Manuela Karloh

The COPD Assessment Test: What Do We Know So Far?: A Systematic Review and Meta-Analysis About Clinical Outcomes Prediction and Classification of Patients Into GOLD Stages

BACKGROUND The COPD Assessment Test (CAT) was developed as a simple instrument to assess health status in patients with COPD. This study aimed to systematically review the determinants of the CAT score, its ability to predict clinical outcomes, and the agreement between CAT (≥ 10) and the modified Medical Research Council scale (mMRC ≥ 2) to categorize patients into the new Global Initiative for Chronic Obstructive Lung Disease classification system. METHODS From January 1, 2009, to June 30, 2015, databases were searched for studies using CAT in adults with COPD and in general populations aiming to detect COPD. Two investigators independently screened, selected, and extracted data by using a standardized form. Where appropriate, the results were combined in a random effects meta-analysis. RESULTS Of 453 studies, 17 were included, and eight were used in the meta-analysis. The models to predict the CAT score were able to explain < 50% of its variance. CAT scores can indicate risk of exacerbation, depression, acute deterioration in health status, and mortality. All studies found a different proportion of patients in each Global Initiative for Chronic Obstructive Lung Disease category using CAT ≥ 10 or mMRC ≥ 2. On average, the distribution was 13% different according to the instrument used. The κ agreement between CAT and mMRC ranged from 0.13 to 0.77. CONCLUSIONS CAT may be used as a complementary tool in a patients clinical assessment to predict COPD exacerbation, health status deterioration, depression, and mortality. The interpretation of this meta-analysis does not support the use of the recommended cutoff points of ≥10 for CAT and ≥2 for mMRC as equivalents for the purpose of assessing patient symptoms.

Relação entre a limitação nas atividades de vida diária (AVD) e o índice BODE em pacientes com doença pulmonar obstrutiva crônica

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that reduces functional capacity, deteriorating the ability to perform activities of daily living (ADL). A close relationship between morbidity and mortality with functional limitation is observed in patients with COPD. OBJECTIVES: To determine if there is a relationship between ADL limitation and the BODE index, which is a predictor of mortality, in patients with moderate to severe COPD. METHODS: Thirty-nine patients with COPD GOLD 2 to 4 recruited by convenience, were submitted to the following tests: spirometry, body mass index (BMI), the London Chest Activity of Daily Living (LCADL) scale, six-minute walking test (6MWT), the Medical Research Council (MRC) scale and the BODE index was calculated. The total score and the percentage of the total score LCADL (LCADL%total) were compared between patients of the four quartiles of the BODE using the Analysis of Variance test. The Spearman correlation coefficient was used to investigate the association between scores of LCADL and BODE index. RESULTS: Patients had an average of FEV1%pred=37±12% and were on average 66±8 years-old. The LCADL%total correlated with the BODE index (r=0.65, p<0.05) as well as with the variables FEV1, dyspnea and walked distance in the 6MWT (r=-0.42, r=0.76 and r=-0.67, p<0.05, respectively). The comparison of the average scores of the LCADL%total between BODE quartiles 1, 2, 3 and 4, demonstrated that only the 4th quartile differed significantly from the others (p<0.05). CONCLUSIONS: ADL limitation has a strong association with the BODE index in patients with moderate to severe COPD and with three of the four variables that composes it.

PHYSIOLOGIcAL RESPOnSES tO tHE GLIttRE-AdL tESt In PAtIEntS WItH cHROnIc OBStRuctIVE PuLMOnARY dISEASE

OBJECTIVE The aim of this study was to investigate the physiological responses induced by the Glittre-ADL test (TGlittre) test in patients with chronic obstructive pulmonary disease (COPD) and compare them with those induced by the 6-minute walk test (6MWT). DESIGN Cross-sectional observational study. SUBJECTS Eighteen patients with COPD 66 years (standard deviation (SD) 8) and forced expiratory volume in 1 s of 40.4% (SD 16.8) predicted) who performed in randomized order the 6MWT and TGlittre on 2 separate days. RESULTS Baseline cardiopulmonary variables were similar between the 6MWT and TGlittre (p > 0.05). TGlittre induced slightly higher final VO2 than 6MWT 83.6 ml/min (SD 163.9); p < 0.05) and oxygen consumption (VO2) reached a plateau after the third lap during TGlittre. The other physiological variables, except respiratory exchange rate, were similar at the end of both tests (p > 0.05). All measured variables were significantly correlated between the 2 tests (p < 0.05). CONCLUSION TGlittre can induce slightly higher oxygen uptake than the 6MWT with similar cardiovascular and ventilatory demand and ventilatory efficiency.

