scholarly journals Reported dyspnea and fatigue using different scales during the physical effort in COPD

2017 ◽  
Vol 30 (2) ◽  
pp. 207-217 ◽  
Author(s):  
Alaís Camargo Corcioli ◽  
Bruna Varanda Pessoa-Santos ◽  
Glaucia Nency Takara ◽  
Valéria Amorim Pires Di Lorenzo ◽  
Mauricio Jamami
Keyword(s):  
Perceived Exertion ◽  
Random Order ◽  
Chronic Obstructive ◽  
Test Results ◽  
Peripheral Oxygen Saturation ◽  
Physical Effort ◽  
Obstructive Pulmonary Disease ◽  
Therapy Choice ◽  
Patient Reported ◽  
Positive Correlations

Abstract Introduction: Therapy choice and its progression for patients with Chronic Obstructive Pulmonary Disease (COPD) should be based on their symptoms and clinical condition according to reports of dyspnea and fatigue. Therefore patient-reported scales have presented a key role during the communication with the patient. Objective: To verify if patients with COPD prefer the Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Glasses Scale (GS), Faces Scale (FS) or Ratings of Perceived Exertion (RPE) during the six-minute walk test(6MWT), and to compare and correlate the scales with each other, with peripheral oxygen saturation (SpO2) and heart rate (HR). Methods: 28 patients with COPD (50% had mild to moderate COPD and 50% had severe to very severe) were evaluated by a respiratory and cognitive assessment. Additionally, they performed the 6MWT, in which the scales were applied simultaneously (random order) and patients reported their preference in the end of the test. Results: 57% of patients were illiterate or presented incomplete primary education and most of them (67%) chose the FS or GS. Significant positive correlations were observed between instruments for both dyspnea and fatigue in the end of the 6MWT, which the strongest was between MBS and FS (r = 0.95). Nevertheless, there was no correlation between the scales and SpO2 and HR. Conclusion: As the majority of patients preferred pictured to numerical scales we suggest their use as a resource for therapeutic evaluation; MBS might be replace by FS, even though they have different scores and not scaled proportionally. However, this change must be carefully considered because there is the risk of dubious interpretation.

scholarly journals Response to Long Term Exercise Training in COPD

2021 ◽  
Vol 10 (11) ◽  
pp. 849-851
Author(s):  
Renukadevi Mahadevan ◽  
Chaya Sindaghatta ◽  
Vijay Samuel Raj Victor
Keyword(s):  
Exercise Training ◽  
Perceived Exertion ◽  
Exercise Intervention ◽  
Exercise Program ◽  
Home Exercise ◽  
Chronic Obstructive ◽  
Peripheral Oxygen Saturation ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

The patient is a 64-year-old male. He presented with difficulty in breathing and was diagnosed with COPD (chronic obstructive pulmonary disease) ten years back. He is a farmer and an active smoker, of 18 packs / year for 35 years. He began to experience dyspnoea when performing moderate exertion, dyspnoea grading of 3 as denoted by modified medical research council mMRC (Modified Medical Research Council) and productive cough with sputum, usually in the morning. He is on long-term oxygen therapy of 4 litres of oxygen for 16 hours per day for 2 years. He has a history of hospitalisation six times and 5 - 6 emergency consultations for acute exacerbation in the last 3 years. The patient was on regular treatment with long-acting inhaled beta-2 agonist (LABA) inhaler and long-acting anticholinergics or long-acting muscarinic receptor antagonists (LAMA) and corticosteroid (ICS) inhalers 200-400 micrograms (μg) three times a day and mometasone 400 μg, continuously. The patient’s body mass index (BMI) was 20.3 Kg / m2. His blood pressure was 140 / 80 mmHg, heart rate (HR) 74 bpm, respiratory rate (RR) 22 rpm and peripheral oxygen saturation (SpO2) at rest was 95 %. Pulmonary auscultation revealed a diffusely reduced breath sounds, and no alterations were found in cardiac auscultation. The patient’s post-bronchodilator pulmonary function test was 52.2 % of forced expiratory volume in 1 second (FEV1). In the six-minute walk test(6mwt), the patient walked a total distance of 294.4 meters, with variations in heart rate from 74bpm to 128bpm. Whenever peripheral oxygen saturation was reduced to 88 %, the patient had taken rest. The patient took rest two times, at the end of the second minute thirtyfive seconds and the end of the fourth minute forty-five seconds. The body-mass index, airflow obstruction, dyspnoea and exercise (BODE) mortality index were used to measure 4 years survival interpretation.1 Saint George’s Respiratory Questionnaire chronic obstructive pulmonary disease (COPD) version (SGRQ-C) was used to measure the quality of life (QoL). After the initial assessment, the patient was enrolled in the pulmonary rehabilitation program. The first three months were supervised, exercise training constituted weekly educational sessions and meeting with the psychology support group and nutrition advice before beginning the exercise intervention. 2 The patient visited the institution three days per week for exercise training. The exercise constituted aerobic on the treadmill and intensity, in the beginning, was 80 % of the 6MWT speed, and Borg’s scale of perceived exertion was 4 as prescribed by American Thoracic Society (ATS). 3 The components of the program were warm-up sessions, conditioning, resistance exercise and a cool-down session. The patient was also advised home exercise program, which included resistance training using weighted sandbags for three sessions per week. The resistance added was based on 1 repetition maximum (RM) and 10RM. 80 % of 10 RM was the training intensity for resistance training for a larger group of muscles. 4 The weight was added gradually and ensured their rated perceived exertion (RPE) was at 4 during exercise. The patient’s outcomes were recorded after three months of training. After 12 weeks of supervised outpatient exercise intervention, the patient was advised home exercise program for the next 6 months. 5

