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Pulmonary rehabilitation, whether performed at home or in a specialised centre, is effective in the management of COPD. As gender-related differences in COPD were previously reported, we aimed to evaluate the impact of gender on pulmonary rehabilitation outcomes in the short, medium and long term. In this retrospective observational study of 170 women and 310 men with COPD, we compared the outcomes of an 8-week home-based pulmonary rehabilitation programme including an individualised plan of retraining exercises, physical activities, therapeutic education, and psychosocial and self-management support. Exercise tolerance, anxiety, depression, and quality of life (QOL) were assessed using the 6-min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS) and Visual Simplified Respiratory Questionnaire (VSRQ), respectively. Assessments were carried out before, immediately after the pulmonary rehabilitation programme (T2) and at 8 (T8) and 14 months (T14). At baseline, women were younger (mean 62.1 versus 65.3 years), more often nonsmokers (24.7% versus 7.7%) and had a higher body mass index (28 versus 26.4 kg·m−2). They more often lived alone (50.6% versus 24.5%) and experienced social deprivation (66.7% versus 56.4%). They had significantly lower exercise tolerance (−34 strokes, 6MST) and higher anxiety and depression (+3.2 HADS total score), but there were no between gender differences in QOL (VSRQ). Both groups showed similar improvements in all outcome measures at T2, T8 and T14 with a tendency for men to lose QOL profits over time. Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme., Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme https://bit.ly/2XfFakK

Jérémy B Coquart,1 Natacha Heutte,1 Gaelle Terce,2 Jean-Marie Grosbois3 1Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, France; 2Centre Hospitalier de Béthune, Service de Pneumologie et de Réhabilitation Respiratoire, Beuvry F-62660, France; 3FormAction Santé, Pérenchies F-59840, FranceCorrespondence: Jérémy B CoquartUniversité de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, FranceTel +33 235 146 775Email jeremy.coquart@univ-rouen.frPurpose: Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients.Patients and methods: Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30–45 mins/week for 8 weeks, including a weekly session supervised by a team member).Results: PR improved all measured variables (p < 0.0001). The correlations were significant (p < 0.0001) between VSRQ and MRF-28 (r = −0.685 at baseline and r = −0.686 after the PR program), and between VSRQ and VQ11 (r = −0.691 at baseline and r = −0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated (p < 0.0001) to changes in score of MRF-28 (r = −0.372) and VQ11 (r = −0.423). Last, we calculated MCIDof −5.2 and −2.0 units for MRF-28 and VQ11, respectively.Conclusion: The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of −5.2 and −2.0, respectively.Keywords: visual simplified respiratory questionnaire, VSRQ, home-based pulmonary rehabilitation

Jean-Marie Grosbois,1,2 Justine Heluain-Robiquet,3 François Machuron,4 Gaelle Terce,2 Cécile Chenivesse,3,5,6 Benoit Wallaert,3,5,6 Olivier Le Rouzic3,5 1FormAction Santé, Pérenchies F-59840, France; 2CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France; 4CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France; 5University Lille, Lille F-59000, France; 6Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, FranceCorrespondence: Jean-Marie Grosbois Email jmgrosbois@formactionsante.comBackground: Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes.Methods: In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline.Results: Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups.Conclusion: Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.Keywords: home-based pulmonary rehabilitation, exercise tolerance, quality of life, anxiety, depression, socioeconomic deprivation

Resume Introduction Les dyspnees inexpliquees apres des epreuves fonctionnelles respiratoires de repos (EFR) et un bilan cardiovasculaire representent une situation frequente en pratique clinique. Le but de ce travail etait de preciser l’interet de l’epreuve fonctionnelle a l’exercice (EFX) pour le diagnostic de ces dyspnees inexpliquees. Methodes Cette etude monocentrique retrospective incluait des patients successifs ayant des examens de repos normaux (examen clinique, hemoglobine, radiographie thoracique, ECG, EFR, echographie cardiaque). L’EFX etait realisee avec analyse des gaz du sang. L’analyse descriptive et la synthese etaient realisees par consensus entre au moins 3 des auteurs et permettait d’evoquer les etiologies suivantes : deconditionnement, hyperventilation inappropriee a l’exercice (HV), anomalies echanges gazeux (AEG), EFX sous-maximale, anomalies cardiovasculaires (ACV) et EFX normale. Resultats Au total, 194 patients etaient inclus, (âge median 53 ans ; sex-ratio (H/F) 0,83 ; IMC moyen 27,3 kg/m2 ± 5,36). On retrouvait 32 % de profils compatibles avec un deconditionnement, 20 % HV, 18 % AEG, 13 % d’epreuves sous-maximales, 9 % ACV, 8 % d’epreuves maximales et normales. Conclusion Cette etude illustre l’interet de realiser l’EFX precocement dans les dyspnees inexpliquees car dans plus de 50 % des cas, celles-ci correspondent soit a un deconditionnement soit a un syndrome d’hyperventilation, redevables d’une prise en charge simple en rehabilitation respiratoire.