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Liao KM, Cheng KC, Sung MI, Shen YT, Chiu CC, Liu CF, Ko SC. Machine learning approaches for practical predicting outpatient near-future AECOPD based on nationwide electronic medical records. iScience 2024; 27:109542. [PMID: 38577104 PMCID: PMC10993192 DOI: 10.1016/j.isci.2024.109542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/07/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
In this research, we aimed to harness machine learning to predict the imminent risk of acute exacerbation in chronic obstructive pulmonary disease (AECOPD) patients. Utilizing retrospective data from electronic medical records of two Taiwanese hospitals, we identified 26 critical features. To predict 3- and 6-month AECOPD occurrences, we deployed five distinct machine learning algorithms alongside ensemble learning. The 3-month risk prediction was best realized by the XGBoost model, achieving an AUC of 0.795, whereas the XGBoost was superior for the 6-month prediction with an AUC of 0.813. We conducted an explainability analysis and found that the episode of AECOPD, mMRC score, CAT score, respiratory rate, and the use of inhaled corticosteroids were the most impactful features. Notably, our approach surpassed predictions that relied solely on CAT or mMRC scores. Accordingly, we designed an interactive prediction system that provides physicians with a practical tool to predict near-term AECOPD risk in outpatients.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan 722013, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
| | - Kuo-Chen Cheng
- Department of Pulmonary Medicine, Chi Mei Medical Center, Tainan 710402, Taiwan
| | - Mei-I Sung
- Department of Medical Research, Chi Mei Medical Center, Tainan 710402, Taiwan
| | - Yu-Ting Shen
- Department of Medical Research, Chi Mei Medical Center, Tainan 710402, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan 710402, Taiwan
| | - Shian-Chin Ko
- Department of Pulmonary Medicine, Chi Mei Medical Center, Tainan 710402, Taiwan
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Vaezi A, Mirsaeidi M. Proposing the potential of utilizing the CAT score for early detection of COPD in asymptomatic patients, shifting towards a patient-centered approach: A review. Medicine (Baltimore) 2024; 103:e37715. [PMID: 38608107 PMCID: PMC11018188 DOI: 10.1097/md.0000000000037715] [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: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a significant public health challenge, with delayed diagnosis and underdiagnosis being pervasive issues. The United States Preventive Service Task Force recommends restricting COPD screening to symptomatic smokers, a focus that has exhibited limitations, leading to delayed diagnoses, and imposing a substantial burden on patients, their families, and the healthcare system. This paper explores an alternative approach, highlighting the potential utility of the COPD assessment test (CAT) score as a prescreening tool. A CAT score of 10 or higher could serve as an appropriate threshold for further diagnostic procedures, given its robust correlation with pulmonary function test parameters and is valuable capacity to quantify patients' symptoms. The utilization of CAT as a prescreening tool in primary care signifies a transition towards a more patient-centered and comprehensive approach to COPD diagnosis and care.
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Affiliation(s)
- Atefeh Vaezi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Jacksonville, FL
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Jiang W, Jin X, Du C, Gu W, Gao X, Zhou C, Tu C, Chen H, Li H, Shen Y, Zhang Y, Ge X, Sun Y, Zhou L, Yu S, Zhao K, Cheng Q, Zhu X, Liao H, Bai C, Song Y. Internet of things-based management versus standard management of home noninvasive ventilation in COPD patients with hypercapnic chronic respiratory failure: a multicentre randomized controlled non-inferiority trial. EClinicalMedicine 2024; 70:102518. [PMID: 38495520 PMCID: PMC10940131 DOI: 10.1016/j.eclinm.2024.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Background Effective monitoring and management are crucial during long-term home noninvasive positive pressure ventilation (NPPV) in patients with hypercapnic chronic obstructive pulmonary disease (COPD). This study investigated the benefit of Internet of Things (IOT)-based management of home NPPV. Methods This multicenter, prospective, parallel-group, randomized controlled non-inferiority trial enrolled patients requiring long-term home NPPV for hypercapnic COPD. Patients were randomly assigned (1:1), via a computer-generated randomization sequence, to standard home management or IOT management based on telemonitoring of clinical and ventilator parameters over 12 months. The intervention was unblinded, but outcome assessment was blinded to management assignment. The primary outcome was the between-group comparison of the change in health-related quality of life, based on severe respiratory insufficiency questionnaire scores with a non-inferiority margin of -5. This study is registered with Chinese Clinical Trials Registry (No. ChiCTR1800019536). Findings Overall, 148 patients (age: 72.7 ± 6.8 years; male: 85.8%; forced expiratory volume in 1 s: 0.7 ± 0.3 L; PaCO2: 66.4 ± 12.0 mmHg), recruited from 11 Chinese hospitals between January 24, 2019, and June 28, 2021, were randomly allocated to the intervention group (n = 73) or the control group (n = 75). At 12 months, the mean severe respiratory insufficiency questionnaire score was 56.5 in the intervention group and 50.0 in the control group (adjusted between-group difference: 6.26 [95% CI, 3.71-8.80]; P < 0.001), satisfying the hypothesis of non-inferiority. The 12-month risk of readmission was 34.3% in intervention group compared with 56.0% in the control group, adjusted hazard ratio of 0.56 (95% CI, 0.34-0.92; P = 0.023). No severe adverse events were reported. Interpretation Among stable patients with hypercapnic COPD, using IOT-based management for home NPPV improved health-related quality of life and prolonged the time to readmission. Funding Air Liquide Healthcare (Beijing) Co., Ltd.
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Affiliation(s)
- Weipeng Jiang
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyan Jin
- Department of Pulmonary Medicine, Tong Ren Hospital, Jiaotong University, Shanghai, China
| | - Chunling Du
- Department of Pulmonary Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenchao Gu
- Department of Pulmonary Medicine, Pudong New Area People's Hospital, Shanghai, China
| | - Xiwen Gao
- Department of Pulmonary Medicine, Minhang Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenjun Zhou
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chunlin Tu
- Department of Pulmonary Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Hongqun Chen
- Department of Pulmonary Medicine, Zhongshan Xuhui Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Pulmonary Medicine, Traditional Chinese Medicine Hospital of Kunshan, Jiangsu, China
| | - Yao Shen
- Department of Pulmonary Medicine, Pudong Hospital, Shanghai, China
| | - Yunfeng Zhang
- Department of Pulmonary Medicine, Putuo District Liqun Hospital, Shanghai, China
| | - Xiahui Ge
- Department of Pulmonary Medicine, Shanghai Ninth People's Hospital, Jiaotong University, Shanghai, China
| | - Yingxin Sun
- Department of Pulmonary Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Pulmonary Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Suyun Yu
- Department of Pulmonary Medicine, Minhang Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kaishun Zhao
- Department of Pulmonary Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, China
| | - Qing Cheng
- Department of Pulmonary Medicine, Pudong Hospital, Shanghai, China
| | - Xiaodan Zhu
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chunxue Bai
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Fudan University, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary Medicine and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Zhongshan Hospital, Fudan University, Shanghai, China
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Regard L, Deslée G, Zysman M, Le Rouzic O, Roche N. [Position paper of the French Language Society of Respiratory Diseases regarding the GOLD 2023 classification: Capital E]. Rev Mal Respir 2024; 41:97-101. [PMID: 38326191 DOI: 10.1016/j.rmr.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Affiliation(s)
- L Regard
- Service de Pneumologie, Hôpital Cochin, AP-HP centre, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Unité Inserm U1016, Institut Cochin, Université Paris-Cité, Paris, France.
| | - G Deslée
- Service de Pneumologie, Inserm U1250, CHU de Reims, Université Reims Champagne Ardenne, Reims, France
| | - M Zysman
- Service des maladies respiratoires et des épreuves fonctionnelles respiratoires, CHU de Bordeaux, 33604 Pessac, France; U1045, CIC 1401, Centre de Recherche Cardio-thoracique de Bordeaux, université de Bordeaux, 33604 Pessac, France
| | - O Le Rouzic
- Pneumologie et Immuno-allergologie, CHU de Lille, 59000 Lille, France
| | - N Roche
- Service de Pneumologie, Hôpital Cochin, AP-HP centre, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Unité Inserm U1016, Institut Cochin, Université Paris-Cité, Paris, France
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Almagro P, Soler-Cataluña JJ, Huerta A, González-Segura D, Cosío BG. Impact of comorbidities in COPD clinical control criteria. The CLAVE study. BMC Pulm Med 2024; 24:6. [PMID: 38166965 PMCID: PMC10759491 DOI: 10.1186/s12890-023-02758-0] [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: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) frequently coexists with other chronic diseases, namely comorbidities. They negatively impact prognosis, exacerbations and quality of life in COPD patients. However, no studies have been performed to explore the impact of these comorbidities on COPD clinical control criteria. RESEARCH QUESTION Determine the relationship between individualized comorbidities and COPD clinical control criteria. STUDY DESIGN AND METHODS Observational, multicenter, cross-sectional study performed in Spain involving 4801 patients with severe COPD (< 50 predicted forced expiratory volume in the first second [FEV1%]). Clinical control criteria were defined by the combination of COPD assessment test (CAT) scores (≤16 vs ≥17) and exacerbations in the previous three months (none vs ≥1). Binary logistic regression adjusted by age and FEV1% was performed to identify comorbidities potentially associated with the lack of control of COPD. Secondary endpoints were the relationship between individualized comorbidities with COPD assessment test and exacerbations within the last three months. RESULTS Most frequent comorbidities were arterial hypertension (51.2%), dyslipidemia (36.0%), diabetes (24.9%), obstructive sleep apnea-hypopnea syndrome (14.9%), anxiety (14.1%), heart failure (11.6%), depression (11.8%), atrial fibrillation (11.5%), peripheral arterial vascular disease (10.4%) and ischemic heart disease (10.1%). After age and FEV1% adjustment, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; all p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; all p < 0.001), sleep disorders (p < 0.0001), anemia (p = 0.015) and gastroesophageal reflux (p < 0.0001). These comorbidities were also related to previous exacerbations and COPD assessment test scores. INTERPRETATION Comorbidities are frequent in patients with severe COPD, negatively impacting COPD clinical control criteria. They are related to health-related quality of life measured by the COPD assessment test. Our results suggest that comorbidities should be investigated and treated in these patients to improve their clinical control. TAKE-HOME POINTS Study question: What is the impact of comorbidities on COPD clinical control criteria? RESULTS Among 4801 patients with severe COPD (27.5% controlled and 72.5% uncontrolled), after adjustment by age and FEV1%, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; p < 0.001), obstructive sleep apnea-hypopnea syndrome (p < 0.0001), anaemia (p = 0.015) and gastroesophageal reflux (p < 0.0001), which were related to previous exacerbations and COPD assessment test scores. INTERPRETATION Comorbidities are related to health-related quality of life measured by the COPD assessment test scores and history of exacerbations in the previous three months.
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Affiliation(s)
- Pere Almagro
- Multimorbidity Patients Unit. Internal Medicine Department, H. Mutua Terrassa University Hospital, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
| | - Juan José Soler-Cataluña
- Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Medicine Department, València University and CIBERES, Valencia, Spain
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain
| | | | - Borja G Cosío
- Department of Pneumology, H. Universitari Son Espases Hospital-IdISBa and CIBERES, Palma de Mallorca, Balearic Islands, Spain
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Steiropoulos P, Georgatou N, Krommidas G, Bartziokas K, Korkontzelou A, Katerelos P, Efstathopoulos P, Papapetrou D, Theodorakis S, Porpodis K. Extrafine single inhaler triple therapy effectiveness in COPD patients previously treated with multiple-inhaler triple therapy: the TRIWIN study. Ther Adv Respir Dis 2024; 18:17534666241263439. [PMID: 39049587 DOI: 10.1177/17534666241263439] [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: 07/27/2024] Open
Abstract
BACKGROUND The extrafine single inhaler triple therapy (efSITT) containing beclomethasone dipropionate/formoterol fumarate/glycopyrronium 87/5/9 μg has proved to be efficacious in patients with chronic obstructive pulmonary disease (COPD) in randomized control trials. OBJECTIVE TRIWIN study evaluated the effectiveness of efSITT delivering beclomethasone dipropionate/formoterol fumarate/glycopyrronium 87/5/9 μg in COPD patients previously treated with multiple-inhaler triple therapy (MITT) in a real-world study in Greece. DESIGN Prospective, multicenter, observational, non-interventional study was conducted over 24 weeks. METHODS A total of 475 eligible patients had moderate-to-severe COPD, an indication for treatment with efSITT, and were symptomatic despite receiving MITT. COPD Assessment Test (CAT) score, pulmonary function parameters, use of rescue medication, and adherence to inhaler use were recorded at baseline (Visit 1), 3 (Visit 2), and 6 months (Visit 3) after treatment. RESULTS Mean CAT score decreased from 21.4 points at Visit 1, to 16.6 at Visit 2 and 15.1 at Visit 3 (p < 0.001 for all pair comparisons). At Visit 3, 79.8% of patients reached a CAT improvement exceeding minimal clinically important difference (⩾2), compared to baseline. Mean forced expiratory volume in 1 s (%pred.) increased from 55.4% at Visit 1 to 63.5% at the end of study period (p < 0.001), while mean forced vital capacity (%pred.) increased from 71.1% at Visit 1, to 76.7% at Visit 3 (p < 0.001). The mean Test of Adherence to Inhalers score increased from 42.5 to 45.3 and 46.3 points, for the three visits, respectively (p < 0.001 comparing Visits 1/2 and Visits 1/3; p = 0.006 comparing Visits 2/3). The percentage of patients showing good adherence rose from 33.7% at baseline to 58.3% at Visit 3. The percentage of patients using rescue medication during the last month dropped from 16.2% to 7.4% at the end of study period (p < 0.001). Pulmonary function parameters also improved. CONCLUSION The TRIWIN results suggest that extrafine beclomethasone dipropionate/formoterol fumarate/glycopyrronium is effective in improving health status, pulmonary function, and adherence and in reducing rescue medication use in COPD patients previously treated with MITT, in a real-world setting in Greece.
