[A clinical study of the usefulness of assessing dyspnea in healthy elderly subjects]

Longitudinal study of respiratory function and symptoms in a non-smoking group of long-term officially-acknowledged victims of pollution-related illness

BACKGROUND

Air pollution is known to be a leading cause of respiratory symptoms. Many cross-sectional studies reported that air pollution caused respiratory disease in Japanese individuals in the 1960s. Japan has laws regulating air pollution levels and providing compensation for victims of pollution-related respiratory disease. However, long-term changes in respiratory function and symptoms in individuals who were exposed to air pollution in the 1960s have not been well studied. This study aimed to investigate longitudinal respiratory function and symptoms in older, non-smoking, long-term officially-acknowledged victims of pollution-related illness.

METHODS

The study included 563 officially-acknowledged victims of pollution-related illness living in Kurashiki, Okayama who were aged ≥ 65 years in 2009. Data were retrospectively collected from yearly respiratory symptom questionnaires and spirometry examinations conducted from 2000 to 2009.

RESULTS

Respiratory function declined significantly from 2000 to 2009 (p < 0.01), but the mean annual changes were relatively small. The change in mean vital capacity was -40.5 ml/year in males and -32.7 ml/year in females, and the change in mean forced expiratory volume in 1 second was -27.6 ml/year in males and -23.9 ml/year in females. Dyspnea was the only symptom that worsened significantly from 2000 to 2009 in both sexes (males: p < 0.05, females: p < 0.01).

CONCLUSIONS

Our results suggest that the high concentrations of air pollutants around 1970 resulted in a decrease in respiratory function and an increase in respiratory symptoms in the study population. From 2000 to 2009, the mean annual changes in respiratory function were within the normal range, even though the severity of dyspnea worsened. The changes in respiratory function and symptoms over the study period were probably due to aging. The laws governing air pollution levels and providing compensation for officially-acknowledged victims of pollution-related illness in Japan may be effective for respiratory disease cause by pollution.

Using the oxygen-cost diagram in ramp-slope selection for dyspneic patients

BACKGROUND

Maximal incremental exercise testing should be completed within 8-12 minutes. The ramp-slope influences the exercise duration. Oxygen-cost diagram (OCD) is a scoring scale for the capability of daily activity performed and therefore can be used to estimate the ramp-slope.

METHODS

The OCD-algorithm and the reported-algorithm were used prospectively in random order for selecting optimal ramp-slope: Ramp-slope(OCD)=Score(OCD)xweight in kg/40 for men and weight/50 for women and Ramp-slope(reported)=(Predicted V(O2peak)-V(O2unloaded))/100. Fifty-three dyspneic patients and 16 normal controls were enrolled to perform a ramp-pattern exercise. Fourteen patients not reaching maximum exercise levels were excluded. The exercise capacity, exercise time, and success rate of loaded exercise between 8 and 12 minutes were measured.

RESULTS

Comparing the reported-algorithm to the OCD-algorithm in normal controls, the only difference was that the ramp-slope was higher in males; in patients, the ramp-slope was higher in males, the exercise time shorter and the success rate lower (8.6+/-3.3 vs. 9.4+/-2.1 min, 61.5% vs. 84.6%, both p<0.05); in obese patients, the ramp-slope was lower and the exercise time longer.

CONCLUSION

OCD score can predict the ramp-slope selection for exercise testing in normal controls and dyspneic patients. This may be affected by gender and body weight when using the reported-algorithm for dyspneic patients.

Correlation between bronchodilator responsiveness and quality of life in chronic obstructive pulmonary disease

BACKGROUND

Guidelines and literature debate the importance of testing for bronchial reversibility and its total significance is unclear. Clinically, patients with greater reversibility have higher fluctuations in respiratory symptoms, and hence may have a reduced health-related quality of life (HRQoL). On the other hand, they may have a better HRQoL as medications may be more effective in this population. Presently, there are no reports concerning the relationship between HRQoL as an indicator of therapy and reversibility. We hypothesized that the reversibility of airflow limitation might be correlated with the HRQoL in COPD.

METHODS

We examined 63 subjects with COPD (mean age: 71.7 years). Reversibility was measured by the change in FEV1 and FVC after the inhalation of salbutamol (300 microg), and we investigated the relationship between the reversibility and the parameters of HRQoL, which included St. George's Respiratory Questionnaire (SGRQ), Visual analogue scale-8 (VAS-8), Short-Form 36-Item Health Study, Basic activities of daily living, Instrumental activities of daily living, and the Oxygen cost diagram.

RESULTS

Post-bronchodilator FEV1, % predicted was positively correlated with both the total scores of SGRQ and VAS-8 (p<0.0001 and p<0.006, respectively). Furthermore, the reversibility of FVC was positively correlated with all items of the SGRQ, except for impact (total score: p<0.02; symptoms: p<0.02; activity, p<0.05; total score of VAS-8: p<0.02). However, the reversibility of FEV1 was neither correlated with the total score nor any items in the scales.

CONCLUSIONS

Those who have FVC that respond to bronchodilator at rest might result in an improvement of HRQoL after treatment.

Respiratory findings in a nursing home population

The prevalence of respiratory abnormalities was studied in an elderly nursing home population. This study investigated 475 female and 147 male individuals living in five nursing homes in Zagreb, Croatia. Chronic respiratory symptoms were recorded using the British Medical Research Council questionnaire. Ventilatory capacity was measured with maximum expiratory flow-volume (MEFV) curves on which forced vital capacity (FVC), one-second forced expiratory volume (FEV1), maximum expiratory flow rate at 50% FVC (FEF50), and maximum expiratory flow rate at 25% FVC (FEF25) were measured. A high rate of chronic respiratory illness and symptoms was found in both female and male nursing home residents. The highest rates were for asthma, chronic cough, and for chest tightness. Odds ratios (OR) showed that smoking and the length of employment were significant risk factors among men. Pulmonary function testing demonstrated a decrease in measured values compared to predicted (p<0.01). This was particularly pronounced for FEF50 and FEF25, suggesting obstructive changes in smaller airways. Regression coefficients were significant for smoking and employment primarily for FEF50 and FEF25. Our data suggest that older individuals residing in nursing homes exhibit an excess of respiratory symptoms, and lung function abnormalities. Smoking and past employment are important risk factors for these respiratory findings. Medical surveillance and preventive strategies should be implemented for this high risk population.