Clinical Role of the Chronic Obstructive Pulmonary Disease Assessment Test in Prediction of the Response to Treatment for Exacerbations

Predictive role of interleukin-6 and CAT score in mechanical ventilation in patients with chronic obstructive pulmonary disease at the acute exacerbation stage in the emergency department / 世界急诊医学杂志（英文）

@#BACKGROUND: The study aimed to evaluate the predictive role of interleukin-6 (IL-6) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) score in mechanical ventilation (MV) in COPD patients at the acute exacerbation stage in the emergency department (ED). METHODS: For a one-year period, among adult patients in the ED who met the criteria of acute exacerbation of COPD, 158 who received MV within 48 hours after admission were compared to 294 who didn't require MV within the same period after admission. IL-6 level and CAT score were compared between the two groups. The predicted value of IL-6 and CAT score was assessed by logistic regression analysis and a receiver operating characteristic (ROC) curve. RESULTS: The IL-6 and CAT scores in the 158 MV patients were much higher than those without. IL-6 and CAT scores were independent predictors of MV within 48 hours using logistic regression analysis (IL-6: odds ratio [OR] 1.053, 95% confidence interval [CI] 1.039–1.067, P<0.001; CAT score: OR 1.122, 95% CI 1.086–1.159, P<0.001). The combination of IL-6 and CAT scores (area under ROC curve [AUC] 0.826, 95% CI 0.786–0.866, P<0.001) improved the accuracy of predicting MV within 48 hours when compared with IL-6 (AUC 0.752, 95% CI 0.703–0.800, P<0.001) and CAT scores alone (AUC 0.739, 95% CI 0.692–0.786, P<0.001). The sensitivity and specificity were 69.6%, 74.1%, 75.32% and 63.6%, respectively. CONCLUSION: The combined of IL-6 and CAT scores is useful for evaluating the risk of COPD patients at acute exacerbation in ED, and can provide a predictive value for MV or not within 48 hours.

Utilization of Chronic Obstructive Pulmonary Disease Assessment Test (CAT) in Patients with COPD in Low Resource Countries

Background:Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder commonly assessed by spirometryand health related quality of life (HRQoL) questionnaires. COPD assessment test (CAT) is a new questionnaire used for HRQoL evaluation especially in a clinic setting. Aims:To assess HRQoL using the CAT, and to determine the relationship of CAT to other measures of COPD such as pulmonary function test (PFT), dyspnea and six minutes walking distance test (6MDWT) among patients with COPD in Nigeria.Settings and Design:Cross-sectional study.Methods:Sixty stable patients with a clinical and spirometric diagnosis of COPD according to the GOLD criteria were recruited into the study. Spirometry was performed according to ATS/ERS guidelines. Health status, dyspnea and functional capacity of the patients were assessed using the CAT questionnaire, modified medical research council (MMRC) dyspnea scaleand six-minute walking distance (6MDWT) respectively.Results:The mean age was 68.8 years ± 10.3. Sixty percent of the study participants were male. The mean BMI was 21.6 ± 4.8 kg/m2, 37(61.7%) of the patients were ex-smokers, 3.3% were current smokers and 35% were never smokers. In terms of frequency of exacerbations 18.3% had ≤ 1 per year and 5.0% had ≥ 2 per year. The CAT was strongly associated with 6MWDT (r = 0.85P < 0.001), FEV1% predicted (r= 0.67, P< 0.001) and with MMRC (r=0.64, p<0.01).Conclusions:CAT scores correlated well with percent FEV1, dyspnea and exercise tolerance which measures various aspect of COPD. It may serve as an easy to administer sensitive tool in assessing stable COPD in outpatientclinics especially in low resource countries

The Relation of COPD Assessment Test (CAT) and BODE Index in Assessing Patients with COPD: Is Cat Alone Simple and Good Enough?

