Search

Marc Beaumont,1,2 Francis Couturaud,3 Florence Jego,4 Romain Pichon,5 Catherine Le Ber,1 Loïc Péran,1 Christophe Rogé,6 David Renault,6 Swathi Narayan,7 Gregory Reychler8–10 1Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, Morlaix, France; 2European University of Occidental Brittany, EA3878, Brest, France; 3Department of Internal Medicine and Chest Diseases, EA3878 (GETBO), CIC INSERM 0502, University Hospital of Brest, European University of Occidental Brittany, Brest, France; 4Clinical Research Unit, Morlaix Hospital Centre, Morlaix, France; 5Pulmonary Rehabilitation Unit, Rennes, France; 6Pulmonology Unit, Morlaix Hospital Centre, Morlaix, France; 7European University of Occidental Brittany, Brest, France; 8Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium; 9Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; 10Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium Introduction: Eighty percent of COPD patients experience dyspnea during activities of daily life (ADL). To the best of our knowledge, the Modified Medical Research Council (MMRC) dyspnea scale is the only validated scale designed to quantify dyspnea during ADL available in the French language. Two other instruments are only available in English versions: the London Chest Activity of Daily Living (LCADL) scale that allows a specific evaluation of dyspnea during ADL and the Dyspnea-12 questionnaire that evaluates the affective (emotional) and sensory components of dyspnea in daily life. The aim of this study was to translate and validate French versions of both LCADL and Dyspnea-12 questionnaires and to determine the reliability of these versions for the evaluation of dyspnea in severe to very severe COPD patients.Methods: Both translation and cultural adaptation were based on Beaton’s recommendations. Fifty consecutive patients completed the French version of LCADL and Dyspnea-12 and other questionnaires (MMRC, Saint George’s Respiratory Questionnaire [SGRQ], Hospital Anxiety and Depression [HAD]), at a 2-week interval. Internal consistency, validity, and reliability of LCADL and Dyspnea-12 were evaluated.Results: The French version of LCADL and Dyspnea-12 demonstrated good internal consistency with Cronbach’s α of, respectively, 0.84 and 0.91. LCADL was correlated significantly with item activity of SGRQ (ρ=0.55, p

Background/Objectives : Patients with COPD have altered self-esteem, and good self-esteem promotes personal, health, and social success. Improving self-esteem could be a method for encouraging the maintenance of physical activity. Only one study has evaluated the effects of pulmonary rehabilitation (PR) on self-esteem in moderate COPD patients. The objective was to assess the evolution of self-esteem in COPD patients of all stages of severity during PR. Methods : COPD patients undergoing PR were included in this prospective observational study. Patients were evaluated before and after the 4-week PR program. The objectives were to (1) assess the evolution of self-esteem using the Physical Self Inventory-6 questionnaire (PSI-6), (2) assess the evolution in each sub-score of PSI-6, (3) examine the correlations between the evolution of self-esteem and the evolution of parameters usually used during PR, and (4) determine an MID for self-esteem. Results : In total, 76 patients were included. We found that there was a significant increase in the total score in PSI-6 (9.29, p < 0.001), CI 95% [6.74; 11.83], and in the sub-scores of PSI-6. The evolution of the PSI-6 score was moderately correlated with changes in exercise capacity using STST1 (r = 0.352, p = 0.002) and quality of life (r = -0.361, p = 0.001) and weakly correlated to changes in dyspnea (r = -0.245, p = 0.03), anxiety (r = -0.248, p = 0.03), and depression (r = -0.290, p = 0.01). Using a distribution-based analysis, we found an MID between 5.2 and 5.6. Conclusions : We showed a significant increase in global score and in each sub-score of self-esteem using PSI-6 in COPD patients undergoing a PR program. We propose an MID of 5.6.

Objective: Inspiratory muscle training is recommended for people with chronic obstructive pulmonary disease (COPD) with inspiratory muscle weakness. Clinical interpretation of changes in inspiratory muscle strength could be helped by the determination of cut-off values. The aim of this study was to estimate the minimal important difference for inspiratory muscle strength assessed with maximal inspiratory pressure (MIP) in people with COPD., Design: Post hoc analysis of a randomized controlled trial (EMI2 study) including people with severe to very severe COPD undergoing a pulmonary rehabilitation program was conducted. The determination of the minimal important difference was realized using both anchor-based and distribution-based methods., Setting: The study includes patients admitted to the rehabilitation program unit of the Centre Hospitalier des Pays de Morlaix (Morlaix, France) between March 5, 2014 and September 8, 2016., Participants: Seventy-three people with severe to very severe COPD (age 62.2  ±  8.0 years, forced expiratory volume in 1 s 36.4  ±  9.5% of theoretical) were analyzed., Intervention: Patients followed a standardized pulmonary rehabilitation program 5 days a week for 4 weeks. The program included aerobic training, ground-based outdoor walking training, and strengthening of lower and upper limb muscles., Main Measures: At the end of the pulmonary rehabilitation program, MIP improved by 14.8  ±  14.9 cmH 2 O (p < 0.05). Regarding the anchor-based method, only the modified Medical Research Council was selected as an appropriate anchor. The receiver operating characteristic curve analysis reported a minimal important difference of 13.5 cmH 2 O (sensibility: 75% specificity: 67.5%). Using distribution-based methods, the estimate of minimal important difference was 7.9 cmH 2 O (standard error of measurement method) and 10.9 cmH 2 O (size effect method)., Results: The estimations proposed by this study ranged from 7.9 to 13.5 cmH 2 O., Conclusions: The measurement of minimal important difference is a simple tool for assessing the changes of inspiratory muscle strength during a pulmonary rehabilitation program. We propose a minimal important difference of 13.5 cmH 2 O for the improvement of MIP. Further studies are needed to confirm this estimation.ClinicalTrials.gov identifier: NCT02074813.

