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.

Meta-analysis of the influence of transitional care on quality of life of patients with chronic obstructive pulmonary disease / 中国实用护理杂志

Objective To reconcile previous studies on the impact of transitional nursing intervention on quality of life in patients with chronic obstructive pulmonary disease (COPD) after discharge from the Chinese population. Methods PubMed, EMBASE, Cochrane Library, Clinical Trial, CBM, Joanna Briggs Institute Library, MEDLINE, Wanfang database and CNKI database, Vip database were searched by computer. The literatures about the influence of transitional nursing on the quality of life of COPD patients were searched until January 1, 2018. the data were analyzed by Rev Man 5.3 software. The results showed that P<0.05 on both sides was statistically significant. Results Five clinical studies were included, and the data were combined according to the symptom, activity, social psychology and St.George's Respiratory Questionnaire (SGRQ) total score in the SGRQ scale. Mean difference and its 95％confidence interval of symptoms, activities, social psychology and SGRQ score were-13.09 (-18.71,-7.48), 12.05 (-14.55,-9.45),-17.87 (-22.27,-13.46) and-15.42 (-19.74,-11.10) (Z=4.57-9.42, all P <0.05). Conclusions The transitional nursing has a significant positive effect on improving the quality of life among patients with COPD, which can effectively improve the psychosocial status of patients, and make the patients respond more actively to the problems in the process of treatment and rehabilitation.

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.

The Effects of Oxygen Therapy on Pulmonary Rehabilitation in Patients with COPD / 昆明医科大学学报

Objective To discuss the effects of oxygen therapy on partial pressure of oxygen, pulmonary function and quality of life among patients with chronic obstructive pulmonary disease (COPD) during respiratory rehabilitation (PR) . Methods Eighty patients with COPD were selected and randomly divided into two groups (receiving oxygen therapy and receiving no oxygen therapy) with 40 in each group.Patients who participated in this study underwent a comprehensive 8-week outpatient PR program. After the 8-week treatment, patients'pulmonary function, blood gas analysis and St.George respiratory questionnaire (SCRQ) score were tested. Results Significant improvements were observed in pulmonary function, partial pressure of oxygen and SCRQ score in both groups after the treatment.The group underwent the oxygen therapy showed better results in partial pressure of oxygen, FEV1 and SCRQ score during the rehabilitation compared to the group underwent no oxygen therapy. Conclusion Oxygen therapy during PR plays a positive role in respiratory rehabilitation, which is worth generalizing.

Adrenal insufficiency in patients with stable non-cystic fibrosis bronchiectasis.

Background & objectives: Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the prevalence of suppressed cortisol responses in stable bronchiectasis and determine their correlation with the use of inhaled corticosteroids, radiologic severity of bronchiectasis and quality of life (QOL) scores. Methods: In this case-control study, cases were patients with bronchiectasis and suppressed cortisol responses and controls were healthy volunteers, and patients with bronchiectasis without suppressed cortisol responses. Symptoms, lung function test values, exercise capacity, HRCT severity scores for bronchiectasis, exacerbations, inhaled corticosteroid use and quality of life scores were compared between patients with and without suppressed cortisol values. Results: Forty consecutive patients with bronchiectasis and 40 matched controls underwent 1-μg cosyntropin testing. Baseline cortisol (mean difference -2.0 μg/dl, P=0.04) and 30-minute stimulated cortisol (mean difference -3.73 μg/dl, P=0.001) were significantly lower in patients with bronchiectasis. One patient had absolute adrenal insufficiency and 39.5 per cent (15/38) patients with bronchiectasis had impaired stimulated responses. Baseline and stimulated cortisol responses were unaffected by inhaled steroids (O.R 1.03, P=0.96). SGRQ scores were negatively correlated with body mass (r= -0.51, P=0.001) and bronchiectasis severity (r=0.37, P=0.019), but not related to baseline or stimulated cortisol responses. Interpretation & conclusions: Our results showed that the impaired adrenal responses to 1-μg cosyntropin were common in patients with bronchiectasis. This was not associated with the use of inhaled steroids or severity of bronchiectasis. Poor health status was associated with advanced disease and not with cortisol responses to the 1-μg cosyntropin test.

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.

Indacaterol and salmeterol in COPD patients: a comparative study of efficacy and safety.

