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Sample records for evaluate copd disease

  1. Application of a theoretical model to evaluate COPD disease management.

    Science.gov (United States)

    Lemmens, Karin M M; Nieboer, Anna P; Rutten-Van Mölken, Maureen P M H; van Schayck, Constant P; Asin, Javier D; Dirven, Jos A M; Huijsman, Robbert

    2010-03-26

    Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. Implementation of the programme was associated with significant improvements in dyspnoea (p model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care.

  2. Application of a theoretical model to evaluate COPD disease management

    Science.gov (United States)

    2010-01-01

    Background Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. Methods A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. Results Implementation of the programme was associated with significant improvements in dyspnoea (p theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care. PMID:20346135

  3. COPD (Chronic Obstructive Pulmonary Disease)

    Science.gov (United States)

    ... To Health Topics / COPD COPD Also known as Chronic Obstructive Pulmonary Disease , Emphysema Leer en español What Is Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive ...

  4. Chronic Obstructive Pulmonary Disease (COPD)

    Science.gov (United States)

    Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease that makes it difficult to empty air out of the lungs. This difficulty in ...

  5. Occupational exposures and chronic obstructive pulmonary disease (COPD): comparison of a COPD-specific job exposure matrix and expert-evaluated occupational exposures.

    Science.gov (United States)

    Kurth, Laura; Doney, Brent; Weinmann, Sheila

    2017-03-01

    To compare the occupational exposure levels assigned by our National Institute for Occupational Safety and Health chronic obstructive pulmonary disease-specific job exposure matrix (NIOSH COPD JEM) and by expert evaluation of detailed occupational information for various jobs held by members of an integrated health plan in the Northwest USA. We analysed data from a prior study examining COPD and occupational exposures. Jobs were assigned exposure levels using 2 methods: (1) the COPD JEM and (2) expert evaluation. Agreement (Cohen's κ coefficients), sensitivity and specificity were calculated to compare exposure levels assigned by the 2 methods for 8 exposure categories. κ indicated slight to moderate agreement (0.19-0.51) between the 2 methods and was highest for organic dust and overall exposure. Sensitivity of the matrix ranged from 33.9% to 68.5% and was highest for sensitisers, diesel exhaust and overall exposure. Specificity ranged from 74.7% to 97.1% and was highest for fumes, organic dust and mineral dust. This COPD JEM was compared with exposures assigned by experts and offers a generalisable approach to assigning occupational exposure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Chronic obstructive pulmonary disease (COPD): evaluation from clinical, immunological and bacterial pathogenesis perspectives.

    Science.gov (United States)

    Hassett, Daniel J; Borchers, Michael T; Panos, Ralph J

    2014-03-01

    Chronic obstructive pulmonary disease (COPD), a disease manifested by significantly impaired airflow, afflicts ∼14.2 million cases in the United States alone with an estimated 63 million people world-wide. Although there are a number of causes, the predominant cause is excessive tobacco smoke. In fact, in China, there have been estimates of 315,000,000 people that smoke. Other less frequent causes are associated with indirect cigarette smoke, air pollutants, biomass fuels, and genetic mutations. COPD is often associated with heart disease, lung cancer, osteoporosis and conditions can worsen in patients with sudden falls. COPD also affects both innate and adaptive immune processes. Cigarette smoke increases the expression of matrix metalloproteases and proinflammatory chemokines and increases lung titers of natural killer cells and neutrophils. Yet, neutrophil reactive oxygen species (ROS) mediated by the phagocytic respiratory burst and phagocytosis is impaired by nicotine. In contrast to innate immunity in COPD, dendritic cells represent leukocytes recruited to the lung that link the innate immune responses to adaptive immune responses by activating naïve T cells through antigen presentation. The autoimmune process that is also a significant part of inflammation associated with COPD. Moreover, coupled with restricted FEV1 values, are the prevalence of patients with single or multiple infections by bacteria, viruses and fungi. Finally, we focus on one of the more problematic infectious agents, the Gram-negative opportunistic pathogenic bacterium, Pseudomonas aeruginosa. Specifically, we delve into the development of highly problematic biofilm infections that are highly refractory to conventional antibiotic therapies in COPD. We offer a non-conventional, biocidal treatment that may be effective for COPD airway infections as well as with combinations of current antibiotic regimens for more effective treatment outcomes and relief for patients with COPD.

  7. COPD assessment test (CAT): simple tool for evaluating quality of life of chemical warfare patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lari, Shahrzad M; Ghobadi, Hassan; Attaran, Davood; Mahmoodpour, Afsoun; Shadkam, Omid; Rostami, Maryam

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the serious late pulmonary complications caused by sulphur mustard exposure. Health status evaluations of chemical warfare patients with COPD are important to the management of these patients. The aim of this study was to determine the efficacy of the COPD assessment test (CAT) in evaluating the health-related quality of life (HRQOL) of chemical warfare patients with COPD. Eighty-two consecutive patients with stable COPD were enrolled in this study. All subjects were visited by one physician, and the HRQOL was evaluated by the CAT and St. George Respiratory Questionnaires (SGRQs). In addition, a standard spirometry test, 6-min walk distance test and pulse oxymetry were conducted. The severity of the COPD was determined using Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging and the body mass index, obstruction, dyspnoea and exercise (BODE) index. The mean age of the patients was 47.30 ± 7.08 years. The mean CAT score was 26.03 ± 8.28. Thirty-five (43%) patients were in CAT stage 3. There were statistically significant correlations between the CAT and the SGRQ (r = 0.70, P = 0.001) and the BODE index (r = 0.70, P = 0.001). A statistically significant inverse correlation was found between the CAT score and the forced expiratory volume in 1 s (r = -0.30, P = 0.03). Our results demonstrated that the CAT is a simple and valid tool for assessment of HRQOL in chemical warfare patients with COPD and can be used in clinical practice. © 2013 John Wiley & Sons Ltd.

  8. The many "small COPDs": COPD should be an orphan disease

    DEFF Research Database (Denmark)

    Rennard, Stephen I; Vestbo, Jørgen

    2008-01-01

    COPD is one of the most common causes of morbidity and mortality. Perhaps paradoxically, COPD also should be an orphan disease. Importantly, this could advance the development of treatments for COPD. There are two criteria for orphan status in the United States. Most widely known is the criterion...... are prospectively monitored, assuring that rigorous longitudinal data are generated. This approach could encourage the pharmaceutical industry to stratify studies based on a more detailed characterization of study subjects at baseline, thus approaching "many small COPDs" instead of a single large and heterogeneous...

  9. COPD

    Science.gov (United States)

    COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate ...

  10. Disease management programs for patients with COPD in Germany: a longitudinal evaluation of routinely collected patient records.

    Science.gov (United States)

    Mehring, Michael; Donnachie, Ewan; Fexer, Johannes; Hofmann, Frank; Schneider, Antonius

    2014-07-01

    The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort. Copyright © 2014 by Daedalus Enterprises.

  11. Prioritizing chronic obstructive pulmonary disease (COPD) candidate genes in COPD-related networks

    OpenAIRE

    Zhang, Yihua; Li, Wan; Feng, Yuyan; Guo, Shanshan; Zhao, Xilei; Wang, Yahui; He, Yuehan; He, Weiming; Chen, Lina

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is a multi-factor disease, which could be caused by many factors, including disturbances of metabolism and protein-protein interactions (PPIs). In this paper, a weighted COPD-related metabolic network and a weighted COPD-related PPI network were constructed base on COPD disease genes and functional information. Candidate genes in these weighted COPD-related networks were prioritized by making use of a gene prioritization method, respectively. Liter...

  12. Markers of early disease and prognosis in COPD

    DEFF Research Database (Denmark)

    Dahl, Morten; Nordestgaard, Børge G

    2009-01-01

    vary substantially over time. This review explores potential markers of early disease and prognosis in COPD by examining genetic markers in the alpha(1)-antitrypsin, cystic fibrosis transmembrane conductance regulator (CFTR), and MBL-2 genes, and by examining the biochemical markers fibrinogen and C......COPD is a complex disease with multiple pathological components, which we unfortunately tend to ignore when spirometry is used as the only method to evaluate the disorder. Additional measures are needed to allow a more complete and clinically relevant assessment of COPD. The earliest potential risk...... factors of disease in COPD are variations in the genetic background. Genetic variations are present from conception and can determine lifelong changes in enzyme activities and protein concentrations. In contrast, measurements in blood, sputum, exhaled breath, broncho-alveolar lavage, and lung biopsies may...

  13. COPD

    National Research Council Canada - National Science Library

    Charles, Janice; Britt, Helena; Fahridin, Salma

    2010-01-01

    ...) data, chronic obstructive pulmonary disease (COPD) was managed by general practitioners at a rate of 8 per 1000 encounters, which suggests it is managed about 923 000 times per year nationally...

  14. A Microfluidic Platform for Evaluating Neutrophil Chemotaxis Induced by Sputum from COPD Patients.

    Directory of Open Access Journals (Sweden)

    Jiandong Wu

    Full Text Available Chronic Obstructive Pulmonary Disease (COPD is a common lung disease characterized by breathing difficulty as a consequence of narrowed airways. Previous studies have shown that COPD is correlated with neutrophil infiltration into the airways through chemotactic migration. However, whether neutrophil chemotaxis can be used to characterize and diagnose COPD is not well established. In the present study, we developed a microfluidic platform for evaluating neutrophil chemotaxis to sputum samples from COPD patients. Our results show increased neutrophil chemotaxis to COPD sputum compared to control sputum from healthy individuals. The level of COPD sputum induced neutrophil chemotaxis was correlated with the patient's spirometry data. The cell morphology of neutrophils in a COPD sputum gradient is similar to the morphology displayed by neutrophils exposed to an IL-8 gradient, but not a fMLP gradient. In competing gradients of COPD sputum and fMLP, neutrophils chemotaxis and cell morphology are dominated by fMLP.

  15. Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema

    Science.gov (United States)

    ... Submit Button NCHS Home Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema Recommend on Facebook ... to emergency departments with chronic obstructive pulmonary disease (COPD): 6.9 million Source: National Hospital Ambulatory Medical ...

  16. Prioritizing chronic obstructive pulmonary disease (COPD) candidate genes in COPD-related networks.

    Science.gov (United States)

    Zhang, Yihua; Li, Wan; Feng, Yuyan; Guo, Shanshan; Zhao, Xilei; Wang, Yahui; He, Yuehan; He, Weiming; Chen, Lina

    2017-11-28

    Chronic obstructive pulmonary disease (COPD) is a multi-factor disease, which could be caused by many factors, including disturbances of metabolism and protein-protein interactions (PPIs). In this paper, a weighted COPD-related metabolic network and a weighted COPD-related PPI network were constructed base on COPD disease genes and functional information. Candidate genes in these weighted COPD-related networks were prioritized by making use of a gene prioritization method, respectively. Literature review and functional enrichment analysis of the top 100 genes in these two networks suggested the correlation of COPD and these genes. The performance of our gene prioritization method was superior to that of ToppGene and ToppNet for genes from the COPD-related metabolic network or the COPD-related PPI network after assessing using leave-one-out cross-validation, literature validation and functional enrichment analysis. The top-ranked genes prioritized from COPD-related metabolic and PPI networks could promote the better understanding about the molecular mechanism of this disease from different perspectives. The top 100 genes in COPD-related metabolic network or COPD-related PPI network might be potential markers for the diagnosis and treatment of COPD.

  17. The many "small COPDs": COPD should be an orphan disease

    DEFF Research Database (Denmark)

    Rennard, Stephen I; Vestbo, Jørgen

    2008-01-01

    are prospectively monitored, assuring that rigorous longitudinal data are generated. This approach could encourage the pharmaceutical industry to stratify studies based on a more detailed characterization of study subjects at baseline, thus approaching "many small COPDs" instead of a single large and heterogeneous...... COPD. This strategy may help to address the increasing burden that COPD presents and for which no novel clinical class of treatment has been introduced for 30 years....

  18. The health economic impact of disease management programs for COPD: A systematic literature review and meta-analysis

    NARCIS (Netherlands)

    M.R.S. Boland (Melinde); A. Tsiachristas (Apostolos); A.L. Kruis (Annemarije); N.H. Chavannes (Nicolas); M.P.M.H. Rutten-van Mölken (Maureen)

    2013-01-01

    markdownabstract__Abstract__ Background: There is insufficient evidence of the cost-effectiveness of Chronic Obstructive Pulmonary Disease (COPD) Disease Management (COPD-DM) programs. The aim of this review is to evaluate the economic impact of COPD-DM programs and investigate the relation

  19. Evaluation of a Telehealthcare Intervention for Patients with COPD

    DEFF Research Database (Denmark)

    Lilholt, Pernille Heyckendorff

    The healthcare system is facing challenges regarding the treatment of chronic obstructive pulmonary disease (COPD), which necessitating alternative ways to treat these patients. Telehealthcare could be this alternative. A range of studies have been conducted to evaluate the effectiveness of teleh......The healthcare system is facing challenges regarding the treatment of chronic obstructive pulmonary disease (COPD), which necessitating alternative ways to treat these patients. Telehealthcare could be this alternative. A range of studies have been conducted to evaluate the effectiveness...... of telehealthcare, but they generally conclude that there is a need for more large-scale studies to obtain sufficient evidence. In this context, a Danish large-scale trial (TeleCare North) was launched in the North Denmark Region in 2012 to enable the management of COPD from patients’ home environments through...

  20. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD

    Directory of Open Access Journals (Sweden)

    Laura Miranda de Oliveira Caram

    Full Text Available ABSTRACT Objective: To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD in COPD patients according to disease severity. Methods: The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted. Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS score was determined. Results: Of the 50 patients evaluated, 38 (76% had been diagnosed with at least one comorbidity, 21 (42% having been diagnosed with at least one CVD. Twenty-four patients (48% had more than one CVD. Eighteen (36% of the patients were current smokers, 10 (20% had depression, 7 (14% had dyslipidemia, and 7 (14% had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively. The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. Conclusions: Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression, appear to be more prevalent in patients with mild-to-moderate COPD.

  1. Continuing to Confront COPD International Patient Survey : methods, COPD prevalence, and disease burden in 2012-2013

    NARCIS (Netherlands)

    Landis, Sarah H.; Muellerova, Hana; Mannino, David M.; Menezes, Ana M.; Han, MeiLan K.; van der Molen, Thys; Ichinose, Masakazu; Aisanov, Zaurbek; Oh, Yeon-Mok; Davis, Kourtney J.

    2014-01-01

    Purpose: The Continuing to Confront COPD International Patient Survey aimed to estimate the prevalence and burden of COPD globally and to update findings from the Confronting COPD International Survey conducted in 1999-2000. Materials and methods: Chronic obstructive pulmonary disease (COPD)

  2. An Overview of Chronic Obstructive Pulmonary Disease (COPD ...

    African Journals Online (AJOL)

    Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases. With the increasing prevalence of COPD in developing countries a good knowledge of disease burden and process is essential.

  3. VALIDITY OF CAT AND MMRC – DYSPNEA SCORE IN EVALUATION OF COPD SEVERITY

    Directory of Open Access Journals (Sweden)

    Nena Milačić

    2015-03-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is one of the leading causes of morbidity and mortality worldwide. Although predominantly denoted as a pulmonary disease, COPD also presents with various extra-pulmonary effects which influence different aspects of patients’ physical, emotional and mental well-being. Traditionally, evaluation of COPD severity is based on determination of pulmonary function and particularly on forced expiratory volume in 1 second (FEV1. However, numerous evidences show that FEV1 is not a parameter of sufficient strength when compared to the value of clinical symptoms, e.g. shortness of breath, cough, and COPD patients’ quality of life (QoL. Besides, many clinical manifestations of COPD (anxiety, depression and decreased physical ability are best expressed by patients themselves, and can be better determined by appropriate questionnaires. Some of currently recommended questionnaires used worldwide are CAT (COPD assessment test and modified Medical Research Council (mMRC dyspnea score, in combination with FEV1. Global initiative for COPD – GOLD with its current directives from 2013 includes CAT and mMRC parallel with a number of clinical exacerbations and FEV1 as the most valid parameters and based on that, introduces COPD classification into four groups – A,B,C and D, according to the severity of disease. Therefore, we consider that a full insight into the patient’s QoL and treatment efficacy are impossible without introduction of these self-evaluation questionnaires to the classical instrumental respiratory function evaluation in COPD patients.

  4. Chronic Obstructive Pulmonary Disease (COPD): A Review of the ...

    African Journals Online (AJOL)

    Background: Chronic Obstructive Pulmonary disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases(NCDs). With the increasing prevalence of COPD in developing countries a good knowledge of the diagnosis and adequate ...

  5. Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE)

    DEFF Research Database (Denmark)

    Vestbo, J; Anderson, W; Coxson, H O

    2008-01-01

    . Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) is a 3-yr longitudinal study with four specific aims: 1) definition of clinically relevant COPD subtypes; 2) identification of parameters that predict disease progression in these subtypes; 3) examination of biomarkers...

  6. Evidence of eosinophil extracellular trap cell death in COPD: does it represent the trigger that switches on the disease?

    Science.gov (United States)

    Uribe Echevarría, Loli; Leimgruber, Carolina; García González, Jorge; Nevado, Alberto; Álvarez, Ruth; García, Luciana N; Quintar, Amado A; Maldonado, Cristina A

    2017-01-01

    In spite of the numerous studies on chronic obstructive pulmonary disease (COPD), the cellular and molecular basis of the disease’s development remain unclear. Neutrophils and eosinophils are known to be key players in COPD. Recently, neutrophil extracellular trap cell death (NETosis), a mechanism due to decondensation and extrusion of chromatin to form extracellular traps, has been demonstrated in COPD. However, there is limited knowledge about eosinophil extracellular trap cell death (EETosis) and its role in the pathogenesis of COPD. The aim of this study was to evaluate EETosis in stable COPD. Induced sputum obtained from healthy smokers and low exacerbation risk COPD A or B group patients or high exacerbation risk COPD C or D group patients were included. Samples were examined using electron microscopy and immunofluorescence. Healthy smokers (n=10) and COPD A (n=19) group exhibited neutrophilic or paucigranulocytic phenotypes, with NETosis being absent in these patients. In contrast, COPD B (n=29), with eosinophilic or mixed phenotypes, showed EETosis and incipient NETosis. COPD C (n=18) and COPD D groups (n=13) were differentiated from low exacerbation rate-COPD group by the abundant cellular debris, with COPD C group having an eosinophilic pattern and numerous cells undergoing EETosis. A hallmark of this group was the abundant released membranes that often appeared phagocytosed by neutrophils, which coincidentally exhibited early NETosis changes. The COPD D group included patients with a neutrophilic or mixed pattern, with abundant neutrophil extracellular trap-derived material. This study is the first to demonstrate EETosis at different stages of stable COPD. The results suggest a role for eosinophils in COPD pathophysiology, especially at the beginning and during the persistence of the disease, regardless of whether the patient quit smoking, with EETosis debris probably triggering uncontrolled NETosis. The main target of these findings should be young

  7. Online Communication and Chronic Obstructive Pulmonary Disease (COPD)

    DEFF Research Database (Denmark)

    Sølling, Ina Koldkjær; Carøe, Per; Lindgren, Kurt

    2015-01-01

    in “Online Viva”, the objective of which was to support the citi-zens’ participatory health and to prevent exacerbation of COPD. The intention was to include 30 citizens with COPD or another chronic disease. As the demographic development results in more elderly people living longer with chronic dis-eases...

  8. Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    McCullagh, Brian N; Comellas, Alejandro P; Ballas, Zuhair K; Newell, John D; Zimmerman, M Bridget; Azar, Antoine E

    2017-01-01

    Chronic Obstructive Pulmonary Disease is the third leading cause of death in the US, and is associated with periodic exacerbations, which account for the largest proportion of health care utilization, and lead to significant morbidity, mortality, and worsening lung function. A subset of patients with COPD have frequent exacerbations, occurring 2 or more times per year. Despite many interventions to reduce COPD exacerbations, there is a significant lack of knowledge in regards to their mechanisms and predisposing factors. We describe here an important observation that defines antibody deficiency as a potential risk factor for frequent COPD exacerbations. We report a case series of patients who have frequent COPD exacerbations, and who were found to have an underlying primary antibody deficiency syndrome. We also report on the outcome of COPD exacerbations following treatment in a subset with of these patients with antibody deficiency. We identified patients with COPD who had 2 or more moderate to severe exacerbations per year; immune evaluation including serum immunoglobulin levels and pneumococcal IgG titers was performed. Patients diagnosed with an antibody deficiency syndrome were treated with either immunoglobulin replacement therapy or prophylactic antibiotics, and their COPD exacerbations were monitored over time. A total of 42 patients were identified who had 2 or more moderate to severe COPD exacerbations per year. Twenty-nine patients had an underlying antibody deficiency syndrome: common variable immunodeficiency (8), specific antibody deficiency (20), and selective IgA deficiency (1). Twenty-two patients had a follow-up for at least 1 year after treatment of their antibody deficiency, which resulted in a significant reduction of COPD exacerbations, courses of oral corticosteroid use and cumulative annual dose of oral corticosteroid use, rescue antibiotic use, and hospitalizations for COPD exacerbations. This case series identifies antibody deficiency as a

  9. Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD)

    Science.gov (United States)

    McCullagh, Brian N.; Comellas, Alejandro P.; Ballas, Zuhair K.; Newell, John D.; Zimmerman, M. Bridget

    2017-01-01

    Chronic Obstructive Pulmonary Disease is the third leading cause of death in the US, and is associated with periodic exacerbations, which account for the largest proportion of health care utilization, and lead to significant morbidity, mortality, and worsening lung function. A subset of patients with COPD have frequent exacerbations, occurring 2 or more times per year. Despite many interventions to reduce COPD exacerbations, there is a significant lack of knowledge in regards to their mechanisms and predisposing factors. We describe here an important observation that defines antibody deficiency as a potential risk factor for frequent COPD exacerbations. We report a case series of patients who have frequent COPD exacerbations, and who were found to have an underlying primary antibody deficiency syndrome. We also report on the outcome of COPD exacerbations following treatment in a subset with of these patients with antibody deficiency. We identified patients with COPD who had 2 or more moderate to severe exacerbations per year; immune evaluation including serum immunoglobulin levels and pneumococcal IgG titers was performed. Patients diagnosed with an antibody deficiency syndrome were treated with either immunoglobulin replacement therapy or prophylactic antibiotics, and their COPD exacerbations were monitored over time. A total of 42 patients were identified who had 2 or more moderate to severe COPD exacerbations per year. Twenty-nine patients had an underlying antibody deficiency syndrome: common variable immunodeficiency (8), specific antibody deficiency (20), and selective IgA deficiency (1). Twenty-two patients had a follow-up for at least 1 year after treatment of their antibody deficiency, which resulted in a significant reduction of COPD exacerbations, courses of oral corticosteroid use and cumulative annual dose of oral corticosteroid use, rescue antibiotic use, and hospitalizations for COPD exacerbations. This case series identifies antibody deficiency as a

  10. COPD is a systemic disease – the ex trapulmonary manifestations

    African Journals Online (AJOL)

    COPD is defined as a preventable and treatable respiratory disease characterised by partially reversible chronic airflow obstruction.1. There is abnormal inflammation of the lungs in response to the inhalation of noxious particles, particularly cigarette smoke. Although COPD predominantly affects the lungs, there are.

  11. True prevalence of COPD and its association with peripheral arterial disease in the internal medicine ward of a tertiary care hospital.

    Science.gov (United States)

    Tschopp, Jonathan; Dumont, Philippe; Hayoz, Daniel

    2017-07-19

    The primary objective was to determine the prevalence of confirmed chronic obstructive pulmonary disease (COPD) in patients aged 45 years or more who were admitted to the internal medicine ward of our tertiary care hospital (HFR Fribourg, Switzerland), and were either "tagged" as having COPD or at risk for COPD. The secondary objective was to determine the prevalence of the association of COPD with peripheral artery disease (PAD) in this population. We evaluated all consecutive patients aged 45 years, admitted to our internal medicine ward between November 2013 and March 2014. All patients with a diagnosis of COPD, chronic bronchitis and/or lung emphysema in their electronic medical record ("tagged" as COPD) were evaluated for inclusion, as well as patients with at least one classic symptom and one classic risk factor for COPD identified by them on a check-list (patients at risk for COPD). Spirometry, and measurement of ankle-brachial index (ABI) and toe-brachial index when necessary, were performed in each patient once they were clinically stable. One hundred and seventy-two of 888 consecutive patients were included. COPD was found in 81 patients. Amongst the 75 patients tagged as COPD, 65 (87%) were actually suffering from COPD and 10 (13%) carried a false diagnosis. COPD was diagnosed in 16 (16%) of the 97 at-risk patients. PAD was identified in 35 (43%) of patients suffering from confirmed COPD and in 22 (24%) of patients without COPD. There was a significant association between COPD and PAD (p <0.01). COPD was identified in 9% of the 888 patients evaluated. The majority of patients tagged as COPD were accurately diagnosed and a substantial proportion of at-risk patients were underdiagnosed. A significant association between COPD and PAD was found. In smokers, spirometry showing COPD is a useful test to detect patients at higher cardiovascular risk. Thus, we suggest that screening for PAD using an ABI should be proposed to every smoker with confirmed COPD.

  12. The development of an integrated care model for patients with severe or very severe chronic obstructive pulmonary disease (COPD): the COPD-Home model.

    Science.gov (United States)

    Sunde, Synnøve; Walstad, Rolf Aksel; Bentsen, Signe Berit; Lunde, Solfrid J; Wangen, Eva Marie; Rustøen, Tone; Henriksen, Anne Hildur

    2014-09-01

    Adherence to guidelines for managing stable chronic obstructive pulmonary disease (COPD) and its exacerbations is inadequate among healthcare workers and patients. An appropriate care model would meet patient needs, enhance their coping with COPD and improve their quality of life (QOL). This study aims to present the 'COPD-Home' as an integrated care model for patients with severe or very severe COPD. One principle of the COPD-Home model is that hospital treatment should lead to follow up in the patient's home. The model also includes education, improved coordination of levels of care, improved accessibility and a management plan. One of the main elements of the COPD-Home model is the clear role of the home-care nurse. Model development is based on earlier research and clinical experience. It comprises: (i) education provided through an education programme for patients and involved nurses, (ii) joint visits and telephone checks, (iii) a call centre for support and communication with a general practitioner and (iv) an individualised self-management plan including home monitoring and a plan for pharmacological and nonpharmacological interventions. The COPD-Home model attempts to cultivate competences and behaviours of patients and community nurses that better accord with guidelines for interventions. The next step in its development will be to evaluate its ability to assist both healthcare workers and planners to improve the management of COPD, reduce exacerbations and improve QOL and coping among patients with COPD. © 2013 Nordic College of Caring Science.

  13. Influence of COPD Assessment Text (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of COPD patients.

    Science.gov (United States)

    Liu, Jing; Meng, Guangju; Ma, Yi; Zhang, Xia; Chen, Dongmei; Chen, Mengting

    2015-01-01

    The study aimed to evaluate the influence of the COPD Assessment Test (CAT) evaluation and rehabilitation education guidance on the respiratory and motor functions of patients with chronic obstructive pulmonary disease (COPD). Forty-five patients with COPD admitted from Nov. 2012 to Nov. 2013 were treated with combined bronchodilators and inhaled corticosteroids. Thirty-five patients admitted from Nov. 2012 to Nov. 2013 and classified as a study group received rehabilitation education guidance on the basis of the treatment of the control group to compare the quality-of-life-scale score, dyspnea index score, and motor function of the two groups of patients after 48 weeks of treatment. After treatment, the CAT score of both groups of patients was significantly lowered. After 48 weeks of treatment, the respiratory function of both groups was significantly improved, but the Medical Research Council (MRC) scale for the study group after treatment was significantly lower than that for the control group. After 48 weeks of rehabilitation exercises, the 6-minute walk test (6MWT) for patients with COPD was significantly prolonged, but the test results were significantly higher for the study group after treatment than for the control group. After receiving CAT rehabilitation education, COPD patients had significantly improved life quality and significantly enhanced exercise tolerance. The treatment mode may be gradually introduced in future clinic and nursing work.

  14. Comparison and evaluation of two different methods to establish the cigarette smoke exposure mouse model of COPD

    OpenAIRE

    Shu, Jiaze; Li, Defu; Ouyang, Haiping; Huang, Junyi; Long, Zhen; Liang, Zhihao; Chen, Yuqin; Chen, Yiguan; Zheng, Qiuyu; Kuang, Meidan; Tang, Haiyang; Wang, Jian; Lu, Wenju

    2017-01-01

    Animal model of cigarette smoke (CS) –induced chronic obstructive pulmonary disease (COPD) is the primary testing methodology for drug therapies and studies on pathogenic mechanisms of disease. However, researchers have rarely run simultaneous or side-by-side tests of whole-body and nose-only CS exposure in building their mouse models of COPD. We compared and evaluated these two different methods of CS exposure, plus airway Lipopolysaccharides (LPS) inhalation, in building our COPD mouse mode...

  15. Chronic obstructive pulmonary disease phenotypes: the future of COPD

    DEFF Research Database (Denmark)

    Han, MeiLan K; Agusti, Alvar; Calverley, Peter M

    2010-01-01

    Significant heterogeneity of clinical presentation and disease progression exists within chronic obstructive pulmonary disease (COPD). Although FEV(1) inadequately describes this heterogeneity, a clear alternative has not emerged. The goal of phenotyping is to identify patient groups with unique...... prognostic or therapeutic characteristics, but significant variation and confusion surrounds use of the term "phenotype" in COPD. Phenotype classically refers to any observable characteristic of an organism, and up until now, multiple disease characteristics have been termed COPD phenotypes. We, however......, propose the following variation on this definition: "a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death)." This more...

  16. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD.

    Science.gov (United States)

    Caram, Laura Miranda de Oliveira; Ferrari, Renata; Naves, Cristiane Roberta; Coelho, Liana Sousa; Vale, Simone Alves do; Tanni, Suzana Erico; Godoy, Irma

    2016-01-01

    To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.

  17. Chronic Obstructive Pulmonary Disease (COPD): A Review of the ...

    African Journals Online (AJOL)

    DATONYE ALASIA

    COPD often has extrapulmonary manifestations. Principal among these systemic manifestations is skeletal-. 32 muscle dysfunction .Pulmonary rehabilitation ..... Improvement in household stoves and risk of chronic obstructive pulmonary disease in. Xuanwei, China: retrospective cohort study. BMJ 2005;331:1050. 30.

  18. Chronic obstructive pulmonary disease (COPD and occupational exposures

    Directory of Open Access Journals (Sweden)

    Zeni Elena

    2006-06-01

    Full Text Available Abstract Chronic obstructive pulmonary disease (COPD is one of the leading causes of morbidity and mortality in both industrialized and developing countries. Cigarette smoking is the major risk factor for COPD. However, relevant information from the literature published within the last years, either on general population samples or on workplaces, indicate that about 15% of all cases of COPD is work-related. Specific settings and agents are quoted which have been indicated or confirmed as linked to COPD. Coal miners, hard-rock miners, tunnel workers, concrete-manufacturing workers, nonmining industrial workers have been shown to be at highest risk for developing COPD. Further evidence that occupational agents are capable of inducing COPD comes from experimental studies, particularly in animal models. In conclusion, occupational exposure to dusts, chemicals, gases should be considered an established, or supported by good evidence, risk factor for developing COPD. The implications of this substantial occupational contribution to COPD must be considered in research planning, in public policy decision-making, and in clinical practice.

  19. Chronic obstructive pulmonary disease (COPD) and occupational exposures

    Energy Technology Data Exchange (ETDEWEB)

    Piera Boschetto; Sonia Quintavalle; Deborah Miotto; Natalina Lo Cascio; Elena Zeni; Cristina E. Mapp [University of Ferrara, Ferrara (Italy). Department of Experimental and Clinical Medicine

    2006-07-01

    Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in both industrialized and developing countries. Cigarette smoking is the major risk factor for COPD. However, relevant information from the literature published within the last years, either on general population samples or on workplaces, indicate that about 15% of all cases of COPD is work-related. Specific settings and agents are quoted which have been indicated or confirmed as linked to COPD. Coal miners, hard-rock miners, tunnel workers, concrete-manufacturing workers, nonmining industrial workers have been shown to be at highest risk for developing COPD. Further evidence that occupational agents are capable of inducing COPD comes from experimental studies, particularly in animal models. In conclusion, occupational exposure to dusts, chemicals, gases should be considered an established, or supported by good evidence, risk factor for developing COPD. The implications of this substantial occupational contribution to COPD must be considered in research planning, in public policy decision-making, and in clinical practice.

  20. Mental disorders in chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Vögele, Claus; von Leupoldt, Andreas

    2008-05-01

    Recent research using questionnaire measures has demonstrated high prevalence rates of mental disorders in chronic obstructive pulmonary disease (COPD). However, clinical interviews and clinical rather than healthy control groups have rarely been employed. The aim of the present study was to assess mental disorders in patients with COPD with advanced methodology, to identify moderating factors explaining mental co-morbidities and to compare results with a clinical control group without COPD. A standardized clinical interview (F-DIPS) and a range of questionnaires were used to assess mental disorders, perceived physical symptoms and cognitions in 20 hospitalized patients with mild-to-moderate COPD (mean FEV(1)/VC (%)=61.3). Results were compared with a hospitalized clinical control group without pulmonary dysfunction (CCG; N=20). Results showed that 55% of patients with COPD received a diagnosis of a mental disorder compared to 30% of CCG patients. All principal mental diagnoses in the COPD group were anxiety disorders (especially Panic Disorder with Agoraphobia), while CCG patients received a wider range of diagnoses (anxiety, pain, alcohol abuse). There was no systematic association between anxiety levels and respiratory function in the whole COPD group, but a positive correlation between anxiety levels and perceived physical symptoms (p<0.001) as well as negative cognitions (p<0.001 and p<0.05, respectively) for COPD patients with anxiety disorder (N=11). The present results confirm the high prevalence rate of anxiety in patients with COPD and suggest further that anxiety in COPD patients may be mediated by cognitive processes. These findings are discussed in terms of their implications for treatment.

  1. Metabolic syndrome and Chronic Obstructive Pulmonary Disease (COPD): The interplay among smoking, insulin resistance and vitamin D.

    Science.gov (United States)

    Piazzolla, Giuseppina; Castrovilli, Anna; Liotino, Vito; Vulpi, Maria Rosaria; Fanelli, Margherita; Mazzocca, Antonio; Candigliota, Mafalda; Berardi, Elsa; Resta, Onofrio; Sabbà, Carlo; Tortorella, Cosimo

    2017-01-01

    A close relationship between Metabolic Syndrome (MetS) and Chronic Obstructive Pulmonary Disease (COPD) has been described, but the exact nature of this link remains unclear. Current epidemiological data refer exclusively to the MetS prevalence among patients with COPD and data about the prevalence of COPD in MetS patients are still unavailable. To analyse and compare risk factors, clinical and metabolic characteristics, as well as the main respiratory function parameters, among patients affected by MetS, COPD or both diseases. We recruited 59 outpatients with MetS and 76 outpatients with COPD. After medical history collection, physical examination, blood sampling for routine analysis, spirometric evaluation, they were subdivided into MetS (n = 46), MetS+COPD (n = 60), COPD (n = 29). A MetS diagnosis was assigned to 62% of COPD patients recruited in the COPD Outpatients Clinic of the Pneumology Department, while the COPD prevalence in MetS patients enrolled in the Internal Medicine Metabolic Disorders Outpatients Clinic was 22%. More than 60% of subjects enrolled in each Department were unaware that they suffered from an additional disease. MetS+COPD patients exhibited significantly higher C-peptide levels. We also found a positive relation between C-peptide and pack-years in all subjects and a negative correlation between C-peptide and vitamin D only in current smokers. Finally, a negative association emerged between smoking and vitamin D. We have estimated, for the first time, the COPD prevalence in MetS and suggest a potential role of smoking in inducing insulin resistance. Moreover, a direct effect of smoking on vitamin D levels is proposed as a novel mechanism, which may account for both insulin resistance and COPD development.

  2. Surfactant protein D in chornic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Moreno, Dolores; Garcia, Alexis; Lema, Diego; De Sanctis, Juan B

    2014-01-01

    In the recent years, a large number of potential biomarkers for Chronic Obstructive Pulmonary Disease (COPD) have been described. One of the important biomarkers is Surfactant Protein D (SPD) since serum SPD levels have been associated with lung function or health status in patients with severe COPD. Several interesting evidences of the protein and gene polymorphisms have been described. The present review highlights the current literature, recent patents and, future prospects of this important collection.

  3. Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome.

    Science.gov (United States)

    Nakawah, Mohammad Obadah; Hawkins, Clare; Barbandi, Farouk

    2013-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both conditions, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited, different mediators produced, and thus differing responses to therapy. Airway obstruction is typically intermittent and reversible in asthma but is progressive and largely irreversible in COPD. However, there is a considerable pathologic and functional overlap between these 2 heterogeneous disorders, particularly among the elderly, who may have components of both diseases (asthma-COPD overlap syndrome). The definitions for asthma and COPD recommended by current guidelines are useful but limited because they do not illustrate the full spectrum of obstructive airway diseases that is encountered in clinical practice. Defining asthma and COPD as separate entities neglects a considerable proportion of patients with overlapping features and is largely based on expert opinion rather than on the best current evidence. The presence of different phenotypes or components of obstructive airway diseases, therefore, needs to be addressed to individualize and optimize treatment to achieve the best effect with the fewest side effects for the patient. Although specific interventions vary by disease, the treatment goals of obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations.

  4. Image-enhanced bronchoscopic evaluation of bronchial mucosal microvasculature in COPD.

    Science.gov (United States)

    Fathy, Eman Mahmoud; Shafiek, Hanaa; Morsi, Tamer S; El Sabaa, Bassma; Elnekidy, Abdelaziz; Elhoffy, Mohamed; Atta, Mohamed Samy

    2016-01-01

    Bronchial vascular remodeling is an underresearched component of airway remodeling in COPD. Image-enhanced bronchoscopy may offer a less invasive method for studying bronchial microvasculature in COPD. To evaluate endobronchial mucosal vasculature and changes in COPD by image-enhanced i-scan3 bronchoscopy and correlate them pathologically by analyzing bronchial mucosal biopsies. This case-control study analyzed 29 COPD patients (41.4% Global initiative for chronic Obstructive Lung Disease B [GOLD B] and 58.6% GOLD D) and ten healthy controls admitted at Alexandria Main University Hospital, Egypt. Combined high-definition white light bronchoscopy (HD WLB) with i-scan3 was used to evaluate endobronchial mucosal microvasculature. The vascularity was graded according to the level of mucosal red discoloration (ie, endobronchial erythema) from decreased discoloration to normal, mild, moderate, and severe increased red discoloration (G-1, G0, G+1, G+2, and G+3, respectively) and scored by three bronchoscopists independently. Bronchial mucosal biopsies were taken for microvascular density counting using anti-CD34 antibody as angiogenesis marker. Different grades of endobronchial erythema were observed across/within COPD patients using combined HD WLB + i-scan3, with significant agreement among scorers (P=0.031; median score of G+1 [G-1-G+2]) being higher in GOLD D (P=0.001). Endobronchial erythema significantly correlated with COPD duration, exacerbation frequency, and body mass index (Pmicrovasculature and surface changes in COPD, which may represent vasodilatation rather than angiogenesis.

  5. Asthma-COPD overlap. Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Christenson, Stephanie A; Steiling, Katrina; van den Berge, Maarten; Hijazi, Kahkeshan; Hiemstra, Pieter S; Postma, Dirkje S; Lenburg, Marc E; Spira, Avrum; Woodruff, Prescott G

    2015-04-01

    Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and likely includes a subgroup that is biologically comparable to asthma. Studying asthma-associated gene expression changes in COPD could add insight into COPD pathogenesis and reveal biomarkers that predict a favorable response to corticosteroids. To determine whether asthma-associated gene signatures are increased in COPD and associated with asthma-related features. We compared disease-associated airway epithelial gene expression alterations in an asthma cohort (n = 105) and two COPD cohorts (n = 237, 171). The T helper type 2 (Th2) signature (T2S) score, a gene expression metric induced in Th2-high asthma, was evaluated in these COPD cohorts. The T2S score was correlated with asthma-related features and response to corticosteroids in COPD in a randomized, placebo-controlled trial, the Groningen and Leiden Universities study of Corticosteroids in Obstructive Lung Disease (GLUCOLD; n = 89). The 200 genes most differentially expressed in asthma versus healthy control subjects were enriched among genes associated with more severe airflow obstruction in these COPD cohorts (P COPD cohorts. Higher T2S scores correlated with increased airway wall eosinophil counts (P = 0.003), blood eosinophil percentage (P = 0.03), bronchodilator reversibility (P = 0.01), and improvement in hyperinflation after corticosteroid treatment (P = 0.019) in GLUCOLD. These data identify airway gene expression alterations that can co-occur in asthma and COPD. The association of the T2S score with increased severity and "asthma-like" features (including a favorable corticosteroid response) in COPD suggests that Th2 inflammation is important in a COPD subset that cannot be identified by clinical history of asthma.

  6. Asthma–COPD Overlap. Clinical Relevance of Genomic Signatures of Type 2 Inflammation in Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Steiling, Katrina; van den Berge, Maarten; Hijazi, Kahkeshan; Hiemstra, Pieter S.; Postma, Dirkje S.; Lenburg, Marc E.; Spira, Avrum; Woodruff, Prescott G.