Objective: To compare strengthening by neuromuscular electrical stimulation versus cycle ergometer training during a pulmonary rehabilitation program, in patients with severe to very severe chronic obstructive pulmonary disease., Design: A prospective randomized controlled study., Setting: Two inpatient pulmonary rehabilitation centers., Subjects: Patients with severe to very severe chronic obstructive pulmonary disease and multidimensional index to predict risk of death ≥5, were randomly assigned to receive neuromuscular electrical stimulation or cycle ergometer training during pulmonary rehabilitation., Main Measures: The primary endpoint was the change in exercise capacity using 1-min sit-to-stand test Secondary endpoints were the changes in exercise capacity using 6-min walk test, quadriceps strength, quality of life and dyspnea., Results: 102 patients were included. After 3 weeks, 47 patients in the neuromuscular electrical stimulation group, and 45 in the cycle ergometer training group were able to be analyzed. No significant difference was seen in the evolution of exercise capacity using 1-min sit-to-stand test (3.3 ± 3.8 and 2.6 ± 4.1) and 6-min walk test (37.8 ± 58.4 and 33.1 ± 46.7), in the evolution of quadriceps strength and endurance (9.2 ± 12.9 and 6.6 ± 16.1; 9.0 ± 13.2 and 6.2 ± 17.0), in the evolution of quality of life (St George's Respiratory Questionnaire: -11.3 ± 11.7 and -8.1 ± 11.6; COPD Assessment Test: -5.7 ± 7.1 and -4.7 ± 7.0), or in the evolution of dyspnea using Dyspnea 12 (-5.5 ± 10.2 and -5.9 ± 8.5) except using modified medical research council scale (95% confidence interval: 0.48 [0.05; 0.91], p = 0.027)., Conclusion: We found no significant difference between the two programs on exercise capacity, quadriceps strength and quality of life.

Introduction: The authors of the international task force about the management of Dyspnoea recommend assessing sensory and affective components of dyspnoea. The Dyspnoea-12 questionnaire (D-12) allows to assess both components of dyspnoea. D-12 is valid and reliable but its sensitivity to pulmonary rehabilitation was not studied. The aim of this study was to estimate the minimal important difference (MID) for D-12 in COPD patients undergoing a pulmonary rehabilitation programme (PRP)., Methods: Severe or very severe COPD patients undergoing a PRP were included. Dyspnoea was assessed using D-12, MMRC dyspnoea scale, London chest of Activity of Daily Living questionnaire (LCADL). Quality of life was assessed using Saint-George respiratory questionnaire (SGRQ) and COPD assessment Test (CAT); exercise capacity using 6-Minute walk Test (6MWT) and 1-minute sit to-stand test (1STST). The MID was evaluated using distribution and anchor-based methods., Results: Sixty patients (age: 64.4 ± 8.2; FEV1 (%): 28.6 ± 8.1) were included. At the end of the PRP, patients had significantly decreased their dyspnoea measured with D-12, MMRC, LCADL (D-12:23.9 ± 8.9 to 17.6 ± 9.4; MMRC: 3 ± 0.7 to 2.2 ± 1.1, LCADL: 38 ± 13.9 to 31.6 ± 11; p < 0.0001). Using the distribution-based analysis, MID of -2.67 (standard error of measurement) or -4.45 (standard deviation) was found. According to methodology, we could only use SGRQ as anchor. With SGRQ as anchor, the receiver operating characteristic curve identified MID for the change in D-12 at -6.1 (sensibility: 58%, specificity: 79%). The correlation with SGRQ was modest (r = 0.33), so the calculated MID should be interpreted with caution., Conclusion: D-12 is a good tool to assess the decrease of dyspnoea after PR. We propose MID of -6 points. However, Future estimates of MID for the D-12 should use anchors that are more strongly correlated with it., (© 2020 John Wiley & Sons Ltd.)

