Search

Background People with COPD have been reported to bear a distinct airway microbiota from healthy individuals based on bronchoalveolar lavage (BAL) and sputum samples. Unfortunately, the collection of these samples involves relatively invasive procedures and is resource-demanding, limiting its regular use. Non-invasive samples from the upper airways could constitute an interesting alternative, but its relationship with COPD is still underexplored. We examined the merits of saliva to identify the typical profile of COPD oral bacteria and test its association with the disease. Methods Outpatients with COPD and age-sex matched healthy controls were recruited and characterised based on clinical parameters and 16S rRNA profiling of oral bacteria. A clustering analysis based on patients’ oral bacteria beta-diversity and logistic regressions were performed to evaluate the association between oral bacteria composition and COPD. Results 128 individuals participated (70 patients and 58 controls). Differential abundance analyses showed differences in patients comparable to the ones previously observed in samples from the lower respiratory tract, i.e., an increase in Proteobacteria (particularly Haemophilus) and loss of microbiota diversity. An unsupervised clustering analysis separated patients in two groups based on microbiota composition differing significantly in the frequency of patients hospitalized due to severe acute exacerbation of COPD (AECOPD) and in the frequency of GOLD D patients. Furthermore, a low frequency of Prevotella was associated with a significantly higher risk of recent severe AECOPD and of being GOLD D. Conclusion Salivary bacteria showed an association with COPD, particularly with severe exacerbations, supporting the use of this non-invasive specimen for future studies of heterogeneous respiratory diseases like COPD.

The 6 min walking test (6MWT) has been largely studied. Less is, however, known about responders and non-responders to pulmonary rehabilitation (PR) in other meaningful activities. We explored responders and non-responders and the predictors of response to PR in the 1 min sit-to-stand test (1 min STS) and the 6MWT and compared both measures in classifying responders. An observational study was conducted with 121 people with chronic obstructive pulmonary disease (COPD). The functional status was assessed before and after PR. Baseline differences between responders and non-responders were tested with Mann–Whitney U, chi-square, or Fisher exact tests. Predictors were explored with binary logistic regressions. Agreement between both measures was assessed with chi-square, Cohen’s kappa, and McNemar tests. There were 54.5% and 57.0% of responders in the 1 min STS and the 6MWT, respectively. The proportion of responders was significantly different (p = 0.048), with a small agreement between the measures (kappa = 0.180; p = 0.048). The baseline 6MWT was the only significant predictor of response in the 6MWT (OR = 0.995; pseudo-r2 = 0.117; p < 0.001). No significant predictors were found for the 1 min STS. A large number of non-responders in terms of functional status exist. The 1 min STS and the 6MWT should not be used interchangeably. Future studies should explore the added benefit of personalizing PR to this outcome and investigate other potential predictors.

Background Cough and sputum are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of minimal clinically important differences (MCIDs). Purpose This study established MCIDs for the Leicester cough questionnaire (LCQ) and the cough and sputum assessment questionnaire (CASA-Q), in patients with COPD after PR. Patients and methods An observational prospective study was conducted in patients with COPD who participated in a 12-weeks community-based PR program. Anchor- (mean change, receiver operating characteristic curves and linear regression analysis) and distribution-based methods [0.5*standard deviation; standard error of measurement (SEM); 1.96*SEM; minimal detectable change and effect size] were used to compute the MCIDs. The anchors used were: i) patients and physiotherapists global rating of change scale, ii) COPD assessment test, iii) St. George's respiratory questionnaire and iv) occurrence of an exacerbation during PR. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 for anchor- and 1/3 for distribution-based methods). Results Forty-nine patients with COPD (81.6% male, 69.8±7.4years, FEV150.4±19.4%predicted) were used in the analysis. The pooled MCIDs were 1.3 for LCQ and for CASA-Q domains were: 10.6 - cough symptoms; 10.1 - cough impact; 9.5 - sputum symptoms and 7.8 - sputum impact. Conclusion The MCIDs found in this study are potential estimates to interpret PR effects on cough and sputum, and may contribute to guide interventions.

Populations respond differently to the current global pandemic of covid-19. This study explores the role of individual factors in the differential response to covid-19, by looking at the genetic background of worldwide populations. Significant SNPs (susceptibility: rs286914/rs12329760; severity: rs657152/rs11385942) were selected from the literature and their allelic frequencies used to calculate the probability of having multiple risk alleles in each population. Portuguese (n=623), Spanish (n=9761) and Italian (n=6363) populations data are observed values, whereas data for world populations are estimations based on public information. All populations, even those with European ancestry (Portuguese/Spanish/Italian), were significantly different from the European population in both covid-19 susceptibility and severity (all p-values < 0.0001)(Fig. 1). Our study highlights a genetic heterogeneity across world populations, especially within European subpopulations. There is a need to build a European genetic map so that differences in the distribution of relevant alleles can be easily accessed and used to better manage the populations, ultimately, safeguarding those under higher genetic risk. published

