Effectiveness of Standard Treatment Outcome for Different Stages of Chronic Obstructive Pulmonary Disease Patients: Role of 6 Minute Walk Test

ABSTRACTBackground: Chronic Obstructive Pulmonary Disease (COPD)is defined as a avertible and curable disease characterized by“persistent airflow limitation” that is usually advanced andassociated with an heightened chronic inflammatory responsein the airways, and the lung tonoxious particles or gases.Habitual smoking of cigarette represents the most significantrisk for impeding COPD, as well as low birth weight, recurrentinfections, indoor air pollution with biomass fuel, low socioeconomic status, occupational exposure such as xoal dust,silica, cadmium etc, Different stages of COPD based on postbronchodilator FEV1, in patients with FEV1/FVC <0.70.Aim: To find out the effectiveness of the combined treatmentoutcomes by studying the patients with different stages ofseverity of Chronic Obstructive Pulmonary Disease.Methods: A Prospective study was carried out during theperiod from 1stJune 2018 to 31st December 2018 in theoutpatients department (OPD) of Patuakhali 250 Bed SadarHospital, Patuakhali. One Hundred and Fifty COPD patientswere included in this study. The study was conducted bymeasuring the response of patients with by following the “6Minute Walk Test” or

Correlation between 6-minute walk distance and spirometry parameters in stable chronic obstructive pulmonary disease patients

Background: Six minute walk test (6MWT) is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. It is simple, objective and reproducible test. The present study was designed to assess correlation of six minute walk test with spirometry parameters, in patients with chronic obstructive pulmonary disease.Methods: In this cross sectional study, fifty patients diagnosed with chronic obstructive pulmonary disease (GOLD criteria) coming to tertiary center were recruited according to inclusion and exclusion criteria. All patients underwent spirometric measurement. Spirometric indices including FEV1, FVC, FEV1/FVC and MVV were tested using computerized spirometer. 6MWT was performed following American Thoracic Society (ATS) guidelines. Percent (%) predicted 6MWD was calculated. Correlation between spirometry and 6MWT was assessed.Results: It was found that correlation between 6MWT and spirometry is statistically significant. There is significant strong positive correlation between percent predicted 6MWD and FEV1 (r=0.850 and p= <0.001), whereas there is significant moderate correlation between percent predicted 6MWD and FVC (r=0.554 and p= <0.001), FEV1/FVC (r=0.509 and p= <0.001) and MVV (r=0.615 and p= <0.001).Conclusions: In chronic obstructive pulmonary disease, percent predicted 6mwd significantly correlated with the spirometry parameters (FEV1, FVC, FEV1/FVC, and MVV). 6MWD decreases as there is decline in the pulmonary function. 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.

Effects of smoking cessation on pulmonary function and quality of life

Background: Cigarette smoking is a major public health problem and is the most important cause of chronic obstructive pulmonary disease (COPD). This study shows the importance of smoking cessation for improvement in respiratory function and quality of life and brings out the potential usage of pharmacological and behavioural therapy for the same.Methods: This prospective study was conducted on 50 male smokers at Kilpauk Medical College, Chennai. During the treatment only 43 patients were continued till the end of follow up. During the period, varenicline treatment was given for three months as per schedule, regular periodic counselling was given to these patients and followed up for a period of 1 year. Forced expiratory volume at one second (FEV1), COPD assessment test (CAT) scoring, 6 min walk test (6MWD), BODE index, was taken before starting therapy and on 3rd month and at the end of one year of follow-up. All the values obtained were analysed statistically.Results: The mean age of the 43 patients was 44.7±7.34, mean BMI was 22.27±4.24. The mean difference between pre and post treatment scores of CAT, 6MWD and BODE index were found to be statistically significant (p<0.0001).Conclusions: Combined behavioural counseling and pharmacotherapy with varenicline significantly improved the odds of achieving tobacco abstinence in the participants by the end of one year of treatment.

Correlation of grade of pulmonary artery pressure with six minutes walk distance and dyspnoea grading in group 3 pulmonary artery hypertension