Introduction: In activities involving upper limbs, patients with chronic obstructive pulmonary disease (COPD) report an increase in dyspnea. For this reason, the authors of the recommendations about pulmonary rehabilitation propose to perform upper limbs muscle strengthening in patients with COPD. However, the modalities of strengthening are not clearly established.The aim of this study is to compare the effects of upper limbs endurance strengthening versus upper limbs force strengthening, in patients with COPD during a pulmonary rehabilitation program., Methods: This study is a randomized, open-label, bi-center controlled trial in parallel groups distributed in a ratio (1:1) comparing upper limbs force strengthening (group F) to the upper limbs endurance strengthening (group E) during a pulmonary rehabilitation program in patients with COPD stages 2 to 4 (A-D).After randomization, patients will be allocated to follow: A 4 weeks pulmonary rehabilitation program with upper limbs resistance strengthening (group F). A 4 weeks pulmonary rehabilitation program with upper limbs endurance strengthening (group E).The primary outcome is dyspnea measured with the London Chest Activity of daily Living questionnaire. The secondary outcomes are dyspnea (using Modified Medical Research Council dyspnea Scale, dyspnea-12 questionnaire, multidimensional dyspnea profile questionnaire), upper limb exercise capacity (using the 6-minute Peg Board and Ring Test), Maximal voluntary strength of deltoid, biceps, and brachial triceps.The sample size calculated is 140 patients per group, or 280 in total., Discussion: The modalities of upper limb strengthening are not very well known, and evidence based is lacking to recommend endurance or resistance upper limb strengthening.We anticipate that the results of this study will be of relevance to clinical practice. They will bring information about the best modality of upper limb strengthening to use during a pulmonary rehabilitation program., Trial Registration: IdRCB n°2018-A00955-50; V1.1 du 11/07/2018; REHABSUP, clinical trial.gov (NCT03611036), registered August 02, 2018, https://clinicaltrials.gov/ct2/show/NCT03611036.

Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise capacity. This parameter is usually evaluated using 6-minute walking test (6MWT). New tools appear regularly. The aim of this study was to validate the 3-minute step test (3MStepT) and to compare 3MStepT and 6MWT in stable patients with COPD as a tool to quantify the functional exercise capacity. Patients with COPD admitted for a pulmonary rehabilitation program in a dedicated center were recruited and randomly performed both tests: 6MWT and 3MStepT. A training test was performed systematically before each test. Walking distance and number of repetitions (3MStepT) were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded pre and post the tests. Fifty patients with COPD (FEV1: 45.2 ± 18.3) were included. 6MWT (423.6 ± 96.3 m) was strongly correlated with 3MStepT (62.1 ± 18.0; r  = 0.780; p  < 0.001). Heart rate and SpO2 were significantly different at the end of the 6MWT and 3MStepT (respectively, 106.2 ± 16.3 vs. 112.9 ± 13.4bpm, p  = 0.002; 87.6 ± 5.4 vs. 89.6 ± 5.3bpm, p  = 0.001). Lower limb fatigue was significantly higher after the 3MStepT (2.5 ± 2.6 vs. 3.4 ± 2.4, p  = 0.01). The 3MStepT is an alternative to the 6MWT to estimate functional exercise capacity in stable patients with COPD but cardiorespiratory adaptation and lower limb fatigue are not similar between these tests.

The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMT versus PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure ( P Imax ), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase of P Imax after IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement of P Imax in the IMT group., Competing Interests: Conflict of interest: None declared., (Copyright ©ERS 2018.)

Background: The validity and reproducibility of the 6-minute stepper test (6MST) have already been demonstrated in patients with chronic obstructive pulmonary disease (COPD)., Objectives: The aim of this study was to evaluate the responsiveness of the 6MST to pulmonary rehabilitation (PR) in patients with COPD, to determine a minimal important difference (MID) for the 6MST, and to compare the 6MST and the 6-minute walk test (6MWT)., Methods: Sixty-two patients with COPD were included in a prospective experimental study. Participants underwent a 3-week inpatient PR program. The primary outcome was the change in the number of steps during the 6MST measured before and after PR. The secondary outcome included the change in the 6-minute walking distance (6MWD) pulse oximetry, heart rate, dyspnea, and leg discomfort during the tests measured before and after PR. MID was determined by anchor-based and distribution approaches., Results: After PR, we observed a significant increase in the number of steps during the 6MST (22.5 steps; 95% CI 13.8-31.3; p < 0.0001) and in the 6MWD (26.6 m; 95% CI 17.6-35.5; p < 0.0001). The 6MST and 6MWT were improved by 10.1 and 6.5%, respectively. The number of steps during the 6MST was significantly correlated with the 6MWD before (r = 0.72; p < 0.0001) and after PR (r = 0.66; p < 0.0001). MID was estimated to be around 20 steps., Conclusion: The 6MST appears to be as responsive as the 6MWT in assessing functional improvement during PR in patients with COPD. The 6MST is a low-cost assessment and requires limited space., (© 2016 S. Karger AG, Basel.)

A random sample of 221 individuals taken from 2000 inhabitants of a small Caribbean island of French origin were typed for Gm and Km allotypes. Gm haplotype frequencies were found to be significantly different from France. Km(1) frequency was found to be lower than in the French population. These differences suggest a small degree of admixture with the Black population, and genetic drift.