Can computer simulators accurately represent the pathophysiology of individual COPD patients?

UK COPD treatment: failing to progress

Background and Objective: Chronic Obstructive Pulmonary Disease (COPD) is a type of obstructive pulmonary disease that is identified by chronic narrowing of the airways. This disease worsens over time, and the main symptoms of this disease include shortness of breath, cough, and phlegm. The purpose of this study was to determine the relationship between COPD disease severity and inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in hospitalized patients. Materials and Methods: After the admission of patients diagnosed with COPD into this descriptive-analytical study, a complete medical history was taken during their hospitalization. Necessary variables were collected, including current or previous cigarette or opium use and duration of exposure to fossil fuels. Especially in those who cook at home, ESR and CRP samples were taken from them in addition to routine tests, and the length of hospital stay was recorded in addition to common treatments. After collecting the data, they were recorded in SPSS V22 software and analyzed using descriptive statistics (prevalence, mean, and standard deviation) and using the Chi-square, Fisher's exact, independent t, and Mann-Whitney tests. The area under the receiver operating characteristic curve was used to determine the accuracy of the prediction of inflammatory markers in the outcome and severity of the disease. The significance level was considered less than 0.05. Results: In this study, it was observed that the average scores of ESR and CRP of people with COPD were 54.68 and 1.50, respectively. The average ESR was 26.46 in people with mild COPD, 54.60 in people with moderate COPD, and 110.62 in people with severe COPD, and this difference was statistically significant (P=0.0001). The average CRP was 0.61 in people with mild COPD, 1.75 in people with moderate COPD, and 2.86 in people with severe COPD, which was statistically significant (P=0.0001). Conclusion: The results of this study showed that there was a significant relationship between ESR and CRP with the outcome of COPD, and a significant relationship was observed between ESR and CRP and the severity of COPD disease.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder characterized by irreversible and progressive limitation of expiratory airflow. COPD is now considered as a systemic disease with several extra-pulmonary manifestations which include osteoporosis, muscle weakness, arrhythmia, stroke, cancer etc. The role of vitamin D in skeletal integrity is well established. Role of it in several other diseases like autoimmune, infectious, respiratory and cardiovascular diseases has been increasingly recognised. Data on vitamin D status in COPD in Indian population was limited while those comparing vitamin D with stage, pack year and body mass index were lacking. To assess Vitamin D in subjects with COPD and matched controls and also to study the variability in serum vitamin D levels with COPD disease characteristics. A total of 162 patients aged 18-65 years from south India presenting to kasturba hospital were included in the study. Serum 25- hydroxy-vitamin D were measured in 81 COPD patients (combined COPD stage A-D) and compared with 81 age and gender matched controls. Level < 20 ng/ml defined deficiency. Risk estimate with Odds ratio and association of COPD characteristics with Vitamin D was assessed using logistic regression analysis. COPD patients had an increased risk for vitamin D deficiency compared to controls after adjustment for age and gender(OR =2.687 (1.40,5.13)). Variables associated with lower 25(OH) D levels in COPD patients were higher pack year (p=0.001), current smoking status (p=0.026), Low BMI (p=0.02), and GOLD stage III- IV (p=0.001). COPD was associated with an increased risk of vitamin D deficiency, and there was a significant association between vitamin D levels and Combined COPD stage severity. Also, a higher pack year and a low BMI are associated with lower levels of vitamin D.

Inflammation is now recognized as an integral part of the pathogenesis of chronic obstructive pulmonary disease (COPD). In contrast to the sterile airways of normal lungs, bacterial pathogens are often isolated from the airways in stable COPD. This "colonization" of the tracheobronchial tree, currently believed to be innocuous, could serve as an inflammatory stimulus, independent of current tobacco smoke exposure. To test the hypothesis that bacterial colonization is associated with airway inflammation in stable COPD. Bronchoscopy with bronchoalveolar lavage (BAL) was performed in three groups of subjects: 26 ex-smokers with stable COPD (COPD), 20 ex-smokers without COPD (ex-smokers), and 15 healthy nonsmokers (nonsmokers). Quantitative bacterial cultures, cell counts, chemokine, cytokine, proteinase/antiproteinase, and endotoxin levels in the BAL fluid were compared. Potentially pathogenic bacteria were recovered at > or = 100 cfu/ml in 34.6% of COPD, 0% of ex-smokers, and in 6.7% of nonsmokers (p = 0.003). All values are expressed as median (interquartile range). Subjects with colonized COPD had significantly greater relative (12.0 [28.4] vs. 3.0 [7.8]%, p = 0.03) and absolute (4.98 [5.26] x 10(4)/ml vs. 3.04 [2.82] x 10(4)/ml, p = 0.02) neutrophil counts, interleukin 8 (33.8 [189.8] vs. 16.9 [20.1] pg/ml, p = 0.005), active matrix metalloproteinase-9 (2.16 [4.30] vs. 0.84 [0.99] U/ml, p = 0.03), and endotoxin (36.0 [72.6] vs. 3.55 [7.17] mEU/ml, p = 0.004) levels in the BAL than the subjects with noncolonized COPD. These inflammatory constituents of BAL were also significantly elevated in subjects with colonized COPD when compared with ex-smokers and nonsmokers. Bacterial colonization is associated with neutrophilic airway lumen inflammation in ex-smokers with COPD and could contribute to progression of airway disease in COPD.