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Affiliation(s)
- Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace Medical School, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Niki Georgatou
- Department of Pulmonology, Iatriko Athinon, Palaio Faliro, Greece
| | | | | | | | | | | | | | | | - Konstantinos Porpodis
- Pulmonary Department - Oncology Unit, 'G. Papanikolaou' General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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van Bakel SIJ, Gosker HR, Wilms E, Schols AMWJ, Havermans RC. Chemosensory function and food perception is affected in COPD, but unrelated to sarcopenia risk. Clin Nutr 2024; 43:218-223. [PMID: 38096626 DOI: 10.1016/j.clnu.2023.11.042] [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: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND & AIMS Patients with advanced COPD often have difficulty maintaining sufficient dietary intake. Chemosensory function influences food choice and intake but is often overlooked in dietary assessment and intervention strategies. This study aimed to assess differences in chemosensory function and hedonic evaluation of food between patients with COPD and age- and gender-matched healthy controls. Additionally, a possible association between increased risk of sarcopenia or frailty and chemosensory impairments was explored. METHODS We recruited 53 COPD patients (34 males, mean age 66.6 ± 7.6 years) and 53 controls (25 males, mean age 68.4 ± 5.7 years). Chemosensory function was assessed using a smell threshold, smell identification (Sniffin' Sticks, Burghart) and taste recognition test (Taste Strips, Burghart) and through self-report. Sensory properties (appearance, smell, taste, mouthfeel) of four standardized food products were evaluated on 9-point hedonic rating scales. Sarcopenia risk was assessed with the SARC-F. RESULTS The COPD group scored lower on both the smell (p = 0.026 for threshold, p = 0.001 for identification) and taste recognition tests (p < 0.001) and also reported more smell and taste impairments (p < 0.001) compared to controls. Hedonic evaluation of food items' appearance (p = 0.009) and smell (p = 0.033) was lower in COPD patients. Within the COPD group, risk of sarcopenia was not associated with chemosensory function. CONCLUSION This study demonstrates that COPD patients have poorer chemosensory function and experience more impairments compared to controls. COPD patients also tend to evaluate foods less positive than do their controls but within COPD patients, sarcopenia risk is not associated with chemosensory function.
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Affiliation(s)
- S I J van Bakel
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands.
| | - H R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands.
| | - E Wilms
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands.
| | - A M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands.
| | - R C Havermans
- Laboratory of Behavioral Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, the Netherlands.
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Quadflieg K, Machado A, de Lima FF, Dederen A, Daenen M, Ruttens D, Thomeer M, Spruit MA, Burtin C. Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events. Respir Med 2023; 220:107437. [PMID: 37918543 DOI: 10.1016/j.rmed.2023.107437] [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: 08/23/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can have a negative impact on functional capacity, symptoms and health-related quality of life (HRQOL). This study aimed to i) investigate the recovery of muscle strength, functional capacity, symptoms, and HRQOL in patients after a severe AECOPD; ii) compare with matched patients with stable COPD (SCOPD); and iii) assess whether these assessments at hospital discharge could discriminate patients' risk for future events. METHODS This observational study assessed patients with AECOPD during hospital discharge (T1) and one month after discharge (T2). Patients with SCOPD were assessed once. Quadriceps force, handgrip strength, short physical performance battery (SPPB), 6-min walk distance (6 MWD), COPD assessment test (CAT), London chest activity of daily living (LCADL), modified medical research council, checklist individual strength-fatigue, patient health questionnaire, and physical activity (Actigraph) were measured. Exacerbation-related readmission and mortality within six months and 1-year were collected. RESULTS Forty-four patients with AECOPD were matched with 44 patients with SCOPD. At T2, a significant improvement was found for the SPPB total score, 6 MWD, CAT score, and LCADL score. Compared to patients with SCOPD, a worse LCADL score was found at T2 in patients with AECOPD. Patients with AECOPD that were readmitted or died had a worse SPPB classification and five-repetition sit-to-stand test at T1. CONCLUSION Patients after severe AECOPD improved in functional capacity and HRQOL one month after hospital discharge, but ADL performance was still worse compared to SCOPD. Patients who were readmitted or died had significantly worse scores on functional tests at hospital discharge.
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Affiliation(s)
- Kirsten Quadflieg
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ana Machado
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Fabiano Francisco de Lima
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Department of Physical Therapy, SãoPaulo State University (UNESP), Presidente Prudente, Brazil
| | - Anand Dederen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Marc Daenen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - David Ruttens
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Michiel Thomeer
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Martijn A Spruit
- CIRO, Center of Expertise for Chronic Organ Failure, Department of Research and Education, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
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Zhou Y, He S, Wang W, Wang X, Chen X, Bu X, Li D. Development and Validation of Prediction Models for Exacerbation, Frequent Exacerbations and Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Registry Study in North China. COPD 2023; 20:327-337. [PMID: 37870866 DOI: 10.1080/15412555.2023.2263562] [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: 05/08/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
In COPD patients, exacerbation has a detrimental influence on the quality of life, disease progression and socioeconomic burden. This study aimed to develop and validate models to predict exacerbation, frequent exacerbations and severe exacerbations in COPD patients. We conducted an observational prospective multicenter study. Clinical data of all outpatients with stable COPD were collected from Beijing Chaoyang Hospital and Beijing Renhe Hospital between January 2018 and December 2019. Patients were followed up for 1 year. The data from Chaoyang Hospital was used for modeling dataset, and that of Renhe Hospital was used for external validation dataset. The final dataset included 456 patients, with 326 patients as the model group and 130 patients as the validation group. Using LABA + ICS, frequent exacerbations in the past year and CAT score were independent risk factors for exacerbation in the next year (OR = 2.307, 2.722 and 1.147), and FVC %pred as a protective factor (OR = 0.975). Combined with chronic heart failure, frequent exacerbations in the past year, blood EOS counts and CAT score were independent risk factors for frequent exacerbations in the next year (OR = 4.818, 2.602, 1.015 and 1.342). Using LABA + ICS, combined with chronic heart failure, frequent exacerbations in the past year and CAT score were independent risk factors for severe exacerbations in the next year (OR = 1.950, 3.135, 2.980 and 1.133). Based on these prognostic models, nomograms were generated. The prediction models were simple and useful tools for predicting the risk of exacerbation, frequent exacerbations and severe exacerbations of COPD patients in North China.
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Affiliation(s)
- Yuyan Zhou
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Respiratory and Critical Care Medicine, Changsha Central Hospital, Changsha, China
| | - Siqi He
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wanying Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoting Chen
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoning Bu
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Deshuai Li
- Department of Respiratory and Critical Care Medicine, Beijing Renhe Hospital, Capital Medical University, Beijing, China
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Bălă GP, Rosca O, Bratosin F, Shetty USA, Vutukuru SD, Sanda II, Marc M, Fira-Mladinescu O, Oancea C. Airborne Particulate Matter Size and Chronic Obstructive Pulmonary Disease Exacerbations: A Prospective, Risk-Factor Analysis Comparing Global Initiative for Obstructive Lung Disease 3 and 4 Categories. J Pers Med 2023; 13:1505. [PMID: 37888116 PMCID: PMC10608161 DOI: 10.3390/jpm13101505] [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: 09/14/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Current research primarily emphasizes the generalized correlations between airborne pollution and respiratory diseases, seldom considering the differential impacts of particular particulate matter sizes on chronic obstructive pulmonary disease (COPD) exacerbations in distinct Global Initiative for Obstructive Lung Disease (GOLD) categories. This study hypothesizes a critical association between particulate matter sizes (PM 1.0, PM 2.5, and PM 10) and exacerbation frequency in COPD patients categorized under GOLD 3 and GOLD 4, with a potential augmenting role played by proximity to main roads and industrial areas. This research aspires to offer a nuanced perspective on the exacerbation patterns in these groups, setting the stage for targeted intervention strategies. Utilizing a prospective design, this study followed 79 patients divided into GOLD 3 (n = 47) and GOLD 4 (n = 32) categories. The participants were monitored for ten days for daily activity levels, symptoms, living conditions, and airborne particulate matter concentrations, with spirometric evaluations employed to measure lung function. Statistical analyses were used to identify potential risk factors and significant associations. The analysis revealed substantial disparities in airborne particulate matter sizes between the two groups. The mean PM 1.0 concentration was notably higher in GOLD 4 patients (26 µg/m3) compared to GOLD 3 patients (18 µg/m3). Similarly, elevated PM 2.5 levels were observed in the GOLD 4 category (35 µg/m3) in contrast to the GOLD 3 category (24 µg/m3). A vital finding was the increased frequency of exacerbations in individuals residing within 200 m of main roads compared to those living further away (OR = 2.5, 95% CI: 1.5-4.1). Additionally, patients residing in homes smaller than 50 square meters demonstrated a greater frequency of exacerbations. Spirometry results corroborated the exacerbated condition in GOLD 4 patients, indicating a significant decline in lung function parameters compared to the GOLD 3 group. This study substantiates a significant association between airborne particulate matter sizes and exacerbation frequencies in COPD patients, particularly accentuating the increased risk in GOLD 4 patients. Our findings underscore the pivotal role of environmental factors, including the size of living areas and proximity to main roads, in influencing COPD exacerbations. These results suggest the need for personalized healthcare strategies and interventions, which account for environmental risk factors and the distinctions between GOLD 3 and GOLD 4 categories of COPD patients.
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Affiliation(s)
- Gabriel-Petrică Bălă
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (G.-P.B.); (M.M.); (O.F.-M.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.-I.S.); (C.O.)
| | - Ovidiu Rosca
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.-I.S.); (C.O.)
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | | | - Sai Diksha Vutukuru
- Department of General Medicine, MNR Medical College, Hyderabad 502285, India;
| | - Isabella-Ionela Sanda
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.-I.S.); (C.O.)
| | - Monica Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (G.-P.B.); (M.M.); (O.F.-M.)
- Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (G.-P.B.); (M.M.); (O.F.-M.)
- Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (I.-I.S.); (C.O.)
- Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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11
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Ambrosino P, Di Minno MND, D'Anna SE, Formisano R, Pappone N, Mancusi C, Molino A, Motta A, Maniscalco M. Pulmonary rehabilitation and endothelial function in patients with chronic obstructive pulmonary disease: A prospective cohort study. Eur J Intern Med 2023; 116:96-105. [PMID: 37349204 DOI: 10.1016/j.ejim.2023.06.015] [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: 02/25/2023] [Revised: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with subclinical atherosclerosis and endothelial dysfunction, thereby leading to increased cardiovascular risk. In the present study, we evaluated the changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of severe COPD patients undergoing pulmonary rehabilitation. METHODS Consecutive COPD patients referred to our Pulmonary Rehabilitation Unit were screened for inclusion. All study procedures were performed at hospital admission and discharge. RESULTS Of 78 patients screened for eligibility, a total of 40 participants (67.5% males, median age 72.5 years) were included. After pulmonary rehabilitation, a significant improvement in functional parameters, exercise capacity, and measures of disability and quality of life were documented. FMD changed from 3.25% (IQR: 2.31-4.26) to 4.95% (IQR: 3.57-6.02), corresponding to a 52.3% increase of its median value (P < 0.001). Significantly lower changes in FMD were documented in COPD patients with hypercholesterolemia as compared to those without (+0.33% ± 1.61 vs. +1.62% ± 1.59, P = 0.037). Changes in FMD (ΔFMD) were positively associated with changes in forced expiratory volume in 1 s (FEV1), when expressed both as absolute values (ΔFEV1) (r = 0.503, P = 0.002) and as percentages of predicted values (ΔFEV1%) (r = 0.608; P < 0.001). In multiple linear regressions, after adjusting for major cardiovascular risk factors, ΔFEV1 (β=0.342; P = 0.049) and ΔFEV1% (β=0.480; P = 0.015) were both confirmed as independent predictors of ΔFMD. CONCLUSIONS Results of our study suggest that endothelial function may improve in COPD after pulmonary rehabilitation. The potential beneficial effect in terms of cardiovascular risk prevention should be evaluated in ad hoc designed studies.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, Italy
| | | | - Silvestro Ennio D'Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Italy
| | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Telese Terme Institute, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy
| | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy.
