Jl Canavan

Phenotypic Characteristics Associated With Reduced Short Physical Performance Battery Score in COPD

BACKGROUNDnThe Short Physical Performance Battery (SPPB) is commonly used in gerontology, but its determinants have not been previously evaluated in COPD. In particular, it is unknown whether pulmonary aspects of COPD would limit the value of SPPB as an assessment tool of lower limb function.nnnMETHODSnIn 109 patients with COPD, we measured SPPB score, spirometry, 6-min walk distance, quadriceps strength, rectus femoris cross-sectional area, fat-free mass, physical activity, health status, and Medical Research Council dyspnea score. In a subset of 31 patients with COPD, a vastus lateralis biopsy was performed, and the biopsy specimen was examined to evaluate the structural muscle characteristics associated with SPPB score. The phenotypic characteristics of patients stratified according to SPPB were determined.nnnRESULTSnQuadriceps strength and 6-min walk distance were the only independent predictors of SPPB score in a multivariate regression model. Furthermore, while age, dyspnea, and health status were also univariate predictors of SPPB score, FEV 1 was not. Stratification by reduced SPPB score identified patients with locomotor muscle atrophy and increasing impairment in strength, exercise capacity, and daily physical activity. Patients with mild or major impairment defined as an SPPB score < 10 had a higher proportion of type 2 fibers (71% [14] vs 58% [15], P = .04).nnnCONCLUSIONSnThe SPPB is a valid and simple assessment tool that may detect a phenotype with functional impairment, loss of muscle mass, and structural muscle abnormality in stable patients with COPD.

S109 Five-Repetition Sit-To-Stand Test: Reliability, Validity and Response to Pulmonary Rehabilitation in COPD

Background Validated field exercise tests, such as the six minute walk test and incremental/endurance shuttle walks, require space and may be time-consuming as repeat walks are needed due to learning effect. Hence they are rarely used outside the research or pulmonary rehabilitation (PR) setting. The five-repetition Sit to Stand test (STS) is a simple test that is feasible in most settings. It measures the quickest time taken to stand and sit five times from a chair, with arms folded. We hypothesized that the STS would be reliable, correlate with the incremental shuttle walk (ISW), and be responsive to PR. Methods The STS was measured in 80 COPD patients on two occasions 24–48 hours apart. Test-retest reliability was calculated using ICCs. STS and ISW were measured in a convenience sample of 396 COPD patients (Mean (SD) age 69 (10); FEV1%predicted 47 (20); ISW 202 (141)) recruited from hospital outpatient clinics. Spearman rank correlation was used to evaluate the relationship between STS and ISW. The STS was measured before and after an 8-week outpatient PR programme in 168 COPD patients. Paired t-tests were used to compare pre- and post-PR outcomes. Results The STS demonstrated excellent test-retest reliability with an ICC value of 0.99 with no learning effect. A significant correlation was seen between STS and ISW (rho = –0.68; p<0.001). The STS improved significantly following PR (Pre: 20.91 (16.23) versus Post: 17.87 (14.93) seconds; 95% confidence interval –1.5 to –4.6 seconds; p<0.001). Conclusions The STS is reliable, correlates with the incremental shuttle walk, and is responsive to PR in patients with COPD. The STS is a practical functional outcome measure suitable for use in most healthcare settings.

P100 The Clinical COPD Questionnaire: Response to Pulmonary Rehabilitation

Background The Clinical COPD Questionnaire (CCQ) is a 10-item health status instrument which has been shown to be reliable and valid in COPD. It takes only two minutes to complete and is simple to score, ranging from 0 (best) – 6 (worst health status). A change in the total CCQ score of 0.4 or more is considered clinically significant (Kocks et al Respir Res 2006). There is a relative paucity of data assessing the responsiveness of the CCQ to pulmonary rehabilitation (PR). We hypothesised that the CCQ would be responsive to PR and that changes would correlate with changes in other well established health status instruments (Chronic Respiratory Questionnaire: CRQ, St George’s Respiratory Questionnaire: SGRQ and the COPD Assessment Test: CAT). Methods 75 consecutive COPD patients referred to an 8-week outpatient PR programme were recruited. The CCQ, along with the CRQ, SGRQ, CAT, and incremental shuttle walk (ISW), were measured before and after PR. Paired t-test was used to compare outcomes before and after PR, whilst Spearman’s rank correlation was used to assess association between change in CCQ with change in other health status questionnaires. Results 53 patients completed PR. Baseline characteristics were 33 Male:20 Female, mean (standard deviation) age 68.5(9.9) years, FEV1% predicted 58 (27) and ISW 224 (178) metres. There was a significant reduction (improvement) in CCQ following PR (Pre: 2.9 (1.3) versus Post: 2.1 (1.2); 95% confidence interval –0.4 to –1.0). Significant improvements were also seen in ISW, CRQ domains, SGRQ and CAT with PR. Changes in CCQ correlated significantly with changes in the other health status instruments (see table 1). Abstract P100 Table 1 Relationship between change in CCQ and change in CRQ, SGRQ and CAT with PR Δ = Change in PR ΔCCQ Rho p-value ΔCRQ Dyspnoea -0.44 0.001 ΔCRQ Fatigue -0.44 0.001 ΔCRQ Emotion -0.34 0.01 ΔCRQ Mastery -0.46 <0.001 ΔSGRQ Symptoms 0.42 0.005 ΔSGRQ Activities 0.59 <0.001 ΔSGRQ Impact 0.60 <0.001 ΔSGRQ Total 0.65 <0.001 ΔCAT 0.64 <0.001 Conclusion The CCQ is responsive to PR and a practical alternative to longer-established health status instruments.

