The Minimal Important Difference for St

Slides:



Advertisements
Similar presentations
Pulmonary Function Testing
Advertisements

GOLD Clasification Antonio Anzueto MD Professor Medicine University of Texas.
RESPIRATION Dr. Zainab H.H Dept. of Physiology Lec.5,6.
COPD MANAGEMENT FALLS SHORT AT RCRMC Jean Solomon, M.D.
Lung function decline and physical activity
Pulmonary Rehabilitation In COPD
The short-term, between-session reproducibility of Sniff nasal pressure (SnPnas) in COPD patients; Implications for baseline measurements prior to rehabilitation.
Lung-2015 Baltimore, USA July , 2015 Suhaj A.
Lung Volume Reduction Surgery and Quality of Life Amy Burker ALHE 4060/ Masini April 22, 2007.
OFEV ® (nintedanib) TOMORROW trial results Last updated These slides are provided by Boehringer Ingelheim for medical to medical education only.
Dr. Taj. What is Spirometry ? It is a measurement of the breathing capacity of the lungs. It is the most basic and frequently performed test of pulmonary.
Proposals by Paramedical Staff to Initiate Rehabilitation in Patients with Critical Illness on Mechanical Ventilation Acknowledgements This study was approved.
Survey of Respiratory Diagnostic Laboratories to Inform the National COPD Strategy T McCarthy,* A McGowan, ¥ M O’Connor,* on behalf of the National COPD.
Development of disability in chronic obstructive pulmonary disease : beyond lung function MarkDEisner, CarlosIribarren, PaulDBlanc, EdwardHYelin, LynnAckerson,
Efficacy of standard rehabilitation in COPD outpatients with comorbidities 호흡기 내과 R1 박 지 윤 E. Crisafulli, P. Gorgone, B. Vagaggini, M. Pagani, G. Rossi,
Measurement of Lung Function
Sarah Wilke, Paul W Jones, H Müllerova, Jørgen Vestbo, Ruth Tal-Singer, Frits ME Franssen, Alvar Agusti, Per Bakke, Peter M Calverley, Harvey O Coxson,
A development study of pulmonary rehabilitation for patients with chronic lung disease in Uganda. Jones, R. Kirenga, B. Pooler, J. Katagira, W. Kasiita,
GOLD 2017 major revision: Summary of key changes
The Impact of Personality Traits on Health Status of Patients with Chronic Obstructive Pulmonary Disease in Primary and Secondary Care in the Netherlands.
External multicentric validation of a COPD detection questionnaire.
Why anxiety associates with non-completion of pulmonary rehabilitation program in patients with COPD? Dr Abebaw Mengistu Yohannes Associate Professor.
Effect of nasal positive expiratory pressure (PEP) on 6-min walk test (6MWT) distance and pre- to post-exercise increase in lung volumes in each individual.
Department of Respiratory Medicine
Research where it is most needed National Respiratory Strategy
S Lungaro-Mifsud, S Montefort
Lung function in health and disease
COPD Report 5 Coles Lane, Oakington, Cambridge, CB24 3BA.
Presenter: Corina de Jong PhD Department of General Practice,
Reduced Quality of Life
Impact of Smoking on Adults Lung Age and Ventilatory Function
Copyright © 2015 by the American Osteopathic Association.
Blood eosinophil count and exacerbation risk in patients with COPD
Kyrgyz State Medical Academy
Health Status in Chronic Obstructive Pulmonary Disease: Measuring the Minimal Clinically Important Difference over Different Periods of Time H.J. Alma,
Improving the Management of COPD in Women
Volume 140, Issue 2, Pages (August 2011)
The Role of Fixed-Dose Dual Bronchodilator Therapy in Treating COPD
Summary findings regarding the efficacy/safety profile across xanthines in chronic obstructive pulmonary disease patients. a) Combined plot of the change.
Relationship between the change in a) ventilatory and b) cerebrovascular responses in older healthy subjects (Older) and chronic obstructive pulmonary.
Chronic Obstructive Pulmonary Disease: An Evidence-Based Approach to Treatment With a Focus on Anticholinergic Bronchodilation  Nicholas J. Gross, MD,