    2015-01-01

    Rationale: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and likely includes a subgroup that is biologically comparable to asthma. Studying asthma-associated gene expression changes in COPD could add insight into COPD pathogenesis and reveal biomarkers that predict a favorable response to corticosteroids. Objectives: To determine whether asthma-associated gene signatures are increased in COPD and associated with asthma-related features. Methods: We compared disease-associated airway epithelial gene expression alterations in an asthma cohort (n = 105) and two COPD cohorts (n = 237, 171). The T helper type 2 (Th2) signature (T2S) score, a gene expression metric induced in Th2-high asthma, was evaluated in these COPD cohorts. The T2S score was correlated with asthma-related features and response to corticosteroids in COPD in a randomized, placebo-controlled trial, the Groningen and Leiden Universities study of Corticosteroids in Obstructive Lung Disease (GLUCOLD; n = 89). Measurements and Main Results: The 200 genes most differentially expressed in asthma versus healthy control subjects were enriched among genes associated with more severe airflow obstruction in these COPD cohorts (P COPD cohorts. Higher T2S scores correlated with increased airway wall eosinophil counts (P = 0.003), blood eosinophil percentage (P = 0.03), bronchodilator reversibility (P = 0.01), and improvement in hyperinflation after corticosteroid treatment (P = 0.019) in GLUCOLD. Conclusions: These data identify airway gene expression alterations that can co-occur in asthma and COPD. The association of the T2S score with increased severity and “asthma-like” features (including a favorable corticosteroid response) in COPD suggests that Th2 inflammation is important in a COPD subset that cannot be identified by clinical history of asthma. PMID:25611785

  7. Evidence of eosinophil extracellular trap cell death in COPD: does it represent the trigger that switches on the disease?

    Directory of Open Access Journals (Sweden)

    Uribe Echevarría L

    2017-03-01

    Full Text Available Loli Uribe Echevarría,1 Carolina Leimgruber,2 Jorge García González,1 Alberto Nevado,1 Ruth Álvarez,3 Luciana N García,2 Amado A Quintar,2 Cristina A Maldonado2 1Pneumonology Service, Sanatorio Allende (Nueva Córdoba, Córdoba, Argentina; 2Electronic Microscopy Center, Instituto de Investigaciones en Ciencias de la Salud (INICSA-CONICET, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina; 3Smoking Cessation Cente, Nuevo Hospital San Roque of Córdoba, Córdoba, Argentina Abstract: In spite of the numerous studies on chronic obstructive pulmonary disease (COPD, the cellular and molecular basis of the disease’s development remain unclear. Neutrophils and eosinophils are known to be key players in COPD. Recently, neutrophil extracellular trap cell death (NETosis, a mechanism due to decondensation and extrusion of chromatin to form extracellular traps, has been demonstrated in COPD. However, there is limited knowledge about eosinophil extracellular trap cell death (EETosis and its role in the pathogenesis of COPD. The aim of this study was to evaluate EETosis in stable COPD. Induced sputum obtained from healthy smokers and low exacerbation risk COPD A or B group patients or high exacerbation risk COPD C or D group patients were included. Samples were examined using electron microscopy and immunofluorescence. Healthy smokers (n=10 and COPD A (n=19 group exhibited neutrophilic or paucigranulocytic phenotypes, with NETosis being absent in these patients. In contrast, COPD B (n=29, with eosinophilic or mixed phenotypes, showed EETosis and incipient NETosis. COPD C (n=18 and COPD D groups (n=13 were differentiated from low exacerbation rate-COPD group by the abundant cellular debris, with COPD C group having an eosinophilic pattern and numerous cells undergoing EETosis. A hallmark of this group was the abundant released membranes that often appeared phagocytosed by neutrophils, which coincidentally exhibited

  8. Chronic obstructive pulmonary disease (COPD) patients' disease-related preferences : a study using conjoint analysis.

    Science.gov (United States)

    Pisa, Giovanni; Freytag, Siegfried; Schandry, Rainer

    2013-01-01

    In the management of chronic obstructive pulmonary disease (COPD), knowledge of disease attributes and preferences that are important to patients is crucial. This knowledge may support drug development and optimization of COPD management strategies. To assess patient preferences in COPD and to use the conjoint methodology in order to propose a self-assessment tool based on patients' preferences gained from this conjoint analysis. This tool might then be used in future observational study settings. A two-step procedure was applied: an initial qualitative research module consisting of interviews with eight COPD patients served to assess COPD patients' health state in-depth, their attitudes towards COPD and their information sources regarding the disease, symptomatology, unmet needs, and their preferences for future COPD medications. In the main quantitative research part of the study, 300 patients (with an average age of 55 years) from across Germany suffering from COPD (n = 225 with stage II and n = 75 with stage III COPD) participated. Each participant was presented with 15 different scenarios during the conjoint exercise. Additionally, the Clinical COPD Questionnaire (CCQ) had to be completed and attitudes towards COPD were assessed. According to the participants, the three COPD attributes of the highest relative importance were dyspnea, performance capability, and sleep quality. Frequency of administration of the medication, onset of medication, and emotional state due to COPD base medication played only a minor role. COPD symptoms were reported to have the highest impact on quality of life, according to the CCQ. Our study proposes an alternative utility-based approach of a self-reported health state concept, utilizing the fact that patients with moderate to severe COPD would trade, e.g., ease of administration and onset of medication for relief from dyspnea.

  9. Gastroesophageal reflux disease in COPD: links and risks

    Directory of Open Access Journals (Sweden)

    Lee AL

    2015-09-01

    Full Text Available Annemarie L Lee,1–3 Roger S Goldstein1,2,4 1West Park Healthcare Centre, 2Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; 3Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia; 4Department of Medicine, University of Toronto, Toronto, ON, Canada Abstract: COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the

  10. Hypertensive/Microvascular Disease and COPD: a Case Control Study

    Directory of Open Access Journals (Sweden)

    Sky KH Chew

    2016-01-01

    Full Text Available Background/Aims: This study tested the hypothesis that individuals with chronic obstructive pulmonary disease (COPD have more small vessel disease and more severe disease than an age- and gender- matched hospital patient comparison group. Methods: This was a single centre, case-control study of 151 individuals with COPD (FEV1/VC Results: Patients with COPD had more microvascular retinopathy (121, 80% and 76, 50%; OR 3.98, 95%CI 2.39 to 6.64 and more severe disease (42, 28% and 18, 12%; OR 2.85, 95% CI 1.55 to 5.23 than other hospital patients. COPD remained an independent determinant of microvascular retinopathy (OR 4.56, 95%CI 2.49 to 8.36 after adjusting for gender, hypertension, smoking, and diabetes duration. Retinal arterioles and venules were wider in patients with COPD than other hospital patients (mean difference +6.5µm, 95% confidence interval 1.4 to 11.6; and +17.4µm, 95%CI 9.4 to 25.5, respectively. Larger venules were more common in younger individuals (+0.6 µm, 0.1 to 1.17 with more cigarette exposure (+0.3 µm, 0.2 to 0.5 or a lower serum albumin (+23.0 µm, 6.0 to 40.0. Venular calibre was not different in current and former smokers (p=0.77. There were trends for venules to be larger with more severe COPD (lower FEV1/VC, p=0.09 and with CT-demonstrated emphysema (p=0.06. Conclusions: Hypertensive/microvascular disease is more common and more severe in patients with COPD. This is likely to contribute to the associated increase in cardiac risk.

  11. Development of the chronic obstructive pulmonary disease morning symptom diary (COPD-MSD).

    Science.gov (United States)

    Globe, Gary; Currie, Brooke; Leidy, Nancy Kline; Jones, Paul; Mannino, David; Martinez, Fernando; Klekotka, Paul; O'Quinn, Sean; Karlsson, Niklas; Wiklund, Ingela

    2016-07-16

    The morning tends to be the most difficult time of day for many patients with chronic obstructive pulmonary disease (COPD) when symptoms can limit one's ability to perform even simple activities. Morning symptoms have been linked to higher levels of work absenteeism, thereby increasing the already substantial economic burden associated with COPD. A validated patient-reported outcome (PRO) instrument designed to capture morning symptoms will allow for a more comprehensive approach to the evaluation of treatment benefit in COPD clinical trials. A qualitative interview study was conducted among a sample of symptomatic adults with COPD. Concept elicitation interviews (n = 35) were conducted to identify COPD morning symptoms, followed by cognitive interviews (n = 21) to ensure patient comprehension of the items, instructions and response options of the draft COPD Morning Symptom Diary (COPD-MSD). All interview transcript data were coded using ATLAS.ti software for content analysis. Mean age of the concept elicitation and cognitive interview sample was 65.0 years (±7.5) and 62.3 years (±8.3), respectively. The study sample represented the full range of COPD severity (Global Initiative for Chronic Lung Disease [GOLD] classifications I-IV) and included a mix of racial backgrounds, employment status and educational achievement. During the concept elicitation interviews, the three most frequently reported morning symptoms were shortness of breath (n = 35/35; 100 %), phlegm/mucus (n = 31/35; 88.6 %), and cough (n = 30/35; 85.7 %). A group of clinical and instrument development experts convened to review the concept elicitation data and develop the initial 32-item draft COPD-MSD. Cognitive interviews indicated subjects found the draft COPD-MSD to be comprehensive, clear, and easy to understand. The COPD-MSD underwent minor editorial revisions and streamlining based on cognitive interviews and input from the experts to yield the final 19-item daily

  12. Validation of chronic obstructive pulmonary disease (COPD) diagnoses in healthcare databases: a systematic review protocol.

    Science.gov (United States)

    Rimland, Joseph M; Abraha, Iosief; Luchetta, Maria Laura; Cozzolino, Francesco; Orso, Massimiliano; Cherubini, Antonio; Dell'Aquila, Giuseppina; Chiatti, Carlos; Ambrosio, Giuseppe; Montedori, Alessandro

    2016-06-01

    Healthcare databases are useful sources to investigate the epidemiology of chronic obstructive pulmonary disease (COPD), to assess longitudinal outcomes in patients with COPD, and to develop disease management strategies. However, in order to constitute a reliable source for research, healthcare databases need to be validated. The aim of this protocol is to perform the first systematic review of studies reporting the validation of codes related to COPD diagnoses in healthcare databases. MEDLINE, EMBASE, Web of Science and the Cochrane Library databases will be searched using appropriate search strategies. Studies that evaluated the validity of COPD codes (such as the International Classification of Diseases 9th Revision and 10th Revision system; the Real codes system or the International Classification of Primary Care) in healthcare databases will be included. Inclusion criteria will be: (1) the presence of a reference standard case definition for COPD; (2) the presence of at least one test measure (eg, sensitivity, positive predictive values, etc); and (3) the use of a healthcare database (including administrative claims databases, electronic healthcare databases or COPD registries) as a data source. Pairs of reviewers will independently abstract data using standardised forms and will assess quality using a checklist based on the Standards for Reporting of Diagnostic accuracy (STARD) criteria. This systematic review protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 statement. Ethics approval is not required. Results of this study will be submitted to a peer-reviewed journal for publication. The results from this systematic review will be used for outcome research on COPD and will serve as a guide to identify appropriate case definitions of COPD, and reference standards, for researchers involved in validating healthcare databases. CRD42015029204. Published by the BMJ

  13. COPD - control drugs

    Science.gov (United States)

    Chronic obstructive pulmonary disease - control drugs; Bronchodilators - COPD - control drugs; Beta agonist inhaler - COPD - control drugs; Anticholinergic inhaler - COPD - control drugs; Long-acting inhaler - COPD - control drugs; Corticosteroid inhaler - COPD - control ...

  14. Asthma-COPD Overlap Syndrome (ACOS): Single disease entity or not? Could exhaled nitric oxide be a useful biomarker for the differentiation of ACOS, asthma and COPD?

    Science.gov (United States)

    Karampitsakos, Theodoros; Gourgoulianis, Konstantinos I

    2016-06-01

    Asthma and chronic obstructive pulmonary disease (COPD) represent two major public health problems. However, there is a significant proportion of patients with a mixed asthma-COPD phenotype. This condition is defined as asthma-COPD overlap syndrome (ACOS). Since there are no internationally accepted criteria for the diagnosis of that syndrome, its management remains difficult. Given the fact that patients with ACOS have an increased risk of exacerbation and hospitalization, there is a pressing need for a more targeted approach and better management. We propose that fractional exhaled nitric oxide (FeNO), a marker of eosinophilic inflammation, could help clinicians differentiate ACOS from asthma and COPD. We evaluate this hypothesis, using data derived from the existing literature. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Long-Term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    Science.gov (United States)

    2012-01-01

    very low quality of evidence, LTOT does not prevent readmissions in patients with COPD who have severe hypoxemia. Limited data suggest LTOT increases the risk of hospitalizations. Limited work has been performed evaluating the safety of LTOT by severity of hypoxemia. Based on low to very low quality of evidence, LTOT may have a beneficial effect over time on health-related quality of life in patients with COPD who have severe hypoxemia. Limited work using disease-specific instruments has been performed. Ethical constraints of not providing LTOT to eligible patients with COPD prohibit future studies from examining LTOT outcomes in an ideal way. PMID:23074435

  16. Depressive disorders in older patients with chronic obstructive pulmonary disease (COPD) in Hong Kong: a controlled study.

    Science.gov (United States)

    Wong, Tak-Shun; Xiang, Yu-Tao; Tsoh, Joshua; Ungvari, Gabor S; Ko, Fanny W S; Hui, David S C; Chiu, Helen F K

    2014-07-01

    There have been few studies examining the relationship between chronic obstructive pulmonary disease (COPD) and psychiatric morbidity in Hong Kong. This study aimed to examine the prevalence of depressive disorders (major depression, dysthymia and adjustment disorder with depressed mood) in Chinese patients with COPD and explore their demographic and clinical correlates. A total of 146 patients aged 50 years and above with COPD and 220 age and gender matched control subjects without COPD formed the study sample. Data of demographic and clinical characteristics were collected by a form designed for this study. Activity of daily living was assessed by the Instrumental Activities of Daily Living Scale and life events were evaluated by the Life Event Scale. Depressive disorders were determined using the Chinese version of the Structured Clinical Interview for DSM-IV. The point prevalence of DSM-IV depressive disorders in patients with COPD and controls were 15.1% and 3.6%, respectively. Multivariate analyses revealed that female sex and severe impairment in daily activity functioning were independently associated with depressive disorders. Only 22.7% of the depressed COPD patients had consulted psychiatrists in the past three months. Depressive disorders are significantly higher in COPD patients than controls. The low percentage of depressed patients with COPD seeking psychiatric treatment suggests that there is an unmet need in the psychiatric care of COPD patients.

  17. Supporting the annotation of chronic obstructive pulmonary disease (COPD) phenotypes with text mining workflows.

    Science.gov (United States)

    Fu, Xiao; Batista-Navarro, Riza; Rak, Rafal; Ananiadou, Sophia

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disorder whose recent prevalence has led to an increasing burden on public healthcare. Phenotypic information in electronic clinical records is essential in providing suitable personalised treatment to patients with COPD. However, as phenotypes are often "hidden" within free text in clinical records, clinicians could benefit from text mining systems that facilitate their prompt recognition. This paper reports on a semi-automatic methodology for producing a corpus that can ultimately support the development of text mining tools that, in turn, will expedite the process of identifying groups of COPD patients. A corpus of 30 full-text papers was formed based on selection criteria informed by the expertise of COPD specialists. We developed an annotation scheme that is aimed at producing fine-grained, expressive and computable COPD annotations without burdening our curators with a highly complicated task. This was implemented in the Argo platform by means of a semi-automatic annotation workflow that integrates several text mining tools, including a graphical user interface for marking up documents. When evaluated using gold standard (i.e., manually validated) annotations, the semi-automatic workflow was shown to obtain a micro-averaged F-score of 45.70% (with relaxed matching). Utilising the gold standard data to train new concept recognisers, we demonstrated that our corpus, although still a work in progress, can foster the development of significantly better performing COPD phenotype extractors. We describe in this work the means by which we aim to eventually support the process of COPD phenotype curation, i.e., by the application of various text mining tools integrated into an annotation workflow. Although the corpus being described is still under development, our results thus far are encouraging and show great potential in stimulating the development of further automatic COPD phenotype extractors.

  18. Total management of chronic obstructive pulmonary disease (COPD) as an independent risk factor for cardiovascular disease.

    Science.gov (United States)

    Onishi, Katsuya

    2017-08-01

    Patients with cardiovascular disease (CVD) often have multiple comorbid conditions that may interact with each other, confound the choice of treatments, and reduce mortality. Chronic obstructive pulmonary disease (COPD) is one of the most important comorbidities of CVD, which causes serious consequences in patients with ischemic heart disease, stroke, arrhythmia, and heart failure. COPD shares common risk factors such as tobacco smoking and aging with CVD, is associated with less physical activity, and produces systemic inflammation and oxidative stress. Overall, patients with COPD have a 2-3-fold increased risk of CVD as compared to age-matched controls when adjusted for tobacco smoking. Chronic heart failure (HF) is a frequent and important comorbidity which has a significant impact on prognosis in COPD, and vice versa. HF overlaps in symptoms and signs and has a common comorbidity with COPD, so that diagnosis of COPD is difficult in patients with HF. The combination of HF and COPD presents many therapeutic challenges including beta-blockers (BBs) and beta-agonists. Inhaled long-acting bronchodilators including beta2-agonists and anticholinergics for COPD would not worsen HF. Diuretics are relatively safe, and angiotensin-converting enzyme inhibitors are preferred to treat HF accompanied with COPD. BBs are only relatively contraindicated in asthma, but not in COPD. Low doses of cardioselective BBs should be aggressively initiated in clinically stable patients with HF accompanied with COPD combined with close monitoring for signs of airway obstruction and gradually up-titrated to the maximum tolerated dose. Encouraging appropriate and aggressive treatment for both HF and COPD should be recommended to improve quality of life and mortality in HF patients with COPD. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  19. Does peripheral arterial occlusive disease influence muscle strength and exercise capacity in COPD patients?

    Directory of Open Access Journals (Sweden)

    Natacha Angélica da Fonseca Miranda

    Full Text Available Abstract Background The pathophysiology of chronic obstructive pulmonary disease (COPD is complex and understanding of it has been changing in recent years, with regard to its multisystemic manifestations, especially peripheral dysfunction and its influence on intolerance to exercise. Objectives To evaluate the relationship between peripheral arterial occlusive disease (PAOD and peripheral muscle strength and exercise capacity in COPD patients. Methods We conducted a cross-sectional study of 35 patients with COPD who were evaluated with the Ankle-Brachial Index, handgrip strength test, 1 repetition maximum (1RM of knee extensors and flexors, and distance covered in the incremental shuttle walking test (dISWT. Results COPD patients with coexisting PAOD had lower dominant handgrip strength test results (33.00 vs. 26.66 kgf, p = 0.02 and worse performance in the dISWT (297.32 vs. 219.41 m, p = 0.02 when compared to the COPD patients without PAOD. Strong correlations were found between the result of the handgrip strength test and both the dISWT (r = 0.78; p < 0.001 and the 1RM/knee extension (r = 0.71; p = 0.03; and also between the dISWT and both the 1RM/knee extension (r = 0.72; p = 0.02 and the 1RM/knee flexion (r = 0.92; p < 0.001. The linear regression model showed that the dISWT variable alone explains 15.3% of the Ankle-Brachial Index result (p = 0.01. Conclusion COPD patients with PAOD exhibit reduced muscle strength and lower exercise capacity than COPD patients without PAOD.

  20. Clinical COPD Questionnaire in patients with chronic respiratory disease.

    Science.gov (United States)

    Canavan, Jane L; Dilaver, Deniz; Clark, Amy L; Jones, Sarah E; Nolan, Claire M; Kon, Samantha S C; Man, William D-C

    2014-10-01

    The Clinical Chronic Obstructive Pulmonary Disease (COPD) Questionnaire (CCQ) is an easy to complete, health-related quality of life questionnaire which has been well-validated in COPD. The responsiveness of the CCQ in chronic respiratory disease patients other than COPD has not been previously described. The study aims were to determine if the CCQ in chronic respiratory disease correlates with other health related quality of life questionnaires, to assess the responsiveness of the CCQ to pulmonary rehabilitation and to determine the minimum important difference. The CCQ, COPD Assessment Test (CAT), the Chronic Respiratory Questionnaire (CRQ) and St George's Respiratory Questionnaire (SGRQ) were measured in 138 chronic respiratory disease patients completing pulmonary rehabilitation. Change in CCQ with pulmonary rehabilitation was correlated with change in the other questionnaires. The minimum important difference of the CCQ was calculated using distribution and anchor-based approaches. The CCQ, CAT, CRQ and SGRQ improved significantly with rehabilitation with effect sizes of -0.43, -0.26, 0.62, -0.37. Change in CCQ correlated significantly with CAT, CRQ and SGRQ (r = 0.53, -0.64, 0.30, all P respiratory disease patients, with an MID estimated at -0.4 at the individual level. © 2014 Asian Pacific Society of Respirology.

  1. COPD is a systemic disease – the ex trapulmonary manifestations ...

    African Journals Online (AJOL)

    COPD is a systemic disease – the ex trapulmonary manifestations. C Smith. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's ...

  2. Pneumocystis jirovecii colonization in Chronic Obstructive Pulmonary Disease (COPD

    Directory of Open Access Journals (Sweden)

    Sadegh Khodavaisy

    2015-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is associated with a chronic inflammatory response in airways and lung parenchyma that results in significant morbidity and mortality worldwide. Cigarette smoking considered as an important risk factor plays a role in pathogenesis of disease. Pneumocystis jirovecii is an atypical opportunistic fungus that causes pneumonia in immunosuppressed host, although the low levels of its DNA in patients without signs and symptoms of pneumonia, which likely represents colonization. The increased prevalence of P. jirovecii colonization in COPD patients has led to an interest in understanding its role in the disease. P. jirovecii colonization in these patients could represent a problem for public health since colonized patients could act as a major reservoir and source of infection for susceptible subjects. Using sensitive molecular techniques, low levels of P. jirovecii DNA have been detected in the respiratory tract of certain individuals. It is necessary to elucidate the role of P. jirovecii colonization in the natural history of COPD patients in order to improve the clinical management of this disease. In the current review paper, we discuss P. jirovecii colonization in COPD patients.

  3. Chronic obstructive pulmonary disease (COPD) and old age?

    Science.gov (United States)

    Jarad, Nabil

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) in old age is an increasing problem. Understanding the features of COPD in older patients is important in order to introduce effective interventions and to inform efforts for health resource allocation. Features of importance to old age include increased prevalence of COPD in non-smokers and rise in the rate of systemic comorbidities. In addition, acute exacerbations in older patients have poorer outcome, manifesting by increase in the rate of hospitalisation, greater length of stay, increase of the rate of re-hospitalisation and in mortality rate. Impaired cognitive functions as well as problems affecting hand joints make using inhaled medications less reliable which leads to further deterioration of outcome of care. Even for those who are competent in using inhalers, the evidence for their efficacy in older patients is not certain.

  4. COPD as a disease of accelerated lung aging.

    Science.gov (United States)

    Ito, Kazuhiro; Barnes, Peter J

    2009-01-01

    There is increasing evidence for a close relationship between aging and chronic inflammatory diseases. COPD is a chronic inflammatory disease of the lungs, which progresses very slowly and the majority of patients are therefore elderly. We here review the evidence that accelerating aging of lung in response to oxidative stress is involved in the pathogenesis and progression of COPD, particularly emphysema. Aging is defined as the progressive decline of homeostasis that occurs after the reproductive phase of life is complete, leading to an increasing risk of disease or death. This results from a failure of organs to repair DNA damage by oxidative stress (nonprogrammed aging) and from telomere shortening as a result of repeated cell division (programmed aging). During aging, pulmonary function progressively deteriorates and pulmonary inflammation increases, accompanied by structural changes, which are described as senile emphysema. Environmental gases, such as cigarette smoke or other pollutants, may accelerate the aging of lung or worsen aging-related events in lung by defective resolution of inflammation, for example, by reducing antiaging molecules, such as histone deacetylases and sirtuins, and this consequently induces accelerated progression of COPD. Recent studies of the signal transduction mechanisms, such as protein acetylation pathways involved in aging, have identified novel antiaging molecules that may provide a new therapeutic approach to COPD.

  5. Quality of life in older patients with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study.

    Science.gov (United States)

    Xiang, Yu-Tao; Wong, Tak-Shun; Tsoh, Joshua; Ungvari, Gabor S; Correll, Christoph U; Sareen, Jitender; Penner-Goeke, Kirsten; Ko, Fanny W S; Hui, David S C; Chiu, Helen F K

    2015-04-01

    To date, there have been few studies examining quality of life (QOL) in older patients with chronic obstructive pulmonary disease (COPD) in China. The aim of the study was to assess QOL in Chinese older patients with COPD and explore its demographic and clinical correlates. Case-control study of 142 outpatients with COPD and 218 matched control subjects without COPD. COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥ 2 major COPD symptoms or > 1 major + minor COPD symptoms for ≥ 2 consecutive days). Controls were recruited from social centers in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale (IADL), life events were evaluated with the Life Event Scale, depressive disorders were diagnosed using the Geriatric Depression Scale (GDS), and QOL was measured using the Medical Outcomes Study Short Form-12 (SF-12) and St. George's Respiratory Questionnaire (SGRQ). Compared to controls, patients had significantly lower scores in the physical (PCS score), but not in the mental (MCS score) QOL domain. Multivariate analyses showed that more hospitalizations in the past year significantly contributed to higher PCS score (p = .03), while higher GDS total score contributed to lower MCS score (p = .003). Severe and very severe COPD, more physical illnesses, and higher IADL total score each independently contributed to higher SGRQ total score, explaining 40.0% of the variance (p patients with COPD are likely of considerable benefit for improving QOL in patients with COPD. © 2014 Wiley Periodicals, Inc.

  6. Hypoxemia in patients with COPD: cause, effects, and disease progression

    Directory of Open Access Journals (Sweden)

    Brian D Kent

    2011-03-01

    Full Text Available Brian D Kent1,2, Patrick D Mitchell1, Walter T McNicholas1,21Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Dublin; 2Conway Institute of Biomolecular and Biomedical Research, University College Dublin, IrelandAbstract: Chronic obstructive pulmonary disease (COPD is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.Keywords: COPD, hypoxia, sleep, inflammation, pulmonary hypertension

  7. Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study.

    Science.gov (United States)

    Soysal Tomruk, Melda; Ozalevli, Sevgi; Dizdar, Gorkem; Narin, Selnur; Kilinc, Oguz

    2015-07-01

    Hand dexterity is important for daily living activities and can be related to cognitive functions in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the relationship between cognitive dysfunction and hand dexterity in patients with COPD. 35 COPD patients and 36 healthy individuals were assessed. The Minnesota Hand Dexterity Test and Mini Mental State Examination (MMSE) were used for assessment of cognitive function and hand dexterity. Hand dexterity test scores and cognitive function of COPD patients' were significantly lower than the healthy group (p COPD group (p COPD; however, hand dexterity did not alter according to hypoxemia severity. Hand dexterity which is important in daily living activities should be evaluated in greater detail with further studies in COPD patients.

  8. Comorbidities of COPD

    Directory of Open Access Journals (Sweden)

    Arnaud Cavaillès

    2013-12-01

    Full Text Available By 2020, chronic obstructive pulmonary disease (COPD will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately.

  9. Comorbidities of COPD.

    Science.gov (United States)

    Cavaillès, Arnaud; Brinchault-Rabin, Graziella; Dixmier, Adrien; Goupil, François; Gut-Gobert, Christophe; Marchand-Adam, Sylvain; Meurice, Jean-Claude; Morel, Hugues; Person-Tacnet, Christine; Leroyer, Christophe; Diot, Patrice

    2013-12-01

    By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately.

  10. The Use of Chinese Herbal Medicine in the Treatment of Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Liao, Yen-Nung; Hu, Wen-Long; Chen, Hsuan-Ju; Hung, Yu-Chiang

    2017-01-01

    In Oriental countries, combinations of Chinese herbal products (CHPs) are often utilized as therapeutic agents for chronic obstructive pulmonary disease (COPD). The effects of CHPs on COPD have been previously reported. This study aimed to analyze the frequency of prescription and usage of CHPs in patients with COPD in Taiwan. In this nationwide population-based cross-sectional study, 19,142 patients from a random sample of one million individuals in the Longitudinal Health Insurance Database 2000 (LHID 2000) of the National Health Insurance Research Database (NHIRD) were enrolled from 2000 to 2011. The multiple logistic regression method was used to evaluate the adjusted odds ratios for the utilization of CHPs. For patients with COPD, there was an average of 6.31 CHPs in a single prescription. The most frequently prescribed CHP for COPD was Xiao-Qing-Long-Tang (XQLT) (2.6%), and the most commonly used combination of two formula CHPs was XQLT with Ma-Xing-Gan-Shi-Tang (MXGST) (1.28%). The most commonly used single CHP for COPD was Bulbus Fritillariae (3.65%), and the most commonly used combination of two single CHPs was Bulbus Fritillariae with Puerariae Lobatae (1.09%). These results provide information regarding personalized therapies and may promote further clinical experiments and pharmacologic research on the use of CHPs for the management of COPD. Furthermore, we found that TCM usage was more prevalent among men, younger, manual workers, residents of Northern Taiwan, and patients with chronic bronchitis and asthma. This information on the distribution of TCM usage around the country is valuable to public health policymakers and clinicians.

  11. Continuing to Confront COPD International Patient Survey: methods, COPD prevalence, and disease burden in 2012–2013

    Science.gov (United States)

    Landis, Sarah H; Muellerova, Hana; Mannino, David M; Menezes, Ana M; Han, MeiLan K; van der Molen, Thys; Ichinose, Masakazu; Aisanov, Zaurbek; Oh, Yeon-Mok; Davis, Kourtney J

    2014-01-01

    Purpose The Continuing to Confront COPD International Patient Survey aimed to estimate the prevalence and burden of COPD globally and to update findings from the Confronting COPD International Survey conducted in 1999–2000. Materials and methods Chronic obstructive pulmonary disease (COPD) patients in 12 countries worldwide were identified through systematic screening of population samples. Telephone and face-to-face interviews were conducted between November 2012 and May 2013 using a structured survey that incorporated validated patient-reported outcome instruments. Eligible patients were adults aged 40 years and older who were taking regular respiratory medications or suffered with chronic respiratory symptoms and reported either 1) a physician diagnosis of COPD/emphysema, 2) a physician diagnosis of chronic bronchitis, or 3) a symptom-based definition of chronic bronchitis. The burden of COPD was measured with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) Dyspnea Scale. Results Of 106,876 households with at least one person aged ≥40 years, 4,343 respondents fulfilled the case definition of COPD and completed the full survey. COPD prevalence ranged from 7% to 12%, with most countries falling within the range of 7%–9%. In all countries, prevalence increased with age, and in all countries except the US was greater among men (range 6%–14%) than among women (range 5%–11%). A significant disease burden was observed when considering COPD symptoms or health status, and showed wide variations across countries. Prevalence of moderate-to-severe dyspnea (mMRC scale ≥2) ranged from 27% to 61%, and mean CAT score ranged from 16.0 to 24.8, indicating medium-to-high impairment. Conclusion This survey, representing 12 countries, showed similar rates of estimated COPD prevalence across countries that were higher than those reported a decade ago in the original Confronting COPD International Survey. A significant burden of COPD was

  12. Image-enhanced bronchoscopic evaluation of bronchial mucosal microvasculature in COPD

    Directory of Open Access Journals (Sweden)

    Fathy EM

    2016-09-01

    Full Text Available Eman Mahmoud Fathy,1 Hanaa Shafiek,1 Tamer S Morsi,1,† Bassma El Sabaa,2 Abdelaziz Elnekidy,3 Mohamed Elhoffy,1 Mohamed Samy Atta1 1Chest Diseases Department, 2Pathology Department, 3Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt †Doctor Tamer Morsi passed away on August 15, 2014 Background: Bronchial vascular remodeling is an underresearched component of airway remodeling in COPD. Image-enhanced bronchoscopy may offer a less invasive method for studying bronchial microvasculature in COPD. Objectives: To evaluate endobronchial mucosal vasculature and changes in COPD by image-enhanced i-scan3 bronchoscopy and correlate them pathologically by analyzing bronchial mucosal biopsies. Methods: This case–control study analyzed 29 COPD patients (41.4% Global initiative for chronic Obstructive Lung Disease B [GOLD B] and 58.6% GOLD D and ten healthy controls admitted at Alexandria Main University Hospital, Egypt. Combined high-definition white light bronchoscopy (HD WLB with i-scan3 was used to evaluate endobronchial mucosal microvasculature. The vascularity was graded according to the level of mucosal red discoloration (ie, endobronchial erythema from decreased discoloration to normal, mild, moderate, and severe increased red discoloration (G-1, G0, G+1, G+2, and G+3, respectively and scored by three bronchoscopists independently. Bronchial mucosal biopsies were taken for microvascular density counting using anti-CD34 antibody as angiogenesis marker. Results: Different grades of endobronchial erythema were observed across/within COPD patients using combined HD WLB + i-scan3, with significant agreement among scorers (P=0.031; median score of G+1 [G-1–G+2] being higher in GOLD D (P=0.001. Endobronchial erythema significantly correlated with COPD duration, exacerbation frequency, and body mass index (P<0.05. Angiogenesis was significantly decreased among COPD patients versus controls (10.6 [8–13.3] vs 14 [11

  13. Adherence to disease management programs in patients with COPD

    Science.gov (United States)

    George, Johnson; Kong, David CM; Stewart, Kay

    2007-01-01

    The management of COPD is complex and patient adherence to treatment recommendations is known to be poor. In this paper the methods used for evaluating adherence in COPD are compared. Self-reporting has satisfactory reliability and offers a cheap, simple and easy method for assessing adherent behaviors. Unlike the objective measures of adherence such as electronic monitoring, self-reporting helps in identifying the reasons for nonadherence, which in turn would be useful in addressing adherence issues. Patients do not follow their treatment recommendations either intentionally or unintentionally. Intentional deviations are driven by patient beliefs and experiences about illness and treatment, which are in turn influenced by social and cultural factors. Unintentional deviations are often due to cognitive impairment and lack of routines. Factors associated with adherence in COPD have been explained using the Becker-Maiman model. Strategies for overcoming nonadherence have to be formulated based on the nature and reasons for nonadherence. In the event of unintentional nonadherence, the use of adherence aids like Dosette boxes, calendar packs and reminders should be promoted. Understanding patient beliefs and experiences, patient education focusing on the pathology of COPD and the role of treatment, periodic monitoring and reinforcement are critical for overcoming the barriers of intentional nonadherence. PMID:18229563

  14. Evaluation of Chronic Obstructive Pulmonary Disease (COPD) and reduced ejection fraction heart failure (HFrEF) discharge medication prescribing: Is drug therapy concordant with national guidelines associated with a reduction in 30-day readmissions?

    Science.gov (United States)

    Richardson, Amy; Tolley, Elizabeth; Hartmann, Jonathan; Reedus, Jasmine; Bowlin, Brandi; Finch, Christopher; Sands, Christopher W; Self, Timothy

    2016-10-01

    Approximately 1 in 5 hospitalized COPD patients are readmitted within 30 days of discharge. CHF coexists in more than 20% of patients with COPD, and is associated with early readmission for COPD. Reducing 30-day hospital readmissions for COPD is of intense current interest. A retrospective chart review was performed to identify patients discharged with COPD exacerbation and HFrEF. The primary objective was to evaluate if discharge medication prescribing following guidelines for both COPD and HFrEF correlates with reduced 30-day readmission rates. The study included 281 admissions with 39.1% prescribed appropriate discharge medications for both COPD and HFrEF; 30-day readmission rate was 24.5% for these patients compared to 31.1% that were not prescribed appropriate medications (p = 0.24). Beta blockers, ACE inhibitors or ARBS, and aldosterone antagonists were under-prescribed, but this did not significantly associate with increased readmission (p = 0.51, p = 0.23 or 0.99, and p = 0.18, respectively). Those prescribed hydralazine or nitrates were more likely to readmit (both p = 0.01). Diabetes and hyperlipidemia were associated with increased readmission (p = 0.01 and 0.05). This study did not show a significant difference in 30-day readmission rate based on appropriate discharge medications for both COPD and HFrEF. The comorbidities diabetes and hyperlipidemia and prescription of hydralazine or nitrates were significantly associated with increased readmission rate. Larger patient populations may be needed to assess if guideline based discharge medication prescribing is associated with reduced 30-day readmissions for COPD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. The COPD Assessment Test as a Prognostic Marker in Interstitial Lung Disease

    Directory of Open Access Journals (Sweden)

    Fujiko Someya

    2016-01-01

    Full Text Available The chronic obstructive pulmonary disease (COPD Assessment Test (CAT, which was developed to measure the health status of patients with COPD, was applied to patients with interstitial lung disease, aiming to examine the CAT as a predictor of outcome. Over a follow-up period of more than one year, 101 consecutive patients with interstitial lung disease were evaluated by the CAT. The CAT scores of 40 in total were categorized into four subsets according to the severity. Patients with higher (more severe scores exhibited lower forced vital capacity and lung diffusion capacity for carbon monoxide. The survival rate was significantly lower in patients with higher scores (log-rank test, P = 0.0002, and the hazard ratios for death of the higher scores and lower lung diffusion capacity for carbon monoxide were independently significant. These findings suggest that CAT can indicate the risk of mortality in patients with interstitial lung disease.

  16. Response of the COPD Assessment Test to pulmonary rehabilitation in unselected chronic respiratory disease.

    Science.gov (United States)

    Kon, Samantha S C; Clark, Amy L; Dilaver, Deniz; Canavan, Jane L; Patel, Mehul S; Polkey, Michael I; Man, William D-C

    2013-08-01

    The COPD Assessment Test (CAT) is a recently introduced, simple-to-use health status instrument that takes less time to complete than better-established health status instruments. In chronic obstructive pulmonary disease (COPD) patients, the CAT improves with pulmonary rehabilitation (PR), and changes correlate with improvements in longer-established health status instruments such as the Chronic Respiratory Questionnaire (CRQ). Increasing numbers of non-COPD patients are referred for PR, but it is not known whether the CAT is responsive to PR in these populations. The CAT score was prospectively measured in 365 consecutive patients (255 COPD, 110 non-COPD) before and after an 8-week PR programme. Pre to post change in CAT was calculated for COPD and non-COPD patients, and correlated with change in the CRQ. For both non-COPD and COPD patients, there was a similar and significant improvement in the mean (95% confidence interval) CAT score following PR (non-COPD: -2.1 (-1.0, -3.2) vs COPD: -3.0 (-2.2, -3.8); P = 0.19). Change in CAT was significantly correlated with all domains of the CRQ in non-COPD patients (all P respiratory disease patients undergoing PR, the CAT is a practical alternative to longer-established health status questionnaires. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  17. Relationship between femur neck bone mineral density and prevalent chronic obstructive pulmonary disease (COPD) or COPD mortality in older non-Hispanic white adults from NHANES III.

    Science.gov (United States)

    Looker, A C

    2014-03-01

    The relationship between femur neck bone mineral density (FNBMD), prevalent COPD, and COPD mortality was examined in older non-Hispanic white adults from NHANES III. FNBMD was significantly related to prevalent COPD and COPD mortality before and after adjusting for shared risk factors. Bone mineral density (BMD) has been linked to chronic obstructive pulmonary disease (COPD), but little is known about its relationship with COPD mortality. The present study examined the relationship between FNBMD, prevalent COPD, and COPD mortality in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). COPD status at baseline was defined by self-reported physician's diagnosis and by airway obstruction based on spirometry measurements in 3,275 non-Hispanic whites aged 50 years and older. COPD mortality cases were identified using linked mortality records obtained through 2006. FNBMD was measured by dual-energy x-ray absorptiometry. Multiple regression was used to examine the baseline relationship between COPD and FNBMD. Cox proportional hazards models were used to estimate the hazards ratio (HR) for COPD mortality by FNBMD. Twelve percent self-reported a physician's diagnosis of COPD, 23 % had mild or moderate airway obstruction, and 9 % had severe or very severe airway obstruction. There were 180 COPD mortality cases in the sample. FNBMD was significantly lower in those with self-reported COPD diagnosis or airway obstruction before and after adjusting for shared risk factors (p COPD mortality risk was significantly increased for each standard deviation decline in FNBMD before (by 68 %) and after (by 26-38 %) adjusting for shared risk factors. Low FNBMD was associated with both baseline COPD and future COPD mortality. Shared risk factors appeared to explain some, but not all, of these relationships.

  18. The COPD-SIB: a newly developed disease-specific item bank to measure health-related quality of life in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Paap, Muirne C S; Lenferink, Lonneke I M; Herzog, Nadine; Kroeze, Karel A; van der Palen, Job

    2016-06-27

    Health-related quality of life (HRQoL) is widely used as an outcome measure in the evaluation of treatment interventions in patients with chronic obstructive pulmonary disease (COPD). In order to address challenges associated with existing fixed-length measures (e.g., too long to be used routinely, too short to ensure both content validity and reliability), a COPD-specific item bank (COPD-SIB) was developed. Items were selected based on literature review and interviews with Dutch COPD patients, with a strong focus on both content validity and item comprehension. The psychometric quality of the item bank was evaluated using Mokken Scale Analysis and parametric Item Response Theory, using data of 666 COPD patients. The final item bank contains 46 items that form a strong scale, tapping into eight important themes that were identified based on literature review and patient interviews: Coping with disease/symptoms, adaptability; Autonomy; Anxiety about the course/end-state of the disease, hopelessness; Positive psychological functioning; Situations triggering or enhancing breathing problems; Symptoms; Activity; Impact. The 46-item COPD-SIB has good psychometric properties and content validity. Items are available in Dutch and English. The COPD-SIB can be used as a stand-alone instrument, or to inform computerised adaptive testing.

  19. Hypoxemia in patients with COPD: cause, effects, and disease progression.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-02-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation\\/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.

  20. Hypoxemia in patients with COPD: cause, effects, and disease progression

    Science.gov (United States)

    Kent, Brian D; Mitchell, Patrick D; McNicholas, Walter T

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain. PMID:21660297

  1. Health-related quality of life is related to COPD disease severity

    Directory of Open Access Journals (Sweden)

    Rönmark Eva

    2005-09-01

    Full Text Available Abstract Background The aim of this study was to evaluate the association between health-related quality of life (HRQL and disease severity using lung function measures. Methods A survey was performed in subjects with COPD in Sweden. 168 subjects (70 women, mean age 64.3 years completed the generic HRQL questionnaire, the Short Form 36 (SF-36, the disease-specific HRQL questionnaire; the St George's Respiratory Questionnaire (SGRQ, and the utility measure, the EQ-5D. The subjects were divided into four severity groups according to FEV1 per cent of predicted normal using two clinical guidelines: GOLD and BTS. Age, gender, smoking status and socio-economic group were regarded as confounders. Results The COPD severity grades affected the SGRQ Total scores, varying from 25 to 53 (GOLD p = 0.0005 and from 25 to 45 (BTS p = 0.0023. The scores for SF-36 Physical were significantly associated with COPD severity (GOLD p = 0.0059, BTS p = 0.032. No significant association were noticed for the SF-36, Mental Component Summary scores and COPD severity. Scores for EQ-5D VAS varied from 73 to 37 (GOLD I-IV p = 0.0001 and from 73 to 50 (BTS 0-III p = 0.0007. The SGRQ Total score was significant between age groups (p = 0.0047. No significant differences in HRQL with regard to gender, smoking status or socio-economic group were noticed. Conclusion The results show that HRQL in COPD deteriorates with disease severity and with age. These data show a relationship between HRQL and disease severity obtained by lung function.