Background: Chronic obstructive pulmonary disease (COPD) is an airway disorder characterized by airflow limitation that is not fully reversible. Indacaterol is a novel, inhaled, once-daily, ultra-long-acting β2-agonist bronchodilator recently approved in India for the treatment of chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the efficacy and safety of indacaterol compared to twice-daily β2-agonist, salmeterol, as an active control. Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a 12 week period. A total of 60 patients with moderate-to-severe COPD were randomised to treatment either with indacaterol (150 μg once daily) or with salmeterol (50 μg twice daily) and 51 (85%) patients completed the study. The efficacy parameters were change in FEV1, health related quality of life by measuring St George’s Respiratory Questionnaire (SGRQ) total score and severity of dyspnoea as measured by Transition Dyspnoea Index (TDI) score which were assessed at baseline first and at weeks 4, 8 and 12. Results: Indacaterol increased FEV1 at week 4 by 50 ml, at week 8 and at week 12 by 60 ml over salmeterol and the increase was highly significant (p<0.001) at all stages of the study. Both treatments improved health status (SGRQ total score) and dyspnoea (TDI score), with differences between them favouring indacaterol. Safety profiles were similar across the treatment groups, and both indacaterol and salmeterol were well tolerated without any severe adverse events. Conclusions: Once-daily treatment with 150 μg indacaterol had a significant and clinically relevant bronchodilator effect and improved health status and dyspnoea to a greater extent than twice-daily 50 μg salmeterol. Indacaterol should prove a useful addition in the treatment of patients with COPD.

The attribution of acute exacerbation in the development of chronic obstructive pulmonary disease / 中国医师进修杂志

Objective To investigate the role of the pulmonary function, arterial blood gas analysis, the St George respiratory questionnaire (SGRQ) score and nutritional status in evaluating the development of chronic obstructive pulmonary disease (COPD). Method Changes of the above-mentioned parameters were analyzed in hospitalized patients suffered from moderate to severe COPD and compared with parameters of those who had acute exacerbations when admitted to hospital. Results The forced expiratory volume in one second (FEV1)% pred and oxygenation index of the patients declined significantly with the development of the disease after one, two, three, four times in hospital [(68.43 ± 3.09)%, (61.27 ± 3.38 )%, (42.05 ± 4.16)%, (33.64 ± 3.34)% and 435.55 ± 10.23, 404.35 ± 11.56, 358.38 ± 13.21, 321.29 ± 11.78] (P < 0.05), while the level of PaCO2 increased significantly in moderate COPD [(36.23 ± 3.62), (45.44 ± 4.67), (57.82 ± 4.12), (78.28 ± 5.21 )mm Hg (1 mm Hg = 0.133 kPa) ] (P<0.05). The oxygenation index was declined significantly in severe COPD. The scores of SGRQ score declined significantly in all patients while the level of hemoglobin, albumin and body mass index did not change significantly. Conclusions Acute ex-acerbation attributes to the deterioration of pulmonary function and life quality of COPD patients. Monitoring the changes of pulmonary function, arterial blood gas analysis and SGRQ score may be useful in the evaluation of the development of COPD.

Effects of simvastatin on inflammation in patients with chronic obstructive pulmonary diseases / 中国综合临床

Objective To investigate the influence of simvastatin on inflammatory indices in nasal lavage,sputum and blood and clinical index in patients with chronic obstructive pulmonary diseases (COPD). Methods Thirty-seven stable COPD patients were randomly divided into simvastatin-treatment group (n=17),orally given simvastatin tablets for 4 weeks in addition to basic therapy,40 mg,qd) and control group (n=20),given usual med-ication). Total cell counts,percentage of leukocytes (N%) and levels of interleukin IL-8,IL-6 in nasal lavage and sputum at pre-post-treatment were compared;Serum C-reactive protein (CRP),total cholesterol (TC),low-density lipoprotein-cholesterol (LDL-C) as well as IL-8,IL-6 concentrations were measured,the variation of lung function,Sino-Nasal Outcome Test 20(SNOT-20) and St George's Respiratory Questionnaire(SGRQ) score were analyzed. Results After the treatment,the nasal lavage and sputum total cell counts,N%,IL-8 and IL-6 levels[nasal lavage: (0.7±0.3)×107/L,(41.1±10.9)%,(105.8±74.5) ng/L,(3.8±1.6) ng/L;sputum: (0.8±0.3)×109/L,(56.6±9.6) %,(2565.5±831.9) ng/L,(109.8±42.3) ng/L] dropped slightly in the simvastatin group com-pared with that at pretreatment [nasal lavage: (0.8±0.3)×107/L,(43.2±10.8) %,(107.6±86.3) ng/L,(4.1±1.9)ng/L;sputum: (0.8±0.3)×109/L,(58.1±9.3)% ,(2659.4±885.2) ng/L,(111.8±46.6) ng/L] (P>0.05) ;There were significant decreases in serum CRP [(4.3±3.7) mg/L vs (2.6±1.8) mg/L],IL-6 [(4.8±2.0)ng/L vs(4.7±1.9)ng/L] ,TC[(4.2±1.0) mmol/L vs(3.7±0.8)mmol/L] ,LDL-C[(2.4±0.5) mmol/L vs (2.2±0.5)mmol/L] (P>0.05) ;IL-8 concentrations in serum were lower gently[(6.2±1.8) ng/L vs (6.4±1.9) ng/L] (P>0.05). Significant change of simvastatin treatment on SGRQ was only reflected in the symp-tom score [pre-post-treatment:39.6±10. 8 vs 32.3±11.6,P<0.05,respectively],while other observation items (SNOT-20,FEV1%,FEV1/FVC) changed not notably (P>0.05). No marked changes in inflammatory markers and quality of life scores,lung function were observed in control group (P>0.05). Conclusion Simvastatin may be as-sociated with the potential to alleviate systemic inflammation and relieve symptoms in COPD patients.