There is strong individual variability in both susceptibility and clinical response to covid-19 infection. People with chronic obstructive pulmonary disease (COPD) constitute one of covid-19 risk groups for poor outcomes upon infection. This study contributes to unveil the underlying reasons for such outcomes by looking at the genetic background of people with COPD. 255 people with COPD (66±9y; 72%♂; FEV1 53.01±20.31pp) and 243 controls (67±10y; 80%♂; FEV1 100.46±19.19pp) were clinically characterized and genotyped using saliva samples. Covid-19 associated SNPs from the literature (susceptibility: rs286914/rs12329760; severity: rs657152/rs11385942) were assessed and their allelic frequencies used to calculate the probability of having multiple risk alleles in both groups. Polygenic risk analysis was also conducted. No differences in genetic risk for covid-19 susceptibility or severity were found between groups (all p-values > 0.01), either considering individual risk alleles, allelic combinations or polygenic risk scores (Fig. 1). These results suggest a low genetic contribution for the poor covid-19 outcomes observed in people with COPD. published

Background Populations seem to respond differently to the global pandemic of severe acute respiratory syndrome coronavirus 2. Recent studies show individual variability in both susceptibility and clinical response to COVID-19 infection. People with chronic obstructive pulmonary disease (COPD) constitute one of COVID-19 risk groups, being already associated with a poor prognosis upon infection. This study aims contributing to unveil the underlying reasons for such prognosis in people with COPD and the variability in the response observed across worldwide populations, by looking at the genetic background as a possible answer to COVID-19 infection response heterogeneity. Methods SNPs already associated with susceptibility to COVID-19 infection (rs286914 and rs12329760) and severe COVID-19 with respiratory failure (rs657152 and rs11385942) were assessed and their allelic frequencies used to calculate the probability of having multiple risk alleles. This was performed on a Portuguese case-control COPD cohort, previously clinically characterized and genotyped from saliva samples, and also on worldwide populations (European, Spanish, Italian, African, American and Asian), using publicly available frequencies data. A polygenic risk analysis was also conducted on the Portuguese COPD cohort for the two mentioned phenotypes, and also for hospitalization and survival to COVID-19 infection. Findings No differences in genetic risk for COVID-19 susceptibility, hospitalization, severity or survival were found between people with COPD and the control group (all p-values > 0.01), either considering risk alleles individually, allelic combinations or polygenic risk scores. All populations, even those with European ancestry (Portuguese, Spanish and Italian), showed significant differences from the European population in genetic risk for both COVID-19 susceptibility and severity (all p-values < 0.0001). Conclusion Our results indicate a low genetic contribution for COVID-19 infection predisposition or worse outcomes observed in people with COPD. Also, our study unveiled a high genetic heterogeneity across major world populations for the same alleles, even within European sub-populations, demonstrating the need to build a higher resolution European genetic map, so that differences in the distribution of relevant alleles can be easily accessed and used to better manage diseases, ultimately, safeguarding populations with higher genetic predisposition to such diseases.

Acknowledgments: The authors would like to thank Professor Timothy Oswald (Department of Languages and Cultures, University of Aveiro, Aveiro, Portugal) for collaborating in the backtranslation of the tool. This work is a secondary study of three projects funded by Fundo Europeu de Desenvolvimento Regional (FEDER) - Comissão Diretiva do Programa Operacional Regional do Centro and by Fundação para a Ciência e Tecnologia - FCT (SAICT-POL/23926/2016), and partially funded by Programa Operacional Competitividade e Internacionalização (COMPETE), through COMPETE 2020 (POCI-01-0145-FEDER-016701 and POCI-01-0145-FEDER-028446) and FCT (SFRH/BD/81328/2011; UIDB/04501/2020, UIDB/05704/2020 e UIDP/05704/2020). The funding sources had no role in study design, data collection/analysis/interpretation, writing or decision to submit the manuscript for publication. Introduction Low physical activity (PA) levels are associated with poor health‐related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice. Objectives This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD, and explored differences in age, sex and COPD grades. Methods After linguistic adaptation of the tool to Portuguese, 110 patients (66.4±9.6yrs, 72.7% male, FEV1=59.3±25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous‐ and moderate‐intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA=1952‐5724 counts‐per‐min[CPM]); vigorous PA, VPA=5725‐∞CPM; moderate‐to‐vigorous PA, MVPA=1952‐∞CPM; daily steps), through: Spearman’s correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data. Results The BPAAT was weakly to moderately correlated with accelerometry (0.394≤ρ≤0.435, p0.05). The BPAAT correctly identified 73.6% patients as ‘insufficiently active’ and 26.4% as ‘sufficiently active’. Agreement was fair to moderate (0.36≤kappa≤0.43; 73.6%≤%agreement≤74.5%; 0.50≤sensitivity≤0.52; 0.84≤specificity≤0.91, 0.55≤PPV≤0.79, 0.72≤NPV≤0.82). Conclusion The BPAAT may be useful to screen patients’ PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients. info:eu-repo/semantics/publishedVersion

People with COPD present microbiota dysbiosis. Clinical implications of this finding are still unknown and need validation. Here, we tested the association between salivary microbiota and COPD and its ability to discriminate different types of patients. 67 patients with COPD (57male, 68±9y, FEV1pp 48±19, GOLD A-12, B-31, C-5, D-19) were characterised based on sociodemographic, anthropometric, clinical data and 16S rRNA profiling of their salivary microbiota. An unsupervised clustering analysis based on patients’ beta diversity was performed to query its relationship with the disease. Two major clusters (comprising 90% of individuals) differing drastically in severity were observed. Cluster1 aggregated all patients hospitalized in the previous year due to acute exacerbations, 71% of GOLD D patients and included a higher frequency of patients under oxygen therapy and heavier smoking history than Cluster 2 (Fig 1A). Furthermore, Cluster1 had a lower microbiota diversity (MW-U, p=0.008) (Fig 1B) and was enriched in Proteobacteria or Firmicutes, particularly Streptococcus. In contrast, Cluster2 was significantly enriched in Bacteroidetes, particularly Alloprevotella and Prevotella (Fig 1C). Saliva’s microbiota showed a strong association with COPD, especially in terms of severe exacerbations, supporting the use of salivary microbiota for further studies in this population. published

