Value of cardiopulmonary exercise testing in the assessment of symptoms and quality of life in Asian patients with chronic obstructive pulmonary disease

BACKGROUND

The natural course of chronic obstructive pulmonary disease (COPD) is characterized by symptom exacerbation and quality-of-life reduction. Therefore, symptoms should be properly assessed. Some studies have demonstrated a weak correlation between cardiopulmonary exercise testing (CPET) parameters and symptoms in patients with COPD; however, data on Asian patients are lacking. We investigated the value of CPET parameters in assessing symptoms and quality of life in Asian patients with COPD.

METHODS

Of 681 patients who underwent CPET at Asan Medical Center between January 2020 and June 2022, we analyzed 195 patients with COPD in this retrospective study. A cycle ergometer was used for the incremental protocol. The modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) were administered to assess the patients' symptoms.

RESULTS

The mMRC grade was related to maximal oxygen uptake (VO2 max, L/min) (Spearman's correlation coefficient ρ=-0.295, P<0.001) and physiological dead space/tidal volume ratio at peak exercise (VD/VT peak) (ρ=0.256, P<0.001). The CAT score was significantly correlated with VO2 max (L/min) (Spearman's correlation coefficient ρ=-0.297, P<0.001) and VD/VT peak (ρ=0.271, P<0.001), but had no correlation with breathing reserve (ρ=-0.122, P=0.089). The optimal cut-off values of VO2 max and VD/VT peak for predicting the onset of clinically significant dyspnea were 1.099 L/min and 0.295, respectively.

CONCLUSIONS

VO2 max and VD/VT peak comprehensively reflect the symptoms and health-related quality of life of patients with COPD.

COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV1 - a post-hoc analysis of pooled data

BACKGROUND

Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV₁₎, exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV₁, exacerbations, and PROs of patients with stable COPD.

METHODS

This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV₁ (PB-FEV₁), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used.

RESULTS

Three hundred seventy-four patients were included in the analysis. The PB-FEV₁ predicted was < 30% in 85 (22.7%), 30-49% in 142 (38.0%), 50-79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV₁ < 30% predicted had significantly more COPD exacerbations than those with PB-FEV₁ 30-49% predicted (p < 0.001), 50-79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV₁ (p = 0.121-0.271). The PB-FEV₁ predicted had significant weak negative correlations with exacerbations (r = - 0.182, p < 0.001), mMRC (r = - 0.121, p = 0.020), and SGRQ-c scores (r = - 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407-0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001).

CONCLUSIONS

In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak.

Effect of Herbal Medicine Formulation (Compound Honey Syrup) on Quality of Life in Patients With COPD: A Randomized Clinical Trial

Background

Chronic obstructive pulmonary disease (COPD) as one of the health-threatening problems imposes many economic costs on health systems. Today, there is a greater tendency to use complementary and alternative therapies in the treatment of diseases. This study aimed to evaluate the efficacy of a Persian herbal formulation in patients with COPD.

Materials and Methods

This randomized clinical trial was conducted on 76 patients with mild-severe COPD assigned to 2 groups (in each group n=38) for 8 weeks. The interventional group received Compound Honey Syrup (CHS), consisting of combination of honey and extracts of five medicinal plants (i.e., ginger, cinnamon, saffron, cardamom, and galangal) and the control group received a placebo. The COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ), and lung function test were used before and after.

Results

Seventy-six patients, 88.6% male and 55.7% under 60 years of age, completed the course of treatment. At the end of the study, the overall score of the CAT questionnaire was significantly different between the first and fourth week (P=0.029). Meanwhile the findings of SGRQ questionnaire were significantly different between the interventional and control groups at other times (P=0.001). FEV1 and FEV1/FVC were found to be significantly different between two groups in weeks 4 and 8 (P <0.05). At the end of the study, no side effects of CHS were reported.

Conclusion

Based on the data presented herein, CHS could be effective as a complementary and safe drug in increasing the quality of life of with COPD.

The impact of a personalised action plan delivered at discharge to patients with COPD on readmissions: a pilot study

Background

Self‐management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory‐related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital.

Aim

This pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3‐month follow‐up.

Methods

The study was carried out in a randomised controlled design with follow‐up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD‐related readmissions was measured as the primary outcome.

Results

Compared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS‐depression, but none in HADS‐anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy.

