Blood Eosinophilia and Its Stability in Hospitalized COPD Exacerbations are Associated with Lower Risk of All-Cause Mortality.

Purpose: Peripheral blood eosinophilic counts are susceptible to many factors and have variability over time. There are limited studies on association of blood eosinophilia with long-term mortality of chronic obstructive pulmonary disease (COPD) patients and these results remain controversial. Our aims were to explore the association of blood eosinophilia at index hospitalization and stability of blood eosinophilia stability over 5 years with all-cause mortality of patients hospitalized for acute exacerbation of COPD (AECOPD). Patients and Methods: Eight hundred twenty-nine patients hospitalized for AECOPD between 2013 and 2014 were included in this study and grouped into two groups according to blood eosinophil with 150 cells/µL used as the cutoff value to form eosinophilic and non-eosinophilic groups. Two hundred forty-one COPD inpatients with at least three blood eosinophils measured from different hospitalizations were used for analysis of longitudinally eosinophilic stability and divided into three groups according to the same cutoff value: predominantly (PE), intermittently (IE) and rarely (RE) eosinophilic groups. Cox regression analysis was used to determine the association of blood eosinophilia and all-cause mortality. Results: In patients hospitalized for AECOPD, 261 (31.5%) at baseline and 41 (17%) based on at least three measurements of blood eosinophils had increased blood eosinophils. For all-cause mortality, eosinophilic COPD patients at index hospitalization had a lower all-cause mortality compared with non-eosinophilic COPD patients (hazard ratio 0.77, 95% confidence interval 0.6-0.99, P=0.04). In patients readmitted for AECOPD by longitudinal eosinophil stability, with the RE group used as reference, the PE group was associated with a lower all-cause mortality of AECOPD patients (hazard ratio 0.43, 95% confidence interval 0.22-0.85, P=0.016), compared to the IE group (hazard ratio 0.72, 95% confidence interval 0.47-1.11, P=0.133). Conclusion: Patients with increased eosinophils (using eosinophil 150 cells/µL as a cutoff value), especially predominantly increased eosinophil levels based on multiple measurements, had a lower risk of all-cause mortality. Blood eosinophilia can be used as a biomarker in hospitalized COPD exacerbations for predicting the risk of all-cause mortality.

[Randomized controlled trial of xiaochuangao acupoint paste to treat chronic obstructive pulmonary disease in the stable phase: treating winter diseases in summer].

OBJECTIVE: To verify the clinical efficacy of Xiaochuangao Acupoint Paste (XAP) to treat chronic obstructive pulmonary disease (COPD) in the stable phase. METHODS: By using a multi-center randomized double-blinded placebo controlled design, 142 patients with COPD were randomly assigned to two groups. Patients in the treatment group were treated with XAP, while those in the control group were treated with the placebo paste. One therapeutic course consisted of six pastes, three times on dog-days within one year, for two successive years. The SGRQ life quality score, BODE index, yearly average times of common cold and acute attack, times of emergency clinics and hospitalization, the lung function, and so on were observed. RESULTS: The post-treatment 1- and 2-year SGRQ life quality scores decreased more than before treatment in the two groups. Compared with one year after treatment, the posttreatment 2-year activities and influence of SGRQ life quality score,and the total score decreased significantly in the treatment group (P<0.05). Besides, the decrement was more in the treatment group than in the control group (P<0.05). The decrement of the BODE index between the post-treatment 2-year and before treatment and between the post-treatment 2-year and the post-treatment 1-year was higher in the treatment group when compared with the control group during the same time periods (P<0.01). The yearly average times of common cold and acute attack were obviously lower 2 years after treatment than those of the control group 2 years after treatment, Besides, they were lower than those before treatment and 1 year after treatment in the treatment group (P<0.05). The yearly average times of emergency clinics and hospitalization were obviously less in the treatment group 2 years after treatment than before treatment of the same group and those of the control group during the same time period (P<0.05). There was no statistical difference in the lung function between the two groups. CONCLUSION: XAP showed positive effects on improving the quality of life of patients with COPD in the stable phase, lessening their acute aggravation times, and lowering medical costs.

