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Health-related quality of life (HRQL) assessment plays a crucial role in the follow-up care of lung transplanted (LTx) patients. Previous reports have indicated that the HRQL achieved by these patients is often poorer compared to that of healthy individuals. However, the factors contributing to this lower HRQL remain unclear. This prospective study aimed to assess the effectiveness of using both a generic and a disease-specific HRQL instrument in evaluating the outcomes of patients who have undergone LTx. A total of 111 LTx patients were enrolled in the study, with 88 survivors completing the 5-year follow-up and 23 nonsurvivors identified within the first 3 y. Among the participants, 84 underwent double LTx, while 27 received a single LTx. Patients were interviewed before LTx, at 6 mo post-transplantation, and annually thereafter. Two validated instruments were utilized: the Euro quality of life five dimensions, a generic measure, and the St. George's Respiratory Questionnaire (SGRQ), a disease-specific questionnaire. The study showed significant improvements in Euro Quality of Life five Dimensions scores from 6 mo after LTx. Specifically, the percentage of patients without Mobility problems increased from 23% before LTx to 71% at 5 y (P = <0.001), while the ability to self-care improved from 48% to 100% (P = <0.001). The ability to carry out usual activities improved from 13% to 86% (P = <0.001), and the proportion of patients without anxiety and depression increased from 50% to 86% (P > 0.004). However, there was no significant improvement observed in Pain, with only a slight reduction from 57% to 42.8% (P = 0.22). The SGRQ also showed improvements in all dimensions (symptoms, impact, activities) (P < 0.001). However, by the fifth year, the HRQL scores remained below normal reference values. Chronic graft dysfunction was associated with a decline in SGRQ scores. Bilateral LTx patients exhibited better SGRQ scores compared to unilateral LTx patients from the first year post-transplantation. Notably, there were no differences in scores between nonsurvivors and survivors. The study highlights the long-term improvement in HRQL among LTx patients, with greater improvements observed in physical dimensions compared to psychological dimensions. Bilateral LTx was associated with better SGRQ scores than unilateral LTx, and chronic graft dysfunction primarily affected SGRQ scores. These findings underscore the importance of utilizing both generic and specific HRQL instruments in assessing LTx outcomes. [ABSTRACT FROM AUTHOR]

Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death, causes pulmonary and extra-pulmonary symptoms, and also impacts the quality of life. Rigorous evidence on manual and mechanical chest physiotherapy is still scarce. Therefore, this review aims to evaluate the effects of different exercise therapies on obstruction, dyspnea, and quality of life in COPD patients. Materials and Methods: We performed a systematic review of randomized controlled trials published from 2011 to 2020 to evaluate the effects of exercise therapies on obstruction, dyspnea, and quality of life in obstructive patients. Databases such as Medline, BioMed Central, CINHAL, and Cochrane were reviewed. Methodological quality and risk of bias were assessed using the Cochrane tool. Results: Most of the trials supported the effectiveness of mechanical chest physiotherapy in improving obstruction, dyspnea, and quality of life. Conclusion: High-to-moderate evidence shows that mechanical chest physiotherapy is useful in the improvement of obstruction, dyspnea, and quality of life in COPD patients. [ABSTRACT FROM AUTHOR]

Context: Respiratory morbidity among construction workers is one of the most neglected occupational diseases, in spite of the high risk. Aims: The aim of this study is to compare the respiratory symptoms, pulmonary function, and respiratory morbidity-related quality of life between people working in construction sites and the age- and gender-matched controls. Settings and Design: It is an analytical cross-sectional study. Methods and Material: People working in the construction sites (mason/daily laborer) for at least 5 years and control group working in other occupations were included. People other than mason/daily laborer and people with a past history of COPD/bronchial asthma before joining the construction industry were excluded. Statistical Analysis Used: Pulmonary function test was done and St. George respiratory questionnaire was used to the quality of life. Unpaired f-test and Chi-square test/Fisher's exact test were used to compare numeric outcomes and categorical outcomes respectively. Results: We have included 120 construction workers and 120 age- and gender-matched controls. The Forced Vital Capacity (FVC) (mean difference [MD] 0.20, 95% CI 0.025-0.381, P value 0.025), FEV1 (MD 0.21, 95% CI 0.061-0.364, P value 0.006), and FEV1\FVC% predicted (MD 5.01, 95% CI 1.11-8.92, P value 0.012) were significantly lower among the construction workers. The overall SGRQ score was also significantly higher among the construction workers indicating poor overall respiratory morbidity-related quality of life (MD 12.69, 95% CI 10.59-14.80, P value <0.001). Conclusions: Pulmonary function and respiratory function-related quality of life are considerably poor among people working in the construction industry. [ABSTRACT FROM AUTHOR]