Chronic obstructive pulmonary disease (COPD) is a significant cause of disability and death worldwide. It is often evaluated with outcome measures like lung function test (LFT), health status and BODE (Body mass, Obstruction, Dyspnoea and Exercise capacity) index, to initiate appropriate treatment. Objectives: To determine the association between the BODE index and COPD assessment test (CAT) in COPD patients. To ascertain the utility of CAT alone as an assessment tool for COPD patients in primary care setting and low resource countries. Methods: A cross-sectional study of sixty (60) patients with clinical and lung function test diagnosis of COPD were recruited consecutively from the outpatient clinic. The body mass index (BMI) of the patients, CAT scores, modified medical research council dyspnoea scale and sixminute walk distance test (6MWDT) was assessed and recorded. The individual score was summed up to obtain the BODE index score for the particular patients. Results: The mean age was 68.8years (± 10.3). There was a strong correlation between the BODE index and CAT scores (r= 0.77 P <0.0001). Inter-rater agreement between the tools (CAT and BODE index) was moderate (k=0.46). The CAT questionnaire also correlated well with the modified medical research council dyspnea scale, the six-minute walk test and the forced expiratory volume in the first second. Conclusion: CAT can serve as a simple, easy to administer tool for the assessment of patients with COPD especially in low resource countries and primary care setting.

Modified medical research council (mMRC) e a sua relação com variáveis respiratórias e o tempo de internação em pacientes hospitalizados com doença pulmonar obstrutiva crônica / Modified medical research council (mMRC) and their relation with respiratory variables and the time of intermission in hospitalized patients with chronic obstructive pulmonary disease

Objetivo: Correlacionar a sensação de dispneia obtida pela escala Medical Research Council modificada (mMRC) com as variáveis respiratórias e o tempo de internação em portadores de doença pulmonar obstrutiva crônica (DPOC) hospitalizados. Material e Métodos: Estudo transversal de caráter observacional e descritivo; no qual participaram do estudo pacientes interna-dos na Santa Casa de Misericórdia (SCM) de Goiânia-GO e Hospital Geral de Goiânia Dr. Alberto Rassi (HGG), com diag-nóstico de DPOC. Foram coletados sinais vitais, dados antro-pométricos e aplicada a escala de mMRC. Resultados: Foram avaliados 28 participantes, com média de idade de 74,10±12,46 anos; a média de mMRC foi de 3,10±1,19, comprometimento moderado, não ocorrendo diferença de mMRC entre homens e mulheres (p=0,503), além de não ter sido encontrada cor-relação entre o mMRC com a FR (r= -0,035 p=0,864), SpO2 (r=-0,228 p=0,222) e o tempo de internação (r=0,140 p=0,486). No entanto, em relação a necessidade de internação em uni-dade de terapia intensiva e o tempo de internação na unidade houve correlação significativa (r-0,457 p<0,01 e r 0,388 p<0,04, respectivamente). Conclusão: Não se encontrou relação da sensação de dispneia com as variáveis respiratórias e o tempo de internação total, porém foi possível verificar uma correlação entre o mMRC e a necessidade de internação e o tempo de internação em unidade de terapia intensiva. (AU)

Objetive:To correlate the dyspnea syndrome with the modified Medical Research Council scale (mMRC) with the respiratory and temporal variables of hospitalization in patients with hospitalized chronic obstructive pulmonary disease (COPD). Method: Cross-sectional observational and descriptive studyin which participated patients from the Santa Casa de Misericórdia (SCM) of Goiânia-GO and the General Hospital of Goiânia Dr. Alberto Rassi (HGG), with the diagnosis of COPD. Vital signs and anthropometric data were collected and the mMRC scale was applied. Results: Twenty-eight participants were evaluated, with a mean age of 74.10 ± 12.46 years; the mean mMRC was 3.10 ± 1.19, there was moderate impairment, no difference of mMRC between men and women (p = 0.503), nor was it found among mMRC with FR (r = -0.035 p = 0.864), SpO2 (r = -0.228 p = 0.222) and length of stay (r = 0.140 p = 0.486), which means that intensive care unit stay and length of stay in the domestic unit are important (r-0,457 p<0,01 e r 0,388 p<0,04 respectively). Conclusion: No differences between dyspnea syndrome and respiratory variables and total hospitalization time were found, but it was possible that they occurred between the MRC and the need for hospitalization and length of stay in intensive care therapy. There is a moderate influence of the dyspnea syndrome to direct the attention to the individuals under hospitalization, in order to minimize the progression of the disorder and greater impairment in the general state of health. (AU)

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.