Background It was observed that coronavirus disease 2019 (COVID-19) respiratory complications might be deleterious in patients with prior chronic respiratory diseases. Chronic obstructive pulmonary disease (COPD) cases had more respiratory symptoms, elevated inflammatory markers, and a higher viral load. We aimed to identify COVID-19 presentation pattern, severity, and outcomes in COPD patients. Patients and methods This cross-sectional comparative hospital-based investigation was executed on 200 patients aged 18 years old and above, of both sexes, diagnosed with COVID-19 infection by PCR. Patients were categorized into two groups: group 1: people with COPD are included based on their prior pulmonary function test results and postbronchodilator FEV1/FVC less than 70%. Patients with COVID-19, but without COPD, are included in group 2. Results The current study included 200 patients who were subdivided into the COPD-group and the non-COPD group. There was a significant difference in smoking status, which was higher in the COPD group [69 (69%) vs. 16 (16%)] in the non-COPD group. In addition, neutrophil/lymphocytes ratio (4.04±1.07 vs. 2.35±1.13), erythrocyte sedimentation rate (56.52±14.99 vs. 46.98±25.88), C-reactive protein (41.39±6.82 vs. 21.31±14.61), ferritin (609.05±52.83 vs. 492.11±44.46), and D-dimer (5.83±1.94 vs. 1.74±0.16) levels were elevated in the COPD group compared with the non-COPD group, regarding severity grades of COVID-19. Critically ill group were more prevalent in the COPD group than the non-COPD group [67 (67%) vs. 27 (27%)]. Regarding ventilatory support, COPD patients were more in need of mechanical ventilation [34 (34%) vs. 18 (18%)] than the non-COPD group. COPD group needed to be admitted to ICUs [46 (46%) vs. 26 (26%)] than the non-COPD group. COPD group had longer length of hospital stay than the non-COPD group (13.98±2.22 vs. 8.09±1.77, respectively). Conclusion The COVID-19 cases with COPD had no difference in clinical presentation compared with the non-COPD group. Most of the COPD group had critical and severe grade of COVID-19 infection in contrast to the non-COPD group. COPD patients had higher frequency of ICU admission, more need for mechanical ventilation, longer hospital stay, and higher mortality than the non-COPD group. We found that predictors for mortality among COVID-19 patients’ infection were male sex, old age, diabetes mellitus, D-dimer, COPD disease, and severe grade of COVID-19.

This study aims to describe current trends in Australia regarding chronic obstructive pulmonary disease (COPD) mortality and morbidity rates, and in its treatment and prevention from 2000 to 2010. The study’s purpose is to better define future directions in curbing COPD. People with COPD and their caregivers who attend patient support groups (n = 21), pulmonary rehabilitation group coordinators (n = 27) within Victoria, and the Australian Lung Foundation provided informed feedback. COPD was a leading underlying cause of death in both sexes during these years. Nevertheless, mortality rates declined from 1980 to 2007, with rates for males almost halving. Its prevalence has also substantially declined. Smoking rates have declined in age groups over 40 years old in both sexes. The COPD-X Plan provides evidence-based guidelines for the management of COPD. Many government, professional, and community initiatives have been recently implemented to promote the Plan. Two studies—one conducted before and one conducted after the publication of the COPD-X Plan—report some progress, but there are still very considerable departures from evidence-based practice. The Australian Lung Foundation estimates that only 1% of patients who could benefit from pulmonary rehabilitation programs have suitable access to such programs. A common priority for all informants was that there needed to be greater awareness of—and a more positive orientation to—COPD in both the Australian and health professional communities. The study concluded that substantial reductions in COPD and smoking cessation rates contrast with more limited progress toward adopting other aspects of evidence-based practice. The “good news” story concerning reductions in COPD disease with improving smoking cessation rates could form the basis for suitable media campaigns.