  2. COPD stage and risk of hospitalization for infectious disease

    DEFF Research Database (Denmark)

    Benfield, Thomas; Lange, Peter; Vestbo, Jørgen

    2008-01-01

    hospitalizations (IDHs) occurred during 230,653 person-years of follow-up (PY), corresponding to an overall incidence of 145 IDHs (95% confidence interval [CI], 139 to 149) per 10,000 PY. The incidence increased with GOLD stage, from 131 (95% CI, 126 to 136) for normal COPD, to 170 (95% CI, 146 to 193) for mild......, or other infectious diseases. CONCLUSIONS: The presence of obstructive lung disease is a significant predictor of IDH caused by respiratory tract infections, but not of hospitalizations due to infections outside the respiratory system....

  3. Microparticles in sputum of COPD patients: a potential biomarker of the disease?

    Directory of Open Access Journals (Sweden)

    Lacedonia D

    2016-03-01

    Full Text Available Donato Lacedonia,1,* Giovanna Elisiana Carpagnano,1,* Teresa Trotta,2 Grazia Pia Palladino,1 Maria Antonietta Panaro,3 Liugi Davide Zoppo,1 Maria Pia Foschino Barbaro,1 Chiara Porro21Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, 2Department of Clinical and Experimental Medicine, University of Foggia, Foggia, 3Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy*These authors contributed equally to this workBackground: Microparticles (MPs are small membrane vesicles of 0.1–1 µm which are released by cells following chemical, physical, and apoptotic stimuli. MPs represent more than a miniature version of the cell. Their composition and function depend not only on cellular origin, but also on stimuli. Chronic obstructive pulmonary disease (COPD is a lung disease characterized by nearly irreversible lung destruction which results in airway limitation.Purpose: We investigated the presence and source of MPs in sputum of COPD patients to evaluate if changes in MP number and origin may reflect the pathophysiological conditions of disease and may serve as potential biomarkers for diagnostic and prognostic use.Methods: Induced sputum samples were collected from 18 male subjects and liquefied with Sputasol. MPs obtained were immunolabeled for leukocyte (CD11a, granulocyte (CD66b, monocyte-macrophage (CD11b, platelets and megakaryocytic cells (CD41, endothelial cells (CD31, and red blood cells (CD235ab and analyzed by cytofluorimetry.Results: There was a negative correlation between CD31-MPs and forced expiratory volume in 1 second (R=−53, P<0.05 and CD66b-MP level was correlated with worse performance index of COPD such as the Body mass index airflow Obstruction, Dyspnea, and Exercise capacity (BODE; they were negatively correlated with 6-minute walking test: 0.65 and −0.64, respectively (P<0.05. CD235ab-MPs showed a negative correlation with body mass index (R=−0.86, P

  4. COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study

    Science.gov (United States)

    Denguezli, Meriam; Daldoul, Hager; Harrabi, Imed; Gnatiuc, Louisa; Coton, Sonia; Burney, Peter; Tabka, Zouhair

    2016-01-01

    Background It’s currently well known that smoking and increasing age constitute the most important risk factors for chronic obstructive pulmonary disease (COPD). However, little is known about COPD among nonsmokers. The present study aimed to investigate prevalence, risk factors and the profiles of COPD among nonsmokers based on the Tunisian Burden of Obstructive Lung Disease (BOLD) study. Methods 807 adults aged 40 years+ were randomly selected from the general population. We collected information about history of respiratory disease, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed for assessment of COPD. COPD diagnostic was based on the post-bronchodilator FEV1/FVC ratio, according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. The lower limit of normal (LLN) was determined as an alternative threshold for the FEV1/FVC ratio. Results and Conclusions Among 485 nonsmokers, 4.7% met the criteria for GOLD grade I and higher COPD. These proportions were similar even when the LLN was used as a threshold. None of the nonsmokers with COPD reported a previous doctor diagnosis of COPD compared to 7.1% of smokers. Nonsmokers accounted for 45.1% of the subjects fulfilling the GOLD spirometric criteria of COPD. Nonsmokers were predominately men and reported more asthma problems than obstructed smokers. Among nonsmokers significantly more symptoms and higher co-morbidity were found among those with COPD. Increasing age, male gender, occupational exposure, lower body mass index and a previous diagnosis of asthma are associated with increased risk for COPD in nonsmokers. This study confirms previous evidence that nonsmokers comprise a substantial proportion of individuals with COPD. Nonsmokers with COPD have a specific profile and should, thus, receive far greater attention to prevent and treat chronic airway obstruction. PMID:27010214

  5. Pneumonia as comorbidity in chronic obstructive pulmonary disease (COPD). Differences between acute exacerbation of COPD and pneumonia in patients with COPD.

    Science.gov (United States)

    Boixeda, Ramon; Bacca, Sandra; Elias, Lorena; Capdevila, Josep Anton; Vilà, Xavier; Mauri, Montserrat; Almirall, Jordi

    2014-12-01

    Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n=104) or PCOPD (n=20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P<.01) and need for oxygen therapy (P<.05). PCOPD patients showed increased presence of fever (P<.05), lower blood pressure (P<.001), more laboratory abnormalities (P<.05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P<.01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  6. COPD uncovered : an international survey on the impact of chronic obstructive pulmonary disease [COPD] on a working age population

    NARCIS (Netherlands)

    Fletcher, Monica J.; Upton, Jane; Taylor-Fishwick, Judith; Buist, Sonia A.; Jenkins, Christine; Hutton, John; Barnes, Neil; Van der Molen, Thys; Walsh, John W.; Jones, Paul; Walker, Samantha

    2011-01-01

    Background: Approximately 210 million people are estimated to have chronic obstructive pulmonary disease [COPD] worldwide. The burden of disease is known to be high, though less is known about those of a younger age. The aim of this study was to investigate the wider personal, economic and societal

  7. Prevalence and Determinants of Chronic Obstructive Pulmonary Disease (COPD) in Bangladesh.

    Science.gov (United States)

    Alam, Dewan S; Chowdhury, Muhammad Ah; Siddiquee, Ali T; Ahmed, Shyfuddin; Clemens, John D

    2015-01-01

    There is a paucity of population-based data on COPD prevalence and its determinants in Bangladesh. To measure COPD prevalence and socioeconomic and lifestyle determinants among ≥40 years Bangladeshi adults. In a cross-sectional study, we measured lung function of 3744 randomly selected adults ≥40 years from rural and urban areas in Bangladesh, using a handheld spirometer. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) COPD was also assessed by the lower limit of normal (LLN) threshold defined as lower fifth percentile for the predicted FEV1/FVC. The prevalence of COPD was 13.5% by GOLD criteria and 10.3% by LLN criteria. Prevalence of COPD was higher among rural than urban residents and in males than females. More than half of the COPD cases were stage II COPD by both criteria. Milder cases (Stages I and II) were over estimated by the GOLD fixed criteria, but more severe cases (Stages III and IV) were similarly classified. In multiple logistic regression analysis, older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD. COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD.

  8. Chronic obstructive pulmonary disease (COPD) assessment test scores corresponding to modified Medical Research Council grades among COPD patients.

    Science.gov (United States)

    Lee, Chang-Hoon; Lee, Jinwoo; Park, Young Sik; Lee, Sang-Min; Yim, Jae-Joon; Kim, Young Whan; Han, Sung Koo; Yoo, Chul-Gyu

    2015-09-01

    In assigning patients with chronic obstructive pulmonary disease (COPD) to subgroups according to the updated guidelines of the Global Initiative for Chronic Obstructive Lung Disease, discrepancies have been noted between the COPD assessment test (CAT) criteria and modified Medical Research Council (mMRC) criteria. We investigated the determinants of symptom and risk groups and sought to identify a better CAT criterion. This retrospective study included COPD patients seen between June 20, 2012, and December 5, 2012. The CAT score that can accurately predict an mMRC grade ≥ 2 versus COPD patients, the percentages of patients classified into subgroups A, B, C, and D were 24.5%, 47.2%, 4.2%, and 24.1% based on CAT criteria and 49.3%, 22.4%, 8.9%, and 19.4% based on mMRC criteria, respectively. More than 90% of the patients who met the mMRC criteria for the 'more symptoms group' also met the CAT criteria. AUROC and CART analyses suggested that a CAT score ≥ 15 predicted an mMRC grade ≥ 2 more accurately than the current CAT score criterion. During follow-up, patients with CAT scores of 10 to 14 did not have a different risk of exacerbation versus those with CAT scores COPD patients.

  9. Sagittal-lung CT measurements in the evaluation of asthma-COPD overlap syndrome: a distinctive phenotype from COPD alone.

    Science.gov (United States)

    Qu, Yanjuan; Cao, Yiyuan; Liao, Meiyan; Lu, Zhiyan

    2017-07-01

    This study aimed at investigating the capability of sagittal-lung computed tomography (CT) measurements in differentiating chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). Clinical and high-resolution CT of 229 patients including 123 pure COPD patients and 106 ACOS patients were included. Sagittal-lung CT measurements in terms of bilateral lung height (LH), anterior-posterior lung diameter (APLD), diaphragm height (DH), and anterior sterno-diaphragmatic angle (ASDA), as well as inter-pulmonary septum length (IPSL) on axial images were measured both before and after bronchodilator (BD) administration. Comparisons of clinical characteristics and CT measurements between patient groups were performed. All pre-BD quantitative sagittal features measuring diaphragm flattening and hyperinflation were not significantly different between patients with COPD and patients with ACOS (P values all >0.05). Following BD administration, the ACOS patients exhibited lower left LH, bilateral APLD, and bilateral ASDA, but higher right DH, compared to pure COPD patients (P values all <0.05). Right LH, left DH and IPSL were not significantly different between patient groups. Besides, variations of all sagittal-lung CT measurements were significantly larger in patients with ACOS than in patients with pure COPD (P values all <0.001) and showed high performance in differentiating these two kinds of patient, with diagnostic sensitivities ranging from 76.4 to 97.2%, specificities ranging from 86.2 to 100.0%, and accuracies ranging from 80.9 to 90.7%. Sagittal-lung CT measurements allow for differentiating patients with ACOS from those with pure COPD. The ACOS patients had larger post-BD variations of sagittal-lung CT measurements than patients with pure COPD.

  10. Continuing to Confront COPD International Patient Survey: methods, COPD prevalence, and disease burden in 2012–2013

    Directory of Open Access Journals (Sweden)

    Landis SH

    2014-06-01

    Full Text Available Sarah H Landis,1 Hana Muellerova,1 David M Mannino,2 Ana M Menezes,3 MeiLan K Han,4 Thys van der Molen,5 Masakazu Ichinose,6 Zaurbek Aisanov,7 Yeon-Mok Oh,8 Kourtney J Davis,9 1Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, UK; 2University of Kentucky College of Public Health, Lexington, KY, USA; 3Federal University of Pelotas, Pelotas, Brazil; 4Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 5University Medical Center Groningen, Groningen, Netherlands; 6Tohoku University Graduate School of Medicine, Sendai, Japan; 7Pulmonology Research Institute, Moscow, Russia; 8University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 9Worldwide Epidemiology, GlaxoSmithKline, Wavre, Belgium Purpose: The Continuing to Confront COPD International Patient Survey aimed to estimate the prevalence and burden of COPD globally and to update findings from the Confronting COPD International Survey conducted in 1999–2000. Materials and methods: Chronic obstructive pulmonary disease (COPD patients in 12 countries worldwide were identified through systematic screening of population samples. Telephone and face-to-face interviews were conducted between November 2012 and May 2013 using a structured survey that incorporated validated patient-reported outcome instruments. Eligible patients were adults aged 40 years and older who were taking regular respiratory medications or suffered with chronic respiratory symptoms and reported either 1 a physician diagnosis of COPD/emphysema, 2 a physician diagnosis of chronic bronchitis, or 3 a symptom-based definition of chronic bronchitis. The burden of COPD was measured with the COPD Assessment Test (CAT and the modified Medical Research Council (mMRC Dyspnea Scale. Results: Of 106,876 households with at least one person aged ≥40 years, 4,343 respondents fulfilled the case definition of COPD and completed the full survey. COPD prevalence ranged from 7% to 12%, with

  11. Chronic Obstructive Pulmonary Disease (COPD): Data and Statistics

    Science.gov (United States)

    ... and Statistics Recommend on Facebook Tweet Share Compartir COPD Death Rates in the United States Printable Version [ ... Ohio and Mississippi Rivers. Printable Version [PDF 733KB] COPD Prevalence in the United States Printable Version [PDF ...

  12. COPD: Health Care Utilisation Patterns with Different Disease Management Interventions.

    Science.gov (United States)

    Luk, Edwin K; Hutchinson, Anastasia F; Tacey, Mark; Irving, Louis; Khan, Fary

    2017-08-01

    The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality. This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances. 517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50-0.92) was seen in those who were PR completers compared to patients who received IDM only. Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation; however, the addition of PR did not reduce healthcare usage further.

  13. A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT).

    Science.gov (United States)

    Suzuki, Masao; Muro, Shigeo; Ando, Yuki; Omori, Takashi; Shiota, Tetsuhiro; Endo, Kazuo; Sato, Susumu; Aihara, Kensaku; Matsumoto, Masataka; Suzuki, Shinko; Itotani, Ryo; Ishitoko, Manabu; Hara, Yoshikazu; Takemura, Masaya; Ueda, Tetsuya; Kagioka, Hitoshi; Hirabayashi, Masataka; Fukui, Motonari; Mishima, Michiaki

    2012-06-11

    Dyspnea on exertion (DOE) is a major symptom of chronic obstructive pulmonary disease (COPD) and is difficult to control. This study was performed to determine whether acupuncture is superior to placebo needling in improving DOE in patients with COPD who are receiving standard medication. Sixty-eight of 111 patients from the Kansai region of Japan who were diagnosed as having COPD and were receiving standard medication participated in a randomized, parallel-group, placebo-controlled trial (July 1, 2006, through March 31, 2009) in which the patients, evaluators, and statistician were unaware of the random allocation. Participants were randomly assigned to traditional acupuncture (real acupuncture group, n=34) or placebo needling (placebo acupuncture group, n=34). Both groups received real or placebo needling at the same acupoints once a week for 12 weeks. The primary end point was the modified Borg scale score evaluated immediately after the 6-minute walk test. Measurements were obtained at baseline and after 12 weeks of treatment. After 12 weeks, the Borg scale score after the 6-minute walk test was significantly better in the real acupuncture group compared with the placebo acupuncture group (mean [SD] difference from baseline by analysis of covariance, -3.6 [1.9] vs 0.4 [1.2]; mean difference between groups by analysis of covariance, -3.58; 95% CI, -4.27 to -2.90). Patients with COPD who received real acupuncture also experienced improvement in the 6-minute walk distance during exercise, indicating better exercise tolerance and reduced DOE. This study clearly demonstrates that acupuncture is a useful adjunctive therapy in reducing DOE in patients with COPD. umin.ac.jp/ctr Identifier: UMIN000001277.

  14. Study Design and Interim Outcomes of Guangzhou Institute of Respiratory Disease COPD Biobank.

    Science.gov (United States)

    Lu, Wenju; Zheng, Zeguang; Chen, Xindong; Tan, Hui; Wang, Jian; Zhang, Zili; Zheng, Jinping; Chen, Rongchang; Zhang, Chenting; Xu, Xiaoming; Chen, Yuqin; Yang, Quan; Xiong, Mingmei; Guo, Meihua; Zhou, Qipeng; Tang, Chun; Wang, Yingfeng; Ye, Jinmei; Li, Defu; Shu, Jiaze; Tan, Shu; Xu, Chuyi; Wang, Yan; Lai, Ning; Yang, Kai; Lu, Jiachun; Ran, Pixin; Zhong, Nanshan

    2016-01-01

    GIRD COPD Biobank is a multicenter observational study blood-based database with local characteristics, in order to investigate the causes, risk factors, pathogenesis, prevalence patterns and trends of COPD and promote new pathogenic insights in China. We enrolled 855 clinically COPD patients and 660 controls with normal lung function. Extensive data collection has been undertaken with questionnaires, clinical measurements, and collection and storage of blood specimens, following Standard Operating Procedures (SOP). All surveys had similar quality controls, supervisions, and training of the investigator team. Since September 2010, a total of 1515 subjects (1116 [73.7%] males; 855 [56.4%] diagnosed with COPD) were enrolled. Analyses of the design and interim results of the GIRD COPD Biobank Study identified patients with COPD were older, lower educational level, a longer history of pack-year smoking, less in kitchen fan usage, X-ray exposure, and history of disease (P respiratory symptoms; Cold air, haze, and influenza acted the top three factors to induce respiratory symptoms in both COPD cases and controls. The GIRD COPD Biobank Study has the potential to provide substantial novel insights into the genetics, biomarkers, environmental and lifestyle aspects of COPD. It is expected to provide new insights for pathogenesis and the long-term progression of COPD.

  15. Dissecting direct and indirect genetic effects on chronic obstructive pulmonary disease (COPD) susceptibility.

    Science.gov (United States)

    Siedlinski, Mateusz; Tingley, Dustin; Lipman, Peter J; Cho, Michael H; Litonjua, Augusto A; Sparrow, David; Bakke, Per; Gulsvik, Amund; Lomas, David A; Anderson, Wayne; Kong, Xiangyang; Rennard, Stephen I; Beaty, Terri H; Hokanson, John E; Crapo, James D; Lange, Christoph; Silverman, Edwin K

    2013-04-01

    Cigarette smoking is the major environmental risk factor for chronic obstructive pulmonary disease (COPD). Genome-wide association studies have provided compelling associations for three loci with COPD. In this study, we aimed to estimate direct, i.e., independent from smoking, and indirect effects of those loci on COPD development using mediation analysis. We included a total of 3,424 COPD cases and 1,872 unaffected controls with data on two smoking-related phenotypes: lifetime average smoking intensity and cumulative exposure to tobacco smoke (pack years). Our analysis revealed that effects of two linked variants (rs1051730 and rs8034191) in the AGPHD1/CHRNA3 cluster on COPD development are significantly, yet not entirely, mediated by the smoking-related phenotypes. Approximately 30% of the total effect of variants in the AGPHD1/CHRNA3 cluster on COPD development was mediated by pack years. Simultaneous analysis of modestly (r (2) = 0.21) linked markers in CHRNA3 and IREB2 revealed that an even larger (~42%) proportion of the total effect of the CHRNA3 locus on COPD was mediated by pack years after adjustment for an IREB2 single nucleotide polymorphism. This study confirms the existence of direct effects of the AGPHD1/CHRNA3, IREB2, FAM13A and HHIP loci on COPD development. While the association of the AGPHD1/CHRNA3 locus with COPD is significantly mediated by smoking-related phenotypes, IREB2 appears to affect COPD independently of smoking.

  16. Insomnia in older adults with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study.

    Science.gov (United States)

    Xiang, Yu-Tao; Wong, Tak-Shun; Tsoh, Joshua; Ungvari, Gabor S; Correll, Christoph U; Ko, Fanny W S; Hui, David S C; Chiu, Helen F K

    2014-06-01

    This study aimed to determine the frequency and sociodemographic/clinical correlates of insomnia in Chinese patients aged ≥60 years suffering from chronic obstructive pulmonary disease (COPD). In this case-control study of 142 outpatients with COPD and 218 sex- and age-matched control subjects, COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥2 major COPD symptoms or >1 major+minor COPD symptoms for ≥2 consecutive days). Controls were recruited from social centres in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale, life events were evaluated using the Life Event Scale, depressive symptoms were ascertained with the Geriatric Depression Scale, and quality of life was measured using the Medical Outcomes Study Short Form-12. Early, middle and late insomnia were measured using items 4, 5 and 6 of the Hamilton Rating Scale for Depression. The frequency of ≥1 type of insomnia was 47.2% in patients and 25.7% in controls; frequencies of early, middle and late insomnia in patients were 24.6%, 31.0%, and 26.1%, respectively, compared to 14.7%, 14.7% and 11.9% in controls. Group differences were non-significant after controlling for relevant covariates. However, in multiple logistic regression analysis, more physical illnesses (p = 0.02, OR = 1.3, 95% CI = 1.1-1.7) and more severe depressive symptoms (p = 0.009, OR = 1.1, 95% CI = 1.03-1.3) were independently associated with any type of insomnia in COPD patients, accounting for 21.3% of the variance. A significant proportion of older adult Chinese COPD patients suffer from insomnia that warrants more attention in clinical practice.

  17. Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study.

    Science.gov (United States)

    Hueper, Katja; Vogel-Claussen, Jens; Parikh, Megha A; Austin, John H M; Bluemke, David A; Carr, James; Choi, Jiwoong; Goldstein, Thomas A; Gomes, Antoinette S; Hoffman, Eric A; Kawut, Steven M; Lima, Joao; Michos, Erin D; Post, Wendy S; Po, Ming Jack; Prince, Martin R; Liu, Kiang; Rabinowitz, Dan; Skrok, Jan; Smith, Ben M; Watson, Karol; Yin, Youbing; Zambeli-Ljepovic, Alan M; Barr, R Graham

    2015-09-01

    Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease. To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema. PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below -950 Hounsfield units (-950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output. Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers. PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature.

  18. Living with COPD: Nutrition

    Science.gov (United States)

    ... Diseases > Lung Disease Lookup > COPD > Living With COPD Nutrition and COPD Most people are surprised to learn ... asking your doctor or visiting the Academy of Nutrition and Dietetics at EatRight.org . Be sure to ...

  19. Adiponectin: an attractive marker for metabolic disorders in Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Bianco, Andrea; Mazzarella, Gennaro; Turchiarelli, Viviana; Nigro, Ersilia; Corbi, Graziamaria; Scudiero, Olga; Sofia, Matteo; Daniele, Aurora

    2013-10-14

    Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease which may be complicated by development of co-morbidities including metabolic disorders. Metabolic disorders commonly associated with this disease contribute to lung function impairment and mortality. Systemic inflammation appears to be a major factor linking COPD to metabolic alterations. Adipose tissue seems to interfere with systemic inflammation in COPD patients by producing a large number of proteins, known as "adipokines", involved in various processes such as metabolism, immunity and inflammation. There is evidence that adiponectin is an important modulator of inflammatory processes implicated in airway pathophysiology. Increased serum levels of adiponectin and expression of its receptors on lung tissues of COPD patients have recently highlighted the importance of the adiponectin pathway in this disease. Further, in vitro studies have demonstrated an anti-inflammatory activity for this adipokine at the level of lung epithelium. This review focuses on mechanisms by which adiponectin is implicated in linking COPD with metabolic disorders.

  20. Evaluation of Quality of Life instruments for use in COPD care and research: a systematic review.

    Science.gov (United States)

    Weldam, Saskia W M; Schuurmans, Marieke J; Liu, Rani; Lammers, Jan-Willem J

    2013-05-01

    Quality of Life (QoL) measurements to quantify disease burden have become an important outcome measure in Chronic Obstructive Pulmonary Disease (COPD) research and treatment. A large variety of QoL instruments is available. The objective of this review was to comprehensively evaluate content and psychometric properties of available QoL instruments used in COPD care and research. A systematic literature search was performed. The databases PubMed, Embase, CINAHL, and the Cochrane Library were used. Two researchers independently identified eligible studies. Methodological quality of the studies and data on measurement properties were assessed by using the Consensus based Standards for selection of health Measurement Instruments (COSMIN). A best evidence synthesis for each instrument was performed. 77 studies describing 13 disease-specific and 10 generic QoL instruments were identified. The content of the instruments showed a great variety. 20 instruments measured mobility. Pulmonary symptoms were measured in 11 disease specific instruments. Pain, vitality, and spiritual activities were domains seen only in generic instruments. Social and emotional functioning were domains seen in disease specific instruments as well as in generic instruments. The methodological quality of the studies was mostly rated fair, according to the COSMIN checklist. The psychometric properties of the instruments (validity, reliability and responsiveness) were in general rated positive. The best evidence synthesis showed the strongest positive evidence for the disease specific instruments Chronic Respiratory Questionnaire (CRQ), COPD Assessment Test (CAT), Saint George Respiratory Questionnaire (SGRQ), and Living with COPD questionnaire (LCOPD). The generic instruments received less favorable ratings. Despite the comprehensive overview we could not uniformly recommend the best instrument to evaluate QoL in COPD patients. However, we could recommend the disease specific instruments CRQ, CAT

  1. Asymmetric Dimethylarginine in Chronic Obstructive Pulmonary Disease (ADMA in COPD

    Directory of Open Access Journals (Sweden)

    Jeremy A. Scott

    2014-04-01

    Full Text Available l-Arginine metabolism including the nitric oxide (NO synthase and arginase pathways is important in the maintenance of airways function. We have previously reported that accumulation of asymmetric dimethylarginine (ADMA in airways, resulting in changes in l-arginine metabolism, contributes to airways obstruction in asthma and cystic fibrosis. Herein, we assessed l-arginine metabolism in airways of patients with chronic obstructive pulmonary disease (COPD. Lung function testing, measurement of fractional exhaled NO (FeNO and sputum NO metabolites, as well as quantification of l-arginine metabolites (l-arginine, l-ornithine, l-citrulline, ADMA and symmetric dimethylarginine using liquid chromatography-mass spectrometry (LC-MS were performed. Concentrations of l-ornithine, the product of arginase activity, correlated directly with l-arginine and ADMA sputum concentrations. FeNO correlated directly with pre- and post-bronchodilator forced expiratory volume in one second (FEV1. Sputum arginase activity correlated inversely with total NO metabolite (NOx and nitrite concentrations in sputum, and with pre- and post-bronchodilator FEV1. These findings suggest that ADMA in COPD airways results in a functionally relevant shift of l-arginine breakdown by the NO synthases towards the arginase pathway, which contributes to airway obstruction in these patients.

  2. COPD in Never Smokers

    Science.gov (United States)

    McBurnie, Mary Ann; Vollmer, William M.; Gudmundsson, Gunnar; Welte, Tobias; Nizankowska-Mogilnicka, Ewa; Studnicka, Michael; Bateman, Eric; Anto, Josep M.; Burney, Peter; Mannino, David M.; Buist, Sonia A.

    2011-01-01

    Background: Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined. Methods: We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal (LLN) was evaluated as an alternative threshold for the FEV1/FVC ratio. Results: Among 4,291 never smokers, 6.6% met criteria for mild (GOLD stage I) COPD, and 5.6% met criteria for moderate to very severe (GOLD stage II+) COPD. Although never smokers were less likely to have COPD and had less severe COPD than ever smokers, never smokers nonetheless comprised 23.3% (240/1,031) of those classified with GOLD stage II+ COPD. This proportion was similar, 20.5% (171/832), even when the LLN was used as a threshold for the FEV1/FVC ratio. Predictors of COPD in never smokers include age, education, occupational exposure, childhood respiratory diseases, and BMI alterations. Conclusion: This multicenter international study confirms previous evidence that never smokers comprise a substantial proportion of individuals with COPD. Our data suggest that, in addition to increased age, a prior diagnosis of asthma and, among women, lower education levels are associated with an increased risk for COPD among never smokers. PMID:20884729

  3. Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD)

    Science.gov (United States)

    McCurdy, BR

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  4. Static and Functional Balance in Individuals With COPD: Comparison With Healthy Controls and Differences According to Sex and Disease Severity.

    Science.gov (United States)

    de Castro, Larissa A; Ribeiro, Laís Rg; Mesquita, Rafael; de Carvalho, Débora R; Felcar, Josiane M; Merli, Myriam F; Fernandes, Karen Bp; da Silva, Rubens A; Teixeira, Denilson C; Spruit, Martijn A; Pitta, Fabio; Probst, Vanessa S

    2016-11-01

    Studies have shown that individuals with COPD have impaired body balance, probably caused by the disease's multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COPD and healthy controls and to check possible differences according to sex and degrees of disease severity. Forty-seven subjects with COPD and 25 healthy controls were included in this study. Their static balance was assessed in one-legged stance using a force platform and functional balance with the Timed Up and Go test. Additionally, participants performed spirometry, the 6-min walk test and isometric quadriceps maximal voluntary contraction assessment. Disease severity was classified according to the Global Initiative for Obstructive Lung Disease stages and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) scores. In comparison with healthy controls, subjects with COPD had worse static (center of pressure displacement area: 9.3 ± 1.9 cm(2) vs 11.6 ± 4.0 cm(2), respectively, P = .01) and functional balance (Timed Up and Go test: 8.5 ± 1.3 s vs 10.3 ± 1.8 s, respectively, P static balance in comparison with men for all parameters related to center of pressure (P balance results. Individuals with COPD had worse static and functional balance in comparison with healthy controls. Sex can mediate these results, depending on the type of balance evaluation (force platform or functional test). Balance performance was similar among the groups classified according to disease severity. Copyright © 2016 by Daedalus Enterprises.

  5. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD)

    DEFF Research Database (Denmark)

    Hallin, Runa; Gudmundsson, Gunnar; Suppli Ulrik, Charlotte

    2007-01-01

    Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality...

  6. Dynamic hyperinflation during daily activities: does COPD global initiative for chronic obstructive lung disease stage matter?

    NARCIS (Netherlands)

    Hannink, J.D.C.; Helvoort, H.A.C. van; Dekhuijzen, P.N.R.; Heijdra, Y.F.

    2010-01-01

    BACKGROUND: One of the contributors to exercise limitation in COPD is dynamic hyperinflation. Although dynamic hyperinflation appears to occur during several exercise protocols in COPD and seems to increase with increasing disease severity, it is unknown whether dynamic hyperinflation occurs at

  7. Decision Making Concepts for the Remote, Personalized Evaluation of COPD Patients' Health Status.

    Science.gov (United States)

    Colantonio, S; Govoni, L; Dellacà, R L; Martinelli, M; Salvetti, O; Vitacca, M

    2015-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced Methods for Neural Signals and Images". This paper presents the main concepts of a decision making approach for the remote management of COPD patients based on the early detection of disease exacerbation episodes. An e-diary card is defined to evaluate a number of physiological variables and clinical parameters acquired remotely by means of wearable and environmental sensors deployed in patients' long-stay settings. The automatic evaluation of the card results in a so-called Chronic Status Index (CSI) whose computation is tailored to patients' specific manifestation of the disease (i.e., patient's phenotype). The decision support method relies on a parameterized analysis of CSI variations so as to early detect worsening changes, identify exacerbation severity and track the patterns of recovery. A preliminary study, carried out in real settings with 30 COPD patients monitored at home, has shown the validity and sensitivity of the method proposed, which was effectively able to timely and correctly identify patients' critical situation. The preliminary results showed that the proposed e-diary card, which presents several novel features with respect to other solutions presented in the literature, can be practically used to remotely monitor COPD patients.

  8. Costs and outcomes of the German disease management programme (DMP) for chronic obstructive pulmonary disease (COPD)-A large population-based cohort study.

    Science.gov (United States)

    Achelrod, Dmitrij; Welte, Tobias; Schreyögg, Jonas; Stargardt, Tom

    2016-09-01

    To curb costs and improve health outcomes in chronic obstructive pulmonary disease (COPD), a nationwide disease management programme (DMP) was introduced in Germany in 2005. Yet, its effectiveness has not been comprehensively evaluated. To examine the effects of the German COPD DMP over three years on costs and health resource utilisation from the payer perspective, process quality, morbidity and mortality. A retrospective, population-based cohort study design is applied, using administrative data. After eliminating differences in observable characteristics between the DMP and the control group with entropy balancing, difference-in-difference estimators were computed to account for time-invariant unobservable heterogeneity. 215,104 individuals were included into the analysis of whom 25,269 were enrolled in the DMP. DMP patients had a reduced mortality hazard ratio (0.89, 95%CI: 0.84-0.94) but incurred excess costs of €553 per year. DMP enrolees reveal higher healthcare utilisation with larger shares of individuals being hospitalised (3.14%), consulting an outpatient clinic due to exacerbations (11.13%) and pharmaceutical prescriptions (2.78). However, average length of hospitalisation due to COPD fell by 0.49 days, adherence to medication guidelines as well as indicators for morbidity improved. The German COPD DMP achieved significant improvements in mortality, morbidity and process quality, but at higher costs. Given the low ICER per life year gained, DMP COPD may constitute a cost-effective option to promote COPD population health. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Once-daily glycopyrronium bromide (Seebri Breezhaler(®)) for the treatment of chronic obstructive pulmonary disease (COPD)

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2015-01-01

    INTRODUCTION: Long-acting bronchodilators are the mainstay of pharmacological therapy for patients with chronic obstructive pulmonary disease (COPD). The choice of optimal bronchodilator therapy for COPD is increasingly difficult for clinicians as new treatments are marketed. AREAS COVERED: Inhaled...

  10. A cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects: modulatory role of systemic biomarkers of inflammation.

    Directory of Open Access Journals (Sweden)

    Silvana P Barros

    Full Text Available BACKGROUND: In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities. OBJECTIVES: Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD. METHODS: Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group. Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation. RESULTS: A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events. CONCLUSIONS: These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to

  11. Singing for adults with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    McNamara, Renae J; Epsley, Charlotte; Coren, Esther; McKeough, Zoe J

    2017-12-19

    Singing is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is active and requires active diaphragm contraction and good posture. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic lung disease characterised by airflow obstruction. Singing is an activity with potential to improve health outcomes in people with COPD. To determine the effect of singing on health-related quality of life and dyspnoea in people with COPD. We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, the World Health Organization trials portal and PEDro, from their inception to August 2017. We also reviewed reference lists of all primary studies and review articles for additional references. We included randomised controlled trials in people with stable COPD, in which structured supervised singing training of at least four sessions over four weeks' total duration was performed. The singing could be performed individually or as part of a group (choir) facilitated by a singing leader. Studies were included if they compared: 1) singing versus no intervention (usual care) or another control intervention; or 2) singing plus pulmonary rehabilitation versus pulmonary rehabilitation alone. Two review authors independently screened and selected trials for inclusion, extracted outcome data and assessed risk of bias. We contacted authors of trials for missing data. We calculated mean differences (MDs) using a random-effects model. We were only able to analyse data for the comparison of singing versus no intervention or a control group. Three studies (a total of 112 participants) were included. All studies randomised participants to a singing group or a control group. The comparison groups included a film workshop, handcraft work, and no intervention. The frequency of the singing intervention in the studies ranged from 1 to 2 times a week over a 6 to 24

  12. Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease (COPD) Using an Ontario Policy Model

    Science.gov (United States)

    Chandra, K; Blackhouse, G; McCurdy, BR; Bornstein, M; Campbell, K; Costa, V; Franek, J; Kaulback, K; Levin, L; Sehatzadeh, S; Sikich, N; Thabane, M; Goeree, R

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  13. Investigating fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO): a scoping review protocol.

    Science.gov (United States)

    Mostafavi-Pour-Manshadi, Seyed-Mohammad-Yousof; Naderi, Nafiseh; Barrecheguren, Miriam; Dehghan, Abolfazl; Bourbeau, Jean

    2017-12-21

    During the last decade, many articles have been published, including reviews on fractional exhaled nitric oxide (FeNO) use and utility in clinical practice and for monitoring and identifying eosinophilic airway inflammation, especially in asthma, and evaluating corticosteroid responsiveness. However, the exact role of FeNO in patients with chronic obstructive pulmonary disease (COPD) and its ability to distinguish patients with COPD and those having concomitant asthma, that is, asthma-COPD overlap (ACO) is still unclear and needs to be defined. Due to the broad topics of FeNO in chronic airway disease, we undertook a scoping review. The present article describes the protocol of a scoping review of peer-reviewed published literature specific to FeNO in COPD/ACO over the last decade. We used Joanna Briggs Institute Reviewers' Manual scoping review methodology as well as Levac et al 's and Arksey et al 's framework as guides. We searched a variety of databases, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and BioSciences Information Service (BIOSIS) on 29 June 2016. Additional studies will be recognised by exploring the reference list of identified eligible studies. Screening of eligible studies will be independently performed by two reviewers and any disagreement will be solved by the third reviewer. We will analyse the gathered data from article bibliographies and abstracts. To investigate the body of published studies regarding the role of FeNO in patients with COPD and its usefulness in the clinical setting, a scoping review can be used as a modern and pioneer model, which does not need ethics approval. By this review, new insights for conducting new research specific to FeNO in COPD/ACO population will emerge. The results of this study will be reported in the scientific meetings and conferences, which aim to provide information to the clinicians, primary care providers and basic

  14. A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: The COPE-III study protocol

    NARCIS (Netherlands)

    Lenferink, Anke; Frith, Peter; van der Valk, Paul; Buckman, Julie; Sladek, Ruth; Cafarella, Paul; van der Palen, Job; Effing, Tanja

    2013-01-01

    Background Chronic Obstructive Pulmonary Disease (COPD) frequently coexists with other diseases. Whereas COPD action plans are currently part of usual care, they are less suitable and potentially unsafe for use in the presence of comorbidities. This study evaluates whether an innovative treatment

  15. Multitask protocols to evaluate activities of daily living performance in people with COPD: a systematic review.

    Science.gov (United States)

    Paes, Thaís; Machado, Felipe Vilaça Cavallari; Cavalheri, Vinícius; Pitta, Fabio; Hernandes, Nidia Aparecida

    2017-07-01

    People with chronic obstructive pulmonary disease (COPD) present symptoms such as dyspnea and fatigue, which hinder their performance in activities of daily living (ADL). A few multitask protocols have been developed to assess ADL performance in this population, although measurement properties of such protocols were not yet systematically reviewed. Areas covered: Studies were included if an assessment of the ability to perform ADL was conducted in people with COPD using a (objective) performance-based protocol. The search was conducted in the following databases: Pubmed, EMBASE, Cochrane Library, PEDro, CINAHL and LILACS. Furthermore, hand searches were conducted. Expert commentary: Up to this moment, only three protocols had measurement properties described: the Glittre ADL Test, the Monitored Functional Task Evaluation and the Londrina ADL Protocol were shown to be valid and reliable whereas only the Glittre ADL Test was shown to be responsive to change after pulmonary rehabilitation. These protocols can be used in laboratory settings and clinical practice to evaluate ADL performance in people with COPD, although there is need for more in-depth information on their validity, reliability and especially responsiveness due to the growing interest in the accurate assessment of ADL performance in this population.

  16. Use of antibiotics in patients admitted to the hospital due to acute exacerbation of chronic obstructive pulmonary disease (COPD)

    DEFF Research Database (Denmark)

    Jacobsen, S K.; Weis, N; Almdal, T

    2002-01-01

    : All adult patients (>18 years of age) discharged from a department of internal medicine in Copenhagen in 1997 with a diagnosis of exacerbation of COPD were included in our study and their reports were retrospectively reviewed. Gender, age, number of admissions and length of hospital stay, use......BACKGROUND: The purpose of this study was to assess to what extent symptoms and signs of bacterial infection are present and evaluated in patients admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD) in relation to initiation of antibiotic treatment. METHODS...... was the initial antibiotic of choice. The median hospital stay was 6 days for the entire group of patients. CONCLUSION: These data suggest that, in patients with acute exacerbation of COPD, a relatively high number of patients with only weak symptoms or signs of bacterial infection are treated with antibiotics....

  17. A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD.

    Science.gov (United States)

    Silver, Patty C; Kollef, Marin H; Clinkscale, Darnetta; Watts, Peggy; Kidder, Robin; Eads, Brittany; Bennett, Debbie; Lora, Carolyn; Quartaro, Michael

    2017-01-01

    Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3-11] d vs 8 [4-18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99). Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.). Copyright © 2017 by Daedalus Enterprises.

  18. Up-regulation of Pim-3 in Chronic Obstructive Pulmonary Disease (COPD) patients and its potential therapeutic role in COPD rat modeling.

    Science.gov (United States)

    Yang, Cheng; Li, Li; Guo, Junhua; Zhang, Weiqiang; Zhu, Wenbiao; Rao, Xinhui; Huang, Wenjie

    2017-04-01

    Pim-3 belongs to the PIM kinase family and plays an important role in promoting inflammation, which is essential in the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD). Immunohistochemistry (IHC), western blot, and RT-PCR analyses were performed to assess the expression of Pim-3 in both COPD and healthy lung tissue samples. SMA (Smooth Muscle Actin) and Cyclin D1 expression were detected by IHC. We also constructed animal models for the control, COPD, and Pim-3 inhibition groups, in order to analyze the effects of Pim-3 inhibition on COPD, and the role of Pim-3 in the p38 pathway. Compared with normal lung tissue, Pim-3 mRNA and protein were up-regulated in COPD tissue. Expression of Cyclin D1 and SMA were also up-regulated in the COPD group. In the animal model experiment, we found that suppression of Pim-3 decreased Pim-3, Cyclin D1, and SMA expression, as well as ameliorated lung damage in COPD patients. The inhibition of Pim-3 also resulted in the suppression of the p38 pathway. Our study suggests that up-regulation of Pim-3 successfully accelerated COPD development, and aggravated lung damage. The molecular mechanism of Pim-3 in COPD might be related to the p38 pathway, and is correlated with Cyclin D1 and SMA expression. Copyright © 2017 Elsevier GmbH. All rights reserved.

  19. Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Bandurska, Ewa; Damps-Konstańska, Iwona; Popowski, Piotr; Jędrzejczyk, Tadeusz; Janowiak, Piotr; Świętnicka, Katarzyna; Zarzeczna-Baran, Marzena; Jassem, Ewa

    2017-06-12

    BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

  20. Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation.

