Assessment of Quality of Life in Asthmatic Patients on Inhaled Corticosteroids: An Observational Study

Introduction: Corticosteroids play a pivotal role in thetreatment of the asthma. They rapidly reduce the numberof eosinophils in the blood and tissues and inhibit theirdegranulation, suggesting that sputum eosinophilia could be agood predictor of response to inhaled corticosteroids. Chronicdiseases like asthma have significant effects on patients'health-related quality of life (HRQoL). HRQoL measuresadditional indices as compared to objective measurements likespirometry. Objective: To assess and compare disease-specificquality of life in asthma patients using St. George's RespiratoryQuestionnaire (SGRQ) receiving inhaled corticosteroids.Material and Methods: Patients were enquired for theirduration of illness, other co morbidities (if present), historyof smoking and familial history of the illness. Pattern ofasthma was duly assessed. For Health-related Quality oflife assessment, Saint George’s Respiratory Questionnaire(SGRQ) was used in the study after obtaining due permissionfrom the concerned authority at St George’s, University ofLondon.Results: Mean age of the study population was found tobe 36.17 ± 18.77 years. Mean duration of illness for theasthmatics was 10.19 ± 11.08 years. Majority i.e. 69% deniedof having any familial history of asthma, while 31% confirmedhaving the same. Smoking status was enquired among thestudy subjects, which revealed that 85% were non-smokers,while 9% were past smokers and 6% were current smokers.Pattern of asthma was found to be seasonal for 65% patientswhile perennial for 35% patients. Baseline symptoms scorewas 61.45± 15.78, which was reduced to 48.19±18.73 after 3months on inhaled corticosteroids therapy. Baseline activityscore was 49.67± 15.34, which was reduced to 41.51±18.52after 3 months on inhaled corticosteroids therapy. Baselineimpact score was 48.79± 16.85, which was reduced to38.69±18.14 after 3 months on inhaled corticosteroids therapy.Conclusion: There was evidence for an early QoLimprovement on inhaled corticosteroids in moderate andsevere persistent asthma.

Assessment of the correlates of respiratory morbidity related quality of life, using St George Respiratory Questionnaire (SGRQ) among male COPD patients

Background: COPD is ranked eighth among the top 20 conditions causing disability globally. Assessment in subjective areas such as dyspnea and HRQL provides complementary information to physiologic measurements. Lower Health-Related Quality of Life has been associated with mortality and morbidity in COPD.Methods: The study was conducted at the Department of Respiratory Medicine and at Vallabhbhai Patel Chest Institute and the associated, Vishwanathan Chest Hospital, University of Delhi. Between September 2012 to August 2013. We conducted present study on 40 male COPD subjects aged more than 45 years, divided into 4 groups based on CT phenotype as normal, Airway Dominant (AD), Emphysema Dominant (ED) and mixed types. We compared the St. George Respiratory Questionnaire scores, 6 Minutes’ walk Distance scores, Clinical parameters, Spirometry indices across these phenotypes. Results: The mean SGRQ score in present study was 54.07 ± 17.24 (Range :17.3 to 84.57). The Mean 6MWD in present study was 434.58 ± 125.47 metres. The significant parameters which had correlation with SGRQ total score were Age (r=0.343, p = 0.03), 6MWD (-0.397, p = 0.011), FEV1 /FVC (0.499, p< 0.001), DLCO (-0.601, p <0.001), Low attenuation areas in CT (0.606, p< 0.001). Conclusions: 6MWD, FEV1/FVC, age, Low attenuation areas in CT, DLCO had an influence on the quality of life as measured by SGRQ scores in present study. Therapeutic approaches to improve the quality of life in COPD should take these indices into consideration.

