Changes in forced oscillation mechanics and symptoms prior to COPD exacerbations during home telemonitoring

Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with increased symptom burden and risk of future exacerbations. One standardized tool that is commonly used to assess the level of health impairment is the COPD Assessment Test (CAT). Objective measures of airway function, such as impulse oscillometry system (IOS) parameters, may offer additional insights into disease activity and outcomes. This study investigated whether IOS parameters, specifically peripheral airway resistance measures (R5-20) and reactance area (AX), were associated with changes in CAT scores and risk of future exacerbation. We hypothesized that IOS parameters would correlate with CAT scores across different time points during and after hospitalization. Methods: A prospective observational study was conducted on 16 patients hospitalized for COPD exacerbation at the Providence VA Medical Center. Each patient underwent IOS testing and completed the CAT at three time points: hospital admission, discharge, and follow up on 4 weeks. Pearson correlation analysis was used to examine the relationship between IOS parameters and CAT scores, with a focus on determining if IOS measurements could serve as predictors of symptom burden and changes over time. Results: The mean CAT scores decreased from admission (30.00) to discharge (27.45) and further reduced at follow-up (22.62), suggesting an improvement in symptom burden post-exacerbation. Similarly, IOS parameters showed improvement across these time points, with R5-20 decreasing from 2.46 (admission) to 1.63 (discharge) and 1.46 (follow-up), and AX reducing from 28.53 (admission) to 20.94 (discharge) and 13.50 (follow-up). There was a positive correlation between changes in R5-20 and AX with CAT score, with R5-20 demonstrating the strongest relationship with CAT scores (r = 0.48) – indicating that higher airway resistance correlated with higher symptom burden. Discussion: The findings support the utility of IOS parameters as objective predictors of symptom severity and recovery trajectories in COPD patients following exacerbations. This small study suggests that respiratory impedence parameters reflect patient-centered outcomes, and this relationship warrants further investigation in larger cohorts to establish IOS as a potential predictive tool in clinical management – potentially guiding treatment interventions and risk of impending COPD exacerbation.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, along with significant extrapulmonary effects that contribute to disease severity. The COPD Assessment Test (CAT) is a validated, self-completed questionnaire consisting of 8 items scored on a 6-point scale (0-5). It is designed to evaluate the perceived severity of COPD symptoms (e.g., shortness of breath, cough, and phlegm) and should be administered to all COPD patients irrespective of disease severity. Objectives: To assess and compare CAT scores, Pulmonary Function Tests (PFTs) in patients with acute exacerbation of COPD (AECOPD) and stable COPD. Materials and Methods: A hospital-based descriptive observational study was conducted over 18 months at Navodaya Medical College, Raichur, Karnataka. The study included 50 diagnosed cases of COPD (25 stable, 25 AECOPD). Detailed patient histories, clinical examinations, and laboratory investigations were conducted. CAT scores were evaluated in the patients' vernacular languages. Results: The mean CAT score was significantly higher in the AECOPD group compared to the stable COPD group (33.76 &plusmn; 0.72 vs. 20.92 &plusmn; 2.61; p < 0.01). Furthermore, AECOPD patients demonstrated significantly reduced FVC and FEV1 parameters compared to stable patients. Conclusion: The CAT score is a concise and valid tool for monitoring COPD health status. The strong clinical correlations observed in this study reinforce the discriminative validity of the CAT and its importance in evaluating the true impact of COPD on patients? daily lives. Its implementation is highly recommended in both hospital and primary care settings.