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)., Motivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients' motives to be physically active, according to three pulmonary rehabilitation (PR) participation groups (Never PR, Previous PR and Current PR) and explored whether these motives were related to the PA levels and clinical characteristics. The motives to be physically active were assessed with the Exercise Motivation Inventory-2 (EMI-2, 14 motivational factors, five dimensions) and PA with accelerometry (PA groups: 0.05) but having less symptoms and ≥two comorbidities were associated with higher scores in psychological/health and body-related motives, respectively (p < 0.05). The findings may encourage health professionals to actively explore with patients their motives to be physically active to individualise PA promotion., This work was funded by FEDER, through COMPETE2020—Programa Operacional Competitividade e Internacionalização and by Portuguese national funds provided by Fundação para a Ciência e Tecnologia (FCT) (OnTRACK projects—POCI-01-0145-FEDER-028446 and UIDB/05704/2020).

Bronchoalveolar lavage (BAL) and sputum samples are commony used to provide valuable information on airway microbiota of COPD but they are too invasive to be routinely collected. An interesting alternative would be the use of non-invasive samples from the upper airways but its validation is still lacking. Here, we have explored the merits of saliva to identify the typical profile of COPD microbiota. 70 patients with COPD (60 male, 68±9y, BMI 25.5±3.5, FEV1pp 48±16, GOLD A-12, B-32, C-5, D-21) and 50 healthy matched controls (42 male, 67±8y, BMI 27.6±3.8, FEV1pp 103±17) were characterised based on sociodemographic, anthropometric, clinical parameters and 16S rRNA profiling of their salivary microbiota. Microbiota composition was significantly different between healthy individuals and patients with COPD and could also descriminate moderate from severe patients. Healthy individuals were enriched in Alloprevotella and Prevotella, both Bacteroidetes’ genera, whereas moderate patients were enriched in Granullicatella and Lachnoanaerobaculum (Firmicutes) and severe patients were significantly enriched in Haemophilus (Proteobacteria) (Fig1.A). Furthermore, patients showed a significantly less diverse microbiota than healthy individuals (MW-U, p=0.001) (Fig1.B). Our results corroborate the findings reported previously using BAL and sputum samples encouraging further exploration of salivary microbiota as a potential disease biomarker. published

A key factor for the adoption of an active lifestyle is self-determined motivation; however, it is often overlooked in COPD. Understanding the motives underlying patients’ decision to be (or not) physically active will provide insight into future interventions. This study assessed the motives for patients with COPD to engage in physical activity (PA) and their association with PA behaviour. A cross-sectional study was conducted in stable patients with COPD. Motivation was assessed with the Exercise Motivation Inventory-2 (EMI-2; score 0[Not at all true for me]–5[Very true for me]; 5 dimensions) and PA with accelerometry [ActiGraph-GT3X+, 7 days; moderate to vigorous PA (MVPA), steps/day]. Spearman’s correlations (ρ) were used to assess their relationship. 60 participants were enrolled (67.2±7.7 years; 76.7% men; FEV1 49.5±19.7pp). Patients’ motives to be physically active were mostly Health, Fitness and Psychological. Correlations with PA were weak and non-significant (p>0.05) (Table 1). Patients with COPD value Health, Fitness and Psychological motives to be physically active, although these are not related to their PA behaviour. Findings highlight the complex nature of PA and the need to further explore factors influencing PA and motivation in this population. info:eu-repo/semantics/publishedVersion

Comprehensive understanding of COPD phenotypes, incorporating simple, widely used and meaningful outcomes (e.g., functional status), might contribute to personalise patients’ assessment and management. We described COPD phenotypes and developed a classification tree for its prediction. A cross-sectional study was conducted with patients with COPD. Data collection included airway obstruction (FEV1pp); comorbidities (Charlson comorbidity index); functional status (one-minute sit-to-stand test [1-minSTS]) and impact of the disease (COPD assessment test [CAT]). Clustering analysis using k-medoids was used to explore existent phenotypes. A classification tree was generated with 70% of the sample. The remaining 30% was used for its validation, i.e., to determine its prediction ability to identify the correct phenotype. Accuracy/agreement (Cohen’s Kappa) were determined. 364 patients with COPD (67yrs; 76%male; FEV1 57±21pp) participated. Four phenotypes (C1, C2, C3, C4) were found (Fig. 1): two presenting severe (C1, C4) and two mild-to-moderate (C2, C3) airflow obstruction; two low (C1, C2) and two high (C3, C4) impact of the disease; two low (C3, C4) and two high (C1, C2) functional status. The classification tree established cut-offs for these variables and correctly classified 85% of new individuals in their phenotype (Cohen’s Kappa=0.8). Meaningful and easily available assessments were able to differentiate COPD phenotypes and may guide patient-centred interventions.