Improving the Management of COPD in Women
Distribution of lower extremity artery disease (LEAD) Fontaine stages over the combined chronic obstructive pulmonary disease (COPD) Global Initiative.
Alexander Ivanov, MD, James Yossef, MD, Jordan Tailon, MD, Berhane M
Dr Amy Stebbings The Chest and Internal Medicine Clinic, Singapore
Schematic representation of breathing levels during positive expiratory pressure in an obstructed patient. Schematic representation of breathing levels.
Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery    The Journal of Thoracic and Cardiovascular.
Level of physical activity by Global Initiative for Obstructive Lung Disease (GOLD) stage, BODE (body mass index, FEV1 for airflow obstruction, dyspnoea,
Occurrence of morning symptoms
Least squares (LS) mean change from baseline (95% CI) in St George's Respiratory Questionnaire (SGRQ) Total score according to chronic obstructive pulmonary.
Representative diaphragm electromyogram (EMG) tracings at rest (a and b) and during maximum voluntary ventilation (c and d) in a healthy subject (a and.
Physical and Psychosocial Factors Associated With Physical Activity in Patients With Chronic Obstructive Pulmonary Disease  Jorine E. Hartman, PhD, H.
Spirometry A. H. Mehrparvar, MD Occupational Medicine department
Roflumilast: il programma di sviluppo clinico
Pressure (P)–volume (V) relationships of the total respiratory system a) in normal and b) in chronic obstructive pulmonary disease (COPD). Pressure (P)–volume.
E. Rand Sutherland, MD, MPH  Journal of Allergy and Clinical Immunology 
Scatter plot of body mass index (BMI) versus forced expiratory volume in the first second (FEV1), and linear correlation lines for normal spirometry and.
Sequential Bilateral Bronchoscopic Lung Volume Reduction With One-Way Valves for Heterogeneous Emphysema  Alfonso Fiorelli, MD, PhD, Antonio D’Andrilli,
Correlation between inspiratory capacity (IC)/total lung capacity (TLC) ratio and oxygen pulse at peak exercise in chronic obstructive pulmonary disease.
Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification based on symptom and risk evaluation. a) GOLD model of symptom/risk evaluation.
Progression in the patient’s pulmonary function tests from 2010 to a) Forced vital capacity (FVC); b) total lung capacity (TLC); c) diffusing capacity.
Mean (95% CI) change in Clinical COPD Questionnaire (CCQ) with pulmonary rehabilitation, according to achievement (+) or non-achievement (−) of the established.
A: Changes in percent of predicted following bronchodilator for spirometric and lung volumes variables. A: Changes in percent of predicted following bronchodilator.
Scatterplots showing baseline correlation between forced expiratory volume in 1 s (FEV1) % pred and a) COPD Assessment Test (CAT), b) Clinical COPD Questionnaire.
Chronic obstructive pulmonary disease (COPD) prevalence (postbronchodilator FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity)
A) Operating lung volumes and b) breathing frequency (Fb) during incremental cycle exercise in patients with moderate chronic obstructive pulmonary disease.
Endobronchial valve (EBV) treatment for emphysema, summary of treatment selection and outcome. Endobronchial valve (EBV) treatment for emphysema, summary.
Interventional bronchoscopic and surgical treatments for chronic obstructive pulmonary disease (COPD). Interventional bronchoscopic and surgical treatments.
Frequency distribution histograms of the Exacerbations of Chronic Pulmonary Disease Tool (EXACT) total, the COPD Assessment Test (CAT), the St George’s.
Receiver operating characteristic (ROC) curves for Saint George’s Respiratory Questionnaire (SGRQ) category scores predicting chronic obstructive pulmonary.
Presentation transcript:

The Minimal Important Difference for St The Minimal Important Difference for St. George’s Respiratory Questionnaire in patients with severe COPD Jorrit Welling, BSc Department of Pulmonary Diseases University Medical Centre Groningen

Contents: Introduction Research Question & Hypothesis Materials & Methods Results Discussion Conclusions

Introduction: Key Concepts Chronic Obstructive Pulmonary Disease (COPD) Bronchoscopic Lung Volume Reduction ( BLVR ) St.George’s Respiratory Questionnaire ( SGRQ ) Minimal Important Difference ( MID )

Introduction : COPD Major cause of morbidity and mortality worldwide “COPD is a progressive lung disease characterized by airflow limitation resulting in premature closure of small airways, air trapping and hyperinflation leading to shortness of breath” (1) Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013 Feb 15;187(4):347-365. 4

Introduction: BLVR Bronchoscopic approach to Lung Volume Reduction Surgery Valves Coils 5

Introduction: SGRQ & MID St. George’s Respiratory Questionnaire Minimal Important Difference Currently Accepted MID: 4 Units 2. Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respir Med 1991; 85 Suppl B: 25-31; discussion 33-7. 3.Jones PW. St. George's Respiratory Questionnaire: MCID. COPD 2005; 2: 75-79. 6

Research Question & Hypothesis What is the minimal important difference for SGRQ in patients with severe COPD? We hypothesize that the currently accepted MID for the SGRQ will not stand and will prove to be larger than 4 SGRQ units.

Methods: Study design Design Inclusion Ethics

Methods: Measurements & MID Calculation SGRQ Spirometry Body Plethysmography Exercise Tests MID calculation: Anchor-based Methods (FEV1, RV, 6 MWT) Distribution-based Methods 4. Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 2008; 61: 102-109.

Results: Inclusion Figure 1: Patient flowchart. SGRQ: St. George’s Respiratory Questionnaire.

Results: ( Baseline Characteristics)   Baseline (n=115) Δ1 month From baseline (n=110) Δ6 months from baseline (n=86) Females/Males 73/42 NA Age (years) 60±8.8 6MWD (meters) 311±95 38.5±60.7 38.2±68.5 SGRQ Total score (units) 62±10.9 -9.8±13.8 -7.5±15.8 Packyears (years) 36±17 RV (liter) 4.9±1.1 -0.5±0.6 FEV1 (liter) 0.7±0.3 0.1±0.2 Table 1: Patient characteristics at baseline and change at 1 and 6 months follow-up. Data are presented as number or mean ± SD. Δ=change between baseline and follow-up. BMI: body mass index; FEV1: forced expiratory volume in 1 second; 6MWD: 6-minute walk distance; SGRQ: St George’s Respiratory Questionnaire; RV: residual volume; TLC: total lung capacity; NA: not applicable.

Results: MID Outcomes SGRQ MID at 1 month at 6 months Anchor: RV -8.7   SGRQ MID at 1 month at 6 months Anchor: RV -8.7 -6.4 FEV1 -9.2 -7.8 6MWD -8.5 -6.3 Distribution Based: -6.9 7.9 Combined: -8.3 -7.1 Table 2: Minimal Important Differences for SGRQ. Data are presented as SGRQ units or percentage change compared to baseline. MID: Minimal Important Difference; SGRQ: St. George’s Respiratory Questionnaire; RV: residual volume; FEV1: Forced expiratory volume in 1 second; 6MWD: 6-minute walk distance.

Discussion: Findings Scope of applicability? Treatment Specific? Strenghts & Limitations - Generalisability Future Prospective - Evaluation Clinical Trials

Conclusions: Retrospective Analysis 7 BLVR Trials Anchor & Distribution Methods A SGRQ MID of -8.3/-7.1

Acknowledgements Nick H. Ten Hacken Karin Klooster Dirk-Jan Slebos Jorine E. Hartman Nick H. Ten Hacken Karin Klooster Dirk-Jan Slebos Groningen Research Institute for Asthma & COPD