    Science.gov (United States)

    Domingo, Enric; Grignola, Juan C; Aguilar, Rio; Messeguer, Manuel López; Roman, Antonio

    2017-05-06

    Pulmonary hypertension (PH) associated with lung disease has the worst prognosis of all types of PH. Pulmonary arterial vasculopathy is an early event in the natural history of chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). The present study characterized the alterations in the structure and function of the pulmonary arterial (PA) wall of COPD and ILD candidates for lung transplantation (LTx). A cohort of 73 patients, 63 pre-LTx (30 COPD, 33 ILD), and ten controls underwent simultaneous right heart catheterisation and intravascular ultrasound (IVUS). Total pulmonary resistance (TPR), capacitance (Cp), and the TPR-Cp relationship were assessed. PA stiffness and the relative area of wall thickness were estimated as pulse PA pressure/IVUS pulsatility and as [(external sectional area-intimal area)/external sectional area] × 100, respectively. Twenty-seven percent of patients had pulmonary arterial wedge pressure > 15 mmHg and were not analyzed. PA stiffness and the area of wall thickness were increased in comparison with controls, even in patients without PH (p < 0.05). ILD patients showed a significant higher PA stiffness, and lower Cp beyond mean PA pressure (mPAP) and lower area of wall thickness than COPD patients (p < 0.05). TPR-Cp relationship was shifted downward left for ILD patients. Significant increase of PA stiffness and area of wall thickness were present even in patients without PH and can make the diagnosis of pulmonary vasculopathy at a preclinical stage in PH-lung disease candidates for LTx. ILD patients showed the worst PA stiffness and Cp with respect to COPD.

  1. Pinterest as a Resource for Health Information on Chronic Obstructive Pulmonary Disease (COPD): A Social Media Content Analysis

    Science.gov (United States)

    Paige, Samantha R.; Stellefson, Michael; Chaney, Beth H.; Alber, Julia M.

    2015-01-01

    Purpose: The purpose of this study was to explore how Pinterest group pinboards are used to communicate health information on chronic obstructive pulmonary disease (COPD). Method A nonprobability census sampling method retrieved 399 pins from the 10 most followed COPD group pinboards. Pins were coded according to COPD information categories,…

  2. A Genome-Wide Association Study in Chronic Obstructive Pulmonary Disease (COPD): Identification of Two Major Susceptibility Loci

    Science.gov (United States)

    Pillai, Sreekumar G.; Shianna, Kevin V.; Need, Anna C.; Feng, Sheng; Hersh, Craig P.; Bakke, Per; Gulsvik, Amund; Ruppert, Andreas; Lødrup Carlsen, Karin C.; Roses, Allen; Anderson, Wayne; Rennard, Stephen I.; Lomas, David A.; Silverman, Edwin K.; Goldstein, David B.

    2009-01-01

    There is considerable variability in the susceptibility of smokers to develop chronic obstructive pulmonary disease (COPD). The only known genetic risk factor is severe deficiency of α1-antitrypsin, which is present in 1–2% of individuals with COPD. We conducted a genome-wide association study (GWAS) in a homogenous case-control cohort from Bergen, Norway (823 COPD cases and 810 smoking controls) and evaluated the top 100 single nucleotide polymorphisms (SNPs) in the family-based International COPD Genetics Network (ICGN; 1891 Caucasian individuals from 606 pedigrees) study. The polymorphisms that showed replication were further evaluated in 389 subjects from the US National Emphysema Treatment Trial (NETT) and 472 controls from the Normative Aging Study (NAS) and then in a fourth cohort of 949 individuals from 127 extended pedigrees from the Boston Early-Onset COPD population. Logistic regression models with adjustments of covariates were used to analyze the case-control populations. Family-based association analyses were conducted for a diagnosis of COPD and lung function in the family populations. Two SNPs at the α-nicotinic acetylcholine receptor (CHRNA 3/5) locus were identified in the genome-wide association study. They showed unambiguous replication in the ICGN family-based analysis and in the NETT case-control analysis with combined p-values of 1.48×10−10, (rs8034191) and 5.74×10−10 (rs1051730). Furthermore, these SNPs were significantly associated with lung function in both the ICGN and Boston Early-Onset COPD populations. The C allele of the rs8034191 SNP was estimated to have a population attributable risk for COPD of 12.2%. The association of hedgehog interacting protein (HHIP) locus on chromosome 4 was also consistently replicated, but did not reach genome-wide significance levels. Genome-wide significant association of the HHIP locus with lung function was identified in the Framingham Heart study (Wilk et al., companion article in this issue

  3. A genome-wide association study in chronic obstructive pulmonary disease (COPD: identification of two major susceptibility loci.

    Directory of Open Access Journals (Sweden)

    Sreekumar G Pillai

    2009-03-01

    Full Text Available There is considerable variability in the susceptibility of smokers to develop chronic obstructive pulmonary disease (COPD. The only known genetic risk factor is severe deficiency of alpha(1-antitrypsin, which is present in 1-2% of individuals with COPD. We conducted a genome-wide association study (GWAS in a homogenous case-control cohort from Bergen, Norway (823 COPD cases and 810 smoking controls and evaluated the top 100 single nucleotide polymorphisms (SNPs in the family-based International COPD Genetics Network (ICGN; 1891 Caucasian individuals from 606 pedigrees study. The polymorphisms that showed replication were further evaluated in 389 subjects from the US National Emphysema Treatment Trial (NETT and 472 controls from the Normative Aging Study (NAS and then in a fourth cohort of 949 individuals from 127 extended pedigrees from the Boston Early-Onset COPD population. Logistic regression models with adjustments of covariates were used to analyze the case-control populations. Family-based association analyses were conducted for a diagnosis of COPD and lung function in the family populations. Two SNPs at the alpha-nicotinic acetylcholine receptor (CHRNA 3/5 locus were identified in the genome-wide association study. They showed unambiguous replication in the ICGN family-based analysis and in the NETT case-control analysis with combined p-values of 1.48 x 10(-10, (rs8034191 and 5.74 x 10(-10 (rs1051730. Furthermore, these SNPs were significantly associated with lung function in both the ICGN and Boston Early-Onset COPD populations. The C allele of the rs8034191 SNP was estimated to have a population attributable risk for COPD of 12.2%. The association of hedgehog interacting protein (HHIP locus on chromosome 4 was also consistently replicated, but did not reach genome-wide significance levels. Genome-wide significant association of the HHIP locus with lung function was identified in the Framingham Heart study (Wilk et al., companion article

  4. A combined pulmonary-radiology workshop for visual evaluation of COPD

    DEFF Research Database (Denmark)

    Barr, R Graham; Berkowitz, Eugene A; Bigazzi, Francesca

    2012-01-01

    The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring....

  5. Impact of an integrated disease management program in reducing exacerbations in patients with severe asthma and COPD.

    Science.gov (United States)

    Jain, Vipul V; Allison, Richard; Beck, Sandra J; Jain, Ratnali; Mills, Paul K; McCurley, James W; Van Gundy, Karl P; Peterson, Michael W

    2014-12-01

    Conflicting data exists on the effectiveness of integrated programs in reducing recurrent exacerbations and hospitalizations in patients with Asthma and chronic obstructive lung disease (COPD). We developed a Pulmonologist-led Chronic Lung Disease Program (CLDP) for patients with severe asthma and COPD and analyzed its impact on healthcare utilization and predictors of its effectiveness. CLDP elements included clinical evaluation, onsite pulmonary function testing, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with ≥2 asthma or COPD exacerbations requiring emergency room visit or hospitalization within the prior year were enrolled, and followed for respiratory related ER visits (RER) and hospitalizations (RHA) over the year (357 ± 43 days) after CLDP interventions. A total of 106 patients were enrolled, and 104 patients were subject to analyses. During the year of follow-up after CLDP enrollment, there was a significant decrease in mean RER (0.56 ± 1.48 versus 2.62 ± 2.81, p logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations. A Pulmonologist-led disease management program integrating key elements of care is cost effective and significantly decreases severe exacerbations. Integrated programs should be encouraged for care of frequent exacerbators of asthma and COPD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. EVALUATION OF RIGHT VENTRICULAR DYSFUNCTION AND PULMONARY ARTERY HYPERTENSION SECONDARY TO COPD SEVERITY BY ELECTROCARDIOGRAM AND ECHOCARDIOGRAPHY

    OpenAIRE

    Bhupendra Kumar; Nikhilesh; Ashok; Ashwin

    2015-01-01

    Patient with COPD carry increased risk of morbidity and mortality due to pulmonary artery hypertension, corpulmonale, cardiac arrhythmias, congestive heart fa ilure and pulmonary embolism. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes secondary to severe COPD. AIM : To evaluate right ventricular dysfunction and pulmonary artery hypertension secondary to COPD severity as per GOLD gui...

  7. Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française (summary).

    Science.gov (United States)

    Jouneau, S; Dres, M; Guerder, A; Bele, N; Bellocq, A; Bernady, A; Berne, G; Bourdin, A; Brinchault, G; Burgel, P R; Carlier, N; Chabot, F; Chavaillon, J M; Cittee, J; Claessens, Y E; Delclaux, B; Deslée, G; Ferré, A; Gacouin, A; Girault, C; Ghasarossian, C; Gouilly, P; Gut-Gobert, C; Gonzalez-Bermejo, J; Jebrak, G; Le Guillou, F; Léveiller, G; Lorenzo, A; Mal, H; Molinari, N; Morel, H; Morel, V; Noel, F; Pégliasco, H; Perotin, J M; Piquet, J; Pontier, S; Rabbat, A; Revest, M; Reychler, G; Stelianides, S; Surpas, P; Tattevin, P; Roche, N

    2017-04-01

    Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach. Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  8. Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study

    Science.gov (United States)

    Hueper, Katja; Vogel-Claussen, Jens; Parikh, Megha A.; Austin, John H. M.; Bluemke, David A.; Carr, James; Choi, Jiwoong; Goldstein, Thomas A.; Gomes, Antoinette S.; Hoffman, Eric A.; Kawut, Steven M.; Lima, Joao; Michos, Erin D.; Post, Wendy S.; Po, Ming Jack; Prince, Martin R.; Liu, Kiang; Rabinowitz, Dan; Skrok, Jan; Smith, Ben M.; Watson, Karol; Yin, Youbing; Zambeli-Ljepovic, Alan M.

    2015-01-01

    Rationale: Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease. Objectives: To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema. Methods: PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below −950 Hounsfield units (−950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output. Measurements and Main Results: Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P emphysema−950HU and radiologist-defined emphysema, particularly panlobular and centrilobular emphysema (all P ≤ 0.01). Registration of MRI and CT images revealed that PMBF was reduced in mild COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers. Conclusions: PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature. PMID:26067761

  9. Reducing COPD admissions with a specialist chronic disease management team.

    Science.gov (United States)

    Annandale, Joseph; Hurlin, Claire; Lewis, Keir

    This article describes the implementation of a specialist community team working with acute care services to manage patients with COPD. It resulted in a sustained reduction in hospital admissions over one year.

  10. Evaluation of the COPD Assessment Test and GOLD patient types: a cross-sectional analysis

    Directory of Open Access Journals (Sweden)

    Lopez-Campos JL

    2015-05-01

    Full Text Available Jose Luis Lopez-Campos,1,2,* Alberto Fernandez-Villar,3,* Carmen Calero-Acuña,1 Cristina Represas-Represas,3 Cecilia Lopez-Ramírez,1 Virginia Leiro Fernández,3 Juan Jose Soler-Cataluña,2,4 Ricard Casamor5 On behalf of the On-Sint study group 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS, Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES, Instituto de Salud Carlos III, Madrid, Spain; 3Servicio de Neumología, Instituto de Investigación Biomédica de Vigo (IBIV, Complexo Hospitalario de Vigo, Vigo, Spain; 4Servicio de Neumología Hospital Arnau de Vilanova, Valencia, Spain; 5Departamento Médico de Novartis Farmacéutica, Barcelona, Spain *These authors contributed equally to this work Background: The COPD Assessment Test (CAT has been recently developed to quantify COPD impact in routine practice. However, no relationship with other measures in the Global Initiative for Obstructive Lung Disease (GOLD strategy has been evaluated. The present study aimed to evaluate the relationship of the CAT with other GOLD multidimensional axes, patient types, and the number of comorbidities.Methods: This was a cross-sectional analysis of the Clinical presentation, diagnosis, and course of chronic obstructive pulmonary disease (On-Sint study. The CAT score was administered to all participants at the inclusion visit. A GOLD 2011 strategy consisting of modified Medical Research Council scale (MRC scores was devised to study the relationship between the CAT, and GOLD 2011 axes and patient types. The relationship with comorbidities was assessed using the Charlson comorbidity index, grouped as zero, one to two, and three or more.Results: The CAT questionnaire was completed by 1,212 patients with COPD. The CAT maintained a relationship with all the three axes, with a ceiling effect for dyspnea and no distinction between mild and

  11. Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

    DEFF Research Database (Denmark)

    Sørensen, Sabrina Storgaard; Pedersen, Kjeld Møller; Weinreich, Ulla Møller

    2015-01-01

    controlled trial, conducted to evaluate the effectiveness and cost-effectiveness of a community-based case management model for patients suffering from chronic obstructive pulmonary disease (COPD). With a focus on support for self-care and care coordination, the intervention was hypothesized to result...... in a reduced number of COPD-related hospital admissions. Patients and methods: The design was a randomized controlled trial conducted from 2012 to 2014 with randomization and intervention at patient level. The study took place in Aalborg Municipality, a larger municipality in Denmark. A total of 150 COPD......, effectiveness will be evaluated on COPD-related hospital admissions, mortality, health- related quality of life, and self-care. An economic evaluation will examine the cost-effectiveness of case management against current usual care from the perspective of the health care sector. Results: Baseline...

  12. Electronic clinical records in primary care for estimating disease burden and management. An example of COPD

    Directory of Open Access Journals (Sweden)

    Luis Verde-Remeseiro

    2015-09-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a significant health problem in developed countries. We aimed to estimate the prevalence of COPD in a single Spanish healthcare area. We also aimed to assess if there are any differences in prevalence and spirometry use among primary care services by utilizing already registered information. We designed a cross-sectional study to determine the prevalence of COPD and the performance of spirometries in each primary care service. A total of 8,444 patients were diagnosed with COPD, with a prevalence of 2.6% for individuals older than 39 years. The prevalence increased with age and was much higher in men. Significant heterogeneity was found in the prevalence of COPD and spirometry use among primary care services. COPD was underdiagnosed and there was wide variability in spirometry use in our area. Greater efforts are needed to diagnose COPD in order to improve its clinical outcomes and to refine registries so that they can be used as reliable sources of information

  13. Prevalence of quadriceps muscle weakness in patients with COPD and its association with disease severity

    Directory of Open Access Journals (Sweden)

    Kharbanda S

    2015-09-01

    Full Text Available Sidharth Kharbanda,1 Anand Ramakrishna,2 Shyam Krishnan31Kasturba Medical College, Manipal University, 2Department of Respiratory Medicine, 3Department of Physiotherapy, Kasturba Medical College Hospital, Mangaluru, Karnataka, IndiaIntroduction: COPD presents with an array of extra-pulmonary symptoms of which skeletal muscle dysfunction, particularly of the quadriceps, is well recognized. This contributes to impaired quality of life and increased health care utilization. Work on the quadriceps originated from the observation that a good proportion of COPD patients stop exercise due to the feeling of leg fatigue rather than breathlessness. This study was carried out with the aim of finding the prevalence of quadriceps weakness in a population set and correlate it with severity of COPD.Methodology: This cross-sectional study was conducted in 75 subjects suffering from COPD aged 45 years or above. COPD severity in the subjects was graded based on the GOLD staging system. A digital hand held dynamometer (HHD was used to measure quadriceps muscle strength. Descriptive statistics were done, and Pearson’s Correlation Coefficient and ANOVA analysis was used for expressing the results.Results: Ninety two percent of subjects were suffering from quadriceps muscle weakness. Quadriceps weakness was present in significantly high proportions even in those suffering from mild disease and belonging to a younger age group. The mean quadriceps muscle force value decreased with disease severity and this relation was found to be significant (P<0.01.Conclusion: Majority of the COPD patients were found to be suffering from quadriceps weakness, which was also present in significant proportions in subjects belonging to younger age groups and suffering from mild disease. These findings indicate that onset of muscle weakness in COPD may precede the onset of symptoms. These findings suggest need for early remedial measure to prevent occurrence of associated systemic

  14. External Validation of Health Economic Decision Models for Chronic Obstructive Pulmonary Disease (COPD): Report of the Third COPD Modeling Meeting.

    Science.gov (United States)

    Hoogendoorn, Martine; Feenstra, Talitha L; Asukai, Yumi; Briggs, Andrew H; Hansen, Ryan N; Leidl, Reiner; Risebrough, Nancy; Samyshkin, Yevgeniy; Wacker, Margarethe; Rutten-van Mölken, Maureen P M H

    2017-03-01

    To validate outcomes of presently available chronic obstructive pulmonary disease (COPD) cost-effectiveness models against results of two large COPD trials-the 3-year TOwards a Revolution in COPD Health (TORCH) trial and the 4-year Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial. Participating COPD modeling groups simulated the outcomes for the placebo-treated groups of the TORCH and UPLIFT trials using baseline characteristics of the trial populations as input. Groups then simulated treatment effectiveness by using relative reductions in annual decline in lung function and exacerbation frequency observed in the most intensively treated group compared with placebo as input for the models. Main outcomes were (change in) total/severe exacerbations and mortality. Furthermore, the absolute differences in total exacerbations and quality-adjusted life-years (QALYs) were used to approximate the cost per exacerbation avoided and the cost per QALY gained. Of the six participating models, three models reported higher total exacerbation rates than observed in the TORCH trial (1.13/patient-year) (models: 1.22-1.48). Four models reported higher rates than observed in the UPLIFT trial (0.85/patient-year) (models: 1.13-1.52). Two models reported higher mortality rates than in the TORCH trial (15.2%) (models: 20.0% and 30.6%) and the UPLIFT trial (16.3%) (models: 24.8% and 36.0%), whereas one model reported lower rates (9.8% and 12.1%, respectively). Simulation of treatment effectiveness showed that the absolute reduction in total exacerbations, the gain in QALYs, and the cost-effectiveness ratios did not differ from the trials, except for one model. Although most of the participating COPD cost-effectiveness models reported higher total exacerbation rates than observed in the trials, estimates of the absolute treatment effect and cost-effectiveness ratios do not seem different from the trials in most models. Copyright © 2017 International

  15. Airway inflammation in chronic obstructive pulmonary disease (COPD): a true paradox.

    Science.gov (United States)

    Eapen, Mathew Suji; Myers, Stephen; Walters, Eugene Haydn; Sohal, Sukhwinder Singh

    2017-10-01

    Chronic obstructive pulmonary disease (COPD) is primarily an airway condition, which mainly affects cigarette smokers and presents with shortness of breath that is progressive and poorly reversible. In COPD research, there has been a long held belief that airway disease progression is due to inflammation. Although this may be true in the airway lumen with innate immunity activated by the effect of smoke or secondary to infection, the accurate picture of inflammatory cells in the airway wall, where the pathophysiological COPD remodeling occurs, is uncertain and debatable. Areas covered: The current review provides a comprehensive literature survey of the changes in the main inflammatory cells in human COPD patients and focuses on contrarian views that affect the prevailing dogma on inflammation. The review also delves into the role of oxidative stress and inflammasomes in modulating the immune response in COPD. Further, the effects of inflammation in affecting the epithelium, fibroblasts, and airway remodeling are discussed. Expert commentary: Inflammation as a driving force for airway wall damage and remodelling in early COPD is at the very least 'oversimplified' and is likely to be misleading. This has serious implications for rational thinking about the illness, including pathogenesis and designing therapy.

  16. Adherence to Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Relation to Chronic Obstructive Pulmonary Disease (COPD): A Case-Control Study.

    Science.gov (United States)

    Ardestani, Mohammad Emami; Onvani, Shokouh; Esmailzadeh, Ahmad; Feizi, Awat; Azadbakht, Leila

    2017-01-01

    This case-control study was designed to investigate the association between adherences to the Dietary Approaches to Stop Hypertension (DASH) diet in patients with chronic obstructive pulmonary disease (COPD) in comparison to subjects without COPD. This is a case-control study. Usual dietary intake was assessed using a validated food frequency questionnaire. Lung function was evaluated with spirometry testing, and one of the researchers inquired about other respiratory symptoms, including chronic cough, sputum, and breathlessness. Adherence to the DASH dietary pattern was assessed according to the Fung method. This study was conducted at Alzahra University Hospital of Isfahan, Iran, in 2015. Eight-four patients with COPD and 80 subjects without a history of COPD participated in study. The mean age of participants was 57 years. Average smoking in the case group was about 27.5 pack-years. Spirometry tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were significantly lower in patients with COPD (p = 0.0001). Among COPD symptoms, cough was significantly decreased across tertiles of DASH score (p = 0.03). Significant differences were found for DASH score between patients with COPD and control subjects (19.82 + 3.63 vs 21.13 + 3.82, p = 0.02). Vitamin C, vitamin E, and dietary fiber intake were lower in patients with COPD (144.32 + 70.51 vs 166.97 + 71.88, p = 0.04, 7.49 + 3.91 vs 8.72 + 3.21, p = 0.02 and 19.34 + 7.05 vs 22.19 + 7.87, p = 0.01, respectively). We observed that adherence to a DASH dietary pattern among patients with COPD was significantly lower compared to the control group. Cough was significantly decreased by increments in adherence to a DASH dietary pattern.

  17. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

    Science.gov (United States)

    Sun, Kuo-Shao; Lin, Ming-Shian; Chen, Yi-Jen; Chen, Yih-Yuan; Chen, Solomon Chih-Cheng; Chen, Wei

    2015-01-01

    Symptomatic peripheral arterial disease (PAD) is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD). However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years) who volunteered to perform ankle-brachial index (ABI) and 6-minute walk test (6MWT) consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90). All patients were free of PAD symptoms at enrollment. Of the 200 COPD patients, 17 (8.5%) were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159). The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r (2)=-0.667, P<0.001), followed by oxygen-cost diagram (r (2)=0.582, P<0.001) and forced expiratory volume in 1 second (r (2)=0.532, P<0.001). In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05). However, body mass index, baseline heart rate, and ABI were not correlated with the distance covered on the 6MWT. Asymptomatic PAD is not associated with walking endurance in patients with COPD. Therefore, it is important to detect and treat asymptomatic PAD early so that COPD patients do not progress to become exercise intolerant. Limited by the small sample size and predominantly male (99%) population in the study, further large-scale prospective studies are needed to verify the results.

  18. Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.

    Science.gov (United States)

    Kawut, Steven M; Poor, Hooman D; Parikh, Megha A; Hueper, Katja; Smith, Benjamin M; Bluemke, David A; Lima, João A C; Prince, Martin R; Hoffman, Eric A; Austin, John H M; Vogel-Claussen, Jens; Barr, R Graham

    2014-11-11

    The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago. This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging. We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≥10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions emphysema subtypes were scored by radiologists. Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea. Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p emphysema. RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Comparison and evaluation of two different methods to establish the cigarette smoke exposure mouse model of COPD.

    Science.gov (United States)

    Shu, Jiaze; Li, Defu; Ouyang, Haiping; Huang, Junyi; Long, Zhen; Liang, Zhihao; Chen, Yuqin; Chen, Yiguan; Zheng, Qiuyu; Kuang, Meidan; Tang, Haiyang; Wang, Jian; Lu, Wenju

    2017-11-13

    Animal model of cigarette smoke (CS) -induced chronic obstructive pulmonary disease (COPD) is the primary testing methodology for drug therapies and studies on pathogenic mechanisms of disease. However, researchers have rarely run simultaneous or side-by-side tests of whole-body and nose-only CS exposure in building their mouse models of COPD. We compared and evaluated these two different methods of CS exposure, plus airway Lipopolysaccharides (LPS) inhalation, in building our COPD mouse model. Compared with the control group, CS exposed mice showed significant increased inspiratory resistance, functional residual capacity, right ventricular hypertrophy index, and total cell count in BALF. Moreover, histological staining exhibited goblet cell hyperplasia, lung inflammation, thickening of smooth muscle layer on bronchia, and lung angiogenesis in both methods of CS exposure. Our data indicated that a viable mouse model of COPD can be established by combining the results from whole-body CS exposure, nose-only CS exposure, and airway LPS inhalation testing. However, in our study, we also found that, given the same amount of particulate intake, changes in right ventricular pressure and intimal thickening of pulmonary small artery are a little more serious in nose-only CS exposure method than changes in the whole-body CS exposure method.

  20. The algorithm for the assessment of functional work capacity of railway workers with chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Okiljević Z.

    2014-01-01

    Full Text Available The assessment of functional work capacity based on the biological function of the body and a specific job demands and job characteristics, determine whether a person is capable to do the job or group of jobs. Evaluation of work capacity (EWC railway workers is conducted according to the program of Regulations for the former and periodic examinations of employees in workplaces with high risk published in the Official Gazette of RS no. 120/ 07 and 655. Regulations on health conditions to be met by railway workers, who are directly involved in railway transport. One of the most common chronic diseases during EWC is chronic obstructive pulmonary disease (COPD. The definition of contraindications for use of railway employees with COPD given by Ordinance 655 is in very general terms, trying to make it easier and improve the quality of assessment of work capacity, we have developed an algorithm for the assessment of work ability among these workers. When doubt the existence of COPD should first prove that the disease exists, according to GOLD (Global Initiative for Chronic Obstructive Lung Disease guidelines, and for occupational medicine we considered important to clarify and standardize the assessment criteria for EWC, which resulting in a diagnostic algorithm for EWC. It is also important to know which type of job will worker to do. Application of a diagnostic algorithm in EWC will allow optimal assessment of disease severity in railway and other workers suffering of COPD working at the workplace with an increased risk efficacy treatment evaluation; assess compensation of functional defects and determine schedule of periodical examination.

  1. Randomized controlled trials and real-world observational studies in evaluating cardiovascular safety of inhaled bronchodilator therapy in COPD.

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    Kardos, Peter; Worsley, Sally; Singh, Dave; Román-Rodríguez, Miguel; Newby, David E; Müllerová, Hana

    2016-01-01

    Long-acting muscarinic antagonist (LAMA) or long-acting β2-agonist (LABA) bronchodilators and their combination are recommended for the maintenance treatment of chronic obstructive pulmonary disease (COPD). Although the efficacy of LAMAs and LABAs has been well established through randomized controlled trials (RCTs), questions remain regarding their cardiovascular (CV) safety. Furthermore, while the safety of LAMA and LABA monotherapy has been extensively studied, data are lacking for LAMA/LABA combination therapy, and the majority of the studies that have reported on the CV safety of LAMA/LABA combination therapy were not specifically designed to assess this. Evaluation of CV safety for COPD treatments is important because many patients with COPD have underlying CV comorbidities. However, severe CV and other comorbidities are often exclusion criteria for RCTs, contributing to a lack in external validity and generalizability. Real-world observational studies are another important tool to evaluate the effectiveness and safety of COPD therapies in a broader population of patients and can improve upon the external validity limitations of RCTs. We examine what is already known regarding the CV and cerebrovascular safety of LAMA/LABA combination therapy from RCTs and real-world observational studies, and explore the advantages and limitations of data derived from each study type. We also describe an ongoing prospective, observational, comparative post-authorization safety study of a LAMA/LABA combination therapy (umeclidinium/vilanterol) and LAMA monotherapy (umeclidinium) versus tiotropium, with a focus on the relative merits of the study design.

  2. Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients.

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    Odler, Balázs; Ivancsó, István; Somogyi, Vivien; Benke, Kálmán; Tamási, Lilla; Gálffy, Gabriella; Szalay, Balázs; Müller, Veronika

    2015-01-01

    The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs), including COPD and bronchial asthma, was previously investigated. As asthma-COPD overlap syndrome (ACOS) is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown. Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D [25(OH)D]) in different OLDs, including ACOS patients, and its correlation with clinical parameters. A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20) were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council); furthermore, 25(OH)D levels were measured in all patients. The 25(OH)D level was significantly lower in ACOS and COPD groups compared to asthma group (16.86±1.79 ng/mL and 14.27±1.88 ng/mL vs 25.66±1.91 ng/mL). A positive correlation was found between 25(OH)D level and forced expiratory volume in 1 second (r=0.4433; P, forced vital capacity (FVC) (r=0.3741; P=0.0004), forced expiratory flow between 25% and 75% of FVC (r=0.4179; P, and peak expiratory flow (r=0.4846; PAsthma control test total scores and the 25(OH)D level showed a positive correlation in the ACOS (r=0.4761; P=0.0339) but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OH)D in ACOS (r=-0.4446; P=0.0495); however, this was not observed in the COPD group. Vitamin D deficiency is present in ACOS patients and circulating 25(OH)D level may affect disease control and severity.

  3. COPD is a systemic disease – the ex trapulmonary manifestations

    African Journals Online (AJOL)

    CLIFFORD SMITH, MB BCh, FCP (SA), MMed (Int Med), FCCP. Pulmonologist, Private practice, Morningside Medi-clinic. Table I. What are the extrapulmonary manifestations of COPD ... Deconditioning. Peripheral muscle dysfunction. Decreased exercise tolerance. Decreased quality of life. April 2009 Vol.27 No.4 CME. 159 ...

  4. COMET: a multicomponent home-based disease-management programmeversusroutine care in severe COPD.

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    Kessler, Romain; Casan-Clara, Pere; Koehler, Dieter; Tognella, Silvia; Viejo, Jose Luis; Dal Negro, Roberto W; Díaz-Lobato, Salvador; Reissig, Karina; Rodríguez González-Moro, José Miguel; Devouassoux, Gilles; Chavaillon, Jean-Michel; Botrus, Pierre; Arnal, Jean-Michel; Ancochea, Julio; Bergeron-Lafaurie, Anne; De Abajo, Carlos; Randerath, Winfried J; Bastian, Andreas; Cornelissen, Christian G; Nilius, Georg; Texereau, Joëlle B; Bourbeau, Jean

    2018-01-01

    The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference -5.3, 95% CI -13.7 to -3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; pmanagement intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients. Copyright ©ERS 2018.

  5. Vitamin K deficiency: the linking pin between COPD and cardiovascular diseases?

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    Piscaer, Ianthe; Wouters, Emiel F M; Vermeer, Cees; Janssens, Wim; Franssen, Frits M E; Janssen, Rob

    2017-11-13

    Cardiovascular diseases are prevalent in patients with chronic obstructive pulmonary disease (COPD). Their coexistence implies that many COPD patients require anticoagulation therapy. Although more and more replaced by direct oral anticoagulants, vitamin K antagonists (VKAs) are still widely used. VKAs induce profound deficiency of vitamin K, a key activator in the coagulation pathway. It is recognized however that vitamin K is also an essential cofactor in the activation of other extrahepatic proteins, such as matrix Gla protein (MGP), a potent inhibitor of arterial calcification. No or insufficient MGP activation by the use of VKAs is associated with a rapid progression of vascular calcification, which may enhance the risk for overt cardiovascular disease. Vitamin K consumption, on the other hand, seems to have a protective effect on the mineralization of arteries. Furthermore, vascular calcification mutually relates to elastin degradation, which is accelerated in patients with COPD associating with impaired survival. In this commentary, we hypothesize that vitamin K is a critical determinant to the rate of elastin degradation. We speculate on the potential link between poor vitamin K status and crucial mechanisms of COPD pathogenesis and raise concerns about the use of VKAs in patients with this disease. Future intervention studies are needed to explore if vitamin K supplementation is able to reduce elastin degradation and vascular calcification in COPD patients.

  6. The quality of life of farmers with chronic obstructive pulmonary disease (COPD).

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    Milanowska, Joanna; Mackiewicz, Barbara; Węgorowski, Paweł; Milanowski, Janusz; Milanowski, Piotr; Makara-Studzińska, Marta

    2017-06-09

    Introduction and objective. COPD is a medical state characterized by chronically poor airflow, and typically worsens over time. Farmers have an increased risk of COPD because of being exposed to ammonia, hydrogen sulfide, inorganic dust, and organic dust. The quality of life of the ill depends on biomedical as well as psychosocial factors, the impact of which has not been a frequent subject of studies among COPD patients. The aim of the study was to indicate the factors that have negative and positive influence on the quality of life of farmers suffering from COPD. Materials and method. The study was conducted among 84 farmers treated for COPD in the Department of Pneumology, Oncology and Allergology of the Medical University in Lublin, Poland. The differences between the farmers concerned: severity of the disease, level of education and income, frequency of smoking tobacco and drinking alcohol, kinds of support they receive from their families, and the level of depression and anxiety experienced by the patients. Results. The study revealed that most patients suffered from depressive and anxiety disorders, and the level of depression higher among the patients who smoked more. Lack of family support had significant influence on exacerbation of the patient's depressive and anxiety symptoms. Patients who had recently experienced a critical situation presented with more severe COPD symptoms, lower quality of life and a higher level of depression. Higher income of the patients had positive influence on their quality of life. Farmers addicted to alcohol suffered from a higher level of anxiety.

  7. Predictors of exacerbations in chronic obstructive pulmonary disease--results from the Bergen COPD cohort study.

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    Gunnar R Husebø

    Full Text Available COPD exacerbations accelerate disease progression.To examine if COPD characteristics and systemic inflammatory markers predict the risk for acute COPD exacerbation (AECOPD frequency and duration.403 COPD patients, GOLD stage II-IV, aged 44-76 years were included in the Bergen COPD Cohort Study in 2006/07, and followed for 3 years. Examined baseline predictors were sex, age, body composition, smoking, AECOPD the last year, GOLD stage, Charlson comorbidity score (CCS, hypoxemia (PaO21 AECOPD last year before baseline [1.65 (1.24-2.21], GOLD III [1.36 (1.07-1.74], GOLD IV [2.90 (1.98-4.25], chronic cough [1.64 (1.30-2.06] and use of inhaled steroids [1.57 (1.21-2.05]. For AECOPD duration more than three weeks, significant predictors after adjustment were: hypoxemia [0.60 (0.39-0.92], years since inclusion [1.19 (1.03-1.37], AECOPD severity; moderate [OR 1.58 (1.14-2.18] and severe [2.34 (1.58-3.49], season; winter [1.51 (1.08-2.12], spring [1.45 (1.02-2.05] and sTNF-R1 per SD increase [1.16 (1.00-1.35].Several COPD characteristics were independent predictors of both AECOPD frequency and duration.

  8. Impaired function of regulatory T-cells in patients with chronic obstructive pulmonary disease (COPD).

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    Tan, Dino B A; Fernandez, Sonia; Price, Patricia; French, Martyn A; Thompson, Philip J; Moodley, Yuben P

    2014-12-01

    Anti-inflammatory pathways affecting chronic obstructive pulmonary disease (COPD) are poorly understood. Regulatory T-cells (Tregs) are important negative regulators of T-cell activity and hence were investigated in COPD patients in this study. We hypothesised that functional defects in Tregs may promote increased inflammation contributing to the pathogenesis of COPD. Peripheral blood mononuclear cells (PBMC) were isolated from patients with stable COPD and age-matched non-smoking controls. Treg-mediated suppression of memory non-Treg (Foxp3(-)CD45RO(+)) CD4(+) T-cell activation was analysed by comparing PBMC responses to staphylococcal enterotoxin-B (SEB) pre- and post-depletion of Tregs (CD25(+)CD127(low)CD4(+) T-cells) by fluorescence-activated cell sorting (FACS). Activation of T-cells was assessed by HLA-DR expression. Levels of secreted cytokines were measured by ELISA. Depletion of Tregs increased SEB-induced activation of Foxp3(-)CD45RO(+) CD4(+) T-cells in samples from 15/15 healthy controls (demonstrating Treg-mediated suppression) and 9/14 COPD patients (Fisher's test, p=0.017). A screen of clinical data associated a failure of Treg-mediated suppression in the remaining five COPD patients with a higher body mass index (BMI) (33-38 kg/m(2)) compared to patients with unimpaired Treg function (20-32 kg/m(2)). In conclusion, we demonstrate impaired Treg-mediated suppression of CD4(+) T-cell activation in a subset of COPD patients, all of whom had high BMI. Obesity and/or perturbed homeostasis of Treg subsets may explain this defect and therefore contribute to increased inflammation observed in COPD. Copyright © 2014 Elsevier GmbH. All rights reserved.

  9. Spirometry is underused in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD)

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    Yu, Wai Cho; Fu, Sau Nga; Tai, Emily Lai-bun; Yeung, Yiu Cheong; Kwong, Kwok Chu; Chang, Yui; Tam, Cheuk Ming; Yiu, Yuk Kwan

    2013-01-01

    Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in a district in Hong Kong. It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Of 126 patients who underwent spirometry, six (4.8%) did not have COPD. Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. The only independent factor predicting spirometry done ever was absence of old pulmonary tuberculosis and follow-up at respiratory specialist clinic. Age, sex, smoking status, comorbidities, duration of COPD, percentage predicted FEV1, body mass index, 6-minute walking distance, and Medical Research Council dyspnea score were not predictive. We conclude that spirometry is underused in general but especially by nonrespiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed. PMID:24009418

  10. Spirometry is underused in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Yu, Wai Cho; Fu, Sau Nga; Tai, Emily Lai-Bun; Yeung, Yiu Cheong; Kwong, Kwok Chu; Chang, Yui; Tam, Cheuk Ming; Yiu, Yuk Kwan

    2013-01-01

    Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in a district in Hong Kong. It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Of 126 patients who underwent spirometry, six (4.8%) did not have COPD. Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. The only independent factor predicting spirometry done ever was absence of old pulmonary tuberculosis and follow-up at respiratory specialist clinic. Age, sex, smoking status, comorbidities, duration of COPD, percentage predicted FEV1, body mass index, 6-minute walking distance, and Medical Research Council dyspnea score were not predictive. We conclude that spirometry is underused in general but especially by nonrespiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed.

  11. Evaluation of glucocorticoid receptor function in COPD lung macrophages using beclomethasone-17-monopropionate.

    Directory of Open Access Journals (Sweden)

    Jonathan Plumb

    Full Text Available Previous studies of glucocorticoid receptor (GR function in COPD lung macrophages have used dexamethasone to evaluate inhibition of cytokine production. We have now used the clinically relevant corticosteroid beclomethasone-17-monopropionate (17-BMP to assess GR function in COPD lung macrophages, and investigated the transactivation of glucocorticoid sensitive genes and GR phosphorylation in addition to cytokine production. Lung macrophages were purified from surgically acquired lung tissue, from patients with COPD, smokers, and non-smokers. The transactivation of glucocorticoid sensitive genes (FKBP51 and GILZ by 17-BMP were analysed by polymerase chain reaction. 17-BMP suppression of LPS-induced TNFα, IL-6 and CXCL8 was measured by ELISA and GR phosphorylation was measured by immunohistochemistry and Western blot. 17-BMP reduced cytokine release in a concentration dependent manner, with >70% inhibition of all cytokines, and no difference between COPD patients and controls. Similarly, the transactivation of FKBP51 and GILZ, and GR phosphorylation was similar between COPD patients and controls. In this context, GR function in COPD lung macrophages is unaltered. 17-BMP effectively suppresses cytokine production in COPD lung macrophages.

  12. Umeclidinium for treating COPD: an evaluation of pharmacologic properties, safety and clinical use.

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    Manickam, Rajapriya; Asija, Amit; Aronow, Wilbert S

    2014-11-01

    Umeclidinium (UMEC) is a long-acting inhaled antagonist of muscarinic cholinergic receptors. The FDA approved UMEC for maintenance treatment of chronic obstructive pulmonary disease (COPD) in 2013 and it became available for commercial use as a single agent in 2014. After tiotropium, this is the only other once daily LAMA available for COPD patients. In this article, we have comprehensively reviewed the pharmacokinetic properties and analyzed the currently available randomized controlled trials on the efficacy and safety profile of UMEC. We have discussed the current clinical application of UMEC and its future implication. UMEC is the newer long-acting antimuscarinic agent (LAMA) that has demonstrated significant improvement in lung function and improved the quality of life in moderate-to-severe COPD patients. It is suitable for once daily dosing, has low anticholinergic side effects and is well tolerated. Overall, it is a safe, effective and convenient LAMA for maintenance therapy in COPD patients.

  13. Epithelial and endothelial cell plasticity in chronic obstructive pulmonary disease (COPD).

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    Sohal, Sukhwinder Singh

    2017-03-01

    Chronic Obstructive Pulmonary Disease (COPD) is mainly caused by smoking and presents with shortness of breath that is progressive and irreversible. It is a worldwide health problem and the fourth most common cause of chronic disability and mortality (even in developed countries). It is a complex disease involving both the airway and lung parenchyma. Small-airway fibrosis is the main contributor to physiological airway dysfunction in COPD. One potential mechanism contributing to small-airway fibrosis is epithelial mesenchymal transition (EMT). When associated with angiogenesis (EMT-type-3), EMT may well also be linked to the development of airway epithelial cancer, which is closely associated with COPD and predominantly observed in large airways. Vascular remodeling has also been widely reported in smokers and patients with COPD but the mechanisms behind it are poorly understood. It is quite possible that the process of endothelial to mesenchymal transition (EndMT) is also active in COPD lungs, in addition to EMT. Understanding these pathological mechanisms will greatly enhance our knowledge of the immunopathology of smoking-related lung disease. Only by understanding these processes can new therapies be developed. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  14. Prevalence of chronic obstructive pulmonary disease (COPD) in China in 1990 and 2010.