Validation of the Chinese version of the Functional Performance Inventory Short Form in patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVE: To determine the reliability and validity of the Chinese version of the Functional Performance Inventory Short Form (FPI-SF-C) in patients with chronic obstructive pulmonary disease in Beijing, China. BACKGROUND: The Functional Performance Inventory Short Form (FPI-SF) is a 32-item instrument designed to measure self-reported functional performance of patients with chronic obstructive pulmonary disease. This instrument had not been translated into Mandarin Chinese and tested for use in mainland China. DESIGN: Cross-sectional validation study with a two-week test of reproducibility. METHOD: The FPI-SF was translated using forward and backward translation procedures and administered to 108 stable chronic obstructive pulmonary disease patients from outpatient clinics of three hospitals in Beijing, China. Pulmonary function and six-minute walking distance (6-MWD) tests were performed on the same day or within one week before the FPI-SF-C completion. Thirty of the patients participated in the reproducibility assessment. RESULTS: Cronbach's alpha for the FPI-SF-C total score was 0·89; subscales ranged from 0·70 (Body Care)-0·89 (Spiritual activities). Test-retest reliability (intraclass correlation coefficient) was 0·93 with subscales ranging from 0·73 (Body Care)-0·96 (Household Maintenance). No ceiling or floor effects were observed for total FPI-SF-C score. Total scores correlated significantly (p<0·05) with 6-MWD (r=0·56), modified Medical Research Council Dyspnoea Scale (MMRC) (r=-0·55), BODE index (r=-0·47), forced expiratory volume in one second (FEV(1)) (r=0·41) and FEV(1) % of predicted (r=0·26) and differentiated patients based on GOLD rating of COPD severity (χ(2)=16·22, p<0·001). CONCLUSIONS: Results suggest the FPI-SF-C is a reliable and valid instrument for measuring functional performance in mainland Chinese patients with chronic obstructive pulmonary disease. Further psychometric testing in a wide range of subjects and an evaluation of its utility in clinical practice are warranted. RELEVANCE TO PRACTICE: The FPI-SF-C may be useful for understanding difficulties in functional performance and evaluating the effect of treatment in Chinese patients with chronic obstructive pulmonary disease.

Predictive validity of BODE index for anxious and depressive symptoms in patients with chronic obstructive pulmonary disease.

BACKGROUND: Anxiety and depression are two of the commonest and most modifiable comorbidities of chronic obstructive pulmonary disease (COPD) and have an independent effect on health and prognosis. FEV1% has been shown to be a poor predictor of anxiety and depression. The body mass index, degree of airflow obstruction, dyspnea, and exercise capacity (BODE) index is a multidimensional assessment system which may predict health outcome in COPD patients. The purpose of this study was to investigate the predictive validity of the BODE index for anxious and depressive symptoms in COPD patients. METHODS: This was a multicenter prospective cross-sectional study in 256 patients with stable COPD. Anxious and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). The relationships between anxiety, depression and potential predictors (including the BODE index) were analyzed by a binary Logistic regression model. RESULTS: Subjects who were anxious and depressive walked a shorter six-minute walking distance (6MWD), had more dyspnea, a higher BODE index, and lower health-related quality of life (P < 0.01). Anxiety and depression score was significantly correlated with BODE index, respectively (r = 0.335, P < 0.001; r = 0.306, P < 0.001). The prevalence of anxiety and depression increased with BODE stage increasing (P < 0.05). On the basis of binary Logistic regression, the BODE index was a good and independent predictor of anxiety and depression because it comprised dyspnea and 6MWD, which were shown to be the main determinants. CONCLUSIONS: The predictive validity of the BODE index for anxiety and depression was demonstrated. We propose that the BODE index should be included in assessment of COPD severity.

