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Six-Minute Step Test to Predict COPD Exacerbations
Chronic Obstructive Pulmonary Disease (COPD) poses significant challenges to patients' daily lives, impacting their ability to perform routine activities due to respiratory impairments and systemic effects. Exercise intolerance is a hallmark of COPD, leading to reduced functional capacity and diminished quality of life.
While exercise assessment is crucial in managing COPD, traditional tests like the cardiopulmonary exercise test are resource intensive. Herein lies the importance of easier, more accessible alternatives like the six-minute walk test (6MWT) and the six-minute step test (6MST), offering valuable insights into patients' exercise capacity.
Key Findings
A recent prospective cohort study investigated the predictive power of the 6MST in anticipating COPD exacerbations over a 36-month period. The study, conducted in Brazil, enrolled 64 patients with COPD who underwent comprehensive evaluations, including clinical assessments, pulmonary function tests, and the 6MST. The test involved ascending and descending a 20 cm high step for six minutes, measuring vital signs and perceived exertion throughout. Remarkably, the study identified that achieving 59 steps or less during the 6MST strongly predicted COPD exacerbations.
The study's findings underscore the potential of the 6MST as a prognostic tool for COPD exacerbations, complementing established tests like the 6MWT. Patients achieving 59 or fewer steps exhibited poorer functional capacity, reflecting worse lung function, dyspnea severity, and COPD severity. Notably, factors such as body mass, sex, and body fat mass influenced test performance and exacerbation prediction. These insights highlight the multifaceted nature of COPD exacerbations and the importance of personalized assessment strategies.
The simplicity and cost-effectiveness of the 6MST make it a valuable asset in COPD management, particularly in primary care settings. By identifying patients at higher risk of exacerbations, clinicians can tailor interventions to mitigate exacerbation risk and enhance patient outcomes.
Moreover, the 6MST's ability to capture nuanced changes in functional capacity over time underscores its utility as a longitudinal monitoring tool in COPD management.
A Promising Tool
The six-minute step test emerges as a promising tool in predicting COPD exacerbations, offering clinicians a simple yet effective means of assessing patients' functional capacity and exacerbation risk. Its integration into routine clinical practice has the potential to enhance COPD management strategies, ultimately improving patient outcomes and quality of life.
As we delve deeper into COPD management, embracing innovative assessment tools like the 6MST is paramount in delivering personalized and effective care to patients with this chronic condition.
Read the full study in Scientific Reports.
COPD Home Management Program Reduces Hospital Admissions
A home-based management program for chronic obstructive pulmonary disease (COPD) has the potential to significantly reduce hospitalizations and improve the quality of life for patients, researchers say. They evaluated a multifaceted, ongoing home-based COPD management program on 9,091 patients from June 2019 to May 2021, with the hospital admission rate as the primary outcome.
All study participants had COPD with a history of hospitalizations – for respiratory failure – and were on noninvasive ventilatory therapy. The home-based management program used COPD software administered by a respiratory therapist via in-home or telemedicine visits. In addition, patients received monthly visits and follow-up calls following their risk profile and care plan.
The patients received more than 278,000 assessments, yielding more than 10 million data points.
During the study period, patient self-reported hospital admissions were measured at 12 months and compared with admission history for the prior 12 months. Researchers found that patients in the program experienced 60% fewer admissions over the previous history.
Researchers concluded that this type of home-based, software-driven COPD management program led by respiratory therapists who can significantly affect COPD admissions and quality of care.
“This demonstrates the opportunity for greater collaboration between physicians, discharge programs, and home medical equipment providers to improve COPD management significantly,” researchers noted.
Additional insight from Dr. Nair: People on non-invasive ventilation at home are often in the further stages of COPD, so they are pretty sick at baseline. It is good to know the more intensive outpatient support is beneficial to them. Maintaining ongoing care and coordination of these services can be very difficult though, as it is very labor intensive.
To read the full report, visit Pulmonology Advisor.
The Relationship Between Asthma and COVID-19
Adults with asthma are more at risk at developing severe illness if they contract COVID-19, according to a study conducted by researchers at Harvard T.H. Chan School of Public Health and Massachusetts General Hospital. The first to specifically examine the link between asthma and coronavirus, the study revealed another crucial finding: the risk was largely driven by non-allergic asthma rather than allergy-induced asthma.
The research team analyzed nearly 500,000 participants in the UK Biobank and found that 65,677 patients had asthma and 641 had severe COVID-19. After adjusting for factors such as age, sex and body mass index, researchers found having non-allergic asthma increased the risk of severe COVID-19 by as much as 48%. That number jumped to 82% for patients with asthma and chronic obstructive pulmonary disease (COPD). However, patients with allergic asthma had no significant relationship to COVID-19.
“Despite reasonable speculation that asthma could be a risk factor for severe COVID-19, rigorous, population-based research is needed to know whether asthma and its major subtypes actually increase risk,” said Liming Liang, corresponding author of the study and associate professor of statistical genetics at Harvard Chan School. “Based on these new findings, clinicians can improve risk-stratification and target COVID-19 prevention in patients with asthma, particularly those with non-allergic asthma.”
