The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.

The 6-min walk distance (6MWD) is used to evaluate the functional capacity of patients with chronic obstructive pulmonary disease (COPD). The change in 6MWD over time and its correlation with changes in spirometry and survival are unclear. Patients (n=198) with severe COPD and 41 age-matched controls were followed for 2 yrs, and anthropometrics, spirometry, 6MWD and comorbidities were measured. The 6MWD decreased in the COPD group from 238 +/- 107 m to 218 +/- 112 m (-26 +/- 37 m x yr(-1)), and increased in the control group from 532 +/- 82 m to 549 +/- 86 m (12 +/- 25 m x yr(-1)). In both groups, there was a poor correlation with changes in forced expiratory volume in one second (FEV1). Nonsurvivors in the COPD group (42%) had a more pronounced change in the 6MWD (-40 versus -22 m x yr(-1)) but a similar change in FEV1 (118 versus 102 mL x yr(-1)). The 6MWD independently predicted survival, after accounting for age, body mass index, FEV1 and comorbidities. In severe chronic obstructive pulmonary disease, the 6-min walk distance predicts mortality better than other traditional markers of disease severity. Its measurement is useful in the comprehensive evaluation of patients with severe disease.     

Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD

The 6-min walking (6MWD) and 6-min treadmill distance (6MTD) are often used as measures of exercise performance in patients with COPD. The aim of our study was to assess their relationship to daily activity in the course of an exercise training program. Eighty-eight patients with stable COPD (71m/17f; mean +/- SD age, 60 +/-8 year; FEV1, 43+/-14% pred) were recruited, 66 of whom performed a hospital-based 10-day walking training, whereas 22 were treated as control. On day 16MTD, and on days 8 and 10, 6MTD and 6MWD were determined. In addition, patients used an accelerometer (TriTrac-R3D) to record 24 h-activity, whereby training sessions were excluded. In both groups there was a linear relationship (r > or = 0.84 and P < 0.0001) between 6MTD and 24 h-activity, the slope of which was 2.5-fold greater in the training group (P < 0.01). Similar relationships emerged for 6MWD. There was no association between baseline 6MTD, FEV1 or BMI and any of the other measures. These data suggest that daily activity did not markedly vary with exercise capacity under baseline conditions. Participation in a training program increased activity significantly stronger than predicted from the gain in exercise capacity. This underlines the importance of non-physiological, patient-centered factors associated with training in COPD.     

C-reactive protein levels and clinically important predictive outcomes in stable COPD patients.

The aim of this study was to determine the relationship between C-reactive protein (CRP) levels and factors known to predict outcome in stable chronic obstructive pulmonary disease (COPD) patients. The following were studied in 130 stable COPD patients: spirometry, lung volume, arterial oxygen tension (P(a,O2)), dyspnoea, 6-min walk distance (6MWD), body mass index, fat-free mass index, BODE (body mass index, obstruction, dyspnoea and exercise capacity), health-related quality of life, smoking status, the presence of cardiovascular risk factors or disease, corticosteroid use and number of exacerbations in the previous year. CRP levels were measured in these patients and in 65 controls. Using univariate and multivariate analyses, any possible association with the predictors of outcomes was evaluated. CRP levels were higher in COPD patients than in controls (4.1 versus 1.8 mg.L(-1), respectively). Correlation was found with the following variables: forced expiratory volume in one second (FEV1; -0.23), FEV1 % (-0.20), forced vital capacity (FVC; -0.24), FVC % (-0.24), Global Initiative for Chronic Obstructive Lung Disease stage (0.17), BODE (0.17), inspiratory capacity/total lung capacity (-0.20), P(a,O2) (-0.40) and 6MWD (-0.30). Using multivariate analysis, P(a,O2) and 6MWD manifested the strongest negative association with CRP levels. C-reactive protein levels in stable chronic obstructive pulmonary disease patients are best correlated with arterial oxygen tension and 6-min walk distance. This should be considered when C-reactive protein levels are measured in stable chronic obstructive pulmonary disease patients.     