scholarly journals Exploring the Relationship between Disease Awareness and Outcomes in Patients with Chronic Obstructive Pulmonary Disease

Respiration ◽  
2021 ◽  
Vol 100 (4) ◽  
pp. 291-297
Author(s):  
Ilaria Baiardini ◽  
Marco Contoli ◽  
Angelo Guido Corsico ◽  
Carla Scognamillo ◽  
Fabio Ferri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Treatment Satisfaction ◽  
Illness Perception ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Post Hoc Analysis ◽  
Disease Awareness ◽  
Patient Reported ◽  
Post Hoc

Background: Disease awareness is a challenge in the management of chronic obstructive pulmonary disease (COPD). Objectives: The aim of this analysis was to explore the association between COPD optimal and suboptimal awareness, clinical parameters, and the following patient-reported outcomes: modified Medical Research Council (mMRC), Treatment Satisfaction Questionnaire (TSQM-9), COPD Assessment Test (CAT), Morisky Medication-Taking Adherence Scale (MMAS-4), and Brief Illness Perception Questionnaire (B-IPQ). Methods: This post hoc analysis of the SAT study included all enrolled patients for whom awareness (Disease Awareness in COPD Questionnaire – DACQ) was assessed at baseline and 12 months. DACQ scores ≥80 were considered an indicator of an optimal awareness. Results: 367 patients (25.8% women, median age 72 years) were included in the analysis. At enrollment, 74 patients (20.2%) had a DACQ score ≥80. Patients with suboptimal awareness, compared to those in which awareness was optimal, had higher median scores for CAT (p = 0.0001) and mMRC (p = 0.0031), a lower median TSQM-9 global score (p < 0.0001), and higher median B-IPQ score (p < 0.0001). The proportion of patients who had exacerbations during the previous year was higher in patients with suboptimal COPD awareness than in those with DACQ score ≥80 (42.8 vs. 21.4%, p = 0.0009). During the 12-month observation period, illness perception, adherence, and treatment satisfaction were found to be independent factors significantly associated with level of disease awareness. Conclusion: The results of our post hoc analysis suggest that patients’ awareness of their COPD disease is related to both clinical outcomes and how they perceive and manage their condition.

scholarly journals Development of the EXAcerbations of Chronic Obstructive Pulmonary Disease Tool (EXACT): A Patient-Reported Outcome (PRO) Measure

2010 ◽  
Vol 13 (8) ◽  
pp. 965-975 ◽  
Author(s):  
Nancy Kline Leidy ◽  
Teresa K. Wilcox ◽  
Paul W. Jones ◽  
Lindsey Murray ◽  
Randall Winnette ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Patient Reported Outcome ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Patient Reported

Non-Invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 15 (2) ◽  
pp. 120-132 ◽  
Author(s):  
Cosei Valentin-Caius ◽  
Borcea Corina-Ioana ◽  
Zaharie Ana-Maria ◽  
Mihaltan Florin-Dumitru ◽  
Deleanu Oana-Claudia
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Patient Reported ◽  
The Right