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12
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Nkhoma KB, Farrant L, Mzimkulu O, Hunter J, Higginson I, Gao W, Maddocks M, Gwyther L, Harding R. High Prevalence and Burden of Physical and Psychological Symptoms in a Chronic Obstructive Pulmonary Disease Population in Primary Care Settings in South Africa. Int J Chron Obstruct Pulmon Dis 2023; 18:1665-1679. [PMID: 37554921 PMCID: PMC10404593 DOI: 10.2147/copd.s395834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/30/2023] [Indexed: 08/10/2023] Open
Abstract
Background Many deaths globally are attributable to non-communicable disease, and four-fifths of these deaths are in low- and middle-income countries. Globally, COPD is currently the third leading cause of mortality. Research Question 1) To determine the prevalence and burden of symptoms and concerns, and 2) determine predicting factors of symptom burden among patients with COPD. Methods A cross-sectional survey was conducted at eight primary care sites in Western Cape. We collected socio-demographic data (age, gender, smoking status, number of missed doses of prescribed medication in the last seven days) and clinical data (PEF and KPS). The Memorial Symptom Assessment Scale (MSAS), the Medical Outcomes Study, Social Support Survey (MOS-SSS), the London Chest Activity of Daily Living Scale (LCADLS) and the COPD Assessment Test (CAT) (impairment on person's life) were administered to patients. We conducted ordered logistic regression analysis to assess factors associated with the burden of symptoms. MSAS subscales: 1) Global symptom distress index, 2) physical symptom distress and 3) psychological symptom distress were dependent outcomes. We constructed three ordinal logistic regression models for each of the three subscales. Covariates were MOS-SSS, LCADLS, CAT, demographic and clinical variables. Results We recruited n=387 patients, mean age 59.5 years, 53.0% female. In multivariate analysis, each of the three models (ie, global, psychological and physical symptom distress) was positively associated with impairment on person's life p<0.001, difficulty to perform activities of daily living p<0.001, and low social support p<0.001. Old age was associated with lower global symptom distress (p=0.004), psychological and (0.014) physical distress (0.005). Missing 1 or more doses of medication was associated with higher levels of global (0.004) and physical (0.005) symptom distress. Interpretation The high prevalence and burden of physical and psychological symptoms provides strong evidence of the need for integrating person-centred assessment and management of symptoms in primary care settings.
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Affiliation(s)
- Kennedy B Nkhoma
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, King’s College London, London, UK
| | - Lindsay Farrant
- Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Olona Mzimkulu
- Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joy Hunter
- Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, King’s College London, London, UK
| | - Liz Gwyther
- Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, King’s College London, London, UK
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13
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Tomaszewski EL, Atkinson MJ, Janson C, Karlsson N, Make B, Price D, Reddel HK, Vogelmeier CF, Müllerová H, Jones PW. Chronic Airways Assessment Test: psychometric properties in patients with asthma and/or COPD. Respir Res 2023; 24:106. [PMID: 37031164 PMCID: PMC10082977 DOI: 10.1186/s12931-023-02394-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/10/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT). METHODS The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD. RESULTS CAAT items were internally consistent (Cronbach's alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson's correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4-0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures. CONCLUSIONS CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice. TRIAL REGISTRATION NCT02760329.
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Affiliation(s)
- Erin L Tomaszewski
- BioPharmaceuticals Medical, AstraZeneca, 1 Medimmune Way, Gaithersburg, MD, USA.
| | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Barry Make
- National Jewish Health and University of Colorado Denver, Denver, CO, USA
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Helen K Reddel
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), University of Marburg, Marburg, Germany
| | | | - Paul W Jones
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
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14
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Porpodis K, Bartziokas K, Chatziapostolou P, Korkontzelou A, Katerelos P, Efstathopoulos P, Bakakos P. "Extrafine single inhaler triple therapy effect on health status, lung function and adherence in COPD patients: A Panhellenic prospective non-interventional study - The TRIBUNE study". Respir Med 2023; 212:107219. [PMID: 36965590 DOI: 10.1016/j.rmed.2023.107219] [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: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
The extrafine single inhaler triple therapy (efSITT) containing beclometasone dipropionate/formoterol fumarate/glycopyrronium 87/5/9μg has proved to be efficacious in patients with Chronic Obstructive Pulmonary Disease (COPD) in randomized control trials. TRIBUNE study aimed to assess the efSITT effectiveness on health status, lung function, adherence and rescue medication use in COPD patients in Greece in a real-world setting. This was a 24-week prospective, multicenter, observational study in 1195 patients with moderate/severe COPD and history of at least one exacerbation during the previous year despite dual therapy. Health status (COPD Assessment Test/CAT), lung function parameters and rescue medication use were recorded at baseline, 3 (Visit 2/V2) and 6 months (Visit 3/V3) after treatment. Adherence (Test of Adherence to Inhalers/TAI) and self-reported overall impression of health condition change (Visual Analogue Scale/VAS) were recorded at V2 and V3. Mean CAT score decreased from 20.9 points at V1, to 15.1 at V2 and 13 at V3 (p < 0.001, all pair comparisons). 85.9% of patients achieved a CAT decrease of minimal clinically important difference (MCID) or more (≥2) at V3, compared to V1. Mean FEV1 increased from 1.4 ± 0.5L on V1, to 1.6 ± 0.5L on V3 (p < 0.001, N = 275). The percentage of patients with "good adherence" increased from 58.4% (V2) to 64.0% (V3). Rescue medication use and VAS also significantly improved. The efSITT achieves improved outcomes on health status, lung function and rescue medication use as well as satisfactory adherence and patient-reported improvement of health condition, in moderate/severe COPD patients previously treated with a dual combination in a Greek real-world setting.
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Affiliation(s)
- Konstantinos Porpodis
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, 57010, Thessaloniki, Greece
| | | | | | | | | | | | - Petros Bakakos
- 1st University Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, "Sotiria" Chest Diseases Hospital, 11527, Athens, Greece
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15
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Dourado IM, Santos PB, Goulart CL, Marinho RS, Santos-De-Araújo AD, Roscani MG, Mendes RG, Borghi-Silva A. Is the six-minute step test able to reflect the severity and symptoms based on cat score? Heart Lung 2023; 58:28-33. [PMID: 36372060 DOI: 10.1016/j.hrtlng.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the first study to investigate the performance of 6MST in COPD patients divided into different symptom severity groups based on the CAT questionnaire score. OBJECTIVES To evaluate the relationship between the degree symptomatology using the chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) with the six- minute step test (6MST) in COPD patients. METHODS This is a cross-sectional study in which 59 patients with COPD were evaluated. The groups were stratified according to the subsequent cutoff points: CAT <10 (little impact) n= 22; CAT 11-20 (moderate impact) n=20; CAT <20 (large impact) n=17. During 6MST the individuals were instructed to go up and down a single step with a height of 20 centimeters (cm). RESULTS Comparing the groups in relation to performance on the 6MST, the number of climbs on the step were significantly higher in the CAT group <10 when compared to the CAT group >20, the variation in HR between rest and peak exercise (∆ HRpeak- rest) was lower in the CAT>20 group compared to the CAT<10 group and the CAT 11- 20 group. We found direct relationships between the number of ascents and descents in the 6MST vs the CAT score (r=0.35, p=0.007); and 6MST vs degree of obstruction of %FEV1 (r-0.46, p=0.002) We verified a linear regression model in which the FEV1 (L) and the CAT score influenced 29% in the performance of the 6MST. CONCLUSION The COPD severity represented by the FEV1 and the CAT score are associated and influenced by 29% the performance of 6-minute step test. Our findings may have important implications for the clinical evaluation of these patients as well as for rehabilitation.
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Affiliation(s)
- Izadora M Dourado
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Polliana B Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Cássia L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | | | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, São Paulo, Brazil.
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16
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Lau CW, Leung SY, Wah SH, Yip CW, Wong WY, Chan KS. Effect on muscle strength after blood flow restriction resistance exercise in early in-patient rehabilitation of post-chronic obstructive pulmonary disease acute exacerbation, a single blinded, randomized controlled study. Chron Respir Dis 2023; 20:14799731231211845. [PMID: 37976375 PMCID: PMC10657539 DOI: 10.1177/14799731231211845] [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: 03/19/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Early commencement of rehabilitation might counteract the loss of muscle strength due to a chronic obstructive pulmonary disease acute exacerbation (COPDAE). Blood flow restriction resistance exercise (BFR-RE) using a low intensity of training load has demonstrated muscle strength gain in varieties of clinical populations. This trial aimed at studying the efficacy and acceptability of BFR-RE in patients with post-COPDAE which was not reported before. METHOD A prospective, assessor blinded, randomized controlled study with 2-week in-patient rehabilitation program with BFR-RE was compared to a matched program with resistance exercise without BFR in patients with post-COPDAE. The primary outcome was the change of muscle strength of knee extensor of dominant leg. The secondary outcomes included changes of hand grip strength (HGS), 6-minute walk test (6MWT) distance, short physical performance battery (SPPB) scores, COPD assessment test (CAT) scores; acceptability and feasibility of BFR-RE; and 1-month unplanned re-admission rate. RESULTS Forty-Five post-COPDAE patients (mean age = 76 ± 10, mean FEV1%=49% ± 24%) were analyzed. After training, BFR-RE group and control group demonstrated a statistically significant median muscle strength gain of 20 (Interquartile range (IQR) 3 to 38) Newton(N) and 12 (IQR -9 to 30) N respectively. BFR-RE group showed a significant change in SPPB scores, but not in 6MWT distance and HGS after training. Between groups did not have statistically significant different in all primary and secondary outcomes, though with similar acceptability. Drop-out rate due to training-related discomfort in BFR-RE group was 3.7%. CONCLUSION BFR-RE is feasible and acceptable in patients with post-COPDAE. A 2-week inpatient pulmonary rehabilitation with BFR-RE improved muscle strength of knee extensors, but not a greater extent than the same rehabilitation program with resistance exercise without BFR. Further studies could be considered with a longer training duration and progression of resistance load. [ClinicalTrials.gov Identifier: NCT04448236].
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Affiliation(s)
- Chung Wai Lau
- Department of Medicine, Haven of Hope Hospital, Kowloon, Hong Kong
| | - Siu Yin Leung
- Department of Physiotherapy, Haven of Hope Hospital, Kowloon, Hong Kong
| | - Shu Hong Wah
- Department of Medicine, Haven of Hope Hospital, Kowloon, Hong Kong
| | - Choi Wan Yip
- Department of Medicine, Haven of Hope Hospital, Kowloon, Hong Kong
| | - Wei Yin Wong
- Department of Medicine, Haven of Hope Hospital, Kowloon, Hong Kong
| | - Kin Sang Chan
- Department of Medicine, Haven of Hope Hospital, Kowloon, Hong Kong
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17
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Portillo EC, Lehmann MR, Hagen TL, Costner MG, Kettner JT, Bhardwaj SD, McFarland MS, Henderson BY, Bowersox NW, Zhao Q, Chui MA. Integration of the patient-centered medical home to deliver a care bundle for chronic obstructive pulmonary disease management. J Am Pharm Assoc (2003) 2022. [DOI: 10.1016/j.japh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Lee SJ, Yoon SS, Lee MH, Kim HJ, Lim Y, Park H, Park SJ, Jeong S, Han HW. Health-Screening-Based Chronic Obstructive Pulmonary Disease and Its Effect on Cardiovascular Disease Risk. J Clin Med 2022; 11:jcm11113181. [PMID: 35683565 PMCID: PMC9181412 DOI: 10.3390/jcm11113181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is considered a major cause of death worldwide, and various studies have been conducted for its early diagnosis. Our work developed a scoring system by predicting and validating COPD and performed predictive model implementations. Participants who underwent a health screening between 2017 and 2020 were extracted from the Korea National Health and Nutrition Examination Survey (KNHANES) database. COPD individuals were defined as aged 40 years or older with prebronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC < 0.7). The logistic regression model was performed, and the C-index was used for variable selection. Receiver operating characteristic (ROC) curves with area under the curve (AUC) values were generated for evaluation. Age, sex, waist circumference and diastolic blood pressure were used to predict COPD and to develop a COPD score based on a multivariable model. A simplified model for COPD was validated with an AUC value of 0.780 from the ROC curves. In addition, we evaluated the association of the derived score with cardiovascular disease (CVD). COPD scores showed significant performance in COPD prediction. The developed score also showed a good effect on the diagnostic ability for CVD risk. In the future, studies comparing the diagnostic accuracy of the derived scores with standard diagnostic tests are needed.
