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Aim To provide a Portuguese version of the Multidimensional Dyspnea Profile (MDP), investigating its validity and reliability in Brazilian patients with COPD. Methods This was a cross-sectional study for translation and linguist validation of the Portuguese MDP version for patients with COPD. The process occurred according to the protocol of Mapi Research Trust, Lyon, France. Three scores of MDP were used for the analysis: the immediate unpleasantness of dyspnea (A1); the “immediate perception domain” (S) (sum of A1 plus the sensory descriptors) and the “emotional response domain” (A2) (sum of the emotional descriptors). The questionnaires COPD assessment Test (CAT), Hospital Anxiety and Depression scale (HADS) and Medical Research Council scale (MRC) were used as anchors to investigate MDP’s validity. Internal consistency was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficient (ICC) and concurrent validity was assessed with Spearman correlation coefficients. Results Thirty patients with moderate-severe COPD were studied for MDP’s validation analysis (43% male, 63±8years, body mass index [BMI] 27±6Kg/m 2 , forced expiratory volume in the first second [FEV 1 ] 48±15%predicted, six-minute walking test [6MWT] 464±84m and 84±16%predicted), whereas 10 patients were excluded from the test-retest reliability analysis due to missing data, resulting in a sample of 20 subjects for this purpose (50% male, 62±8years, BMI 27±6Kg/m 2 , FEV 1 48±15%predicted, 6MWT 452±93m and 82±19%predicted). Both samples were similar regarding general characteristics ( P >0,05 for all variables). MDP presented strong correlations, i.e., ICC intra-rater: A1: 0.77 (0.48–0.90), S: 0.78 (0.52–0.91), and A2: 0.85 (0.66–0.94), with high internal consistency (Cronbach's α 0.86, 0.88 and 0.92 respectively); and ICC inter-rater: A1: 0.74 (0.46–0.89), S: 0.75 (0.48–0.89) and A2: 0.91 (0.78–0.96) with Cronbach's α 0.85, 0.86 and 0.95 respectively. Conclusion The Portuguese version of the MDP is the first valid and reliable instrument to assess dyspnea multidimensionally in Portuguese-speaking patients with COPD.

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The Londrina ADL protocol was reproducible and valid in physically independent adults age ≥50 y. A reference equation for the protocol was established including only age as an independent variable (r = 0.21), allowing a better interpretation of the protocol's results in clinical practice.

IntroductionLow fat-free mass (FFM) is linked to poor health outcomes in COPD, including impaired exercise tolerance and premature death. The aim of this systematic review was to synthesise evidence on the effectiveness of interventions for increasing FFM in COPD.MethodsSearches of electronic databases (MEDLINE, Cochrane Library, EMBASE, Web of Science, Scopus) and trial registers (ClinicalTrials.gov) were undertaken from inception to August 2022 for randomised studies of interventions assessing measures of FFM in COPD. The primary outcome was change in FFM (including derivatives). Secondary outcomes were adverse events, compliance, and attrition.Results99 studies (n=5138 people with COPD) of 11 intervention components, used alone or in combination, were included. Exercise training increased mid-thigh cross-sectional area (k=3, SMD=1.04, 95% CI 0.02–2.06, p=0.04), but not FFM (k=4, SMD=0.03, 95% CI −0.18–0.24, p=0.75). Nutritional supplementation significantly increased FFM index (k=11, SMD=0.31, 95% CI 0.13–0.50, p<0.001), but not FFM (k=19, SMD=0.16, 95% CI −0.06–0.39, p=0.16). Combined, exercise training and nutritional supplementation increased measures related to FFM in 67% of studies. Anabolic steroids increased FFM (k=4, SMD=0.98, 95% CI 0.24–1.72, p=0.009). Neuromuscular electrical stimulation increased measures related to FFM in 50% of studies. No interventions were more at risk of serious adverse events, low compliance, or attrition.DiscussionExercise training and nutritional supplementation were not effective in isolation to increase FFM but were for localised muscle and index measures, respectively. Combined, exercise and nutritional supplementation shows promise as a strategy to increase FFM in COPD. Anabolic steroids are efficacious for increasing FFM in COPD.