Effect of influenza and 23-valent pneumococcal polysaccharide vaccinations on elderly with chronic obstructive pulmonary diseases: a community-based intervention study / 中华流行病学杂志

Objective To explore the effect of influenza and 23 valent pneumococcal polysaccharide pneumococcal vaccinations on symptom-improvement among elderly with chronic obstructive pulmonary diseases (COPD).Methods Data was gathered from 4 communities in 3 National Demonstration Areas set for comprehensive prevention and control of chronic non-communicable diseases in Chongqing city and Ningbo city respectively,from November 2013 to October 2014.The communities were selected by cluster sampling and divided into 4 groups:(1) injected influenza vaccines;(2) injected with pneumococcal vaccines;(3) received both of the two vaccines;(4) the control group that without any intervention measures.All the subjects aged from 60 to 75 were selected to fill in demographic information questionnaire and receive (COPD assessment test,CAT) scores twice,before intervention and 1 year after the vaccination.SAS 9.4 software was used to analyze the change of symptoms and CAT scores before and after the intervention program and comparing the improvement on symptoms among the elderly people under study.Results A total of 1 244 subjects with nearly same baseline conditions after the propensity score matching,were involved in this study.CAT scores appeared as Median=21 (IQR:17-26) at baseline.The CAT scores appeared as Median=18 (IQR:14-24),decreasing in all the 3 vaccinated groups,one year after the intervention program (influenza vaccines,matching t test,t=-6.531,P=0.403;pneumococcal vaccines,Wilcoxon test,H=-9 623,P＜0.001;combined vaccine vaccines,matching t test,t=-10.803,P＜0.001).However,in the control group,no obvious change was observed (Wilcoxon H=1 167,P=0.403).Proportions of impacts at high or very high levels all decreased in the 3 intervention groups,while little change was observed in the control group.Outcomes from the Factorial analysis suggested that influenza vaccination could improve the general conditions and symptoms including cough,chest tightness,dyspnea,physical activities,and stamina.Pneumococcal vaccination appeared more effective on all of symptoms and indicators.Conclusion Pneumococcal and influenza vaccination seemed helpful for elderly people suffering COPD to improve the general health condition.

Assessment of cognitive impairment in Systemic Lupus Erythematosus using the Mini-Mental Status Exam and the Montreal Cognitive Assessment Test-Filipino Version

Introduction@#Cognitive impairment (CI) in patients with systemic lupus erythematosus (SLE) presents with or without overt signs of central nervous involvement. The prevalence of CI is variable, ranging from 19-80%. It is often overlooked, leading to high healthcare costs and productivity loss. The usual tools for detection are expensive, time-consuming and not locally available. Detection of CI using the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Test (MoCA) is more clinically relevant and practical. The objectives of this study are to determine the prevalence of CI in SLE patients using MMSE/MoCA, to determine the degree of impairment in the different cognitive domains, and to characterize patients with CI in terms of disease activity, education, and employment.@*Methods@#This is a cross-sectional study of 62 SLE patients, 19 years or older, at a rheumatology clinic. Demographic and disease characteristics were collected. The validated Filipino versions of the MMSE/MoCA test were administered. Descriptive and non-parametric statistics were applied.@*Results@#Most patients are female (96.77%), below collegiate level of education (58.06%), and unemployed (70.97%). Mean disease duration is 8.92 (SD±7.03) years. Mean age at diagnosis is 28 (SD±10.30) years. Hypertension is the most common co-morbidity. Most have low lupus disease activity or are in remission (80.65%). Most are on prednisone (72.58%), with an average dose of 11.88mg/day (SD±10.66). The prevalence of CI is 38.71% (MMSE-P) and 77.42% (MoCA-P). The presence of CI is not related to educational level, employment, and disease activity.@*Conclusion@#Cognitive impairment (CI) is common in this cohort of SLE patients. Disease activity, level of education and employment do not seem to affect its occurrence. The MMSE-P and MoCA-P are rapid tools to assess the presence of CI and should be used in clinical practice to improve the quality of care for patients with lupus.

Effect of influenza and 23-valent pneumococcal polysaccharide vaccinations on elderly with chronic obstructive pulmonary diseases: a community-based intervention study / 中华流行病学杂志