The coexistence of upper airways disease with chronic obstructive pulmonary disease (COPD) is not well documented. The aim of this research was to assess sino-nasal inflammation in COPD by various tools, and look for the impact on quality of life, relation to smoking, disease severity and systemic inflammation. Current and ex-smokers with COPD (n = 42) and healthy never-smokers (n = 21) were included in this study. COPD severity was assessed by GOLD criteria and BODE index. Markers of systemic inflammation were measured. Nasal symptoms and general quality of life were assessed using the questionnaires; sino-nasal questionnaire (SNAQ-11) and St. George's Respiratory Questionnaire (SGRQ). Nasal endoscopy and saccharine test were performed. Nasal lavages were collected for cytological examination and eicosanoids (cysteinyl leukotrienes, leukotriene B4, 8-isoprostane). Symptoms and endoscopic scores were higher in COPD (P ≤ 0.0001). Only SGRQ symptoms subscore correlated with SNAQ-11 (r = 0.34, P = 0.035). Mucociliary clearance was impaired only in current smokers (9.91 ± 0.49 versus 13.12 ± 0.68 minutes, P ≤ 0.001). 8-isoprostane was higher in COPD smokers compared to the controls (0.17 ± 0.04 versus 0.34 ± 0.09 pg/g protein, P < 0.05). Endoscopic score and mucociliary of impairment patients who currently smoked cigarettes correlated with concentrations of 8-isoprostane. None of the parameters correlated with disease severity and markers of systemic inflammation. We provide evidence of upper airways disease in COPD, which appears to be related more to patients who currently smoke than to disease severity.

Background: Knowledge about the COPD disease is a strong shield against suffering from, especially those patients who are acquired from environmental, chemical and habitual factors. Worldwide concepts, smokers are really less aware about the consequences. Objectives: To assess the awareness and level of knowledge about (COPD) among smokersin Saudi Arabia. Subjects and methods: This study was a cross-sectional study carried out in all regions in Saudi Arabia included anyone accepts participation in the questionnaire at any region in Saudi Arabia include Active, Passive and Ex. Smoker. An electronic questionnaire was sent by advanced social contacting to our participants re-analyzed by using SPSS. Results: Weak knowledge was seen in the sector of COPD general knowledge, treatment, relationship with smoking and total knowledge while average knowledge about common symptoms of COPD. The mean and standard deviation of total knowledge was 8.9±5.05. Conclusion: This study showed a low level of awareness about the initiation and progression of the disease and even the linkage between two points (smoking, COPD) is not clear for more than 60% of participants.

COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.

Lettre ouverte aux membres du comité GOLD – 13 juillet 2010

Chronic obstructive pulmonary disease (COPD) is recognized as a source of systemic inflammation and is associated with the development of cardiovascular disease. However, little is known about the association between COPD and chronic kidney disease (CKD). Therefore, we investigated the relationship between COPD and CKD and the association between COPD and mortality in patients with CKD. We conducted a cohort study of 3358 vascular surgery patients between 1990 and 2006. CKD was defined according to the Modification of Diet in Renal Disease equation as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). In addition, the patients were divided into three categories based on the baseline estimated GFR: > or =90 mL/min/1.73 m(2); 60-89 mL/min/1.73 m(2) and <60 mL/min/1.73 m(2). Multivariable logistic regression analysis was used to evaluate the independent association between prevalent COPD and CKD. The prevalence of COPD was inversely related to kidney function. COPD was present in 47, 38 and 32% of patients with an estimated GFR <60, 60-89 and > or =90 mL/min/1.73 m(2), respectively. COPD was independently associated with CKD (OR 1.22; 95% CI 1.03-1.44; P = 0.03). This association was strongest in patients with moderate COPD (OR 1.33; 95% CI 1.07-1.65; P = 0.01). Both moderate and severe COPD were associated with increased long-term mortality in patients with CKD (HR 1.27; 95% CI 1.03-1.56; P = 0.03 and HR 1.61; 95% CI 1.10-2.35; P = 0.01, respectively), compared to patients without COPD. Our findings indicate that COPD is moderately associated with CKD in a large cohort of vascular surgery patients. In addition, moderate and severe COPD are related to increased long-term mortality in patients with CKD.