The benefit of non-invasive ventilation (NIV) in stable chronic obstructive pulmonary disease (COPD) remains controversial. However, there is increasingly more evidence of NIV efficiency, especially high-flow NIV. This review presents the old and the new evidence of NIV effectiveness in stable COPD, considering pathophysiological arguments for NIV in COPD. Guidelines, randomized controlled trials (RCTs) and crossover studies included in review and metaanalysis based on patient-reported outcomes (PROs) have been analyzed. The role of NIV in rehabilitation and in palliative care and the role of telemedicine in relation with NIV are still up for debate. Challenges in choosing the right device and the optimal mode of ventilation still exist. There are also discussions on the criteria for patient inclusion and on how to meet them. More studies are needed to determine the ideal candidate for chronic NIV and to explain all the benefits of using NIV.

Assessment of transdiaphragmatic pressure in humans

1985 ◽  
Vol 58 (5) ◽  
pp. 1469-1476 ◽  
Author(s):  
D. Laporta ◽  
A. Grassino
Keyword(s):  
Pulmonary Disease ◽  
Visual Feedback ◽  
Random Order ◽  
Normal Subjects ◽  
Chronic Obstructive ◽  
Disease Group ◽  
Obstructive Pulmonary Disease ◽  
Transdiaphragmatic Pressure ◽  
Residual Capacity ◽  
Group 1

Maximal force developed by the diaphragm at functional residual capacity is a useful index to establish muscle weakness; however, great disparity in its reproducibility can be observed among reports in the literature. We evaluated five maneuvers to measure maximal transdiaphragmatic pressure (Pdimax) in order to establish best reproducibility and value. Thirty-five naive subjects, including 10 normal subjects (group 1), 12 patients with chronic obstructive pulmonary disease (group 2), and 13 patients with restrictive pulmonary disease (group 3), were studied. Each subject performed five separate maneuvers in random order that were repeated until reproducible values were obtained. The maneuvers were Mueller with (A) and without mouthpiece (B), abdominal expulsive effort with open glottis (C), two-step (maneuver C combined with Mueller effort) (D), and feedback [two-step with visual feedback of pleural (Ppl) and abdominal (Pab) pressure] (E). The greatest reproducible Pdimax values were obtained with maneuver E (P less than 0.01) (group 1: 180 +/- 14 cmH2O). The second best maneuvers were A, B, and D (group 1: 154 +/- 25 cmH2O). Maneuver C produced the lowest values. For all maneuvers, group 1 produced higher values than groups 2 and 3 (P less than 0.001), which were similar. The Ppl to Pdi ratio was 0.6 in maneuvers A and B, 0.4 in D and E, and 0.2 in C. We conclude that visual feedback of Ppl and Pab helped the subjects to elicit maximal diaphragmatic effort in a reproducible fashion. It is likely that the great variability of values in Pdimax previously reported are the result of inadequate techniques.

scholarly journals Glycopyrrolate/eFlow CS: The First Nebulized Long-Acting Muscarinic Antagonist Approved to Treat Chronic Obstructive Pulmonary Disease

2018 ◽  
Vol 53 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Roy A. Pleasants
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Data Extraction ◽  
Treatment Options ◽  
Dose Finding ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Muscarinic Antagonist ◽  
Patient Reported ◽  
Long Acting

Objective: To review the pharmacology, efficacy, and safety of the first nebulized long-acting muscarinic antagonist (LAMA), glycopyrrolate (GLY)/eFlow closed system (CS) nebulizer, approved for maintenance treatment of chronic obstructive pulmonary disease (COPD). Data Sources: A PubMed search was conducted (January 2000 to July 2018) using the following terms/phrases: nebulized glycopyrrolate, inhalation devices in COPD, long-acting muscarinic antagonists COPD, and COPD survey. Retrieved articles were reviewed to identify additional references. Study Selection and Data Extraction: Primary and review articles on GLY/eFlow CS and other treatment options for patients with COPD were selected. Data Synthesis: Guidelines recommend the use of LAMAs, alone or in combination with long-acting β2-agonists, as maintenance therapy for the majority of patients with COPD. With the range of different devices and bronchodilators now available, treatment can be tailored based on individual needs. The eFlow CS nebulizer delivers GLY rapidly over a 2- to 3-minute period and provides bronchodilation within 30 minutes, lasting 12 hours. Phase 2 dose-finding and phase 3 studies demonstrated sustained statistically significant and clinically important improvements in pulmonary function and patient-reported outcomes with GLY/eFlow CS. Relevance to Patient Care and Clinical Practice: GLY/eFlow CS provides a novel, portable, efficient, and rapid drug delivery system. Conclusions: The recently approved GLY/eFlow CS drug-device combination provides a viable treatment option for patients with COPD, particularly those with conditions that may impair proper use of traditional handheld inhalers.