Objective To explore the effect of influenza and 23 valent pneumococcal polysaccharide pneumococcal vaccinations on symptom-improvement among elderly with chronic obstructive pulmonary diseases (COPD).Methods Data was gathered from 4 communities in 3 National Demonstration Areas set for comprehensive prevention and control of chronic non-communicable diseases in Chongqing city and Ningbo city respectively,from November 2013 to October 2014.The communities were selected by cluster sampling and divided into 4 groups:(1) injected influenza vaccines;(2) injected with pneumococcal vaccines;(3) received both of the two vaccines;(4) the control group that without any intervention measures.All the subjects aged from 60 to 75 were selected to fill in demographic information questionnaire and receive (COPD assessment test,CAT) scores twice,before intervention and 1 year after the vaccination.SAS 9.4 software was used to analyze the change of symptoms and CAT scores before and after the intervention program and comparing the improvement on symptoms among the elderly people under study.Results A total of 1 244 subjects with nearly same baseline conditions after the propensity score matching,were involved in this study.CAT scores appeared as Median=21 (IQR:17-26) at baseline.The CAT scores appeared as Median=18 (IQR:14-24),decreasing in all the 3 vaccinated groups,one year after the intervention program (influenza vaccines,matching t test,t=-6.531,P=0.403;pneumococcal vaccines,Wilcoxon test,H=-9 623,P＜0.001;combined vaccine vaccines,matching t test,t=-10.803,P＜0.001).However,in the control group,no obvious change was observed (Wilcoxon H=1 167,P=0.403).Proportions of impacts at high or very high levels all decreased in the 3 intervention groups,while little change was observed in the control group.Outcomes from the Factorial analysis suggested that influenza vaccination could improve the general conditions and symptoms including cough,chest tightness,dyspnea,physical activities,and stamina.Pneumococcal vaccination appeared more effective on all of symptoms and indicators.Conclusion Pneumococcal and influenza vaccination seemed helpful for elderly people suffering COPD to improve the general health condition.

Hospitalization due to exacerbation of COPD: "Real-life" outcomes / Hospitalização por exacerbação da DPOC: desfechos da "vida real"

Summary Introduction: Hospitalization due to chronic obstructive pulmonary disease exacerbation (eCOPD) may indicate worse prognosis. It is important to know the profile of hospitalized patients and their outcome of hospitalization to customize and optimize treatment. Method: Evaluation of patients hospitalized for eCOPD, with ≥ 10 pack/years and ≥ 1 previous spirometry with airway obstruction over the course of one year at the pulmonology service of a general hospital, applying: COPD assessment test (CAT); mMRc and Visual Analogue Scale (VAS) for dyspnea; hospitalized anxiety and depression questionnaire (HAD); Divo's comorbidities and Cote index; spirometry; and laboratory tests including number of eosinophils, C-reactive protein (CRP), brain natriuretic protein (BNP). Patient progression, number of days of hospitalization and hospitalization outcomes were observed. Results: There were 75 (12%) hospitalizations for eCOPD, with 27 readmissions, nine of which during a period ≤ 30 days after hospital discharge. The main outcomes were: number of days of hospitalization (17±16.5 [2-75]); hospital discharge (30 [62.5%] patients); discharge/rehospitalization (18 [37.5%] patients), eight of them more than once; death (7 [14.5%] patients), five during rehospitalization. We analyzed 48 patients in their first hospitalization. The sample comprised a heterogeneous group separated in three clusters according to age, FEV1, body mass index (BMI) and CAT. The clusters did not correlate with the main outcomes. Conclusion: Hospitalization for eCOPD is frequent. The number of readmissions was high and associated with death as an outcome. Patients hospitalized for eCOPD were a heterogeneous group separated in three clusters with different degrees of disease severity and no correlation with hospitalization outcomes.

Resumo Introdução: As hospitalizações por exacerbação da doença pulmonar obstrutiva crônica (eDPOC) podem indicar um pior prognóstico. É importante conhecer o perfil dos pacientes internados e os desfechos das internações para personalizar e otimizar seu tratamento. Método: Avaliação dos pacientes hospitalizados por eDPOC, com ≥ 10 anos/maços e ≥ 1 espirometria prévia com obstrução ao fluxo aéreo no período de um ano em um serviço de pneumologia de um hospital geral. Foram utilizados: teste de avaliação da DPOC (CAT); mMRC e Escala Analógica Visual (EAV) para aferição da dispneia; escala hospitalar de ansiedade e depressão (HAD); comorbidades pelos critérios de Divo e índice de Cote; espirometria; e exames laboratoriais, eosinófilos no sangue, proteína C reativa (PCR), brain natriuretic peptide (BNP). Observamos evolução dos pacientes, duração da internação e desfechos da hospitalização. Resultados: Ocorreram 75 (12%) internações por eDPOC, sendo 27 reinternações, nove das quais com menos de 30 dias após a alta. Os principais desfechos foram: duração da internação de 17±16,5 (2-75) dias; 30 (62,5%) altas hospitalares; 18 (37,5%) altas/reinternações, oito pacientes reinternaram mais de uma vez; e sete (14,5%) óbitos, cinco durante as reinternações. Analisamos 48 pacientes em sua primeira internação. A amostra era um grupo heterogêneo que ordenamos em três clusters de acordo com idade, VEF1, índice de massa corporal (IMC) e CAT. Os clusters não se correlacionaram com os principais desfechos. Conclusão: A eDPOC é causa frequente de internações. Foram frequentes as reinternações e estas se correlacionaram com o desfecho óbito. Os pacientes internados por eDPOC formaram um grupo heterogêneo, que pôde ser agrupado em três clusters com diferentes graus de gravidade e sem correlação com os desfechos das hospitalizações.

