Prev 2018; 38:411-418. [DOI: 10.1097/hcr.0000000000000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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Affiliation(s)
- Annemarie L Lee
- Monash University; Department of Physiotherapy; Melbourne Australia
- Institute for Breathing and Sleep; Commercial Road Melbourne Australia
- La Trobe University; Department of Rehabilitation, Nutrition and Sport; Melbourne Australia
| | - Carla S Gordon
- Monash University; Department of Physiotherapy; Melbourne Australia
- Monash Health; Department of Physiotherapy; Melbourne Australia
| | - Christian R Osadnik
- Monash University; Department of Physiotherapy; Melbourne Australia
- Monash Health; Monash Lung and Sleep; Melbourne Australia
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Gea J, Sancho-Muñoz A, Chalela R. Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations. J Thorac Dis 2018; 10:S1332-S1354. [PMID: 29928517 PMCID: PMC5989104 DOI: 10.21037/jtd.2018.02.66] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022]
Abstract
Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.
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Affiliation(s)
- Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Antoni Sancho-Muñoz
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
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Clinical Determinants of Incremental Shuttle Walk Test in Adults with Bronchiectasis. Lung 2018; 196:343-349. [PMID: 29435737 DOI: 10.1007/s00408-018-0094-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Exercise capacity is impaired in patients with bronchiectasis. Incremental shuttle walk test (ISWT) stresses cardiorespiratory system physiologically to symptom-limited maximal exercise capacity. The purpose of this study was to investigate the clinical determinants of ISWT in adults with non-cystic fibrosis (CF) bronchiectasis. METHODS Forty-one clinically stable bronchiectasis patients aged 18-72 years (27 females, 14 males) participated in the study. Subjects' demographics and physical characteristics were recorded. Bronchiectasis Severity Index was used to identify disease severity. Pulmonary function test was performed. Dyspnea perception was assessed using the modified Medical Research Council Dyspnea Scale. Maximum inspiratory and expiratory pressures were measured. Peripheral muscle strength using a hand held dynamometer was measured. ISWT was performed to determine exercise capacity. Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Leicester Cough Questionnaire were used to determine fatigue, psychosocial status, and quality of life. RESULTS Patients' mean ISWT distance was 469.5 m. The ISWT distance was significantly related with age (r = - 0.472), height (r = 0.469), gender (r = 0.520), FEV1 (r = 0.651), and FVC (r = 0.545, p < 0.05). Quadriceps muscle strength was higher in males (p = 0.001) as compared to females. Age and gender were identified as independent predictors of the ISWT, explaining 42% of variance in ISWT distance (r = 0.649, r2 = 0.421, F(2,38) = 13.794, p < 0.001). CONCLUSION The clinical determinants of ISWT in clinically stable patients with non-CF bronchiectasis are age and gender. Pulmonary function, dyspnea perception, muscle strength, disease severity, fatigue, psychosocial factors, and health-related quality of life seems to have an independent effect on ISWT in this group of patients with bronchiectasis.
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Yoon SY, Kim YW, Choi JY. Pulmonary Rehabilitation in a Patient With Bronchiectasis and Underlying Cerebral Palsy: A Case Presentation. PM R 2017; 10:548-551. [PMID: 28988977 DOI: 10.1016/j.pmrj.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022]
Abstract
Bronchiectasis is a chronic pulmonary disease characterized by the permanent dilatation of the airways, with recurrent infections. As the disease progresses, extrapulmonary symptoms manifest. If the patient with bronchiectasis has an underlying central nervous system disease such as cerebral palsy (CP), extrapulmonary functions decline faster. The co-occurrence of these 2 diseases may make care more complex, and there have been no reports about pulmonary rehabilitation (PR) in this class of patients. Here, we present a patient with bronchiectasis and underlying CP who showed marked improvement of pulmonary function and clinical symptoms after 6 weeks of a patient-specific intensive PR program. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea; Department of Medicine, Graduate Program, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Physical Medicine and Rehabilitation, Eulji University Hospital, Eulji University College of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea; Department of Medicine, Graduate Program, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Physical Medicine and Rehabilitation, Eulji University Hospital, Eulji University College of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
| | - Ja Young Choi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea; Department of Medicine, Graduate Program, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Physical Medicine and Rehabilitation, Eulji University Hospital, Eulji University College of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
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José A, Holland AE, Oliveira CSD, Selman JPR, Castro RASD, Athanazio RA, Rached SZ, Cukier A, Stelmach R, Corso SD. Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care? Braz J Phys Ther 2017; 21:473-480. [PMID: 28869119 PMCID: PMC5693395 DOI: 10.1016/j.bjpt.2017.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/26/2017] [Accepted: 06/22/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis. OBJECTIVES To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis. METHODS An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. INTERVENTIONS The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20min (intensity: 60-80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). CONTROL The patients will receive an educational manual and a recommendation to walk three times a week for 30min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. MAIN OUTCOME MEASURES incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization. DISCUSSION The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis. TRIAL REGISTRATION www.ClinicalTrials.gov (NCT02731482). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00060X6&selectaction=Edit&uid=U00028HR&ts=2&cx=1jbszg.