Evaluation for airway obstruction in adult patients with stable ischemic heart disease

Background Ischemic heart disease (IHD) and chronic airway disease (COPD and Asthma) are major epidemics accounting for significant mortality and morbidity. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. There is a need for airway evaluation in these patients to plan appropriate management. Methods Consecutive stable IHD patients attending the cardiology OPD in a tertiary care centre were interviewed for collecting basic demographic information, brief medical, occupational, personal history and risk factors for coronary artery disease and airway disease, modified medical research centre (MMRC) grade for dyspnea, quality of life-St. George respiratory questionnaire (SGRQ), spirometry and six-min walk tests. Patients with chronic airway obstruction were treated as per guidelines and were followed up at 3rd month with spirometry, six-minute walk test and SGRQ. Results One hundred fourteen consecutive patients with stable cardiac disease were included (Males-88, Females-26). Mean age was 58.89 ± 12.24 years, 53.50% were smokers, 31.56% were alcoholics, 40.35% diabetics, 47.36% hypertensive. Twenty five patients had airway obstruction on spirometry (COPD-13 and Asthma-12) and none were on treatment. Thirty-one patients had cough and 48 patients had dyspnea. Patients with abnormal spirometry had higher symptoms, lower exercise tolerance and quality of life. Treatment with appropriate respiratory medications resulted in increase in lung function, quality of life and exercise tolerance at 3rd month. Conclusion Chronic respiratory disease in patients with stable IHD is frequent but often missed due to overlap of symptoms. Spirometry is a simple tool to recognize the underlying pulmonary condition and patients respond favorably with appropriate treatment

Evaluation of respiratory impairment and health related quality of life in pulmonary tuberculosis sequelae patients

Background: Pulmonary tuberculosis is a common disease that can result in residual anatomical and functional changes despite microbiological cure. But the ideal method to identify and evaluate persons with pulmonary impairment after tuberculosis and its impact on population health are unknown. Hence the study was conducted with the aim of the present study was to Evaluate the respiratory and cardiac impairment and to assess the health related quality of life in pulmonary tuberculosis sequelae patients.Methods: This observational study was conducted on 200 patients randomly at the Institute of thoracic medicine at Chetpet and Rajiv Gandhi government general hospital, Chennai during a period of 6 months from April 2013 to October 2013. All patients were investigated for sputum for acid fast Bacillus, chest skiagram, spirometry, electrocardiogram, echo, six minute walk test and St. George respiratory questionnaire.Results: In this study, spirometry abnormalities were present in 81% of patients. No significant correlation observed between smoking index and pulmonary function abnormality (0.145). However, moderate correlation was seen between radiology and pulmonary function abnormality (0.307). 98% of the patients showed diminished exercise capacity. The prevalence of corpulmonale was increased with the degree of radiological impairment progress from grade 1 to 3 with a moderate correlation (0.385). No significant correlation (0.198) was noticed between the parameters smoking index and exercise capacity. The overall SGRQ scores mean (SD) were 54�.5, 41.7�.7, 28.9�.6 and 37.0�.1 for the symptom, activity, impact and overall scales respectively. No significant relationship was noticed between smoking index and SGRQ total score (p=0.512).Conclusions: The present study confirms that there is significant functional limitation in pulmonary sequelae, addressing the need of pulmonary rehabilitation for better quality of life. Smoking cessation therapy all can improve their quality of life after pulmonary impairment. Cardiac evaluation must be done in all post tuberculosis patients to rule out corpulmonale.

Clinical Efficacy of Budesonide and Formoterol Fumarate Powder in the Treatment of Patients with Bronchial Asthma and Its Effect on the Serum Levels of Inflammatory Factors / 现代生物医学进展