Background: Pulmonary Artery Hypertension (PAH) is defined as mean pulmonary artery pressure greater than 25 mmHg at rest as assessed by Right heart catheterization. 1 PAH secondary to lung disease is categorized under Group 3 PAH according to WHO classification, the major causes being COPD, ILD, OSA etc. Only few studies have analyzed the clinico-radiological profile, severity, morbidity and mortality associated with group 3 PAH. Hence this study was undertaken to study the clinic-radiological and functional profile of patients with group 3 pulmonary hypertension and to correlate grade of PAH with six-minute walk distance (6MWD) and Dyspnoea grading by modified Medical Research Council (mMRC). Primary objective was to correlate grade of PAH with 6MWD and dyspnoea grading (mMRC) in group 3 pulmonary artery hypertension. Secondary objective was to study the clinic- radiological and functional profile of patients with group 3 pulmonary hypertension in a tertiary care centre.Methods: Seventy two patients diagnosed to have PAH by 2D ECHO with underlying lung disease were retrospectively analyzed in Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai. Their demographic data, clinical history, examination, Dyspnoea according to MMRC grading, Chest X ray, CT chest, ECG, 2D ECHO (using VIVID 5), PFT (Easy on PC 2700-1-01. EOPC SN 219295, ATS guidelines), six minute walk test (ATS guidelines) and other Special investigations like CT Pulmonary Angiogram, Polysomnography were included wherever necessary.Results: Out of the 72 patients with group 3 PAH 44.4% belong to the age group of 46-65 years with a mean age of 57.59�.6 years along with a slight male preponderance. The commonest cause being COPD (27.7%) followed by ILD (15.30%) and Bronchiectasis (5.50%) and the combined etiology contributing to 48.8%. There was a statistically significant positive correlation between grade of PAH and mMRC score (p< 0.05) and significant negative correlation between grade of PAH with 6MWD and FEV1 (p <0.05).Conclusions: This study shows that Simple bed side tools like 6MWD and mMRC score can be used for the evaluation of presence and severity of Group 3 PAH.

The value of pulmonary rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease / 天津医药

Objective To observe the effect of early pulmonary rehabilitation (PR) on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods AECOPD patients (n=97) were randomly distributed into two groups:control group (n=39) and rehabilitation group (n=58). Patients in both groups were assessed when symptom im?proved from acute phase (baseline, T1). Then patients in control group only received pharmaco-therapy and rehabilitation ed?ucation without PR. When symptom was relieved and stable (T2), they were given 12 weeks PR (T3). On the other hand, pa?tients in rehabilitation group underwent a 12-week PR after T1 directly (T2). The lung function parameters, 6 min walking distance (6MWD), MRC scores and CAT scores were observed and analyzed in two groups. Results Until the end of the 12-weeks observation, the value of lung function showed no statistic differences between two groups(either T1 in control group vs T1 in PR group or T2 in PR group vs T2 and T3 in control group. In control group, the value of 6MWD scores of T3 was bet?ter than that of T1 and T2, in PR group(F6MWD=8.762,FMRC=4.432,FCAT=10.266,P<0.05)while MRC, CAT value in T3 of control group were higher than those in T1 and T2 of PR group. At T1, parameters does not demonstrate significant difference between these two groups. Value of 6MWD was higher while MRC and CAT were lower in T2 of PR group than that in T2 and T3 of control group. Conclusion Early pulmonary rehabilitation could improve the mobility and qulity of life, as well as ameliorate the severity of dyspnea in AECOPD patients.

Análise dos resultados de um programa de reabilitação pulmonar em portadores de doença pulmonar obstrutiva crônica / Analysis of results of a pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease

Introdução: A doença pulmonar obstrutiva crônica (DPOC) é uma doença caracterizada por alterações estruturais no parênquima pulmonar, cursando com manifestações sistêmicas. Como forma de tratamento, é indicado Programa de Reabilitação Pulmonar (PRP). O objetivo da pesquisa foi analisar os resultados de um PRP para portadores de DPOC, avaliando a capacidade de exercício, a qualidade de vida e o estado nutricional. Métodos: Estudo prospectivo tipo antes e depois, com 78 portadores de DPOC. Foram analisadas as seguintes variáveis: Teste de Caminhada de 6 minutos (TC6), Índice de Massa Corporal (IMC) e Questionário de Qualidade de Vida do Hospital Saint George (QQVSG). Resultados: Os pacientes eram na maioria do sexo masculino (56,41%), com uma idade média de 63,56 ± 8,13 anos. A maioria dos pacientes foi classificada no estádio III do GOLD (38,46%). Em relação à qualidade de vida, ocorreu uma melhora clinicamente significativa, com redução de 4% em todos os domínios, conforme os resultados pré e pós-PRP, respectivamente (47,96 ± 15,78 vs 33,65 ± 13,80), no total, no domínio sintomas (46,80 ± 19,16 vs 37,06 ± 17,57), impacto (32,87± 17,26 vs18,74 ± 14,05), atividades (69,21 ± 22,48 vs 56,14 ± 20,53). O IMC não sofreu modificação (25,45 ± 4,92 vs 25,46 ± 4,80). No TC6 obteve-se uma melhora significativa na distância percorrida (375,35 ± 95,84 m vs 420,80 ± 87,92m~ p=0,001). Conclusão: O PRP resultou numa melhora clinicamente significativa da qualidade de vida e na capacidade de exercício neste grupo de pacientes portadores de DPOC