    Science.gov (United States)

    Chan, Kit Yee; Li, Xue; Chen, Wanjing; Song, Peige; Wong, Nuen Wing Katy; Poon, Adrienne N; Jian, Weiyan; Soyiri, Ireneous N; Cousens, Simon; Adeloye, Davies; Sheikh, Aziz; Campbell, Harry; Rudan, Igor

    2017-12-01

    Chronic obstructive pulmonary disease (COPD) is set to become the third most frequent cause of death and also the third largest cause of global morbidity by 2020. In China, where the population is aging rapidly, COPD has become one of the leading causes of disability and a large economic burden. An epidemiological assessment of the COPD in China is required, with a focus on the number of cases living with disease, main determinants of the disease and time trends. We systematically searched large Chinese bibliographic databases and English databases to identify spirometry-based epidemiological studies of the prevalence of COPD in China diagnosed according to GOLD criteria. We estimated age- and gender-specific prevalence of COPD using a multilevel mixed-effect logistic regression. We also presented the time trends of COPD between 1990 and 2010 by age, gender and setting (urban vs rural). In 1990, the prevalence of COPD ranged from 0.49% (95% CI = 0.29-0.85) in  = 80 years group, and the crude prevalence for China was 2.70% (95% CI = 1.86-3.51). In 2010, the prevalence in  = 80 years was 22.89% (95% CI = 18.13-28.96), with the crude prevalence for China of 3.84% (95% CI = 3.30-4.77). The COPD prevalence in males was about two-fold higher than in females, and it increased with increasing age. Between 1990-2010, the total number of Chinese people living with COPD increased by 66.73%, from 30.90 million (95% CI = 21.28-40.02) in 1990 to 51.52 million (95% CI = 44.26-63.93) in 2010. This increase was most striking in middle age, and greater in females than in males from 30 years up to 64 years. Our estimates, which used an independent approach to acquiring data and development of analytical methods, and were based on a more complete data set, are remarkably similar to those produced recently by the GBD 2013 collaboration, differing by only about 5% in the estimated number of COPD cases in 1990 and by 1% in 2010. COPD is a highly prevalent

  15. Course of COPD Assessment Test (CAT) Scores During Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease Treated in Outpatient Setting.

    Science.gov (United States)

    Minov, Jordan; Karadzinska-Bislimovska, Jovanka; Vasilevska, Kristin; Stoleski, Saso; Mijakoski, Dragan

    2015-01-01

    COPD Assessment Test (CAT) is an 8-items questionnaire for assessment of health status in patients with chronic obstructive pulmonary disease (COPD). To evaluate the course of CAT scores during bacterial exacerbations of COPD treated in outpatient setting. We performed an observational, prospective study including 81 outpatients (57 males and 24 females, aged 43 to 74 years) with bacterial exacerbation of COPD. All participants completed CAT at initial visit (i.e. at the time of diagnosis of exacerbation and beginning of its treatment), 10 and 30 days after initial visit. Mean scores of each item, as well as the overall mean score, at these time points were compared. The mean scores for each CAT question at initial visit varied from 2.6 to 3.5, whereas the mean scores for each CAT question 10 days after initial visit varied from 1.7 to 2.6. We registered significant reduction of the mean overall CAT score 10 days after initial visit as compared to its value at initial visit of 6.9 ± 2.7 points (16.8 vs 23.7; P CAT question 30 days after initial visit varied from 1.3 to 2.4. We registered reduction of mean overall CAT score 30 days after initial visit as compared to its score 10 days after initial visit of 2.9 ± 1.2 points (13.9 vs 16.8; P CAT score 30 days after initial visit was reduced for 9.8 ± 4.5 points as compared to its value at initial visit (13.9 vs 23.7; P CAT as an effective tool to measure health status in patients with COPD.

  16. Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD.

    Science.gov (United States)

    van Gestel, Yvette R B M; Hoeks, Sanne E; Sin, Don D; Stam, Henk; Mertens, Frans W; Bax, Jeroen J; van Domburg, Ron T; Poldermans, Don

    2009-01-01

    Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD) because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta-blockers and health-related quality of life (HRQOL) in patients with peripheral arterial disease and COPD. Of the original cohort of 3371 vascular surgery patients, 1310 had COPD of whom 469 survived during long-term follow-up. These COPD patients were sent the Short Form-36 (SF-36) health-related quality of life questionnaire, which was completed and returned by 326 (70%) patients. No significant differences in any of the SF-36 domains were observed between COPD patients who did and did not use beta-blockers (p > 0.05 for all). Furthermore, beta-blockers were not associated with any impairment in HRQOL among patients with COPD. Beta-blockers had no material impact on the HRQOL of patients with peripheral arterial disease who also had COPD. This suggests that beta-blockers can, in most circumstances, be administered to patients with COPD without impairment in HRQOL.

  17. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

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    Ming-Shian Lin

    Full Text Available AIM: Chronic obstructive pulmonary disease (COPD is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD and the associated risk factors for patients with COPD. METHODS: This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI was used to detect PAD (ABI<0.90. RESULTS: The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118 and 10% in the elderly participants (≥65 years of age, n = 309. The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4% and hypertension (79.4% vs. 45.8% than those without asymptomatic PAD (p<0.05. There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR: 6.89, p<0.005, followed by old age (OR: 4.80, hypertension (OR: 3.39 and smoking burden (pack-years, OR: 1.02. CONCLUSIONS: The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  18. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

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    Lin, Ming-Shian; Hsu, Kun-Yen; Chen, Yi-Jen; Chen, Cheng-Ren; Chen, Chuan-Mu; Chen, Wei

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD) and the associated risk factors for patients with COPD. This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years) without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI) was used to detect PAD (ABI<0.90). The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118) and 10% in the elderly participants (≥65 years of age, n = 309). The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4%) and hypertension (79.4% vs. 45.8%) than those without asymptomatic PAD (p<0.05). There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second) between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR): 6.89, p<0.005), followed by old age (OR: 4.80), hypertension (OR: 3.39) and smoking burden (pack-years, OR: 1.02). The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  19. Cognitive dysfunction in severe chronic obstructive pulmonary disease (COPD) with or without Long-Term Oxygen Therapy (LTOT)

    OpenAIRE

    Dal Negro, Roberto W; Bonadiman, Luca; Bricolo, Fernanda P; Tognella, Silvia; Turco, Paola

    2015-01-01

    Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition which can lead to comorbidities of variable severity, cognitive dysfunction included. The role of supplemental oxygen in preventing COPD-induced cognitive deterioration is still debated, but only episodically investigated. The aim of this study was to compare the cognitive pattern of hypoxemic COPD subjects treated with long-term oxygen (LTOT) to that of patients of comparable severity assuming oxyg...

  20. Use of ``Cold Spell'' indices to quantify excess chronic obstructive pulmonary disease (COPD) morbidity during winter (November to March 2000-2007): case study in Porto

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    Monteiro, Ana; Carvalho, Vânia; Góis, Joaquim; Sousa, Carlos

    2013-11-01

    The aim of this study was to examine the relationship between the occurrence of cold episodes and excess hospital admissions for chronic obstructive pulmonary disease (COPD) in Porto, Portugal, in order to further understand the effects of cold weather on health in milder climates. Excess COPD winter morbidity was calculated from admissions for November to March (2000-2007) in the Greater Porto Metropolitan Area (GPMA). Cold spells were identified using several indices (Díaz, World Meteorological Organization, Cold Spell Duration Index, Australian Index and Ondas’ Project Index) for the same period. Excess admissions in the periods before and after the occurrence of cold spells were calculated and related to the cold spells identified. The COPD seasonal variation admission coefficient (CVSA) showed excess winter admissions of 59 %, relative to other months. The effect of cold spell on the aggravation of COPD occurs with a lag of at least 2 weeks and differs according to the index used. This study indicates the important role of the persistence of cold periods of at least 2 weeks duration in the increase in COPD admissions. The persistence of moderate temperatures (Tmin ≤5 °C) for a week can be more significant for increasing COPD admissions than very low temperatures (Tmin ≤ 1.6 °C) for just a few days. The Ondas projects’ index provides the most accurate detection of the negative impacts of cold persistency on health, while the Diaz index is better at evaluating the consequences of short extreme cold events.

  1. Role of music in the management of chronic obstructive pulmonary disease (COPD): a literature review.

    Science.gov (United States)

    Panigrahi, Atman; Sohani, Shardul; Amadi, Chioma; Joshi, Ashish

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a pulmonary disease characterized by airflow limitation that is not fully reversible. It is projected to be the third leading cause of death worldwide by 2020. The objective of the study was to examine the impact of music on psychological and physiological outcomes among individuals with COPD. The scientific databases PubMed, google scholar and EBSCO were used to search for relevant articles published during a period of 01/01/2005 to 12/31/2012. The search terms "Music and COPD", "Music and Emphysema", "Singing and COPD", "Singing and Emphysema" , "music improves COPD" and "singing therapy on COPD", were used either in single or in combination. The inclusion criteria included studies having an experimental study design, were written in English and were conducted among individuals age 18 years and above. Studies that focused on the healthy population or had a disease other than COPD were excluded. Studies where music therapy was not the primary intervention and were systematic reviews were also excluded from the final analysis. Variables analyzed included year of publication, study location, study setting, target audience, study design, sample size, study duration, intervention and its components and the outcomes including physiological and psychological were assessed. A total of 7 papers that met the inclusion criteria were included in the final analysis. Studies included various music interventions such as singing, listening and playing music. Forty percent of the studies were performed in US. More than half of the studies (70%, n=5) had a randomized control study design and were performed in a hospital setting. The duration of the studies varied from 6 weeks to 21 months. The sample size in these studies varied from 7 to 72. Music showed improvement in the psychological outcomes such as quality of life, dyspnea and anxiety and mixed results in the improvement of physiological outcomes such as FEV, FVC, and breathing

  2. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

    Directory of Open Access Journals (Sweden)

    Sun KS

    2015-07-01

    Full Text Available Kuo-Shao Sun,1,2* Ming-Shian Lin,1,2* Yi-Jen Chen,1,2 Yih-Yuan Chen,3 Solomon Chih-Cheng Chen,4 Wei Chen1,5,6 1Division of Pulmonary and Critical Care Medicine, 2Department of Respiratory Care, Chang Gung University of Science and Technology, 3Department of Internal Medicine, 4Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 5College of Nursing, Dayeh University, Changhua, 6Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, Republic of China *These authors contributed equally to this work Objective: Symptomatic peripheral arterial disease (PAD is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD. However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. Methods: This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years who volunteered to perform ankle-brachial index (ABI and 6-minute walk test (6MWT consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90. All patients were free of PAD symptoms at enrollment. Results: Of the 200 COPD patients, 17 (8.5% were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159. The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r2=-0.667, P<0.001, followed by oxygen-cost diagram (r2=0.582, P<0.001 and forced expiratory volume in 1 second (r2=0.532, P<0.001. In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05. However, body mass index, baseline heart rate, and

  3. Tiotropium bromide in the routine care of GOLD stage II COPD patients: a pharmaeconomic evaluation

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    Orietta Zaniolo

    2011-06-01

    Full Text Available Background: a secondary pre-specified analysis of the UPLIFT cohort demonstrated that the inclusion of tiotropium bromide in the routine care of GOLD stage II (moderate chronic obstructive pulmonary disease (COPD patients is associated with stronger improvements of survival, quality of life, and exacerbation rate than those shown in the total cohort; in this subgroup, tiotropium furthermore induces a significant reduction in the rate of FEV1 decline.Objective: to adapt the Spiriva® model, originally built to evaluate cost-effectiveness of tiotropium inclusion in the general COPD population, to GOLD II patients.Methods: the Spiriva® model is a probabilistic Markov patient-level simulation developed over a lifetime horizon to compare outcomes associated with the inclusion of tiotropium in routine care (RC for COPD treatment with those obtained with RC alone. Patients are characterised by gender, age, height, smoking status and FEV1. Model structure and sources have been maintained unvaried, except for demographic characteristics, specific for GOLD II patients, as extrapolated from an Italian observational study, and tiotropium efficacy, based on the secondary analysis of GOLD II UPLIFT patients. As in the original model, only direct health care costs are considered.Results: patients treated with tiotropium on average (95% CI gain 0.70 (0.00/7.23 LYs or 0.77 (0.02/4.67 QALYs compared to RC. The incremental lifetime cost is € 3,520 (-6,391/26,686, meaning that the incremental cost required to gain a QALY (incremental cost-effectiveness ratio – ICER is equal to € 4,548. Sensitivity analysis shows that tiotropium has a 50% probability of being cost-effective for a willingness-to-pay (WTP around 4,600 €/QALY; 100% probability is achieved with a WTP of € 9,300.Conclusions: the adoption of a strategy based on the inclusion of tiotropium from the early COPD stages represents good value for money in Italy, as the ICER estimated for GOLD II

  4. Emphysema and airway disease affect within-breath changes in respiratory resistance in COPD patients.

    Science.gov (United States)

    Hasegawa, Koichi; Sato, Susumu; Tanimura, Kazuya; Fuseya, Yoshinori; Uemasu, Kiyoshi; Sato, Atsuyasu; Hirai, Toyohiro; Mishima, Michiaki; Muro, Shigeo

    2015-07-01

    Chronic obstructive pulmonary disease (COPD) is characterized by a mixture of emphysema and airway disease. The forced oscillation technique (FOT) has been applied to COPD patients to clarify changes in respiratory mechanics; dynamic changes in respiratory resistance (Rrs) during breathing (within-breath changes in Rrs, ΔRrs) are characteristic of COPD. However, the pathophysiological significance of these changes is unknown. The aim of this study was to assess how emphysema and airway disease influence ΔRrs in COPD patients. In this cross-sectional study, stable COPD patients were recruited and underwent respiratory impedance measurements with a commercially available FOT device. Rrs was recorded during tidal breathing and then analyzed as whole-breath Rrs (Rrs at 5 Hz, R5; Rrs at 20 Hz, R20; and their difference, R5-R20) or as ΔRrs, the difference between the expiratory and inspiratory Rrs (ΔR5, ΔR20 and ΔR5-R20). The percentage of the low attenuation area (LAA%) and airway wall area (WA%) was quantified by computed tomography analysis, and their contributions to ΔRrs were examined. Seventy-five COPD patients were recruited. LAA% was negatively correlated with ΔR5 and ΔR5-R20 (P = 0.0002 and P = 0.0033, respectively); meanwhile, WA% in B(10) was positively correlated with ΔR5 and ΔR5-R20 (P = 0.0057 and P disease increases ΔRrs in these patients. © 2015 Asian Pacific Society of Respirology.

  5. COPD: Learn More, Breathe Better

    Science.gov (United States)

    ... Health Information for the Public » Educational Campaigns & Programs » COPD (Chronic Obstructive Pulmonary Disease) Join the conversation: Doctors ... Diesases explain what you need to know about COPD. Get the Facts COPD is on the rise— ...

  6. Grading obstructive lung disease using tomographic pulmonary scintigraphy in patients with chronic obstructive pulmonary disease (COPD) and long-term smokers.

    Science.gov (United States)

    Bajc, Marika; Markstad, Hanna; Jarenbäck, Linnea; Tufvesson, Ellen; Bjermer, Leif; Jögi, Jonas

    2015-01-01

    The severity of chronic obstructive lung disease (COPD) is defined by the degree of flow limitation measured as forced expiratory volume in 1 s, which mainly reflects impairment of large and intermediate airways. However, COPD is primarily a small airways disease. Therefore, better diagnostic tools are needed. Ventilation-Perfusion (V/P) SPECT is a sensitive method to detect obstructive lung changes but criteria for staging airway obstruction are missing. To define and validate criteria to stage COPD using V/P SPECT. 74 subjects (healthy non-smokers, healthy smokers or with stable COPD) were included. All were examined with V/P SPECT in a hybrid SPECT/CT system. Spirometry was performed and patients were evaluated with the clinical COPD questionnaire (CCQ). V/P SPECT was interpreted independently. Preserved lung function (%) was evaluated. The degree of airway obstruction on V/P SPECT was graded according to newly-developed grading criteria. The degree of airway obstruction was graded from normal (0) to severe (3). The airway obstructivity-grade and degree of preserved lung function were compared to GOLD, CCQ and LDCT emphysema extent. Obstructivity-grade (r = 0.66, P obstructivity-grade (P = 0.001) and preserved lung function (P obstructivity-grade and preserved lung function, respectively). However, patients in GOLD 1 differed in obstructivity-grade from non-smoking controls (P = 0.02). Functional imaging with V/P SPECT enables standardized grading of airway obstruction as well as reduced lung function, both of which correlate with GOLD stage. V/P SPECT shows that long-term smokers in most cases have signs of ventilatory impairment and airway obstruction not shown by spirometry.

  7. A review of the availability and cost effectiveness of chronic obstructive pulmonary disease (COPD) management interventions in rural Australia and New Zealand.

    Science.gov (United States)

    Brooke, Michelle E; Spiliopoulos, Nicolaos; Collins, Margaret

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is a chronic, progressive disease, which consumes a significant proportion of the Australian and New Zealand healthcare budget. Studies have shown that people living with COPD outside of urban areas have higher rates of hospitalisations. Two international reviews have demonstrated reduced hospital admissions and length of stay in people with COPD who participate in an integrated disease management program. However, most studies included in these reviews are in urban settings. The purpose of this review is to explore the type and cost-effectiveness of COPD management interventions located in rural or remote settings of Australia and New Zealand in order to inform planning and ongoing service development in the authors' local health district. Six databases and Google scholar were searched to find literature relating to the availability and cost-effectiveness of non-pharmaceutical interventions for the management of COPD in rural and remote areas of Australia and New Zealand. Two studies were found that met the inclusion criteria. Both studies had small sample sizes, were single intervention studies and showed a positive influence on variables such as number of hospital admissions and length of stay at 12 months post-intervention. However, because of the limited number of studies and the lack of homogeneity of interventions, no conclusions regarding availability and cost-effectiveness of COPD interventions in rural and remote areas of Australia and New Zealand could be drawn. Limited literature exists to inform planning and development of services for people with COPD living in rural and remote areas of Australia and New Zealand. Approximately 50% of pulmonary rehabilitation programs are situated in rural and remote locations in Australia and New Zealand. Outcomes from existing programs need to be reported in a consistent and coordinated manner to allow evaluation of health resource utilisation.

  8. Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: a systematic review.

    Science.gov (United States)

    Dang-Tan, Tam; Ismaila, Afisi; Zhang, Shiyuan; Zarotsky, Victoria; Bernauer, Mark

    2015-09-21

    Chronic obstructive pulmonary disease (COPD) is a chronic, irreversible disease and a leading cause of worldwide morbidity and mortality. In Canada, COPD is the fourth leading cause of death. This systematic review was undertaken to update healthcare professionals and decision makers regarding the recent clinical, humanistic and economic burden evidence in Canada. A systematic literature search was conducted in PubMed, EMBASE, and Cochrane databases to identify original research published January 2000 through December 2012 on the burden of COPD in Canada. Each search was conducted using controlled vocabulary and key words, with "COPD" as the main search concept and limited to Canadian studies, written in English and involving human subjects. Selected studies included randomized controlled trials, observational studies and systematic reviews/meta-analyses that reported healthcare resource utilization, quality of life and/or healthcare costs. Of the 972 articles identified through the literature searches, 70 studies were included in this review. These studies were determined to have an overall good quality based on the quality assessment. COPD patients were found to average 0-4 annual emergency department visits, 0.3-1.5 annual hospital visits, and 0.7-5 annual physician visits. Self-care management was found to lessen the overall risk of emergency department (ED) visits, hospitalization and unscheduled physician visits. Additionally, integrated care decreased the mean number of hospitalizations and telephone support reduced the number of annual physician visits. Overall, 60-68 % of COPD patients were found to be inactive and 60-72 % reported activity restriction. Pain was found to negatively correlate with physical activity while breathing difficulties resulted in an inability to leave home and reduced the ability to handle activities of daily living. Evidence indicated that treating COPD improved patients' overall quality of life. The average total cost per patient

  9. Metabolic Disorder in Chronic Obstructive Pulmonary Disease (COPD) Patients: Towards a Personalized Approach Using Marine Drug Derivatives.

    Science.gov (United States)

    Lamonaca, Palma; Prinzi, Giulia; Kisialiou, Aliaksei; Cardaci, Vittorio; Fini, Massimo; Russo, Patrizia

    2017-03-20

    Metabolic disorder has been frequently observed in chronic obstructive pulmonary disease (COPD) patients. However, the exact correlation between obesity, which is a complex metabolic disorder, and COPD remains controversial. The current study summarizes a variety of drugs from marine sources that have anti-obesity effects and proposed potential mechanisms by which lung function can be modulated with the anti-obesity activity. Considering the similar mechanism, such as inflammation, shared between obesity and COPD, the study suggests that marine derivatives that act on the adipose tissues to reduce inflammation may provide beneficial therapeutic effects in COPD subjects with high body mass index (BMI).

  10. Alpha-1 antitrypsin gene polymorphism in Chronic Obstructive Pulmonary Disease (COPD

    Directory of Open Access Journals (Sweden)

    Sabri Denden

    2010-01-01

    Full Text Available Alpha-1-antitrypsin (AAT plays an important role in the pathogenesis of emphysema, the pathological lesion underlying the majority of the manifestations of Chronic Obstructive Pulmonary Disease (COPD. In this study we tested the hypothesis that common AAT polymorphisms influence the risk of developing COPDs. We investigated PiM1 (Ala213Val, PiM2 (Arg101His, PiM3 (Glu376Asp, PiS (Glu264Val and PiZ (Glu342Lys SERPINA1 alleles in 100 COPD patients and 200 healthy controls. No significant differences were observed in allele frequencies between COPD patients and controls, neither did haplotype analysis show significant differences between the two groups. A cross-sectional study revealed no significant relationship between common SERPINA1 polymorphisms (PiM1, PiM2, PiM3 and the emphysematous type of COPD. In addition, FEV1 annual decline, determined during a two-year follow up period, revealed no difference among carriers of the tested polymorphisms.

  11. The evidence for the use of oral mucolytic agents in chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Davies, L; Calverley, P M A

    2010-01-01

    Oral mucolytics are now recommended in some treatment guidelines for the management of chronic obstructive pulmonary disease (COPD). This article reviews the evidence for their use and their possible benefits. The review is based upon peer reviewed publications relating to the use of mucolytics in COPD cited in PubMed. Much of the published evidence is of somewhat poor quality and many studies include patients with both chronic bronchitis and COPD. Mucolytics reduce exacerbations by up to 0.8 exacerbations per year, but have little additional benefit in those on standard maximum therapy. Data that mucolytics improve symptoms, alter mucus or impact health-related quality of life in COPD patients receiving other standard therapy are unconvincing. In those on little or no other treatment, they may reduce exacerbation rate. The use of mucolytics to treat acute exacerbations is promising. Head-to-head trials of mucolytics versus long-acting bronchodilators and/or inhaled corticosteroids are lacking. Even in patients with severe COPD who remain symptomatic despite maximal inhaled therapy the role of mucolytics remains unproven.

  12. Prevalence and characteristics of three clinical phenotypes of chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Izquierdo-Alonso, José Luis; Rodriguez-Gonzálezmoro, Jose Miguel; de Lucas-Ramos, Pilar; Unzueta, Irune; Ribera, Xabier; Antón, Esther; Martín, Antonio

    2013-05-01

    To determine the prevalence and analyze the most relevant clinical characteristics of three clinical phenotypes of COPD: emphysema (type 1), chronic bronchitis (type 2) or COPD-asthma (type 3). Observational, multicenter study performed with 331 COPD patients recruited in pulmonology outpatient services. The stratification in three phenotypes was performed with imaging tests, pulmonary function, and a standardized clinical questionnaire. The 43.2% presented an emphysematous phenotype, 44.7% were chronic bronchitic and the other 12.1% presented a phenotype showing mixed characteristics with asthma. There were no significant differences in the smoking level, in the gasometric values or time of disease evolution. Type 1 patients showed lower FEV1 values in comparison with types 2 and 3, 46.6% (21.1), 55.2% (21.2) and 54.4% (21.8), respectively (p COPD), or in the number of hospital admittances. Type 2 patients showed a greater prevalence of cardiovascular comorbidities and of sleep apnea syndrome (4.9%, 23.6% and 12.5%, respectively, p COPD, emphysematous patients present worse pulmonary function and greater dyspnea, although there were no differences in the use of hospital health care resources. The greater comorbidity in Group 2 patients may require specific strategies in this subgroup of patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Alpha-1 antitrypsin gene polymorphism in Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Denden, Sabri; Khelil, Amel Haj; Knani, Jalel; Lakhdar, Ramzi; Perrin, Pascale; Lefranc, Gérard; Chibani, Jemni Ben

    2010-01-01

    Alpha-1-antitrypsin (AAT) plays an important role in the pathogenesis of emphysema, the pathological lesion underlying the majority of the manifestations of Chronic Obstructive Pulmonary Disease (COPD). In this study we tested the hypothesis that common AAT polymorphisms influence the risk of developing COPDs. We investigated PiM1 (Ala213Val), PiM2 (Arg101His), PiM3 (Glu376Asp), PiS (Glu264Val) and PiZ (Glu342Lys) SERPINA1 alleles in 100 COPD patients and 200 healthy controls. No significant differences were observed in allele frequencies between COPD patients and controls, neither did haplotype analysis show significant differences between the two groups. A cross-sectional study revealed no significant relationship between common SERPINA1 polymorphisms (PiM1, PiM2, PiM3) and the emphysematous type of COPD. In addition, FEV(1) annual decline, determined during a two-year follow up period, revealed no difference among carriers of the tested polymorphisms.

  14. Cochrane corner: is integrated disease management for patients with COPD effective?

    NARCIS (Netherlands)

    Kruis, A.L.; Smidt, N.; Assendelft, W.J.; Gussekloo, J.; Boland, M.R.; Rutten-van Molken, M.P.; Chavannes, N.H.

    2014-01-01

    Patients with COPD experience respiratory symptoms, impairments of daily living and recurrent exacerbations. The aim of integrated disease management (IDM) is to establish a programme of different components of care (ie, self-management, exercise, nutrition) in which several healthcare providers

  15. Cochrane corner: Is integrated disease management for patients with COPD effective?

    NARCIS (Netherlands)

    A.L. Kruis (Annemarije); N. Smidt (Nynke); W.J.J. Assendelft (Willem); J. Gussekloo (Jacobijn); M.R.S. Boland (Melinde); M.P.M.H. Rutten-van Mölken (Maureen); N.H. Chavannes (Nicolas)

    2014-01-01

    markdownabstractPatients with COPD experience respiratory symptoms, impairments of daily living and recurrent exacerbations. The aim of integrated disease management (IDM) is to establish a programme of different components of care (ie, self-management, exercise, nutrition) in which several

  16. Cochrane corner : is integrated disease management for patients with COPD effective?

    NARCIS (Netherlands)

    Kruis, Annemarije L.; Smidt, Nynke; Assendelft, Willem J. J.; Gussekloo, Jacobijn; Boland, Melinde R. S.; Rutten-van Molken, Maureen; Chavannes, Niels H.

    2014-01-01

    Patients with COPD experience respiratory symptoms, impairments of daily living and recurrent exacerbations. The aim of integrated disease management (IDM) is to establish a programme of different components of care (ie, self-management, exercise, nutrition) in which several healthcare providers

  17. Controlled expiration in mechanically-ventilated patients with chronic obstructive pulmonary disease (COPD)

    NARCIS (Netherlands)

    J.G.J.V. Aerts (Joachim); B.W. van den Berg (Bart); J.M. Bogaard (Jan)

    1997-01-01

    textabstractIn patients with severe chronic obstructive pulmonary disease (COPD), lung emptying may be affected by flow limitation. We tested the hypothesis that the airway compression leading to flow limitation can be counteracted by controlling the expiratory flow. The effects

  18. Prevalence and risk factors of chronic obstructive pulmonary disease (COPD) in Dhaka city population.

    Science.gov (United States)

    Islam, M S; Hossain, M M; Pasha, M M; Azad, A K; Murshed, K M

    2013-07-01

    This prospective, cross-sectional population based survey was carried out in the Respiratory wing, Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to see the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among Dhaka City Population in Bangladesh. The total sample size was 900 at the age of 35 years or above. Spirometry was performed according to ATS criteria. Data related to smoking history, respiratory symptoms, co-morbidities, physical examination findings, spirometry values and other investigation reports were noted in the questionnaire. The mean age was 45.26±10.08 (Mean±SD); of them, male 76.9% and female 23.1%. Among them, smoker was 481 with a smoking duration of 10 pack year 27.8% and non smoker were 419. Spirometric screening yielded diagnosis of COPD in 11.4% (103/900). Using operational severity criteria adopted from Global Initiative for Obstructive Lung Disease (GOLD) mild, moderate, severe and very severe COPD were found in 42.7%, 27.2%, 20.4% and 9.7% respectively. The hall mark symptom of COPD exertional dyspnea was seen in 10.4%, non-specific symptoms like cough and sputum were found in 40% and 19% respectively. Physical sign like vesicular breath sound with prolonged expiration and ronchi were found in 6.1% and 4.1% respectively. In this study, age (Mean±SD in years) (57.34±11.74), Sex (Male: Female = 4:1), low BMI (Mean±SD) (21.56±3.83), Smoker 56(20.2%) and low Socio-economic condition 54(13.6%) found to be risk factor of COPD. Regression analysis revealed that age (pCOPD.

  19. Effect of beta-blockers on exacerbation rate and lung function in chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Duffy, Sean; Marron, Robert; Voelker, Helen; Albert, Richard; Connett, John; Bailey, William; Casaburi, Richard; Cooper, J Allen; Curtis, Jeffrey L; Dransfield, Mark; Han, MeiLan K; Make, Barry; Marchetti, Nathaniel; Martinez, Fernando; Lazarus, Stephen; Niewoehner, Dennis; Scanlon, Paul D; Sciurba, Frank; Scharf, Steven; Reed, Robert M; Washko, George; Woodruff, Prescott; McEvoy, Charlene; Aaron, Shawn; Sin, Don; Criner, Gerard J

    2017-06-19

    Beta-blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with beta-blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective beta-blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts. We retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with beta blocker use. Overall 13.9% (170/1219) of participants reported taking beta-blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking beta-blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking beta-blockers. In the STATCOPE cohort, patients taking beta-blockers had an exacerbation rate of 1.14/person-year. Patients without beta-blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of beta blockers with respect to change in lung function over time. We found no evidence that beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.

  20. Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

    Science.gov (United States)

    Lalmolda, C; Coll-Fernández, R; Martínez, N; Baré, M; Teixidó Colet, M; Epelde, F; Monsó, E

    2017-01-01

    Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P=0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P=0.014, and R2=0.219). A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

  1. Reconsidering sex-based stereotypes of COPD.

    Science.gov (United States)

    Ohar, Jill; Fromer, Leonard; Donohue, James F

    2011-12-01

    Chronic obstructive pulmonary disease (COPD) has historically been considered a disease of older, white, male smokers, as illustrated in Frank Netter's classic images of the 'pink puffer' and 'blue bloater'. However, women may be more susceptible to COPD than men, and the disease course may be reflective of that increased susceptibility. From a review of epidemiological data of COPD, we found differences in the way men and women present with COPD symptoms, a bias in the way COPD symptoms are treated in men and women, and differences in susceptibility to airway obstruction based on age, sex, and smoking history. These data show that classic stereotypes of COPD - including male predominance - should be abandoned, and that there are not two but multiple COPD phenotypes, which are characterised by differences between women and men in susceptibility, symptoms, and disease progression. These differences impact on physician perception. Although further research into this concept is needed, the differences we found should prompt, in the short term, changes in the way (and in whom) COPD is evaluated, diagnosed, and treated; in the long term, these differences should prompt research into the prognosis of COPD based on sex differences.

  2. Geroprotectors as a novel therapeutic strategy for COPD, an accelerating aging disease

    Directory of Open Access Journals (Sweden)

    Ito K

    2012-09-01

    Full Text Available Kazuhiro Ito, Thomas Colley, Nicolas MercadoAirways Disease Section, National Heart and Lung Institute, Imperial College London, London, United KingdomAbstract: Chronic obstructive pulmonary disease (COPD progresses very slowly and the majority of patients are therefore elderly. COPD is characterized by an abnormal persistent inflammatory response to noxious environmental stimuli and there are increasing evidences for a close relationship between premature aging and chronic inflammatory diseases. Thus, COPD is considered to be a disease of an accelerating aging. In this review, we collected the evidence for roles of aging on pathogenesis of COPD and considered future therapeutic strategy for COPD based on this senescence hypothesis. Since calorie restriction has been proved to extend lifespan, many efforts were made to clarify the molecular mechanism of aging. Aging is defined as the progressive decline of homeostasis that occurs after the reproductive phase of life is complete, leading to an increasing risk of disease or death due to impaired DNA repair after damage by oxidative stress or telomere shortening as a result of repeated cell division. During aging, pulmonary function progressively deteriorates; innate immunity is impaired and pulmonary inflammation increases, accompanied by structural changes, such as an enlargement of airspaces. Noxious environmental gases, such as cigarette smoke, may worsen these aging-related events in the lung or accelerate aging of the lung due to reduction in anti-aging molecules and/or stimulation of aging molecules. Aging signaling are complex but conserved in divert species, such as worm, fruit fry, rodent and humans. Especially the insulin like growth factor (IGF-1 signaling was well documented. Geroprotectors are therapeutics that affect the root cause of aging and age-related diseases, and thus prolong the life-span of animals. Most of geroprotectors such as melatonin, metformin, rapamycin and

  3. COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update.

    Science.gov (United States)

    Yang, Ian A; Brown, Juliet L; George, Johnson; Jenkins, Sue; McDonald, Christine F; McDonald, Vanessa M; Phillips, Kirsten; Smith, Brian J; Zwar, Nicholas A; Dabscheck, Eli

    2017-11-20

    Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.

  4. Proposing a standardized method for evaluating patient report of the intensity of dyspnea during exercise testing in COPD.

    Science.gov (United States)

    Hareendran, Asha; Leidy, Nancy K; Monz, Brigitta U; Winnette, Randall; Becker, Karin; Mahler, Donald A

    2012-01-01

    Measuring dyspnea intensity associated with exercise provides insights into dyspnea-limited exercise capacity, and has been used to evaluate treatment outcomes for chronic obstructive pulmonary disease (COPD). Three patient-reported outcome scales commonly cited for rating dyspnea during exercise are the modified Borg scale (MBS), numerical rating scale for dyspnea (NRS-D), and visual analogue scale for dyspnea (VAS-D). Various versions of each scale were found. Our objective was to evaluate the content validity of scales commonly used in COPD studies, to explore their ability to capture patients' experiences of dyspnea during exercise, and to evaluate a standardized version of the MBS. A two-stage procedure was used, with each stage involving one-on-one interviews with COPD patients who had recently completed a clinic-based exercise event on a treadmill or cycle ergometer. An open-ended elicitation interview technique was used to understand patients' experiences of exercise-induced dyspnea, followed by patients completing the three scales. The cognitive interviewing component of the study involved specific questions to evaluate the patients' perspectives of the content and format of the scales. Results from Stage 1 were used to develop a standardized version of the MBS, which was then subjected to further content validity assessment during Stage 2. Thirteen patients participated in the two-stage process (n = 6; n = 7). Mean forced expiratory volume in 1 second (FEV(1)) percent predicted was 40%, mean age 57 years, and 54% were male. Participants used a variety of terms to describe the intensity and variability of exercise-induced dyspnea. Subjects understood the instructions and format of the standardized MBS, and were able to easily select a response to report the level of dyspnea associated with their recent standardized exercise. This study provides initial evidence in support of using a standardized version of the MBS version for quantifying dyspnea intensity

  5. Chronic obstructive pulmonary disease (COPD) during the two last years of life--a retrospective study of decedents.

    Science.gov (United States)

    Sundblad, Britt-Marie; Jansson, Sven-Arne; Nyström, Lennarth; Arvidsson, Peter; Lundbäck, Bo; Larsson, Kjell

    2013-01-01

    Little is known about the management of patients suffering from chronic obstructive pulmonary disease (COPD) during the last years of life. The aim of the study was to describe how management of COPD is performed in Sweden during the last two years of life. From the nationwide Cause of Death register all individuals with COPD as the underlying cause of death during two years were identified in one sparsely and one densely populated area of Sweden. Data were collected from medical records using a pre-defined protocol, especially developed for this purpose. Of 822 individuals with COPD as underlying cause of death, medical records from 729 were available. The COPD diagnosis was based on lung function measurements in approximately half of the patients and median age at COPD diagnosis was 74 years (range 34-95). Women died at younger age, median 78 years (range 52-96) than did men (80 years (51-99)). The median survival time from diagnosis to death was 6 years in men and women in both areas. Among women and men 8.3% and 4.3% were never smokers, respectively. The structure of COPD management differed between the two areas, with utilization of physiotherapists, dieticians and working therapists being more used in the northern area, likely because of differences in accessibility to care institutions. In Sweden COPD is mostly diagnosed late in life and often not verified by lung function measurements. Opposite to the general population, women with COPD die at a lower age than men.

  6. Lung cancer in patients with chronic obstructive pulmonary disease. Development and validation of the COPD Lung Cancer Screening Score.

    Science.gov (United States)

    de-Torres, Juan P; Wilson, David O; Sanchez-Salcedo, Pablo; Weissfeld, Joel L; Berto, Juan; Campo, Arantzazu; Alcaide, Ana B; García-Granero, Marta; Celli, Bartolome R; Zulueta, Javier J

    2015-02-01

    Patients with chronic obstructive pulmonary disease (COPD) are at high risk for lung cancer (LC) and represent a potential target to improve the diagnostic yield of screening programs. To develop a predictive score for LC risk for patients with COPD. The Pamplona International Early Lung Cancer Detection Program (P-IELCAP) and the Pittsburgh Lung Screening Study (PLuSS) databases were analyzed. Only patients with COPD on spirometry were included. By logistic regression we determined which factors were independently associated with LC in PLuSS and developed a COPD LC screening score (COPD-LUCSS) to be validated in P-IELCAP. By regression analysis, age greater than 60, body mass index less than 25 kg/m(2), pack-years history greater than 60, and emphysema presence were independently associated with LC diagnosis and integrated into the COPD-LUCSS, which ranges from 0 to 10 points. Two COPD-LUCSS risk categories were proposed: low risk (scores 0-6) and high risk (scores 7-10). In comparison with low-risk patients, in both cohorts LC risk increased 3.5-fold in the high-risk category. The COPD-LUCSS is a good predictor of LC risk in patients with COPD participating in LC screening programs. Validation in two different populations adds strength to the findings.

  7. Vitamin D deficiency is associated with impaired disease control in asthma–COPD overlap syndrome patients

    Directory of Open Access Journals (Sweden)

    Odler B

    2015-09-01

    Full Text Available Balázs Odler,1 István Ivancsó,1 Vivien Somogyi,1 Kálmán Benke,2 Lilla Tamási,1 Gabriella Gálffy,1 Balázs Szalay,3 Veronika Müller11Department of Pulmonology, 2Heart and Vascular Centre, 3Department of Laboratory Medicine, Semmelweis University, Budapest, HungaryIntroduction: The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs, including COPD and bronchial asthma, was previously investigated. As asthma–COPD overlap syndrome (ACOS is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown.Aim: Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D [25(OHD] in different OLDs, including ACOS patients, and its correlation with clinical parameters.Methods: A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20 were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council; furthermore, 25(OHD levels were measured in all patients.Results: The 25(OHD level was significantly lower in ACOS and COPD groups compared to asthma group (16.86±1.79 ng/mL and 14.27±1.88 ng/mL vs 25.66±1.91 ng/mL. A positive correlation was found between 25(OHD level and forced expiratory volume in 1 second (r=0.4433; P<0.0001, forced vital capacity (FVC (r=0.3741; P=0.0004, forced expiratory flow between 25% and 75% of FVC (r=0.4179; P<0.0001, and peak expiratory flow (r=0.4846; P<0.0001 in OLD patient groups. Asthma control test total scores and the 25(OHD level showed a positive correlation in the ACOS (r=0.4761; P=0.0339 but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OHD in ACOS (r=-0.4446; P=0.0495; however, this was not observed in the COPD group.Conclusion: Vitamin D deficiency is present in ACOS patients and

  8. Recommendations for Diagnosis and Management of Osteoporosis in COPD Men

    OpenAIRE

    Mazokopakis, Elias E.; Starakis, Ioannis K.

    2011-01-01

    Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for osteoporosis and fractures because of lifestyle factors, systemic effects of the disease, side effects of treatment, and comorbidities. The initial evaluation of COPD men for osteoporosis must include a detailed medical history and physical examination, assessment of COPD severity, and additional tests, as suggested by results of clinical evaluation. Osteoporosis is diagnosed on the basis of bone mineral dens...

  9. COPD flare-ups

    Science.gov (United States)

    COPD exacerbation; Chronic obstructive pulmonary disease exacerbation; Emphysema exacerbation; Chronic bronchitis exacerbation ... health care provider on an action plan for COPD exacerbations so that you know what to do. ...

  10. Influence of lung CT changes in chronic obstructive pulmonary disease (COPD on the human lung microbiome.

    Directory of Open Access Journals (Sweden)

    Marion Engel

    Full Text Available Changes in microbial community composition in the lung of patients suffering from moderate to severe COPD have been well documented. However, knowledge about specific microbiome structures in the human lung associated with CT defined abnormalities is limited.Bacterial community composition derived from brush samples from lungs of 16 patients suffering from different CT defined subtypes of COPD and 9 healthy subjects was analyzed using a cultivation independent barcoding approach applying 454-pyrosequencing of 16S rRNA gene fragment amplicons.We could show that bacterial community composition in patients with changes in CT (either airway or emphysema type changes, designated as severe subtypes was different from community composition in lungs of patients without visible changes in CT as well as from healthy subjects (designated as mild COPD subtype and control group (PC1, Padj = 0.002. Higher abundance of Prevotella in samples from patients with mild COPD subtype and from controls and of Streptococcus in the severe subtype cases mainly contributed to the separation of bacterial communities of subjects. No significant effects of treatment with inhaled glucocorticoids on bacterial community composition were detected within COPD cases with and without abnormalities in CT in PCoA. Co-occurrence analysis suggests the presence of networks of co-occurring bacteria. Four communities of positively correlated bacteria were revealed. The microbial communities can clearly be distinguished by their associations with the CT defined disease phenotype.Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

  11. Cost-Utility Analysis of Telemonitoring Interventions for Patients with Chronic Obstructive Pulmonary Disease (COPD) in Germany.