<b>Introduction:</b> Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major events with negative impact on the course of the disease that need to be properly evaluated. COPD Assessment Test (CAT) has been showed to be responsive to AECOPD. <b>Aims:</b> To evaluate CAT responsiveness to AECOPD recovery and to investigate the influence of patients characteristics on CAT recovery. <b>Methods:</b> Patients previously diagnosed with COPD who were admitted in emergency department of a tertiary hospital due to AECOPD were included. CAT was performed at admission and 30 days after discharge. Clinical data and readmissions were recorded. <b>Results:</b> 111 patients were enrolled. 77.4% were male, mean of forced expiratory volume in one second (FEV1) was 49.2 ± 15.2% and majority of patients were GOLD D (36.0%) or C (21.6%). 63.5% were treated as inpatients and mean length of hospitalization was 11.5±11.1 days. 19.8% were readmitted 30 days after discharge due to AECOPD and from these, the majority needed hospitalization for treatment. Mean CAT score at admission was 22.0±6.2, 30 days after discharge was 18.4±6.8 and mean CAT recovery was 3.6±3.7 (p&lt;0.001). Readmitted patients had worst CAT recovery compared to non-readmitted patients (2.5±2.2 versus 3.9±3.9). Moreover, an association between CAT recovery and body mass index (BMI) was found (p=0.003). Underweight patients had the worst CAT recovery (1.8±1.2) followed by obese patients (2.7±2.4). Comparing normal BMI and overweight patients, the last group showed a better CAT recovery (5.0±3.6 versus 3.2±4.1). <b>Conclusions:</b> CAT is an useful tool to evaluate AECOPD recovery. CAT score recovery following AECOPD is influenced by BMI.

BackgroundAccurate prediction of acute exacerbation helps select patients with chronic obstructive pulmonary disease (COPD) for individualized therapy. The potential of lymphocyte subsets to function as clinical predictive factors for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains uncertain.MethodsIn this single-center prospective cohort study with a 2-year follow-up, 137 patients aged 51 to 79 with AECOPD were enrolled. We examined the prognostic indicators of AECOPD by analyzing lymphocyte subsets and baseline symptom score. Furthermore, a predictive model was constructed to anticipate the occurrence of respiratory failure in patients experiencing AECOPD.ResultsThe COPD Assessment Test (CAT) score combined with home oxygen therapy and CD4+CD8+ T cells% to predict respiratory failure in AECOPD patients were the best (the area under the curves [AUC] = 0.77, 95% CI: 0.70–0.86, P < 0.0001, sensitivity: 60.4%, specificity: 86.8%). The nomogram model, the C index, calibration plot, decision curve analysis, and clinical impact curve all indicate the model’s good predictive performance. The observed decrease in the proportions of CD4+CD8+ T cells appears to be correlated with more unfavorable outcomes.ConclusionsThe nomogram model, developed to forecast respiratory failure in patients with AECOPD, utilizing variables such as home oxygen therapy, CAT score, and CD4+CD8+ T cells%, demonstrated a high level of practicality in clinical settings. CD4+CD8+ T cells serve as a reliable and readily accessible predictor of AECOPD, exhibiting greater stability compared to other indices. It is less susceptible to subjective influences from patients or physicians. This model facilitated personalized estimations, enabling healthcare professionals to make informed decisions regarding preventive interventions.

<b>Background:</b> Japanese COPD patients tend to have lower CAT scores than Western patients. A previous 1-year study showed wide variation in change in CAT score over time (Rassouli et al. Int J COPD 2017;12:3103). <b>Aims:</b> Identify whether change in health status over time was associated with exacerbations in Japanese patients with COPD. <b>Methods:</b> Patients were studied in routine practice. CAT data were collected weekly for 1 year using a smartphone app (YaDoc, Integrity Healthcare Co. Ltd. Japan). Patients were categorized as improved, stable and worsened, based on linear regression analysis of change in weekly CAT scores. Association between CAT progression group and occurrence of a COPD exacerbation was tested using a Cox regression model including a time-varying variable. <b>Results:</b> 84 COPD patients were enrolled; mean age: 68.7 years and mean±SD CAT and % predicted FEV1 at baseline: 8.3±6.6 and 72.9±22.0. Median compliance of weekly record was 81%. Median CAT slope was 0.6 units/year (IQR -1.0 to +3.8). 28% of patients had a significant negative slope (improved); 22% had a slope not significantly different from 0 (stable); 50% had a significant positive slope (worsened). A significant positive association was found between CAT change category and occurrence of a single exacerbation during the study (HR: 1.15, 95% CI: 1.06–1.26; p&lt;0.001). <b>Conclusions:</b> Weekly telemedicine CAT measurements provide useful information in individual patients with COPD. Occurrence of a single exacerbation was associated with progressive worsening of CAT compared to no exacerbation, suggesting that worsening health status is a risk factor for exacerbation. <b>Funding:</b> GSK (212648).