P106 Validity of the Clinical COPD Questionaire (CCQ) in Non-COPD Patients

Background The Clinical COPD Questionnaire (CCQ) is a 10-item health status instrument that takes only two minutes to complete, and has been shown to be reliable and valid in patients with COPD (van der Molen T et al 2003, Damato S et al 2005). In COPD patients, the CCQ correlates with established health status instruments such as the Chronic Respiratory Disease Questionnaire (CRQ), COPD Assessment Test (CAT) and St George’s Respiratory Questionnaire (SGRQ) (Tsiligianni IG et al 2012). Although the CRQ and SGRQ were originally developed in patients with chronic airway obstruction, they are commonly used in clinical practise in chronic respiratory diseases other than COPD. We hypothesised that the CCQ would correlate with existing health status measures and exercise capacity in a survey of non-COPD patients Methods 60 patients were recruited from respiratory outpatient clinics. Disease classifications included interstitial lung disease (n=23), asthma (n=10), bronchiectasis (n=17), extrathoracic restriction (n=8) and thoracic surgery for lung cancer (n=2). CCQ, CAT, CRQ, SGRQ and incremental shuttle walk (ISW) were recorded. Spearman’s rank correlation was used to assess the relationship between CCQ and other outcome measures. Results Baseline characteristics are presented as mean (standard deviation) or median (25th, 75th percentiles); Age 65 (58, 77), FEV1% predicted 69.8 (24.4), BMI 28.0 (25.4, 32.3), MRC 3(1), CCQ 2.1 (1.5, 3.8) and ISW 210 (90, 320). There was a significant correlation between the total CCQ and CAT, SGRQ, CRDQ, MRC and ISW (all p<0.01 see Table. 1). In addition individual domains of the CCQ correlated significantly with MRC, CAT and individual domains of the CRQ (p<0.01). Abstract P106 Table 1 Relationship between CCQ and other outcome measures, r = Spearman’s Correlation Coefficient ISW (m) MRC CAT CRQ-D CRQ- F CRQ-E CRQ-M SGRQ Symptom SGRQ Activities SGRQ Impact SGRQ Total CCQ Symptoms –0.41 0.54 0.63 –0.46 –0.42 –0.50 –0.58 0.47 0.61 0.55 0.63 CCQ Functional –0.44 0.52 0.65 –0.42 –0.67 –0.78 –0.72 0.21 0.58 0.75 0.66 CCQ Mental –0.59 0.64 0.67 –0.64 –0.63 –0.62 –0.76 0.27 0.81 0.71 0.77 CCQ Total –0.54 0.65 0.74 –0.59 –0.66 –0.71 –0.79 0.37 0.78 0.76 0.79 Conclusions The CCQ correlates well with existing health status and functional outcome measures in non-COPD patients. CCQ may be a useful assessment tool to test the efficacy of interventions such as pulmonary rehabilitation in this population, but longitudinal studies are required to confirm.

P104 Response of the COPD Assessment Test (CAT) to Pulmonary Rehabilitation in Non-COPD Patients

Background The COPD (chronic obstructive pulmonary disease) assessment test (CAT) is a recently introduced, simple to use health status instrument, which takes less time to complete than better-established health status instruments (Jones PW et al 2009, Ringbaek T et al 2012). In COPD patients, the CAT improves with pulmonary rehabilitation (PR) and correlates with improvements in longer established health status instruments such as the Chronic Respiratory Disease Questionnaire (CRDQ) (Dodd et al 2011). As increasing numbers of non-COPD patients are referred for PR we investigated whether the CAT is responsive to PR in these populations. Methods 365 consecutive patients (255 COPD, 110 non-COPD) completing an eight week outpatient pulmonary rehabilitation programme were recruited. For the non-COPD group, disease classifications included interstitial lung disease (n=27), asthma (n=37), bronchiectasis (n=29), extrathoracic restriction (n=12) and thoracic surgery for lung cancer (n=5). CAT, CRDQ and incremental shuttle walk (ISW) were collected prospectively. Paired t-tests were used to assess the CAT in COPD and non-COPD patients, and a Pearson’s correlation coefficient used to assess the relationship between change in CAT and change in CRQ with PR for non-COPD and COPD patients. Results Following PR there was a significant improvement in the CAT, CRDQ and ISW in both non-COPD and COPD (p<0.001). There was a similar improvement in the mean (95% confidence interval) CAT score in both non-COPD and COPD patients (non-COPD: –2.1 (–1.0, –3.2) versus COPD: –3.0 (–2.2, –3.8); p=0.19). Change in CAT was significantly correlated with all domains of the CRQ in non-COPD patients (all p<0.01 see Table 1). Abstract P104 Table 1 Relationship between change in CAT and change in CRQ with PR for non-COPD and COPD patients Non-COPD r p-value Δ CRQ Dyspnoea –0.29 0.003 Δ CRQ Fatigue –0.33 0.004 Δ CRQ Emotion –0.38 <0.001 Δ CRQ Mastery –0.25 0.009 COPD r p-value Δ CRQ Dyspnoea –0.32 <0.001 Δ CRQ Fatigue –0.38 <0.001 Δ CRQ Emotion –0.43 <0.001 Δ CRQ Mastery –0.39 <0.001 Δ = Change with PR; CRQ = self-report Chronic Respiratory Questionnaire; r=Pearson Correlation Coefficient. Conclusions As in COPD patients, the CAT is immediately responsive to PR in non-COPD patients. Even in unselected patients undergoing PR, the CAT is a practical but robust health status instrument.