Chronic Respiratory Disease最新文献

ObjectiveThis retrospective study in individuals with chronic respiratory diseases (CRDs) compared changes in quality of life, anxiety and depressive symptoms, and exercise capacity after a home pulmonary rehabilitation (PR) programme, based on the care manager's professional background.MethodsPR team was composed of nurses (Gr1, n = 989 patients), physiotherapists (Gr2, n = 466), one dietician and one sociomedical beautician (Gr3, n = 794) and one respiratory physician (Gr4, n = 201) who supervised one home session per week during 8 weeks. Quality of life, anxiety and depressive symptoms, dyspnea and exercise capacity were assessed at the beginning and end of PR, and at 12 months after the end of PR.Results2450 participants were included (females: 41.6%, age: 64.1 ± 13.0 years, FEV₁: 50.7 ± 25.2% of predicted, people with COPD: 51%, with ILD: 23%, with asthma: 10%). Gr 1, Gr 3 and Gr 4 improved all the assessments at short- and long-term (p < 0.01). Improvement in the Visual Simplified Respiratory Questionnaire in Gr2 was not maintained at long-term. According to the linear mixed models, changes over time were not statistically different between groups.ConclusionA personalised PR programme delivered by one care manager, led to similar short-term benefits regardless of the care manager's initial professional background.

BackgroundChronic respiratory disease burden in Nepal is high, although data from the Terai (lowlands) is limited.MethodsThrough a community outreach programme in Mechinagar, 3398 adults (mean age 49.6 years, 59% female) were recruited to complete spirometry and questionnaires to determine prevalences of airflow obstruction, breathlessness (MRC dyspnoea score ≥3) and self-reported chronic lung disease. Multivariate logistic regression examined associated demographic and lifestyle factors.ResultsPrevalences of airflow obstruction (15%) and breathlessness (13%) exceeded self-reported chronic lung disease (8%). Age (odds ratio = 1.06, 95% confidence interval = 1.05-1.07), body mass index (BMI) per 1 kg/m² (0.90, 0.88-0.93), physical inactivity (1.95, 1.07-3.84) and no formal education (1.46, 1.14-1.88) were associated with airflow obstruction. Smoking was only associated with airflow obstruction in females (1.90, 1.22-2.94) and adults ≥40 years (1.40, 1.05-1.86). Age (1.04, 1.03-1.05), airflow obstruction (2.43, 1.85-3.18), and male sex (0.63, 0.49-0.80) were associated with breathlessness. Only in females was breathlessness associated with BMI (1.08, 1.05-1.12) and mixed biomass use (2.65, 1.39-4.85). In men, labour/farming/agriculture work (3.30, 1.12-14.20) or unemployment (4.39, 1.43-19.30) was associated with breathlessness.ConclusionThere is likely underdiagnosis of chronic lung disease in the Terai. Addressing smoking, educational disparities, physical inactivity and environmental pollutant exposure are public health priorities to improve respiratory health in the region.

IntroductionEffective management of pulmonary exacerbations (PEx) in cystic fibrosis (CF) is essential to minimise lung damage and reduce morbidity and mortality. Spirometry, the standard tool for lung function assessment in adult people with CF (pwCF), has limitations. Forced Oscillometry Technique (FOT) is an effort-independent method that assesses small airways disease and has been validated in other respiratory conditions. This study evaluated the feasibility and acceptability of implementing FOT during treatment for PEx in adult pwCF.MethodsTwelve adult pwCF underwent FOT and spirometry at the start and end of PEx treatment, and at clinically convenient intervals. FOT was also measured before and after physiotherapy-directed airway clearance. A questionnaire assessed patient satisfaction with FOT.ResultsAll patients had spirometry below baseline at PEx onset and small airways dysfunction on FOT. Treatment was associated with improvements in median FEV1pp (5.1%, p = 0.050) and X5 (0.2 cm H₂O/L/s, p = 0.023), with a significant association between FEV1pp and X5 (p = 0.004). There was no significant FOT change after airway clearance. Patients rated FOT more favourably than spirometry.DiscussionFOT is feasible, well-tolerated, and may complement spirometry in assessing adult pwCF during PEx. Further studies are warranted.