Change in the COPD assessment test (CAT) score as predictor of short-term evolution of patients admitted for an exacerbation of COPD

Introduction : COPD Assessment Test (CAT) is an 8-items questionnaire for assessment of health status in patients with chronic obstructive pulmonary disease (COPD).Objective : To evaluate the course of CAT scores during bacterial exacerbations of COPD treated in outpatient setting.Methods : We performed an observational, prospective study including 81 outpatients (57 males and 24 females, aged 43 to 74 years) with bacterial exacerbation of COPD. All participants completed CAT at initial visit (i.e. at the time of diagnosis of exacerbation and beginning of its treatment), 10 and 30 days after initial visit. Mean scores of each item, as well as the overall mean score, at these time points were compared.Results : The mean scores for each CAT question at initial visit varied from 2.6 to 3.5, whereas the mean scores for each CAT question 10 days after initial visit varied from 1.7 to 2.6. We registered significant reduction of the mean overall CAT score 10 days after initial visit as compared to its value at initial visit of 6.9 ± 2.7 points (16.8 vs 23.7; P < 0.001). The mean scores for each CAT question 30 days after initial visit varied from 1.3 to 2.4. We registered reduction of mean overall CAT score 30 days after initial visit as compared to its score 10 days after initial visit of 2.9 ± 1.2 points (13.9 vs 16.8; P < 0.005). The mean overall CAT score 30 days after initial visit was reduced for 9.8 ± 4.5 points as compared to its value at initial visit (13.9 vs 23.7; P < 0.001).Conclusion : We found significant improvement in the patient’s health status during recovery from exacerbation as compared to their health status at the time of exacerbation confirming the CAT as an effective tool to measure health status in patients with COPD.

Objective To explore the association between familial aggregation and lung function damage and COPD Assessment Test (CAT) scores in patients with chronic obstructive pulmonary disease (COPD), and the correlation between lung function damage and CAT scores. Methods A prospective analysis was conducted on the patients with COPD in Shengjing Hospital of China Medical University from January 2016 to May 2017.The diagnostic criteria were in line with the 2017 global chronic obstructive pulmonary disease initiative.The gender, age, body mass index, smoking index and family history of the subjects were recorded.The case group was divided into a family history group and a no family history group.CAT score test and lung function test are performed on all subjects (including pulse forced oscillation, plethysmography, pulmonary ventilation, dispersion function detection). We analyzed the association between familial aggregation and lung function and CAT scores in the 2 groups, and the correlation between lung function and CAT scores. Results ①A total of 102 cases were included in the case group, among them, 59 cases were in the family history group (accounting for 57.84%), 43 cases were in the no family history group (accounting for 42.16%). There was no statistically significant difference between the two groups in gender, age, body mass index, smoking index and severity of airway limitation.②There was no statistically significant difference in the other indexes between the two groups except the percentage of the estimated value of carbon monoxide diffusing capacity (P<0.05) and the percentage of the estimated value of carbon monoxide diffusing capacity/alveolar volume (P<0.05). ③There was no statistically significant difference in CAT scores between the family history group and no family history group.④In no family history group, forced expiratory volume in the first second%pred (FEV1%pred) and forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) were not related to COPD assessment test scores.There was a weak and positive correlation between FEV1%pred, FEV1/FVC and CAT scores in family history group. Conclusions There was no relationship between the familial aggregation of COPD and the lung function and CAT scores.The correlation between lung function and CAT scores is weak. Key words: Chronic obstructive pulmonary disease; Familial aggregation; Lung function; COPD Assessment Test scores