Evaluation of clinical value of chronic pulmomary disease assessment test score in patients with acute exacerbation of chronic obstructive pulmonary disease / 中国中西医结合急救杂志

Objective To explore the clinical value and significance of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) in patients with acute exacerbation of COPD (AECOPD).Methods A prospective observational study was conducted,AECOPD patients were admitted to the Department of Respiration Medicine in Jiaxing Second Hospital from February 2011 to July 2016 were enrolled,and they all underwent CAT assessment test and lung function examination.The patients were assigned to Ⅱ,Ⅲ and Ⅳ grade groups according to the lung function level,and the difference of forced expiratory end volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) ratio were compared among the three groups;the patients were also assigned into 2,3 and 4 grade groups according to CAT scores,and the difference of length of stay in the hospital and hospitalization expenses were compared among the three groups.Spearman correlation analysis was used to analyze the correlations between the CAT score and lung function indexes.Results One hundred and thirty-five patients with AECOPD were accepted and all of their clinical data were analyzed in the study.Their mean FEV1 was (0.42±0.16) L,FEV1/FVC was 0.44 ±0.13 and CAT score was 26.64 ± 5.43.The correlation analyses showed:there were significant negative correlations between CAT score and FEV1,FEV1/FVC (r value was-0.691,-0.728,both P ＜ 0.001).With the elevation of lung function grade,FEV1 and FEV1/FVC were decreased gradually (1Ⅱ,Ⅲ,Ⅳ grade groups were 0.62±0.07,0.40±0.06,0.25±0.03 and 0.64±0.01,0.40±0.00,0.33±0.06 respectively),while CAT score raised gradually (20.03 ± 3.36,28.30 ± 3.31,30.18±3.86,all P ＜ 0.01);with the CAT score getting higher and higher,hospitalization expenses (yuan) and the length of stay in hospital (day) of patients with AECOPD were increased significantly (2,3,4 grade groups:expense were 6214.09±1396.16,8339.31±1866.46,9600.97±4339.87,and length of stay in hospital were 7.54± 1.62,9.52±2.21,14.85 ±5.62,respectively,all P ＜ 0.01).Conclusion CAT is a reliable tool to measure the life quality of AECOPD patients and has certain relevance to the severity and prognosis of the disease.

The Airflow Obstruction and Subjective Health Status Among Stable Chronic Obstructive Pulmonary Disease Patients Residing in the Community

PURPOSE: This study was undertaken to examine the relationship between airflow obstruction and subjective health status reported by stable patients with chronic obstructive pulmonary disease (COPD) residing in the community. METHODS: A cross-sectional descriptive study was conducted with 78 stable COPD patients aged 69.7 years old on average and selected by a convenient sampling from an outpatient department of pulmonology in tertiary hospitals. They completed a constructed questionnaire including general characteristics, smoking history, dyspnea by modified medical research council (mMRC) scale, and health status by COPD assessment test (CAT). Anthropometric measurements were performed for body mass index (BMI) and pulse oxymetry for O₂ saturation (Sat O₂). Medical records were reviewed to obtain disease-related characteristics including duration of the disease, cardiovascular comorbidity, and forced expiratory volume in 1 second (FEV₁). Data were analyzed using PASW statistics 20.0. RESULTS: Mean FEV₁% and CAT scores were 55.11% and 17.73, respectively. Those in the lower stage of mMRC showed significantly higher FEV1 and lower CAT. FEV1 and CAT showed significant negative correlations; age and BMI with FEV₁, and Sat O₂ with CAT. CONCLUSION: The findings suggest that the less airway obstruction was, the better health status was, and provide the support for using subjective measures in clinical practices for COPD patients.

