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Background: The Chronic Respiratory Questionnaire (CRQ) is an established measure of health status for chronic obstructive pulmonary disease (COPD). It has been found to be reproducible and sensitive to change, but as an interviewer led questionnaire is very time consuming to administer. A study was undertaken to develop a self-reported version of the CRQ (CRQ-SR) and to compare the results of this questionnaire with the conventional interviewer led CRQ (CRQ-IL).Methods: Fifty two patients with moderate to severe COPD participated in the study. Subjects completed the CRQ-SR 1 week after completing the CRQ-IL, and a further CRQ-SR was administered 1 week later. For patients in group A (n=27) the dyspnoea provoking activities that they had previously selected were transcribed onto the second CRQ-SR, while patients in group B (n=25) were not informed of their previous dyspnoea provoking activities when they completed the second CRQ-SR. To assess the short term reproducibility and reliability of the CRQ-SR it was then administered twice at an interval of 7-10 days to a further group of 21 patients. The CRQ-IL was not administered. Longer term reproducibility was examined in 39 stable patients who completed the CRQ-SR at initial assessment and then again 7 weeks later.Results: Mean scores per dimension, mean differences, and limits of agreement are given for each dimension in the comparison of the two questionnaires. There were no statistically significant differences between the CRQ-IL and CRQ-SR in the mastery and fatigue dimensions (p>0.05). A statistically significant difference between the two scores was found in the dyspnoea dimension (p=0.006) and the emotional function dimension (p=0.04), but these differences were well within the minimum clinically important threshold. No statistically significant difference in the mean dyspnoea score was seen between groups A and B. The CRQ-SR was found to be reproducible both in the short term and after the longer period of 7 weeks, with no statistically or clinically significant differences in any dimension. Test-retest reliability was found to be high in each dimension, both in the short and longer term.Conclusions: The CRQ-SR is a reproducible, reliable, and stable measure of health status. It compares well with the CRQ-IL but cannot be used interchangeably. The main advantage of the CRQ-SR over the CRQ-IL is that is quick to administer, reducing assessment time and hence cost. [ABSTRACT FROM AUTHOR]

Background: Pulmonary rehabilitation programmes have been shown to improve both exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). The optimal duration for a pulmonary rehabilitation programme is, however, unknown. To assess whether the current pulmonary rehabilitation programme could be shortened a randomised controlled trial was conducted in 44 patients with COPD who were allocated to either a seven week or a four week course.Methods: Patients were randomised to either our standard seven week twice weekly outpatient based programme or a comparable but shortened four week course. They were assessed at baseline and at completion by the Chronic Respiratory Questionnaire (CRQ), the Breathing Problems Questionnaire (BPQ), the incremental shuttle walking test (SWT), and the treadmill endurance test (TET).Results: Twenty one patients (61% men) of mean (SD) age 68 (9.2) years and forced expiratory volume in one second ( FEV(1)) 1.08 (0.4) l completed a conventional seven week course and 23 (67% men) of mean (SD) age 69 (8.8) years and FEV(1) 1.03 (0.3) l completed a shortened four week course. Patients who completed the seven week rehabilitation programme had greater improvements in all outcome measures than those undertaking the four week course. These differences reached clinical and statistical significance for the total CRQ score, which was the primary outcome variable (mean difference (95% confidence intervals (CI) of difference) -0.61(-0.15 to -1.08), p<0.05), and the CRQ domains of dyspnoea (-0.80 (95% CI -0.13 to -1.48), p<0.05), emotion (-0.89 (95% CI -0.33 to -1.45), p<0.005), and mastery (-0.84 (95% CI -0.10 to -1.58), p<0.05). There were also trends towards greater improvements in exercise assessments in the seven week group but the differences did not reach statistical significance (SWT: mean difference -16.9 (95% CI 24.8 to -58.6), p=0.41; TET: geometric mean difference -1.21 (95% CI -0.60 to -2.47), p=0.56).Conclusions: A seven week course of pulmonary rehabilitation provides greater benefits to patients than a four week course in terms of improvements in health status. Larger prospective studies are required to determine the optimal duration of a pulmonary rehabilitation programme. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of dyfunctional breathing in adults with asthma treated in the community Design: Postal questionnaire survey using Nijmegen questionnaire. Setting: One general practice with 7033 patients. Participants: All adult patients aged 17-65 with diagnosed asthma who were receiving treatment. Main outcome measure : Score ≥ 23 on Nijmegen questionnaire. Results: 227/307 patients returned completed questionnaires; 219 (71.3) questionnaires were suitable for analysis. 63 participants scored ≥ 23. Those scoring ≥ 23 were more likely to be female than male (46/132 (35%) v 17/87(20%), p = 0.016) and were younger (mean (SD) age 44.8(14.7) v 49.0 (13.8), p = 0.05). Patients at different treatment steps of the British Thoracic Society asthma guidelines were affected equally. Conclusions: About a third of women and a fifth of men had scores suggestive of dyfunctional breathing. Although further studies are needed to confirm the validity of this screening tool and these findings, these prevalences suggest scope for therapeutic intervention and may explain the anecdotal success of the Buteyko method of treating asthma. [ABSTRACT FROM AUTHOR]

A hospital admission or readmission for an exacerbation of chronic obstructive pulmonary disease (COPD) is bad news for everyone. In British hospitals emergency inpatient admission is the largest component of the total cost of respiratory disease to the NHS that amounts to over £2.5 billion. In recent years attention has focused on reducing the cost and impact of hospital admissions for COPD. The emphasis of the strategy to date has been on admission avoidance and early supported discharge schemes. These have had some success in curtailing admissions and reducing lengths of hospital stay, and are beginning to be introduced more widely into clinical practice.