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Affiliation(s)
- Anderson José
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil.
| | - Anne E Holland
- La Trobe University, Institute for Breathing and Sleep, Melbourne, Australia
| | - Cristiane S de Oliveira
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
| | - Jessyca P R Selman
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
| | - Rejane A S de Castro
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
| | - Rodrigo A Athanazio
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Samia Z Rached
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Alberto Cukier
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Rafael Stelmach
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Instituto do Coração, Divisão de Pneumologia, São Paulo, SP, Brazil
| | - Simone Dal Corso
- Universidade Nove de Julho (UNINOVE), Programa de Pós Graduaçaão em Ciências da Reabilitação, São Paulo, SP, Brazil
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Lee AL, Hill CJ, McDonald CF, Holland AE. Pulmonary Rehabilitation in Individuals With Non–Cystic Fibrosis Bronchiectasis: A Systematic Review. Arch Phys Med Rehabil 2017; 98:774-782.e1. [DOI: 10.1016/j.apmr.2016.05.017] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/27/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
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Al-Shair K, Muldoon EG, Morris J, Atherton GT, Kosmidis C, Denning DW. Characterisation of fatigue and its substantial impact on health status in a large cohort of patients with chronic pulmonary aspergillosis (CPA). Respir Med 2016; 114:117-22. [PMID: 27109821 DOI: 10.1016/j.rmed.2016.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Fatigue is a prominent disabling symptom in several pulmonary diseases. Its impact on health status in patients with chronic pulmonary aspergillosis (CPA) has not been investigated. METHODS A total of 151 CPA patients attending the National Aspergillosis Centre completed Manchester COPD Fatigue Scale (MCFS), St. George's Respiratory Questionnaire (SGRQ) and Medical Research Council (MRC) dyspnoea score. Lung function and BMI were measured. Univariate, multivariate linear and binary analyses, and principal component analysis (PCA) were used. RESULTS Female patients accounted for 44%. The mean (range) of age was 59.6 (31-83) years, FEV1% was 64 (14-140), BMI was 23.6 (16.3-43.4), SGRQ total score was 56 (4-96.2) and MCFS total score was 30.6 (0-54). PCA showed that 27 items of MCFS loaded on three components; physical, psychosocial and cognitive fatigue, explaining 78.4% of fatigue variance. MCFS score correlated strongly with total SGRQ score (r = 0.83, p < 0.001). Using linear multivariate analysis, fatigue was the strongest factor (beta = 0.7 p < 0.0001) associated with impaired health status, after adjusting for age, BMI, FEV1%, and MRC dyspnoea score. Using patients' 5 self-assessment grades of their health, one-way ANOVA showed that those with "very poor" health status had the highest fatigue scores (45 (±6) (p < 0.001)). Logistic regression analysis showed that fatigue score (OR = 0.9, 95% CI 0.84-0.97; p = 0.005) and FEV1% (OR = 1.03, 95% CI 1.01-1.07, p = 0.02) are significantly associated with self-assessed impaired health status after correcting for age, gender and DLCO%. CONCLUSION Fatigue is a major component of impaired health status of CPA patients.