Conclusions

A personally tailored action plan introduced at or postdischarge combined with follow‐up support is an effective self‐management tool to support recovery and to reduce unnecessary readmissions. In future follow‐up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.

Baseline health status and setting impacted minimal clinically important differences in COPD: an exploratory study

OBJECTIVES

Minimal clinically important differences (MCIDs) are used as fixed numbers in the interpretation of clinical trials. Little is known about its dynamics. This study aims to explore the impact of baseline score, study setting, and patient characteristics on health status MCIDs in chronic obstructive pulmonary disease (COPD).

STUDY DESIGN AND SETTING

Baseline and follow-up data on the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and St. George's Respiratory Questionnaire (SGRQ) were retrospectively analyzed from pulmonary rehabilitation (PR) and routine clinical practice (RCP). Anchor- and distribution-based MCID estimates were calculated and tested between settings, gender, age, Global initiative for Obstructive Lung Disease (GOLD) classification, comorbidities, and baseline health status.

RESULTS

In total, 658 patients were included with 2,299 change score measurements. MCID estimates for improvement and deterioration ranged for all subgroups 0.50-6.30 (CAT), 0.10-0.84 (CCQ), and 0.33-12.86 (SGRQ). Larger MCID estimates for improvement and smaller ones for deterioration were noted in patients with worse baseline health status, females, elderly, GOLD I/II patients, and patients with less comorbidities. Estimates from PR were larger.

CONCLUSION

Baseline health status and setting affected MCID estimates of COPD health status questionnaires. Patterns were observed for gender, age, spirometry classification, and comorbidity levels. These outcomes would advocate the need for tailored MCIDs.

The Relationship between COPD Assessment Test (CAT) Scores and Severity of Airflow Obstruction in Stable COPD Patients

BACKGROUND

COPD is a major cause of morbidity in smokers. The COPD assessment test (CAT) is a validated test for evaluation of COPD impact on health status. CAT is not a diagnostic test and pulmonary function test (PFT) still remains the most important diagnostic test. However, its predictive value for evaluation of disease impact is weak. The purpose of this study was to determine the relationship between CAT score and PFT in COPD patients.

MATERIALS AND METHODS

We evaluated 105 patients with stable COPD. Demographic data were obtained at baseline. Severity of airflow obstruction was assessed by standard spirometry and classified by the Global initiative for Obstructive Lung Disease (GOLD) criteria. Then, the impact of COPD on health status was assessed using CAT. The CAT scores were categorized into four groups. We statistically compared the relationship between CAT score, COPD stages, CAT groups and PFT.

RESULTS

The mean age of patients and mean period of smoking (p/y) were 59.60±11.93SD and 35.43±15.33 SD yrs, respectively. The mean FEV1%predicted was 71.01±26.70SD. The mean CAT score was 19.61±8.07 SD. The correlation between the severity of smoking and GOLD classification was significant (p=0.006). There was a significant association between the FEV1%predicted and total CAT score (r= -0.55, p< 0.001). The correlation between mean FEV1%predicted and mean score of CAT groups 1, 2, 3, and 4 was statistically significant (p<0.001).

CONCLUSION

The relationship between CAT score and FEV1%predicted suggests that CAT is linked to severity of airflow limitation and GOLD classification in stable COPD patients. Health status as measured by CAT worsens with severity of airflow limitation.

Association between COPD Assessment Test (CAT) and Disease Severity Based on Reduction of Respiratory Volumes in Chemical Warfare Victims

BACKGROUND

This study aimed to find an association between the short validated patient-completed questionnaire, the COPD Assessment Test (CAT) and disease severity according to spirometric findings in chemical warfare victims.

MATERIALS AND METHODS

A total of 55 patients referred to Sasan Hospital (special complex for chemical warfare victims) were included in this survey. They completed CAT questionnaire and then spirometry was performed. According to GOLD criteria, the subjects were divided into four severity groups. All candidates were non-smoker males. They all had FEV1/FVC < 70%.

RESULTS

CAT scores varied from 5 to 39, with a mean score of 22.25. FEV1 varied from 17.5% to 89% with a mean of 53.14, and FVC ranged from 22.9% to100% with a mean of 61.12. Data analysis revealed a significant relationship between CAT and FEV1 (P = 0.01). There was also a significant relationship between CAT and FVC (P = 0.05).

CONCLUSION

Our findings show a significant association between CAT and disease severity obtained by lung function in chemical warfare victims.