Background Fatigue is a burdensome and prevailing symptom in patients with COPD. Pulmonary rehabilitation (PR) improves fatigue; however, interpreting when such improvement is clinically relevant is challenging. Minimal clinically important differences (MCIDs) for instruments assessing fatigue are warranted to better tailor PR and guide clinical decisions. Research Question This study estimated MCIDs for the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-FS), the modified FACIT-FS, and the Checklist Individual Strength-Fatigue Subscale in patients with COPD following PR. Study Design and Methods Data from patients with COPD who completed a 12-week community-based PR program were used to compute the MCIDs. The pooled MCID was estimated by calculating the arithmetic weighted mean, resulting from the combination of anchor-based (weight, two-thirds) and distribution-based (weight, one-third) methods. Anchors were patients' and physiotherapists' Global Rating of Change Scale, COPD Assessment Test, St. George's Respiratory Questionnaire (SGRQ), and exacerbations. To estimate MCIDs, we used mean change, receiver-operating characteristic curves, and linear regression analysis for anchor-based approaches, and 0.5 × SD, SE of measurement, 1.96 × SE of measurement, and minimal detectable change for distribution-based approaches. Results Fifty-three patients with COPD (79% male, 68.4 ± 7.6 years of age, and FEV1 48.7 ± 17.4% predicted) were included in the analysis. Exacerbations and the SGRQ-impact and the SGRQ-total scores fulfilled the requirements to be used as anchors. Pooled MCIDs were 4.7 for FACIT-FS, 3.8 for the modified FACIT-FS, and 9.3 for the Checklist Individual Strength-Fatigue Subscale. Intrpretation The MCIDs proposed in this study can be used by different stakeholders to interpret PR effectiveness. Clinical Trial Registration ClinicalTrials.gov; No.: NCT03799666; URL: www.clinicaltrials.gov

Physical activity (PA) may improve COPD prognosis, thus its assessment and promotion are crucial. The International Physical Activity Questionnaire Short-Form (IPAQ-sf) is widely used for assessing PA but there is limited evidence on its clinimetric properties in COPD. We assessed the test-retest reliability and validity of the IPAQ-sf in patients with COPD. Fifty-five participants (68.6±7.8yrs, 48 males, FEV1 52.3±22.5%pred) completed the IPAQ-sf, wore an accelerometer for 7 days and completed a second IPAQ-sf. Test-retest reliability/agreement was assessed with: Intraclass Correlation (ICC, 95%CI), 95% Limits of Agreement (LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for continuous variables; %agreement for categories (“active” vs “inactive”). Validity was assessed with Spearman’s correlations (ρ) between the IPAQ-sf (METs-min/week, time in vigorous [VPA] and moderate PA [MPA] per week) and accelerometry [time in MVPA, VPA and MPA per week] for continuous variables; %agreement, Cohen’s kappa, sensitivity and specificity (95%CI) for categories. Reliability was acceptable (ICC=0.738, 0.629→0.873) but with wide LoA (-5713→4793.3 METs-min/week). SEM and MDC95 were 1844.7 and 5113.3 METs-min/week, respectively. %agreement of the two IPAQ-sf was 85.5% (kappa=0.660, 0.444→0.876). Significant correlations were found between METsmin/week and accelerometry (0.515≤ρ≤0.596), except for VPA (p>0.05). %agreement between tools was 67.3% (kappa=0.350, 0.279→0.571) with high sensitivity (0.89, 0.887→0.891) but low specificity (0.46, 0.46→0.47). The IPAQ-sf could be used as PA measurement tool in COPD although caution is needed to avoid misclassification. info:eu-repo/semantics/publishedVersion

Background: Functional impairment is a critical consequence of COPD. The 1-minute sit-to-stand (1STS) is a valid and reliable test to measure this health domain in patients with COPD, with established reference values. We aimed to quantify the prevalence of functional impairment in patients with COPD and identify the distribution of this impairment across disease stages. Methods: A cross-sectional study with patients with COPD and healthy age-/gender-matched controls was conducted. Spirometry, the modified British Medical Research Council questionnaire (mMRC) and the 1STS were collected. Patients were grouped by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications. Differences between groups were explored with Kruskal-Wallis and Bonferroni-adjusted pairwise comparisons. Results: 366 patients with COPD (76% male, 67±10y, FEV1 56±21pp) and 345 controls (70% male, 67±9y, FEV1104±21pp) participated. 50% of the patients presented functional impairment (i.e., performed below 80%predicted). Patients with COPD presented lower functional ability than controls, independently of the GOLD grade/group (Fig. 1). The most symptomatic patients (i.e., GOLD B and D) had the lowest functional levels. Conclusion: Functional ability is reduced in patients with COPD in all GOLD grades/groups, especially in the most symptomatic. Future studies should explore therapeutic interventions to address this problem.