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Affiliation(s)
- Sang-Jun Lee
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
| | - Sung-Soo Yoon
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
| | - Myeong-Hoon Lee
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
| | - Hye-Jun Kim
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
| | - Yohwan Lim
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
| | - Hyewon Park
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Seogsong Jeong
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
- Correspondence: (S.J.); (H.-W.H.); Tel.: +82-31-881-7129 (H.-W.H.)
| | - Hyun-Wook Han
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13488, Korea; (S.-J.L.); (S.-S.Y.); (M.-H.L.); (H.-J.K.); (Y.L.); (H.P.)
- Institute of Basic Medical Sciences, School of Medicine, CHA University, Seongnam 13488, Korea
- Institute for Biomedical Informatics, School of Medicinie, CHA University, Seongnam 13488, Korea
- Healthcare Big-Data Center, Bundang CHA Hospital, Seongnam 13488, Korea
- Correspondence: (S.J.); (H.-W.H.); Tel.: +82-31-881-7129 (H.-W.H.)
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Tang T, Dou B, Zha HX, Tao LS, Gu ZJ, Liu KY, Xie WP. Factors Related to Activation in Chinese Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Survey Study. J Nurs Res 2022; 30:e209. [PMID: 35471203 DOI: 10.1097/jnr.0000000000000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Improving patient activation can lead to better health outcomes among patients with chronic obstructive pulmonary disease (COPD). However, no studies have focused on the issue of activation in patients with COPD in China. PURPOSE This study was designed to explore the status of activation in patients with COPD in China and explicate the significant influencing factors. METHODS One hundred seventy patients with COPD were recruited using a convenience sampling method from eight tertiary and secondary hospitals in Nanjing, China. Sociodemographic, clinical, and patient-reported factor data were collected. Univariate analysis and multivariate linear regression were performed. RESULTS Only 10.6% of the patients were identified as activated for self-management. Multivariate linear regression analysis revealed four explanatory elements as significantly associated with patient activation, including social support (β = .463, p < .001), free medical insurance (β = .173, p = .007), smoking status (β = -.195, p = .002), and health status (β = -.139, p = .04). CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings of this study indicate that a minority of patients with COPD are activated for self-management in China. Having a higher level of patient activation was associated with having better social support, having free medical insurance, being a nonsmoker, and having a better health status. Creating a supportive environment, promoting smoking cessation, and improving medical security and health status may be considered as potential strategies to activate patients into better self-management.
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Affiliation(s)
- Ting Tang
- MSc, RN, Department of Respiration and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People Republic of China
| | - Bei Dou
- BD, Master Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People Republic of China
| | - Hui-Xian Zha
- BD, Master Student, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People Republic of China
| | - Lian-Shan Tao
- BD, RN, Chief Nurse, Department of Respiration and Critical Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People Republic of China
| | - Ze-Juan Gu
- MSc, RN, Associate Professor, Party Committee Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People Republic of China
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20
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Garratt AM, Nerheim EM, Einvik G, Stavem K, Edvardsen A. Evaluation of the Norwegian version of the Dyspnoea-12 questionnaire in patients with COPD. BMJ Open Respir Res 2022; 9:9/1/e001262. [PMID: 35609940 PMCID: PMC9131054 DOI: 10.1136/bmjresp-2022-001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Dyspnoea-12 (D-12) questionnaire is widely used and tested in patients with breathing difficulties. The objective of this study was to translate and undertake the first evaluation of the measurement properties of the Norwegian version of the D-12 in patients with chronic obstructive pulmonary disease (COPD) attending a 4-week inpatient pulmonary rehabilitation programme. METHODS Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, sex and comorbidity. Based on a priori hypotheses, validity was assessed through comparisons with scores for the COPD Assessment Test (CAT), Hospital Anxiety and Depression Scales (HADS) and clinical variables. RESULTS There were 203 (86%) respondents with a mean age (SD) of 65.2 (9.0) years, and 49% were female. The D-12 showed satisfactory structural validity including presence of physical and affective domains. There was acceptable fit to Rasch model including unidimensionality for the two domains, and no evidence of DIF. Correlations with scores for the CAT, HADS and clinical variables were as hypothesised and highest for domains assessing similar aspects of health. CONCLUSIONS The Norwegian version of the D-12 showed good evidence for validity and internal consistency in this group of patients with COPD, including support for two separate domains. Further testing for these measurement properties is recommended in other Norwegian patients with dyspnoea.
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Affiliation(s)
| | | | - Gunnar Einvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Anne Edvardsen
- LHL Hospital Gardermoen, Jessheim, Norway.,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
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21
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Zhou L, Meng X, Huang Y, Kang K, Zhou J, Chu Y, Li H, Xie D, Zhang J, Yang W, Bai N, Zhao Y, Zhao M, Wang G, Carin L, Xiao X, Yu K, Qiu Z, Gao X. An interpretable deep learning workflow for discovering subvisual abnormalities in CT scans of COVID-19 inpatients and survivors. NAT MACH INTELL 2022. [DOI: 10.1038/s42256-022-00483-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AbstractTremendous efforts have been made to improve diagnosis and treatment of COVID-19, but knowledge on long-term complications is limited. In particular, a large portion of survivors has respiratory complications, but currently, experienced radiologists and state-of-the-art artificial intelligence systems are not able to detect many abnormalities from follow-up computerized tomography (CT) scans of COVID-19 survivors. Here we propose Deep-LungParenchyma-Enhancing (DLPE), a computer-aided detection (CAD) method for detecting and quantifying pulmonary parenchyma lesions on chest CT. Through proposing a number of deep-learning-based segmentation models and assembling them in an interpretable manner, DLPE removes irrelevant tissues from the perspective of pulmonary parenchyma, and calculates the scan-level optimal window, which considerably enhances parenchyma lesions relative to the lung window. Aided by DLPE, radiologists discovered novel and interpretable lesions from COVID-19 inpatients and survivors, which were previously invisible under the lung window. Based on DLPE, we removed the scan-level bias of CT scans, and then extracted precise radiomics from such novel lesions. We further demonstrated that these radiomics have strong predictive power for key COVID-19 clinical metrics on an inpatient cohort of 1,193 CT scans and for sequelae on a survivor cohort of 219 CT scans. Our work sheds light on the development of interpretable medical artificial intelligence and showcases how artificial intelligence can discover medical findings that are beyond sight.
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22
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Jiang W, Song Y. Internet of things-based home noninvasive ventilation in COPD patients with hypercapnic chronic respiratory failure: study protocol for a randomized controlled trial. Trials 2022; 23:393. [PMID: 35551646 PMCID: PMC9097410 DOI: 10.1186/s13063-022-06372-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Home noninvasive positive pressure ventilation (NIPPV) has become evidence-based care for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate follow-up, telemonitor, and management to ensure treatment effectiveness, compliance, and security and to improve quality of life. The Internet of things (IOT) is the name given to the network of devices and other “things” with built-in sensors, software, electronics, and network connectivity, communicating these objects over wireless networks and sending data to a cloud platform. The study aims to evaluate the effectiveness and safety of the IOT-based management of NIPPV for the COPD patients with hypercapnic chronic respiratory failure. Methods This multicenter, prospective, randomized controlled trial was conducted with a total of 200 COPD patients with chronic hypercapnic respiratory failure. Using a computer-generated randomization process, patients were randomized (in a 1:1 ratio) into the usual NIPPV (control group) or to receive additional IOT-based management (intervention group) for 12 months. The primary outcome was the Severe Respiratory Insufficiency (SRI) questionnaire. Secondary outcomes included compliance with the ventilator, gas exchange, lung function, health-related quality of life, hospitalization frequency, time to death within 1-year, all-cause mortality, safety analysis, and cost-effectiveness analysis. Discussion This study will be the first and largest randomized trial in China to evaluate the effectiveness and safety of the IOT-based management of NIPPV for COPD patients with chronic hypercapnic respiratory failure. The results will help to understand the current situation of IOT-based home ventilation and may provide new evidence for home NIPPV treatment and management in the future. Trial registration Chinese Clinical Trials Registry ChiCTR1800019536. Registered on 17 November 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06372-z.
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Affiliation(s)
- Weipeng Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Shanghai Respiratory Research Institute, Shanghai, 200032, China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200000, China. .,Department of Pulmonary Medicine, Qingpu Branch, Zhongshan Hospital, Fudan University, Shanghai, 201700, China. .,Jinshan Hospital of Fudan University, Shanghai, 201508, China.
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Sugawara H, Saito A, Yokoyama S, Tsunematsu K, Chiba H. Association between annual change in FEV1 and comorbidities or impulse oscillometry in chronic obstructive pulmonary disease. BMC Pulm Med 2022; 22:185. [PMID: 35527263 PMCID: PMC9080138 DOI: 10.1186/s12890-022-01980-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. The decline in forced expiratory volume in one second (FEV1) is considered to be one of the most important outcome measures for evaluating disease progression. However, the only intervention proven to improve COPD prognosis is smoking cessation. This study therefore investigated the factors associated with annual FEV1 decline in COPD. Methods This retrospective study followed up 65 patients treated for COPD for 5 years: 13 current smokers and 52 former smokers, 25 with pneumonia, 24 with asthma, 18 with cancer, and 17 with cardiovascular disease. The patients were divided into groups based on clinical cutoff parameters of the impulse oscillometry system (IOS): 11 high and 54 low R5, 8 high and 57 low R20, 21 high and 44 low R5–R20, 26 high and 39 low X5, 38 high and 27 low Fres, and 36 high and 29 low AX. We investigated whether the decline in FEV1 was associated with comorbidities and IOS parameters. Results The annual change in FEV1 over 5 years was significantly affected by smoking status (current − 66.2 mL/year vs. former − 5.7 mL/year, p < 0.01), pneumonia (with − 31.5 mL/year vs. without − 8.9 mL/year, p < 0.05), asthma (with − 30.2 mL/year vs. − 10.8 mL/year, p < 0.01), but not by cancer and cardiovascular disease. In the groups defined by IOS results, only the high AX group had significantly more annual decline in FEV1 and %FEV1 than the low AX group (− 22.1 vs. − 12.8, p < 0.05 and − 0.20 vs. 0.40, p < 0.05, respectively). Conclusions Continuing smoking as well as complications in pneumonia and asthma would be risk factors for the progression of COPD. AX might be a suitable parameter to predict the prognosis of patients with COPD. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01980-6.
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Ozsoy I, Kodak MI, Kararti C, Ozsoy G, Erturk A, Kahraman T. Intra- and Inter-Rater Reproducibility of the Face-to-Face and Tele-Assessment of Timed-up and Go and 5-Times Sit-to-Stand Tests in Patients with Chronic Obstructive Pulmonary Disease. COPD 2022; 19:125-132. [PMID: 35385377 DOI: 10.1080/15412555.2022.2038119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Timed-Up and Go (TUG) and 5-Times Sit-to-Stand (5STS) are frequently used in clinical practice for patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the intra- and inter-rater reproducibility of the TUG and 5STS as both face-to-face and tele-assessment tests in patients with COPD. Forty-four patients with diagnosed COPD were included. Evaluations were carried out face-to-face and tele-assessment (synchronized and asynchronized). Inter-reliability between face-to-face and tele-assessment was excellent for TUG (ICC = 0.977) and 5STS (ICC = 0.970). Inter-reliability between two tele-raters was also excellent for TUG (ICC = 0.995) with the SEM = 0.04, SEM95% = 0.08, and SDC95% = 0.10 s, and 5STS (ICC = 0.990) with the SEM = 0.06, SEM95% = 0.12, and SDC95% = 0.18 s. Intra-rater reliability of the tele-assessment (synchronized) was excellent for TUG (ICC = 0.976) and 5STS (ICC = 0.964). The SEM, SEM95%, and SDC95% values were computed as 0.08, 0.16, and 0.22 s for TUG, and 0.11, 0.22, and 0.31 s for 5STS, respectively. The TUG and 5STS tests are reproducible tele-assessment measures in patients with COPD with excellent intra- and inter-rater reproducibility. The authors recommend these tests as practical assessment tools in patients with COPD at home for tele-health interventions. The reported SEM, SEM95%, and SDC95% values can be used as a minimum change that needs to be observed to be confident that the observed change is real and not, potentially, a product of measurement error.