Chronic respiratory diseases are among the most important causes of morbidity and mortality worldwide. According to the Global Burden of Disease Study 2017, chronic obstructive pulmonary disease (COPD) was the third leading cause of global disability-adjusted life-years (DALY) among non-communicable diseases, with an increase of 13.5% over the last decade.1 Asthma is associated with a high burden of disease and substantial economic and societal impact.2 Interstitial lung diseases (ILD) represent a heterogeneous group of chronic and often progressive lung conditions, with limited response to pharmacotherapy, increasing disability and incremental healthcare utilization.3 Despite advances in pharmacological treatments for these and other chronic respiratory diseases, a large proportion of patients remain symptomatic and suffer from frequent exacerbations and hospitalizations, and the course of these diseases cannot be reversed. In addition, chronic respiratory diseases are characterized by extra-pulmonary features, and many patients suffer from comorbidities.4-6 In addition to smoking, physical inactivity is a well-recognized disadvantageous lifestyle factor contributing to disease progression, impaired health status and exercise capacity and increased mortality in COPD and other chronic respiratory diseases.7, 8 Unhealthy diet, extremes in body weight and low muscle mass are associated with poor outcomes in patients with COPD and ILD.9, 10 Many patients also experience difficulties coping with their disease11 and have limited knowledge about their condition and poor self-management skills.12 Thus, there is a clear clinical indication for additional, comprehensive interventions optimizing the physical and psychological condition of these patients and inducing a healthier lifestyle. Pulmonary rehabilitation (PR) offers this potential. It takes the factors contributing to the current and future burden of disease in individual patients into account. Clinically relevant improvements in health status, exercise capacity and other outcomes have been convincingly demonstrated in patients with stable disease13 and following exacerbation.14 Consequently, PR is considered an essential component of respiratory disease management and is recommended by various international guidelines.15-17 Despite the abundance of literature reporting the benefits of PR for patients with chronic respiratory diseases, this intervention is faced with numerous challenges. A very limited proportion of potential PR candidates are referred for these programmes, and adherence is low. Lack of awareness regarding access and benefits and insufficient funding and availability of PR programmes are important issues related to this underuse.18 Motivated by the lack of resources and poor uptake of traditional centre-based PR, alternative models, including home-based PR with minimal resources, have been studied.19, 20 The clinical outcomes of these programmes were positive, but they have instigated an international debate about the definition of PR and its minimal core components. Programmes consisting of exercise training only may improve physical functioning but may downsize the complexity of chronic respiratory diseases into a single dimension. Therefore, such programmes neglect the need for an integrated approach of all treatable components of these conditions. To move ahead and avoid devaluation of the term PR, international experts must come to agreement on essential organizational aspects and components of comprehensive PR or introduce alternative terminology for other approaches. Another challenge is related to non-response to PR in a proportion of patients and the current lack of ability to select the appropriate patients for PR programmes.21 In the realm of ‘precision medicine’, researchers in PR need to focus on these non-responders, identify treatable traits and determine which components of PR will be effective and use the outcomes to innovate and increase the efficacy of PR. For this review series on rehabilitation for chronic lung diseases, we have invited a group of global experts in PR to highlight the opportunities and challenges of this field and to provide the readers of this journal with a state-of-the-art update on the organization and content of PR in various respiratory conditions. With this, we aim to increase the awareness, implementation, quality, customization and outcomes of PR in different states (stable or exacerbation) and stages of severity of these diseases. Our experts will discuss the urgency of conceptual clarity and international consensus on the term PR and its essential components. They will also focus on the need for tailored programmes that meet the needs of individual patients. In addition to achieving a consensus on meaningful and sustainable outcomes, opportunities and limitations of PR programmes in different settings will be discussed and balanced against availability and costs. The invited authors will also provide expertise on selection of patients for PR and the components of an integrated assessment. Readers will be educated on the personalized exercise training and educational components of PR, along with other interventions. The effects of PR on patients with COPD and on patients with non-COPD diagnoses, including ILD, bronchiectasis, lung cancer and pulmonary hypertension, will be presented. In addition, invited authors will focus on the effects and safety of PR during acute exacerbations or recovery from these events. The experts will also describe the latest developments in PR for the most severe patients, for example by combining exercise training with (high-flow) oxygen supplementation and non-invasive ventilation. Finally, they will show us the evidence regarding maintenance programmes and inform readers of the barriers and facilitators for long-term benefits of PR. PR is a powerful intervention for patients with chronic respiratory diseases. Whilst these diseases remain incurable, PR will help support patients to live their life to the max. We truly hope that this review series in Respirology will be informative and interesting and that it will increase awareness among healthcare professionals, policymakers, payers and patients regarding the role of PR in respiratory health. We also hope that these reviews will stimulate the implementation of PR in regions of the world where it is not available and encourage scientists to explore the uncertainties in PR and ultimately advance this field.