To assess the impact that educational interventions to improve inhaler techniques have on the clinical and functional control of asthma and COPD, we evaluated 44 participants before and after such an intervention. There was a significant decrease in the number of errors, and 20 patients (46%) significantly improved their technique regarding prior exhalation and breath hold. In the asthma group, there were significant improvements in the mean FEV1, FVC, and PEF (of 6.4%, 8.6%, and 8.3% respectively). Those improvements were accompanied by improvements in Control of Allergic Rhinitis and Asthma Test scores but not in Asthma Control Test scores. In the COPD group, there were no significant variations. In asthma patients, educational interventions appear to improve inhaler technique, clinical control, and functional control. RESUMO Para avaliar o impacto do ensino da técnica inalatória no controle clínico e funcional de pacientes com asma ou DPOC, incluíram-se 44 participantes antes e após essa intervenção. Houve uma diminuição significativa no número de erros cometidos, sendo que 20 pacientes (46%) melhoraram significativamente sua técnica na expiração prévia e apneia final. No grupo asma, houve significativa melhora nas médias de FEV1 (6,4%), CVF (8,6%) e PFE (8,3%), e essa melhora correlacionou-se com os resultados no Control of Allergic Rhinitis and Asthma Test, mas não com os do Asthma Control Test. No grupo DPOC, não houve variações significativas. O ensino da técnica inalatória parece melhorar seu desempenho e os controles clínico e funcional em pacientes com asma.

Peripheral muscle strength training is a key component of pulmonary rehabilitation (PR). However, the clinical interpretability of changes in muscle strength following PR is limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for leg extension (LE-MS) and chest press (CP-MS) muscle strength using one-repetition maximum (1-RM) in patients with COPD. 51 patients (44♂; 69.2±7.2yrs; FEV149.4±19.2%predicted) were included. 1-RM was measured on a multigym (BH Fitness G112X). The 6-minute walk test (6MWT) and the modified Medical Research Council (mMRC) dyspnoea scale were used as anchors. All measures were assessed pre/post 12-weeks of PR. MCID were calculated using anchor- and distribution-based methods. Pooled values were obtained using Meta XL with a quality effects model weighting 2/3 for anchor and 1/3 for distribution-based methods. Significant correlations were only found between the LE-MS and the 6MWT (r=.309; p=.028). The pooled of the anchor- and distribution-based methods resulted in a MCID of 5.14kg for LE-MS and 6.25kg for CP-MS (Fig. 1).Improvements of approximately 5 and 6kg in LE-MS and CP-MS, respectively, were identified as clinically relevant. Only distribution-based methods could be used to compute the MCID for CP-MS, which could have overestimated this value. Studies with larger samples are needed to consolidate these results. published

Pulmonary Rehabilitation (PR) remains highly inaccessible to patients with chronic respiratory diseases (CRD). We assessed the effects of a minimal-resource community-based PR programme in patients with CRD. Seventy-seven patients (48 male;68±11yrs;57.7±22.2%FEV1%predicted; 80.3±19.6FVC%predicted) with COPD(n=52), asthma(n=13), asthma-COPD overlap(n=3), interstitial lung disease(n=7), lung transplant due to COPD(n=1) and bronchiectasis(n=1) participated in a 12-week community-based PR programme. The modified Medical Research Council–dyspnoea scale (mMRC), Saint George’s Respiratory Questionnaire (SGRQ), quadriceps muscle strength (QMS), 1-minute sit-to-stand (1-minSTS), six-minute walk test (6MWT), Brief Balance Evaluation System Test (Brief-BESTest) and Hospital Anxiety and Depression Scale (HADS) were collected pre/post PR. Differences were examined using the Student’s t-test/Wilcoxon test and effect sizes (ES) were calculated. The number of patients improving above the minimal clinically important difference (MCID) was established, whenever a MCID was available. Significant improvements were observed (Figure 1). The number of patients above the MCID were: 33 in mMRC(1 point), 47 in SGRQ(4 points); 41 in 1min-STS(3 repetitions); 50 in the 6MWT(25m), 18 in the Brief-BESTest(4.9 points) and 32 and 28 in the HADS Anxiety and Depression scores(1.5 points). Community-based PR programmes are feasible and effective in patients with CRD. published

COPD occurrence is mediated by immune response, environmental factors and microbial dysbiosis. Airway microbiota has been found to be different between healthy people and patients with COPD and these differences could influence disease severity. But, its clinical implications are still unclear. Here, we have explored the airway microbiota of patients with COPD as well as its relations with specific clinical parameters. 40 patients (35?, 67±9y, FEV1pp 33±7, GOLD III-26, IV-14) and 40 healthy controls (34?, 67±12y, FEV1pp 101±19) were recruited and sociodemographic, anthropometric and clinical data were collected. Saliva microbiota was characterised by 16S rRNA sequencing and analysed using Qiime2 pipeline. Significant differences in airway microbiota composition between patients and healthy people were observed (Fig 1). The microbiota of patients with worse clinical parameters, like lower FEV1pp and SpO2, or with higher number of exacerbations and hospitalisations, clustered separately from less severe. Loss of microbiota diversity correlated with age in patients, but not in healthy people, raising the hypothesis of the cumulative use of antibiotics (by patients) contributing to dysbiosis.The association between microbiota composition and clinical parameters supports its contribution to COPD trajectory. Future studies should focus on remodelling patients’ dysbiotic microbiotas towards healthier ensembles aiming at preventing disease decline. published

