Week 8 - Respiratory disease

Question 1

Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population-based cohort study

Answer 1

A level of physical activity equivalent to walking or cycling 2 hours/week or more was associated with a 30–40% reduction in the risk of both hospital admission due to COPD and respiratory mortality.
Related mechanisms: - Physical activity improves peripheral muscle function
- At the cellular level, exercise training improves the bioenergetics of skeletal muscle in COPD patients which, through a reduction in lactate production during exercise, could reduce symptoms.
- Important anti-inflammatory and anti-oxidant effects have been reported both in healthy subjects exposed to moderate levels of exercise and in COPD patients participating in rehabilitation programs.

Question 2

Pulmonary rehabilitation

Answer 2

• Pulmonary rehabilitation programmes include exercise as a key component; some programmes contain other interventions such as assessment, education, psychological support and dietary advice. Pulmonary rehabilitation is one of the key recommended approaches in the treatment of COPD
  Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition.
  Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity.

Question 3

The GOLD system

Answer 3

Airflow Limitation - GOLD Stages
The GOLD system classifies airflow limitation (based on post-bronchodilator FEV1/FVC ratio):

GOLD 1 (Mild): FEV1 ≥ 80% predicted
GOLD 2 (Moderate): FEV1 50–79% predicted
GOLD 3 (Severe): FEV1 30–49% predicted
GOLD 4 (Very Severe): FEV1 < 30% predicted

Question 4

BODE Score - COPD Severity Assessment

Answer 4

The BODE score combines four factors to measure disease severity in COPD:

Body Mass Index (BMI):
21 = 0 points, ≤ 21 = 1 point

FEV₁ % Predicted:
≥ 65 = 0 points, 50–64 = 1 point, 36–49 = 2 points, ≤ 35 = 3 points
mMRC Dyspnea Scale:
0–1 = 0 points, 2 = 1 point, 3 = 2 points, 4 = 3 points
6-Minute Walk Distance (meters):
≥ 350 = 0 points, 250–349 = 1 point, 150–249 = 2 points, ≤ 149 = 3 points
Note: Higher scores (≥ 5) suggest severe COPD and need for specialty referral.

Question 5

The 6-minute walk distance (6MWD)

Answer 5

The 6-minute walk distance (6MWD) test is a key tool for assessing the functional capacity of patients with chronic obstructive pulmonary disease (COPD). The 6MWD is a reliable, inexpensive, and easy-to-use test that provides a comprehensive overview of the effects of COPD on a patient.

Question 6

The Medical Research Council (MRC) dyspnea scale

Answer 6

a questionnaire that helps measure the level of breathlessness a person experiences during daily activities. It’s a self-assessment tool that uses a scale of 0 to 4 to rate the severity of breathlessness:
* Grade 0
No breathlessness except during strenuous exercise
* Grade 1
Shortness of breath when walking up a slight hill or hurrying on level ground
* Grade 2
Walks slower than people of the same age on level ground or stops to catch breath while walking at their own pace
* Grade 3
Stops for breath after walking about 100 yards or after a few minutes on level ground
* Grade 4
Too breathless to leave the house or breathless when dressing or undressing

The MRC dyspnea scale is considered a valid and reliable tool for measuring dyspnea and predicting severity. It can also provide an idea of a patient’s functional status

Question 7

Physical activity in patients with COPD (Watz et al 2009)

Answer 7

• The main findings of the present study are that significant limitations of physical activity are present in patients with COPD from GOLD stage II/BODE score 1.
  steps per day and physical activity level were significantly reduced from GOLD stage II/BODE score 1 and from GOLD stage III/BODE score 1, respectively.
• This indicates that limitations of physical activity are visible first in patients with GOLD stage II/BODE score 1
• The present authors speculate that one possible explanation of this discrepancy might be the increased metabolic and ventilatory demands for activities of daily living in patients with COPD compared to healthy subjects.
• Overall, moderate relationships were found between the clinical characteristics of COPD patients and their physical activity.
• In the current study, GOLD stages III and IV were shown to be the best predictors of very inactive patients.