To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound. A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and diaphragm thickening fraction (TFdi) were observed in each group. Before and after treatment, the inflammatory and immune indexes (levels of white blood cell [WBC], procalcitonin [PCT], hypersensitive C-reactive protein [hs-CRP] and T lymphocyte percentage [ %]), auxiliary respiratory muscle movement score, the score of chronic obstructive pulmonary disease (COPD) assessment test (CAT), the score of the modified British Medical Research Council dyspnea scale (mMRC) and the TCM syndrome score were compared in each group. The duration of mechanical ventilation, relative complications, 14-day clinical controlled discharge rate and the therapeutic effect were observed in each group. On day 3, 7 and 10 of treatment, PaO2 and TFdi were all increased as compared with those before treatment (P<0.01) and PaCO2 was reduced as compared with that before treatment in each group (P<0.01). After treatment, % was increased as compared with that before treatment in each group (P<0.01), WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score, mMRC score and TCM syndrome score were all reduced as compared with those before treatment in each group (P<0.01). After treatment, PaCO2, WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score and mMRC score in the acupuncture group were all lower than the other two groups (P<0.01), PaO2 and TFdi were higher than the other two groups (P<0.01); % was higher and TCM syndrome score was lower in the acupuncture group compared with those in the non-acupoint acupuncture group (P<0.01). The duration of mechanical ventilation and the total incidence of complications in the acupuncture group were all lower than the other two groups (P<0.01), and the 14-day clinical controlled discharge rate and total clinical effective rate were higher than the other two groups (P<0.01). Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.

Background: While severe exacerbations are known to worsen the prognosis of patients with chronic obstructive pulmonary disease (COPD), the extent of this impact based on the degree of deterioration is unclear. COPD Assessment Test (CAT) scores increase during exacerbations, reflecting symptom worsening. This study aimed to compare healthcare resource utilisation and mortality among patients with COPD after a severe exacerbation, stratified by changes in CAT scores. Methods: This observational study included patients hospitalised for COPD exacerbation. The CAT questionnaire was administered twice: once referring to the time of admission and once to the stable phase. Patients were divided into tertiles based on symptom worsening. A prospective follow-up was conducted to compare emergency room visits, hospital admissions, and survival rates. Results: This study included 50 patients, of whom 30 (60%) were male. Their mean age was 70.5 years (standard deviation [SD]: 9.6), mean forced expiratory volume in the first second (FEV1) was 46.7% (SD: 0.8) of the predicted value, and median CAT score deterioration was 9 points (interquartile range: 5-15.25). Patients in the third tertile had earlier healthcare utilisation than those in the first tertile (emergency room visits: log-rank = 5.27, p = 0.022; hospitalisations: log-rank = 5.27, p = 0.022). Survival rates did not differ significantly among tertiles. Conclusions: Patients with greater CAT score deterioration experienced earlier COPD-related events, suggesting the need for closer monitoring after severe exacerbation.

Background COPD is a chronic respiratory disease with a long course and recurrent characteristics. According to relevant statistics, the global incidence of COPD is more than 30%, which seriously affects the life of patients and endangers their health. Objective To observe the curative effect of Xiyanping in elderly patients with COPD and its influence on the expressions of growth differentiation GDF-15 and HIF-1α in serum. Methods From August 2019 to December 2021, 86 elderly patients with acute exacerbation of COPD were admitted to our hospital. As the research objects, they were divided into the control group (n = 43) and the observation group (n = 43) randomly. The control group received the conventional treatment, while the observation group got Xiyanping on the basis of the control group. The differences in the duration of antibiotic use, expectoration, hospital stays, adverse reactions and serum-related factors, blood routine, pulmonary function, airway hyperreactivity index, COPD assessment test (CAT) score, and Borg score were made a comparison between them. Results On the 3rd and 7th days after being treated, the sputum excretion in them was higher than before, but on the 3rd day of treatment, the sputum excretion in the observation group was higher than that in the control group, while on the 7th day of treatment, the sputum excretion was lower than that in the control group with statistically significant differences (P < 0.05). Before treatment, the serum-related factors and blood routine indexes between them were similar (P > 0.05). After treatment, GDF-15, HIF-1α, CXCL12, TNF-α, IL-8, TGF-β, WBC, and NEU in them were significantly lower than before, and the values in the observation group were significantly lower than those in the control group with statistically significant differences (P < 0.05). There was no difference in the related indexes of pulmonary function and airway hyperreactivity between them before treatment. After being treated, FEV1, FVC, and FEV1/FVC in them were significantly higher than those before treatment. The airway resistance and lung compliance of the two groups at exhalation and inspiration were significantly lower than before, and the values in the observation group were significantly lower than those in the control group (P < 0.05). There was no difference in CAT and Borg scores between them before treatment. After treatment, the CAT score and Borg score of these patients were significantly lower than those before treatment, and the value of the observation group was significantly lower than that of the control group (P < 0.05). The duration of antibiotic use and length of stay in the observation group were significantly shorter than those of the control group, while the incidence of adverse reactions was not statistically significantly different compared with the control group (P > 0.05). Conclusion Xiyanping can improve pulmonary function of elderly patients with acute exacerbation of COPD, reduce the response of airway hyperreactivity, and promote the excretion of sputum.