Effects of inspiratory muscle thixotropy on the 6-min walk distance in COPD

Thixotropy conditioning of inspiratory muscles at lower lung volumes decreases functional residual capacity (FRC) of following breath cycles with increases in inspiratory capacity. It remains uncertain whether this conditioning would improve exercise tolerance in chronic obstructive pulmonary disease (COPD). Sixteen male stable COPD patients with mild to severe airway obstruction participated. Before the study, all patients completed the 6-min walk test at least twice. The 6-min walk distance (6MWD) was measured after single inspiratory muscle training (IMT) maneuver or without intervention (control) in a randomized cross-over fashion. The 6MWD was also measured after thixotropy conditioning of inspiratory muscles at the maximal expiratory position or without intervention (control). There were no significant differences in the 6MWD after the IMT maneuver (493.2+/-83.7m, P>0.05) versus without intervention (495.7+/-85.9m). The 6MWD after thixotropy conditioning (526.2+/-96.3m, P=0.030) was significantly higher than the 6MWD without intervention (504.3+/-94.1m). The 95% confidence interval of the difference was from 2.6 to 41.2m. Percentage predicted FRC correlated positively with differences in the 6MWD between control and after the thixotropy conditioning maneuver (r=0.78, P=0.007), whereas percentage predicted forced expiratory volume in 1s or the BODE index did not correlate with differences in the 6MWD (P>0.05). Thixotropy conditioning increases self-paced walking distance in patients with COPD. Patients with higher resting FRC benefited more from the conditioning with greater walking distance.     

Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient!

Several studies of chronic obstructive pulmonary disease (COPD) have shown that pulmonary rehabilitation, consisting of at least three training sessions a week, improves exercise performance and health status. This study investigates feasibility, effect and economic aspects of a rehabilitation programme consisting of two sessions a week for 8 weeks. Twenty-four patients with moderate COPD were randomized to rehabilitation and 21 to placebo. Patients were assigned to an 8-week programme of exercise plus education (Exercise group) or conventional community care (Placebo group). The rehabilitation program was carried out in a hospital outpatient setting and consisted of 16 h exercise and 13.5 h of education. The exercise group received physiotherapy and education twice a week. Seven patients did not complete the programme. The characteristics of the 38 COPD-patients at baseline were the following: (mean +/- SD) forced expiratory volume in 1 sec (FEV1) 1.1+/-0.4 1 (47% of predicted), 6-min walking distance (6MWD) 413+/-75 m, score of St. George's Respiratory Questionnaire (SGRQ) 44+/-21. Health-status, assessed by SGRQ and The Psychological General Well-being (PGWB) Index, did not improve. Rehabilitation resulted in an insignificant improvement in the 6MWD [29 m (95% confidence interval: -8 -66 m)]. We conclude that a rehabilitation program consisting of exercise and education twice a week for 8 weeks had no effect on exercise performance and well being in patients with moderate COPD.     

The Bronchitis Randomized On NAC Cost-Utility Study (BRONCUS): hypothesis and design. BRONCUS-trial Committee.

Chronic obstructive pulmonary disease (COPD) is an irreversible disorder characterized by airflow obstruction and a progressive decline in forced expiratory volume in one second (FEV1). At present, no treatment except quitting smoking appears to affect the progression of the disease. Oxidative stress has been implicated in its pathogenesis. The Bronchitis Randomized on NAC Cost-Utility Study (BRONCUS) is a phase III, randomized, double-blind, placebo-controlled, parallel group, multicentre study designed to assess the effectiveness of the antioxidant agent N-acetylcysteine (NAC) in altering the decline in FEV1, exacerbation rate, and quality of life in patients with moderate to severe COPD. In addition, cost-utility of the treatment will be estimated. Patients will be followed for 3 yrs and evaluated every 3 months. The necessary sample size to demonstrate an effect on the decline in FEV1 of 20 mL x yr(-1) was estimated to be 478 patients. Five hundred and twenty-three patients with moderate to severe COPD were recruited from 10 European countries from June 1, 1997-December 31, 1999. They were 63+/-8 yrs old and consisted of 243 (46%) current smokers and 280 (54%) exsmokers. Patients had on the average 4.9+/-1.6 exacerbations during the last 2 yrs. Postbronchodilator FEVI averaged 57+/-9% and the reversibility after 400 microg of Salbutamol averaged 4+/-4% predicted. The final results of the trial will be available in about 2 yrs. The study will provide objective data on the effects of N-acetylcysteine on outcome variables in chronic obstructive pulmonary disease.     