Objective:To explore the clinical efficacy of Budesonide and Formoterol Fumarate Powder in the treatment of patients with bronchial asthma and its effect on the serum levels of inflammatory factors.Methods:123 cases treated and diagnosed as bronchial asthma in our hospital from February,2014 to February,2016 were randomly divided into the observation group (65 cases) and control group (58 cases).The serum levels of IL-17,IL-33,MMP-9,pulmonaryfunction,quality of life,total effective rate and incidence of adverse reactions were compared between the two groups.Results:The total effective rate of observation group was 92.3％,which was significantly higher than that of the control group (81.03％,P＜0.05).After therapy,the serum level ofIL-17,IL-33 in both groups were largely decreased compared with those before therapy (p＜0.05),and those of observation group were significantly lower than the control group (p ＜0.05);the serum level of MMP-9 in both groups showed no statistical difference compared with that of before therapy.Similarly,the level of FEV1,PEF and FEV1/FVC of observation group were obviously increased compared with those before therapy (p＜0.05) and were significantly higher than those of the control group (p＜0.05);the quality of life in the observation group was better than that of the control group based on the SGRQ score (p ＜0.05).Conclusion:Budesonide and Formoterol Fumarate Powder was effective on the patients with chronic bronchial asthma,which could control the inflammatory reactions,improve the pulmonary function as well as the quality of life.

Reliability and Validity of the Malay Version Chronic Respiratory Questionnaire for used among COPD Patients

Introduction: Chronic Respiratory Questionnaire (CRQ) is one of the disease-specific questionnaires to assess health related quality of life (HRQoL) among chronic obstructive pulmonary disease (COPD) patients. Objectives: This study investigate the validity and reliability of Malay version CRQ among COPD patients. Methods: The CRQ was administered twice to 46 patients with COPD (mean FEV1 44% predicted, FEV1/ IVC 37% predicted) from Medical Center of University Kebangsaan Malaysia (PPUKM).Test-retest reliability was assessed using intra-class correlation coefficients (ICC). Internal consistency was determined using Crohnbach’s alpha coefficients (α = 0.7). Spearman’s correlation coefficient was done among the scores of CRQ, St George Respiratory Questionnaire (SGRQ) and sixminute walking test (6MWT) to examine the concurrent validity of the CRQ (p 0.70) was observed for 3 domains of CRQ with exception of dyspnoea domain (α = -0.631). Test retest reliability demonstrated strong correlation (ICC >0.80). Concurrent validity of CRQ, showed significant correlations observed between domain of SGRQ’s symptom, impact and total scores of SGRQ with CRQ’s dyspnoea and emotional function (-0.3< r < -0.4; p<0.05). Significant correlation was observed between 6MWT and CRQ’s fatigue domain (r= 0.390; p=0.007). Conclusions: The Malay version of CRQ is a reliable instrument for measuring health status of patients among chronic respiratory disease especially COPD. Items of fatigue, emotion, and mastery domain of the CRQ are reliable and valid and can be used to assess quality of life in patients with severe airways obstruction. Items of the dyspnoea dimension are less reliable and should not be included in the overall score of the CRQ in comparative research.

A C OMPARISON OF SYSTEMIC AND INHALED CORTICOSTEROID THERAPY IN PATIENTS WITH EXACERBATION OF COPD / Шинэ санаа Шинэ нээлт

Objective: To compare the efficacy of systemic and inhaled corticostcroid in patients with acute exacerbation of COPD.Methods: In this randomized, parallel-group study 80 patients (average age 59,7±7.7) were randomized to receive inhaled corticosteroid (fluticasone propionate 1000-1200 meg/daily, n -40) or systemic corticosteroid (intravenous dcxamethasone 4-8 mg every 24 hours, n-40). Outcome variables included the lung function tests (FEV1, FVC, FEV1/FVC), 6MWT, and 1 Symptoms. 2. Activity and 3. Impact components of St George's Respiratory Questionnaire for t OPD patients (SGRQ-C).Results: In group with systemic corticosteroid increased the FF.V1 from 63.5±9 to 68.118.1, FVC from 78.7±11.8 to 86.6±11, FEV1/FVC from 64.918.7 to 69.917.3; score of SGRQ-C improved I.from 58.5114.3 to 31 5ÈË 2. from 60.6116.7 to 37.7117.2, 3.1'rom 44.9+14.5 to 21.5113. In group wi«fi fluticasone propionate increased the FEV1 improved from 64.719 to 68.718.5, FVC from 79.7111.3 to 88.1110.7, and FEV1/FVC from 64.9+8.6 to 69.517.5; score of SGRQ-C I .from 58.5111.1 to 36.4113,0. 2.from 59.9117.2 to 39.1 + 16.8. 3.from 45.7114.7 to 23.5+13.8. The difference in efficacy of treatment in two groups was not significant.Conclusion:I fioth inhaled and systemic GSs improve airflow and lung function test in C'OPI) patients with