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Affiliation(s)
- Khaled Al-Shair
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Eavan G Muldoon
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Julie Morris
- Department of Medical Statistics, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Graham T Atherton
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Kosmidis
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Spinou A, Fragkos KC, Lee KK, Elston C, Siegert RJ, Loebinger MR, Wilson R, Garrod R, Birring SS. The validity of health-related quality of life questionnaires in bronchiectasis: a systematic review and meta-analysis. Thorax 2016; 71:683-94. [PMID: 26869589 DOI: 10.1136/thoraxjnl-2015-207315] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/03/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND A range of questionnaires have been used to assess health-related quality of life (HRQOL) in bronchiectasis. A systematic review was conducted to evaluate their psychometric properties and assess associations between HRQOL and clinical measures. METHODS Five electronic databases were searched. Studies eligible for inclusion were those that investigated the validity of HRQOL questionnaires and/or their association with other outcomes in adults with bronchiectasis. Patients with cystic fibrosis were excluded. The identified questionnaires were assessed for convergent, discriminant and cross-cultural translation validity; missing data, floor and ceiling effects, internal consistency, responsiveness and test-retest reliability. A meta-analysis was conducted to estimate the strength of associations between HRQOL and clinical measures. RESULTS From 1918 studies identified, 43 studies were included in the systematic review, of which 38 were suitable for the meta-analysis. Nine HRQOL questionnaires were identified, with the most widely used being: St George's Respiratory Questionnaire, Leicester Cough Questionnaire, Quality of Life-Bronchiectasis and Short Form-36. HRQOL questionnaires had moderate to good internal consistency and good test-retest reliability. Only 8 of 18 studies that used translated HRQOL questionnaires reported or referred to the validity of the translated questionnaire. There was a stronger correlation (mean r (95% CI)) between HRQOL and subjective outcome measures, such as dyspnoea (0.55 (0.41 to 0.68)) and fatigue (0.42 (0.23 to 0.58)) compared with objective measures; exercise capacity (-0.41 (-0.54 to -0.24)), FEV1% predicted (-0.31 (-0.40 to -0.23)) and extent of bronchiectasis on CT scan (0.35 (0.03 to 0.61)); all p<0.001. CONCLUSIONS This review supports most HRQOL questionnaires used in bronchiectasis have good psychometric properties. There was a weak to moderate association between HRQOL and objective outcome measures. This suggests that HRQOL questionnaires assess a unique aspect of health not captured by objective measures.
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Affiliation(s)
- Arietta Spinou
- Division of Asthma, Allergy and Lung Biology, King's College London, Respiratory Medicine, London, UK
| | | | - Kai K Lee
- Adult Cystic Fibrosis Unit, King's College Hospital, London, UK
| | - Caroline Elston
- Adult Cystic Fibrosis Unit, King's College Hospital, London, UK
| | - Richard J Siegert
- Auckland University of Technology (AUT), School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupation Studies, Auckland, New Zealand
| | | | - Robert Wilson
- Host Defence Unit, Royal Brompton Hospital, London, UK
| | - Rachel Garrod
- Denmark Hill Campus, King's College London, Therapies, London, UK
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, Respiratory Medicine, London, UK
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Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, Spruit MA, Masefield S, Casaburi R, Clini EM, Crouch R, Garcia-Aymerich J, Garvey C, Goldstein RS, Hill K, Morgan M, Nici L, Pitta F, Ries AL, Singh SJ, Troosters T, Wijkstra PJ, Yawn BP, ZuWallack RL. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med 2015; 192:1373-86. [DOI: 10.1164/rccm.201510-1966st] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Field Walking Tests Are Reliable and Responsive to Exercise Training in People With Non–Cystic Fibrosis Bronchiectasis. J Cardiopulm Rehabil Prev 2015; 35:439-45. [DOI: 10.1097/hcr.0000000000000130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tasdemir F, Inal-Ince D, Ergun P, Kaymaz D, Demir N, Demirci E, Egesel N. Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease. Expert Rev Respir Med 2015; 9:493-502. [DOI: 10.1586/17476348.2015.1068691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Qi Q, Li T, Li JC, Li Y. Association of body mass index with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis. ACTA ACUST UNITED AC 2015; 48:715-24. [PMID: 26176309 PMCID: PMC4541691 DOI: 10.1590/1414-431x20154135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 03/18/2015] [Indexed: 01/22/2023]
Abstract
The objective of this observational, multicenter study was to evaluate the
association of body mass index (BMI) with disease severity and prognosis in patients
with non-cystic fibrosis bronchiectasis. A total of 339 patients (197 females, 142
males) diagnosed with non-cystic fibrosis bronchiectasis by high-resolution computed
tomography were classified into four groups: underweight (BMI<18.5
kg/m2), normal weight (18.5≤BMI<25.0 kg/m2), overweight
(25.0≤BMI<30.0 kg/m2), and obese (BMI≥30.0 kg/m2). Clinical
variables expressing disease severity were recorded, and acute exacerbations,
hospitalizations, and survival rates were estimated during the follow-up period. The
mean BMI was 21.90 kg/m2. The underweight group comprised 28.61% of all
patients. BMI was negatively correlated with acute exacerbations, C-reactive protein,
erythrocyte sedimentation rate, radiographic extent of bronchiectasis, and chronic
colonization by P. aeruginosa and positively correlated with
pulmonary function indices. BMI was a significant predictor of hospitalization risk
independent of relevant covariates. The 1-, 2-, 3-, and 4-year cumulative survival
rates were 94%, 86%, 81%, and 73%, respectively. Survival rates decreased with
decreasing BMI (χ2=35.16, P<0.001). The arterial carbon dioxide partial
pressure, inspiratory capacity, age, BMI, and predicted percentage of forced
expiratory volume in 1 s independently predicted survival in the Cox proportional
hazard model. In conclusion, an underweight status was highly prevalent among
patients with non-cystic fibrosis bronchiectasis. Patients with a lower BMI were
prone to developing more acute exacerbations, worse pulmonary function, amplified
systemic inflammation, and chronic colonization by P. aeruginosa.