    Science.gov (United States)

    Hofer, Florian; Achelrod, Dmitrij; Stargardt, Tom

    2016-12-01

    Chronic obstructive pulmonary disease (COPD) poses major challenges for health care systems. Previous studies suggest that telemonitoring could be effective in preventing hospitalisations and hence reduce costs. The aim was to evaluate whether telemonitoring interventions for COPD are cost-effective from the perspective of German statutory sickness funds. A cost-utility analysis was conducted using a combination of a Markov model and a decision tree. Telemonitoring as add-on to standard treatment was compared with standard treatment alone. The model consisted of four transition stages to account for COPD severity, and a terminal stage for death. Within each cycle, the frequency of exacerbations as well as outcomes for 2015 costs and quality adjusted life years (QALYs) for each stage were calculated. Values for input parameters were taken from the literature. Deterministic and probabilistic sensitivity analyses were conducted. In the base case, telemonitoring led to an increase in incremental costs (€866 per patient) but also in incremental QALYs (0.05 per patient). The incremental cost-effectiveness ratio (ICER) was thus €17,410 per QALY gained. A deterministic sensitivity analysis showed that hospitalisation rate and costs for telemonitoring equipment greatly affected results. The probabilistic ICER averaged €34,432 per QALY (95 % confidence interval 12,161-56,703). We provide evidence that telemonitoring may be cost-effective in Germany from a payer's point of view. This holds even after deterministic and probabilistic sensitivity analyses.

  12. Level of daily physical activity in chronic obstructive pulmonary disease (COPD) patients according to GOLD classification.

    Science.gov (United States)

    Rodó-Pin, Anna; Balañá, Ana; Molina, Lluís; Gea, Joaquim; Rodríguez, Diego A

    2017-02-09

    The Global Initiative for Chronic Obstructive Lung Disease (GOLD guideline) for patients with chronic obstructive pulmonary disease does not adequately reflect the impact of the disease because does not take into account daily physical activity (DPA). Forty eight patients (12 in each GOLD group) were prospectively recruited. DPA was evaluated by accelerometer. Patients were classified into 3 levels of activity (very inactive, sedentary, active). No significant differences in levels of physical activity among GOLD groups (P=.361) were observed. The percentages of very inactive patients were 33% in group A, 42% in group B, 42% in group C and 59% in group D. In addition, high percentage of sedentary patients were observed through 4 groups, in group A (50%), B and C (42%, each), and group D (41%). COPD patients has very low levels of physical activity at all stages of GOLD classification even those defined as low impact (such as GOLD A). Is necessary to detect patients at risk who might benefit from specific interventions. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  13. Validation of a New Questionnaire with Generic and Disease-Specific Qualities: The Mcgill Copd Quality of Life Questionnaire

    Directory of Open Access Journals (Sweden)

    Smita Pakhale

    2012-01-01

    Full Text Available BACKGROUND: A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease (COPD with advantages of both generic- and disease-specific questionnaires is needed to capture patients’ perspectives of severity and impact of the disease. The McGill COPD questionnaire was created to include these advantages in English and French. It assesses three domains: symptoms, physical function and feelings with 29 items (12 from the 36-item Short-Form Health Survey with 17 from the previously developed COPD-specific module.

  14. ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers.

    Science.gov (United States)

    Montes de Oca, María; López Varela, María Victorina; Acuña, Agustín; Schiavi, Eduardo; Rey, María Alejandra; Jardim, José; Casas, Alejandro; Tokumoto, Antonio; Torres Duque, Carlos A; Ramírez-Venegas, Alejandra; García, Gabriel; Stirbulov, Roberto; Camelier, Aquiles; Bergna, Miguel; Cohen, Mark; Guzmán, Santiago; Sánchez, Efraín

    2015-08-01

    ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  15. Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Moayeri, Foruhar; Hsueh, Ya-Seng Arthur; Clarke, Philip; Hua, Xinyang; Dunt, David

    2016-06-01

    Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I(2) = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.

  16. “What are my chances of developing COPD if one of my parents has the disease?” A systematic review and meta-analysis of prevalence of co-occurrence of COPD diagnosis in parents and offspring

    Directory of Open Access Journals (Sweden)

    Li LSK

    2017-01-01

    Full Text Available Lok Sze Katrina Li,1 Catherine Paquet,2 Kylie Johnston,1 Marie T Williams3 1School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 2Center for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 3Alliance for Research in Exercise, Nutrition and Activity (ARENA, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, AustraliaIntroduction: Intergenerational associations in chronic obstructive pulmonary disease (COPD have been well recognized and may result from genetic, gene environment, or exposure to life course factors. Consequently, adult offspring of parents with COPD may be at a greater risk of developing COPD. The aim of this study was to review the prevalence of co-occurrence of COPD in adult offspring with one or both parents having COPD independent of specific genetic variations.Methods: In total, five databases were searched for original studies in which prevalence of COPD was reported in both offspring (children and one or both parents. Studies were excluded if COPD was not clearly defined, COPD was linked to specific genetic variations, COPD was combined with other chronic respiratory conditions, or estimates included other first-degree relatives. Data extraction (ie, sample characteristics, prevalence of COPD, and odds ratio [OR] if reported was completed by two independent reviewers. A meta-analysis of prevalence and OR was conducted, where possible. Results: Of the 3,382 citations, 129 full texts were reviewed to include eight studies (six case–control, one cross-sectional, and one cohort reflecting either prevalence of COPD in offspring of parents with COPD (descendent approach, n=3, which ranged from 0% to 17.3%, or prevalence of people with COPD reporting positive parental history of COPD (antecedent approach, n=5, for which the pooled prevalence

  17. Disease Burden of Patients with Asthma/COPD Overlap in a US Claims Database: Impact of ICD-9 Coding-based Definitions.

    Science.gov (United States)

    Wurst, Keele E; St Laurent, Samantha; Hinds, David; Davis, Kourtney J

    2017-04-01

    The inclusion of an asthma/chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) population in the 2015 Global Initiative for Chronic Obstructive Lung Disease strategic documents has raised questions about the profile of these patients in clinical practice, as they are mostly excluded from asthma and COPD clinical trials. We estimated the disease burden, co-morbidities, and respiratory treatments of patients with asthma/COPD overlap, utilizing the Truven MarketScan commercial and Medicare databases. Patients with ≥1 COPD or chronic obstructive asthma diagnostic code were identified between January 1, 2008, and December 31, 2011. The asthma/COPD overlap group was defined and stratified based upon type and frequency of asthma diagnostic code (chronic obstructive asthma only, COPD and chronic obstructive asthma, and COPD and ≥1 asthma code). 1,488,613 patients were identified; of these, 1,171,626 were diagnosed with COPD alone and 316,987 with asthma/COPD overlap. Patients with asthma and COPD had higher disease burden indicators and inhaled corticosteroid/long-acting beta-agonist use compared with COPD alone. This trend was consistent for all definitions of asthma/COPD overlap. Patients with obstructive asthma and COPD tended to be older, with greater disease burden compared with other definitions; this population may represent a more severe form of asthma/COPD overlap. Disease burden and treatment also varied based on the codes defining asthma/COPD overlap, indicating possible phenotypic differences. More clinical insight and detailed phenotyping is needed to determine the reasons for coding variation in asthma/COPD overlap, with implications for further research to address unmet needs.

  18. Burden of Respiratory Disease in Korea: An Observational Study on Allergic Rhinitis, Asthma, COPD, and Rhinosinusitis.

    Science.gov (United States)

    Yoo, Kwang Ha; Ahn, Hae Ryun; Park, Jae Kyoung; Kim, Jong Woong; Nam, Gui Hyun; Hong, Soon Kwan; Kim, Mee Ja; Ghoshal, Aloke Gopal; Muttalif, Abdul Razak Bin Abdul; Lin, Horng Chyuan; Thanaviratananich, Sanguansak; Bagga, Shalini; Faruqi, Rab; Sajjan, Shiva; Baidya, Santwona; Wang, De Yun; Cho, Sang Heon

    2016-11-01

    The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea. Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity. The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs. Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.

  19. Sinonasal inflammation in COPD

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Konge, Lars; Thomsen, Sf

    2013-01-01

    In this review we demonstrate that patients with chronic obstructive pulmonary disease (COPD) frequently report sinonasal symptoms. Furthermore, we present evidence that smoking on its own can cause nasal disease, and that in COPD patients, nasal inflammation mimics that of the bronchi. All...... this evidence suggests that COPD related sinonasal disease does exist and that smoking on its own rather than systemic inflammation triggers the condition. However, COPD related sinonasal disease remains to be characterized in terms of symptoms and endoscopic findings. In addition, more studies are needed...... to quantify the negative impact of sinonasal symptoms on the quality of life in COPD patients....

  20. Evaluation of COPD's diaphragm motion extracted from 4D-MRI

    Science.gov (United States)

    Swastika, Windra; Masuda, Yoshitada; Kawata, Naoko; Matsumoto, Koji; Suzuki, Toshio; Iesato, Ken; Tada, Yuji; Sugiura, Toshihiko; Tanabe, Nobuhiro; Tatsumi, Koichiro; Ohnishi, Takashi; Haneishi, Hideaki

    2015-03-01

    We have developed a method called intersection profile method to construct a 4D-MRI (3D+time) from time-series of 2D-MRI. The basic idea is to find the best matching of the intersection profile from the time series of 2D-MRI in sagittal plane (navigator slice) and time series of 2D-MRI in coronal plane (data slice). In this study, we use 4D-MRI to semiautomatically extract the right diaphragm motion of 16 subjects (8 healthy subjects and 8 COPD patients). The diaphragm motion is then evaluated quantitatively by calculating the displacement of each subjects and normalized it. We also generate phase-length map to view and locate paradoxical motion of the COPD patients. The quantitative results of the normalized displacement shows that COPD patients tend to have smaller displacement compared to healthy subjects. The average normalized displacement of total 8 COPD patients is 9.4mm and the average of normalized displacement of 8 healthy volunteers is 15.3mm. The generated phase-length maps show that not all of the COPD patients have paradoxical motion, however if it has paradoxical motion, the phase-length map is able to locate where does it occur.

  1. Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients.

    Science.gov (United States)

    Pandolfi, Paolo; Zanasi, Alessandro; Musti, Muriel Assunta; Stivanello, Elisa; Pisani, Lara; Angelini, Sabrina; Maffei, Francesca; Hrelia, Silvana; Angeloni, Cristina; Zenesini, Corrado; Hrelia, Patrizia

    2015-01-01

    Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients. Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant'Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines. 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01-16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52-8.83), belonging to moderate (HR = 3.50; 95% CI 1.01-12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35-28.85). Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.

  2. Development and characterization of a rat model of chronic obstructive pulmonary disease (COPD) induced by sidestream cigarette smoke.

    Science.gov (United States)

    Zheng, Hongao; Liu, Yuening; Huang, Tian; Fang, Zheman; Li, Guishuang; He, Shaoheng

    2009-09-28

    Cigarette smoke (CS) induced chronic obstructive pulmonary disease (COPD) has been emerging as a great health problem in China. However, lack of appropriate animal model slows down the progress in understanding pathogenesis of the disease. The aim of current study is to establish and evaluate a more adequate rat model of COPD. Study was performed with rats exposed to sidestream cigarette smoke 2h/d and 7d/wk for 2, 4, 6, 8, 10, 12, 24 and 36 wk in a CS chamber (carbon monoxide concentration was 231+/-11ppm). The lung function was determined by using the forced oscillation technique. Pathologic changes were determined by using histological analyses and mucin measurement. Following 36-wk exposure, airway resistance (Raw) and respiratory system elastance (Ers) in CS group rats was elevated by 28.5% and 37.5%, respectively. Up to 4.1-, 2.3- and 1.4-fold increase in the number of neutrophils, macrophages and lymphocytes was observed in the BALF of CS rats. Using quantitative histomorphology techniques, it was found that mean linear intercept (MLI) and mean alveolar airspace (MAA) of CS rats increased by 44.8% and 43.7%, respectively, indicating the occurrence of emphysema. The characteristics of chronic bronchitis including hyperplasia of bronchial epithelial cells, hypersecretion of mucus and development of peribronchial fibrosis were also found in rat lungs. CS group rats showed 43% body weight gain reduction. To conclude, a more adequate sidestream cigarette smoke rat COPD model was established, which will be beneficial for understanding the pathogenesis of the disease and for evaluation of drug effectiveness.

  3. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China.

    Science.gov (United States)

    Dong, Xiao-Yan; Wang, Lan; Tao, Yan-Xia; Suo, Xiu-Li; Li, Yue-Chuan; Liu, Fang; Zhao, Yue; Zhang, Qing

    2017-01-01

    Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients' quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR), which has been developed and validated in its English version, is needed for patients with COPD in China. A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women), who met the inclusion and exclusion criteria, were enrolled in the study. Test-retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach's α. Content validity was examined using the Content Validity Index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). Besides, convergent validity and construct validity were also examined. The AIR-C (AIR-Chinese version) scale had high test-retest reliability (intraclass correlation coefficient =0.904) and internal consistency (Cronbach's α=0.914); the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89-1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, Panxiety and panic symptoms in the AIR-C scale had the best fit according to Confirmatory Factor Analysis (CFA). The AIR-C scale had a good reliability and validity for patients with COPD and can be used as a user-friendly and valid tool for measuring anxiety symptoms among patients with COPD in China.

  4. Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns

    National Research Council Canada - National Science Library

    Lalmolda C; Coll-Fernández R; Martínez N; Baré M; Teixidó Colet M; Epelde F; Monso E

    2017-01-01

    ... Monsó1-3 On behalf of the COPD Multidisciplinary Management Group 1Respiratory Diseases Department, Hospital Universitari Parc Tauli, 2Ciber de Enfermedades Respiratorias - Ciberes, 3Universitat...

  5. RELATION BETWEEN BETA-LACTAMASE-PRODUCING BACTERIA AND PATIENT CHARACTERISTICS IN CHROMIC OBSTRUCTIVE PULMONARY-DISEASE (COPD)

    NARCIS (Netherlands)

    SPORTEL, JH; KOETER, GH; VANALTENA, R; LOWENBERG, A; BOERSMA, WG

    Background - In addition to bronchodilator and anti-inflammatory therapy, exacerbations in patients with chronic obstructive pulmonary disease (COPD) are often treated with antibiotics. Haemophilus influenzae and Moraxella (Branhamella) catarrhalis, two important respiratory pathogens, may produce

  6. Costs of chronic obstructive pulmonary disease (COPD) in Italy: The SIRIO study (Social Impact of Respiratory Integrated Outcomes)

    National Research Council Canada - National Science Library

    Dal Negro, R.W; Tognella, S; Tosatto, R; Dionisi, M; Turco, P; Donner, C.F

    2008-01-01

    .... The aim of the Social Impact of Respiratory Integrated Outcomes (SIRIO) study was to measure the health resources consumption and costs generated in 1 year by a population of patients with chronic obstructive pulmonary disease (COPD...

  7. A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: the COPE-III study protocol.

    Science.gov (United States)

    Lenferink, Anke; Frith, Peter; van der Valk, Paul; Buckman, Julie; Sladek, Ruth; Cafarella, Paul; van der Palen, Job; Effing, Tanja

    2013-09-01

    Chronic Obstructive Pulmonary Disease (COPD) frequently coexists with other diseases. Whereas COPD action plans are currently part of usual care, they are less suitable and potentially unsafe for use in the presence of comorbidities. This study evaluates whether an innovative treatment approach directed towards COPD and frequently existing comorbidities can reduce COPD exacerbation days. We hypothesise that this approach, which combines self-initiated action plans and nurse support, will accelerate proper treatment actions and lead to better control of deteriorating symptoms. In this multicenter randomised controlled trial we aim to include 300 patients with COPD (GOLD II-IV), and with at least one comorbidity (cardiovascular disease, diabetes, anxiety and/or depression). Patients will be recruited from hospitals in the Netherlands (n = 150) and Australia (n = 150) and will be assigned to an intervention or control group. All patients will learn to complete daily symptom diaries for 12-months. Intervention group patients will participate in self-management training sessions to learn the use of individualised action plans for COPD and comorbidities, linked to the diary. The primary outcome is the number of COPD exacerbation days. Secondary outcomes include hospitalisations, quality of life, self-efficacy, adherence, patient's satisfaction and confidence, health care use and cost data. Intention-to-treat analyses (random effect negative binomial regression and random effect mixed models) and cost-effectiveness analyses will be performed. Prudence should be employed before extrapolating the use of COPD specific action plans in patients with comorbidities. This study evaluates the efficacy of tailored action plans for both COPD and common comorbidities. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Static and Functional Balance in Individuals With COPD: Comparison With Healthy Controls and Differences According to Sex and Disease Severity

    OpenAIRE

    de Castro, Larissa A.; Ribeiro, Lais R. G.; Mesquita, Rafael; de Carvalho, Debora R.; Felcar, Josiane M.; Merli,Myriam F.; Karen B.P. Fernandes; da Silva, Rubens A.; Denilson C Teixeira; Spruit, Martijn A; Pitta, Fabio; Probst, Vanessa S.

    2016-01-01

    BACKGROUND: Studies have shown that individuals with COPD have impaired body balance, probably caused by the disease's multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COP...

  9. Airway disease: similarities and differences between asthma, COPD and bronchiectasis

    Directory of Open Access Journals (Sweden)

    Rodrigo Athanazio

    2012-11-01

    Full Text Available Airway diseases are highly prevalent worldwide; however, the prevalence of these diseases is underestimated. Although these diseases present several common characteristics, they have different clinical outcomes. The differentiation between asthma, chronic obstructive pulmonary disease and bronchiectasis in the early stage of disease is extremely important for the adoption of appropriate therapeutic measures. However, because of the high prevalence of these diseases and the common pathophysiological pathways, some patients with different diseases may present with similar symptoms. The objective of this review is to highlight the similarities and differences between these diseases in terms of the risk factors, pathophysiology, symptoms, diagnosis and treatment.

  10. Proposing a standardized method for evaluating patient report of the intensity of dyspnea during exercise testing in COPD

    Directory of Open Access Journals (Sweden)

    Hareendran A

    2012-05-01

    Full Text Available Asha Hareendran,1 Nancy K Leidy,2 Brigitta U Monz,3 Randall Winnette,1 Karin Becker,3 Donald A Mahler41United BioSource Corporation, London, UK; 2United BioSource Corporation, Bethesda, MD, USA; 3Boehringer Ingelheim, Ingelheim, Germany; 4Dartmouth Medical School, Hanover, NH, USABackground: Measuring dyspnea intensity associated with exercise provides insights into dyspnea-limited exercise capacity, and has been used to evaluate treatment outcomes for chronic obstructive pulmonary disease (COPD. Three patient-reported outcome scales commonly cited for rating dyspnea during exercise are the modified Borg scale (MBS, numerical rating scale for dyspnea (NRS-D, and visual analogue scale for dyspnea (VAS-D. Various versions of each scale were found. Our objective was to evaluate the content validity of scales commonly used in COPD studies, to explore their ability to capture patients' experiences of dyspnea during exercise, and to evaluate a standardized version of the MBS.Methods: A two-stage procedure was used, with each stage involving one-on-one interviews with COPD patients who had recently completed a clinic-based exercise event on a treadmill or cycle ergometer. An open-ended elicitation interview technique was used to understand patients' experiences of exercise-induced dyspnea, followed by patients completing the three scales. The cognitive interviewing component of the study involved specific questions to evaluate the patients' perspectives of the content and format of the scales. Results from Stage 1 were used to develop a standardized version of the MBS, which was then subjected to further content validity assessment during Stage 2.Results: Thirteen patients participated in the two-stage process (n = 6; n = 7. Mean forced expiratory volume in 1 second (FEV1 percent predicted was 40%, mean age 57 years, and 54% were male. Participants used a variety of terms to describe the intensity and variability of exercise-induced dyspnea. Subjects

  11. Costs of illness analysis in Italian patients with chronic obstructive pulmonary disease (COPD: an update

    Directory of Open Access Journals (Sweden)

    Dal Negro RW

    2015-03-01

    Full Text Available Roberto W Dal Negro,1,2 Luca Bonadiman,1 Paola Turco,2 Silvia Tognella,3 Sergio Iannazzo41National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy; 2Research and Clinical Governance, Verona, Italy; 3General Hospital, ULSS 22 Regione Veneto, Bussolengo, Italy; 4SIHS Health Economics Consulting, Torino, ItalyBackground: Chronic obstructive pulmonary disease (COPD is a major cause of chronic morbidity and mortality worldwide, and its epidemiological, clinical, and socioeconomic impact is progressively increasing. A first estimate of the economic burden of COPD in Italy was conducted in 2008 (the SIRIO [Social Impact of Respiratory Integrated Outcomes] study. The aim of the present study is to provide an updated picture of the COPD economic burden in Italy.Methods: Sequential patients presenting at the specialist center for the first time during the period 2008–2012 and with record file complete (demographic, clinical, lung function, and therapeutic data; health care resources consumed in the 12 months before the enrollment and for the 3 subsequent years were selected from the institutional database.Results: Two hundred and seventy-five COPD patients fitting the inclusion criteria were selected (226 males; mean age: 70.9 years [standard deviation: ±8.4 years]; 45.8% were from the north, 25.1% from central Italy, and 29.1% from south Italy. COPD-related average costs per patient in the 12 months before enrollment were as follows: hospitalization: €1,970; outpatient care: €463; pharmaceutical: €499; and indirect costs: €358. Average direct costs and total societal costs were €2,932 and €3,291, respectively. Direct cost was €2,461 (hospitalization: €1,570; outpatient: €344; and pharmaceutical: €547 in the first year of follow-up, while total societal cost was €2,707. No significant difference was reported in any cost category between sexes.Conclusion: The therapeutic approach followed in a

  12. Panax ginseng C.A Meyer root extract for moderate Chronic Obstructive Pulmonary Disease (COPD: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Story David

    2011-06-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD impairs quality of life and leads to premature mortality. COPD sufferers experience progressive deterioration of lung function and decreased ability to undertake day-to-day activities. Ginseng has been used for thousands of years in Chinese medicine for respiratory symptoms. Several controlled clinical trials using ginseng for COPD have shown promising clinical effect, however these studies were generally small and with some potential bias, prompting the need for rigorously designed studies. Aim The objective of this study is to evaluate the therapeutic value and safety profile of a standardised root extract of Panax ginseng C.A Meyer (ginseng for symptomatic relief, with a focus on quality of life (QoL improvements in individuals with moderate (Stage II COPD FEV1/FVC 1 50% - 80% predicted. Methods This paper describes the design of a randomised, multi-centre, double-blind, placebo controlled, two-armed parallel clinical trial. Two trial sites in Melbourne Australia will proportionately randomise a total of 168 participants to receive either ginseng capsule (100 mg or matching placebo twice daily for 24 weeks. The primary outcomes will be based on three validated QoL questionnaires, St Georges Respiratory Questionnaire (SGRQ, Short Form Health Survey (SF-36 and the COPD Assessment Test (CAT. Secondary outcomes are based on lung function testing, relief medication usage and exacerbation frequency and severity. Safety endpoints include blood tests and adverse event reporting. Intention-to-treat will be applied to all data analyses. Discussion Findings from this study may lead to new therapeutic development for chronic respiratory diseases, particularly COPD. This protocol may also guide other investigators to develop quality herbal medicine clinical trials in the future. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR: ACTRN12610000768099

  13. Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands.

    Science.gov (United States)

    Tsiachristas, Apostolos; Burgers, Laura; Rutten-van Mölken, Maureen P M H

    2015-12-01

    Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior. The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness. Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%). The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. A validated disease specific prediction equation for resting metabolic rate in underweight patients with COPD

    Directory of Open Access Journals (Sweden)

    Anita Nordenson

    2010-09-01

    Full Text Available Anita Nordenson2, Anne Marie Grönberg1,2, Lena Hulthén1, Sven Larsson2, Frode Slinde11Department of Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; 2Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska Academy at University of Gothenburg, SwedenAbstract: Malnutrition is a serious condition in chronic obstructive pulmonary disease (COPD. Successful dietary intervention calls for calculations of resting metabolic rate (RMR. One disease-specific prediction equation for RMR exists based on mainly male patients. To construct a disease-specific equation for RMR based on measurements in underweight or weight-losing women and men with COPD, RMR was measured by indirect calorimetry in 30 women and 11 men with a diagnosis of COPD and body mass index <21 kg/m2. The following variables, possibly influencing RMR were measured: length, weight, middle upper arm circumference, triceps skinfold, body composition by dual energy x-ray absorptiometry and bioelectrical impedance, lung function, and markers of inflammation. Relations between RMR and measured variables were studied using univariate analysis according to Pearson. Gender and variables that were associated with RMR with a P value <0.15 were included in a forward multiple regression analysis. The best-fit multiple regression equation included only fat-free mass (FFM: RMR (kJ/day = 1856 + 76.0 FFM (kg. To conclude, FFM is the dominating factor influencing RMR. The developed equation can be used for prediction of RMR in underweight COPD patients.Keywords: pulmonary disease, chronic obstructive, basal metabolic rate, malnutrition, body composition

  15. Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD, prevalence and association with disease severity: Using tissue Doppler study

    Directory of Open Access Journals (Sweden)

    Abeer M. Rawy

    2015-10-01

    Conclusion: There is a high prevalence of LVDD in COPD patients which is associated with increased disease severity and associated with high levels of inflammatory markers (serum MMP-9 and TIMP-1. It is important to exclude decompensated heart failure during COPD exacerbation.

  16. Psychometric properties of the Anxiety Inventory for Respiratory Disease in patients with COPD in China

    Directory of Open Access Journals (Sweden)

    Dong X

    2016-12-01

    Full Text Available Xiao-Yan Dong,1,* Lan Wang,1,* Yan-Xia Tao,1 Xiu-li Suo,2 Yue-Chuan Li,2 Fang Liu,1 Yue Zhao,1 Qing Zhang1 1School of Nursing, Tianjin Medical University, 2Department of Respiratory Care, Tianjin Chest Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work Background: Anxiety is a common comorbidity in patients with COPD in China, and it can significantly decrease patients’ quality of life. Almost all anxiety measurements contain somatic items that can overlap with symptoms of COPD and side effects of medicines, which can lead to bias in measuring anxiety in patients with COPD. Therefore, a brief and disease-specific non-somatic anxiety measurement scale, the Anxiety Inventory for Respiratory Disease (AIR, which has been developed and validated in its English version, is needed for patients with COPD in China.Methods: A two-center study was conducted in two tertiary hospitals in Tianjin, China. A total of 181 outpatients with COPD (mean age 67.21±8.10 years, 32.6% women, who met the inclusion and exclusion criteria, were enrolled in the study. Test–retest reliability was examined using intraclass correlation coefficients. The internal consistency was calculated by Cronbach’s α. Content validity was examined using the Content Validity Index (CVI, scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave. Besides, convergent validity and construct validity were also examined.Results: The AIR-C (AIR-Chinese version scale had high test–retest reliability (intraclass correlation coefficient =0.904 and internal consistency (Cronbach’s α=0.914; the content validity of the AIR-C scale was calculated by CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.89–1, 0.90, and 0.98, respectively. Meanwhile, the AIR-C scale had good convergent validity, correlating with the Hospital Anxiety and Depression Scale-Anxiety (r=0.81, P<0.01, and there were

  17. Standardized evaluation of lung congestion during COPD exacerbation better identifies patients at risk of dying

    Directory of Open Access Journals (Sweden)

    Høiseth AD

    2013-12-01

    Full Text Available Arne Didrik Høiseth,1 Torbjørn Omland,1 Bo Daniel Karlsson,2 Pål H Brekke,1 Vidar Søyseth11Cardiothoracic Research Group, Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 2Deptartment of Radiology, Akershus University Hospital, Lørenskog, NorwayBackground: Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease (COPD. Pulmonary congestion on chest radiograph at admission for acute exacerbation of COPD (AECOPD is associated with an increased risk of mortality. A standardized evaluation of chest radiographs may enhance prognostic accuracy.Purpose: We aimed to evaluate whether a standardized, liberal assessment of pulmonary congestion is superior to the routine assessment in identifying patients at increased risk of long-term mortality, and to investigate the association of heart failure with N-terminal prohormone of brain natriuretic peptide (NT-proBNP concentrations.Material and methods: This was a prospective cohort study of 99 patients admitted for AECOPD. Chest radiographs obtained on admission were routinely evaluated and then later evaluated by blinded investigators using a standardized protocol looking for Kerley B lines, enlarged vessels in the lung apex, perihilar cuffing, peribronchial haze, and interstitial or alveolar edema, defining the presence of pulmonary congestion. Adjusted associations with long-term mortality and NT-proBNP concentration were calculated.Results: The standardized assessment was positive for pulmonary congestion in 32 of the 195 radiographs (16% ruled negative in the routine assessment. The standardized assessment was superior in predicting death during a median follow up of 1.9 years (P=0.022, and in multivariable analysis, only the standardized assessment showed a significant association with mortality (hazard ratio 2.4, 95% confidence interval [CI] 1.2–4.7 (P=0.016 and NT-proBNP (relative

  18. Up-to-date on mortality in COPD - report from the OLIN COPD study

    Directory of Open Access Journals (Sweden)

    Lindberg Anne

    2012-01-01

    Full Text Available Abstract Background The poor recognition and related underdiagnosis of COPD contributes to an underestimation of mortality in subjects with COPD. Data derived from population studies can advance our understanding of the true burden of COPD. The objective of this report was to evaluate the impact of COPD on mortality and its predictors in a cohort of subjects with and without COPD recruited during the twenty first century. Methods All subjects with COPD (n = 993 defined according to the GOLD spirometric criteria, FEV1/FVC 1 % predicted and reported heart disease. Results The mortality was significantly higher among subjects with COPD, 10.9%, compared to subjects without COPD, 5.8% (p 1 % predicted in the multivariate model resulted in the decreasing level of FEV1 being a significant risk factor for death, while heart disease was not a significant risk factor for death in any of the models. Conclusions In this cohort COPD and decreased FEV1 were significant risk factors for death when adjusted for age, gender, smoking habits and reported heart disease.

  19. COPD is frequent in conditions of comorbidity in patients treated with various diseases in a university hospital

    Directory of Open Access Journals (Sweden)

    Akira Yamasaki

    2010-09-01

    Full Text Available Akira Yamasaki, Kiyoshi Hashimoto, Yasuyuki Hasegawa, Ryota Okazaki, Miki Yamamura, Tomoya Harada, Shizuka Ito, Soichiro Ishikawa, Hiroki Takami, Masanari Watanabe, Tadashi Igishi, Yuji Kawasaki, Eiji ShimizuDivision of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, JapanBackground: Chronic obstructive pulmonary disease (COPD is one of the leading causes of death and loss of disability-adjusted life-years. However, many COPD patients are not diagnosed because of underrecognition or underdiagnosis of this disease among many patients and physicians. One possible reason is underrecognition of spirometry. In this study, we examined the prevalence of airflow limitation and underlying disease in patients with airflow limitation.Methodology: From April 2006 to March 2008, patients who had spirometry performed were examined. The original disease of patients, pulmonary function tests, smoking status, and respiratory symptoms were surveyed from their medical records.Results: Of all patients who had spirometry performed, 15.8% showed airflow limitation (FEV1/FVC < 0.7. A variety of diseases were observed in patients with airflow limitation. Among all diseases, cardiovascular disease was the highest and gastrointestinal malignant disease had the second highest prevalence in patients with airflow limitation.Conclusion: COPD might be frequent in conditions of comorbidity in patients treated for various diseases. Attention should be paid to the possibility of co-existence of COPD and the influence of COPD on these patients.Keywords: airflow limitation, chronic obstructive pulmonary disease, comorbidity, spirometry, prevalence

  20. The Prevalence of COPD in Individuals with Acute Coronary Syndrome: A Spirometry-Based Screening Study.

    Science.gov (United States)

    Mooe, Thomas; Stenfors, Nikolai

    2015-08-01

    The prevalence of COPD among individuals with acute coronary syndrome (ACS) is estimated at 5% to 18%, and COPD appears to be a predictor of poor outcome. Diagnosis of COPD has mostly been based on medical records without spirometry. As COPD is largely undiagnosed and misdiagnosed, the prevalence and clinical significance of COPD in the ACS population has not been reliably assessed. The present study aimed to estimate the prevalence of COPD in patients with ACS and evaluate the accuracy of medical record-based COPD diagnoses. This was a single-centre spirometry screening study for COPD in patients admitted for ACS in the county of Jämtland, Sweden. Patient medical records were reviewed to register previous medical history. Spirometry was performed prior to discharge or at the first follow-up outpatient visit after discharge. COPD was defined as a post-bronchodilator FEV1/FVC of coronary disease. ISRCTN number 05697808 (www. controlled-trials.com).

  1. Managing comorbidities in COPD

    Science.gov (United States)

    Hillas, Georgios; Perlikos, Fotis; Tsiligianni, Ioanna; Tzanakis, Nikolaos

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity. PMID:25609943

  2. Vitamin D deficiency: What does it mean for chronic obstructive pulmonary disease (COPD)? a compherensive review for pulmonologists.

    Science.gov (United States)

    Kokturk, Nurdan; Baha, Ayse; Oh, Yeon-Mok; Young Ju, Jung; Jones, Paul W

    2018-02-01

    Vitamin D deficiency and Chronic Obstructive Pulmonary Disease (COPD) are both under-recognized health problems, world-wide. Although Vitamin D has long been known for calcemic effects it also has less known noncalcemic effects. Recent data have shown that Vitamin D deficiency is highly prevalent in patients with COPD and correlates with forced expiratory volume in one second (FEV 1 ) and FEV 1 decline. The objective of this work was to review the current literature on vitamin D deficiency in relation with COPD. A literature search, using the words "vitamin D" and "COPD", was undertaken in Pubmed database. The noncalcemic effects of vitamin D relating with COPD may be summarised as increasing antimicrobial peptide production, regulation of inflammatory response and airway remodelling. Vitamin D inhibits the production of several proinflammatory cytokines and leads to suppression Th1 and Th17 responses which may be involved in the pathogenesis of COPD. Vitamin D insufficiency may also contribute to chronic respiratory infections and airway colonization so returning vitamin D concentrations to an optimal range in patients with COPD might reduce bacterial load and concomitant exacerbations.Vitamin D is also important for COPD-related comorbodities such as osteoporosis, muscle weakness and cardiovascular diseases. Data about the effect of Vitamin D supplementation on those comorbidities in relation with COPD are been scarce. Improving the blood level of Vitamin D into the desired range may have a beneficial effect bones and muscles, but more studies are needed to test to test that hypothesis. © 2017 John Wiley & Sons Ltd.

  3. Prevalence of renal and hepatobiliary disease, laboratory abnormalities, and potentially toxic medication exposures among persons with COPD

    Directory of Open Access Journals (Sweden)

    Mapel DW

    2013-03-01

    Full Text Available Douglas W Mapel,1 Jenõ P Marton21Lovelace Clinic Foundation, Albuquerque, New Mexico, NM, USA; 2Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USABackground: The purpose of this study was to describe the prevalence of renal and hepatic disease, related laboratory abnormalities, and potentially hepatotoxic and nephrotoxic medication use in a population-based cohort of persons with chronic obstructive pulmonary disease (COPD.Methods: This was a retrospective case-control cohort analysis of COPD patients enrolled in one regional health system for at least 12 months during a 36-month study period (n = 2284. Each COPD patient was matched by age and gender to up to three persons not diagnosed with COPD (n = 5959.Results: The mean age for cases and controls was 70.3 years, and 52.5% were women. The COPD cohort had significantly higher prevalences (cases/100 of acute, chronic, and unspecified renal failure as compared with controls (1.40 versus 0.59, 2.89 versus 0.79, and 1.09 versus 0.44, respectively. Among the cases, 31.3% had at least one renal or urinary tract diagnosis during the study period, as compared with 21.1% of controls. COPD cases also had more gallbladder disease (2.76 versus 1.63 and pancreatic disease (1.40 versus 0.60, but not hepatic disease. COPD patients were more likely to have at least one serum creatinine level (5.1 versus 2.1 or liver aspartate aminotransferase level (4.5 versus 2.7 that was more than twice the upper limit of normal. COPD patients had prescription fills for an average of 17.6 potentially nephrotoxic and 27.4 hepatotoxic drugs during the study period, as compared with 13.6 and 19.9 for the controls (P value for all comparisons < 0.01.Conclusion: COPD patients have a substantially increased prevalence of renal, gallbladder, and pancreatic diseases, as well as abnormal renal and hepatic laboratory values, but not diagnosed liver disease. COPD patients are also more likely to be prescribed

  4. Comparison of tumor markers and inflammatory biomarkers in chronic obstructive pulmonary disease (COPD) exacerbations.

    Science.gov (United States)

    Barouchos, Nikolaos; Papazafiropoulou, Athanasia; Iacovidou, Nicoletta; Vrachnis, Nikolaos; Barouchos, Nektarios; Armeniakou, Eleni; Dionyssopoulou, Vasiliki; Mathioudakis, Alexandros G; Christopoulou, Eleni; Koltsida, Spiridoula; Bassiakou, Eleni

    2015-04-01

    The aim of the present study was: (a) to measure levels of the tumor markers, Carcinoembryonic antigen (CEA), Cancer antigen 19-9 (CA19-9), Cancer antigen 125 (CA125), Neuron specific enolase (NSE) and Cytokeratin fragments 19 (CYFRA21-1); (b) to investigate any correlation between them and the inflammatory biomarkers C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and white blood cells count (WBC), in patients with chronic obstructive pulmonary disease (COPD) exacerbation, who belong in groups of severity C and D, as classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD); (c) and finally, to compare these results in these two groups. Fifty-two patients with COPD exacerbation [35 male/17 female, mean age (± SD) 68.3 ± 6.4 years] were the study subjects, and were classified in severity groups C (n = 27) and D (n = 25), based on the spirometric classification, the number of exacerbations in the preceding year and the assessment of their symptoms by GOLD. Results. CEA and CA125 were increased in group D. In group C, there was a significant correlation between CRP and CA125 (p = 0.05). In group D, there was a significant correlation between WBC and NSE (p = 0.02), between CRP and CA19-9 (p = 0.02) and NSE (p COPD.

  5. Dehydroepiandrosterone (DHEA) improves pulmonary hypertension in chronic obstructive pulmonary disease (COPD): a pilot study.

    Science.gov (United States)

    Dumas de La Roque, Eric; Savineau, Jean-Pierre; Metivier, Anne-Cécile; Billes, Marc-Alain; Kraemer, Jean-Philippe; Doutreleau, Stéphane; Jougon, Jacques; Marthan, Roger; Moore, Nicholas; Fayon, Michael; Baulieu, Etienne-Émile; Dromer, Claire

    2012-02-01

    It was previously shown that dehydroepiandrosterone (DHEA) reverses chronic hypoxia-induced pulmonary hypertension (PH) in rats, but whether DHEA can improve the clinical and hemodynamic status of patients with PH associated to chronic obstructive pulmonary disease (PH-COPD) has not been studied whereas it is a very severe poorly treated disease. Eight patients with PH-COPD were treated with DHEA (200mg daily orally) for 3 months. The primary end-point was the change in the 6-minute walk test (6-MWT) distance. Secondary end-points included pulmonary hemodynamics, lung function tests and tolerance of treatment. The 6-MWT increased in all cases, from 333m (median [IQR]) (257; 378) to 390m (362; 440) (PDHEA treatment did not change respiratory parameters of gas exchange and the 200mg per day of DHEA used was perfectly tolerated with no side effect reported. DHEA treatment significantly improves 6-MWT distance, pulmonary hemodynamics and DLCO of patients with PH-COPD, without worsening gas exchange, as do other pharmacological treatments of PH (trial registration NCT00581087). Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  6. Identification of patients with chronic obstructive pulmonary disease (COPD) by measurement of plasma biomarkers

    DEFF Research Database (Denmark)

    Shaker, S.B.; Wachenfeldt, K.A. von; Larsson, S.

    2008-01-01

    Introduction: Inflammation is an important constituent of the pathology of chronic obstructive pulmonary disease (COPD), leading to alveolar destruction and airway remodelling. Objective: The aim of this study was to assess the difference in plasma biomarkers of inflammation between asymptomatic...... computed tomography by measuring the relative area of emphysema below -910 Hounsfield units (RA-910). Results: The results of the biomarker measurements on the two occasions were highly reproducible. Patients with COPD had significantly higher plasma levels of IL-8 (P = 0.004) and significantly lower...... levels of TIMP-1 (P = 0.02) than smokers and non-smokers. There was no statistically significant difference between the three groups in the level of TNF-alpha, MMP-9, MCP-1 and TIMP-2. The IL-8/TIMP-1 ratio correlated significantly with the degree of airway obstruction measured as forced expiratory...

  7. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD)

    DEFF Research Database (Denmark)

    Hallin, Runa; Gudmundsson, Gunnar; Suppli Ulrik, Charlotte

    2007-01-01

    Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality...... Questionnaire. After 2 years, mortality data was obtained from the national registers in each country. Of the 261 patients in the study 19% where underweight (BMI underweight and highest...... in the overweight group (p=0.001) whereas the prevalence of diabetes and cardio-vascular co-morbidity went the opposite direction. Of the 261 patients 49 (19%) had died within 2 years. The lowest mortality was found among the overweight patients, whereas underweight was related to increased overall mortality...

  8. Effects of clinical pathways for chronic obstructive pulmonary disease (COPD) on patient, professional and systems outcomes: protocol for a systematic review.

