Should we use gait speed in COPD, FEV<sub>1</sub>in frailty and dyspnoea in both?

Bousquet, Jean; Dinh-Xuan, Anh Tuan; Similowski, Thomas; Malva, João O.; Ankri, Joël; Barbagallo, Mario; Fabbri, Leonardo M.; Humbert, Marc; Mercier, Jacques; Cordeiro, Carlos Robalo; Rodríguez‐Mañas, Leocadio; Vellas, Bruno

doi:10.1183/13993003.00633-2016

Cited by 20 publications

(31 citation statements)

References 67 publications

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“…This does not mean that they are not predictors of outcome in COPD ( 8 , 9 ), but rather suggests that stronger factors are involved. NYHA, which is both a marker of dyspnea and frailty ( 10 ) could be a candidate factor in patients with physical deconditioning worsened by the acute exacerbation and the corresponding bed rest in ICU ( 11 ). This hypothesis is in line with current evidence that post-exacerbation respiratory rehabilitation (a comprehensive and multidisciplinary therapeutic intervention) reduces dyspnea, use of healthcare resources, readmissions, and mortality ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Severe Dyspnea Is an Independent Predictor of Readmission or Death in COPD Patients Surviving Acute Hypercapnic Respiratory Failure in the ICU

et al. 2018

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Background: Predicting outcome after index admission in the ICU for COPD-related acute hypercapnic respiratory failure (AHRF) is difficult. Simple tools to stratify this risk and to promote interventions to mitigate it are needed.Aim: To prospectively evaluate the ability of severe dyspnea (NYHAIII-IV) to predict hospital readmission or death in COPD patients surviving AHRF in the ICU.Methods: 50 consecutive COPD patients were recruited from a larger cohort of patients (n = 78) surviving AHRF in the ICU. All predictive variables were collected within 15 days after resolution of respiratory failure before hospital discharge. COPD was diagnosed by spirometry. Heart failure was diagnosed with clinical rules and echocardiography. NYHA was measured upon hospital discharge. Hospital readmission and death were recorded at regular intervals for 3 months.Results: 21/50 (42%) COPD patients died or were readmitted to the hospital during the observation period: 12 out of the 20 NYHA III-IV patients (60%) and 8 out of the 28 NYHA I-II patients (29%). NYHA III-IV was associated with risk of readmission or death (univariate HR: 2.73, IC95: 1.11–6.69, p = 0.028). After controlling for age, FEV1, heart failure and BMI, NYHA III-IV remained associated with readmission or death (multivariate HR: 2.71, IC95: 1.06–6.93, p = 0.038).Conclusions: Our findings suggest that severe dyspnea measured upon hospital discharge in COPD patients surviving AHRF can stratify patient's risk of 3-month readmission or death.

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Section: Discussionmentioning

confidence: 99%

Severe Dyspnea Is an Independent Predictor of Readmission or Death in COPD Patients Surviving Acute Hypercapnic Respiratory Failure in the ICU

et al. 2018

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“…Elderly patients with COPD are often defined as frail subjects [95,96]. Frailty is a progressive physiological decline in multiple organ systems marked by loss of function, loss of physiological reserve and increased vulnerability to disease [97].…”

Section: Elderly Copd and Frailtymentioning

confidence: 99%

Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease

Rogliani

Brusasco

Fabbri

et al. 2017

Expert Review of Respiratory Medicine

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Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbidities occurring either independently or as consequences of COPD. Areas covered: This review examines the interactions between the pathophysiology of COPD and the most frequent comorbidities, and highlights the need for multidimensional clinical strategies to manage COPD patients with comorbidities. Expert commentary: Most COPD patients need to be approached in a complex and multifactorial scenario. The diagnosis of COPD is necessarily based on the presence of chronic respiratory symptoms and poorly reversible airflow obstruction, but exacerbations and comorbidities need to be considered in the evaluation of disease severity and prognosis in individual patients. More importantly, defining the precise relationship between COPD and comorbidities for each patient is the basis for a correct therapeutic approach.

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“…There is some mention of the health-impairing consequences of dyspnea or poor physical performance in the literature, but only under specific conditions involving populations of older subjects with COPD, postoperative situations, frailty and depressive symptoms. [5][6][7] Since dyspnea is a nonspecific symptom associated with adverse outcomes such as exercise intolerance, physical disability and increased mortality among older adults, investigation of dyspnea, allied with evaluation of physical performance, is important. It needs to be borne in mind that a large proportion of older adults who report dyspnea do not have any previously installed cardiopulmonary impairment.…”

Section: Introductionmentioning

confidence: 99%

Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study

et al. 2020

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BACKGROUND: Dyspnea and poorer physical performance are conditions that may be related and be present among the elderly. However, few studies have evaluated associations between these variables. OBJECTIVE: To determine whether there is an association between dyspnea and physical performance among community-dwelling older adults of both sexes (age 60 years and over). DESIGN AND SETTING: Cross-sectional study conducted in the city of Macapá, state of Amapá, Brazil. METHODS: Socioeconomic and health data were collected using a structured form. Frailty syndrome was assessed based on the frailty phenotype proposed by Fried et al. Dyspnea was measured using the modified Medical Research Council (mMRC) scale and physical performance was measured using the Short Physical Performance Battery (SPPB). Data were analyzed using a linear regression model. RESULTS: A total of 411 subjects (70.15 ± 7.25 years) were evaluated, most of them females (66.4%). It was observed from the mMRC scale that 30.9% (n = 127) of the subjects had some dyspnea symptoms: grade 1 was most frequent. The physical performance score from the SPPB was 9.22 ± 2.01. Higher dyspnea scores were associated with poor physical performance, both in the crude analysis (β =-0.233; P = 0.028) and after adjustment for frailty condition (β =-0.148; P = 0.002) and for the socioeconomic and health variables (age, sex, number of diseases, smoking habit and frailty status) (β =-0.111; P = 0.025). CONCLUSION: Higher dyspnea score was independently associated with poor physical performance among community-dwelling older adults. Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study | ORIGINAL ARTICLE

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Should we use gait speed in COPD, FEV₁in frailty and dyspnoea in both?

Cited by 20 publications

References 67 publications

Severe Dyspnea Is an Independent Predictor of Readmission or Death in COPD Patients Surviving Acute Hypercapnic Respiratory Failure in the ICU

Severe Dyspnea Is an Independent Predictor of Readmission or Death in COPD Patients Surviving Acute Hypercapnic Respiratory Failure in the ICU

Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease

Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study

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Should we use gait speed in COPD, FEV1in frailty and dyspnoea in both?

Cited by 20 publications

References 67 publications

Severe Dyspnea Is an Independent Predictor of Readmission or Death in COPD Patients Surviving Acute Hypercapnic Respiratory Failure in the ICU

Severe Dyspnea Is an Independent Predictor of Readmission or Death in COPD Patients Surviving Acute Hypercapnic Respiratory Failure in the ICU

Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease

Dyspnea is associated with poor physical performance among community-dwelling older adults: a population-based cross-sectional study

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Should we use gait speed in COPD, FEV₁in frailty and dyspnoea in both?