Sevgi Ozalevli

Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease

AIM: Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease (COPD). However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients. METHODS: A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions (pulmonary function test), general health- and disease-related quality of life (Medical Outcomes Study 36-Item Short-Form of Health Survey, St Georges Respiratory Questionnaire), and gait speed (6-minute walk test) were assessed. RESULTS: The mean gait speed values were slower in moderate (75.7 ± 14.0 m/min), severe (64.3 ± 16.5 m/min), and very severe (60.2 ± 15.5 m/min) COPD patients than controls (81.3 ± 14.3 m/min). There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results (FEV1, FVC, FVC%, FEV1/FVC ratio, PEF, PEF%), and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St Georges Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD. CONCLUSIONS: As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD.

Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

ObjectiveThe aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF).DesignA prospective study.PatientsSeventeen patients diagnosed with IPF.MethodsA home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale), pulmonary function (pulmonary function test), exercise capacity (6-minute walking test, 6MWD), and general health related quality of life (Medical Outcomes Short Form-36) were evaluated.ResultsA significant decrease in perceived dyspnea (p = 0.003) and leg fatigue (p < 0.05) severities, and an increase in the 6MWD (p = 0.04) and general health related quality of life scores (health perception, physical role, and emotional status subscores) were found after the program (p < 0.05).ConclusionHome-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.RiassuntoObiettivoScopo di questo studio era valutare gli effetti di un programma di riabilitazione respiratoria domiciliare sugli indicatori funzionali nei pazienti con fibrosi polmonare idiopatica(IPF). Disegno dello studio: Studio prospetticoPazientiDiciassette pazienti con diagnosi di IPFMetodiUn programma di riabilitazione respiratoria della durata di 12 settimane è stato applicato in 17 pazienti con IPF. Sono state oggetto di valutazione l’intensità della dispnea durante le attività quotidiane (Medical Research Council Scale), la funzionalità respiratoria (prove di funzionalità respiratoria), la capacità di esercizio fisico (test del cammino di 6 minuti - 6MWD), ed il livello complessivo di qualità della vita legato alla salute(Medical Outcomes Short Form-36)RisultatiAl termine del programma sono stati rilevati una riduzione significativa della gravità della dispnea percepita (p = 0,003) e dell’affaticabilità degli arti inferiori (p < 0,05), un incremento del 6MWD (p = 0,04) e punteggi del questionario sulla qualità di vita (nei sottogruppi di percezione del proprio stato di salute, ruolo fisico e di condizione emotiva) (p < 0,05)ConclusioniUn programma di riabilitazione respiratoria domiciliare può ridurre l’intensità della dispnea e dell’affaticabilità, migliorare la capacità di esercizio fisico e la qualità di vita rela tivaalla salute in pazienti con IPF. Nel trattamento dei pazienti con IPF i programmi di riabilitazione respiratoria domiciliari dovrebbero perciò essere inclusi nelle opzioni terapeutiche diroutine

Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study

Background and aims: To investigate the relationship between disease-related factors and balance, and a history of falls in chronic obstructive pulmonary disease (COPD). Methods: Thirty-six patients with COPD and twenty healthy individuals were studied. Pulmonary function (pulmonary function test), hypoxemia (analysis of arterial blood gases), history of falls and tripping (number of falls and tripping in the past year), balance (Berg’s Balance Scale-BBS), quadriceps femoris muscle strength (manual muscle test), and exercise capacity (6-minute walking test-6MWT) were assessed. Results: BBS scores were significantly different between groups (p=0.001). BBS scores, frequency of falls and tripping were correlated in COPD patients (p≤0.01). BBS score and frequency of falls were correlated with dyspnea and peripheral oxygen saturation measured after the 6MWT, partial arterial oxygen pressure, and arterial oxygen saturation values in COPD patients (p<0.05). Conclusions: According to our results, hypoxemia, dyspnea and fatigue are disease- related factors, which are related with balance impairment and falls in COPD patients. For this reason, we suggest that assessment of and training to improve balance impairment among the elderly with COPD should be a component of pulmonary rehabilitation programs in clinical practice.