ObjectivesTreatable traits are identifiable and treatable features of disease. The primary objective was to evaluate whether a bronchiectasis clinic in a regional setting, implementing a treatable traits approach, would lead to improvements in quality of life. Secondary objectives were to evaluate clinic implementation outcomes, annual exacerbations and hospitalisation.MethodsAn implementation study. Adults with bronchiectasis attending an outpatient clinic in Rockhampton, Australia between 2021 and 2023 were recruited. Clinical care was implemented by a physiotherapist and nurses according to traits identified. Quality of life (QoL-Bronchiectasis respiratory symptom score (QoL-B rs), Leicester Cough Questionnaire (LCQ) total score) was evaluated at baseline, three and 12-months from first attendance. Implementation outcomes were determined by clinic appointment uptake and attendance and pulmonary rehabilitation uptake and completion at 12-months. Exacerbation frequency and hospitalisation for the 12-months before and after enrolment were compared.Results50 participants were recruited [mean (SD) age 71 (12) years; Bronchiectasis Severity Index (%) mild (22) moderate (44) severe (34)]. There was a significant improvement in QoL at three and 12-months from baseline (mean difference, 95% CI) [3 months: QoL-B rs 9.2 (3.2-15.2), LCQ 1.7 (0.6-2.8); 12-months: QoL-B rs 10.1 (3.9-16.3), LCQ 1.8 (0.8-2.8)]. Clinic uptake (91%), attendance (97%) and pulmonary rehabilitation uptake (74%) and completion (84%) were high. Exacerbation frequency [median (IQR) 1.0 (3.0) to 0.0 (1.0), p = 0.007], and hospitalisation decreased (18% vs 0%, p = 0.005).DiscussionA treatable traits approach improved quality of life, was feasible, including the achievement of high pulmonary rehabilitation uptake and completion, and reduced exacerbation frequency and hospitalisation.

Introduction: Abnormal breathing patterns unexplained by pathophysiology are typically referred to using terms including chronic breathlessness syndrome or complex breathlessness. Often patients with these conditions are referred to physiotherapy for an assessment of this breathlessness, where some are diagnosed with breathing pattern disorder (BrPD) or dysfunctional breathing (DB). The condition seen in physiotherapy occurs in at least 10% of the general population, increasing to 29-40% with coexisting conditions. Inconsistency in the nomenclature and physiotherapy assessment reduces recognition of the condition and hinders development in this area. Aims of the study: To establish expert physiotherapists' consensus on terminology to describe this condition and provide guidance for its physiotherapy assessment. Participants and methods: The opinions and experiences of ten respiratory physiotherapists, nine other clinicians (doctors, nurses, and speech and language therapists), and five patients diagnosed with BrPD were explored in focus groups or interviews regarding the terminology used and assessment experience. A second separate purposive sample of clinical expert physiotherapists (n = 11) took part in a nominal group technique (NGT) process to build consensus on the following questions: Question 1: What is your preferred term for this condition? Question 2: What are the most important assessment components to be included in all assessments? Results: One focus group (n = 10) and 14 interviews were completed. Framework analysis of the data from focus groups and interviews was undertaken and these results were shared with the participants in the nominal group. Consensus (71%) for the term breathing pattern disorder (BrPD) was achieved and an assessment guide was created. Conclusion: With improved consistency in its description and assessment, the adoption of breathing pattern disorder may help to further develop clinical and research priorities in this area within physiotherapy services.

BackgroundPneumothorax is a common and important complication of transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD), however little is known about what predisposes patients to pneumothorax during TBLC.MethodsWe reviewed the pre-TBLC ILD work-up of 76 patients who underwent TBLC in our tertiary ILD referral center from 2017 to 2023. We assessed factors including pulmonary function tests, bronchoalveolar lavage (BAL), blood tests, and imaging and to see if any of them caused an increased risk of iatrogenic pneumothorax.Results19 patients suffered a pneumothorax (25%). Neutrophilia on BAL (37.9% pneumothorax when present vs 12.8% when not present, p = 0.046) and the presence of ground glass opacification on high resolution CT-Thorax (38.2% vs 12.5%, p = 0.014) increased the risk of pneumothorax during TBLC. Other factors such as the presence of pleura in the biopsy sample (47.1% vs 17.2%, p = 0.021), as well as taking 3 or more biopsies (35.7% vs 11.8%, p = 0.019) were also significant predictors of pneumothorax.ConclusionsMarkers of acute inflammation as well as increased number of biopsies taken in a procedure lead to increased risk of pneumothorax. This may lead to changes in planning, patient selection and timing of TBLC procedures in ILD patients.

PurposeThis study aimed to investigate the associations of the Geriatric Nutritional Risk Index (GNRI) and the simplified Geriatric Nutritional Risk Index (sGNRI) with Chronic Obstructive Pulmonary Disease (COPD).MethodsWe assessed 161 patients with COPD and 947 healthy controls. The sGNRI was derived using the formula: serum albumin (g/dL) + 0.1 × body mass index (BMI, kg/m²). Primary outcomes included the BODE (body mass index, airflow obstruction, dyspnea, exercise capacity) index and hospital length of stay (LOS). The secondary outcome was the prevalence of COPD.ResultsMalnourished patients (GNRI <95.40 or sGNRI <5.89) exhibited lower BMI and albumin levels, as well as worse pulmonary function (all p < 0.05). GNRI (Odds Ratio [OR] = 0.945, 95% Confidence Interval [CI]: 0.903-0.989, p = 0.015) and sGNRI (OR = 0.413, 95% CI: 0.191-0.890, p = 0.024) were significantly associated with the severity of COPD in a multivariable-adjusted model. Subgroup analysis revealed stronger predictive performance of GNRI and sGNRI among males, non-hypertensive patients, and smokers (for sGNRI).ConclusionsCompared with GNRI, sGNRI may serve as a more practical tool for identifying malnutrition-related risk among patients with COPD.