Copyright © 2018 American Academy of Sleep Medicine. All rights reserved., Study objectives: This study has as its primary objective to evaluate the quality and effectiveness of type II ambulatory polysomnography (Amb-PSG) versus type I attended laboratory polysomnography (Lab-PSG) in diagnosing obstructive sleep apnea (OSA). Its secondary objective is to evaluate the clinical efficacy, quality of life (QoL), and treatment adherence after diagnosis. Methods: An observational study of patients with OSA (n = 225) in whom diagnosis was made via Amb-PSG (n = 114) or Lab-PSG (n = 111). Patients' clinical data were retrospectively assessed (including general demographic and clinical data, Epworth Sleepiness Scale, blood pressure, indices from polysomnography, and treatment adherence. Cross-sectional assessment (patient questionnaire) was used to evaluate clinical efficacy indicators, comorbidities, current treatment, and QoL. Results: Polysomnography indices were comparable between Amb-PSG and Lab-PSG (apnea-hypopnea index: 38.9 ± 22.5 versus 35.8 ± 23.1 events/h; P > .05), except for an elevation of total sleep time (510 ± 54.7 versus 476.3 ± 79.4 minutes; P < .01) and loss of oximetry signal (9.8% versus 0.0%; P < .05). Based on polysomnography parameters, OSA was severe in 119 patients (52.9%), moderate in 88 (39.1%), and mild in 18 (8.0%). Diagnostic effect of Amb-PSG in clinical (body mass index, blood pressure, Epworth Sleepiness Scale) and treatment follow-up (CPAP adherence and QoL) indicators was comparable to that of Lab-PSG. Conclusions: Amb-PSG showed an OSA diagnostic capacity comparable to Lab-PSG. Secondary analyses (diagnostic quality, clinical efficacy, treatment compliance, QoL) underline the value of Amb-PSG as an emerging alternative to improve accessibility to care.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with pulmonary/systemic changes, however quantification of those changes during AECOPD and factors influencing recovery are lacking. This study characterised patients’ evolution during AECOPD and identified factors influencing their recovery. 44 outpatients with AECOPD (31♂; 68.2±9.1y; 51.1±20.3 FEV1%predicted) were enrolled. Body mass index (BMI) and modified medical research council–dyspnea (mMRC) (independent variables) were collected within 24-48h of hospital presentation (T1) and quadriceps muscle strength (QMS, handheld dynamometry), 5 times sit-to-stand (5STS) and COPD Assessment (CAT) tests (dependent variables) were collected at T1 and at days 8 (T2), 15 (T3) and 45 (T4) after T1. Generalized Estimating Equations were used for analysis. QMS, 5STS and CAT improved overtime (p Significant changes on muscle strength, functionality and impact of the disease occur during an AECOPD. BMI and mMRC values at the onset seem to be factors playing a key role on patients’ recovery from an AECOPD.

Dyspnoea assessment is essential to monitor patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, the ability of dyspnoea scales to detect AECOPD and evaluate response to treatments is hindered by the lack of evidence on their measurement properties. This study assessed the minimal clinically important difference (MCID) and predictive validity of the modified Borg scale (MBS) and modified Medical Research Council dyspnoea scale (mMRC). 33 patients with AECOPD and not requiring hospitalisation (23♂, 68.5y, FEV1 43±15.2 predicted) were assessed with the MBS and the mMRC and received pharmacological treatment. Both measures and an 11 point Global Rating of Change scale were repeated 3weeks later. Patients were then followed up for 3months. MCID (anchor methods with linear regression analysis) and predictive validity (Cox analysis) were established. MCIDs were of -1 (95% CI -1.8 to 0) for the MBS and -0.5 (95% CI -1.4 to -0.7) for the mMRC after 3weeks of treatment. Neither the MBS (Hazard ratio [HR]=0.97; p=0.94) nor the mMRC (HR=1.03; p=0.85) were predictors of AECOPD. Changes of 1 unit in the MBS and of 0.5 in the mMRC appear to be associated with improvements after 3weeks of pharmacological treatment. These changes are in line with those observed in stable patients after bronchodilator and pulmonary rehabilitation. Future studies should address these measurement properties with other therapies, such as pulmonary rehabilitation during AECOPD, and with larger follow ups and samples sizes to understand dyspnoea ability to respond to treatments and predict exacerbations. This would contribute for enhancing the management in AECOPD.

Sem resumo disponível. published

A síndrome de Erasmus designa a associação entre esclerose sistémica e exposição à silica, com ou sem silicose associada. Não existe nenhuma particularidade clínica, radiológica ou histológica distintiva, além da justaposição sindrómica dos estigmas das duas doenças. Várias hipóteses explicativas têm sido avançadas para esta síndrome, cujo tratamento efetivo não existe. É assim evidente a importância da prevenção primária e do seu reconhecimento precoce, motivo pelo qual apresentamos aquí uma revisão diagnóstica, a propósito de caso clínico. Abstract Erasmus syndrome refers to the association between systemic sclerosis and exposure to silica, with or without silicosis. There are no clinic, radiologic or histologic findings, except the overlapping symptoms of the two diseases. There are a few theories to explain this syndrome, which has no effective treatment. Its primary prevention and early recognition are, so, very important, and this is the reason why we present a diagnostic review, based on a clinical case.