Prevalence of depression in COPD: A systematic review and meta-analysis of controlled studies

BACKGROUND Depression is frequently reported in association with COPD. However, the prevalence of depression in these patients ranges largely. This study aimed to systematically review the prevalence of depression in COPD and controls and to explore remaining causes of inter-study variability in the reported prevalence. METHODS A systemic review of the literature and a meta-analysis was performed to evaluate the source of variability in the reported rates of depression in stable COPD. Main eligibility criteria were: controlled studies with a sample size >100, outpatients with COPD diagnosed by spirometry and, use of a validated depression screening instrument. RESULTS From 1613 studies identified, eight controlled studies were included in the review. The number of participants in the pooled studies was of 5.552 COPD subjects and 5.211 controls. Using stricter criteria for study selection reduced the variability of the depression prevalence in COPD and controls, which was 27.1% [25.9-28.3] in COPD subjects and 10.0% [9.2-10.8] in the control group. The pooled odds ratio and 95% CI was 3.74 [2.4-5.9]. However, the heterogeneity across studies was high. Possible explanatory factor included sample sizes, COPD/controls ratio, smokers/nonsmokers ratio and qualitative differences (source of subjects, instruments to screen depression, COPD severity, smoking status, and comorbidities). CONCLUSION The study highlights the variability in estimates of depression prevalence in COPD. It could be explained by methodological differences across the included studies. This suggests that a standardization is critical to improve precision of the estimates.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects

BACKGROUND the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients.

Glittre-ADL Multiple Tasks Induce Similar Dynamic Hyperinflation With Different Metabolic and Ventilatory Demands in Patients With COPD

Purpose: This cross-sectional study compared the physiological responses and dynamic hyperinflation (DH) of the Glittre-ADL test (TGlittre) and its specific tasks in patients with chronic obstructive pulmonary disease (COPD). Methods: Thirty patients with COPD performed the TGlittre. The individual tasks included stand up and sit down (TSS); climb up and down stairs (TSTAIRS); walk on a flat surface (TWALK); and move objects onto and off a shelf (TSHELF). While performing these tasks, the physiological responses were evaluated and inspiratory capacity measured before and immediately after the tests. Results: All physiological variables and inspiratory capacity were different at the end of the TGlittre and its tasks compared with baseline (P < .05). For most of the physiological variables, there were no significant differences between TSHELF and TWALK (P > .05), which were the tasks with the greatest physiological requirement, whereas the TSS represented the lowest metabolic, cardiovascular, and ventilatory demands among TGlittres tasks. DH did not differ significantly among TGlittres tasks. Conclusions: TWALK and TSHELF were the tasks that resulted in greater physiological overload, whereas TSS induced the lowest metabolic and ventilatory demands. Despite this, DH did not differ among the TGlittres tasks in patients with COPD.

Influência da força muscular periférica e respiratória na limitação das atividades de vida diária em pacientes com doença pulmonar obstrutiva crônica: relato de casos

O objetivo do estudo foi investigar a forca muscular periferica e respiratoria e a capacidade de execucao das atividades de vida diaria, em pacientes com Doenca Pulmonar Obstrutiva Cronica (DPOC). Trata-se de um relatos de caso composto por cinco pacientes submetidos a avaliacao espirometrica e antropometrica, pico de torque isometrico de quadriceps, forca de preensao palmar e as pressoes respiratorias maximas. Foram aplicados: teste de AVD-Glittre, escalas London Chest Activity Daily Living (LCADL) e Medical Research Council (MRC), e questionarios de qualidade de vida SF-36 e o Saint George na Doenca Respiratoria (SGRQ). Dos cinco pacientes avaliados (quatro do genero masculino), dois tinham DPOC moderada, dois grave e um muito grave. As idades variaram de 57 a 67 anos. A pressao inspiratoria maxima variou de 66% a 205% do valor previsto, enquanto a pressao expiratoria maxima oscilou entre 95% e 131%. O percentual previsto da forca de preensao palmar permaneceu entre 87% e 107%. Ja o pico de torque isometrico de quadriceps variou de 38% a 86% do valor previsto. O teste de AVD-Glittre foi executado entre 3,13min e 6,46min. Os resultados encontrados sugerem uma associacao entre forcas musculares periferica e respiratoria e a limitacao nas AVD, porem mais estudos com delineamento adequado para testar essas associacoes deverao ser realizados.