Resistance versus endurance training in patients with COPD and peripheral muscle weakness.

The effects of endurance training on exercise capacity and health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) patients have been studied thoroughly, while resistance training has been rarely evaluated. This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness (isometric knee extension peak torque <75% predicted). Forty-eight patients (age 64+/-8 yrs, forced expiratory volume in one second 38+/-17% pred) were randomly assigned to resistance training (RT, n=24) or endurance training (ET, n=24). The former consisted of dynamic strengthening exercises. The latter consisted of walking, cycling and arm cranking. Respiratory and peripheral muscle force, exercise capacity, and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation (RT n=14, ET n=16). Statistically significant increases in knee extension peak torque (RT 20+/-21%, ET 42+/-21%), maximal knee flexion force (RT 31+/-39%, ET 28+/-37%), elbow flexion force (RT 24+/-19%, ET 33+/-25%), 6-min walking distance (6MWD) (RT 79+/-74 m, ET 95+/-57 m), maximum workload (RT 15+/-16 Watt, ET 14+/-13 Watt) and HRQL (RT 16+/-25 points, ET 16+/-15 points) were observed. No significant differences in changes in HRQL and 6MWD were seen between the two treatments. Resistance training and endurance training have similar effects on peripheral muscle force, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness.     

Reliability,repeatability and sensitivity to change of externally and self-paced walking tests in COPD patients

In COPD, several walking tests have been proposed to measure exercise tolerance but their relative merits are uncertain. We studied 57 moderate-to-severe, stable COPD patients (mean FEV1 35 +/- 12% predicted). Within a 2-month period, we compared reliability (inter-subject variability) and repeatability (intra-subject variability) of the most widely used 6-min walks (6MWD), with self-paced 2-min walks (2MWD) and externally paced, incremental shuttles (Shuttle). On 9 separate days either of the three 6MWD, 2MWD or Shuttles were performed (nine walks of each type). Then, each walk was performed before and after bronchodilators (BD) to assess sensitivity to change (mean change/standard deviation of change (sensitivity index--SI)). For all exercise tests, reliability was >90% (2MWD 95%, 6MWD 92% and Shuttle 91%). Repeatability was excellent (overall <10% intra-subject variation; for 2MWD 5%, 6MWD 8% and Shuttle 9%). On average, the first walking distance was significantly shorter, but there were no significant differences between second and third walks. Dyspnoea scores were much less reproducible. BD produced highly significant improvements in Shuttle (pre-BD 27 SD=11 --> post-BD 30 SD=11), 6MWD (424 m SD=115 --> 462 m SD=106) and 2MWD (153 m SD=35 --> 162 m SD=34), (P < 0.0001). SI was similar for all walks (6MWD 0.84, 2MWD 0.75 and Shuttle 0.76). In moderate-to-severe COPD, 2MWDs are as informative as 6MWDs without their disadvantages. Self-paced walks are as useful as externally paced Shuttles.     