Background: People with chronic obstructive pulmonary disease (COPD) are at a higher risk of falls. This preliminary study aims to externally validate a previously developed clinical prediction model for falls in community-dwelling older adults with COPD.

Methods: This was a secondary analysis of a 12-month prospective cohort study. Older adults (≥60 years) with COPD, who reported a fall in the past year and/or had balance concerns, were tracked for 12-month future falls. Baseline predictors included 12-month history of ≥2 falls, total chronic conditions, and Timed Up and Go Dual-Task (TUG-DT) test scores. Model performance was assessed for discrimination (c-statistic), calibration (E:O, CITL, and calibration slope), and clinical value (decision curve analysis).

Results: The study included 89 participants (average age 73 ± 9 years; 83 females; FEV₁%predicted = 47%). Of these, 35 (39%) reported ≥1 future fall, totaling 89 falls. The model demonstrated acceptable discrimination (c-statistic = 0.62, CI [0.51,0.72]), and calibration (E:O = 1, CITL = 0, and a calibration slope = 1). Decision curve analysis showed greater clinical value when using the prediction model compared to screening for fall history alone.

Conclusions: A 12-month history of ≥2 falls, higher total chronic conditions, and worse TUG-DT test scores, predicts falls in community-dwelling older adults with COPD. Larger studies are needed before clinical application.

Introduction: Many qualitative studies have explored patients' experiences of an Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) retrospectively. To our knowledge, no study has conducted a real-time investigation of COPD exacerbation experience during hospitalisation.Objective: To establish an in-depth and comprehensive understanding of the whole COPD exacerbation experience and uncover any unrecognised burdens that might serve as barriers to engagement in discharge services post-AECOPD.Methods: Semi-structured interviews were conducted, and data were analysed using thematic analysis. The study included participants who were admitted to the hospital with a primary diagnosis of AECOPD.Results: Twelve participants were included in the study (Male, n = 9; Female, n = 3), with a mean ± SD age of 66 ± 8 years. Findings generated three overarching themes, and sub-themes: (I) Health deterioration phase (II) Implications of AECOPD and the associated hospitalisation, and (III) Recovery journey.Conclusion: The impact of breathlessness appears to extend across the COPD exacerbation journey and, for some, well beyond. Breathlessness both within and extending beyond the acute phase was associated with comorbid psychological distress. Interventions should consider appropriate phasing within the management process, focus on breathlessness and involve a behavioural therapy component.

Objectives: Sarcopenia is influenced by multiple factors, including psychological aspects. This study aimed to explore the relationships among depressive symptoms, dyspnea-related fear, and sarcopenia, with a focus on the mediating role of physical activity. Methods: A cross-sectional study was conducted among 348 COPD patients at a tertiary hospital in Western China from July 2023 to July 2024. Sarcopenia was assessed according to the 2019 AWGS criteria, including hand bioelectrical impedance analysis (BIA), and grip strength testing. Depressive symptoms, dyspnea-related fear, and physical activity were evaluated through self-reported measures using the depression subscale of the Hospital Anxiety and Depression Scale (HADS), the Breathlessness Beliefs Questionnaire (BBQ), and the International Physical Activity Questionnaire Short Form (IPAQ-SF), respectively. Logistic regressions analyses explored associations among depressive symptoms, dyspnea-related fear, and sarcopenia. Maximum Likelihood (ML) estimation was employed using Mplus software to evaluate the mediating effect of physical activity on the relationships. Results: The prevalence of sarcopenia among COPD patients was 60.3%. In the logistic regression analysis with sarcopenia as the dependent variable, physical activity levels (OR = 0.508, p = 0.019) and depressive symptoms (OR = 1.079, p = 0.029) were statistically significant, while BBQ scores were not (OR = 1.031, p = 0.070). Mediating analyses revealed that depressive symptoms directly increased the risk of sarcopenia (β = 0.076, p = 0.042) but did not do so indirectly via physical activity (β = 0.056, p = 0.146). Conversely, dyspnea-related fear had an indirect effect on sarcopenia through physical activity, with a borderline statistical significance (β = 0.053, p = 0.049). Conclusions: This study highlights the critical role of psychological factors in sarcopenia development among COPD patients, with physical activity serving as a significant mediator. These findings underscore the need for integrated rehabilitation strategies addressing both psychological and physical activity barriers to improve outcomes for COPD patients.