Introduction: Sleep/awake homeostasis has a major role in insulin production and blood glucose control. Several studies propose that sleep disturbances are associated with an increased risk of type 2 Diabetes Mellitus (DM2). Objective: To compare sleep measures between patients with and without DM2. Methods: Retrospective analysis using data from polysomnographic recordings obtained at the pulmonology department of CHBV since 2011 to 2014. Sleep measures [total sleep time (TST); sleep efficiency (SE); time spent on each sleep stage], respiratory parameters [apnea/hipopnea index (AHI); oxygen desaturation index (ODI); average peripheral oxygen saturation (SpO2)] and data on demographics and medical history were collected. The association between DM2 and sleep measures was estimated using Mann-Whitney tests or t-tests. Linear regression model was performed taking into account other demographic and clinical characteristics. Results: Four hundred ninety nine patients were included (mean age 54.3±12,46; 68,3% male). Among these 81 patients (16,2%) had DM2 which was associated with decreased TST, SE, slow wave and REM sleep but with no statistically significant differences. In univariate analysis DM2 was associated with lower SpO2, higher AHI, and ODI, which was statistically significant (p Conclusion: Our results reveal an association of sleep disordered breathing and DM2, however this association seems to be only a piece of an intricate puzzle that includes other metabolic and cardiovascular disorders that perhaps share stronger risk factors such as obesity/overweight.

Introduction: COPD and asthma affect almost 300 million individuals worldwide. Inhaled therapy is often associated with technical errors reducing efficacy and compliance. Objective: To assess the impact of teaching the inhalation technique in clinical and functional control of Asthma and COPD. Methods: Inhalation was evaluated in 4 steps: previous expiration, device activation, forced inspiration and end inspiratory pause. Clinical control was measured through Asthma Control Test (ACT), Control of Allergic Rhinitis and Asthma Test (CARAT), modified Medical Research Council and COPD Assessment Test. Pulmonary function tests were performed in all patients. After the first visit patients were educated on correct use of their devices using repeated placebo devices manipulation and visual support material. They were reevaluated 6 to 8 months later. Results: 44 participants were included. Overall there was a significant decrease in the number of performed errors (average 0.7) (p Conclusions: Inhalation technique education improves its performance, leading to an improvement in clinical and functional control in Asthma. These findings were not reproduced in the COPD group, which may reflect its physiopathological hallmark of irreversible obstruction.

Este trabalho teve como objetivo identificar a mineralogia da matéria-prima utilizadas pelas indústrias cerâmicas do município de Cedro de São João, Sergipe. As áreas trabalhadas são os depósitos aluvionares, constituídos de cascalhos, areias, siltes e argilas; e o Grupo Igreja Nova, cujo interesse está voltado para o Membro Boacica da Formação Batinga, constituído de siltitos laminados, com estratificação cruzada e frequentes gradações para arenitos e folhelhos. A metodologia utilizada iniciou-se com pesquisas bibliográficas a respeito da obtenção de material argiloso no município, junto ao cadastro mineiro do DNPM Departamento Nacional de Produção Mineral. Foram feitos trabalhos de campo, em que foram coletadas 9 amostras nos depósitos aluvionares e na Formação Batinga. A etapa seguinte foi a de análise em laboratório, em que foi utilizada a técnica de difratometria de raios-x para a identificação de minerais. Os resultados encontraram como fases minerais ilita e caulinita, embora não tão expressivas, em amostras da Formação Batinga e quartzo. Nas amostras dos depósitos aluvionares, os minerais identificados não são argilominerais, porém apresenta clorita e mica (muscovita), além da albita e quartzo. Dados do DNPM mostram que os requerimentos de licenciamento do município estão sobre os depósitos aluvionares, enquanto que os processos de autorização de pesquisa e concessão de lavra referem-se às áreas da Formação Batinga, uma vez que é necessário o conhecimento da área, através da autorização de pesquisa para que passe a fase de concessão de lavra. As conclusões deste trabalho podem subsidiar interesses acadêmicos e comerciais sobre as substâncias extraídas pelas indústrias cerâmicas na região.

Resumo: A esplenose torácica é uma condição rara, benigna que resulta da rutura do baço associada ou não a lesão do diafragma, geralmente assintomática e acidentalmente diagnosticada após a realização de exames de imagem por qualquer outro motivo. Apresentamos o caso clínico de um homem de 45 anos de idade, assintomático, com antecedentes de traumatismo do baço consequente a um acidente de viação aos 18 anos de idade. O doente foi enviado a consulta de Pneumologia por achados imagiológicos compatíveis com nódulos pleurais no hemitórax esquerdo, mas a análise histopatológica das referidas lesões demonstrou tratar-se de tecido esplénico. O tratamento dos remanescentes esplénicos é conservador. Estes podem adquirir função imunológica, independentemente do local onde estão implantados, e proteger o organismo de eventuais infeções. Summary: Thoracic splenosis is a rare, benign condition that results from the rupture of the spleen associated or not to diaphragm injury, usually asymptomatic and incidentally diagnosed after performing imaging exams for other reasons. We present the case of a 45-year-old male, asymptomatic, with splenic trauma history subsequent to a traffic accident at 18 years of age. The patient was sent to Pneumology consultation due to imaging findings consistent with pleural nodules in the left hemithorax, but histopathological examination of these lesions showed the presence of splenic tissue. The treatment of splenic remnants is conservative. These can acquire immune function, regardless of their location, and protect the patient from possible infections.