慢性阻塞性肺疾病评估测试评分对预后的评估意义

目的探讨慢性阻塞性肺疾病评估测试(CAT)评分与慢性阻塞性肺疾病(COPD)患者预后因素之间的相关性,明确CAT评分对COPD患者预后评估的应用价值。方法选取2013年1月至2015年1月我院呼吸内科住院及门诊就诊的106例COPD患者为研究对象。对106例患者治疗前后进行CAT评分、6 min步行实验(6MWD)、改良英国MRC呼吸困难指数(m MRC)、BODE(B为体质量指数,O为气道阻塞程度,D为呼吸困难分数,E为运动耐力)指数、圣乔治呼吸问卷(SGRQ)评分及肺功能的测定。采用单因素线性相关分析CAT评分与患者各临床特征之间的相关性。结果随着CAT评分的升高,患者6MWD、用力呼气容积(FVC)实测值、FVC实测/预测值、一秒用力呼气容积(FEV1)实测值、FEV1实测/预测值、FEV1/FVC、呼气峰流速(PEF)实测值、PEF实测/预测值均明显降低(P0.05),而m MRC评分、BODE指数及SGRQ总评分明显升高(P0.05);患者经短期治疗后,CAT评分、BODE指数及SGRQ总评分均显著低于治疗前(P0.05),而6MWD、FEV1实测值、FEV1实测/预测值、FEV1/FVC则均显著高于治疗前(P0.05);单因素相关分析发现,治疗前CAT评分与m MRC评分(r=0.254,P=0.018)、BODE指数(r=0.426,P=0.009)及SGRQ总评分(r=0.563,P=0.007)呈显著正相关,与6MWD(r=-0.387,P=0.008)、FVC实测值(r=-0.181,P=0.023)、FVC实测/预测值(r=-0.192,P=0.021)、FEV1实测值(r=-0.201,P=0.016)、FEV1实测/预测值(r=-0.214,P=0.013)及FEV1/FVC(r=-0.223,P=0.012)呈显著负相关;治疗后CAT评分与m MRC评分(r=0.304,P=0.011)、BODE指数(r=0.382,P=0.010)及SGRQ总评分(r=0.621,P=0.004)呈显著正相关,与6MWD(r=-0.407,P=0.007)、FEV1实测值(r=-0.211,P=0.014)、FEV1实测/预测值(r=-0.228,P=0.012)及FEV1/FVC(r=-0.231,P=0.011)呈显著负相关。结论 CAT评分与COPD患者m MRC评分、BODE指数、SGRQ总评分、6MWD及肺功能指标均有较好的相关性,具有较好的预测COPD患者预后的应用价值。     

Nutritional depletion in patients on long-term oxygen therapy and/or home mechanical ventilation.

The purpose of this study was to estimate the prevalence of malnutrition in outpatients on long-term oxygen therapy or home mechanical ventilation, to determine the relationships between malnutrition and impairment/disability and smoking and also to identify relevant tools for routine nutritional assessment. In 744 patients (M:F 1.68, aged 65+/-15 yrs) with chronic obstructive pulmonary disease (COPD, 40%), restrictive disorders (27%), mixed respiratory failure (15%), neuromuscular diseases (13%) and bronchiectasis (5%), body mass index (BMI), fat-free mass (FFM), serum albumin, transthyretin, 6-min walking test, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and blood gases were recorded. FFM was the most sensitive parameter for detecting malnutrition, being abnormal in 53.6% of patients, while BMI was <20 in 23.2%, serum albumin <35 g x L(-1) in 20.7%, and serum transthyretin <200 mg x L(-1) in 20%. FFM depletion predominated in neuromuscular, bronchiectasis and restrictive disorders. BMI and FFM were correlated with FEV1, FVC and 6-min walking test. In multivariate analysis a BMI<20 was related to FEV1 and smoking habits, and a low FFM to smoking, FEV1 and female sex. Malnutrition is highly prevalent in home-assisted respiratory patients and is related to causal disease, forced expiratory volume in one second, smoking and disability. Fat-free mass appeared to be the most sensitive and relevant nutritional parameter according to impairment and disability.     

家庭无创正压机械通气联合呼吸操对稳定期慢性阻塞性肺疾病患者的随机对照研究

目的 探索与评估家庭无创正压机械通气(HNPPV)联合呼吸操对稳定期重度慢性阻塞性肺疾病(COPD)患者的疗效.方法 将56例经住院治疗处于稳定期的重度COPD患者分为呼吸操+HNPPV组(治疗组)26例和无创呼吸机组(对照组)30例.分别记录治疗前、治疗后2年两组患者的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、肺功能、6分钟行走距离(6MWD)、呼吸困难分级、辅助呼吸肌评分、年住院次数及病死率等指标.结果 治疗前治疗组与对照组的年龄、性别、COPD病程、体质量指数、PaCO2、PaO2、第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC%)、6MWD、呼吸困难分级、辅助呼吸肌评分、每年住院次数均具有可比性.2年后治疗组呼吸困难分级、辅助呼吸肌评分、6MWD、每年住院次数,优于对照组[(1.76±0.52)分vs(2.09±0.57)分、(2.44±0.62)分vs(2.96±0.58)分、(262.64±32.98)m vs(244.25±25.83)m、(2.06±0.85)次/年vs(2.62±0.92)次/年],差异均具有统计学意义(P值均＜0.05),治疗组死亡1例(1/26),对照组死亡2例(2/30),两组病死率比较差异无统计学意义(x2=0.02).结论 长期应用HNPPV联合呼吸操锻炼对稳定期重度COPD患者的康复更加有效.     