Quality of life of chronic obstructive pulmonary disease patients / Монголын Анагаах Ухаан

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Pathological changes characteristic COPD are found in the proximal airways, peripheral airways, lung parenchyma, and pulmonary vasculature.GoalTo evaluate corticosteroid therapy effects in patients with acute exacerbation of COPDMaterial and MethodsWe examined the efficacy of corticosteroid (CS) therapy in 45 patients who admitted to Department of Pulmonology at Shastin`s Central Hospital during 2011-2012 and met GOLD criteria of COPD exacerbation. All patients randomly divided into two groups. Patients received from randomization inhaled corticosteroids (flixotide 1000 mcg/daily or frenolyn 800-1200 mcg/daily), systemic corticosteroid (intravenous prednisone 30- 60 mg every 24 hours). In evaluation of efficacy of treatment we use lung function tests and St George`s Respiratory Questionnaire for COPD patients (SGRQ-C).Results45 patients (average age 59, 6±7.9) were enrolled in our study. 23 patients were randomly assigned to high dose of inhaled corticosteroids (ICS), 22 to intravenous prednisone. Outcomes of treatment were evaluated by 1. Symptoms, 2. Activity and 3. Impact components of SGRQ-C and FEV1, FVC, FEV1/FVC. The difference in quality of life and lung functional tests between ICS and prednisone was not significant. Score of SGRQC in two groups improved with CS therapy from 1. 50,8±1,7 2. 63,9 ±10,7 3. 45.2±15,0 to 1. 27,3±4,2 2. 40,8±9.5 3. 22,7±9,7 The changes of lung functional tests were 1.FEV1 65,7±10,7 2.FVC 80,5±12,0 3.FEV1/ FVC 65,1±8,7 before and 1.FEV1 69,4±9,2 2.FVC 88,3±11,1 3.FEV1/FVC 69,5±7,8 after treatment. Incidence of hyperglycemia and hypertension observed with prednisone. In some patients who used ICSs we detect throat hoarse.Conclusions:1. Both inhaled and systemic GSs improve airflow and lung function test in COPD patients with acute exacerbation.2. After treatment improve quality of life in COPD patients with acute exacerbation.3. High dose of ICSs may be an alternative to systemic prednisone in the treatment of no severe acute exacerbation of COPD.

Assessment of long term status of sputum positive pulmonary TB patients successfully treated with short course chemotherapy.

Background: Long term status of pulmonary tuberculosis (PTB) patients treated with short course chemotherapy (SCC) regimens remains unknown. Objective: To assess the clinical, bacteriological, radiological status and health related quality of life (HRQoL) of PTB patients 14 -18 years after successful treatment with SCC. Methodology: In a cross-sectional study, cured PTB patients treated during 1986 – 1990 at the Tuberculosis Research Centre (TRC) were investigated for their current health status including pulmonary function tests (PFT). The St Georges respiratory questionnaire (SGRQ) was used to assess the HRQoL Results: The mean period after treatment completion for the 363 eligible participants was 16.5yrs (range 14-18 yrs, 84% coverage) ; 25 (7 %) had been re-treated and 52 (14%) died. Among the investigated, 58 (29%) had persistent respiratory symptoms; 170(86%) had radiological sequelae but none had active disease. Abnormal PFT was observed in 96 (65%) with predominantly restrictive type of disease in 66(45%). The SGRQ scores for activity and impact were high implying impairment in HRQoL. Conclusion: Assessment of long term status of cured PTB patients showed an impairment of lung functions and HRQoL highlighting the need to address these issues in the management of TB that may provide added value to patient care.

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.