Diaphragmatic curvature analysis using dynamic digital radiography

Bronchodilatory effects of NVA237, a once daily long-acting muscarinic antagonist, in COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) is a great public health burden worldwide. Few studies have focused on pain problems in patients with mild and moderate COPD in Chinese community settings.MethodsA cross-sectional study of 283 patients with mild and moderate COPD was conducted in six communities that were randomly sampled in Pudong New Area of Shanghai, China, in 2016. A face-to-face interview was conducted to collect data on personal characteristics and health conditions. The short form McGill Pain Questionnaire and the COPD assessment test (CAT) were applied to evaluate pain problems and health status, respectively.ResultsAmong 283 subjects, more than one third (37%) had pain problems indicated by the present pain intensity (PPI) scale. COPD patients aged <65 years with exacerbation in the past 12 months or a CAT score of ≥10 had a significantly higher score in affective dimension. Female sex, COPD severity, and length of disease were significantly related to higher scores of the sensory dimension. Those with moderate COPD or a CAT score of ≥10 had significantly higher scores of visual analog scale than those with mild COPD or a CAT score <10. Patients with moderate COPD had a higher rank of PPI than those with mild COPD.ConclusionPain was common in patients with mild and moderate COPD in the community settings of Shanghai, China. Severity of COPD and CAT score were significantly related to the prevalence of pain. Intervention measures should be developed to improve pain problems for COPD patients.

Objective To explore the relationship between fat-free mass (FFM) and peak exercise performance in chronic obstructive pulmonary disease(COPD) patients. Methods 26 healthy subjects and 62 stable COPD patients performed incremental cardiopulmonary exercise testing with cycle ergometer. 62stable COPD patients were divided three groups(mild COPD,moderate COPD,severe COPD) according to FEV1%pred, peakVO2, peakLoad, peakO2 pulse, AT were measured during exercise. FFM and routine subjects, peakVO2 ,peakVO2 %pred,peakLoad,peakLoad%pred,peakO2 pulse,peakO2 pulse% pred and AT peakLoad%pred,AT and peakO2 pulse% pred ( r =0. 671,0. 478,0. 423,0. 618, P＜0. 05) in COPD patients.Conclusions FFM is significantly associated with muscle aerobic capacity and exercise tolerance in COPD patients. Key words: Fat-free mass; Chronic obstructive pulmonary disease; Cardiopulmonary exercise testing

Chronic Obstructive Pulmonary Disease (COPD) is increasingly recognized as a systemic disease characterized by progressive airflow limitation as well as respiratory and peripheral muscle weakness. Deficiency in the levels of carnitine “an essential nutrient for optimal muscle function” has been associated with peripheral and respiratory muscle weakness in other diseases, but has not yet been examined in COPD patients. The aim of this study was to investigate whether plasma acyl carnitine fractions were reduced in patients with COPD, and examine if the deficiency correlated with COPD severity. Patients and methods: A prospective case control study to compare acyl carnitine levels and other parameters in 81 COPD patients treated at the Pulmonology Department, King Fahad Specialist Hospital Dammam, with 48 age and sex matched healthy controls. All subjects participating in the study underwent a complete physical examination and detailed pulmonary function tests (PFTs). Blood samples were taken for acyl carnitine profiles as well as a panel of other tests including albumin, total protein, Iron, CRP and pre-albumin. Acyl carnitine profile was determined using LC-MS/MS analysis. Results: COPD patients had significantly lower total carnitine levels compared to controls (43.9±6.5 and 22.7±11.9 respectively). Furthermore there was a significantly greater reduction in carnitine levels in patients with very severe COPD compared to patients with mild COPD. Conclusion: Our study demonstrated a significant deficiency in carnitine levels in COPD patients, and the degree of deficiency correlated with the severity of COPD.