Health status deterioration in patients with chronic obstructive pulmonary disease

This study examined health status decline in patients with chronic obstructive pulmonary disease (COPD). Data are from the Inhaled Steroids in Obstructive Lung Disease (ISOLDE) trial. After an 8-wk run-in, 751 patients (566 male), mean age 64 yr, were randomized to receive fluticasone propionate (FP) 500 microg twice daily (376 patients) or placebo (375 patients). Mean baseline postbronchodilator FEV1 was 50 +/- 15% predicted. Patients completed the St George's Respiratory Questionnaire (SGRQ) and the Short-Form 36 (SF-36) at baseline and every 6 mo for 3 yr. FEV1 and smoking status were assessed at baseline and at 3-mo intervals. A total of 387 (212 FP) patients completed the trial. All SGRQ components (p = 0.03 to 0.004) and Physical Function, Mental Health, Energy/ Vitality, and Physical Role Limitation scales of the SF-36 (p = 0.05 to 0.005) deteriorated faster in the placebo group. FEV1 and SGRQ scores correlated at baseline values (r = -0.25, p < 0.0001), as did change in FEV1 and change in SGRQ (Delta r = -0.24, p < 0.0001). At baseline values smokers had worse SGRQ Total, Symptoms, and Impacts scores than ex-smokers. This difference was maintained throughout the study. Smoking status did not influence the rate of decline in health status. The SGRQ Total scores of FP-treated patients took 59% longer than placebo to deteriorate by a clinically significant amount. We conclude that health status decline in moderate to severe COPD can be reduced by high-dose fluticasone.     

Relation between pulmonary ventilation parameters,exercise tolerance and quality of life in patients with chronic obstructive lung disease

Patients with chronic obstructive pulmonary disease (COPD) do usually have decreased tolerance of exercise capacity and impaired quality of life. Several studies have shown that exercise capacity is related relatively weakly to lung functions in this group of patients. The aim of the present study was to find parameter which could better reflect or predict maximal exercise capacity. 19 patients with the diagnosis COPD with mean value of forced expiratory volume in one second (FEV1) 46% predicted (range 21-79%) entering pulmonary rehabilitation program were included into the study. Enrolled patients were chosen to cover the whole range of airway obstruction severity. Post-bronchodilator static and dynamic ventilation parameters were used for evaluation and calculation. Quality of live was measured using St. George's respiratory questionnaire (SGRQ), evaluating symptoms, activity and impact of the disease with range from 0 (the best level) to 100 (the worst level). Values of FEV1 (p < 0.001) and ratio of FEV1 to vital capacity (FEV1/VC, p < 0.001) were significantly positively correlated with 6 minute walking distance (6MWD). FEV1/VC were closely related to 6MWD then FEV1. The degree of hyperinflation expressed by residual volume (RV, p < 0.005) and by ratio of residual volume to total lung capacity (RV/TLC, p < 0.001) significantly negatively correlated with 6MWD. Maximal occlusion mouth pressures (PImax, p < 0.05) were positively related to 6MWD. Total score of SGRQ correlated significantly to maximal exercise capacity. Pulmonary function tests and respiratory muscle function have important impact on exercise tolerance in patients with COPD. Tolerance of exercise capacity is significantly reflected by total score of quality of life in this group of patients.     

Effect of inhaled metaproterenol on exercise performance in patients with stable "fixed" airway obstruction

We studied the effect of inhaled metaproterenol on exercise performance in ten patients with moderate to severe nonreversible chronic obstructive pulmonary disease (COPD), defined as a FEV1/FVC ratio below 60%, and less than 15% improvement in FEV1 and FVC after both one-time administration of inhaled metaproterenol and a 10-day therapeutic trial with oral theophylline, inhaled metaproterenol, and oral prednisone. After baseline evaluation, on two separate days all selected patients had spirometry and a self-paced 12-min treadmill walking test performed (in double-blind crossover fashion) before and after random administration of five puffs of inhaled metaproterenol or placebo. A few weeks later, testing was repeated single-blind before and after inhaled metaproterenol, but this time the 12-min walk was done in an enclosed hall. Pretreatment spirometry values were similar on all study days, and none of the subjects had a significant change (greater than 15% from baseline) in FEV1 or FVC after the administration of placebo or metaproterenol. The postmetaproterenol treadmill and hall walking distances improved by a mean (+/- SD) of 112 +/- 56 m (p less than 0.001) and 82 +/- 46 m (p less than 0.01), respectively. Individual improvements in exercise performance did not correlate with the corresponding changes in FEV1 or FVC, or with the baseline DLCO measurement. We conclude that an objective improvement in physical performance after administration of a relatively high dose of inhaled metaproterenol can be seen in some patients with moderate to severe "fixed" airway obstruction, despite a lack of significant response as judged by conventional spirometry criteria.     