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Affiliation(s)
- Ismail Ozsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selcuk University, Konya, Turkey
| | - Muhammed Ihsan Kodak
- School of Physical Therapy and Rehabilitation, Kırsehir Ahi Evran University, Kırsehir, Turkey
| | - Caner Kararti
- School of Physical Therapy and Rehabilitation, Kırsehir Ahi Evran University, Kırsehir, Turkey
| | - Gulsah Ozsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selcuk University, Konya, Turkey
| | - Arzu Erturk
- Department of Chest Disease, Faculty of Medicine, Kırsehir Ahi Evran University, Kırsehir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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Pulmonary infection after hepatic resection: Associated factors and impact on outcomes. Clin Res Hepatol Gastroenterol 2022; 46:101733. [PMID: 34146724 DOI: 10.1016/j.clinre.2021.101733] [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: 11/16/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Postoperative pulmonary complications are frequent after hepatectomy. The aim of this retrospective study was to use preoperative and intraoperative data to establish specific factors associated with post-hepatectomy pneumonia (PHPN). METHODS Patients underwent minor or major hepatectomy for cancer or non-cancer treatment. Surgical procedure was performed by laparoscopy or laparotomy. PHPN was defined as a new radiologic finding associated with fever, leucocytosis and purulent bronchial secretions. The incidence, associated factors and prognosis of PHPN were investigated. RESULTS In 399 patients undergoing planned hepatectomy, 49 (12.3%) developed pneumonia. Of 81 patients (20.3%) with cirrhosis, 77 were Child-Pugh A and 4 were Child-Pugh B. Hepatectomy indication was cancer in 331 patients (of which metastasis in 213). Laparoscopy rate was 31.3%. In multivariate analysis, the main factors statistically associated with PHPN were: chronic obstructive pulmonary disease (COPD) (odds ratio [OR] = 4.17; 95% confidence interval [CI], 1.60-10.84; P = 0.003), intraoperative blood transfusion (OR = 2.46; 95% CI 1.01-5.70; P = 0.001), laparotomy (OR = 3.01; 95% CI 1.09-8.27; P = 0.03), and nasogastric tube maintained at day 1 (OR = 2.09; 95% CI 1.03-4.22; P = 0.04). Length of stay was significantly different between groups without PHPN (10.2 days) versus with PHPN (26.4 days; P < 0.001). Intra-hospital and one-year mortality were greater in the PHPN group than the pneumonia-free group (8.16 vs 0% and 18.4 vs 3.4%, respectively; P < 0.001). CONCLUSIONS COPD, transfusion and laparotomy (versus laparoscopy) are factors associated with PHPN and impaired survival.
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A Machine Learning Approach to Predict the Rehabilitation Outcome in Convalescent COVID-19 Patients. J Pers Med 2022; 12:jpm12030328. [PMID: 35330328 PMCID: PMC8953386 DOI: 10.3390/jpm12030328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: After the acute disease, convalescent coronavirus disease 2019 (COVID-19) patients may experience several persistent manifestations that require multidisciplinary pulmonary rehabilitation (PR). By using a machine learning (ML) approach, we aimed to evaluate the clinical characteristics predicting the effectiveness of PR, expressed by an improved performance at the 6-min walking test (6MWT). Methods: Convalescent COVID-19 patients referring to a Pulmonary Rehabilitation Unit were consecutively screened. The 6MWT performance was partitioned into three classes, corresponding to different degrees of improvement (low, medium, and high) following PR. A multiclass supervised classification learning was performed with random forest (RF), adaptive boosting (ADA-B), and gradient boosting (GB), as well as tree-based and k-nearest neighbors (KNN) as instance-based algorithms. Results: To train and validate our model, we included 189 convalescent COVID-19 patients (74.1% males, mean age 59.7 years). RF obtained the best results in terms of accuracy (83.7%), sensitivity (84.0%), and area under the ROC curve (94.5%), while ADA-B reached the highest specificity (92.7%). Conclusions: Our model enables a good performance in predicting the rehabilitation outcome in convalescent COVID-19 patients.
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Crisafulli E, Sartori G. A shadow in the GOLD ABCD classification system: measurement of perception of symptoms in COPD. J Bras Pneumol 2021; 47:e20210389. [PMID: 34878055 PMCID: PMC9013535 DOI: 10.36416/1806-3756/e20210389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ernesto Crisafulli
- . Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giulia Sartori
- . Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Oca MMD, Varela MVL, Menezes AMB, Wehrmeister FC, Ramirez L, Miravitlles M. Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study. J Bras Pneumol 2021; 47:e20210156. [PMID: 34787288 DOI: 10.36416/1806-3756/e20210156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. METHODS In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. RESULTS Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden's index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden's index (1.48). CONCLUSION GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.
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Affiliation(s)
| | | | - Ana Maria B Menezes
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas (RS) Brasil
| | - Fernando C Wehrmeister
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas (RS) Brasil
| | | | - Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, CIBER de Enfermedades Respiratorias, Barcelona, Spain
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Forced oscillatory parameters as predictors of COPD assessment test improvement in untreated COPD patients. Respir Physiol Neurobiol 2021; 296:103809. [PMID: 34718186 DOI: 10.1016/j.resp.2021.103809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/16/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies have examined whether baseline spirometry and the forced oscillation technique (FOT) would predict The COPD Assessment Test (CAT) score improvement after treatment of untreated COPD patients. METHODS The study subjects included 65 untreated COPD patients. They underwent the CAT, spirometry, and FOT (MostGraph) before and after treatment for more than 2 months. In addition, recursive partitioning analysis was performed using spirometry and the FOT parameters to identify the predictors of CAT improvement (CAT score ≥2). RESULTS CAT scores and lung function significantly improved after treatment. Recursive partitioning analysis identified 3 improved classes, defined by Rrs at 20 Hz (R20), Xrs at 5 Hz (X5), and ΔX5, but not by spirometry. The accuracy of predicting CAT improvement was as follows: odds ratio, 25.3; 95 % confidence interval, 6.1 to 104.1; sensitivity, 91.2 %; specificity, 71.0 %; positive likelihood ratio, 3.14; and negative likelihood ratio, 0.12. CONCLUSIONS FOT helps predict improved health status in untreated COPD patients.
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Pisi R, Aiello M, Calzetta L, Frizzelli A, Tzani P, Bertorelli G, Chetta A. The COPD assessment test and the modified Medical Research Council scale are not equivalent when related to the maximal exercise capacity in COPD patients. Pulmonology 2021; 29:194-199. [PMID: 34233862 DOI: 10.1016/j.pulmoe.2021.06.001] [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: 12/14/2020] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The management and treatment of Chronic Obstructive Pulmonary Disease (COPD) are based on a cutoff point either of ≥ 10 on the COPD Assessment Test (CAT) or of ≥ 2 of the Medical Research Council (mMRC). Up to now, no study has assessed the equivalence between CAT and mMRC, as related to exercise tolerance in COPD. The aim of this study was to investigate as primary outcome the relationship between CAT and mMRC and maximal exercise capacity in COPD patients. We also evaluated as secondary outcome the agreement between CAT (≥ 10) and mMRC (≥ 2) to categorize patients according to their exercise tolerance. MATERIAL AND METHODS 118 consecutive COPD patients (39 females), aged between 47 and 85 years with a wide range of airflow obstruction and lung hyperinflation were studied. Maximal exercise capacity was assessed by cardiopulmonary exercise test. RESULTS CAT and mMRC scores were significantly related to VO2 peak (p<0.01). CAT (≥ 10) and mMRC (≥ 2) have a high likelihood to be associated to a value of VO2 peak less than 15.7 and 15.6 mL/kg/min, respectively. The interrater agreement between CAT (≥ 10) and mMRC (≥ 2) was found to be fair (κ = 0.20) in all patients but slight when they were subdivided in those with VO2 peak < 15 mL/kg/min and in those with VO2 peak ≥ 15 mL/kg/min (κ = 0.10 and κ = 0.20 respectively). CONCLUSION This study shows that CAT and mMRC are useful tools to predict exercise tolerance in COPD, but they cannot be considered as supplementary measures.
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Affiliation(s)
- Roberta Pisi
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy
| | - Marina Aiello
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy.
| | - Annalisa Frizzelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy
| | - Panagiota Tzani
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy
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Chan KH, Tsoi YYS, McCall M. The Effectiveness of Traditional Chinese Medicine (TCM) as an Adjunct Treatment on Stable COPD Patients: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5550332. [PMID: 34188688 PMCID: PMC8195656 DOI: 10.1155/2021/5550332] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Traditional Chinese medicine (TCM), including Chinese herbal medicine (CHM) and acupuncture, exhibits beneficial effects on stable chronic obstructive pulmonary disease (COPD) such as improving lung function and reducing exacerbation. Previous research studies have examined either CHM or acupuncture alone, which are not the usual practice in TCM clinic setting. We conduct a systematic review for evaluating the clinical effectiveness and safety of TCM by combining CHM and acupuncture. METHODS Databases are searched from inception to November 2019. Randomized controlled trials examining either acupuncture or CHM on stable COPD are included. Primary outcomes include lung functions, exacerbations, and COPD assessment test. Secondary outcomes include quality of life, TCM syndrome score and effective rate, and 6-minute walk distance. Two independent reviewers extract data and assess the quality of evidence and generate meta-analysis and risk of bias by STATA. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. RESULTS 100 randomized controlled trials (8291 participants) were included to compare add-on Chinese medicine treatment with conventional treatment (CT). Combining CHM with CT improves FEV1 (MD: 0.18, 95% CI: 0.08, 0.28), exacerbation rate (MD: -0.29, 95% CI: -0.61, 0.03), COPD assessment test (MD: -2.16, 95% CI: -3.44, -0.88), TCM syndrome score (MD: -3.96, 95% CI: -5.41, -2.51) and effective rate (RR: 0.89, 95% CI: 0.80, 0.93), and 6-minute walk test (MD: 37.81, 95% CI: 20.90, 54.73). No serious adverse events were reported. Risk of bias: low to unclear. CONCLUSIONS This review identifies sufficient moderate-to-low-quality evidence to suggest TCM as an adjunct treatment for stable COPD patients. Though heterogeneity was low among studies, the results were limited and the quality of evidence was low or very low based on small sample sizes and risk of bias. Future studies with larger sample sizes are warranted. The trial is registered with CRD42019161324.
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Affiliation(s)
- K. H. Chan
- Department for Continuing Education, The University of Oxford, England, UK
- Department of Primary Care Health Sciences, The University of Oxford, England, UK
| | - Y. Y. S. Tsoi
- Independent Researcher Hong Kong China, The University of Oxford, Hong Kong, China
| | - M. McCall
- Department of Primary Care Health Sciences, The University of Oxford, England, UK
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Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation. Biomedicines 2021; 9:biomedicines9060614. [PMID: 34071308 PMCID: PMC8226503 DOI: 10.3390/biomedicines9060614] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Growing evidence points to a key role of endothelial dysfunction in the pathogenesis of COVID-19. In this study, we evaluated changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of convalescent COVID-19 patients undergoing pulmonary rehabilitation (PR). Methods: After swab test negativization, convalescent COVID-19 patients referring to a post-acute care facility for PR were consecutively screened for inclusion. Study procedures were performed at the time of hospitalization and discharge. Results: We enrolled 82 convalescent COVID-19 patients (85.4% males, mean age 60.4 years). After PR, a significant improvement in most pulmonary function tests and exercise capacity was documented. FMD changed from 2.48% ± 2.01 to 4.24% ± 2.81 (p < 0.001), corresponding to a 70.9% increase. Significantly higher changes in FMD were found in patients without a history of vascular events as compared to those with (+2.04% ± 2.30 vs. +0.61% ± 1.83, p = 0.013). Values of forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLCO%) significantly and directly correlated with FMD both at baseline and after PR. Patients with normal FEV1% (≥80% predicted) during the overall study period or those normalizing FEV1% after PR showed a more significant FMD change as compared to patients with persistently impaired FEV1% (<80% predicted) (p for trend = 0.029). This finding was confirmed in a multivariate analysis. Conclusions: Clinically evaluated endothelial function improves after PR in convalescent COVID-19 patients. A direct and persistent association between the severity of pulmonary and vascular disease can be hypothesized. Endothelial function testing may be useful in the follow-up of convalescent COVID-19 patients.