Comparison of Short Form‐36 Health Survey and Nottingham Health Profile in moderate to severe patients with COPD

OBJECTIVE To compare the health-related quality of life (HRQoL) assessed by Short Form-36 Health Survey (SF-36) and Nottingham Health Profile (NHP) on the basis of lung function and exercise capacity parameters in patients with moderate to severe chronic obstructive pulmonary disease (COPD). METHODS AND MATERIALS The investigation was a prospective, quality-of-life survey and cross-sectional study of 130 consecutive COPD patients. The NHP and SF-36 as generic HRQoL instruments, the Chronic Respiratory Disease questionnaire (CRQ) as a disease-specific HRQoL instrument and 6-minute walking test, severity of dyspnea, leg fatigue and lung function, were the measurements and instruments used in the study. RESULTS It was determined that the subscales of both questionnaires were generally related with the FEV(1), walking distance, CRQ, severity of dyspnea and leg fatigue values (P<0.05). The much higher correlation coefficient was determined between these parameters and NHP compared with the SF-36. Only NHP was found to be correlated with the age, body mass index and smoking consumption (P<0.05). CONCLUSIONS The stronger relation of NHP with the clinical and physical parameters of the patients compared with that of SF-36 may be associated with the increased sensitivity of NHP to the clinical state owing to the increasing respiratory symptoms of our old patients with moderate to severe obstruction and/or the more intelligible and easy-to-respond nature of NHP compared with SF-36.

Comparison of six-minute walking tests conducted with and without supplemental oxygen in patients with chronic obstructive pulmonary disease and exercise-induced oxygen desaturation.

BACKGROUND There are contradictory reports in the literature on the effects of supplemental oxygen administered before or after exercise tests. In light of this, we compared the results of 6-minute walking tests performed in room-air conditions (A6MWT) and with supplemental oxygen (O6MWT) in patients with chronic obstructive pulmonary disease (COPD) and exercise-induced oxygen desaturation. PATIENTS AND METHODS Thirty-one patients with COPD were included in the study. The A6MWT and O6MWT were performed in randomized order on each patient. During the tests, severity of dyspnea and tiring of the leg were evaluated by the Modified Borg Scale. Heart rate and pulsed oxygen saturation and blood pressure were measured by pulse oximeter. RESULTS Walking distance was longer with the O6MWT than with the A6MWT (P=0.001). The O6MWT resulted in a smaller increase in dyspnea, leg fatigue, and heart rate and a smaller drop in pulsed saturation than the A6MWT (P<0.05). The walking distance with the O6MWT correlated with respiratory function and hemodynamic parameters (P<0.05). CONCLUSION The O6MWT, which produced less hemodynamic stress and was safer than the A6MWT, might provide more accurate information on exercise limitation for patients with COPD. These results suggest that the O6MWT can be used as a standard walking exercise test for patients with COPD and exercise-induced oxygen desaturation.

Impact of physiotherapy on patients with advanced lung cancer.

Patients with lung cancer have high mortality and high morbidity. Lung cancer-related symptoms and problems such as dyspnea, fatigue, pain, and cachexia that begin in the early phase later result in poor physical functioning, psychosocial, and quality of life status. In addition, advancing age is associated with significant comorbidity. These patients may benefit from multidisciplinary therapy to reduce the perceived severity of dyspnea and fatigue and increase physical functioning and quality of life. Based on management of symptoms and problems such as dyspnea, physical inactivity, cancer-related fatigue, respiratory secretions, pain, and anxiety–depression of these patients, it is thought that physiotherapy techniques can be used on advanced lung cancer patients following a comprehensive evaluation. However, well-designed, prospective, and randomized-controlled trials are needed to prove the efficacy of physiotherapy and pulmonary rehabilitation in general for patients with advanced lung cancer.

Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

Abstract Background: Hand dexterity is important for daily living activities and can be related to cognitive functions in patients with chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to investigate the relationship between cognitive dysfunction and hand dexterity in patients with COPD. Methods: 35 COPD patients and 36 healthy individuals were assessed. The Minnesota Hand Dexterity Test and Mini Mental State Examination (MMSE) were used for assessment of cognitive function and hand dexterity. Results: Hand dexterity test scores and cognitive function of COPD patients’ were significantly lower than the healthy group (p < 0.01). The MMSE scores were negatively correlated with hand dexterity scores in the COPD group (p < 0.05). Conclusions: There was a relationship between cognitive function and hand dexterity in the patients with COPD; however, hand dexterity did not alter according to hypoxemia severity. Hand dexterity which is important in daily living activities should be evaluated in greater detail with further studies in COPD patients.