Aside from proving a link between COVID-19 and asthma, it could also give a measure of reassurance to the millions of people around the world who have allergies that they are not at an increased risk of contracting severe COVID-19.
Click here for the whole story.
Living Well With COPD: Challenges and Options
Affecting more than 15 million individuals in the United States, chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability among adults ages 65-74. According to the National Institutes of Health, “an estimated 80 to 90 percent of COPD cases are diagnosed in individuals with a long-term history of smoking. Nonsmokers can also develop COPD from causes such as long-term exposure to substances that irritate and damage the lungs (like air pollution).”
Of those 15 million individuals affected, there are as many as 12 million thought to be affected as well that can’t recognize the signs and symptoms associated, delaying treatment and prevention of the disease. So, what can be done to help identify symptoms in order to prevent and treat the onset of COPD?
As COPD progresses symptoms worsen and for many who wait to get treatment, the disease will have already caused permanent lung damage, but for those who identify symptoms early on have a higher chance of maintaining a healthy lifestyle.
Doctors recommend checking yourself for these common symptoms of COPD:
- Frequent cough or cough that produces a lot of mucus, especially upon waking in the morning
- Shortness of breath, especially during physical activity
- Wheezing
- Chest tightness
- Inability to take a deep breath
- Frequent respiratory infections
- Fatigue and lack of energy
- Blueness of the lips or fingernail beds
If you are experiencing some or all of these symptoms, see a doctor for formal diagnosis. A doctor will examine your medical history and the results of any tests ordered, such as lung function tests, blood tests and chest X-rays or CT scans. Upon diagnosis, your doctor will determine the best treatment options for you based on your symptoms, medical history and the severity of the disease. Since every case of COPD is different, it is imperative to receive customized treatment options.
While there is no cure for COPD, “several treatment options are available to relieve the associated symptoms. These include medications, oxygen therapy, pulmonary rehabilitation, lifestyle modifications and surgery. If you smoke, quitting is a critical step in treating COPD. The goals of treatment are geared toward relieving symptoms, slowing disease progression and improving overall quality of life.”
Click Here to Access the Full Story on U.S. News and World Report
For COPD Patients, Early Diagnosis Is Key
According to a recent article published in the International Journal of Chronic Obstructive Pulmonary Disease, “New Developments in the Assessment of COPD: Early Diagnosis Is Key,” the majority of patients with chronic obstructive pulmonary disease (COPD) are not aware of their condition and, as a result, do not receive the treatment they need to aggressively target the disease in its early stages.
The article, which reviewed a short list of recent findings on the treatment and diagnosis of COPD, found that roughly half of all patients who have COPD are undiagnosed and, as a result, are unaware of their condition. This in turn results in significant delays in treatment, including aggressive smoking-cessation intervention, which is likely to jeopardize future health.
“Traditional opinion has described COPD as a progressive disease that responds poorly to treatment, with the lone intervention capable of altering the course of disease progression being smoking cessation,” wrote study authors Nicholas G. Csikesz and Eric J. Gartman. “However, recent studies have called these axioms into question. The period of most rapid decline in lung function may occur much earlier than previously thought, and it is during this period that aggressive testing strategies, smoking-cessation efforts and the initiation of treatments may be beneficial.”
As a result, novel methods of diagnostic testing, community health programs and primary-care provider recommendations hold promise to expand the recognition of COPD in its incipient stages.
“Diagnosing patients early on in their course may offer the best chance at mitigating the substantial morbidity and mortality associated with COPD,” wrote Csikesz and Gartman. “Early diagnosis is feasible and cost-effective in the primary-care setting, and efforts to expand diagnostic and therapeutic opportunities should be universally supported.”
Children with Severe Asthma at Greater Risk of Developing COPD
Children with severe asthma may be at greater risk for developing chronic obstructive pulmonary disease (COPD) during adulthood. That is according to a recent study published in the March 2014 online issue of Thorax, “The Association Between Childhood Asthma and Adult Chronic Obstructive Pulmonary Disease.”
The study, which examined children with asthma aged 6 to 7 years from a 1957 birth cohort, collected data via respiratory questionnaires and lung function spirometry with post-bronchodilator response every seven years until the children reached 50 years of age. At age 50, subjects were then classified into the following subgroups: non-asthmatics, asthma remission, current asthma and COPD. Of the participants, 21 died before the study was completed, while 197 completed both the questionnaire and lung function tests.
Researchers found that the risk of developing COPD for children with severe asthma was 32 times higher than that of children without symptoms of wheeze at age 7. However, there was no difference in the rate of declining lung function per year between those in the COPD group and the other groups, including non-asthmatics. In addition, researchers note that 43% of patients in the COPD group were nonsmokers.
“It is increasingly apparent that [COPD] often has its roots decades before the onset of symptoms,” wrote the study authors. “Impaired growth of lung function during childhood and adolescence, caused by premature gestation, asthma, recurrent infections or tobacco smoking, may lead to lower maximally attained lung function in early adulthood and also predispose to development of COPD.”