Linguistic adaptation of the rhinitis control assessment test in Korean

PURPOSE: Allergic rhinitis is one of the most common chronic diseases that affect in sleep, fatigue, headache, impaired cognition, and performances at work or school. Monitoring rhinitis control is important, because rhinitis is a life-long disease and affects patients' health-related quality of life. The rhinitis control assessment test (RCAT) completed its development and initial validation, following confirmation of its reliability, validity, and responsiveness in the United States. To apply the RCAT in Korean clinical practice, we conducted linguistic adaptation of the RCAT in Korean language. METHODS: The process of linguistic adaptation was composed of 10 steps: preparation, forward translation, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, review of cognitive debriefing results and finalization, proofreading, and the final report. RESULTS: We completed a Korean version of the RCAT according to 10 steps. The Korean version of the RCAT was composed of 6 items, including nasal and ocular symptoms, sleep disturbances, limitation of casual activity, and symptom control. The score ranged from 5 to 30. Higher score indicated the well-controlled status of rhinitis. CONCLUSION: We conducted linguistic adaptation of the RCAT in Korean, which would be helpful in clinical practice to assess the status of rhinitis control and to adjust rhinitis medications.

Acuerdo intra-interobservador en las pruebas Minimental State Examination (MMSE) y Montreal Cognitive Assessment (MoCA test) aplicados por personal en entrenamiento / Intra and interrater reliability of the Minimental State Exmination (MMSE) and Montréal Cognitive Assessment (MoCA test) applied by health personnel in training

Introducción: en el proceso del diagnóstico neuropsicológico, los instrumentos de tamizaje cognitivo, son una herramienta útil en la identificación de cambios mentales del sujeto, en momentos puntuales o a través del tiempo. Su uso se fundamenta en el análisis psicométrico. Objetivo: determinar el acuerdo inter e intra-observador en el MoCA test y el MMSE, aplicado por profesores y estudiantes en procesos de entrenamiento de tamización cognitiva. Materiales y métodos: a los estudiantes y profesores en entrenamiento en la puntuación del MoCA test y el MMSE, se les presentó un video en dos sesiones, con un intervalo de 5 meses, mostrando el desempeño de dos adultos mayores, respondiendo el MoCA test y el MMSE, previo consentimiento informado. Se compararon los puntajes dados en las dos sesiones por los sujetos en entrenamiento, con los de ellos mismos (intra-observador), usando el coeficiente de concordancia y correlación de Lin(rho) y con los del grupo restante (inter-observador) usando el coeficiente de correlación intra-clase (ICC). Resultados: participaron 46 evaluadores. Se encontró alta confiabilidad inter-observador para el MoCA (ICC=0.86), pero baja para el MMSE (ICC=0.24) y baja confiabilidad intra-observador tanto para el MoCA (rho paciente 1=0.012 y rho paciente 2=0.152) como para el MMSE (rho paciente 1=0.008 y rho paciente 2=0.012). Aunque los puntajes difirieron, las clasificaciones diagnósticas realizadas por los evaluadores fueron similares a las del patrón de oro. Conclusión: la correcta aplicación del test, requiere varios entrenamientos, y aunque hubo pocas diferencias entre los puntajes, los errores cuando se está cerca del punto de corte propuesto, aumentan el riesgo de sesgo.

Introduction: The instruments for screening cognitive functions, applied to subjects in clinical settings and research, are useful for determining if this person has any trouble in cognition or show changes in the time. The usefulness of these instruments is defined with the evaluation of their psychometrics properties. Objective: This study allows to determine the intra and inter-observer agreement, when the MoCA test and MMSE were applied by a group in training process Materials and methods: The study group who attended two training sessions, with an interval of 5 months, scored the MoCA test and MMSE, from two patients which were filmed responding the tests, previous informed consent signature. We compared how close were the scores of participants among themselves by concordance correlation coefficient of Lin (rho) and with those given from the others by intra-class correlation coefficients (ICC). Results: In total, 46 participants were included. Intra-rater reliability was high for MoCA test (ICC = 0.86), but it was poor for MMSE (ICC=0.24). Inter-rater was poor for MoCA test (rho patient 1= 0.012, rho patient 2= 0.152) and MMSE (rho patient 1 = 0.008, rho patient 2 = 0.012). Although the scores between participants and gold standard were different, the diagnoses were similar. Conclusion:The correct scoring of the test, requires several trainings to clinical and research groups, and although they can be found few differences between scores applied by non-expert personnel, if the scores mistakenly given, are close to the cut-of point proposed for each test, the bias increases.

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.