Usefulness of the forced oscillation technique in assessing the therapeutic result of tracheobronchial central airway obstruction.

Gastroesophageal reflux disease (GERD) may be a potential risk factor for exacerbations of chronic obstructive pulmonary disease (COPD). The aim of the present study was to explore the association of GERD risk with exacerbations of COPD. Patients with COPD were consecutively recruited, and COPD Assessment Test (CAT) and Reflux Diagnostic Questionnaire (RDQ) were administered. If the CAT score was 5 points higher than that taken in the stable states, the patient was considered as having exacerbations of COPD. A RDQ score of ≥ 12 is defined high GERD risk. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between high GERD risk and exacerbations of COPD. Among 386 patients with COPD, the mean CAT score was 18.3 ± 6.6, and 76 (19.7%) patients had exacerbations during the 1-year follow-up. The mean RDQ score was 10.1 ± 4.7, and 132 (34.2%) patients were identified as having high GERD risk. Multivariate logistic regression analyses revealed that the high GERD risk (odds ratio, 2.31; 95% confidence interval, 1.29-3.87) was an independent risk factor of COPD exacerbations. In conclusion, high GERD risk appears to be associated with higher odds for COPD exacerbations.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease with acute exacerbation (AECOPD) being a common sequalae which negatively impact health status, rates of hospitalization and readmission, and disease progression. N-acetylcysteine (NAC) has been studied in COPD in both stable state and acute exacerbations, which has been shown to have small beneficial effects in stable COPD, as well as AECOPD. Yet, there has been lack of study with well-designed protocol to assess the role of NAC in more objective outcomes in AECOPD. This is a double-blind randomized controlled trial. Patients will be randomized in 1:1 ratio to receive oral NAC at 600 mg twice daily or placebo twice daily with standard of care. Partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2) will be measured on days 1 and 7. The following will be measure at baseline and on day 4 and 7: Forced expiratory volume in one second (FEV1), 24-hour sputum volume, oxygen saturation (SaO2), end-tidal CO2, Leicester Cough Questionnaire (LCQ) score, COPD Assessment Test (CAT) score, grading of wheeze and grade of dyspnoea; blood inflammatory markers (leucocyte count, neutrophil count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and high sensitivity CRP (hs-CRP)). Patients will be randomized to oral NAC at 600 mg twice daily or placebo for 7 days. The main outcome measures include: The difference in PaO2 on day 7. Secondary outcome: Change in following parameters on day 4/7 from baseline: FEV1, sputum volume, CAT score, LCQ score, SaO2, grade of wheeze; mMRC Dyspnoea Scale, end-tidal CO2, blood inflammatory marker, change in PaO2/FiO2 ratio from baseline to day 7, PaCO2 on day 7, 28 and 90 days' mortality, time to wean off supplemental oxygen, length of stay.Primary and secondary outcomes will be compared among the two treatment groups with two-sample t-test. We hypothesize that NAC use in COPD exacerbation can provide benefits in clinical and laboratory parameters. Name of the registry : ClinicalTrials.gov Trial registration number : NCT05706402. URL of the trial registry record for this trial : https://classic.clinicaltrials.gov/ct2/show/NCT05706402 Date of registration : Registered on 11th January 2023 Funding of the trial : The Health and Medical Research Fund (HMRF). Name and contact information for the trial sponsor : Wang Chung Kwok, Clinical Assistant Professor, Honorary Associate Consultant, Queen Mary Hospital, The University of Hong Kong, Hong Kong. Role of sponsor : The funder is not involved in the planning of the study, gathering, analysing, and interpreting the data, or in preparing the manuscript.

Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events