BMI was a major determinant of hospitalization and death risks. BMI should be
considered in the routine assessment of patients with non-cystic fibrosis
bronchiectasis.
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Affiliation(s)
- Q Qi
- Department of Respirology, Qilu Hospital, Shandong University, Shandong Province, Jinan, China
| | - T Li
- Department of Respirology, Qilu Hospital, Shandong University, Shandong Province, Jinan, China
| | - J C Li
- Neurosurgical Intensive Care Unit, First Affiliated Hospital,, Sun Yat-sen University, Guangdong Province, Guangzhou, China
| | - Y Li
- Department of Respirology, Qilu Hospital, Shandong University, Shandong Province, Jinan, China
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Vodanovich DA, Bicknell TJ, Holland AE, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Thompson P, Stirling RG, Lee AL. Validity and Reliability of the Chronic Respiratory Disease Questionnaire in Elderly Individuals with Mild to Moderate Non-Cystic Fibrosis Bronchiectasis. Respiration 2015; 90:89-96. [PMID: 26088151 DOI: 10.1159/000430992] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The chronic respiratory disease questionnaire (CRDQ) is designed to assess health-related quality of life (HRQOL) in chronic respiratory conditions, but its reliability, validity and responsiveness in individuals with mild to moderate non-cystic fibrosis (CF) bronchiectasis are unclear. OBJECTIVES This study aimed to determine measurement properties of the CRDQ in non-CF bronchiectasis. METHODS Participants with non-CF bronchiectasis involved in a randomised controlled trial of exercise training were recruited. Internal consistency was assessed using Cronbach's α. Over 8 weeks, reliability was evaluated using intra-class correlation coefficients and Bland-Altman analysis for measures of agreement. Convergent and divergent validity was assessed by correlations with the other HRQOL questionnaires and the Hospital Anxiety and Depression Scale (HADS). The responsiveness to exercise training was assessed using effect sizes and standardised response means. RESULTS Eighty-five participants were included (mean age ± SD, 64 ± 13 years). Internal consistency was adequate (>0.7) for all CRDQ domains and the total score. Test-retest reliability ranged from 0.69 to 0.85 for each CRDQ domain and was 0.82 for the total score. Dyspnoea (CRDQ) was related to St George's respiratory questionnaire (SGRQ) symptoms only (r = 0.38), with no relationship to the Leicester cough questionnaire (LCQ) or HADS. Moderate correlations were found between the total score of the CRDQ, the SGRQ (rs = -0.49) and the LCQ score (rs = 0.51). Lower CRDQ scores were associated with higher anxiety and depression (rs = -0.46 to -0.56). The responsiveness of the CRDQ was small (effect size 0.1-0.24). CONCLUSIONS The CRDQ is a valid and reliable measure of HRQOL in mild to moderate non-CF bronchiectasis, but responsiveness was limited.
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Veauthier C. Younger age, female sex, and high number of awakenings and arousals predict fatigue in patients with sleep disorders: a retrospective polysomnographic observational study. Neuropsychiatr Dis Treat 2013; 9:1483-94. [PMID: 24109185 PMCID: PMC3792952 DOI: 10.2147/ndt.s50763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Fatigue Severity Scale (FSS) is widely used to assess fatigue, not only in the context of multiple sclerosis-related fatigue, but also in many other medical conditions. Some polysomnographic studies have shown high FSS values in sleep-disordered patients without multiple sclerosis. The Modified Fatigue Impact Scale (MFIS) has increasingly been used in order to assess fatigue, but polysomnographic data investigating sleep-disordered patients are thus far unavailable. Moreover, the pathophysiological link between sleep architecture and fatigue measured with the MFIS and the FSS has not been previously investigated. METHODS This was a retrospective observational study (n = 410) with subgroups classified according to sleep diagnosis. The statistical analysis included nonparametric correlation between questionnaire results and polysomnographic data, age and sex, and univariate and multiple logistic regression. RESULTS The multiple logistic regression showed a significant relationship between FSS/MFIS values and younger age and female sex. Moreover, there was a significant relationship between FSS values and number of arousals and between MFIS values and number of awakenings. CONCLUSION Younger age, female sex, and high number of awakenings and arousals are predictive of fatigue in sleep-disordered patients. Further investigations are needed to find the pathophysiological explanation for these relationships.
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Affiliation(s)
- Christian Veauthier
- Department of Neurology, Hanse-Klinikum, Stralsund, Germany ; Department of Neurology, Centre Hospitalier de Belfort-Montbéliard (CHBM), Montbéliard, France
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