A simple and rapid test of physical performance in chronic obstructive pulmonary disease

Ali Mufraih Albarrati,1 Nichola S Gale,1 Stephanie Enright,1 Margaret M Munnery,2 John R Cockcroft,2 Dennis J Shale2 1Physiotherapy Department, School of Healthcare Sciences, University Hospital of Wales, Cardiff University, Cardiff, UK; 2Cardiorespiratory Medicine Department, Cardio-Respiratory Medicine, Wales Heart Research Institute, Cardiff University, University Hospital of Wales, Cardiff, UK Abstract: Impaired physical performance is common in chronic obstructive pulmonary disease (COPD), but its assessment can be difficult in routine clinical practice. We compared the timed up and go (TUG) test and other easily applied assessments of physical performance with the 6-minute walk distance (6MWD). In a longitudinal study of comorbidities in COPD, submaximal physical performance was determined in 520 patients and 150 controls using the TUG test and 6MWD. Spirometry, body composition, handgrip strength, the COPD assessment test, St George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council dyspnoea scale were also determined. Patients and controls were similar in age, body mass index, and sex proportions. The TUG in the patients was greater than that in the control group, P=0.001, and was inversely related to 6MWD (r=–0.71, P<0.001) and forced expiratory volume in one second predicted (r=–0.19, P<0.01) and was directly related to the SGRQ activity (r=0.39, P<0.001), SGRQ total (r=0.37, P<0.001), and total COPD assessment test scores (r=0.37, P<0.001). The TUG identified the difference in physical performance between patients and controls. The TUG test and validated questionnaires provide a measure of physical performance, which is rapid and could be used in clinical practice. Keywords: COPD, physical inactivity, timed up and go tes

P75 Physical impairment and Frailty in Patients with Chronic Obstruction Pulmonary Disease (COPD): Abstract 75 Table 1

Background COPD is a multi-system disease, which has been linked to premature physiological ageing. Recognised co-morbidities include increased risk of cardiovascular events and osteoporosis, loss of muscle mass, function and impaired quality of life (QoL). The Chronic Geriatric Assessment (CGA) has been used to measure impairments, frailty and predict outcomes in older individuals. We hypothesised that the CGA would be greater in COPD than comparator subjects, and would relate to physical function and QoL in patients with COPD. Methods As part of the Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE)* longitudinal study, 300 patients with COPD (149 male) and 50 (28 male) comparators free from respiratory disease were evaluated. In all subjects spirometry, BMI, handgrip, 6 minute walk distance (6MWD), timed up and go (TUG), and the CGA were determined. The CGA is a 20 item interviewer administered questionnaire, which quantifies, physical, functional, psychosocial and medical impairments, scored out of 61, higher scores indicate more impairment. Health-related QoL was measured in patients using the St George’s Respiratory Questionnaire (SGRQ) and MRC breathless was recorded. Results Patients and comparators were similar in age, gender and BMI, but differed in lung function, grip strength, 6MWD, TUG and all domains of the CGA (Table 1). There was no difference in gender for BMI and CGA score. In patients, the total CGA score related to FEV1% r= –0.187, handgrip r= –0.335, 6MWD r= –0.548, TUG r=0.506, MRC breathlessness r=0.351 and number of exacerbations per year r=0.313 (all p<0.05) but did not relate to age. Of these, stepwise multiple regression showed that 6MWD, TUG, handgrip and number of exacerbations per year predicted the total CGA score. All of the CGA impairment categories related to all domains of the SGRQ (p<0.001)

Cardiovascular and inflammatory effects of simvastatin therapy in patients with COPD: a&nbsp;randomized controlled trial

Michelle E John,1 John R Cockcroft,2 Tricia M McKeever,3 William R Coward,1 Dennis J Shale,2 Simon R Johnson,1 Jim G Thornton,4 Timothy W Harrison,1 Alan J Knox,1 Charlotte E Bolton1 1Nottingham Respiratory Research Unit, School of Medicine, University of&nbsp;Nottingham, Nottingham, UK; 2Wales Heart Research Institute, Cardiff University, Cardiff, UK; 3Division of Epidemiology and Public Health, 4Clinical Trials Unit and Department of Obstetrics and Gynaecology, School of Medicine, University of&nbsp;Nottingham, Nottingham, UK Background: There is excess cardiovascular mortality in patients with chronic obstructive pulmonary disease. Aortic stiffness, an independent predictor of cardiovascular risk, and systemic and airway inflammation are increased in patients with the disease. Statins modulate aortic stiffness and have anti-inflammatory properties. A proof-of-principle, double-blind, randomized trial determined if 6 weeks of simvastatin 20 mg once daily reduced aortic stiffness and systemic and airway inflammation in patients with chronic obstructive pulmonary disease.Methods: Stable patients (n=70) were randomized to simvastatin (active) or placebo. Pre-treatment and post-treatment aortic stiffness, blood pressure, spirometry, and circulating and airway inflammatory mediators and lipids were measured. A predefined subgroup analysis was performed where baseline aortic pulse wave velocity (PWV) was &gt;10 m/sec.Results: Total cholesterol dropped in the active group. There was no significant change in aortic PWV between the active group and the placebo group (-0.7 m/sec, P=0.24). In those with aortic stiffness &gt;10 m/sec (n=22), aortic PWV improved in the active group compared with the placebo group (-2.8 m/sec, P=0.03). Neither systemic nor airway inflammatory markers changed. Conclusion: There was a nonsignificant improvement in aortic PWV in those taking simvastatin 20 mg compared with placebo, but in those with higher baseline aortic stiffness (a higher risk group) a significant and clinically relevant reduction in PWV was shown. Keywords: chronic obstructive pulmonary disease, arterial stiffness, statin