[Reliability and validity of modified pulmonary functional status and dyspnea questionnaire in Chinese patients with chronic obstructive pulmonary disease].

OBJECTIVE: To determine the reliability and validity of the modified pulmonary functional status and dyspnea questionnaire (PFSDQ-M) Chinese version in patients with chronic obstructive pulmonary disease (COPD) at 2 hospitals in Beijing, China. METHODS: PFSDQ-M has three domains, i.e., change experienced by patient with activities or activity restriction (CA), dyspnea with activities (DA) and fatigue with activities (FA). Sixty-one patients with COPD in stable condition were assessed by interview with PFSDQ-M Chinese version, modified Medical Research Council dyspnea scale (MMRC), respectively, and underwent pulmonary function test (PFT) and 6-minute walking test (6MWT) on the same day or within one week before interview. RESULTS: Cronbach's alpha was 0.84, 0.85 and 0.89 for domains of CA, DA and FA of the PFSDQ-M, respectively. Scores of change in activities, dyspnea and fatigue with activities in patients of COPD correlated to their 6-minute walking distance (r = -0.39 to -0.50), FEV(1) (r = -0.28 to -0.36), FEV(1)/FVC (r = -0.27 to -0.37), FEV(1)% of predicted (r = -0.27 to -0.37), dyspnea score in MMRC (r = 0.59 to 0.66) and BODE index (r = 0.40 to 0.51), respectively (all P < 0.01). Degrees of restriction of activity, dyspnea and fatigue with activities varied significantly in patients with different severity of COPD (chi(2) = 7.35 to 15.21, P < 0.05, P < 0.01, respectively). CONCLUSIONS: Results of 61 patients with COPD interviewed with PFSDQ-M Chinese version suggest its good reliability and validity in discriminating patients with COPD of varied severity and stages.

The cross-sectional and longitudinal association of the BODE index with quality of life in patients with chronic obstructive pulmonary disease.

BACKGROUND: The body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index was shown at predicting the risk of death, exacerbation and disease severity among patients with COPD, but few studies verified relationship between BODE index and health related quality of life (HRQoL) among Chinese COPD patients. The objective of this study was to evaluate the relationship between BODE index and HRQoL in cross-sectional and longitudinal association analyses. METHODS: A multi-center prospective cohort study was initially conducted in 491 stable COPD patients in Beijing, China. Health status (HRQoL) was assessed by St. George's Respiratory Questionnaire (SGRQ); the BODE index was calculated for each patient; dyspnea was assessed using the 5-grade Medical Research Council dyspnea scale. Other measurements included socio-demographic, body mass index (BMI), lung function test and 6-minute-walk test (6MWT). Patients were then followed monthly for 12 months. RESULTS: Only 450 patients completed the 1-year follow up and were enrolled in our present analyses. Mean age was (65.2 +/- 10.6) years, men 309 (68.7%). The BODE index was categorized into 4 subgroups: 0 - 2, 3 - 4, 5 - 6 and 7 - 10. At baseline BODE index was gradually increased with baseline total SGRQ and SGRQ subscales (P trend < 0.001). For individual components of BODE index, with the decrease of airflow limitation, and 6MWD, and with the increase of Medical Research Council (MRC) dyspnea grade, total SGRQ and SGRQ subscales were increased correspondingly, P trend < 0.05, respectively. Similar association patterns were found between baseline BODE index and its individual components and mean SGRQ scores at the end of 1-year follow up. By multiple linear regression analyses, baseline BODE index was not only significantly associated with SGRQ score at baseline but also with SGRQ score at the end of 1-year follow up after adjustment for age, male, current smoking, betas being 0.434 and 0.378, respectively. CONCLUSIONS: BODE index is associated with SGRQ score cross-sectionally and longitudinally among stable COPD patients. BODE index might have potential to be used as a sensitive tool to assess the status of quality of life and to monitor disease progression among stable COPD patients.