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.

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.

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.

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.

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.

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.

Chronic Obstructive Pulmonary Disease Assessment Test Can Predict Depression: A Prospective Multi-Center Study

This study was conducted to investigate the association between the chronic obstructive pulmonary disease (COPD) assessment test (CAT) and depression in COPD patients. The Korean versions of the CAT and patient health questionnaire-9 (PHQ-9) were used to assess COPD symptoms and depressive disorder, respectively. In total, 803 patients with COPD were enrolled from 32 hospitals and the prevalence of depression was 23.8%. The CAT score correlated well with the PHQ-9 score (r=0.631; P or =21 had the highest accuracy rate (80.6%). Among the eight CAT items, energy score showed the best correlation and highest power of discrimination. CAT scores are significantly associated with the presence of depression and have good performance for predicting depression in COPD patients.