Chronic obstructive pulmonary disease (COPD) assessment test scores corresponding to modified Medical Research Council grades among COPD patients

BACKGROUND/AIMS: In assigning patients with chronic obstructive pulmonary disease (COPD) to subgroups according to the updated guidelines of the Global Initiative for Chronic Obstructive Lung Disease, discrepancies have been noted between the COPD assessment test (CAT) criteria and modified Medical Research Council (mMRC) criteria. We investigated the determinants of symptom and risk groups and sought to identify a better CAT criterion. METHODS: This retrospective study included COPD patients seen between June 20, 2012, and December 5, 2012. The CAT score that can accurately predict an mMRC grade > or = 2 versus or = 15 predicted an mMRC grade > or = 2 more accurately than the current CAT score criterion. During follow-up, patients with CAT scores of 10 to 14 did not have a different risk of exacerbation versus those with CAT scores or = 15 is a better indicator for the 'more symptoms group' in the management of COPD patients.

Assess the nutritional status of patients with chronic obstructive pulmonary disease by SGA / 天津医药

Objective To explore the subjective global assessment (SGA) to evaluate the nutritional status of patients with chronic obstructive pulmonary disease(COPD). Methods Patients with stable COPD (n=122) were included and divid?ed into three groups base on their SGA scores:SGA-A (n=21), SGA-B (n=57), SGA-C (n=44). Nutritional status of all pa?tients was assessed by SGA. Anthropometric measurement, biochemical test, pulmonary function test, COPD assessment test (CAT) and shuttle walking test (SWT) were studied between all three groups to search statistical significance and correlation with SGA. Results Body mass index(BMI), arm muscle circumference (AMC) and forced expiratory volume in the first sec?ond%of predicted (FEV1%Pred) were all lower in SGA-B and SGA-C than those in SGA-A(P<0.05),there were no statis?tical differences of these parameters between SGA-B and SGA-C. Triceps skin fold (TSF) was lower in SGA-C than that in SGA-B than that in SGA-A, while CAT score is the reverse order (P<0.05). The walking distance of incremental shuttle walking test (ISWI) and the endurance time of endurance shuttle walking test (ESWI) were lower in SGA-C than that in SGA-A (P<0.05). There were no statistical differences of forced expiratory volume in the first second (FEV1)/forced vital ca?pacity(FVC), biochemical parameters between all three groups. SGA scores correlated positively with CAT and negatively with anthropometric parameters, FEV1%Pred and SWT (P<0.05). However no correlations was deduced between SGA scores with FEV1/FVC and biochemical parameters. Conclusion SGA scores correlated with anthropometric parameters, FEV1%Pred, CAT and SWT. SGA is an effective method to assess the nutritional status in patients with stable COPD.

Usefulness of COPD Assessment Test as valuable predictor of depression in chronic obstructive pulmonary disease / 동물의과학연구지

Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, including depression, which carries a higher risk of exacerbation and hospitalization in patients with stable COPD. A newly developed questionnaire, the COPD Assessment Test (CAT), was developed as an alternative to other complex, time-consuming tools for quantifying the symptom burden of COPD in routine practice. It is possible that the correlation between the CAT and depression scales could be useful for early evaluation and management of depression in COPD patients. Thus, we investigated the relationship between the CAT and depression as measured by the Patient Health Questionnaires-9 (PHQ- 9). We performed a retrospective observational COPD cohort study. A total of 97 patients were enrolled. The Korean versions of the CAT and PHQ-9 were completed for stable patients. A correlation analysis was performed between the PHQ-9 and CAT scores. Significant depression among the groups based on the 2011 GOLD guidelines occurred only in class Gold B and D patients (40% and 60%, respectively). The frequency of depression was significantly higher in the group with higher CAT scores (20~29 versus > or =30; odds ratio: 5.67 versus 22.66). Significant association was observed between the PHQ-9 and CAT scores (r=0.545 and P<0.001). As a result, the PHQ-9 score was significantly higher in COPD patients with a higher CAT score. The CAT is a simple and valuable predictor of depression in COPD patients, and it should be frequently used to detect COPD patients with depression in clinical practice.