Background: Non-communicable respiratory morbidities such as asthma and COPD are rapidly rising to emerge as leading causes of mortality worldwide. Occupational lung diseases form the majority of the work related morbidity in India, mainly in the form of occupational asthma and COPD. Due to paucity of data on respiratory disorders among construction workers in India, this study was conducted to investigate the prevalence of respiratory disorders among construction workers in Gujarat. Methods: 236 construction workers at sites across different regions of Gujarat state were screened using a Gujarati and Hindi versions of St. George Respiratory Questionnaire (SGRQ). Full time workers, having work experience more than 2 years and above the age of 20 years were included. Those with BMI >25 kg/m2 and with history of trauma, pre-existing medical conditions like diabetes, hypertension, stroke or any obvious musculoskeletal deformities like scoliosis, genu valgum and those with history of chest trauma, previous pulmonary surgery or on medications for pulmonary diseases were excluded. Results: The prevalence of respiratory symptoms was found to be high with 60% having attacks of wheezing, 50% workers complaining of cough, 45.1% complaining of phlegm, 40% having shortness of breath. Also, those with 16-20 years of exposure in the construction industry reported a significant impact on their respiratory health as measured by SGRQ. Conclusion: The prevalence of respiratory symptoms was found to be high among the construction workers, hence it becomes imperative to highlight these impairments for appropriate prevention and intervention. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major public health challenge in India with significant economic burden and healthcare utilization and contributes to patients' daily life limitations. Health-related quality of life (HRQoL) reflects the health- and disease-related aspects of QoL. Limited studies have examined this dimension in healthcare settings. We explored the HRQoL among patients with COPD attending a tertiary care facility and the factors (enablers and constraints) influencing it. Materials and Methods: A parallel mixed-method study design was adopted to undertake the study. Data were collected from 110 patients with COPD attending the outpatient department of the tertiary care hospital at Bhubaneswar, Odisha, during June and July 2014. The translated and pretested version of St. George Respiratory Questionnaire (SGRQ) was used. In addition, in-depth interviews were held with 11 patients. Results: The overall HRQoL was significantly lower in females and patients from rural area. It declined with increasing age and was worst in patients age 70 years or above. Patients having two or more comorbid conditions had the poorest HRQoL. Reason for not using inhalers was mentioned to be perceived harm due to prolonged use. Family support and better financial condition were enablers while easy accessibility of healthcare facilities helped in early interventions. Conclusion: COPD has considerable negative impact on the QoL with advancing age and is worse among the geriatric age group population. Acute exacerbations impair HRQoL. The degree of severity of COPD could be determined by SGRQ which reflects the impairment of their HRQoL. [ABSTRACT FROM AUTHOR]

Background & objectives: Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the prevalence of suppressed cortisol responses in stable bronchiectasis and determine their correlation with the use of inhaled corticosteroids, radiologic severity of bronchiectasis and quality of life (QOL) scores. Methods: In this case-control study, cases were patients with bronchiectasis and suppressed cortisol responses and controls were healthy volunteers, and patients with bronchiectasis without suppressed cortisol responses. Symptoms, lung function test values, exercise capacity, HRCT severity scores for bronchiectasis, exacerbations, inhaled corticosteroid use and quality of life scores were compared between patients with and without suppressed cortisol values. Results: Forty consecutive patients with bronchiectasis and 40 matched controls underwent 1-µg cosyntropin testing. Baseline cortisol (mean difference -2.0 µg/dl, P=0.04) and 30-minute stimulated cortisol (mean difference -3.73 µg/dl, P=0.001) were significantly lower in patients with bronchiectasis. One patient had absolute adrenal insufficiency and 39.5 per cent (15/38) patients with bronchiectasis had impaired stimulated responses. Baseline and stimulated cortisol responses were unaffected by inhaled steroids (O.R 1.03, P=0.96). SGRQ scores were negatively correlated with body mass (r= -0.51, P=0.001) and bronchiectasis severity (r=0.37, P=0.019), but not related to baseline or stimulated cortisol responses. Interpretation & conclusions: Our results showed that the impaired adrenal responses to 1-µg cosyntropin were common in patients with bronchiectasis. This was not associated with the use of inhaled steroids or severity of bronchiectasis. Poor health status was associated with advanced disease and not with cortisol responses to the 1-µg cosyntropin test. [ABSTRACT FROM AUTHOR]