scholarly journals Comparison between electronic and paper versions of patient-reported outcome measures in subjects with chronic obstructive pulmonary disease: an observational study with a cross-over administration

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032767
Author(s):  
Koichi Nishimura ◽  
Masaaki Kusunose ◽  
Ryo Sanda ◽  
Yousuke Tsuji ◽  
Yoshinori Hasegawa ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Intraclass Correlation ◽  
Patient Reported Outcome ◽  
Elderly Subjects ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease ◽  
Wide Range ◽  
Patient Reported

ObjectivesA wide range of electronic devices can be used for data collection of patient-reported outcome (PRO) measures in subjects with chronic obstructive pulmonary disease (COPD). Although comparisons between electronic and paper-based PRO measures have been undertaken in asthmatics, it is currently uncertain whether electronic questionnaires work equally as well as paper versions in elderly subjects with COPD. The aim of this study was to compare the responses to paper and electronic versions of the Evaluating Respiratory Symptoms in COPD (E-RS) and the COPD Assessment Test (CAT).DesignA randomised cross-over design was used to compare the responses to paper and electronic versions of the two tools. The interval between the two administrations was 1 week.SettingElectronic versions were self-administered under supervision using a tablet computer at our outpatient clinic (secondary care hospital in Japan) while paper questionnaires completed at home were requested to be returned by mail. It was intended that half of the patients completed the electronic versions of both questionnaires first, followed by the paper versions while the other half completed the paper versions first.ParticipantsEighty-one subjects with stable COPD were included.ResultsThe E-RS total scores (possible range 0–40) were 6.8±7.4 and 5.0±6.6 in the paper-based and electronic versions, respectively, and the CAT scores (possible range 0–40) were 10.0±7.4 and 8.6±7.8. In both questionnaires, higher scores indicate worse status. The relationship between electronic and paper versions showed significant reliability for both the E-RS total score and CAT score (intraclass correlation coefficient=0.82 and 0.89, respectively; both p<0.001). However, both the E-RS total and CAT scores were significantly higher in the paper versions (p<0.05).ConclusionsIn both cases, the two versions of the same questionnaire cannot be used interchangeably even though they have both been validated.

scholarly journals Interference of nail polish on the peripheral oxygen saturation in patients with lung problems during exercise

2012 ◽  
Vol 20 (6) ◽  
pp. 1169-1175
Author(s):  
Walkiria Shimoya-Bittencourt ◽  
Carlos Alberto de Castro Pereira ◽  
Solange Diccini ◽  
Ana Rita de Cássia Bettencourt
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Oxygen Saturation ◽  
Pulmonary Disease ◽  
Exercise Programme ◽  
Chronic Obstructive ◽  
Peripheral Oxygen Saturation ◽  
Obstructive Pulmonary Disease ◽  
Opposite Hand ◽  
Nail Polish ◽  
The Right

AIM: To assess the interference of nail polish on the reading of peripheral oxygen saturation in patients with chronic obstructive pulmonary disease on the step exercise. METHODS: In this study, there was the inclusion of patients with chronic obstructive pulmonary disease, current non-smokers, of both sexes. Four different colours of nail polish were used in the present study (base, light pink, red and brown), randomly distributed among the fingers of the right hand, with the corresponding fingers on the opposite hand being controls. Saturation was measured at rest, with and without the polish, and also during the 4th, 5th and 6th minutes of the exercise programme. RESULTS: The experimental universe included 42 patients with ages of 62.9±8.7 years. In the exercise considered, the red colour reduced it in the fourth minute of the exercise (p=0.047). In contrast, the brown colour reduced saturation at rest and also during the course of exercise (p=0.01). CONCLUSION: In patients with chronic obstructive pulmonary disease, the red and brown colours interfered with the reading of the peripheral oxygen saturation during exercise. This study is registered at the Brazilian Register of Clinical Trials (Registro Brasileiro de Ensaios Clínicos) under No. RBR-9vc722.

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