Relationship between disease severity and quality of life in patients with chronic obstructive pulmonary disease

Few studies have evaluated the relationship between Airways Questionnaire 20 (AQ20), a measure of the quality of life, scores and physiological outcomes or with systemic markers of disease in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the relationship of forced expiratory volume in 1 s (FEV1), body mass index, fat-free mass index, 6-min walk test (6MWT) results, dyspnea sensation and peripheral oxygen saturation (SpO2) with the quality of life of COPD patients. Ninety-nine patients with COPD (mean age: 64.2 ± 9.2 years; mean FEV1: 60.4 ± 25.2 percent of predicted) were evaluated using spirometry, body composition measurement and the 6MWT. The baseline dyspnea index (BDI) and the Modified Medical Research Council (MMRC) scale were used to quantify dyspnea. Quality of life was assessed using the AQ20 and the St. George's Respiratory Questionnaire (SGRQ). The Charlson index was used to determine comorbidity. The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index was also calculated. AQ20 and SGRQ scores correlated significantly with FEV1, SpO2, 6MWT, MMRC and BDI values as did with BODE index. In the multivariate analyses, MMRC or BDI were identified as predictors of AQ20 and SGRQ scores (P < 0.001 in all cases). Thus, the relationship between AQ20 and disease severity is similar to that described for SGRQ. Therefore, the AQ20, a simple and brief instrument, can be very useful to evaluate the general impact of disease when the time allotted for measurement of the quality of life is limited.

Effect of inhaled tiotropium on patients with COPD / 대한내과학회지

BACKGROUND: Tiotropium is a long acting anticholinergic bronchodilator and it reduces exacerbations and improves the quality of life of patients with stable chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the effect of tiotropium on dyspnea, the quality of life and the pulmonary function in patients with COPD. METHODS: Between April 2005 and April 2006, the patients with moderate to severe COPD, as based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, and who needed to use long-acting bronchodilator were enrolled in this study. They inhaled tiotropium as a dry powder capsule, 18 microgram once daily for six months, with using the Handihaler(R) device. The lung function tests, including lung volume, the St. George's respiratory questionnaire and the MRC dyspnea scale, was measured at baseline and after 6 months treatment with tiotropium. RESULTS: 21 patients with COPD were enrolled. The mean age of the patients was 69 years and the mean baseline FEV1 was 1.0 L (40% predicted). Compared with the baseline, tiotropium produced significant improvement of the FEV1 (1.0+/-0.2 L vs. 1.1+/-0.3 L, respectively, p=0.013), IC (1.65+/-0.3 L vs. 1.7+/-0.3 L, respectively, p=0.037), the RV (4.0+/-0.7 L vs. 3.8+/-0.4, respectively, p=0.003), the SGRQ score (48.7+/-10 vs. 41.3+/-10.4, respectively, p<0.001), and the MRC dyspnea scale (3.4+/-0.6 vs. 3.0+/-0.8, respectively, p=0.009) after 6 months treatment. The dyspnea scale was associated with physical activity, the impact on life, the inspiratory capacity and the residual volume rather than the symptom score or FEV1. The treatment was well tolerated. CONCLUSIONS: Treatment with tiotropium once daily for 6 months improved lung functions, the health related quality of life and dyspnea.

Application of St George's respiratory questionaire in evaluating the life quality of community patients with chronic obstructive pulmonary disease / 中国基层医药

Objective To study the value of St George's respiratory questionaire(SGRQ)in evaluating the life quality of community patients with COPD.Methods The SGRQ score,PEF% were collected from 35 patient with COPD.Paired t test was performed to evaluate the sensitivity of SGRQ to changes of disease severity.Correla- tion coefficients were calculated to evaluate the validity.Results Three parts of the SGRQ score and the total score were significantly correlated with the changes of SGRQ(P＜0.001),SGRQ was more sensitive than PEF in evalu- ating the changes of disease severity.The three part of the scale and the total scale were significantly correlated with PEF%.Conclusion SGRQ is a valid,sensitive and feasible method in measuring the quality of life in community patients with COPD.