Introduction: Chronic obstructive pulmonary disease (COPD) is a disorder characterized by structural changes to the lung parenchyma, coursing with systemic manifestations. Pulmonary Rehabilitation Program (PRP) is indicated as a form of treatment. The aim of this study was to analyze the outcomes of a PRP for COPD patients by assessing their exercise capacity, quality of life, and nutritional status. Methods: A pre- and post-PRP prospective analysis of 78 patients with COPD. We analyzed the following variables: Six Minutes Walk Test (6MWT), body mass index (BMI), and Saint George’s Respiratory Questionnaire (SGRQ) as a measure of the quality of life. Results: Patients were mostly males (56.41%), with mean age of 63.56 ± 8.13 years. Most patients were classified in stage III GOLD (38.46%). There was a clinically significant improvement in patients’ quality of life, with a 4% reduction in all domains, according to the results before and after PRP, respectively (47.96 ± 15.78 vs. 33.65 ± 13.80) overall, and in the symptoms (46.80 ± 19.16 vs. 37.06 ± 17.57), impact (32.87 ± 17.26 VS18, 74 ± 14.05), and activity (69.21 ± 22.48 vs 56.14 ± 20.53) domains. BMI remained unchanged (25.45 ± 4.92 vs. 25.46 ± 4.80). In the 6MWT a significant improvement in the walked distance was obtained (375.35 ± 95.84 m vs. 420.80 ± 87.92 m, p = 0.001). Conclusion: The PRP resulted in clinically significant improvement in the quality of life and exercise capacity in this group of patients with COPD

The six-minute walk test and body weight-walk distance product in healthy Brazilian subjects

We assessed the 6-min walk distance (6MWD) and body weight x distance product (6MWw) in healthy Brazilian subjects and compared measured 6MWD with values predicted in five reference equations developed for other populations. Anthropometry, spirometry, reported physical activity, and two walk tests in a 30-m corridor were evaluated in 134 subjects (73 females, 13-84 years). Mean 6MWD and 6MWw were significantly greater in males than in females (622 ± 80 m, 46,322 ± 10,539 kg.m vs 551 ± 71 m, 36,356 ± 8,289 kg.m, P < 0.05). Four equations significantly overestimated measured 6MWD (range, 32 ± 71 to 137 ± 74 m; P < 0.001), and one significantly underestimated it (-36 ± 86 m; P < 0.001). 6MWD significantly correlated with age (r = -0.39), height (r = 0.44), body mass index (r = -0.24), and reported physical activity (r = 0.25). 6MWw significantly correlated with age (r = -0.21), height (r = 0.66) and reported physical activity (r = 0.25). The reference equation devised for walk distance was 6MWDm = 622.461 - (1.846 x Ageyears) + (61.503 x Gendermales = 1; females = 0); r2 = 0.300. In an additional group of 85 subjects prospectively studied, the difference between measured and the 6MWD predicted with the equation proposed here was not significant (-3 ± 68 m; P = 0.938). The measured 6MWD represented 99.6 ± 11.9 percent of the predicted value. We conclude that 6MWD and 6MWw variances were adequately explained by demographic and anthropometric attributes. This reference equation is probably most appropriate for evaluating the exercise capacity of Brazilian patients with chronic diseases.

The benefit of pulmonary rehabilitation against quality of life alteration and functional capacity of chronic obstructive pulmonary disease (COPD) patient assessed using St George’s respiratory questionnaire (SGRQ) and 6 minutes walking distance test (6MWD).

Patients with chronic obstructive pulmonary disease (COPD) have been shown to be benefit from pulmonary rehabilitation programs. We assessed an entirely outpatient-based program of pulmonary rehabilitation in patients with COPD, using the St George’s Respiratory Questionnaire (SGRQ) and six minutes walking distance test (6MWD) (which measures health-related quality of life and functional exercise tolerance) as the primary outcome measure. We undertook a randomized, opened, prospective, parallel-group controlled study of outpatient rehabilitation program in 56 patients with COPD (52 men and 4 women). The active group (n=27) took part in a 6-weeks program of education and exercise. The control group (n=29) were reviewed routinely as medical outpatients. The SGRQ and 6MWD were administered at study entry and after 6 weeks. Outcome with SGRQ and 6MWD before and after therapy was performed. Decrease score SGRQ and increase 6MWD in both groups of study, it was analyzed by statistic study and in active group the decrease of SGRQ and the increase of 6MWD was statistically significant. In conclusion 6-weeks outpatient-based program significantly improved quality of life and functional capacity in mild-to-moderate COPD patient.