    Science.gov (United States)

    Plishka, Christopher; Rotter, Thomas; Kinsman, Leigh; Hansia, Mohammed Rashaad; Lawal, Adegboyega; Goodridge, Donna; Penz, Erika; Marciniuk, Darcy D

    2016-08-11

    Chronic obstructive pulmonary disease (COPD) is a respiratory syndrome characterized by progressive, partially reversible airway obstruction and lung hyperinflation. COPD has a substantial burden which is seen in both patient quality of life and healthcare costs. One proposed method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs aim to guide evidence-based practice and improve the interaction between health services. They bring the best available evidence to a range of healthcare professionals by adapting evidence-based clinical guidelines to a local context and detailing the essential steps in the assessment and care of patients. The aim of this systematic review is to synthesize existing literature on the effects of CPWs for the treatment or management of COPD. We will screen search hits from search strategies developed for a Cochrane Effective Practice and Organisation of Care (EPOC) systematic review on the use of CPWs in primary care and a Cochrane EPOC review on the use of CPWs in hospitals. These searches were run in a range of databases. Studies will be screened independently by two reviewers. All studies identified by our search strategy will be considered regardless of study design as long as they meet the operational definition for clinical pathways developed by Kinsman et al. (BMC Medicine 8, 2010) and focus on the treatment or management of COPD. All included studies will be evaluated for risk of bias utilizing methodologies set out by the Cochrane collaboration. Data regarding patient, professional and systems outcomes will be extracted from all included studies. Data will be presented in both narrative and tabular form. The systematic review outlined in this protocol aims to identify, assess and synthesise all available evidence on the effects of CPWs regarding the treatment and management of COPD. As a result, this review will provide an evidence base for decision makers regarding the practicality, cost

  9. Determining the Most Suitable Spirometric Parameters to Differentiate Chronic Obstructive pulmonary Disease (COPD from Asthma

    Directory of Open Access Journals (Sweden)

    S Mehrabi

    2010-01-01

    Full Text Available Introduction & Objective: Chronic Obstructive Pulmonary Disease (COPD and asthma are common diseases with difference in prognosis and treatment. It is believed that spirometry is the best modality for differentiating the two conditions however, the data is heterogeneous. This study aims at determining the most suitable spirometric parameters in this regard. Materials & Methods: In this case control study, fifty patients (25 patients with asthma and 25 patients with COPD in pulmonology ward of Dr.Faqi’hi Hospital of Shiraz in 2008 under the base spirometry and post bronchodilator were recruited and comparison between these two groups was done. The collected data was analyzed by the SPSS software using independent t-test, Man-Whitney, Chi-square and Fisher test. Results: Frequency of male patients and the mean age were significantly higher in the COPD group. Increase of forced expiratory volume in one second (FEV1 after administration of bronchodilator was significantly higher in asthmatic patients with an optimal cut-off point of ≥0.165 L (15% increase yielded a sensitivity and specificity of 64% and 60%, respectively. Change of other parameters was not significantly different between the two groups. The best differentiating spirometric parameter was post-inhalation FEV1/predicted value with an optimal cut-off point of ≥64.2, with relating sensitivity and specificity of 88%. Conclusion: According to our results and in concordance to other reports, changing of spirometric parameters after inhalation of a short-acting bronchodilator is not a reliable indicator of asthma or COPD. Post-inhalation FEV1/predicted value is the best parameter in this regard however, the clinical suspicion should not be replaced by it.

  10. A cross-sectional study on prevalence of chronic obstructive pulmonary disease (COPD) in India: rationale and methods.

    Science.gov (United States)

    Rajkumar, Prabu; Pattabi, Kamaraj; Vadivoo, Selvaraj; Bhome, Arvind; Brashier, Bill; Bhattacharya, Prashanta; Mehendale, Sanjay M

    2017-05-29

    Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable chronic respiratory disease, which affects 210 million people globally. Global and national guidelines exist for the management of COPD. Although evidence-based, they are inadequate to address the phenotypic and genotypic heterogeneity in India. Co-existence of other chronic respiratory diseases can adversely influence the prognosis of COPD.India has a huge burden of COPD with various risk factors and comorbid conditions. However, valid prevalence estimates employing spirometry as the diagnostic tool and data on important comorbid conditions are not available. This study protocol is designed to address this knowledge gap and eventually to build a database to undertake long-term cohort studies to describe the phenotypic and genotypic heterogeneity among COPD patients in India. The primary objective is to estimate the prevalence of COPD among adults aged ≥25 years for each gender in India. The secondary objective is to identify the risk factors for COPD and important comorbid conditions such as asthma and post-tuberculosis sequelae. It is also proposed to validate the currently available definitions for COPD diagnosis in India. A cross-sectional study will be undertaken among the populations of sub-urban areas of Chennai and Shillong cities, which represent the Southern and Northeastern regions of India. We will collect data on sociodemographic variables, economic characteristics, risk factors of COPD and comorbidities. The Global Initiative for Obstructive Lung Disease (GOLD) and Global Initiative for Asthma (GINA) definitions will be used for the diagnosis of COPD and asthma. Data will be analysed for estimation of the prevalence of COPD, asthma and associated factors. This study proposal was approved by the respective institutional ethics committees of participating institutions. The results will be disseminated through publications in the peer-reviewed journals and a report

  11. Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Cameron-Tucker HL

    2014-05-01

    Full Text Available Helen L Cameron-Tucker,1 Richard Wood-Baker,1 Christine Owen,2 Lyn Joseph,3 E Haydn Walters11Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, University of Tasmania, Hobart, TAS, Australia; 2Faculty of Education, University of Tasmania, Hobart, TAS, Australia; 3Department of Respiratory Medicine, Royal Hobart Hospital, Hobart, TAS, AustraliaPurpose: Both exercise and self-management are advocated in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD. The widely used 6-week, group-based Chronic Disease Self-Management Program (CDSMP increases self-reported exercise, despite supervised exercise not being a program component. This has been little explored in COPD. Whether adding supervised exercise to the CDSMP would add benefit is unknown. We investigated the CDSMP in COPD, with and without a formal supervised exercise component, to address this question.Patients and methods: Adult outpatients with COPD were randomized to the CDSMP with or without one hour of weekly supervised exercise over 6 weeks. The primary outcome measure was 6-minute walk test distance (6MWD. Secondary outcomes included self-reported exercise, exercise stage of change, exercise self-efficacy, breathlessness, quality of life, and self-management behaviors. Within- and between-group differences were analyzed on an intention-to-treat basis.Results: Of 84 subjects recruited, 15 withdrew. 6MWD increased similarly in both groups: CDSMP-plus-exercise (intervention group by 18.6±46.2 m; CDSMP-alone (control group by 20.0±46.2 m. There was no significant difference for any secondary outcome.Conclusion: The CDSMP produced à small statistically significant increase in 6MWD. The addition of a single supervised exercise session did not further increase exercise capacity. Our findings confirm the efficacy of a behaviorally based intervention in COPD, but this would seem to be less than expected from

  12. Visual versus Automated Evaluation of Chest Computed Tomography for the Presence of Chronic Obstructive Pulmonary Disease.

    NARCIS (Netherlands)

    Mets, O.M.; Smit, E.J.; Mohamed Hoesein, F.A.; Gietema, H.A.; Bokkers, R.P.; Attrach, M.; Amelsvoort-van de Vorst, S. van; Scholten, E.T.; Buckens, C.F.; Oudkerk, M.; Lammers, J.W.; Prokop, M.; Jong, P.A. de

    2012-01-01

    BACKGROUND: Incidental CT findings may provide an opportunity for early detection of chronic obstructive pulmonary disease (COPD), which may prove important in CT-based lung cancer screening setting. We aimed to determine the diagnostic performance of human observers to visually evaluate COPD

  13. Chronic obstructive pulmonary disease (COPD), illness narratives and Elias's sociology of knowledge.

    Science.gov (United States)

    Malcolm, Dominic; Orme, Mark W; Morgan, Mike D; Sherar, Lauren B

    2017-11-01

    This paper draws on Elias's sociology of knowledge to provide a critical assessment of illness narratives. Focusing on a cohort of chronic obstructive pulmonary disease (COPD) patients (n = 26), the paper employs a comparative analysis of mixed method data derived from qualitative interviews, quantitative questionnaires, and physiological and accelerometer testing. The article firstly compares four narratives conveyed in interviews with the broader paradigmatic approach to illness narratives and existing COPD-specific studies. It then explores the relationship between these 'stories' and COPD patients' biographical contingencies (e.g. age, wealth, context of diagnosis) and embodied condition (e.g. co-morbidities, lung function), demonstrating how illness narratives are shaped by both broader social structural factors and embodied experience. Invoking Elias we further find that different narrative subthemes are varyingly affected by patients' emotional engagement and ontological security and thus that people are differently enabled or constrained to present illness narratives that are consistent with their broader social and physical condition. Consequently, while narratives, social structure and embodied experience are interdependent, our reading of 'truth' must be sensitive to the social positioning of the 'teller' and the specific content being relayed. The paper therefore presents a more systematic, comparative, bio-psycho-social analysis than has hitherto been produced. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Ventricular performance during exercise in patients with chronic obstructive pulmonary disease (COPD)

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    Sasaki, Iwao; Akashiba, Tsuneto; Horie, Takashi (Nihon Univ., Tokyo (Japan). School of Medicine)

    1992-01-01

    We assessed ventricular performance during exercise in 16 chronic obstructive pulmonary disease (COPD) patients and 8 normal control subjects by means of radionuclide equilibrium angiography using technetium-99m as a tracer. Supine exercise on a bicycle ergometer was performed until symptom-limited exhaustion. Data were accumulated for 300 heart beats at rest and 150 heart beats during exercise. We used the standard voxel count method to calculate the ventricular volumes. Age, FEV{sub 1.0}%, %VC, PaO{sub 2} and PaCO{sub 2} of the COPD patients were 63{+-}8 yr, 46{+-}11%, 69{+-}18%, 68{+-}11 Torr and 44{+-}7 Torr (mean{+-}SD), respectively. Systolic dysfunction of both the left and right ventricles was well confirmed in the present study. In 12 patients who also underwent hemodynamic studies, resting total pulmonary vascular resistance index (TPVRI) and mean pulmonary artery pressure (P-barpa) significantly correlated with right ventricular end-systolic volume index (RVESVI) obtained by RI angiography; {gamma}=0.769 (p<0.01) and {gamma}=0.631 (p<0.05), respectively. A significant relationship was also observed between left ventricular dysfunction and the degree of hypercapnia. In response to exercise testing, 10 of 16 patients exhibited insufficient augmentation of stroke volume, and both left and right end-diastolic volumes decreased in half of 10 patients. It is suggested that cardiac function may be disturbed by mechanical factors such as pulmonary hyperinflation in COPD patients. (author).

  15. Economic valuation and determinants of informal care to disabled people with Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Peña-Longobardo, Luz María; Oliva-Moreno, Juan; Hidalgo-Vega, Álvaro; Miravitlles, Marc

    2015-03-15

    We aimed to estimate the monetary value of informal care of disabled people with chronic obstructive pulmonary disease (COPD) in Spain and to identify the main determinants of the time involved in informal caregiving. We used the Survey on Disabilities, Autonomy and Dependency carried out in Spain in 2008 to obtain information on disabled individuals with COPD and their informal caregivers. Assessment of informal caregiving time was performed using the proxy good method. A statistical multivariate analysis (ordered probit model) was performed to study the determinants of informal care provided. It was estimated that 220,892 disabled people with COPD received informal care. The total annual number of caregiving hours was 694.44 million, with an estimated monetary value between 4,981 and 8,254 million EUR. Based on the condition of having received informal care, the cost of informal care per disabled person with COPD ranged from 24,549 to 40,681 EUR per year (depending on the shadow price applied). This value varies significantly depending on the degree of dependency; it ranged from 17,089 EUR per person annually for non-dependents to 33,033 EUR for those who were greatly dependent (under the most conservative scenario). Degree of dependency and the formal care received were the main variables that explained the variability of informal caregiving time provided. The results partially reveal the high hidden social costs, and the association between the level of dependency and the time provided by the caregivers. This information should be a useful tool to design policies that focus on improving caregivers' well-being.

  16. Clinical commentary --COPD is not a systemic disease. Results from the AIMAR Expert Opinion Consensus/Dissensus Seminar "COPD is/is not a systemic disease?", Venice, Italy, 13-14 November 2008.

    Science.gov (United States)

    Donner, Claudio F; Bjermer, Leif

    2009-09-01

    Although COPD is a major disease worldwide there is a perplexing current uncertainty about the nature of this disease. COPD is characterized at onset and prevalently by the involvement of the lungs and bronchi, but as the disease evolves abnormalities develop in other organs and systems and the question arises: what is the pathogenesis of these respiratory and systemic impairments? Are the alterations that occur outside the respiratory system in the course of COPD a direct consequence of the lung pathology or is the lung simply the local expression of a pathological event whose origin lies in the organism as a whole? To tease out this issue, the Expert Opinion Consensus/Dissensus Seminar "COPD is/is not a systemic disease?" took place in Venice, on 13-14 November 2008. The Seminar was conceived and organized by the Italian Interdisciplinary Association for Research in Lung Disease, AIMAR. Top international opinion leaders in the respiratory field were invited to participate, the aim being to bring together sustainers of the two sides in a format allowing the best opportunity for an in-depth debate. Over the two days, different aspects of the issue 'upstream' (pathophysiology and biology) and 'downstream' (treatment and outcome assessment) were discussed. The general consensus that emerged, based on the still limited evidence available, was that COPD begins as a local inflammation in the lungs and this leads - through differentiated pathways yet to be fully clarified - to systemic consequences.

  17. Day to day with COPD

    Science.gov (United States)

    COPD - day to day; Chronic obstructive airways disease - day to day; Chronic obstructive lung disease - day to ... Having COPD can sap your energy. These simple changes can make your days easier and preserve your strength. Ask ...

  18. Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial.

    Science.gov (United States)

    Rose, Louise; Istanboulian, Laura; Carriere, Lise; Thomas, Anna; Lee, Han-Byul; Rezaie, Shaghayegh; Shafai, Roshan; Fraser, Ian

    2018-01-01

    We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63-0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54-0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32-0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control. Copyright ©ERS 2018.

  19. Classification of Chronic Obstructive Pulmonary Disease (COPD) according to the new Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017: Comparison with GOLD 2011.

    Science.gov (United States)

    Marçôa, Raquel; Rodrigues, Daniela Marta; Dias, Margarida; Ladeira, Inês; Vaz, Ana Paula; Lima, Ricardo; Guimarães, Miguel

    2018-02-01

    Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) project has been working to improve awareness, prevention and management of this disease. The aim of this study is to evaluate how COPD patients are reclassified by the 2017 GOLD system (versus GOLD 2011), to calculate the level of agreement between these two classifications in allocation to categories and to compare the performance of each classification to predict future exacerbations. Two-hundred COPD patients (>40 years, post bronchodilator forced expiratory volume in one second/forced vital capacity<0.7) followed in pulmonology consultation were recruited into this prospective multicentric study. Approximately half of the patients classified as GOLD D [2011] changed to GOLD B [2017]. The extent of agreement between GOLD 2011 and GOLD 2017 was moderate (Cohen's Kappa = 0.511; p < 0.001) and the ability to predict exacerbations was similar (69.7% and 67.6%, respectively). GOLD B [2017] exacerbated 17% more than GOLD B [2011] and had a lower percent predicted post bronchodilator forced expiratory volume in one second (FEV1). GOLD B [2017] turned to be the predominant category, more heterogeneous and with a higher risk of exacerbation versus GOLD B [2011]. Physicians should be cautious in assessing the GOLD B [2017] patients. The assessment of patients should always be personalized. More studies are needed to evaluate the impact of the 2017 reclassification in predicting outcomes such as future exacerbations and mortality.

  20. Literature review of gender differences in respiratory conditions: a focus on asthma and Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Cadeddu, Chiara; Capizzi, Silvio; Colombo, Delia; Nica, Mihaela; De Belvis, Antonio Giulio

    2016-01-01

    Gender differences are evident in many common health conditions, especially respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The aim of this review was to identify published studies describing gender differences in asthma and COPD, in particular regarding pathophysiology, diagnosis and treatment, with a focus on Italian data. a literature review was performed from April to November 2015, using the PubMed scientific database and the following ??eywords: "gender differences" and "asthma" for the asthma review and "gender differences" and "COPD" for the COPD review. Gender differences in asthma are related to age groups. In the female population, asthma is generally more severe and disabling, and presents higher mortality rates with respect to same-age males. COPD prevalence is growing and is underestimated in women, because it tends to be diagnosed with difficulty and at a delayed stage. The same findings were observed when restricting the review to Italian data. Clinicians should collaborate to develop a more gender-oriented approach towards diagnosis and treatment of asthma and COPD. In Italy, this would also facilitate measures to improve compliance, particularly among women.

  1. Chronic obstructive pulmonary disease and coronary disease: COPDCoRi, a simple and effective algorithm for predicting the risk of coronary artery disease in COPD patients.

    Science.gov (United States)

    Cazzola, Mario; Calzetta, Luigino; Matera, Maria Gabriella; Muscoli, Saverio; Rogliani, Paola; Romeo, Francesco

    2015-08-01

    Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular artery disease (CAD), representing a potential and independent risk factor for cardiovascular morbidity. Therefore, the aim of this study was to identify an algorithm for predicting the risk of CAD in COPD patients. We analyzed data of patients afferent to the Cardiology ward and the Respiratory Diseases outpatient clinic of Tor Vergata University (2010-2012, 1596 records). The study population was clustered as training population (COPD patients undergoing coronary arteriography), control population (non-COPD patients undergoing coronary arteriography), test population (COPD patients whose records reported information on the coronary status). The predicting model was built via causal relationship between variables, stepwise binary logistic regression and Hosmer-Lemeshow analysis. The algorithm was validated via split-sample validation method and receiver operating characteristics (ROC) curve analysis. The diagnostic accuracy was assessed. In training population the variables gender (men/women OR: 1.7, 95%CI: 1.237-2.5, P COPD patients, whereas in control population also age and diabetes were correlated. The stepwise binary logistic regressions permitted to build a well fitting predictive model for training population but not for control population. The predictive algorithm shown a diagnostic accuracy of 81.5% (95%CI: 77.78-84.71) and an AUC of 0.81 (95%CI: 0.78-0.85) for the validation set. The proposed algorithm is effective for predicting the risk of CAD in COPD patients via a rapid, inexpensive and non-invasive approach. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The asthma-COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease?

    Science.gov (United States)

    Kostikas, Konstantinos; Clemens, Andreas; Patalano, Francesco

    2016-01-01

    The term asthma-COPD overlap syndrome (ACOS) is one of multiple terms used to describe patients with characteristics of both COPD and asthma, representing ~20% of patients with obstructive airway diseases. The recognition of both sets of morbidities in patients is important to guide practical treatment decisions. It is widely recognized that patients with COPD and coexisting asthma present with a higher disease burden, despite the conceptual expectation that the "reversible" or "treatable" component of asthma would allow for more effective management and better outcomes. However, subcategorization into terms such as ACOS is complicated by the vast spectrum of heterogeneity that is encapsulated by asthma and COPD, resulting in different clinical clusters. In this review, we discuss the possibility that these different clusters are suboptimally described by the umbrella term "ACOS", as this additional categorization may lead to clinical confusion and potential inappropriate use of resources. We suggest that a more clinically relevant approach would be to recognize the extreme variability and the numerous phenotypes encompassed within obstructive airway diseases, with various degrees of overlapping in individual patients. In addition, we discuss some of the evidence to be considered when making practical decisions on the treatment of patients with overlapping characteristics between COPD and asthma, as well as the potential options for phenotype and biomarker-driven management of airway disease with the aim of providing more personalized treatment for patients. Finally, we highlight the need for more evidence in patients with overlapping disease characteristics and to facilitate better characterization of potential treatment responders.

  3. Asthma and COPD: Differences and Similarities

    Science.gov (United States)

    ... and COPD: differences and similarities Share | Asthma and COPD: Differences and Similarities This article has been reviewed ... or you could have Chronic Obstructive Pulmonary Disease (COPD) , such as emphysema or chronic bronchitis. Because asthma ...

  4. COPD -- managing stress and your mood

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000700.htm COPD - managing stress and your mood To use the ... you manage COPD and feel better in general. COPD and Your Emotions Having chronic obstructive pulmonary disease ( ...

  5. A multistate model to evaluate COPD progression integrating drugs consumption data and hospital databases

    Directory of Open Access Journals (Sweden)

    Nicola Bartolomeo

    2015-06-01

    Full Text Available Background The increase in costs related to the diagnosis and treatment of chronic-degenerative diseases requires a better knowledge of the true care pathway of patients. The study objective was to explore, using multi-state modeling, how analyses of drug prescriptions and data obtained from hospital discharge sheets can be used in combination to build a model of patients health care pathway in a non experimental setting. The model was applied to Chronic Obstructive Pulmonary Disease (COPD. Methods Based on the GOLD guidelines, access to hospitalization for COPD and prescription pharmaceuticals were awarded to seven transients states theoretically progressive. The intensity of transition were estimated with the non-parametric method proposed by Aalen and Johansen for multi-state Markov models non-homogeneous in time. Results The COPD patients included in the study are 111190. Patients admitted with a diagnosis of non acute COPD had a growing probability over time of needing prescriptions for inhaled corticosteroids (ICS or the set combination of long-acting beta-agonists (LABA and ICS; they also had a rising probability of an exacerbation. The use of ICS alone or in combination with LABA delays a hospital admission for acute respiratory failure by about 6 months, as compared to short-acting beta-agonists or anticholinergics. Conclusion The probabilities of a transition and their distribution in relation to time, sex, age and clinical status can be a helpful tool for those operating in the health care sector, who are called upon to carry out decisions from the standpoints of both efficacious clinical management and an efficient use of resources.

  6. IL-8 gene variants are associated with lung function decline and multidimensional BODE index in COPD patients but not with disease susceptibility: a validation study.

    Science.gov (United States)

    Córdoba-Lanús, Elizabeth; Baz-Dávila, Rebeca; Espinoza-Jiménez, Adriana; Rodríguez-Pérez, María C; Varo, Nerea; de-Torres, Juan P; González-Almeida, Delia; Aguirre-Jaime, Armando; Casanova, Ciro

    2015-02-01

    COPD is a leading cause of dead worldwide and tobacco smoking is its major risk factor. IL8 is a proinflammatory chemokine mainly involved in the acute inflammatory reaction. The aim of this study was to test the association of IL-8, CXCR1 and CXCR2 gene variants and COPD susceptibility as part of a replication study and explore the effect of these variations in disease progression. 9 tagSNPs were genotyped in 728 Caucasian individuals (196 COPD patients, 80 smokers and 452 non-smoking controls). Pulmonary compromise was evaluated using spirometry and clinical parameters at baseline and annually over a 2 years period. We also determined plasma levels of TNF-α, IL-6, IL-8 and IL-16 in COPD patients. There was a lack of association between gene variants or haplotypes with predisposition to COPD. No correlation was observed between the polymorphisms and cytokines levels. Interestingly, significant associations were found between carriers of the rs4073A (OR = 3.53, CI 1.34-9.35, p = 0.01), rs2227306C (OR = 5.65, CI 1.75-18.88, p = 0.004) and rs2227307T (OR = 4.52, CI = 1.49-12.82, p = 0.007) alleles in the IL-8 gene and patients who scored higher in the BODE index and showed an important decrease in their FEV1 and FVC during the 2 years follow-up period (p disease, with an affectation beyond the pulmonary function and importantly, a reduction in lung function along the follow-up years.

  7. A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from spirometry in Asthma and COPD: a comparative evaluation Italian study.

    Science.gov (United States)

    Lusuardi, Mirco; De Benedetto, Fernando; Paggiaro, Pierluigi; Sanguinetti, Claudio M; Brazzola, Giancarlo; Ferri, Paolo; Donner, Claudio F

    2006-04-01

    To evaluate whether office spirometry by general practitioners (GPs) is feasible and may improve the diagnosis of asthma and COPD. A prospective, randomized, comparative trial was planned involving 57 Italian pulmonology centers and 570 GPs who had to enroll consecutive subjects aged 18 to 65 years with symptoms of asthma or COPD without a previous diagnosis. Patients were randomized 1:1 into two groups with an interactive voice responding system: conventional evaluation alone vs conventional evaluation and spirometry. Office spirometry was performed by GPs who were trained by reference specialists using a portable electronic spirometer (Spirobank Office; MIR; Rome, Italy). Diagnosis was confirmed by the reference specialist center in blind fashion. Seventy-four GPs complied to the trial. Of 333 patients enrolled, 136 nonrandom violators completed the protocol. Per-protocol analysis showed a concordant diagnosis between GPs and specialists in 78.6% of cases in the conventional evaluation-plus-spirometry group vs 69.2% in the conventional evaluation group (p = 0.35). In the intention-to-treat analysis, the respective percentages of concordant diagnosis were 57.9 and 56.7 (p = 0.87). Office spirometry by GPs is feasible, but frequent protocol violation and inadequate sample size did not allow us to prove a significant advantage of office spirometry in improving the diagnosis of asthma and COPD in standard general practice as organized at present in Italy, thus reinforcing the need for close cooperation between GPs and specialists in respiratory medicine.

  8. History of pneumonia is a strong risk factor for chronic obstructive pulmonary disease (COPD) exacerbation in South Korea: the Epidemiologic review and Prospective Observation of COPD and Health in Korea (EPOCH) study.

    Science.gov (United States)

    Hwang, Yong Il; Lee, Sang Haak; Yoo, Jee Hong; Jung, Bock Hyun; Yoo, Kwang Ha; Na, Moon Jun; Lee, Jong Deog; Park, Myung Jae; Jung, Chi Young; Shim, Jae Jeong; Kim, Kyung Chan; Kim, Yeon Jae; Choi, Hye Sook; Choi, Ik Su; Lee, Choon-Taek; Lee, Sang Do; Kim, Do Jin; Uh, Soo-Taek; Lee, Ho Sung; Kim, Young Sam; Lee, Kwan Ho; Ra, Seung Won; Kim, Hak Ryul; Choi, Soo Jeon; Park, In Won; Park, Yong Bum; Park, So Young; Lee, Jaehee; Jung, Ki-Suck

    2015-12-01

    In South Korea, chronic obstructive pulmonary disease (COPD) is one of the ten leading causes of death. COPD exacerbations are significantly associated with mortality in COPD patients. This study was conducted to investigate the epidemiology of COPD in South Korea, specifically the clinical characteristics of South Korean COPD patients, the COPD exacerbation rate and the risk factors associated with COPD exacerbations. This study covers a 2-year interval. One year was data collected retrospectively and the second year was prospectively obtained data. A total of 1,114 subjects were enrolled in the study. These subjects were observed for a period of 1 year from the enrollment, and a total of 920 subjects completed the study. A total of 1,357 COPD exacerbations occurred in 711 subjects (63.8%) out of the total of 1,114 subjects during the study period of 2 years. Multivariate logistic regression results showed that if patients had had a pneumonia before the retrospective year of analysis, they had a 18 times greater chance of having an exacerbation during the prospective year when other variables were controlled. Also, the subjects who had a history of two or more exacerbations during the retrospective year were approximately 6 times more likely to experience the COPD exacerbation compared to those who did not. This study examined the demographic and clinical characteristics of South Korean COPD patients and found that a history of pneumonia and two or more occurrences of exacerbation within 1 year was significantly associated with a higher rate of COPD exacerbation.

  9. Impact of a Post-Discharge Integrated Disease Management Program on COPD Hospital Readmissions.

    Science.gov (United States)

    Russo, Ashlee N; Sathiyamoorthy, Gayathri; Lau, Chris; Saygin, Didem; Han, Xiaozhen; Wang, Xiao-Feng; Rice, Richard; Aboussouan, Loutfi S; Stoller, James K; Hatipoğlu, Umur

    2017-11-01

    Readmission following a hospitalization for COPD is associated with significant health-care expenditure. A multicomponent COPD post-discharge integrated disease management program was implemented at the Cleveland Clinic to improve the care of patients with COPD and reduce readmissions. This retrospective study reports our experience with the program. Groups of subjects who were exposed to different components of the program were compared regarding their readmission rates. Multivariate logistic regression analysis was performed to build predictive models for 30- and 90-d readmission. One hundred sixty subjects completed a 90-d follow-up, of which, 67 attended the exacerbation clinic, 16 subjects received care coordination, 51 subjects completed both, and 26 subjects did not participate in any component despite referral. Thirty- and 90-d readmission rates for the entire group were 18.1 and 46.2%, respectively. Thirty- and 90-d readmission rates for the individual groups were: exacerbation clinic, 11.9 and 35.8%; care coordination, 25.0 and 50.0%; both, 19.6 and 41.2%; and neither, 26.9 and 80.8%, respectively. The model with the best predictive ability for 30-d readmission risk included the number of hospitalizations within the previous year and use of noninvasive ventilation (C statistic of 0.84). The model for 90-d readmission risk included receiving any component of the post-discharge integrated disease management program, the number of hospitalizations, and primary care physician visits within the previous year (C statistic of 0.87). Receiving any component of a post-discharge integrated disease management program was associated with reduced 90-d readmission rate. Previous health-care utilization and lung function impairment were strong predictors of readmission. Copyright © 2017 by Daedalus Enterprises.

  10. Randomized controlled trials and real-world observational studies in evaluating cardiovascular safety of inhaled bronchodilator therapy in COPD

    Directory of Open Access Journals (Sweden)

    Kardos P

    2016-11-01

    Full Text Available Peter Kardos,1 Sally Worsley,2 Dave Singh,3 Miguel Román-Rodríguez,4 David E Newby,5 Hana Müllerová2 1Group Practice and Respiratory, Allergy and Sleep Unit, Red Cross Maingau Hospital, Frankfurt, Germany; 2GSK, Stockley Park, Middlesex, 3University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 4Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain; 5BHF Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK Abstract: Long-acting muscarinic antagonist (LAMA or long-acting β2-agonist (LABA bronchodilators and their combination are recommended for the maintenance treatment of chronic obstructive pulmonary disease (COPD. Although the efficacy of LAMAs and LABAs has been well established through randomized controlled trials (RCTs, questions remain regarding their cardiovascular (CV safety. Furthermore, while the safety of LAMA and LABA monotherapy has been extensively studied, data are lacking for LAMA/LABA combination therapy, and the majority of the studies that have reported on the CV safety of LAMA/LABA combination therapy were not specifically designed to assess this. Evaluation of CV safety for COPD treatments is important because many patients with COPD have underlying CV comorbidities. However, severe CV and other comorbidities are often exclusion criteria for RCTs, contributing to a lack in external validity and generalizability. Real-world observational studies are another important tool to evaluate the effectiveness and safety of COPD therapies in a broader population of patients and can improve upon the external validity limitations of RCTs. We examine what is already known regarding the CV and cerebrovascular safety of LAMA/LABA combination therapy from RCTs and real-world observational studies, and explore the advantages and

  11. Chronic obstructive pulmonary disease (COPD) rehabilitation at primary health‐care centres – the KOALA project

    DEFF Research Database (Denmark)

    Godtfredsen, Nina Skavlan; Grann, Ove; Larsen, Hanne Bormann

    2012-01-01

    Background:  Implementation of pulmonary rehabilitation in primary health care in Denmark is a new challenge in the management of patients with chronic obstructive pulmonary disease (COPD). Objectives:  To assess the feasibility of introducing a nationwide web-based tool for data recording...... health-care centres have been invited to participate. We present summary statistics and correlation analyses of the 1699 patients who have been enrolled so far. Results:  Thirty-three municipalities are currently engaged in the KOALA project. Descriptive analyses reveal that 33% of the patients do...

  12. Continuing to Confront COPD International Patient Survey: Economic Impact of COPD in 12 Countries.

    Directory of Open Access Journals (Sweden)

    Jason Foo

    Full Text Available The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD.This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation, contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct and indirect costs estimated the total societal costs per patient.The annual direct costs of COPD ranged from $504 (South Korea to $9,981 (USA, with inpatient hospitalisations (5 countries and home oxygen therapy (3 countries being the key drivers of direct costs. The proportion of patients completely prevented from working due to their COPD ranged from 6% (Italy to 52% (USA and UK with 8 countries reporting this to be ≥20%. Total societal costs per patient varied widely from $1,721 (Russia to $30,826 (USA but a consistent pattern across countries showed greater costs among those with increased burden of COPD (symptoms, health status and more severe disease and a greater number of comorbidities.The economic burden of COPD is considerable across countries, and requires targeted resources to optimise COPD management encompassing the control of symptoms, prevention of exacerbations and effective treatment of comorbidities. Strategies to allow COPD patients to remain in work are important for addressing the substantial wider societal costs.

  13. Development and Evaluation of an Automated, Home-Based, Electronic Questionnaire for Detecting COPD Exacerbations

    Directory of Open Access Journals (Sweden)

    Francisco de B. Velazquez-Peña

    2015-01-01

    Full Text Available Collaboration between patients and their medical and technical experts enabled the development of an automated questionnaire for the early detection of COPD exacerbations (AQCE. The questionnaire consisted of fourteen questions and was implemented on a computer system for use by patients at home in an un-supervised environment. Psychometric evaluation was conducted after a 6-month field trial. Fifty-two patients were involved in the development of the questionnaire. Reproducibility was studied using 19 patients (ICC = 0.94. Sixteen out of the 19 subjects started the 6 month-field trial with the computer application. Cronbach’s alpha of 0.81 was achieved. In the concurrent validity analysis, a correlation of 0.80 (p = 0.002 with the CCQ was reported. The results suggest that AQCE is a valid and reliable questionnaire, showing that an automated home-based electronic questionnaire may enable early detection of exacerbations of COPD.

  14. [Chronic obstructive pulmonary disease (COPD) prevalence in Brindisi Province (Southern Italy) for the years 2005-2009].

    Science.gov (United States)

    Bruni, Antonella; Gianicolo, Emilio Antonio Luca; Vigotti, Maria Angela; Faustini, Annunziata

    2014-01-01

    to estimate the prevalence of chronic obstructive pulmonary disease (COPD) in Brindisi Province (Southern Italy) during the period 2005-2009. longitudinal approach using electronic health data. prevalence of COPD cases where defined as: 35+ year-old residents in Brindisi Province discharged from hospital with a diagnosis of COPD, recorded in any of the diagnostic fields, during the period 2005-2009; residents discharged in the previous 4 years and still alive at the beginning of the year considered; residents who died of COPD without previous hospital admissions for the same disease. Diagnoses codes selected from discharge data and cause of mortality archive were 490-492, 494 and 496, of the International Classification of Diseases - IX Revision - Clinical Modification (ICD-9-CM). crude prevalence and age standardized prevalence (per 100 residents), with confidence intervals (95%CI), by gender. COPD prevalence rates did not change in Brindisi Province over the period of study and the rate was around 6.6%. Prevalence was higher in males and increased with age both among males and females. The rates were higher among the females resident in Brindisi town than those observed among females resident in the rest of the municipalities of the Province considered. Among males, prevalence rates were similar between males living in the selected areas. this study is the first to present COPD prevalence rates estimated for the Brindisi Province based on electronic health data. The results showed a higher COPD prevalence in Brindisi then in other Italian cities and spatial and temporal differences by gender among Brindisi and the rest of the municipalities considered. Results require additional investigations. In particular, the use of additional health data sources not considered in the present study might help in better explaining the differences observed.

  15. [The evaluation of nutritional status of stable COPD patients and to investigate the effect of nutritional status on perception of dyspnea, exercise capacity, body composition, hospitalisation and life quality].

    Science.gov (United States)

    Ayar Karakoç, Gamze; Ernam, Dilek; Aka Aktürk, Ülkü; Öztaş, Selahattin; Oğur, Erhan; Kabadayı, Feyyaz

    2016-06-01

    Malnutrition is a comorbidity oftenly seen in COPD patients who have progressive chronic inflammation and severity. In this prospective study, we aimed to determine the nutritional status of stable COPD patients and to investigate the impact of nutritional status on perception of dyspnoea, exercise capacity, body composition, hospitalisation and life quality. COPD patients were assessed using previous smoking story, physical examination and irreversible airway obstruction. This study was done with 50 COPD patients older than 65 years of age and 30 control subjects. Exclusion criteria were also the co-existance of malignancies, malabsorbtion, DM, neurological diseases, renal failure and unstable cardiac diseases known to influence the nutritional state. The obstruction degree was evaluated by spirometry, nutritional status was classified by the MNA questionnaire, perception of dyspnoea was assessed by the MMRC scale, exercise capacity was assessed by the 6MWT, life quality was assessed by the CAT scale. Body composition parameters FM, FFM and FMI were analyzed and hospitalisations during 6 months after discharge were recorded. The COPD patients were divided into three groups as without malnutrition (n= 25,%50), under risk of malnutrition (n= 19,%38) and malnourished (n= 6,%12). The COPD severity, MMRC dyspnoea score, CAT score and hospitalisations during 6 months following were higher among the malnourished patients. On the other hand, body mass index, 6MWT results, FM and FFM were lower in malnourished patients. A positive correlation between FFM and 6MWT and a negative correlation between FFM and hospitalisation were observed. MNA is a well-developed questionnaire which evaluates malnutrition in COPD patients. We determined that malnourished COPD patients have higher airway obstruction degree, perception of dyspnoea, CAT score and lower exercise capacity and FFM. FFM is an independent predictor of exercise capacity and rehospitalisation during 6 months.

  16. Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

    Directory of Open Access Journals (Sweden)

    Yvette RBM van Gestel

    2009-05-01

    Full Text Available Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Henk Stam3, Frans W Mertens3, Jeroen J Bax4, Ron T van Domburg5, Don Poldermans61Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Medicine, University of British Columbia and The James Hogg iCAPTURe Center, St. Paul’s Hospital, Vancouver, Canada; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; 4Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; 6Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The NetherlandsBackground: Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta-blockers and health-related quality of life (HRQOL in patients with peripheral arterial disease and COPD.Methods: Of the original cohort of 3371 vascular surgery patients, 1310 had COPD of whom 469 survived during long-term follow-up. These COPD patients were sent the Short Form-36 (SF-36 health-related quality of life questionnaire, which was completed and returned by 326 (70% patients.Results: No significant differences in any of the SF-36 domains were observed between COPD patients who did and did not use beta-blockers (p > 0.05 for all. Furthermore, beta-blockers were not associated with any impairment in HRQOL among patients with COPD.Conclusion: Beta-blockers had no material impact on the HRQOL of patients with peripheral arterial disease who also had COPD. This suggests that beta-blockers can, in most circumstances, be

  17. Relationship between lung function impairment and health-related quality of life in COPD and interstitial lung disease.

    Science.gov (United States)

    Berry, Cristine E; Drummond, M Bradley; Han, MeiLan K; Li, Daner; Fuller, Cathy; Limper, Andrew H; Martinez, Fernando J; Schwarz, Marvin I; Sciurba, Frank C; Wise, Robert A

    2012-09-01

    Health-related quality-of-life (HRQL) measures have been correlated with lung function in patients with COPD and interstitial lung disease (ILD). However, different pathophysiologic mechanisms may influence how these distinct diseases affect HRQL, resulting in differing HRQL by pulmonary diagnosis among patients with similar severity of ventilatory impairment. The National Heart, Lung, and Blood Institute Lung Tissue Research Consortium provided data on well-characterized participants with COPD (n = 576) and ILD (n = 405) at four clinical sites. Using multiple linear regression, we examined the effects of FEV₁ (% predicted) and diagnosis (ILD vs COPD) on HRQL scores, including total St. George Respiratory Questionnaire (SGRQ) scores and Short Form-12 (SF-12) physical component summary (PCS) and mental component summary (MCS) scores. Participants with ILD had, on average, higher SGRQ scores (15.33 points; 95% CI, 12.46-18.19; P <.001) and lower SF-12 PCS scores (-4.73 points; 95% CI, -6.31 to -3.14; P <.001) compared with patients with COPD with similar FEV₁ % predicted values, indicating worse HRQL. The specific diagnosis also modified the effect of FEV₁ on the total SGRQ score (P = .003) and the SF-12 PCS score (P = .03). There was no relationship between lung function and SF-12 MCS scores. HRQL scores were worse for patients with ILD compared with patients with COPD with similar degrees of ventilatory impairment. Differences in dyspnea mechanism or in the rate of disease progression may account for these differences in HRQL.

  18. Effectiveness of Teamwork in an Integrated Care Setting for Patients with COPD: Development and Testing of a Self-Evaluation Instrument for Interprofessional Teams.

    Science.gov (United States)

    Van Dijk-de Vries, Anneke N; Duimel-Peeters, Inge G P; Muris, Jean W; Wesseling, Geertjan J; Beusmans, George H M I; Vrijhoef, Hubertus J M

    2016-04-08

    Teamwork between healthcare providers is conditional for the delivery of integrated care. This study aimed to assess the usefulness of the conceptual framework Integrated Team Effectiveness Model for developing and testing of the Integrated Team Effectiveness Instrument. Focus groups with healthcare providers in an integrated care setting for people with chronic obstructive pulmonary disease (COPD) were conducted to examine the recognisability of the conceptual framework and to explore critical success factors for collaborative COPD practice out of this framework. The resulting items were transposed into a pilot instrument. This was reviewed by expert opinion and completed 153 times by healthcare providers. The underlying structure and internal consistency of the instrument were verified by factor analysis and Cronbach's alpha. The conceptual framework turned out to be comprehensible for discussing teamwork effectiveness. The pilot instrument measures 25 relevant aspects of teamwork in integrated COPD care. Factor analysis suggested three reliable components: teamwork effectiveness, team processes and team psychosocial traits (Cronbach's alpha between 0.76 and 0.81). The conceptual framework Integrated Team Effectiveness Model is relevant in developing a practical full-spectrum instrument to facilitate discussing teamwork effectiveness. The Integrated Team Effectiveness Instrument provides a well-founded basis to self-evaluate teamwork effectiveness in integrated COPD care by healthcare providers. Recommendations are provided for the improvement of the instrument.

  19. Effectiveness of Teamwork in an Integrated Care Setting for Patients with COPD: Development and Testing of a Self-Evaluation Instrument for Interprofessional Teams

    Directory of Open Access Journals (Sweden)

    Anneke N Van Dijk-de Vries

    2016-04-01

    Full Text Available Introduction: Teamwork between healthcare providers is conditional for the delivery of integrated care. This study aimed to assess the usefulness of the conceptual framework Integrated Team Effectiveness Model for developing and testing of the Integrated Team Effectiveness Instrument. Theory and methods: Focus groups with healthcare providers in an integrated care setting for people with chronic obstructive pulmonary disease (COPD were conducted to examine the recognisability of the conceptual framework and to explore critical success factors for collaborative COPD practice out of this framework. The resulting items were transposed into a pilot instrument. This was reviewed by expert opinion and completed 153 times by healthcare providers. The underlying structure and internal consistency of the instrument were verified by factor analysis and Cronbach’s alpha. Results: The conceptual framework turned out to be comprehensible for discussing teamwork effectiveness. The pilot instrument measures 25 relevant aspects of teamwork in integrated COPD care. Factor analysis suggested three reliable components: teamwork effectiveness, team processes and team psychosocial traits (Cronbach’s alpha between 0.76 and 0.81. Conclusions and discussion: The conceptual framework Integrated Team Effectiveness Model is relevant in developing a practical full-spectrum instrument to facilitate discussing teamwork effectiveness. The Integrated Team Effectiveness Instrument provides a well-founded basis to self-evaluate teamwork effectiveness in integrated COPD care by healthcare providers. Recommendations are provided for the improvement of the instrument.