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Hirai K, Tanaka A, Homma T, Kawahara T, Oda N, Mikuni H, Uchida Y, Saito H, Kaneko K, Fujiwara A, Goto Y, Uno T, Miyata Y, Ohta S, Yamaguchi F, Suzuki S, Ohnishi T, Sagara H. Investigating Patient and Family Satisfaction with the Respiratory Status in Patients with Chronic Obstructive Pulmonary Disease. COPD 2021; 18:83-90. [PMID: 33504227 DOI: 10.1080/15412555.2021.1874898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current chronic obstructive pulmonary disease (COPD) management aims to improve the patients' quality of life and healthy life expectancy; however, few studies have evaluated the level of satisfaction with the patients' current respiratory status in COPD patients and their families. This study aimed to examine the level of patient and family satisfaction with the patients' current respiratory status and to identify the clinical factors closely linked to dissatisfaction.This multicenter, cross-sectional study included 454 outpatients with COPD and 296 family members. Patients and families were allocated to the satisfied and dissatisfied groups based on their satisfaction with the patients' current respiratory status. Patients' health status, dyspnoea, appetite, respiratory function, and mood disorders were assessed.Among the participants of this study, 67% of patients and 60% of their families were dissatisfied with the patients' current respiratory status. The COPD assessment test (CAT) was the most sensitive marker of dissatisfaction compared to other clinical factors (p < 0.01). The statistical cut-off value of CAT for predicting patient dissatisfaction was 11. CAT reflected patient dissatisfaction independent of age, sex, dyspnoea, appetite, mood disorders, body mass index, and respiratory function (odds ratio: CAT; 1.12 (1.07-1.19): p < 0.01).Many patients and families are dissatisfied with the patients' respiratory status, and the patients' CAT score is useful to predict dissatisfaction. Our findings are consistent with the Global Initiative for Chronic Obstructive Lung Disease indicating that treatment should be enhanced in patients with a CAT score ≥10. Furthermore, treatment strategies targeting CAT may contribute to an improved patient satisfaction.
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Affiliation(s)
- Kuniaki Hirai
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoko Kawahara
- Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan
| | - Naruhito Oda
- Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan
| | - Hatsuko Mikuni
- Department of Medicine, Division of Respiratory Medicine, Kokuho Asahi Chuo Hospital, Chiba, Japan
| | - Yoshitaka Uchida
- Department of Medicine, Division of Respiratory Medicine, Kokuho Asahi Chuo Hospital, Chiba, Japan
| | - Haruhisa Saito
- Department of Medicine, Division of Respiratory Medicine, Kokuho Asahi Chuo Hospital, Chiba, Japan
| | - Keisuke Kaneko
- Department of Medicine, Division of Respiratory Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Akiko Fujiwara
- Department of Medicine, Division of Respiratory Medicine, Odawara Municipal Hospital, Odawara, Kanagawa, Japan
| | - Yuiko Goto
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoki Uno
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshito Miyata
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Shin Ohta
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Fumihiro Yamaguchi
- Department of Medicine, Division of Respiratory Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Shintaro Suzuki
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Tsukasa Ohnishi
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
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Flores MP, Arcuri JF, Carvalho da Silva MM, Pires Di Lorenzo VA. Validity of the Brazilian version of the COPD assessment test in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2020; 15:358-364. [PMID: 33210809 DOI: 10.1111/crj.13308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION COPD Assessment Test (CAT) is a questionnaire defined as one of the main options in the assessment of the impact of Chronic Obstructive Pulmonary Disease on patients' life, according to the Global Initiative on Obstructive Lung Diseases. However, the Consensus-based Standards for the Selection of Health Measurement Instruments-COSMIN 2018 has recently determined a correlation coefficient greater than 0.70 and an optimal sample size must have a hundred subjects, hence, validity of the Brazilian version of this instrument is still not yet proven. OBJECTIVE To verify the validity of the Brazilian version of the Questionnaire CAT in patients with Chronic Obstructive Pulmonary Disease, comparing it to the Saint George's Respiratory Questionnaire (SGRQ) and correlate it with other outcomes. MATERIALS AND METHODS Observational transversal study with 101 COPD diagnosed subjects who underwent anthropometric data collection, life habits, CAT and SGRQ questionnaires, modified Medical Research Council (mMRC) dyspnoea scale. Spirometry, six-minute walking test (6MWT) and body mass index, Dyspnoea and exercise capacity (BODE). Each evaluative measure was compared to the total CAT score. The validity was considered for a significant Pearson correlation coefficient (r) greater than 0.7. RESULTS It was observed a strong correlation between the total CAT score and the total SGRQ score (r = 0.703; P < 0.001), as well as moderate correlation with mMRC (r = 0.518; P < 0.001). SGRQ Symptoms (r = 0.627; P < 0.001). SGRQ Activity (r = 0.636; P < 0.001) and SGRQ Impact (r = 0.655; P < 0.001). There were similar correlations between CAT and other variables (6MWT, mMRC and BODE) and SGRQ and the same variables. CONCLUSION The CAT questionnaire is a valid, reliable and easy-to-use instrument for assessing symptoms and can record the impact of COPD on the patient's quality of life.
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Affiliation(s)
- Mariana Pereira Flores
- Physiotherapy Department of Federal University of São Carlos, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Juliano Ferreira Arcuri
- Physiotherapy Department of Federal University of São Carlos, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Marcela Maria Carvalho da Silva
- Postgraduate Physiotherapy Program of Federal University of São Carlos, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Valéria Amorim Pires Di Lorenzo
- Physiotherapy Department of Federal University of São Carlos, Universidade Federal de São Carlos, São Carlos, Brazil.,Postgraduate Physiotherapy Program of Federal University of São Carlos, Universidade Federal de São Carlos, São Carlos, Brazil
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Cagsin H, Uzan A, Tosun O, Rasmussen F, Serakinci N. Tissue-Specific Ultra-Short Telomeres in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:2751-2757. [PMID: 33154635 PMCID: PMC7608580 DOI: 10.2147/copd.s267799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Telomere biology, especially tissue-specific ultra-short telomeres, might provide a strong contribution to our current knowledge in COPD development as well as a predictive marker for prognosis. To test this hypothesis, we investigated telomere lengths in lung tissue and leukocytes in patients diagnosed with COPD. Patients and Methods Thirty-two patients were included in the current study. All patients showed a post-bronchodilator ratio of less than 70% post-bronchodilator predicted value of forced expiratory volume in second (FEV1%), mean 56%; range [19% to 86%]. To be able to investigate ultra-short telomeres, universal single telomere length analysis (U-STELA) was used. Results Our results showed a higher level of the ultra-short telomere presence in bronchoalveolar lavage (BAL) cells when compared to leukocytes with statistical significance t(62)=5.771, p<0.00001. The FEV1% was lower in subjects with ultra-short telomeres in BAL (50.6% vs 81.6%: p<0.001) and in ultra-short telomeres in blood leukocytes (37.3% vs 58.5%: p=0.051) when compared to subjects without ultra-short telomeres in leukocytes. Furthermore, the patients who had ultra-short telomeres in BAL samples were significantly older (p=0.014) than patients who did not have ultra-short telomeres. Ultra-short telomeres in BAL (p=0.05) but not in leukocytes (p=0.33) were associated with FEV1% in a regressions model adjusting for age (p<0.0001), ever smoking (p<0.0001) and sex (p=0.71). The patients with ultra-short telomeres were graded higher in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification (p=0.006). Conclusion This study emphasizes the need to investigate the correct tissue to get a representative evaluation of the stage or advancedness of COPD. To our knowledge, this is the first study to show that there is a correlation between the presence of ultra-short telomeres in lung tissue and COPD severity. Our results suggest that ultra-short telomeres are involved in the molecular pathogenesis of COPD and might be used as a tissue-specific predictive biomarker.
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Affiliation(s)
- Huseyin Cagsin
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia, Cyprus.,Department of Molecular Biology of Genetics, Arts and Sciences Faculty, Near East University, Nicosia, Cyprus
| | - Ali Uzan
- Department of Allergy Sleep and Respiratory Medicine, Near East University Hospital, Nicosia, Cyprus
| | - Ozgur Tosun
- Department of Biostatistics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Finn Rasmussen
- Department of Allergy Sleep and Respiratory Medicine, Near East University Hospital, Nicosia, Cyprus.,Section of Respiratory Medicine; Department of Internal Medicine, Sydvestjysk Hospital, Esbjerg, Denmark
| | - Nedime Serakinci
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia, Cyprus.,Department of Molecular Biology of Genetics, Arts and Sciences Faculty, Near East University, Nicosia, Cyprus
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36
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Kakavas S, Papanikolaou A, Kompogiorgas S, Stavrinoudakis E, Karayiannis D, Balis E. The Correlation of Sit-to-Stand Tests with COPD Assessment Test and GOLD Staging Classification. COPD 2020; 17:655-661. [PMID: 33023324 DOI: 10.1080/15412555.2020.1825661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD classification tool has been used to assess the symptom burden and exacerbation risk of patients with chronic obstructive pulmonary disease (COPD). An area requiring further exploration is the relationship between the GOLD classification's basic components and the measurements acquired by Sit-to-Stand tests (STST). We aimed to study the relationship between STST and the component of the GOLD classification tool. This study was conducted on a sample of 42 COPD subjects with patient history, COPD assessment test (CAT) and spirometry. 5STST performance time and the number 30s-STST repetitions showed differences of statistical significance in COPD subjects considered to be more symptomatic and in subjects with high risk of future exacerbations. Both STSTs correlated significantly with forced expiratory volume in one second % predicted (FEV1%), CAT, number of acute exacerbations in the past year and number of hospitalized exacerbations in the past year. STST performance correlates significantly with items of the CAT questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy. Using multivariate analysis, age, FEV1% and CAT score manifested the strongest negative association with STST performance. 5STST performance time and the number 30s-STST repetitions in COPD patients correlates with the level of symptoms and the risk of future exacerbations that define groups A-D based on GOLD 2018 classification tool (at the time of data acquisition). The correlation of STST performance with CAT score involves specific items of the questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy.
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Affiliation(s)
- Sotirios Kakavas
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Steven Kompogiorgas
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Dimitrios Karayiannis
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Evangelos Balis
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Athens, Greece
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Cognitive and motor performances in dual task in patients with chronic obstructive pulmonary disease: a comparative study. Ir J Med Sci 2020; 190:723-730. [PMID: 32885377 DOI: 10.1007/s11845-020-02357-6] [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: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) may display a motor and/or cognitive disadvantage during dual tasking. However, studies investigating dual task are quite limited in patients with COPD. AIMS To compare cognitive and motor performances (i.e., muscle force production and functional balance/mobility together with a cognitive task) in dual task between patients with COPD and healthy controls. METHODS Thirty-five clinically stable patients with COPD and 27 age- and sex-matched healthy controls participated in this cross-sectional controlled study. The muscle force production (knee extension muscle strength assessed with an isokinetic strength dynamometer) and functional balance/mobility (Timed Up and Go (TUG) test) were performed with and without a cognitive task. Dual-task interference (DTI) was assessed. Additionally, the rate of correct responses per second (RCR) was calculated to evaluate cognitive performance. RESULTS The decrease in RCRmuscle force production values was greater in the COPD group compared with the control group (p = 0.045). Similarly, the cognitive DTI in muscle force production test was higher in the control group than in the COPD group (p < 0.001). There was no significant difference in other outcome measures between the two groups (p > 0.05). CONCLUSION The study results indicate that in individuals with COPD, cognitive performance deteriorations are more pronounced than motor performance defects during dual tasking. Further studies are needed to investigate the effects of dual task taking into account this disadvantage in patients with COPD rather than focusing solely on motor performance.