Chronic obstructive pulmonary disease (COPD) is common in patients with aortic aneurysms. Severe COPD is associated with an increased risk of aneurysm rupture and perioperative complications. This study assesses the outcomes of COPD and non-COPD patients after fenestrated-branched endovascular aortic aneurysm repair (FBEVAR). A single institution, retrospective study of FBEVAR patients between 2011 and 2020 compared outcomes between COPD and non-COPD patients. COPD patients were stratified by Global Initiative for Chronic Obstructive Lung Disease criteria and oxygen dependence. Outcome measures included 30-day mortality, pulmonary complications, major adverse events (MAE), and mid-term survival. 387 patients (71% male, age 72 years, interquartile range [68-79]) underwent FBEVAR. 181 patients (47%) had COPD. Smoking history was more frequent in COPD patients (P = .022). Among COPD patients, 20.4% were oxygen-dependent. Technical success, defined as successful delivery of the main aortic endograft and all intended side branches, was 98.4%. 30-day mortality (P = .83) and MAE rates (P = .87) were similar between groups. While not statistically significant, COPD patients had more frequent pulmonary complications (6.1% vs. 2.4%, P = .13) and were more frequently discharged on oxygen (P = .002). There were no differences in intensive care unit or hospital length of stay between groups (P = .29; P = .85, respectively). 5-year survival was similar between groups (P = .10). Oxygen-dependent COPD and severe-very severe COPD were associated with decreased mid-term survival (Hazard Ratio 2.39, P = .048). FBEVAR is safe and effective for treating complex aortic pathology in COPD patients, including oxygen-dependent patients. Patients with more severe COPD were more frequently discharged on oxygen. Mid-term survival was slightly reduced in patients with oxygen-dependent and severe-very severe COPD. Level 3, non-randomized controlled cohort/follow-up study.

To assess the diagnostic value of interleukin 6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) as inflammatory markers in chronic obstructive pulmonary disease (COPD) patients. IL-6, IL-8 and TNF-α levels were measured by ELISA in the serum and the bronchoalveolar lavage (BAL) in 10 control participants and 25 mild and moderate COPD patients, whereas 25 patients with severe COPD were studied for the serum level of these inflammatory biomarkers. The mean value and SD of BAL and serum IL-6, IL-8 and TNF-α levels were significantly higher in COPD patients when compared with control participants; the serum level of these biomarkers were also significantly higher in severe compared with mild and moderate COPD patients. Increased srum and/or BAL IL-6, IL-8 and TNF-α can be used as biomarkers of the systemic inflammatory response in COPD patients, and their levels are correlated with the severity of COPD. Egypt J Broncho 2014 8:91–99

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in India especially in rural areas. COPD is the 5th leading cause of death worldwide. COPD causes hypoxia in lungs triggering the pulmonary vasoconstriction which leads to increase in pulmonary vascular resistance finally involving the heart and causes right sided cardiac complications which can be evidenced by Electrocardiography (ECG). Therefore, the present study was conducted to evaluate the diagnostic values of ECG changes among COPD patients. MATERIAL AND METHODS: This was a cross-sectional study done in the Medicine department of Chirayu Medical College and Hospital, Bhopal during the period from January 2012 to June 2012. 60 cases of COPD were selected for study. The diagnosis of COPD is based upon the clinical history, clinical examination, X-ray chest and Pulmonary Function Test (PFT). ECG was done in all the 60 patients and looked for heart axis, Right Ventricular Enlargement (RVE), Right Atrial Enlargement (RAE) and Right Bundle Branch Block (RBBB). RESULTS: ECG analysis shows the features suggestive of RAE in >40% of COPD patients having duration of >10 yrs. Out of total 60 patients 24 patients had Forced Expiratory Volume First(FEV1) ≥80% (mild COPD), 30 had FEV1 50 % to 79% (moderate COPD), 5 patients had FEV1 30-49% (severe COPD) and 1 patient had FEV1 < 30% (very severe COPD). When the disease severity is compared with the Manifestations in ECG RAE, RVE and RBBB was found in 3 (60%) of the patients out of 5 patients who had severe disease. CONCLUSION: The prevalence of ECG abnormalities related to cardiac diseases, in general is higher in those with more severe pulmonary obstruction and ECG findings should be taken into consideration when diagnosing these patients of COPD for delivering a more integrated pulmonary and cardiovascular care.

Background: Cardiovascular diseases associated with chronic obstructive pulmonary disease (COPD) account for 50% of COPD deaths. Autonomic dysfunction and poor pulmonary function increase the cardiovascular risk in COPD patients. Severity of COPD can be assessed by forced expiratory volume in 1 s. Autonomic balance can be assessed by heart rate variability (HRV). There are variations in the reports of COPD patients regarding the level or onset of dysfunction is a sympathetic or parasympathetic system in them. Aims and Objectives: In our study, we intended to assess HRV parameters such as, total power (TP), high frequency normalized units (HFnu), low frequency normalized units (LFnu), LF/HF ratio, mean HR, root mean square of the successive differences (RMSSD), NN50, and pNN50 among different stages of COPD and also to identify the association of these HRV parameters with disease severity. Materials and Methods: It is a cross-sectional study done on (n = 130) male stable COPD patients. Anthropometric parameters, HRV parameters, and pulmonary function test were assessed. Later, based on the Global Initiative for Chronic Obstructive Lung Disease stage criteria (mild, moderate, severe, and very severe), they were divided into four subgroups. Data were analyzed by SPSS 19.0 version software. Kruskal–Wallis test was used to find a statistical difference between the groups. Correlations between the variables were done using Spearman correlation test. Results: LF/HF ratio (2 ± 0.5) was increased when compared to reference value reported by the previous studies. TP, HFnu, and RMSSD levels were significantly decreased in very severe, severe, and moderate COPD patients when compared to mild COPD patients. The mean HR, LFnu, and LF/HF ratio levels were significantly increased in very severe, severe, and moderate COPD patients when compared to mild COPD patients. TP, HFnu, and RMSSD levels negatively correlated with disease severity and mean HR, LFnu, and LF/HF ratio positively correlated with disease severity. Conclusion: We have noted that cardiac autonomic dysfunction in the form of increased sympathetic and reduced parasympathetic activity occurs in COPD patients and the association was more prominent when the disease severity increased.