New Research May Improve Emphysema Treatment
Researchers may have discovered a way to investigate the complex pathological features of emphysema, thus improving research surrounding the cause of the disease and subsequently treatment options for both emphysema and chronic obstructive pulmonary disease (COPD). That is according to a recent study published in the April 26, 2012, online version of The Journal of Allergy and Clinical Immunology, “A New Short-Term Mouse Model of Chronic Obstructive Pulmonary Disease Identifies a Role for Mast Cell Tryptase in Pathogenesis.”
University of Michigan Begins New Research for Emphysema & Other COPD
The University of Michigan Health System will start two new multi-center research studies that seek to improve diagnosis and treatment for millions of people affected by emphysema, chronic bronchitis and other lung diseases. Researchers seek to answer two major questions related to chronic obstructive pulmonary disease (COPD):
- Why do some smokers develop lung disease and others don't?
- How effective is supplemental oxygen therapy in treating patients with emphysema?
The first study, COPDGeneTM, hopes to uncover why only 25 percent of smokers develop the disease. UM will enroll hundreds of current and former smokers with and without COPD between 45 and 80 years old to discover the inherited factors that put some people at a higher risk of developing the disease. The study will enroll more than 12,000 people across 21 leading medical centers in the United States.
Funded by the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health and National Jewish Health, the study will include people with mild to severe COPD and people without the disease to serve as comparisons.
The University of Michigan will also be studying patients 40 years of age or older for the Long-term Oxygen Treatment Trial (LOTT), which will take a look at the effects of 24-hour supplemental oxygen therapy on patients with COPD. This study will also be funded by the NHLBI, as well as the Centers for Medicare and Medicaid Services.
“To be selected to participate in two groundbreaking COPD clinical trials demonstrates the depth and breadth of UM’s significant achievements in diagnosing, treating and preventing COPD,” says Fernando J. Martinez, M.D., M.S., director of Pulmonary Diagnostic Services, professor of internal medicine and principal investigator for both clinical trials. "Furthermore, within the next several months new studies for improved diagnosis and therapy of COPD patients will be starting. Unlocking the keys to the genetic disposition of COPD and the efficacy of oxygen therapy can go far in making life better for the millions affected by COPD.” Click here to access the full story on Medical News Today
Rheumatoid Arthritis May Increase Risk of COPD
People with rheumatoid arthritis (RA) may be twice as likely as healthy people to develop chronic obstructive pulmonary disease (COPD), according to a recent study presented at the European League Against Rheumatism annual conference in London.
The study, which was conducted by researchers out of Israel, used data from the nation’s largest healthcare provider to compare and contrast information on nearly 16,000 RA patients above the age of 20. Researchers compared these patients’ information with more than 15,000 healthy control patients who were matched based on age and gender.
Findings of the study indicate that the link between RA and COPD was evident even when factors such as smoking, age, obesity and gender were controlled. Further, the incidence of COPD in RA patients was 8.9 percent compared with 4.4 percent for the controls. Lifestyle habits and disease risks, including income levels, were also included in the research.
“We know that similar changes in core physiological processes cause symptoms in RA and COPD, and we hope that the results of our study prompts new research into potential links between altered genetic and autoimmune processes in the two conditions,” said researcher Dr. Howard Amital of the Sheba Medical Centre, Israel, in a meeting news release.
An autoimmune disease, RA is different from osteoarthritis, the form of arthritis that typically develops with older age. RA causes pain, swelling and stiffness in joints but can also affect other body parts, such as the mouth and lungs. The severe form of RA can last a lifetime.
While the findings of this study are strong, research presented at meetings is considered preliminary until it is published in a peer-reviewed journal.
Risk of COPD Exceeds That of Heart Failure and Cancer
Twenty-seven percent of individuals aged 35 and older are likely to develop chronic obstructive pulmonary disease (COPD) at some point in their lives, meaning that the risk of developing the disease now exceeds that of developing congestive heart failure, acute heart attack and several common cancers. That is according to a recent study published in a special European Respiratory Society issue of The Lancet.
To reach these findings, researchers examined health administrative data from Ontario, Canada, with a total population of roughly 13 million people. All individuals free of COPD in 1996 were monitored for 14 years for three possible outcomes: diagnosis of COPD, reached 80 years of age or death. Results were grouped by sex, socioeconomic status and whether individuals lived in a rural or urban setting.
Researchers found that the overall projected lifetime risk of being diagnosed with COPD by a physician is 27.6%, meaning one in four adults will be diagnosed with the disease at some point in their lives. Researchers also found that risk of diagnosis was increased by lower socioeconomic status and living in a rural area. Further, the lifetime risk of developing COPD is triple that of having a heart attack and developing breast cancer in women and prostate cancer in men and is comparable to that of developing asthma.
Researchers believe that by 2030, COPD will be the third-most common cause of death worldwide, a leading cause of hospitalizations and one of the most expensive chronic diseases. They note that “clinical evidence-based approaches, public health action and more research are needed to identify effective strategies to prevent COPD and ensure that those with the disease have the highest quality of life possible.”
