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Open Access 01-12-2023 | Research

Longitudinal significance of six-minute walk test in patients with nontuberculous mycobacterial pulmonary disease: an observational study

Authors: Atsuho Morita, Kazuma Yagi, Takanori Asakura, Ho Namkoong, Yasunori Sato, Takunori Ogawa, Tatsuya Kusumoto, Shoji Suzuki, Hiromu Tanaka, Ho Lee, Satoshi Okamori, Shuhei Azekawa, Kensuke Nakagawara, Masanori Kaji, Genta Nagao, Yohei Funatsu, Yoshifumi Kimizuka, Hirofumi Kamata, Tomoyasu Nishimura, Makoto Ishii, Koichi Fukunaga, Naoki Hasegawa

Published in: BMC Pulmonary Medicine | Issue 1/2023

Abstract

Background

The long-term exercise tolerance changes in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) are of great interest because of its chronic course. This study aimed to characterize the associations between changes over time in six-minute walking test (6MWT) parameters and clinical parameters in patients with NTM-PD.

Methods

Overall, 188 patients with NTM-PD, visiting outpatient clinics at Keio University Hospital from April 2012 to March 2020 were included in the study. Data were collected using the St. George’s Respiratory Questionnaire (SGRQ), pulmonary function test (PFT), blood tests, and the 6MWT at registration and at least once after that. The association of the anchors and clinical indicators with the 6MWT parameters was assessed.

Results

The median age [interquartile range] of the patients was 67 [63–74] years. The median baseline six-minute walk distance (6MWD) and final Borg scale (FBS) were 413 [361–470] m and 1 [0–2], respectively. In the correlation analysis, ΔSGRQ total/year (yr), Δforced vital capacity (FVC, % predicted)/yr, Δforced expiratory volume in 1 s (FEV₁, % predicted)/yr, and Δdiffusing capacity for carbon monoxide (DL_CO, % predicted)/yr correlated with both Δ6MWD/yr and ΔFBS/yr in the longitudinal analysis (|Rho| > 0.20). When stratified into three quantiles of changes in each anchor, the 6MWT parameters worsened over time in the bottom 25% group by mixed-effects model. Specifically, Δ6MWD was affected by SGRQ activity, SGRQ impacts, PFT (FVC, FEV₁, and DL_CO), and C-reactive protein (CRP). ΔFBS was affected by all SGRQ components, total score, and PFT. Anchor scores and variables at baseline that worsened Δ6MWD were higher SGRQ scores, lower FVC (% predicted), lower DL_CO (% predicted), higher Krebs von den Lungen-6, old age, and undergoing treatment at registration. Similarly, these clinical parameters and elevated CRP, excluding undergoing treatment at registration, worsened ΔFBS.

Conclusions

The decreased walking distance and exacerbation of dyspnea on exertion over time in patients with NTM-PD may reflect a deterioration of health-related quality of life and pulmonary function. Thus, the change in 6MWT over time can be used as an indicator to accurately assess the patient’s condition and tailor their healthcare environment.

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Title: Longitudinal significance of six-minute walk test in patients with nontuberculous mycobacterial pulmonary disease: an observational study
Authors: Atsuho Morita
Kazuma Yagi
Takanori Asakura
Ho Namkoong
Yasunori Sato
Takunori Ogawa
Tatsuya Kusumoto
Shoji Suzuki
Hiromu Tanaka
Ho Lee
Satoshi Okamori
Shuhei Azekawa
Kensuke Nakagawara
Masanori Kaji
Genta Nagao
Yohei Funatsu
Yoshifumi Kimizuka
Hirofumi Kamata
Tomoyasu Nishimura
Makoto Ishii
Koichi Fukunaga
Naoki Hasegawa
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: BMC Pulmonary Medicine / Issue 1/2023
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-023-02528-y

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Abstract

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