Background and purpose: Bronchiectasis causes pulmonary infections and loss of lung function, resulting in chronic respiratory symptoms and worsening health-related quality of life. The aims of this study were to measure symptoms of depression and anxiety in a sample of patients with bronchiectasis and evaluate their relationship to health outcomes and health-related quality of life. Methods: This cross-sectional study included adolescents and adults with bronchiectasis. Patients completed the hospital anxiety and depression scale and the St. George respiratory questionnaire. Health outcome data, including clinical, radiological and spirometric values, were recorded from medical charts. Results: Ninety-three participants with bronchiectasis of any aetiology were recruited: 20 % had elevated depression-related scores and 38 % had elevated anxiety-related scores. Increased symptoms of depression and anxiety were significantly associated with age; anxiety was associated with more frequent exacerbations. Regression analyses indicated that after controlling for demographic (gender and age) and clinical variables (exacerbations frequency, daily sputum, aetiology and spirometry), both depression and anxiety symptoms predicted significantly worse health-related quality of life. In comparison with other predictors, psychological symptoms explained the largest amount of variance in health-related quality of life. Conclusions: Symptoms of depression and anxiety were significant predictors of health-related quality of life in patients with bronchiectasis, independently of respiratory involvement, gender, age or other variables. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aims are to assess respiration-related quality of life using the St. George Respiratory Questionnaire and determine its influencing factors among patients with silicosis in China. Background. The incidence of silicosis had an increasing trend in recent years in developing countries. Although the majority of patients with silicosis are in therapy routinely, the patients' quality of life has been impaired because silicosis cannot be cured. The study on quality of life of patients with silicosis is few, and clinical physicians have difficulty in planning to promote quality of life of patients with silicosis according to the current health situation. Design. A cross-sectional design was used for this study. Methods. A survey was performed on patients with silicosis by face-to-face interview in the Shenyang No. 9 Hospital in China. The St. George Respiratory Questionnaire was used to assess respiration-related quality of life. Results. In all 208 enrolled patients with silicosis, symptoms, activity and impacts scores were 56·02, 56·46 and 52·33, respectively. Lower impacts scores were found comparing with symptoms and activity ones. Patient age was associated with an expected decrease in respiration-related quality of life. Patients with longer duration of exposure had higher total scores of the St. George Respiratory Questionnaire, indicating worse quality of life. Patients with more co-morbidities reported worse quality of life. Conclusion. Patients with silicosis were found relatively moderate respiration-related quality of life. Shortening dust exposure, decreasing the number of co-morbidity and controlling the occurrence of pulmonary tuberculosis could improve respiration-related quality of life. Relevance to clinical practice. As indicated by the results of this study, the number of co-morbidity negatively impact the quality of life of patients with silicosis. Clinical physicians and nurses should pay close attention to the co-morbidity to promote quality of life of patients with silicosis according to the current health situation. [ABSTRACT FROM AUTHOR]

The article presents information on a study which tries to develop an improved version of the St. George respiratory questionnaire (SGRQ-C) for chronic obstructive pulmonary disease (COPD) patients. The responses of 893 COPD patients to the St. George respiratory questionnaire (SGRQ) were recorded and Rasch analysis was performed to remove weaker items. A previously published trial was also used to test the responsiveness.

