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Aims: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that affects health outcomes on multiple levels including overall wellbeing. More specifically, factors such as spiritual wellbeing, and psychological, mental and motivational status which may be at least as important as others, have been rarely studied. This article reports the method of validating a new wellness assessment questionnaire and the status of several wellness domains in patients with COPD. Methods: The study consisted of two phases: first, the development of a new Wellness Questionnaire with the help of focus groups; second, the validation and use of the questionnaire in a cohort of patients with COPD. For focus groups, healthy people ⩾45 years of age with no known comorbidity as well as people with a clinical diagnosis of COPD were invited to participate in the study. Results: Thematic analysis of findings from focus groups and original cohort respondents highlighted some factors that appear to influence wellness status. Five domains were explored as potential markers of wellness in patients with COPD. Quantitative analysis with Spearman correlation demonstrated a significant correlation between Physical/Personal Wellness and other markers of COPD progression such as Global Initiative Obstructive Lung Disease (GOLD; 0.006), force expiratory volume in 1 s (FEV1%; 0.01), health-related quality of life (0.009), multidimensional BOD score and quartile (0.003 and 0.02). Conclusion: The findings suggest that a combination of personal, physical, emotional, mental and other psychological factors is responsible for negative COPD outcomes. While there is a need to validate this new wellness questionnaire in further research, it incorporates new markers of wellness that could benefit management of COPD.

Background: The assessment of the severity of chronic obstructive pulmonary disease (COPD) should involve a multidimensional approach that is now clearly shown to be better than using spirometric impairment alone. The aim of this study is to validate and compare novel tools without an exercise test and to extend prognostic value to patients with less severe impairment of Forced expiratory volume 1 s. Methods: A prospective, observational, primary care cohort study identified 458 eligible patients recruited from the primary care clinics in the northeast of England in 1999–2002. A new prognostic indicator - body mass index, airflow obstruction and dyspnea (BOD) together with the conventional prognostic indices age, dyspnea and airflow obstruction (ADO), global initiative for chronic obstructive lung disease (GOLD) and new GOLD matrix were studied. We also sought to improve prognostication of BOD by adding age (A) and smoking history as pack years (S) to validate BODS (BOD with smoking history) and BODAS (BOD with smoking history and age) as prognostic tools and the predictive power of each was analyzed. Results: The survival of the 458 patients was assessed after a median of 10 years when the mortality was found to be 33.6%. The novel indices BOD, BODS, and BODAS were significantly predictive for all-cause mortality in our cohort. Furthermore with ROC analysis the C statistics for BOD, BODS, and BODAS were 0.62, 0.66, and 0.72, respectively (P < 0.001 for each), whereas ADO and GOLD stages had a C statistic of 0.70 (P < 0.001) and 0.56 (P < 0.02), respectively. GOLD Matrix was not significant in this cohort. Conclusion: BOD, BODS, and BODAS scores are validated predictors of all-cause mortality in a primary care cohort with COPD.

Aim: To examine the relationship of duration of symptoms with the disease outcomes in patients with COPD. Background: COPD patients have varying degree of symptoms. We hypothesized that duration of symptoms may be useful to understand the disease progression. Methods: This observational study carried out in England. The patients were recruited and followed up between September 1999 and December 2002 and then 2007-2008, respectively. Patient’s demographics were recorded. Medical Research Council Dyspnoea (D) score were used to measure degree of breathlessness and spirometry were utilized to evaluate the severity of disease. Patients were asked about the COPD symptoms and for how long they have these symptoms including shortness of breath, cough, and the duration of their symptoms. Results: A total of 269 subjects were recruited. Of those 227 were with the diagnosis of COPD and 42 as non COPD or control group. The data is normally distributed. The study results show that there is a strong correlation between duration of symptoms and physiological variables both at baseline and at follow up. These include age (p=0.04), pack years (p=0.02), MRC score (p=0.04) and FEV1 (p

Background: Measured reductions in lung function, as a result of COPD, use a measured current value and make comparisons to a determined 'normal' value arrived at using a regression equation based upon a patients height. Osteoporosis is a recognised co-morbidity in patients with chronic obstructive pulmonary disease (COPD) and may cause excessive height loss resulting in the 'normal' values and disease progression being under-estimated. Purpose: The aim of the study was to examine the height variation in a cohort of COPD patients and controls over a 7-8 years period and evaluate its impact on estimates of lung function and hence COPD progression. Methods: In 1999-2002 we studied a cohort of primary care patients in Sunderland, UK with and without COPD and re- examined 104 (56 male) during 2007-2009. We calculated FEV1% predicted for actual and estimated height (armspan/1.03 and armspan/1.01 in males and females respectively). Results: In 1999-2002 the subjects were aged 62.6 ± 9.4 years, BMI was 26.4± 4.7 kg/m 2 , predicted FEV1 was 59.0 ±16.0, and mean actual height was 167.3±8.9cm. The actual height changed significantly (p

