Ebru Calik

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

BackgroundThere are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis.MethodsTwenty patients with bronchiectasis (43.5 ± 14.1 years) and 20 healthy subjects (43.0 ± 10.9 years) participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP), and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC) were determined. A six-minute walk test (6MWT) was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively) using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS) and the Leicester Cough Questionnaire (LCQ), respectively.ResultsNumber of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p < 0.05). In bronchiectasis patients, QMS was significantly associated with HGS, MIP and MEP (p < 0.05). The 6MWT distance was significantly correlated to LCQ psychological score (p < 0.05). The FSS score was significantly associated with LCQ physical and total and MMRC scores (p < 0.05). The LCQ psychological score was significantly associated with MEP and 6MWT distance (p < 0.05).ConclusionsPeripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

Background and aimsFatigue is associated with longitudinal ratings of health in patients with chronic obstructive pulmonary disease (COPD). Although the degree of airflow obstruction is often used to grade disease severity in patients with COPD, multidimensional grading systems have recently been developed. The aim of this study was to investigate the relationship between perceived and actual fatigue level and multidimensional disease severity in patients with COPD.Materials and methodsTwenty-two patients with COPD (aged 52-74 years) took part in the study. Multidimensional disease severity was measured using the SAFE and BODE indices. Perceived fatigue was assessed using the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS). Peripheral muscle endurance was evaluated using the number of sit-ups, squats, and modified push-ups that each patient could do.ResultsThirteen patients (59%) had severe fatigue, and their St Georges Respiratory Questionnaire scores were significantly higher (p < 0.05). The SAFE index score was significantly correlated with the number of sit-ups, number of squats, FSS score and FIS score (p < 0.05). The BODE index was significantly associated with the numbers of sit-ups, squats and modified push-ups, and with the FSS and FIS scores (p < 0.05).ConclusionsPeripheral muscle endurance and fatigue perception in patients with COPD was related to multidimensional disease severity measured with both the SAFE and BODE indices. Improvements in perceived and actual fatigue levels may positively affect multidimensional disease severity and health status in COPD patients. Further research is needed to investigate the effects of fatigue perception and exercise training on patients with different stages of multidimensional COPD severity.RiassuntoRazionale e scopo dello studioLa sensazione di fatica si collega, nella valutazione longitudinale dello stato di salute, con la broncopneumopatia cronica ostruttiva (BPCO). Sebbene il livello di ostruzione del flusso delle vie aeree sia spesso utilizzato per stratificare la gravità di malattia nella BPCO, sono stati recentemente sviluppati sistemi di stadiazione multidimensionali. Scopo di questo studio è indagare il rapporto tra il livello di fatica percepito e reale con il livello di gravità multidimensionale nei pazienti con BPCO.Materiali e metodi22 pazienti con BPCO (età 52-74 anni) hanno preso parte allo studio. Gli indici SAFE e BODE sono stati utilizzati per valutare in modo multidimensionale la gravità di malattia. La fatica percepita è stata valutata con le scale FSS (Fatigue Severity Scale) e FIS (Fatigue Impact Scale). La resistenza dei muscoli periferici è stata indagata con il numero di ripetizioni degli esercizi seduto-in piedi, flessione sulle gambe e sollevamento modificato che ogni paziente era in grado di sostenere.Risultati13 pazienti (59%) hanno riferito grave fatica e il loro punteggio al St George’s Respiratory Questionnaire era significativamente più elevato (p < 0,05). Il punteggio dell’indice SAFE era correlato in modo significativo con il numero di ripetizioni degli esercizi seduto-in piedi, flessione sulle gambe e sollevamento modificato e con i punteggi FSS e FIS (p < 0,05).ConclusioniLa resistenza dei muscoli periferici e la percezione di fatica nei pazienti con BPCO è risultata correlata con il livello di gravità multidimensionale della patologia stimata sia con l’indice SAFE che col BODE. I miglioramenti nei livelli di fatica percepiti e reali possono perciò avere conseguenze positive sul quadro multidimensionale di gravità della malattia e sulla condizione di salute nei pazienti con BPCO. Ulteriori ricerche sono necessarie per valutare gli effetti della percezione di fatica e del riallenamento allo sforzo in pazienti con differenti stadi di gravità multidimensionale della BPCO.

Associations of Components of Metabolic Syndrome with Pulmonary Function and Functional Capacity

O S T E R S mortality. ROC curve analysis was performed to detect the best cut-off value of NLR in the prediction of in-hospital mortality. Results: The mean age of the study population was 61 13.8 years (M: 30, F: 17). Twenty-eight patients underwent operation due to type A aortic dissection. The rest of the patients with chronic type B dissection were followed-up under medical treatment. Nine patients died during hospitalization; higher levels of NLR was observed in these patients compared to the patients who did survive (21.8 18.5 versus 8.1 5.6; p1⁄40.008). Twelve patients (26%) had pericardial effusion on admission and NLR was significantly higher in these patients than the patients wihout effusion (17.3 10.7 versus 9.7 11.8; p1⁄40.02). Multivariate analysis showed that age 65 years, aortic diameter 49 mm, pericardial effusion, history of smoking, systolic blood pressure <90 mmHg were associated with in-hospital mortality. NLR value > 8 yielded an AUC value of 0.795 (95% CI 0.623-0.966; p1⁄40.009) which demonstrated a sensitivity of 78% and specificity of 65 % for the prediction of mortality. Conclusıons: NLR may be associated with in-hospital cardiac events in patients with acute aortic dissection.