Chronic obstructive pulmonary disease and asthma affect almost 300 million individuals. Inhaled therapy is often associated with technical errors reducing efficacy and compliance.To evaluate the inhalation technique and its relation with clinical and functional control in asthma and chronic obstructive pulmonary disease.Analytical cross-sectional study including patients with asthma and chronic obstructive pulmonary disease treated with any type of inhaler device. Demographic data and inquiry about previous teaching of inhalation technique were collected in all participants. Inhalation technique was evaluated in: Step 1 - device activation; Step 2 - previous expiration; Step 3 - inspiration; Step 4 - end inspiratory pause. Clinical control was assessed from the questionnaires Asthma Control Test, Control of Allergic Rhinitis and Asthma Test, modified Medical Research Council and Chronic Obstructive Pulmonary Disease Assessment Test. Spirometric evaluation was performed in all participants.From a total of 62 subjects, 74.19% made at least one error, mainly during step 2 (53.2%). Previous education on inhalation technique was associated with lower number of errors (p = 0.014). There was no association between number of errors and age (p = 0.321), years of diagnosis (p = 0.119) or spirometric evaluation (p0.05). In asthma an association was found between number of errors and Asthma Control Test (p = 0.032) and Control of Allergic Rhinitis and Asthma Test (p = 0.008).Teaching inhalation technique has a positive impact on its future performance. Most patients make mistakes, affecting clinical control in asthma, although in chronic obstructive pulmonary disease no relation was found. This is an ongoing work that aims to reevaluate inhalation technique after patients' education and its further impact.Introdução: A doença pulmonar obstrutiva crónica e a asma afectam quase 300 milhões de indivíduos em todo o mundo. A terapêutica inalatória associa-se frequentemente a erros na técnica realizada reduzindo a eficácia e adesão.Objectivo: Avaliar a técnica inalatória e sua relação com o controlo clínico e funcional em asma e doença pulmonar obstrutiva crónica. Material e Métodos: Estudo transversal analítico incluindo doentes com asma e doença pulmonar obstrutiva crónica medicados com dispositivos inalatórios. Recolheram-se dados demográficos e existência de ensino prévio da técnica. Avaliou-se a técnica inalatória em: Passo 1 - expiração prévia; Passo 2 - activação do dispositivo; Passo 3 - inspiração; Passo 4 - apneia final. O controlo clínico avaliou-se com os questionários Asthma Control Test, Control of Allergic Rhinitis and Asthma Test, modified Medical Research Council e Chronic Obstructive Pulmonary Disease Assessment Test. Todos os participantes realizaram avaliação espirométrica. Resultados: Obtiveram-se 62 participantes, dos quais 74,19% cometeram pelo menos um erro na inalação, principalmente na expiração prévia (53,2%). A existência prévia de ensino da técnica associou-se a menor n'º de erros (p = 0,014). Não houve associação entre n'º de erros e idade (p = 0,321), n'º de anos de diagnóstico (p = 0,119) ou avaliação espirométrica (p0,05). Na asma encontrou-se associação entre menor número de erros e Asthma Control Test (p = 0,032) e Control of Allergic Rhinitis and Asthma Test (p = 0,008). Discussão e Conclusão: O ensino da técnica inalatória melhora o seu desempenho futuro. A maioria dos doentes comete erros afectando o controlo clínico na asma, apesar de na doença pulmonar obstrutiva crónica não se verificar nenhuma associação. Este trabalho encontra-se a decorrer procurando reavaliar os doentes após o ensino da técnica e verificar o seu impacto subsequente.

Behcet s disease is a multi systemic vasculitis whose presentation does not always meet the typical triad of orogenital ulceration, skin and ocular lesions. Right ventricular thrombus, thromboembolism and pulmonary artery aneurysms are rare manifestations and associated with poor prognosis. The authors describe the clinical case of a 38 year old man with multiple admissions for respiratory infection and erythema nodosum. A chest angiotomography revealed pulmonary thromboembolism and right ventricular thrombus, without other changes in laboratory tests. The patient did not take the prescribed oral anticoagulation and abandoned follow up, was admitted two years later with a similar clinic and recurrent oral ulceration. New thromboembolic and angiography showed aneurysmal dilatation of the pulmonary arteries. Behcet’s disease was diagnosed. Corticosteroid therapy was started with a good response after one month. *Corresponding author: Joana Neves, Interna de Formacao Especifica de Medicina Interna, Servico Medicina II, Centro Hospitalar Baixo Vouga – Aveiro, Portugal, Tel: +49 6221 56 4582; E-mail: joana.brrneves@gmail.com Received November 05, 2013; Accepted December 09, 2013; Published December 11, 2013 Citation: Neves J, Andrade L, Saraiva A (2013) Pulmonary Thromboembolism and Intracardiac Thrombus as a Presentation of Behcet s Disease. J Pulm Respir Med 3: 162. doi:10.4172/2161-105X.1000162 Copyright: © 2013 Neves J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Bronchial-associated lymphoid tissue (BALT) lymphoma is a rare condition that accounts for only 0.5-1% of all malignant lung tumours. We present the case of a 66-year-old man admitted with pneumonia for further study and therapy. Initially the sputum was positive for Mycobacterium tuberculosis complex using polymerase chain reaction technology and antituberculous therapy was initiated. Due to the lack of imagiological improvement, the patient underwent a pulmonary transthoracic biopsy that revealed BALT lymphoma. Months later, Mycobacterium chelonae was identified and specific therapy was started with clarithromycin and tobramycin, before initiating BALT treatment with cyclophosphamide. There are only a few documented cases of BALT lymphoma associated with Mycobacterium. In this case M. chelonae might have been present before BALT lymphoma, contributing as an immunologic stimulus, or appeared afterwards, in the neoplastic context. BALT has an indolent evolution with a good prognosis and that is the reason why some experts favour a “watchful waiting” option.