肺康复治疗对稳定期慢性阻塞性肺疾病病人的疗效分析

目的观察肺康复治疗对稳定期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者的效果。方法测定以下肢训练为主的社区康复治疗前后患者的FEV1(第一秒用力呼气量占预计值百分比)、6 min步行距离、呼吸困难评分(Borg评分)、年人均急性发作次数、年人均住院次数。结果肺康复治疗前后的FEV1、6 min步行距离、Borg评分明显好于治疗前(P0.05),年COPD急性发作次数及住院次数治疗前后有统计学意义。结论肺康复治疗可改善COPD患者的呼吸功能,减少年均急性发作次数及住院次数。     

Improved quality of life after lung volume reduction surgery.

Lung volume reduction surgery (LVRS) improves dyspnoea, pulmonary function, and physical performance in patients with severe pulmonary emphysema. This study investigated the impact of LVRS on health-related quality of life (HRQL) over a 2-yr period following surgery. Thirty-nine consecutive patients were prospectively assessed before LVRS, and followed over 24 months postoperatively. The assessments included pulmonary function, dyspnoea (Medical Research Council (MRC) dyspnoea score), 6-min walking distance (6MWD) and HRQL using the Short Form 36-item questionnaire (SF-36). Several domains of SF-36 improved considerably over 2 yrs after surgery: Physical Functioning: 39 +/- 4 (mean +/- SEM) versus 16 +/- 2 (p<0.01); Vitality: 51 +/- 3 versus 32 +/- 3 (p<0.01); Social Functioning: 72 +/- 4 versus 51 +/- 5 (p<0.01). Also, improvements in pulmonary function (forced expiratory volume in one second (FEV1): 27 +/- 1% predicted, residual volume (RV)/total lung capacity (TLC): 0.65 +/- 0.01), 6 MWD (274 +/- 16 m) and dyspnoea (MRC: 3.9 +/- 01) were sustained for up to 2 yrs after LVRS (FEV1 36 +/- 2% pred, RV/TLC: 0.58 +/- 0.02; 6 MWD: 342 +/- 19 m; MRC: 2.0 +/- 0.2; p<0.05). In patients with severe emphysema, lung volume reduction surgery had positive effects on health-related quality of life and pulmonary function over 2 yrs.     

Health-related quality of life in COPD: why both disease-specific and generic measures should be used.

Although research has consistently demonstrated that chronic obstructive pulmonary disease (COPD) impairs health-related quality of life (HRQL), little agreement has been evidenced regarding the factors identified as contributing to impaired HRQL. The aim was to study such factors using well established generic and specific HRQL instruments. The patients (n=68) were stratified by forced expiratory volume in one second (FEV1) to represent a wide range of disease severity. Pulmonary function, blood gases and 6-min walking distance test (6MWD) were assessed. HRQL instruments included: St George's Respiratory Questionnaire (SGRQ), Sickness Impact Profile (SIP), Hospital Anxiety and Depression Scale and Mood Adjective Check List. The strength of the impact of COPD on HRQL was represented along a continuum ranging from lung function, functional status (physical and psychosocial) to wellbeing. Although correlations between FEV1 versus SGRQ total and SIP overall scores (r=-0.42 and -0.32) were stronger than previously reported, multiple regression analyses showed that lung function contributed little to the variance when dyspnoea-related limitation, depression scores and 6MWD were included in the models. These three factors were important to varying degrees along the whole range of HRQL. Physiological, functional and psychosocial consequences of chronic obstructive pulmonary disease are only poorly to moderately related to each other. The present study concludes that a comprehensive assessment of the effects of chronic obstructive pulmonary disease requires a battery of instruments that not only tap the disease-specific effects, but also the overall burden of the disease on everyday functioning and emotional wellbeing.     