Value of CAT and mMRC in clinical evaluation of chronic obstructive pulmonary disease / 重庆医学

Objective To evaluate the health status ,dyspnea and exercise endurance in the patients with chronic obstructive pul-monary disease(COPD) by the CAT scale ,modified medical research council(mMRC) dyspnea scale and 6-min walk test(6MWT) and to analyze the correlation between their evaluation results with the percentage (FEV1% pred) of the forced expiratory volume at 1 second(FEV1) in the predict value and whether complicating pulmonary hypertension (PH) .Methods 70 patients with COPD were performed the examinations of the lung function ,CAT scale ,mMRC score and 6MWT .The correlation among the various e-valuation systems and between each evaluation system with the severity of the pulmonary function airway limitation were compre -hensively evaluated .The CAT scores ,mMRC scores and 6 min walking distance(6MWD) were compared between the COPD com-plicating PH group and the simple COPD group .Results The CAT scale was negatively correlated with 6MWD(r= -0 .623 ,P0 .05) .The CAT scores had statistical difference between the COPD complicating PH group and the simple COPD group (P<0 .01) .6MWD had the highest accuracy for screening COPD whether complicating PH ,followed by CAT .The diagnostic cut-off point by adopting CAT for judging the risk of COPD complicating PH was 21 .Conclusion The CAT scale has good correlation with 6MWD and no correlation with FEV1% pred .The CAT scale is more suitable for the overall assessment of the total severity of COPD .Patients with the high CAT scores have higher risk of suffering from PH .

Relationship between chronic obstructive pulmonary disease (COPD) assessment test score and prognostic factors of COPD patients / 第二军医大学学报

Objective To observe the correlation between chronic obstructive pulmonary disease (COPD) assessment test (CAT) score and prognostic factors, so as to investigate the value of CAT score in predicting the prognosis of COPD. Methods A total of 81 patients with newly diagnosed COPD in our hospital during Jul. 2011 to Sep. 2012, without using inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) or long-acting antimuscarinic agent (LAMA), were divided into group A (low risk, less symptoms), B (low risk, more symptoms), C (high risk, less symptoms) and D (high risk, more symptoms) groups according to Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2011 edition), and the patients were given ICS/LABA or ICS/LABA+ LAMA treatment for 3 months. The CAT score, age, smoking quantity, pulmonary function indices, body mass index (BMI), 6-min walking distance (6MWD), modified medical British research council (mMRC) dyspnea scale, and the times of acute exacerbation of COPD (AECOPD) in previous one year were collected before and after treatment. The clinical characteristics analysis and correlation analysis were performed. Results The average age of the 81 COPD patients was (66.27±8.52) years, with 88.89% being males and 85.19% having smoking history. The proportions of group A, B, C and D were 8.64%, 30.86%, 4.94% and 55.56% before treatment, repectively. The values of the forced expiratory volumein one second (FEV1), predicted amount as a percentage of FEV1 (FEV1%Pred), forced vital capacity (FVC), predicted amount as a percentage of FVC (FVC% Pred), peak expiratory flow (PEF), predicted amount as a percentage of PEF (PEF%Pred), and 6MWD in CAT score ≥ 10 groups were significantly less than those in CAT score 10 group (P < 0. 05). The above parameterswere not significantly different between patients with CAT score being 10-20, 20-30 and ≥ 30 groups. mMRC scale and times of AECOPD in CAT score ≥20 groups were significantly higher than those in CAT score 10 group (P < 0. 05). No significant difference in FEV1/FVC was found in different CAT score groups. The CAT score was significantly correlated with mMRC scale (pre-treatment r2 = 0. 417, P lt; 0. 001; post-treatment r2 =0. 19, P < 0. 001), 6MWD (pretreatment r2 = 0. 320, P < 0. 001 post-treatment r2 = 0. 19, P < 0. 001), pre-treatment FEV1 (r2 = 0. 177, P = 0. 001 5), FEV1 %Pred(r2 = 0. 125, P = 0. 002), PEF(r2=0. 164, P = 0. 002 4), PEF%Pred (r2=0. 129, P = 0. 007 6), FVC (r2 = 0. 098, P=0. 021), FVC%Pred (r2 = 0. 094, P = 0. 024), FEV1/FVC(r2 = 0. 101, P = 0. 005 7), and AECOPD number (r2 = 0. 059, P = 0. 028); and not correlated with the quantity of smoking (r2 = 0. 041, P = 0. 083), BMI (r2 =0. 00, P = 0.89), and post-treatment FEV1 (r2 =0. 01, P = 0. 22) or FEV1 %Pred (r2 =0. 003, P = 0. 09). Conclusion COPD is prone to occur in the male smokers, with the highest proportion found in group D. CAT score has a good correlation with pre- and pos-- treatment mMRC scale and exercise capacity, suggesting it has a potential for predicting prognosis of COPD.