Reference Accuracy in Four Respiratory Medical Journals

The citation error numbers are recorded as number and percentage according to the error grade. The total number of citations with errors among all published journals was 103 (25.8%). The number of references with errors ranged from the lowest error rate of 22% for the European Respiratory Journal to the highest of 31% recorded for the Respiratory Medicine and bibliographically classified errors for all journals are presented in table 1 . Our study of respiratory medical journals gave a prevalence of citation errors of 25.8%. The rate of citation errors in respiratory medicine is lower than the median rate of biomedical journals (median 36%, range 4–66.7%) [6] . Errors in citation reflect poorly on the author, the validity of the article, the peer review process, and the reputation of the journal [1, 3, 7] . The problem of inappropriate citations is not so easily solved, and would require prodigious effort on the part of reviewers, editors or journal staff members [2] . The ultimate responsibility for and solution to the problem of citation inaccuracies and misuse must lie with authors themselves [8] . Authors must be more vigilant and precise in their referencing practices and in the final review and reading of galley proofs [2, 9] . They should also always check the original source when citing references used in other articles [2, 9] . How can errors in references be reduced? Obviously, submission of photocopies of the first and last page of all references cited in the submitted article [2, 3, 8, 9] and this has been effective in reducing citation errors [1] . Alternatively, spot checks of the references by editors or reviewers may also be effective [1, 3, 4] . The direct downloading of references from MEDLINE [1, 2, 4] downloadable E-Journals [2, 7] , or the use of referencing software (such as End-note) [2, 7] to avoid errors instead of copying them manually from the original article may help to avoid errors [1, 3, 9] , although computerized databases can themselves contain errors [2] . Other precautions may include citational or quotational conReferences are essential components of published articles [1, 2] and serve a number of important and useful functions [3] . Thus, the accuracy of references is critical [4] . Our study aimed to evaluate the current frequency of reference errors in the field of respiratory medicine over a 5-year period. The four widely circulated major peer -reviewed respiratory medical journals: Respiratory Medicine, European Respiratory Journal, Thorax, and Respiration were selected for investigation. All issues of the journals between 2004 and 2008 were investigated. For each journal, references from articles were consecutively numbered, and, using a random number generator, 100 references were selected from each journal. Each cited reference was then compared against the MEDLINE and checked for accuracy, including the authors’ names, the title of the article, the title of the journal, volume and page numbers, and publication date. Errors were graded as suggested by Sutherland et al. [5] : grade I errors are those that have little or no impact on the value of the reference (error in author initials, missing author, wrong journal abbreviation or spelling); grade II errors are those detract significantly from the value of the references (missing subtitle, missing page numbers, wrong page numbers, or inaccurate title), and grade III errors are those that prevent the quoted paper from being located. Published online: March 10, 2010

The effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life among healthy women

Introduction Smoking leads to more respiratory symptoms and negative effects on the health-related quality of life (HRQOL) in women than men for the same smoking burden. However, the relationship between smoking and body composition and its influencing factors remains unclear. In this study, we aim to investigate the effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life (HRQOL) among healthy women. Materials and Methods A total of 73 young healthy women, current cigarette smokers and who had never smoked were included. The level of physical activity was assessed using the International Physical Activity Questionnaire; body mass index, circumference measurements, waist-to-hip ratio, skinfold measurements and body fat percentage were used to determine the body composition; HRQOL was assessed through the World Health Organization Quality of Life Instrument; level of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale; pulmonary functions were evaluated with spirometry. Result We found higher incidence of respiratory symptoms and lower physical activity levels in smokers than those of non-smokers (p< 0.05). There was no significant difference between smokers and non-smokers in respect of HRQOL, depression and anxiety (p> 0.05). In smokers whom cigarette consumption more than 150 p-years, we observed positive correlations between cigarette consumption and arm circumference, waist circumference, waist-to-hip ratio (p< 0.05). Conclusions Our results show that the smoking causes an increase in the incidence of respiratory symptoms and reduces the level of physical activity in healthy women. Additionally it leads to abdominal obesity depending on cigarette consumption.

Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients

OBJECTIVE The aim of the study was to investigate the effects of smoking on respiratory symptoms and functional levels by questioning use of cigarette in Multiple Sclerosis (MS) patients. METHODS A questionnaire was sent via e-mail to the 135 MS patients, who clinically diagnosed with MS and EDSS score was determined.Perceived dyspnea was assessed by the mMRC scale.The severity of dyspnea and fatigue perceived during rest and effort was assessed by the mBORG scale.Functional levels of the patients were assessed by asking the average daily walking distance and the average sitting time daily. RESULTS The mean EDSS score of the smoker and the non-smoker group were 2.85 ± 0.75, 2.96 ± 1.03 respectively(p = 0.48).There was no statistically difference found between groups in terms of age,height,weight,BMI,gender,EDSS scores(p > 0.05).The rate of cough, sputum and severity of perceived dyspnea was statistically higher in the smoker group(p < 0.05).The mean walking distance daily of the smokers was statistically lower (p < 0.001).The smoker group had a high level of sedanter lifestyle(p < 0.05). CONCLUSION It has been proven that smoking increases respiratory problems even in MS patients with a good EDSS score.Moreover, these problems lead to a further reduction in the functional levels of the patients, in addition to the disease progression.