噻托溴铵联合N-乙酰半胱氨酸及呼吸训练治疗稳定期中度慢阻肺的临床观察

目的探讨噻托溴铵联合N-乙酰半胱氨酸(N-acetylcysteine,NAC)及呼吸训练对稳定期中度慢性阻塞性肺病(简称慢阻肺)患者的临床治疗效果。方法筛选稳定期中度慢阻肺患者,随机分为噻托溴铵治疗组、噻托溴铵+NAC治疗组和噻托溴铵+NAC+呼吸训练治疗组,各33例。在治疗前、治疗后6个月评定临床症状、改良英国MRC呼吸困难指数(m MRC)、6分钟步行距离(6-minute walk distance,6MWD)及肺功能。结果各组患者治疗前临床症状评分、m MRC评分、6MWD及1秒用力呼气容积(FEV_1)占预计值百分比(FEV_1%)、FEV_1/用力肺活量(forced vital capacity,FVC)比较均无显著差异(P0.05)。治疗6个月后,患者的临床症状及m MRC评分下降,FEV_1%、FEV_1/FVC及6MWD均增加(P0.05),而噻托溴铵+NAC+呼吸训练治疗组临床症状及mMRC评分、FEV_1%、6MWD的改善效果均优于同期对照组(P0.05)。结论噻托溴铵联合NAC和呼吸训练治疗对改善慢阻肺患者的临床症状、增加运动耐力有显著疗效。     

Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has defined stage I chronic obstructive pulmonary disease (COPD) as forced expiratory volume in one second/forced vital capacity (FEV1/FVC)% <70% and a FEV1% predicted of >80%. Stage 2 has been defined as FEV1/FVC <70% and a FEV1% pred of <80%. The authors examined the extent of COPD misdiagnosis using this definition in healthy, never-smoker, asymptomatic adults aged >70 yrs in Bergen, Norway. A respiratory questionnaire was mailed to a random sample of 2,871 persons aged >70 yrs. In a random, well-defined subgroup of 208 never-smoker respondents with no current respiratory disease and significant dyspnoea or heart disease/hypertension complicated with dyspnoea, 71 were able to perform an acceptable spirometry. Approximately 35% of these healthy, elderly never-smokers had an FEV1/FVC% of <70% and would be classified as having at least a stage 1 COPD. This percentage increased with age and in those aged >80 yrs approximately 50% would be classified as having COPD and approximately one-third would have an FEV1 of <80% pred (stage 2 COPD). The estimated 5th percentile of FEV1 was consistently <80% pred. The Global Initiative for Chronic Obstructive Lung Disease criteria will probably lead to a significant degree of over-diagnosis of chronic obstructive pulmonary disease in those aged >70 yrs. The criteria used to define the various stages of chronic obstructive pulmonary disease need to be age-specific.     

Longitudinal changes in the nature, severity and frequency of COPD exacerbations.

Exacerbations are an important feature and outcome measure in chronic obstructive pulmonary disease (COPD), but little is known about changes in their severity, recovery, symptom composition or frequency over time. In this study 132 patients (91 male; median age 68.4 yrs and median forced expiratory volume in one second (FEV1) 38.4% predicted) recorded daily symptoms and morning peak expiratory flow. Patients were monitored for a median of 918 days and 1,111 exacerbations were identified. Patients with severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) category III, n=38) had an annual exacerbation frequency of 3.43 x yr(-1), 0.75 x yr(-1) higher than those with moderate COPD (GOLD II, n=94). Exacerbation frequency did not change significantly during the study. At exacerbation onset, symptom count increased to 2.23, relative to a baseline of 0.36 set 8-14 days previously, and this increase rose by 0.05 x yr(-1). Recovery to baseline levels in symptoms and FEV1 took longer (0.32 and 0.55 days x yr(-1)). Sputum purulence at exacerbation became more prevalent over time by 4.1% x yr(-1) from an initial value of 17%. The results of this study suggest that over time, individual patients have more symptoms during exacerbations, with an increased chance of sputum purulence and longer recovery times.