The study indicates, for the first time, the changes in both ATPase and AChE activities in the membrane of red blood cells of patients diagnosed with COPD. Chronic obstructive pulmonary disease (COPD) is one of the most common and severe lung disorders. We examined the impact of COPD on redox balance and properties of the membrane of red blood cells. The study involved 30 patients with COPD and 18 healthy subjects. An increase in lipid peroxidation products and a decrease in the content of -SH groups in the membrane of red blood cells in patients with COPD were observed. Moreover, an increase in the activity of glutathione peroxidase and a decrease in superoxide dismutase, but not in catalase activity, were found as well. Significant changes in activities of erythrocyte membrane enzymes in COPD patients were also evident demonstrated by a considerably lowered ATPase activity and elevated AChE activity. Changes in the structure and function of red blood cells observed in COPD patients, together with changes in the activity of the key membrane enzymes (ATPases and AChE), can result from the imbalance of redox status of these cells due to extensive oxidative stress induced by COPD disease.

Chronic cough and sputum production are common features of chronic obstructive pulmonary disease (COPD) and have a significant impact on exacerbation frequency and quality of life. Despite this, techniques to assist with removal of sputum from the airway do not have a well-defined role in COPD management. Clinical trials of airway clearance techniques (ACTs) in COPD have shown mixed results with little evidence of long-term benefit. However many studies have failed to account for the heterogeneity of COPD lung disease, particularly with regard to the presence of bronchiectasis. Analysis of short-term studies suggests that there may be a cohort of patients who will benefit from prescription of a sputum clearance regimen. This review proposes a physiological rationale for the use of ACTs in COPD, taking into consideration the presence of bronchiectasis, the amount of sputum produced, the degree of airflow obstruction and the presence of decreased lung elastic recoil. The selection of an optimal ACT for individuals with COPD should take into account its effects on lung vloumes, expiratory flow and dynamic airway compression. Care should be taken to avoid airway collapse during forced expirations in patients with reduced lung recoil pressure; positive expiratory pressure therapy or autogenic drainage may prove effective in this patient group. The acceptability of ACTs to patients should also be considered, especially where long-term adherence is required. Future research should focus on more appropriate matching of the physiological effects of individual ACTs to the pathophysiology of lung disease in COPD.

BackgroundRecently, variations in a component of high-density lipoprotein (HDL), namely apolipoprotein M (apoM), were found to be associated with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the association between apoM and COPD severity. Factors associated with apoM, COPD, or coronary artery disease (CAD) were also assessed.MethodsA total of 110 COPD patients and 110 age- and sex-matched non-COPD controls were included. Among them, thirty COPD patients and seven non-COPD controls had CAD. ApoM and pentraxin-3 levels were measured by ELISA. Additionally, the levels of high-sensitivity C-reactive protein (hs-CRP), cholesterol, and triglyceride were assessed using an automatic biochemical analyzer.ResultsSerum apoM levels increased gradually with COPD severity, with the most prominent apoM elevation observed in very severe COPD cases. In addition, ApoM was correlated with percent-predicted forced expiratory volume in one second (% predicted FEV1) (r = −0.38, P < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.23, P < 0.017), and hs-CRP (r = 0.24, P = 0.01) in COPD patients. Furthermore, apoM was shown to be a risk factor for COPD onset (OR = 1.095, 95 % CI = 1.034–1.160, P = 0.002), but not associated with CAD in COPD patients.ConclusionsSerum apoM was elevated in COPD patients and increased gradually with COPD severity. However, there was no association between apoM and CAD development in COPD patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-016-0228-1) contains supplementary material, which is available to authorized users.