Background Multiple factors contribute to muscle weakness and reduced muscle mass in chronic obstructive pulmonary disease (COPD) and this impacts patients’ quality of life. One factor implicated in this process is systemic inflammation, an accompaniment of acute exacerbations. Recurrent exacerbations are associated with lower health status. This study examines the relationship between muscle weaknesses, health status and exacerbation frequency in a cohort of patients with COPD. Methods This is an observational study of 188 (95 female) patients with COPD attending two hospital clinics in the northeast of England between 2004 and 2007. We measured spirometry, body mass index, health status (St George’s Respiratory Questionnaire) and grip strength and recorded Medical Research Council dyspnoea scores and the frequency of exacerbations in the previous year. Results Patients were aged 72.568.3 years (data expressed as mean6SD) with Medical Research Council score of 3.660.8, forced expiratory volume in one second (FEV1) of 49.2621.5 per cent predicted and a total St George’s Respiratory Questionnaire score of 72.2615.5. Grip strength, expressed as per cent predicted, was 72.0621.8 in men and 81.0618.2 in women. Exacerbations ranged from zero to five in the previous year and there were associations of reduced grip strength with exacerbation frequency (c 2 ¼9.634; p¼0.0019) and lower health status (c 2 ¼34.00; p

The Urgent Care Team (UCT) in Sunderland (pop. 293,000) is a unique nurse practitioner service operating a hospital at home 24/7/365 to deal promptly with patients suffering an exacerbation of their COPD (AECOPD). Treatment is according to patient group directions utilising nebulised bronchodilators, doxycycline and prednisolone. To compare the health status and pathophysiology during and two months after an AECOPD in 60 UCT patients (31 male) and 30 hospital-managed patients (16 male). The St. Georges Respiratory Questionnaire (SGRQ), Mahler Baseline Dyspnoea Index (BDI) and MRC dyspnoea score recorded health status. Spirometry, BMI and grip strength were also measured. All patients were reviewed 2–3 months after the AECOPD. Changes from BDI were measured using the Transitional Dyspnoea Index (TDI). Mean FEV1% predicted was 47%. In the recovery phase the two groups were comparable for all variables. But during their AECOPD hospitalised patients had a significantly lower BDI ( P

BACKGROUND: Both ventilation (V) and perfusion (Q) of the lungs are altered in asthma, but their relationships with allergen-induced airway responses and gas exchange are not well described.METHODS: The effects of aerosolized allergen provocation of V/Q abnormalities in nonsmoking, male atopic asthmatics (six dual responders and two isolated early responders) were compared with measurements of airflow limitation (forced expiratory volume in 1 s [FEV1]), gas exchange (arterial oxygen saturation, arterial oxygen partial pressure and alveolar-arterial oxygen gradient) and airway reactivity (provocative concentration of histamine causing a decrease of 20% in FEV1). V and Q lung scans at 30 min and 6 h following allergen challenge and changes in all variables were compared with prechallenge data. Digital image data were registered to baseline scans, and quantitative comparisons of changes made were supported by qualitative assessments of the images.RESULTS: All subjects showed evidence of impaired gas exchange, as reflected by lowered arterial oxygen tension and widened alveolar arterial oxygen gradients. Baseline V/Q scans were abnormal, and there were allergen-induced changes in V and Q at 30 min, with scans at 6 h showing additional changes in Q, particularly in dual responders. Allergen-induced gas trapping was evident at 30 min and was sustained at 6 h.CONCLUSIONS: Regional patterns of V and Q derived from lung scintigraphy showed a wider range of disturbances than were indicated by the magnitude of airflow limitation and arterial hypoxemia following allergen provocation, and they remained abnormal despite normalization of FEV1. Imaging of regional abnormalities of gas exchange may be relevant in the evaluation of patients with asthma.

Of potential prognostic variables for COPD to use in a multidimensional staging tool, BMI, severity of airflow obstruction (FEV 1 % predicted) and the MRC Dyspnoea Score (BOD) have been shown to be useful for a more complete assessment of the impact of the disease.1 In 1999–2002 we identified 431 patients (208 women) with COPD in primary care surgeries and recorded their BOD scores (maximum 7). For men and women (mean±SD): age was 66±10 and 64±10; pack/years 34±19 and 34±18; BMI 27±5 and 25±6; FEV 1 % predicted 55±15 and 57±16; and MRC Dyspnoea Score 2.6±1.0 and 2.6±1.0; with BOD scores 1.9±1.5 and 2.0±1.6 respectively. The low mean BOD scores indicate the mainly moderate severity for this primary care cohort (only one subject had an MRC score of 5). Because of the similarities in these variables for men and women further analysis is of the whole cohort. Mortality was assessed in October 2010 and a Kaplan–Meier analysis for those with BOD scores 0 and 1 shows 80% and 75% probability of survival, whereas for a BOD score of >4 the 10-year survival was 4 in a Kaplan–Meier plot. Conclusion BOD, a multidimensional index of the clinical impact of COPD is valid for a 10-year prognosis and outperforms GOLD staging over that period.