BackgroundPulmonary Rehabilitation (PR) is an important treatment for patients with chronic obstructive pulmonary disease (COPD) but it is not established whether any baseline parameter can predict response or compliance.AimTo identify whether baseline measures can predict who will complete the programme and who will achieve a clinically significant benefit from a Minimum Clinical Important Difference (MCID) in terms of exercise capacity and health-related quality of life (HRQoL).MethodsData were collected prospectively from patients with COPD at their baseline assessment for an outpatient PR programme in one of eight centres across London. ‘Completion’ was defined as attending at least 75% of the designated PR visits and return for the follow-up evaluation. The MCID for outcome measures was based on published data.Results787 outpatients with COPD (68.1±10.5 years old; 49.6% males) were included. Patients who completed PR (n=449, 57.1%) were significantly older with less severe airflow obstruction, lower anxiety and depression scores, less dyspnoea and better HRQoL. Only baseline CAT score (OR=0.925; 95% CI 0.879 to 0.974; p=0.003) was retained in multivariate analysis. Patients with the lowest baseline walking distance were most likely to achieve the MCID for exercise capacity. No baseline variable could independently predict achievement of an MCID in HRQoL.ConclusionsPatients with better HRQoL are more likely to complete PR while worse baseline exercise performance makes the achievement of a positive MCID in exercise capacity more likely. However, no baseline parameter could predict who would benefit the most in terms of HRQoL.
Background The COPD assessment test (CAT) was introduced last year.1 It is a questionnaire that contains eight questions covering domains relating to the impact of COPD symptoms. It is a self completion questionnaire and does not require scoring software. Scores of 0e10, 11e20, 21e30, 31e40 represent mild, moderate, severe or very severe clinical impact. In cross-sectional studies it has similar scaling properties to the SGRQ, so that 1 point in the CAT is equivalent to approximately 2.5 points on the SGRQ. It is not known how the CAT score performs in the context of pulmonary rehabilitation (PR). Methods We prospectively studied the introduction of the CAT score as an assessment tool in several pulmonary rehabilitation programs across London, where it was used alongside a range of other outcome measures in different programs including the SGRQ, CCQ, HAD score, MRC dyspnoea score and several different walking tests. Primary outcome was a comparison of change in CAT score against an anchor question used to assess overall response, scored 1 "I feel much better " 2 "I feel a little better", 3 "I feel no different", 4 "I feel a little worse", 5 "I feel much worse". Results Data were available for 172 COPD patients, mean(SD) age 69.6(9.3) years, FEV 1 51.9(18.9)% predicted, MRC dyspnoea score 3.0(0.9), CAT score 20.0(7.5) who attended five different programs. Mean improvement in CAT score after PR was 2.8(5.8) points. In those scoring "much better " (n¼108) CAT fell by 3.7(6.1) points and by 1.2(4.8) in those who felt "a little better" (n¼56) (p¼0.01). In those scoring 3 or 4 on the anchor question (grouped together as n¼8) change in CAT was À0.6(3.5). Conclusion The CAT score improves in response to pulmonary rehabilitation and more so in those who report a greater overall improvement. Further accrual is underway to allow comparison of changes in CAT to other outcome measures. Introduction Biomarkers have been investigated in order to speed up diagnosis of VAP, a common condition in ICU patients. TREM-1 is a protein involved in amplification of immune responses to bacterial and fungal infection and exists as soluble and surface forms.1 2 The diagnostic value of soluble TREM-1 in broncho-alveolar lavage fluid (BALF) in VAP is controversial.3 Therefore the utility of surface TREM-1 for diagnosing VAP in a two-compartment model (BALF and blood) was investigated. Methodology Paired blood and BALF were obtained in consenting patients in the following groups: (1) Ventilated patients with VAP diagnosed on semi-quantitative microbiology and Clinical Pulmonary Infection Score (CPIS); (2) Ventilated patients without sepsis; (3) Day-case bronchoscopy patients without evidence of infection. Flow cytometry was performed on cell pellets derived from simultaneous BALF and blood samples. Surface TREM-1, CD11b (immune cell activation marker) and L-selectin (immune cell migration marker) levels were measured on monocytes and neutrophils. At the same time an inflammatory cytokine panel (comprising IL-1b, IL-6, IL-8 and soluble TREM-1...
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