Targeted Deletion of Jun/AP-1 in Alveolar Epithelial Cells Causes Progressive Emphysema and Worsens Cigarette Smoke–Induced Lung Inflammation

Investigation of ocular microstructural changes according to disease severity in patients with chronic obstructive pulmonary disease

Context:A total of 20% of Chronic Obstructive Pulmonary Disease(COPD) patients are non-smokers due to preventable causes, such as biomass fuel exposure, post tuberculous sequelae, occupational exposure, air pollution, persistent chronic asthma, and genetic predisposition.Aims:To compare smokers and non-smokers with COPD.Settings and Design:An observational study was conducted at a tertiary care hospital on 60 patients diagnosed with COPD, (GOLD criteria), who were divided into smoker and non-smoker groups.Subjects and Methods:Demographic data, clinical profile, smoking history, and radiological data were collected and compared. Exclusion criteria were individuals having active pulmonary tuberculosis and reversible air flow limitations.Statistical Analysis Used:Using STATA 14.2, quantitative and qualitative data were presented using descriptive statistics.Results:A total of 100% of smokers were male, whereas 70% of non-smokers were female. Compared to non-smokers (16.67%), smokers (26.6%) presented with higher grade of dyspnea. A statistically significant difference was seen with more smokers diagnosed as severe (40%) and very severe (30%) COPD compared to non-smokers with mild (16.67%) and moderate (46.67%) COPD (P < 0.012), Post bronchodilator FEV1 among smokers (42.63) compared to non-smokers (56.63) (P < 0.01) and decrease in FEV1 as the grade of dyspnea increased (P < 0.002). Compared to 36.67% in non-smokers, 70% smokers showed emphysematous x-rays.Conclusions:In our study we found majority of non-smokers to be female, and smokers had a higher grade of dyspnea, more severe COPD, lower post bronchodilator FEV1, and more emphysematous changes on x-rays.

RATIONALE: In patients with chronic obstructive lung disease (COPD), expiratory time constant of the respiratory system varies significantly among lung regions causing the Pendelluft (P) phenomenon, defined as asynchronous alveolar ventilation at the beginning of inspiration. This undetected airflow is configured as an “intrinsic” rebreathing, not measurable at the airway opening, that may contribute to worsening hypercapnia. We previously provided evidence that in COPD patients with acute hypercapnic respiratory failure Pendelluft accounts for more than 50% extra tidal volume measured at the airways opening. Aim of the present study was to assess and, if present, quantitate Pendelluft also in stable patients with severe COPD. We also aimed to investigate P effects on CO2 retention and ventilatory response of these patients. METHODS: in 13 patients (age 76±6 yrs, 12 males, 1 female) with stable severe COPD (FEV1/FVC 53,4%±6,8%, FEV1 44,5±7,3 %predicted) we assessed Tidal volume (VT, L), respiratory rate (RR, breaths/min), minute ventilation (VE, L/min), dynamic intrinsic PEEP (PEEPidyn, cm H2O), static intrinsic PEEP (PEEPistat, cm H2O), lung compliance (Clung, L/cm H2O), and arterial blood gases during a15 minutes spontaneous breathing trial. Pendelluft was calculated as follows: P=(PEEPistat – PEEPidyn)[asterisk]Clung, L, and VEP=P[asterisk]RR, L/min. Statistics: results are expressed as mean±SD; agreement between variables was assessed by simple linear regression; the statistical significance of the regressions was considered for a p value&amp;lt;0.05. RESULTS: According to previous literature, patients had moderate levels of PEEPi, dyn (2,4±1,3 cmH2O), being on average 54% of PEEPi, stat (4,3±1,9 cmH2O). Compliance was 0,13±0,09 L/cmH2O. Pendelluft was quite relevant (0,232±0,223 L), representing a substantantial portion (30% on average) of VT measured at the airway opening. A significant linear relationship was found between P and both (PEEPistat – PEEPidyn) and compliance (p&amp;lt;0,0096 and p=0,0260, respectively) suggesting that both variables contributed to its presence. PaCO2 was still within normal limits (38,7±2,6 mmHg), being significantly and positively correlated with Pendelluft (PaCO2=37,154+6,622[asterisk]P; p=0,0425), but not with VT, RR, or VE. Finally, total ventilatory output (VETOT=VE+VEP) exceeded by about 32% the expected VE in absence of P, fact that allowed a normal PaCO2 notwithstanding the significant “intrinsic” rebreathing (figure 1). CONCLUSIONS: in severe stable COPD patients: 1) significant pendelluft is present because of both expiratory time constant inhomogeneities within lungs and increased compliance; 2) resting PaCO2 depends mainly on the “intrinsic” rebreathing caused by Pendelluft; and 3) some hyperventilation is operated by respiratory system to keep PaCO2normal, causing a significant ventilatory (and inspiratory effort) overload.