OBJECTIVES: To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice. DESIGN: Observational study. SETTING: General medicine acute care wards. PARTICIPANTS: Four hundred fifty-nine elderly patients admitted to the hospital because of exacerbated COPD. MEASUREMENTS: Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses. RESULTS: Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27–3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0–2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home. CONCLUSION: The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity. [ABSTRACT FROM AUTHOR]

The article focuses on medical research related to lung volume reduction surgery. Researchers in Sweden conducted a collaborative randomized study comparing lung volume reduction surgery and physical training with physical training alone. Emphysema is a lung disease causing a decrease in elastic retraction of the lung tissue. Even with intense conservative treatment including physical training and other rehabilitative efforts, patients with severe emphysema perceive only small temporary beneficial effects. The objective of lung volume reduction surgery is to improve elastic retraction, and this procedure has achieved clinically significant improvements of lung function, exercise capacity, and the quality of health in selected patients.

The article reports on a study to determine the most important variables influencing health-related quality of with clinically stable bronchiectasis. It is characterized by chronic expectoration, progressive dyspnea that may become incapacitating, pulmonary functional deterioration, and multiple infectious exacerbations. The study comprised all patients with bronchiectasis involving more than one lobe or cystic bronchiectasis not attributable to cystic fibrosis in a medical care unit during the period between 1990 and 2003.

Study objective: To evaluate the efficacy and safety of tobramycin solution for inhalation (TSI) in patients with severe bronchiectasis. Design: Open-label clinical trial consisting of three treatment cycles (14 days of drug therapy, and 14 days off drug) and an additional 40-week follow-up by chart review. Setting: Nine clinical sites throughout the United States. Subjects: Forty-one adult patients (> 18 years old) with diffuse bronchiectasis affecting two or more lung segments and a history of Pseudomonas aeruginosa infection. Interventions: TSI, 300 mg tobramycin per dose bid. Measurements and results: During the 12-week treatment period, significant improvements (reduction of 1.5 U [p = 0.006]) occurred in mean pulmonary total symptom severity score, a composite score that assesses the severity of cough, shortness of breath, sputum production, fatigue, and wheezing. Significant improvements (reduction of 9.8 U [p < 0.001]) were also observed in St. George Respiratory Questionnaire scores, which measure health-related quality of life. Eradication or presumed eradication of P aeruginosa occurred in 6 of 27 evaluable subjects (22.2%). Tobramycin-resistant P aeruginosa developed in two subjects (minimal inhibitory concentration ≥ 16 µg/mL). Ten subjects withdrew from the study due to adverse events; in nine of these subjects, adverse events were considered probably or possibly related to treatment. The most common adverse events were cough, wheezing, and dyspnea. Conclusions: TSI therapy resulted in significant improvements in respiratory symptoms and health-related quality of life in subjects with severe bronchiectasis, but some subjects did not tolerate TSI therapy. Bronchiectasis patients receiving this therapy should be monitored for signs of intolerance. [ABSTRACT FROM AUTHOR]

Study objective: To investigate the efficacy and safety of a fully human monoclonal antibody recognizing the chemokine interleukin (IL)-8 in patients with COPD. Design: Randomized, double-blind, parallel-group, placebo-controlled trial. Setting: Eighteen clinics/hospitals in the United States. Patients: One hundred nine patients with stable COPD. Interventions: Three IV infusions of either monoclonal antibody recognizing IL-8 (800-mg loading dose; 400-mg subsequent doses) or active buffer solution administered monthly over a 3-month period. Measurements and results: The differences in the transition dyspnea index (TDI) total score, the primary outcome measure, between fully human monoclonal IgG2 antibody directed against IL-8 and placebo were 0.8, 1.0, 0.8, and 0.3 at week 2 (p = 0.046) and months 1 to 3, respectively. At all time points, the proportion of patients achieving ≥ 1 point improvement in the TDI was greater for the monoclonal antibody group compared with the placebo group: 28% vs 11% at week 2 (p = 0.028). There were no significant differences observed for lung function, health status, 6-min walking distance, and adverse events between groups. Conclusions: The results of this phase 2 study suggest that neutralization of IL-8 with monoclonal antibody therapy may improve dyspnea in patients with COPD. These results support the further investigation of monoclonal antibody therapy targeting IL-8 for the treatment of this disease. [ABSTRACT FROM AUTHOR]