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Müllerová H, Dransfield MT, Thomashow B, Jones PW, Rennard S, Karlsson N, Fageras M, Metzdorf N, Petruzzelli S, Rommes J, Sciurba FC, Tabberer M, Merrill D, Tal-Singer R. Clinical Development and Research Applications of the Chronic Obstructive Pulmonary Disease Assessment Test. Am J Respir Crit Care Med 2020; 201:1058-1067. [PMID: 31815521 DOI: 10.1164/rccm.201907-1369pp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hana Müllerová
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Paul W Jones
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Stephen Rennard
- University of Nebraska, Omaha, Nebraska.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Malin Fageras
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Frank C Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maggie Tabberer
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | | | - Ruth Tal-Singer
- Value Evidence and Outcomes, Medical Innovation, Global Medical R&D, GlaxoSmithKline, Collegeville, Pennsylvania
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Mugii N, Someya F. Ability of the COPD Assessment Test to evaluate the lung‐specific quality of life in systemic sclerosis‐associated interstitial lung disease. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:527-532. [PMID: 32045097 PMCID: PMC7318680 DOI: 10.1111/crj.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
Introduction The COPD Assessment Test (CAT) is utilised to evaluate the treatment outcome regarding the health status in idiopathic interstitial pneumonia (IIP). However, the ability of the CAT to evaluate the lung‐specific quality of life in systemic sclerosis‐associated interstitial lung disease (SSc‐ILD) is not established. Therefore, we investigated whether CAT scores can be used to evaluate SSc‐ILD as they are for IIP. Methods A total of 150 patients with IIP or SSc‐ILD who were evaluated by the CAT were retrospectively assigned to this study. Clinical data at the visit for the CAT were analysed. Results The forced vital capacity and distance walked during the 6‐minute walk test (6MWD) were significantly correlated with the CAT score for SSc‐ILD and IIP, and the CAT scores were similarly distributed in SSc‐ILD and IIP. The CAT score of SSc‐ILD patients was negatively affected by pulmonary arterial hypertension, but not by corticosteroids, which affected it in IIP patients. CAT scores of patients with either disease receiving home oxygen therapy were poor. In multiple regression analysis, pulmonary arterial hypertension and 6MWD were independent predictors for the CAT score in patients with SSc‐ILD, while corticosteroid administration was selected as an independent factor in patients with IIP. Conclusions Our study suggests that the CAT can be applied to evaluate the lung‐specific quality of life in SSc‐ILD similar to IIP regarding the pulmonary function, but it should be noted that pulmonary arterial hypertension in SSc‐ILD influences the CAT score.
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Affiliation(s)
- Naoki Mugii
- Graduate School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Japan
- Kanazawa University Hospital Kanazawa University Kanazawa Japan
| | - Fujiko Someya
- School of Health Sciences Kanazawa University Kanazawa Japan
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Rehman AU, Hassali MAA, Harun SN, Abbas S, Muneswarao J, Ali IABH, Hussain R. Validation and clinical interpretation of the St George's respiratory questionnaire for COPD (SGRQ-C) after adaptation to Malaysian language and culture, in patients with COPD. Health Qual Life Outcomes 2020; 18:138. [PMID: 32404113 PMCID: PMC7218514 DOI: 10.1186/s12955-020-01393-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/05/2020] [Indexed: 01/29/2023] Open
Abstract
Background Cultural differences affect the administration and results of health status questionnaires. “Cross cultural adaptation” ensures retention of psychometric properties such as validity and reliability at an item and/or scale level. Objective To develop a Malaysian version of St George’s respiratory COPD specific questionnaire (SGRQ-CM), to evaluate the full spectrum of psychometric properties (reliability, validity and responsiveness), to test the factor structure and to assess minimum clinically important difference for the SGRQ-CM, to be used in population of Malaysia. Methodology SGRQ-C was translated to Bahasa Malaysia using a standard protocol. 240 COPD patients were included in the study. All patients were followed-up for six months. Construct validity, internal consistency, item convergent validity, test-retest ability, responsiveness, factor analysis and MCID of the Malaysian version of SGRQ-C to be used in population of Malaysia were evaluated. Results The Cronbach alpha coefficient and intraclass correlation coefficients (ICC) for SGRQ-CM were reported as 0.87, and 0.88 respectively. Correlation of SGRQ-CM with CAT, EQ-5D-5 L, mMRC dyspnea scales and FEV1%predicted were reported as 0.86, − 0.82, 0.72 and − 0.42 respectively. Correlation coefficient between the subscales and other clinical and health status measures ranged from r = − 0.35 to r = − 0.87. The MCID was reported as 5.07 (− 2.54–12.67). Conclusion The Malaysian version of SGRQ-C has a good psychometric property comparable to those of the original version and has a strong evidence of validity, reliability and responsiveness towards disease severity in Malaysian COPD patients. It can be recommended as a reliable quality of life measure for future research.
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Affiliation(s)
- Anees Ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Minden, 11800, Penang, Malaysia. .,Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan.
| | - Mohamed Azmi Ahmad Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Minden, 11800, Penang, Malaysia
| | - Sabariah Noor Harun
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Minden, 11800, Penang, Malaysia
| | - Sameen Abbas
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | - Jaya Muneswarao
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Minden, 11800, Penang, Malaysia
| | | | - Rabia Hussain
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Minden, 11800, Penang, Malaysia
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Jiang Y, Liu F, Guo J, Sun P, Chen Z, Li J, Cai L, Zhao H, Gao P, Ding Z, Wu X. Evaluating an Intervention Program Using WeChat for Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17089. [PMID: 32314971 PMCID: PMC7201319 DOI: 10.2196/17089] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background The application of telemedicine in home pulmonary rehabilitation interventions for the management of patients with chronic obstructive pulmonary disease (COPD) has achieved promising results. Objective This study aimed to develop a WeChat official account (Pulmonary Internet Explorer Rehabilitation [PeR]) based on social media. It further evaluated the effect of PeR on the quality of life, symptoms, and exercise self-efficacy of patients with COPD. Methods The functional modules of PeR were developed by a multidisciplinary team according to the electronic health–enhanced chronic care model (eCCM) components. A total of 106 patients were randomly selected (53 in the PeR group and 53 in the outpatient face-to-face group [FtF]). Pulmonary rehabilitation intervention was conducted for 3 months, and the outcome was observed for 3 months. The primary outcome was patient quality of life measured with the COPD assessment test (CAT). The secondary outcomes were evaluated using the modified Medical Research Council scale (mMRC), exercise self-regulatory efficacy scale (Ex-SRES), and St George’s Respiratory Questionnaire (SGRQ). Results The intention-to-treat analysis was used in the study. A total of 94 participants completed the 6-month pulmonary rehabilitation program. No statistically significant differences were observed in CAT (F1,3=7.78, P=.001), Ex-SRES (F1,3=21.91, P<.001), and mMRC scores (F1,3=29.64, P<.001) between the two groups with the variation in time tendency. The Ex-SRES score had a significant effect on the CAT score (P=.03). The partial regression coefficient of Ex-SRES to CAT was 0.81, and Exp (B) was 2.24. Conclusions The telemedicine technology was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy. Pulmonary rehabilitation at home through PeR and FtF could improve the sense of self-efficacy and quality of life and alleviate symptoms in patients with COPD. Trial Registration Chinese Clinical Trial Registry ChiCTR1900022770; https://tinyurl.com/tmmvpq3
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Affiliation(s)
- Yuyu Jiang
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Fenglan Liu
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jianlan Guo
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Pingping Sun
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Zhongyi Chen
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jinping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Liming Cai
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | | | - Ping Gao
- Wuxi Second Hospital of Traditional Chinese Medicine, Wuxi, China
| | | | - Xiaoliang Wu
- Huishan District Rehabilitation Hospital, Wuxi, China
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Liu F, Jiang Y, Xu G, Ding Z. Effectiveness of Telemedicine Intervention for Chronic Obstructive Pulmonary Disease in China: A Systematic Review and Meta-Analysis. Telemed J E Health 2020; 26:1075-1092. [PMID: 32069170 DOI: 10.1089/tmj.2019.0215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Telemedicine market in China has been rapidly developing. However, no systematic review has been published in China. Details of the implementation of telemedicine interventions in the chronic obstructive pulmonary disease (COPD) in China have not been described, and the effectiveness of telemedicine interventions is still unclear. Therefore, in this review, we describe the implementation details of telemedicine intervention in China and access the efficacy of telemedicine. Materials and Methods: A literature search was conducted in Embase, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), Wan Fang Data, and China Science and Technology Journal Database by July 9, 2018. Results: A total number of 24 studies were meta-analyzed. There are many differences during the implementation of telemedicine in China. Quality of life in the group of the telemedicine intervention was better than that in the control group (mean difference = -4.93 [95% confidence interval; CI -6.86 to -3.01], p < 0.00001), but the heterogeneity is high (I2 = 86%, p = 0.0001). The rates of hospitalization were lower than those in the control group (odds ratio = 0.24 [95% CI 0.20-0.29], p < 0.00001), and the heterogeneity was low (I2 = 25%, p = 0.14). Conclusion: The implementation of telemedicine in China has not yet been standardized. Nonetheless, results of our review indicated that telemedicine in China can improve the quality of life and reduce the rates of hospitalization in COPD patients.
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Affiliation(s)
- Fenglan Liu
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yuyu Jiang
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Guangqing Xu
- Huishan District Rehabilitation Hospital, Wuxi, China.,Huishan Qianzhou District Community Health Service Center, Wuxi, China
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Yang T, Cai B, Cao B, Kang J, Wen F, Yao W, Zheng J, Ling X, Shang H, Wang C. REALizing and improving management of stable COPD in China: a multi-center, prospective, observational study to realize the current situation of COPD patients in China (REAL) - rationale, study design, and protocol. BMC Pulm Med 2020; 20:11. [PMID: 31931767 PMCID: PMC6958695 DOI: 10.1186/s12890-019-1000-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 11/19/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in China with a reported prevalence of 8.2% people aged ≥40 years. It is recommended that Chinese physicians follow Global Initiative for Chronic Obstructive Lung Disease (GOLD) and national guidelines, yet many patients with COPD in China remain undiagnosed. Furthermore, missed diagnoses and a lack of standardized diagnosis and treatment remain significant problems. The situation is further complicated by a lack of large-scale, long-term, prospective studies of real-world outcomes, including exacerbation rates, disease severity, efficacy of treatment, and compliance of COPD patients in China. METHODS/DESIGN The REALizing and improving management of stable COPD in China (REAL) study is a 52-week multi-center, prospective, observational trial. REAL aims to recruit approximately 5000 outpatients aged ≥40 years with a clinical diagnosis of COPD per GOLD 2016. Outpatients will be consecutively recruited from approximately 50 tertiary and secondary hospitals randomly selected across six geographic regions to provide a representative population. Patients will receive conventional medical care as determined by their treating physicians. The primary objective is to evaluate COPD patient outcomes including lung function, health status, exacerbations, hospitalization rate, and dyspnea following 1 year of current clinical practice. Secondary objectives are to assess disease severity, treatment patterns, adherence to medication, and associated risk factors. Data will be collected at two study visits, at patients' usual care visits, and by telephone interview every 3 months. DISCUSSION Knowledge of COPD among physicians in China is poor. The REAL study will provide reliable information on COPD management, outcomes, and risk factors that may help improve the standard of care in China. Patient recruitment began on 30 June 2017 and the estimated primary completion date is 30 July 2019. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03131362. Registered on 20 March 2017.
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Affiliation(s)
- Ting Yang
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Science, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
| | - Baiqiang Cai
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Science, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
| | - Jian Kang
- Department of Respiratory Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Fuqiang Wen
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wanzhen Yao
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Jinping Zheng
- Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, 1st Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Xia Ling
- Department of Medical Affairs, AstraZeneca China, Shanghai, China
| | - Hongyan Shang
- Department of Medical Affairs, AstraZeneca China, Shanghai, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Science, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
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Yang Y, Li Q, Mao J, Mao Z. Fatigue and health‐related quality of life among patients with chronic obstructive pulmonary disease in China. CLINICAL RESPIRATORY JOURNAL 2019; 14:109-115. [DOI: 10.1111/crj.13107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ying Yang
- School of Health Sciences Wuhan University Wuhan China
- School of Nursing Tongji Medical College Huazhong University of Science & Technology Wuhan China
| | - Qianqiu Li
- Department of Cardiovascular Surgery Union Hospital Tongji Medical College Huazhong University of Science & Technology Wuhan China
| | - Jing Mao
- School of Nursing Tongji Medical College Huazhong University of Science & Technology Wuhan China
| | - Zongfu Mao
- School of Health Sciences Wuhan University Wuhan China
- Global Health Institute Wuhan University Wuhan China
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Ray R, Hahn B, Stanford RH, White J, Essoi B, Hunter AG. Classification of Patients with COPD on LAMA Monotherapy Using the GOLD Criteria: Analysis of a Claims-Linked Patient Survey Study. Pulm Ther 2019; 5:191-200. [PMID: 32026409 PMCID: PMC6967324 DOI: 10.1007/s41030-019-00099-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To address the burden of chronic obstructive pulmonary disease (COPD), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends treatment according to classification of patients by symptom severity and exacerbation risk. This post hoc analysis of a previously reported claims-linked, cross-sectional survey [study 205862 (HO-16-16642)] classified patients with COPD receiving long-acting muscarinic antagonist (LAMA) monotherapy based on the GOLD 2017 categories. METHODS Eligible patients who were ≥ 40 years of age, with ≥ 2 claims with International Classification of Diseases-10th Revision-Clinical Modification COPD diagnosis codes J40-J44 ≥ 30 days apart during the 12-month baseline period, and ≥ 2 claims for LAMA monotherapy in the 6 months prior to identification, were identified using claims data from the Optum Research Database. Patients completed a survey assessing modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT) scores and demographics; clinical characteristics were assessed from claims and survey data, while exacerbation history was assessed from claims data. GOLD symptom severity classifications were low (groups A and C) for patients with low scores on both the CAT and mMRC scales (scores of < 10 and 0-1, respectively), and high (groups B and D) for patients with high scores on either scale (scores of ≥ 10 and 2-4, respectively). RESULTS Of 433 patients included, 85.5% reported a CAT total score ≥ 10, and 45.5% reported mMRC grades 2-4. During the baseline period, 63.7% of patients had ≤ 1 moderate and 0 severe (hospitalized) exacerbations, and 36.3% had ≥ 1 severe or ≥ 2 moderate exacerbation(s). The proportions of patients with each GOLD classification were: A: 9.0%; B: 54.7%; C: 4.6%; D: 31.6%. CONCLUSIONS In this population, over 85% of LAMA monotherapy users have symptoms and/or exacerbation risk that may necessitate therapy escalation according to 2017 GOLD guidelines. FUNDING GlaxoSmithKline [study 205862 (HO-16-16642)].