Background: Chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH) are common and underdiagnosed medical conditions in India. Prevalence of these chronic diseases is high both in rural and urban areas. However, the exact prevalence of PAH in Indian COPD patients is unclear. Comorbid conditions like PAH have a great impact on the outcome of COPD in the form of severity, exacerbations, morbidity, and mortality. Right heart catheterization remains the gold standard test for diagnosis of PAH, but it is invasive and practically not feasible. Aims and objectives: The present study objective was to screen COPD patients for PAH using two-dimensional transthoracic Doppler echocardiography (ECHO) in Tertiary Care Hospital. Results: A total of 2040 patients with a confirmed diagnosis of COPD were enrolled in the study. Among these patients, 1509 were males (73.9%), 531 were females (23.06%), and 1428 were known or ex-smokers (70%). None of the females were smokers, but there was a history of biomass fuel exposure for >10 years. As per global initiative for chronic obstructive lung disease criteria, mild, moderate, severe, and very severe COPD was noted in 525,629,511, and 375 patients, respectively. When they were screened using ECHO, prevalence of PAH was 41.96% as 856 subjects had PAH. Prevalence of PAH among mild, moderate, severe, and very severe COPD was 23.8%, 34.81%, 48.53%, and 70.4%, respectively. There was a linear relationship between PAH and severity of COPD. Conclusion: PAH is very common in COPD patients in India. As the severity of COPD increased, the frequency and degree of PAH also increased. ECHO is an excellent tool for detection of PAH in COPD patients. All patients with severe to very severe COPD should be routinely screened by ECHO for PAH and with mild to moderate COPD, who have dyspnea out of proportion to their clinical condition should also be screened for PAH.

Basic research implicates alveolar endothelial cell apoptosis in the pathogenesis of chronic obstructive pulmonary disease (COPD) and emphysema. However, information on endothelial microparticles (EMPs) in mild COPD and emphysema is lacking. We hypothesized that levels of CD31(+) EMPs phenotypic for endothelial cell apoptosis would be elevated in COPD and associated with percent emphysema on computed tomography (CT). Associations with pulmonary microvascular blood flow (PMBF), diffusing capacity, and hyperinflation were also examined. The Multi-Ethnic Study of Atherosclerosis COPD Study recruited participants with COPD and control subjects age 50-79 years with greater than or equal to 10 pack-years without clinical cardiovascular disease. CD31(+) EMPs were measured using flow cytometry in 180 participants who also underwent CTs and spirometry. CD62E(+) EMPs phenotypic for endothelial cell activation were also measured. COPD was defined by standard criteria. Percent emphysema was defined as regions less than -950 Hounsfield units on full-lung scans. PMBF was assessed on gadolinium-enhanced magnetic resonance imaging. Hyperinflation was defined as residual volume/total lung capacity. Linear regression was used to adjust for potential confounding factors. CD31(+) EMPs were elevated in COPD compared with control subjects (P = 0.03) and were notably increased in mild COPD (P = 0.03). CD31(+) EMPs were positively related to percent emphysema (P = 0.045) and were inversely associated with PMBF (P = 0.047) and diffusing capacity (P = 0.01). In contrast, CD62E(+) EMPs were elevated in severe COPD (P = 0.003) and hyperinflation (P = 0.001). CD31(+) EMPs, suggestive of endothelial cell apoptosis, were elevated in mild COPD and emphysema. In contrast, CD62E(+) EMPs indicative of endothelial activation were elevated in severe COPD and hyperinflation.

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.