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Affiliation(s)
- Riju Ray
- US Medical Affairs, GSK, Research Triangle Park, NC, USA
| | - Beth Hahn
- US Value Evidence and Outcomes, GSK, Research Triangle Park, NC, USA.
| | | | - John White
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Breanna Essoi
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
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Hahn B, Stanford RH, Hunter AG, White J, Essoi B, Ray R. Predictors of Symptom Burden in Patients with COPD on LAMA Monotherapy: Multivariable Analysis of a Claims-Linked Survey Study. Pulm Ther 2019; 5:179-190. [PMID: 32026410 PMCID: PMC6967173 DOI: 10.1007/s41030-019-00098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Many patients with chronic obstructive pulmonary disease (COPD) prescribed long-acting muscarinic antagonist (LAMA) monotherapy remain symptomatic. This multivariable analysis of a previously reported claims-linked, cross-sectional survey assessed symptom burden measured by the COPD assessment test (CAT) in patients treated with LAMA monotherapy. METHODS Eligible patients aged ≥ 40 years with COPD (≥ 2 International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] diagnosis codes ≥ 30 days apart during the 12-month baseline period) and ≥ 2 claims for LAMA monotherapy in the latter half of the baseline period were identified using claims data from the Optum Research Database. Patients completed a survey and 7-day daily diary; baseline clinical characteristics and resource utilization were assessed from claims data. Association between symptom burden and baseline characteristics was assessed using generalized linear regression modeling with normal distribution and identity link. RESULTS Overall, 433 patients prescribed LAMA monotherapy with claims-linked survey and diary data were included in the analysis. Most patients (85.5%) had a mean CAT score ≥ 10; 39.0% had scores ≥ 21. Overall, the factors most related to a clinically meaningful increase in CAT score (≥ 2 points) were being diagnosed with COPD for > 5 years and being a current smoker (2.25 points, P = 0.003 and 2.22 points, P = 0.025, respectively). CONCLUSIONS Results demonstrate that many patients with COPD receiving LAMA monotherapy remain symptomatic, especially those diagnosed > 5 years ago or those who continue to smoke. Use of patient-reported outcomes such as the CAT should be considered part of routine visits for patients with COPD. FUNDING GlaxoSmithKline (GSK study number 205862 [HO-16-16642]).
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Affiliation(s)
- Beth Hahn
- US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA.
| | - Richard H Stanford
- US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA
| | - Alyssa Goolsby Hunter
- Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - John White
- Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Breanna Essoi
- Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Riju Ray
- US Medical Affairs, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA
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Hao W, Li M, Zhang C, Zhang Y, Du W. Increased levels of inflammatory biomarker CX3CL1 in patients with chronic obstructive pulmonary disease. Cytokine 2019; 126:154881. [PMID: 31629111 DOI: 10.1016/j.cyto.2019.154881] [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: 06/07/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the concentration of CX3CL1 in serum of patients with chronic obstructive pulmonary disease (COPD), and to evaluate the associations between the CX3CL1 level and systemic inflammation, small airway obstruction, and COPD assessment test (CAT) scores in COPD patients. METHODS Enzyme-linked immunosorbent assay were utilized to detect the CX3CL1 protein in serum separately from 64 patients with COPD and 53 healthy controls. RESULTS Compared with healthy non-smokers, healthy smokers and COPD non-smokers, serum CX3CL1 protein levels were significantly elevated in COPD smokers (258.33 ± 56.27 pg/mL versus 177.32 ± 43.21 pg/mL, 185.64 ± 47.03 pg/mL, and 226.55 ± 51.79 pg/mL, P < 0.05). Correlation analysis indicated that serum CX3CL1 in COPD smokers was negatively correlated with FEV1/FVC (justified r = -0.319, P < 0.001), FEV1/Pre (justified r = -0.476, P < 0.001), FEV3/FVC (justified r = -0.354, P < 0.001), MMEF25-75/Pre (justified r = -0.428, P < 0.001), but positively correlated with CRP (justified r = 0.331, P < 0.001) and MMP-12 (justified r = 0.352, P < 0.001). However, our results showed no significant correlation between serum CX3CL1 of COPD smokers and the diffusing capacity of the lung for carbon monoxide (DLCO) (justified r = 0.0397, P = 0.6025), but a positive correlation with COPD assessment test (CAT) scores (justified r = 0.367, P < 0.001). Finally, through multivariate linear analysis, statistical results demonstrated age (β = -0.2694, P = 0.005), FEV1/Pred (β = -0.2653, P = 0.003), CRP (β = 0.1427, P = 0.0478) and MMP-12 (β = 0.430, P < 0.001) are independent parameters associated with CX3CL1. CONCLUSION The results demonstrated that elevated circulating CX3CL1 level is associated with the systemic inflammation, small airway obstruction, and CAT scores in COPD patients, suggesting that CX3CL1 may play crucial roles in the pathogenesis of COPD. Blocking CX3CL1 might prevent the progression of chronic obstructive pulmonary disease.
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Affiliation(s)
- Wendong Hao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, PR China; Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yan'an University, Yan'an 716099, Shaanxi Province, PR China
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, PR China.
| | - Cailian Zhang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yan'an University, Yan'an 716099, Shaanxi Province, PR China
| | - Yunqing Zhang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yan'an University, Yan'an 716099, Shaanxi Province, PR China
| | - Weiping Du
- Clinical Laboratory Diagnosis Department, The Affiliated Hospital of Yan'an University, Yan'an 716099, Shaanxi Province, PR China
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De la Rosa Carrillo D, Olveira C, García-Clemente M, Girón-Moreno RM, Nieto-Royo R, Navarro-Rolon A, Prados-Sánchez C, Sibila O, Martínez-García MÁ. COPD Assessment Test in Bronchiectasis: Minimum Clinically Important Difference and Psychometric Validation: A Prospective Study. Chest 2019; 157:824-833. [PMID: 31446064 DOI: 10.1016/j.chest.2019.08.1916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Health-related quality of life (QoL) is one of the most important end points in bronchiectasis (BE). However, the majority of health-related QoL questionnaires are time-consuming or not validated in BE. The COPD Assessment Test (CAT) is an easy-to-use questionnaire. The objective of this study was to perform a complete validation of the CAT in BE. METHODS This was an observational, multicenter, prospective study in patients with BE. Psychometric properties of the CAT were measured: internal consistency (Cronbach α), repeatability (test-retest; intraclass correlation coefficient), discriminant validity (correlation with severity scores), convergent validity (correlation with some validated QoL questionnaire and other clinical variables of interest), longitudinal validity (measuring before and after each exacerbation during follow-up to determine the sensitivity to change and responsiveness), predictive validity to future exacerbations, and finally minimum clinically important difference. RESULTS Ninety-six patients were included and followed up for 1 year. Their mean age was 62.2 (15.6) years (79.2% women). The CAT showed excellent internal consistency (α, 0.95) and repeatability (intraclass correlation coefficient, 0.95). The validity of the CAT was excellent in all the measures (almost all with a Pearson coefficient > 0.40) except for the correlations with severity scores (Pearson coefficient between 0.22 and 0.26). Sensitivity to change before and after exacerbations was set at between 5.4 and 5.8 points. A CAT value ≥ 10 points showed prognostic value for patients with more than one exacerbation, and finally the minimum clinically important difference was set at 3 points. CONCLUSIONS The CAT presented excellent psychometric properties and is a questionnaire that is easy to use and interpret in patients with BE.
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Affiliation(s)
| | - Casilda Olveira
- Pneumology Service, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain.
| | | | | | - Rosa Nieto-Royo
- Pneumology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Oriol Sibila
- Pneumology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Hirai K, Tanaka A, Homma T, Kaneko K, Uno T, Sato H, Manabe R, Ohta S, Kusumoto S, Yamaguchi F, Suzuki S, Sagara H. Comparison of three frailty models and a sarcopenia model in elderly patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2019; 19:896-901. [PMID: 31309700 DOI: 10.1111/ggi.13740] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/11/2022]
Abstract
AIM Frailty and sarcopenia affect the prognosis and quality of life of patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain which model is the most suitable for evaluating vulnerability in patients with COPD. We evaluated the validity of three frailty models - the Kihon Checklist (KCL), the Japanese version of the Cardiovascular Health Study and the Study of Osteoporotic Fractures - and one sarcopenia model for older patients with COPD. METHODS This cross-sectional study included 201 older (aged ≥65 years) outpatients with COPD. We used three frailty models and one sarcopenia model to identify their correlation with various indices that can evaluate the status of COPD and determine the most ideal model for evaluating vulnerability in patients with COPD. RESULTS The highest prevalence of frailty (38%) and lowest prevalence of robustness (26%) were observed using the KCL. Although all models reflected the characteristics of COPD, the KCL yielded the strongest correlations with clinically important physical, psychological and prognostic indices. The KCL yielded statistically significant differences in almost all indices among the three intergroup comparisons (robust, pre-frailty and frailty). The KCL was superior in extracting mood disorders to the other models. CONCLUSION Although all investigated models were useful, the KCL was the most suitable for evaluating the frailty status and might enable interventions in patients with COPD. Geriatr Gerontol Int 2019; 19: 896-901.
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Affiliation(s)
- Kuniaki Hirai
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Keisuke Kaneko
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoki Uno
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Haruna Sato
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Ryo Manabe
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Shin Ohta
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Sojiro Kusumoto
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Fumihiro Yamaguchi
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Shintaro Suzuki
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
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Yang L, Zhu Y, Huang JA, Jin J, Zhang X. A Low Lean-to-Fat Ratio Reduces the Risk of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients with a Normal or Low Body Mass Index. Med Sci Monit 2019; 25:5229-5236. [PMID: 31302663 PMCID: PMC6647929 DOI: 10.12659/msm.914783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Increased risk of acute exacerbation of chronic obstructive pulmonary disease (COPD) has been reported in patients who are overweight and obese. However, the effects of body fat in patients with normal or low body mass index (BMI) and COPD remain unknown. This study aimed to examine the association between acute exacerbations of COPD and the lean-to-fat (LTF) ratio in patients with a normal or low BMI. Material/Methods Patients with COPD (n=68) underwent assessment of body composition, in whom 43 cases had a normal BMI (18.5 to 25 kg/m2) and 14 cases were underweight (<18.5 kg/m2). Patients with COPD were treated according to current clinical guidelines and underwent regular follow-up for one year. Acute exacerbations of COPD were recorded. Results BMI, the fat-free mass index (FFMI), skeletal muscle mass index (SMMI), and LTF ratio had no significant effect of the risk of acute exacerbations of COPD in the whole study cohort, but a low LTF ratio was significantly associated with reduced risk of acute exacerbations of COPD in the subgroup with a BMI<25 kg/m2 (OR=4.528; P<0.05). The Fat Mass Index (FMI) had a protective effect in the whole cohort (OR=0.292; P=0.024) and in the subgroup with BMI <25 kg/m2 (OR=0.253, P=0.049). The cumulative incidence of acute exacerbations of COPD was significantly increased in the patients with a high LTF ratio in the whole cohort (P=0.047) and in the subgroup with BMI <25 kg/m2 (P=0.014). Conclusions In patients with BMI <25 kg/m2, the LTF ratio was positively correlated with the risk of occurrence of acute exacerbations of COPD.
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Affiliation(s)
- Lingyi Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Yehan Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jian-An Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jianqiang Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xiuqin Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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