  20. Detection of COPD in a high-risk population

    DEFF Research Database (Denmark)

    Kjeldgaard, Peter; Dahl, Ronald; Løkke, Anders

    2015-01-01

    BACKGROUND: Underdiagnosis of chronic obstructive pulmonary disease (COPD) is widespread. Early detection of COPD may improve the outcome by timely smoking cessation, a change in lifestyle, and treatment with an inhaled bronchodilator (BD). The objective of this study was to evaluate the diagnost...

  1. Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Ecological Study in the Basque Country, Spain (2000-2011).

    Science.gov (United States)

    Tamayo-Uria, Ibon; Altzibar, Jone M; Mughini-Gras, Lapo; Dorronsoro, Miren

    2016-12-01

    Chronic obstructive pulmonary disease (COPD) is a prevalent condition in adults aged ≥40 years characterized by progressive airflow limitation associated with chronic inflammatory response to noxious particles in the airways and lungs. Smoking, genetics, air pollution, nutrition and other factors may influence COPD development. Most hospitalizations and deaths for COPD are caused by its acute exacerbations, which greatly affect the health and quality of life of COPD patients and pose a high burden on health services. The aims of this project were to identify trends, geographic patterns and risk factors for COPD exacerbations, as revealed by hospitalizations and deaths, in the Basque Country, Spain, over a period of 12 years (2000-2011). Hospitalization and mortality rates for COPD were 262 and 18 per 100,000 population, respectively, with clusters around the biggest cities. Hospital mortality was 7.4%. Most hospitalized patients were male (77.4%) and accounted for 72.1% of hospital mortality. Hospitalizations decreased during the study period, except for 50-64 year-old women, peaking significantly. Using a multivariate modeling approach it was shown that hospitalizations were positively correlated with increased atmospheric concentrations of NO 2 , CO, PM 10 , and SO 2 , and increased influenza incidence, but were negatively associated with increased temperatures and atmospheric O 3 concentration. COPD exacerbations decreased in the Basque Country during 2000-2011, but not among 50-64-year-old women, reflecting the high smoking prevalence among Spanish women during the 1970-1990s. The main metropolitan areas were those with the highest risk for COPD exacerbations, calling attention to the role of heavy car traffic. Influenza virus, cold temperatures, and increased atmospheric NO 2 , CO, PM 10 , and SO 2 (but decreased O 3 ) concentrations were identified as potential contributors to the burden of COPD exacerbations in the community. These findings are

  2. LAMA/LABA vs ICS/LABA in the treatment of COPD in Japan based on the disease phenotypes

    Directory of Open Access Journals (Sweden)

    Hizawa N

    2015-06-01

    Full Text Available Nobuyuki Hizawa Department of Pulmonary Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan Abstract: In the combined use of bronchodilators of different classes, ie, long-acting β2-agonists (LABAs and long-acting muscarinic antagonists (LAMAs, bronchodilation is obtained both directly, through LABA-mediated stimulation of β2-adrenergic receptors, and indirectly, through LAMA-mediated inhibition of acetylcholine action at muscarinic receptors. The clinical trial data for LABAs/LAMAs in the treatment of chronic obstructive pulmonary disease (COPD continue to be promising, and these combinations will provide the convenience of delivering the two major bronchodilator classes, recommended as first-line maintenance options in COPD treatment guidelines. COPD is a complex condition that has pulmonary and extrapulmonary manifestations. These clinical manifestations are highly variable, and several are associated with different responses to currently available therapies. The concept of a COPD phenotype is rapidly evolving from one focusing on the clinical characteristics to one linking the underlying biology to the phenotype of the disease. Identification of the peculiarities of the different COPD phenotypes will permit us to implement a more personalized treatment in which the patient’s characteristics, together with his or her genotype, will be key to choosing the best treatment option. At present in Japan, fixed combinations of inhaled corticosteroids (ICSs and LABAs are frequently prescribed in the earlier stages of COPD. However, ICSs increase the risk of pneumonia. Notably, 10%–30% of patients with COPD with or without a history of asthma have persistent circulating and airway eosinophilia associated with an increased risk of exacerbations and sensitivity to steroids. Thus, sputum or blood eosinophil counts might identify a subpopulation in which ICSs could have potentially deleterious effects as well as a subpopulation that

  3. Factors that influence disease-specific quality of life or health status in patients with COPD : a systematic review and meta-analysis of Pearson correlations

    NARCIS (Netherlands)

    Tsiligianni, Ioanna; Kocks, Janwillem; Tzanakis, Nikolaos; Siafakas, Nikolaos; van der Molen, Thys

    Background: A major goal in the management of chronic obstructive pulmonary disease (COPD) is to ensure that the burden of the disease for patients with COPD is limited and that patients will have the best possible quality of life. Aims: To explore all the possible factors that could influence

  4. Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX): a randomised controlled equivalence trial.

    Science.gov (United States)

    Cross, Jane L; Elender, Frances; Barton, Gary; Clark, Allan; Shepstone, Lee; Blyth, Annie; Bachmann, Max O; Harvey, Ian

    2012-07-02

    Manual chest physiotherapy (MCP) techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions. However, methodological limitations in existing research have led to a state of clinical equipoise with respect to this treatment. Thus, for patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), clinical preference tends to dictate whether MCP is given to assist with sputum clearance. We standardised the delivery of MCP and assessed its effectiveness on disease-specific quality of life. In this randomised, controlled trial powered for equivalence, 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK. Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone. The primary outcome was a COPD specific quality of life measure, the Saint Georges Respiratory Questionnaire (SGRQ) at six months post randomisation. Analyses were by intention to treat (ITT). This study was registered, ISRCTN13825248. All patients were included in the analyses, of which 372 (71%) provided evaluable data for the primary outcome. An effect size of 0·3 standard deviations in SGRQ score was specified as the threshold for superiority. The ITT analyses showed no significant difference in SGRQ for patients who did, or did not receive MCP (95% CI -0·14 to 0·19). These data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD. However, this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances.

  5. Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX: a randomised controlled equivalence trial

    Directory of Open Access Journals (Sweden)

    Cross Jane L

    2012-07-01

    Full Text Available Abstract Background Manual chest physiotherapy (MCP techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions. However, methodological limitations in existing research have led to a state of clinical equipoise with respect to this treatment. Thus, for patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD, clinical preference tends to dictate whether MCP is given to assist with sputum clearance. We standardised the delivery of MCP and assessed its effectiveness on disease-specific quality of life. Methods In this randomised, controlled trial powered for equivalence, 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK. Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone. The primary outcome was a COPD specific quality of life measure, the Saint Georges Respiratory Questionnaire (SGRQ at six months post randomisation. Analyses were by intention to treat (ITT. This study was registered, ISRCTN13825248. Results All patients were included in the analyses, of which 372 (71% provided evaluable data for the primary outcome. An effect size of 0·3 standard deviations in SGRQ score was specified as the threshold for superiority. The ITT analyses showed no significant difference in SGRQ for patients who did, or did not receive MCP (95% CI −0·14 to 0·19. Conclusions These data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD. However, this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances.

  6. MIOTIC study: a prospective, multicenter, randomized study to evaluate the long-term efficacy of mobile phone-based Internet of Things in the management of patients with stable COPD.

    Science.gov (United States)

    Zhang, Jing; Song, Yuan-Lin; Bai, Chun-Xue

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is a common disease that leads to huge economic and social burden. Efficient and effective management of stable COPD is essential to improve quality of life and reduce medical expenditure. The Internet of Things (IoT), a recent breakthrough in communication technology, seems promising in improving health care delivery, but its potential strengths in COPD management remain poorly understood. We have developed a mobile phone-based IoT (mIoT) platform and initiated a randomized, multicenter, controlled trial entitled the 'MIOTIC study' to investigate the influence of mIoT among stable COPD patients. In the MIOTIC study, at least 600 patients with stable GOLD group C or D COPD and with a history of at least two moderate-to-severe exacerbations within the previous year will be randomly allocated to the control group, which receives routine follow-up, or the intervention group, which receives mIoT management. Endpoints of the study include (1) frequency and severity of acute exacerbation; (2) symptomatic evaluation; (3) pre- and post-bronchodilator forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) measurement; (4) exercise capacity; and (5) direct medical cost per year. Results from this study should provide direct evidence for the suitability of mIoT in stable COPD patient management.

  7. Integrated disease management improves one-year quality of life in primary care COPD patients: a controlled clinical trial.

    Science.gov (United States)

    Chavannes, Niels H; Grijsen, Marlous; van den Akker, Marjan; Schepers, Huub; Nijdam, Maddy; Tiep, Brian; Muris, Jean

    2009-09-01

    AIMD: To assess the long-term effectiveness of an integrated disease management (IDM) program (consisting of optimal medication, reactivation, education, and exacerbation management) in primary care patients with chronic obstructive pulmonary disease (COPD). Controlled trial comparing the effects of IDM on quality of life--assessed by the St. George's Respiratory Questionnaire (SGRQ)--in primary care COPD patients. The minimal clinically important change on the SGRQ was accepted as being -4 points. Baseline and one year differences were compared using paired sample T-tests. The differential effects of an FEV1/FVC ratio 2 and FEV1/FVC 2.

  8. Analysis of visceral fat in patients with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Lenártová, Petra; Habánová, Marta; Mrázová, Jana; Chlebo, Peter; Wyka, Joanna

    2016-01-01

    Cigarette smoking is a major public health problem, which leads to the formation of chronic obstructive pulmonary disease (COPD) and is one of the main causes of avoidable death and disability worldwide. The aim of study was analysis and comparison of the visceral fat in the body of the three groups of subjects (non-smokers, smokers and COPD patients) by Tanita Viscan 140. The control group was composed of: (1) non-smokers (n=30), consisted of 13 males (43.4%) and 17 women (56.6%) - the average age was 52 ± 6.51 years and (2) smokers (n=30), consisted of 12 men (40%) and 18 women (60%) - the average age 46.53 ± 9.22 years. Study group consisted of patients with COPD (n=60), which consisted of 48 men (80%) and 12 women (20%). Mean age was 69.25 ± 9.90 years. The measurement of visceral fat by Tanita Viscan device 140, which uses bioelectrical impedance analysis to measure fat in the abdomen of the patient in the supine position. High levels of visceral fat (women from 36.9% to 52.3% and more, men from 27.1% to 40.3% or more) were observed in 19 patients (3 women and 16 men), with 19 smokers (10 women and 9 men) and non-smokers in 22 subjects (10 women and 12 men). The average value of waist circumference measured with a Tanita Viscan 140 was in the group of patients 96.38 ± 12.27 cm, in the group of smokers 95.23 ± 10.12 cm and in group of non-smokers 96.86 ± 10.88 cm. The results of our work are of great importance for the health assessment not only among patients with COPD but also in the group of smokers. Therefore it would be appropriate to remind the general public, eg. by campaign for chronic obstructive pulmonary disease and its serious complications and reduce the life quality of these patients and thus help protect human health and in particular young people from the harmful effects of tobacco products.

  9. Interaction between Chronic Obstructive Pulmonary Disease (COPD) and other important health conditions and measurable air pollution

    Science.gov (United States)

    Blagev, D. P.; Mendoza, D. L.; Rea, S.; Sorensen, J.

    2015-12-01

    Adverse health effects have been associated with urban pollutant exposure arising from close proximity to highly-emitting sources and atmospheric mixing. The relative air pollution exposure dose and time effects on various diseases remains unknown. This study compares the increased risk of health complications when patients are exposed to short term high-levels of air pollution vs. longer term exposure to lower levels of air pollution. We used the electronic medical record of an integrated hospital system based in Utah, Intermountain Healthcare, to identify a cohort of patients with Chronic Obstructive Pulmonary Disease (COPD) who were seen between 2009-2014. We determined patient demographics as well as comorbidity data and healthcare utilization. To determine the approximate air pollution dose and time exposure, we used the Hestia highly-resolved emissions inventory for Salt Lake County, Utah in conjunction with emissions based on the National Emissions Inventory (NEI). Hourly emissions of CO2 and criteria air pollutants were gridded at a 0.002o x 0.002o resolution for the study years. The resulting emissions were transported using the CALPUFF and AERMOD dispersion models to estimate air pollutant concentrations at an hourly 0.002o x 0.002oresolution. Additionally, pollutant concentrations were estimated at each patient's home and work address to estimate exposure. Multivariate analysis adjusting for patient demographics, comorbidities and severity of COPD was performed to determine association between air pollution exposure and the risk of hospitalization or emergency department (ED) visit for COPD exacerbation and an equivalency estimate for air pollution exposure was developed. We noted associations with air pollution levels for each pollutant and hospitalizations and ED visits for COPD and other patient comorbidities. We also present an equivalency estimate for dose of air pollution exposure and health outcomes. This analysis compares the increased risk of

  10. The effects of theophylline on hospital admissions and exacerbations in COPD patients: audit data from the Bavarian disease management program.

    Science.gov (United States)

    Fexer, Johannes; Donnachie, Ewan; Schneider, Antonius; Wagenpfeil, Stefan; Keller, Manfred; Hofmann, Frank; Mehring, Michael

    2014-04-25

    Theophylline is often used to treat chronic obstructive pulmonary disease (COPD). Current evidence leaves the effectiveness and safety of this drug open to question. Thus, we evaluated the effectiveness of theophylline on the rate of hospitalizations and disease exacerbations by examining routine data from the ambulatory disease management program for COPD in the German state of Bavaria. Data sets from a total of 30 330 patients were examined. Logistic regression models were used to calculate propensity scores that controlled for baseline characteristics. These propensity scores, in turn, were used to create comparable patient groups, which were observed for a median follow-up time of 9 quarters (the theophylline group) and 10 quarters (the control group). 1496 patients with first prescription of theophylline were matched with 1496 patients with no record of theophylline treatment. 1. The probability of suffering an exacerbation during the period of observation, was 33.5% for the control group and 43.4% for the theophylline group [hazard ratio (HR) 1.41; 95% confidence interval (CI) 1.24 to 1.60], yielding a number needed to harm (NNH) of 11 (95% CI 7.7 to 20.9). The probability for hospitalization was 11.4% for the control group and 17.4% of the theophylline group (HR 1.61; 95% CI 1.29 to 2.01), yielding a NNH of 17 (95%CI 11.0-34.5). Treatment with theophylline is associated with an elevated incidence of exacerbations and hospitalizations. The therapeutic value of this drug should be reconsidered and investigated in further studies.

  11. The asthma–COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease?

    Directory of Open Access Journals (Sweden)

    Kostikas K

    2016-06-01

    Full Text Available Konstantinos Kostikas, Andreas Clemens, Francesco Patalano Novartis Pharma AG, Basel, Switzerland Abstract: The term asthma–COPD overlap syndrome (ACOS is one of multiple terms used to describe patients with characteristics of both COPD and asthma, representing ~20% of patients with obstructive airway diseases. The recognition of both sets of morbidities in patients is important to guide practical treatment decisions. It is widely recognized that patients with COPD and coexisting asthma present with a higher disease burden, despite the conceptual expectation that the “reversible” or “treatable” component of asthma would allow for more effective management and better outcomes. However, subcategorization into terms such as ACOS is complicated by the vast spectrum of heterogeneity that is encapsulated by asthma and COPD, resulting in different clinical clusters. In this review, we discuss the possibility that these different clusters are suboptimally described by the umbrella term “ACOS”, as this additional categorization may lead to clinical confusion and potential inappropriate use of resources. We suggest that a more clinically relevant approach would be to recognize the extreme variability and the numerous phenotypes encompassed within obstructive airway diseases, with various degrees of overlapping in individual patients. In addition, we discuss some of the evidence to be considered when making practical decisions on the treatment of patients with overlapping characteristics between COPD and asthma, as well as the potential options for phenotype and biomarker-driven management of airway disease with the aim of providing more personalized treatment for patients. Finally, we highlight the need for more evidence in patients with overlapping disease characteristics and to facilitate better characterization of potential treatment responders. Keywords: emphysema, chronic bronchitis, COPD, asthma, ACOS, overlap syndrome

  12. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD.

    Science.gov (United States)

    Holland, Anne E; Wadell, Karin; Spruit, Martijn A

    2013-12-01

    Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD) and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

  13. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD

    Directory of Open Access Journals (Sweden)

    Anne E. Holland

    2013-12-01

    Full Text Available Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

  14. A comparison of cognitive functions in non-hypoxemic chronic obstructive pulmonary disease (COPD patients and age-matched healthy volunteers using mini-mental state examination questionnaire and event-related potential, P300 analysis

    Directory of Open Access Journals (Sweden)

    Prem Parkash Gupta

    2013-01-01

    Full Text Available Objective: To assess sub-clinical cognitive dysfunctions in stable chronic obstructive pulmonary disease (COPD patients having no hypoxemia vs. age-matched healthy volunteers using (i an electrophysiological test: Auditory event related potential, P300 test and (ii a questionnaire tool: Mini-mental state examination (MMSE questionnaire. Materials and Methods: Eighty male subjects were included: 40 stable COPD patients (smoking history >20 pack years and 40 healthy volunteers (HVs. Age, duration of illness, smoking pack years, and spirometric indices were assessed. MMSE scores were evaluated in these groups. Latency of P300 wave and amplitude of P300 wave were studied in both groups to detect P300 abnormalities in COPD group. Correlations of P300 abnormalities with patient characteristic parameters and MMSE scores were assessed. In addition, individual COPD patients having significant cognitive dysfunctions beyond cut-off value of 99 th percentile of HVs were analyzed. Results: We observed significantly prolonged P300 latency ( P 0.05 for all. Conclusions: Our study explores cognitive dysfunctions in stable COPD patients with no hypoxemia. This study highlights the relative importance of using MMSE and P300. Cognitive dysfunctions were detected both by MMSE and P300; however, MMSE abnormalities were more frequent compared to P300 abnormalities (27/40 vs. 10/40 in COPD patients.

  15. State Fact Sheets on COPD

    Science.gov (United States)

    ... Submit Search The CDC Chronic Obstructive Pulmonary Disease (COPD) Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . COPD Homepage Data and Statistics Fact Sheets Publications Publications ...

  16. Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD exacerbations

    Directory of Open Access Journals (Sweden)

    Jose Luis Lopez-Campos

    2015-01-01

    Full Text Available Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV for providing ventilatory support in chronic obstructive pulmonary disease (COPD exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1 NIV is not invariably available, 2 its availability depends on countries and hospital sizes, and 3 numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations.

  17. Low back pain and gastroesophageal reflux in patients with COPD: the disease in the breath

    Directory of Open Access Journals (Sweden)

    Bordoni B

    2018-01-01

    Full Text Available Bruno Bordoni,1 Fabiola Marelli,2,3 Bruno Morabito,2,3 Beatrice Sacconi,4,5 Philippe Caiazzo,6 Roberto Castagna2 1Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Scientific Institute of Hospitalization and Care, Milan, 2Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, 3Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Fano, 4Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 5Department of Radiological, Oncological and Anatomopathological Sciences, Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Rome, 6Department of Osteopathic Research, AITOP, Italian Academy of Postural Osteopathic Therapy, Levizzano Rangone – Castelvetro, Italy Abstract: COPD is a worsening condition that leads to a pathologic degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of associated comorbidity. This article analyzes gastroesophageal reflux disease (GERD and low back pain (LBP in patients with COPD and tries to produce anatomo-clinical considerations on the reasons of the presence of these comorbidities. The considerations of the authors are based on the anatomic functions and characteristics of the respiratory diaphragm that are not always considered, from which elements useful to comprehend the symptomatic status of the patient can be deduced, finally improving the therapeutic approach. The information contained in the article can be of help to the clinician and for physiotherapy, and to all health professionals who gravitate around the patient’s care, improving the approach to the diaphragm muscle. Keywords: COPD, diaphragm, low back pain, GERD, fascia

  18. Influence of age, past smoking, and disease severity on TLR2, neutrophilic inflammation, and MMP-9 levels in COPD.

    Science.gov (United States)

    Simpson, Jodie L; McDonald, Vanessa M; Baines, Katherine J; Oreo, Kevin M; Wang, Fang; Hansbro, Philip M; Gibson, Peter G

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is a common and serious respiratory disease, particularly in older individuals, characterised by fixed airway obstruction and persistent airway neutrophilia. The mechanisms that lead to these features are not well established. We investigated the contribution of age, prior smoking, and fixed airflow obstruction on sputum neutrophils, TLR2 expression, and markers of neutrophilic inflammation. Induced sputum from adults with COPD (n = 69) and healthy controls (n = 51) was examined. A sputum portion was dispersed, total, differential cell count and viability recorded, and supernatant assayed for CXCL8, matrix metalloproteinase- (MMP-) 9, neutrophil elastase, and soluble TLR2. Peripheral blood cells (n = 7) were stimulated and TLR2 activation examined. TLR2 levels were increased with ageing, while sputum neutrophils and total sputum MMP-9 levels increased with age, previous smoking, and COPD. In multivariate regression, TLR2 gene expression and MMP-9 levels were significant independent contributors to the proportion of sputum neutrophils after adjustment for age, prior smoking, and the presence of airflow obstruction. TLR2 stimulation led to enhanced release of MMP-9 from peripheral blood granulocytes. TLR2 stimulation activates neutrophils for MMP-9 release. Efforts to understand the mechanisms of TLR2 signalling and subsequent MMP-9 production in COPD may assist in understanding neutrophilic inflammation in COPD.

  19. Managing comorbidities in COPD

    Directory of Open Access Journals (Sweden)

    Hillas G

    2015-01-01

    Full Text Available Georgios Hillas,1 Fotis Perlikos,1 Ioanna Tsiligianni,2,3 Nikolaos Tzanakis2 1Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, 2Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece; 3Department of General Practice, University Medical Centre of Groningen, Groningen, The NetherlandsAbstract: Chronic obstructive pulmonary disease (COPD is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for

  20. Asthma-like Features and Clinical Course of Chronic Obstructive Pulmonary Disease. An Analysis from the Hokkaido COPD Cohort Study.

    Science.gov (United States)

    Suzuki, Masaru; Makita, Hironi; Konno, Satoshi; Shimizu, Kaoruko; Kimura, Hiroki; Kimura, Hirokazu; Nishimura, Masaharu

    2016-12-01

    Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features, such as significant bronchodilator reversibility, blood eosinophilia, and/or atopy, even if they are not clinically diagnosed as having asthma. However, the clinical significance of asthma-like features overlapping with COPD remains unclear. The aim of this study was to assess the effect of asthma-like features on the clinical course of patients with COPD who were adequately treated and followed-up over 10 years. A total of 268 patients with COPD who had been clinically considered as not having asthma by respiratory specialists were included in this study. The asthma-like features included in this study were bronchodilator reversibility (ΔFEV1, ≥12% and ≥200 ml), blood eosinophilia (≥300 cells/μl), and atopy (positive specific IgE for any inhaled antigen). The annual changes in post-bronchodilator FEV1 and COPD exacerbations were monitored during the first 5 years, and mortality was followed during the entire 10 years of the study. Fifty-seven subjects (21%) had bronchodilator reversibility, 52 (19%) had blood eosinophilia, and 67 (25%) had atopy. Subjects with blood eosinophilia had significantly slower annual post-bronchodilator FEV1 decline; bronchodilator reversibility and atopy did not affect the annual post-bronchodilator FEV1 decline, and none of the asthma-like features was associated with development of COPD exacerbation. Even if subjects had two or more asthma-like features, they displayed annual post-bronchodilator FEV1 declines and exacerbation rates similar to those of subjects with one or zero asthma-like features, as well as a lower 10-year mortality rate (P = 0.02). The presence of asthma-like features was associated with better clinical course in patients with COPD receiving appropriate treatment.

  1. Biochemical parameters as monitoring markers of the inflammatory reaction by patients with chronic obstructive pulmonary disease (COPD)

    Science.gov (United States)

    Lenártová, Petra; Kopčeková, Jana; Gažarová, Martina; Mrázová, Jana; Wyka, Joanna

    Chronic obstructive pulmonary disease (COPD) is an airway inflammatory disease caused by inhalation of toxic particles, mainly cigarette smoking, and now is accepted as a disease associated with systemic characteristics. The aim of this work was to investigate and compare selected biochemical parameters in patients with and without COPD. Observation group consisted of clinically stable patients with COPD (n = 60). The control group was healthy persons from the general population, without COPD, who were divided into two subgroups – smokers (n = 30) and non-smokers (n = 30). Laboratory parameters were investigated by automated clinical chemistry analyzer LISA 200th. Albumin in our measurements showed an average value of 39.55 g.l-1 in the patient population; 38.89 g.l-1 in smokers and in non-smokers group 44.65 g.l-1. The average value of pre-albumin in the group of patients was 0.28 ± 0.28 g.l-1 and 0.30 ± 0.04 g.l-1 in smokers group. The average value of the orosomucoid in patients was about 1.11 ± 0.90 mg.ml-1. In the group of smokers, the mean value of orosomucoid was 0.60 ± 0.13 mg.ml-1. The level of C-reactive protein (CRP) in the patient group reached an average value of 15.31 ± 22.04 mg.l-1, in the group of smokers was 5.18 ± 4.58 mg. l-1. Prognostic inflammatory and nutritional index (PINI) in the group of patients showed a mean value of 4.65 ± 10.77 and 0.026 ± 0.025 in smokers. The results of this work show, that the values of index PINI in COPD patients are significantly higher than in smokers (P COPD.

  2. Effectiveness of Influenza Vaccination for Individuals with Chronic Obstructive Pulmonary Disease (COPD) in Low- and Middle-Income Countries.

    Science.gov (United States)

    Lall, Dorothy; Cason, E; Pasquel, F J; Ali, M K; Narayan, K M V

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In addition to the mortality associated with it, people with COPD experience significant morbidity, making this set of conditions a major public health concern. Infections caused by influenza virus are a preventable cause of morbidity and vaccination has been shown to be effective. The evidence of their benefit in persons with COPD mainly comes from high-income countries where influenza vaccination is used in routine practice, but little is known about the effectiveness, cost-effectiveness, and scalability of vaccination in low- and middle-income countries. We therefore systematically reviewed and present evidence related to vaccination against influenza in persons with COPD with a special focus on studies from low- and middle-income countries (LMICs). Available data from 19 studies suggest that the use of influenza vaccine in persons with COPD is beneficial, cost-effective, and may be relevant for low- and middle-income countries. Wider implementation of this intervention needs to take into account the health care delivery systems of LMICs and use of prevalent viral strains in vaccines to be most cost effective.

  3. Smoking cessation strategies in patients with COPD

    DEFF Research Database (Denmark)

    Warnier, Miriam J; van Riet, Evelien E S; Rutten, Frans H

    2013-01-01

    Smoking cessation is the cornerstone of treatment of chronic obstructive pulmonary disease (COPD) patients. This systematic review evaluates the effectiveness of behavioural and pharmacological smoking cessation strategies in COPD patients. MEDLINE was searched from January 2002 to October 2011....... Randomised controlled trials evaluating the effect of smoking cessation interventions for COPD patients, published in English, were selected. The methodological quality of included trials was assessed using the Delphi list by two reviewers independently. The relative risks of smoking cessation due...... to be of acceptable quality. Pharmacological therapy combined with behavioural counselling was more effective than each strategy separately. In COPD patients, the intensity of counselling did not seem to influence the results, nor did the choice of drug therapy make a difference. This systematic review makes clear...

  4. Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy.

    Science.gov (United States)

    Grochowalska, Aneta; Kozioł-Montewka, Maria; Sobieszczańska, Anna

    2017-06-12

    Introduction. Multi-resistant Acinetobacter baumannii isolated from patients has become one of the most hazardous pathogens in health care settings. The aim of the study was to analyze pneumonia caused by Acinetobacter baumannii in patients hospitalized because of exacerbation of chronic obstructive pulmonary diseases (COPD), who were admitted to the Pulmonology Ward of the Masovian Specialistic Hospital in Radom (MSS). The incidence and drug sensitivity of these non-fermenting rods were evaluated, and compliance with antimicrobial procedure with the algorithm of the guidelines in applicable recommendations, was estimated. This should result in determining the local patterns of resistance and verifying therapeutic procedures in accordance with the assumptions of hospital antibiotic policy. In addition, the study examined the effectiveness of empiric and targeted therapy according to the clinical condition of the patient, and the eradication of A. baumannii, in comparison with the aggravating factors of the patient. Materials and Method. The retrospective study included 90 patients with exacerbation of COPD whose etiological factor of infection was A. baumannii, hospitalized in the Department of Pulmonology (MSS) in 2012-2016. Results. Studies were conducted on 90 patients with COPD exacerbation from which A. baumannii was isolated. Co-infections with other bacterial species among 41 patients were additionally noted. The majority of A. baumannii strains showed a high resistance (90%) to fluoroquinolones, ceftazidime, piperacillin/tazobactam. For strains causing a co-infection, drug resistance was successively 44-56%, 44%, 44%. All of patients received empirical therapy. The most commonly used drug was amoxicillin with a clavulanic acid, often combined with fluoroquinolone. This type of therapy was effective among 10% of patients. The mortality in this group was determined at 29%. Among 79% of patients with COPD, a targeted therapy was performed which proved to be

  5. Evaluation of body composition in COPD patients using multifrequency bioelectrical impedance analysis

    Directory of Open Access Journals (Sweden)

    de Blasio F

    2016-09-01

    Full Text Available Francesca de Blasio,1 Francesco de Blasio,2,3 Giulia Miracco Berlingieri,2 Andrea Bianco,3,4 Marta La Greca,1 Frits M E Franssen,5 Luca Scalfi1 1Department of Public Health, Medical School, “Federico II” University of Naples, 2Respiratory Medicine and Pulmonary Rehabilitation Section, Clinic Center, Private Hospital, Naples, 3Department of Medicine and Health Sciences “V Tiberio”, University of Molise, Campobasso, 4Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy; 5Department of Research and Education, CIRO, Horn, the NetherlandsBackground: Multifrequency bioelectrical impedance analysis (MF-BIA is a technique that measures body impedance (Z at different frequencies (5, 10, 50, 100, and 250 kHz. Body composition may be estimated using empirical equations, which include BIA variables or, alternatively, raw BIA data may provide direct information on water distribution and muscle quality.Objectives: To compare raw MF-BIA data between COPD patients and controls and to study their relationship with respiratory and functional parameters in COPD patients.Methods: MF-BIA was performed (Human Im-Touch analyzer in 212 COPD patients and 115 age- and BMI-matched controls. Fat-free mass (FFM and fat mass were estimated from BIA data, and low- to high-frequency (5 kHz/250 kHz impedance ratio was calculated. Physical fitness, lung function and respiratory muscle strength were also assessed in COPD patients.Results: After adjusting for age, weight, and body mass index, FFM and the 5/250 impedance ratio were lower in COPD patients (P<0.001 and were negatively affected by disease severity. In both male and female patients, the 5/250 impedance ratio was significantly correlated mainly with age (r=−0.316 and r=−0.346, respectively. Patients with a 5/250 impedance ratio below median value had lower handgrip strength (P<0.001, 6-minute walk distance (P<0.005, respiratory muscle strength (P<0.005, forced

  6. Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial.

    Science.gov (United States)

    Liang, Jenifer; Abramson, Michael J; Zwar, Nicholas; Russell, Grant; Holland, Anne E; Bonevski, Billie; Mahal, Ajay; Hecke, Benjamin van; Phillips, Kirsten; Eustace, Paula; Paul, Eldho; Petrie, Kate; Wilson, Sally; George, Johnson

    2017-09-18

    Up to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings. A cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS - Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identified and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confirmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-finding. RADICALS includes individualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George's Respiratory Questionnaire score of patients with COPD at 6 months from baseline. This project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 - 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time. ACTRN

  7. Feasibility, acceptability and effectiveness of integrated care for COPD patients: a mixed methods evaluation of a pilot community-based programme.

    Science.gov (United States)

    Carron, Tania; Bridevaux, Pierre-Olivier; Lörvall, Karin; Parmentier, Rachel; Moix, Jean-Bernard; Beytrison, Vincent; Pernet, Raymond; Rey, Constance; Roberfroid, Pierre-Yves; Chhajed, Prashant N; Dieterle, Thomas; Joos Zellweger, Ladina; Kohler, Malcolm; Maier, Sabrina; Miedinger, David; Thurnheer, Robert; Urwyler, Pascal; Tschopp, Jean-Marie; Zuercher, Emilie; Leuppi, Jörg Daniel; Burnand, Bernard; Peytremann-Bridevaux, Isabelle

    2017-12-12

    The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland. The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care. A process and outcome evaluation of the pilot phase of the programme was conducted by means of qualitative and quantitative methods. Reach (coverage, participation rates), dosage (interventions carried out), fidelity (delivered as intended) and stakeholders' acceptance of the programme were evaluated through data monitoring and conduct of focus groups with patients and healthcare professionals. Effectiveness was assessed with pre-post analyses (before and after the intervention). The primary outcome measures were; (1) generic and disease-specific quality of life (36-Item Short Form Health Survey, Chronic Respiratory Questionnaire); and (2) hospitalisations (all-cause and for acute exacerbations) in the past 12 months. Secondary outcomes included self-efficacy, number of exacerbations and exercise capacity. Finally, controlled pre-post comparisons were also made with patients from the Swiss COPD Cohort for three common outcome measures (dyspnoea [mMRC score], number of exacerbations and smoking status). During the first 2 years of the programme, eight series of group-based education sessions were delivered to 57 patients with COPD in three different locations of the canton of Valais. Coverage objectives were achieved and attendance rate at the education sessions was high (83.6%). Patients' and healthcare professionals' reported a high degree of satisfaction, except for multidisciplinarity and transfer of information. Exploration of the effectiveness of this pilot programme suggested positive pre-post results at 12

  8. Systemic biomarkers of neutrophilic inflammation, tissue injury and repair in COPD patients with differing levels of disease severity.

    Directory of Open Access Journals (Sweden)

    Debra A Cockayne

    Full Text Available The identification and validation of biomarkers to support the assessment of novel therapeutics for COPD continues to be an important area of research. The aim of the current study was to identify systemic protein biomarkers correlated with measures of COPD severity, as well as specific protein signatures associated with comorbidities such as metabolic syndrome. 142 protein analytes were measured in serum of 140 patients with stable COPD, 15 smokers without COPD and 30 non-smoking controls. Seven analytes (sRAGE, EN-RAGE, NGAL, Fibrinogen, MPO, TGF-α and HB-EGF showed significant differences between severe/very severe COPD, mild/moderate COPD, smoking and non-smoking control groups. Within the COPD subjects, univariate and multivariate analyses identified analytes significantly associated with FEV(1, FEV(1/FVC and DLCO. Most notably, a set of 5 analytes (HB-EGF, Fibrinogen, MCP-4, sRAGE and Sortilin predicted 21% of the variability in DLCO values. To determine common functions/pathways, analytes were clustered in a correlation network by similarity of expression profile. While analytes related to neutrophil function (EN-RAGE, NGAL, MPO grouped together to form a cluster associated with FEV(1 related parameters, analytes related to the EGFR pathway (HB-EGF, TGF-α formed another cluster associated with both DLCO and FEV(1 related parameters. Associations of Fibrinogen with DLCO and MPO with FEV(1/FVC were stronger in patients without metabolic syndrome (r  =  -0.52, p  =  0.005 and r  =  -0.61, p =  0.023, respectively compared to patients with coexisting metabolic syndrome (r  =  -0.25, p  =  0.47 and r  =  -0.15, p  =  0.96, respectively, and may be driving overall associations in the general cohort. In summary, our study has identified known and novel serum protein biomarkers and has demonstrated specific associations with COPD disease severity, FEV(1, FEV(1/FVC and DLCO. These data highlight systemic

  9. Short-Term Intra-Subject Variation in Exhaled Volatile Organic Compounds (VOCs in COPD Patients and Healthy Controls and Its Effect on Disease Classification

    Directory of Open Access Journals (Sweden)

    Christopher Phillips

    2014-05-01

    Full Text Available Exhaled volatile organic compounds (VOCs are of interest for their potential to diagnose disease non-invasively. However, most breath VOC studies have analyzed single breath samples from an individual and assumed them to be wholly consistent representative of the person. This provided the motivation for an investigation of the variability of breath profiles when three breath samples are taken over a short time period (two minute intervals between samples for 118 stable patients with Chronic Obstructive Pulmonary Disease (COPD and 63 healthy controls and analyzed by gas chromatography and mass spectroscopy (GC/MS. The extent of the variation in VOC levels differed between COPD and healthy subjects and the patterns of variation differed for isoprene versus the bulk of other VOCs. In addition, machine learning approaches were applied to the breath data to establish whether these samples differed in their ability to discriminate COPD from healthy states and whether aggregation of multiple samples, into single data sets, could offer improved discrimination. The three breath samples gave similar classification accuracy to one another when evaluated separately (66.5% to 68.3% subjects classified correctly depending on the breath repetition used. Combining multiple breath samples into single data sets gave better discrimination (73.4% subjects classified correctly. Although accuracy is not sufficient for COPD diagnosis in a clinical setting, enhanced sampling and analysis may improve accuracy further. Variability in samples, and short-term effects of practice or exertion, need to be considered in any breath testing program to improve reliability and optimize discrimination.

  10. Diaphragm adaptations in patients with COPD

    Directory of Open Access Journals (Sweden)

    Heunks Leo MA

    2008-01-01

    Full Text Available Abstract Inspiratory muscle weakness in patients with COPD is of major clinical relevance. For instance, maximum inspiratory pressure generation is an independent determinant of survival in severe COPD. Traditionally, inspiratory muscle weakness has been ascribed to hyperinflation-induced diaphragm shortening. However, more recently, invasive evaluation of diaphragm contractile function, structure, and biochemistry demonstrated that cellular and molecular alterations occur, of which several can be considered pathologic of nature. Whereas the fiber type shift towards oxidative type I fibers in COPD diaphragm is regarded beneficial, rendering the overloaded diaphragm more resistant to fatigue, the reduction of diaphragm fiber force generation in vitro likely contributes to diaphragm weakness. The reduced diaphragm force generation at single fiber level is associated with loss of myosin content in these fibers. Moreover, the diaphragm in COPD is exposed to oxidative stress and sarcomeric injury. This review postulates that the oxidative stress and sarcomeric injury activate proteolytic machinery, leading to contractile protein wasting and, consequently, loss of force generating capacity of diaphragm fibers in patients with COPD. Interestingly, several of these presumed pathologic alterations are already present early in the course of the disease (GOLD I/II, although these patients appear not limited in their daily life activities. Treatment of diaphragm dysfunction in COPD is complex since its etiology is unclear, but recent findings indicate the ubiquitin-proteasome pathway as a prime target to attenuate diaphragm wasting in COPD.

  11. The 6-Minute-Walk Distance Test as a Chronic Obstructive Pulmonary Disease Stratification Tool. Insights from the COPD Biomarker Qualification Consortium.

    Science.gov (United States)

    Celli, Bartolome; Tetzlaff, Kay; Criner, Gerard; Polkey, Michael I; Sciurba, Frank; Casaburi, Richard; Tal-Singer, Ruth; Kawata, Ariane; Merrill, Debora; Rennard, Stephen

    2016-12-15

    The 6-minute-walk distance (6MWD) test predicts mortality in chronic obstructive pulmonary disease (COPD). Whether variability in study type (observational vs. interventional) or region performed limits use of the test as a stratification tool or outcome measure for therapeutic trials is unclear. To analyze the original data from several large observational studies and from randomized clinical trials with bronchodilators to support the qualification of the 6MWD test as a drug development tool in COPD. Original data from 14,497 patients with COPD from six observational (n = 9,641) and five interventional (n = 4,856) studies larger than 100 patients and longer than 6 months in duration were included. The geographical, anthropometrics, FEV1, dyspnea, comorbidities, and health status scores were measured. Associations between 6MWD and mortality, hospitalizations, and exacerbations adjusted by study type, age, and sex were evaluated. Thresholds for outcome prediction were calculated using receiver operating curves. The change in 6MWD after inhaled bronchodilator treatment and surgical lung volume reduction were analyzed to evaluate the responsiveness of the test as an outcome measure. The 6MWD was significantly lower in nonsurvivors, those hospitalized, or who exacerbated compared with those without events at 6, 12, and greater than 12 months. At these time points, the 6MWD receiver operating characteristic curve-area under the curve to predict mortality was 0.71, 0.70, and 0.68 and for hospitalizations was 0.61, 0.60, and 0.59, respectively. After treatment, the 6MWD was not different between placebo and bronchodilators but increased after surgical lung volume reduction compared with medical therapy. Variation across study types (observational or therapeutic) or regions did not confound the ability of 6MWD to predict outcome. The 6MWD test can be used to stratify patients with COPD for clinical trials and interventions aimed at modifying exacerbations

  12. COPD: recognizing the susceptible smoker

    NARCIS (Netherlands)

    Hoonhorst, Susan

    2014-01-01

    Smoking is the main cause of COPD, a chronic non-curable lung disease. Not all smokers develop COPD and it is still unclear why COPD is only manifested in a small subset of smokers (15-20%). Probably their genetic background makes the difference. We investigated whether young individuals (18-40

  13. Effect of progressive relaxation exercises on fatigue and sleep quality in patients with chronic obstructive lung disease (COPD).

    Science.gov (United States)

    Akgün Şahin, Zümrüt; Dayapoğlu, Nuray

    2015-11-01

    This research was conducted to investigate the effect of Progressive Muscle Relaxation Technique on fatigue and sleep quality in patients with COPD. This research was performed as a single-group pretest/post-test pretrial model. The study was conducted with 45 patients who met the research criteria and agreed to participate in the study. A Personal Information Form was used as a data collection tool, Fatigue Severity Scale was used for measuring fatigue, and the Pittsburgh Sleep Quality Index was used for evaluating the sleep quality. It was determined that PMRT decreased patients' fatigue level and improved their sleep quality, patients' fatigue level increased as their sleep quality decreased. Progressive relaxation exercises programs represent effective therapeutic intervention approaches for relieving COPD-associated fatigue and sleep quality. PMRT programs will extend the scope of the rehabilitation nurses' work, as it is an important course of COPD patients' continuity nursing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Life event stress and chronic obstructive pulmonary disease (COPD): associations with mental well-being and quality of life in a population-based study.

    Science.gov (United States)

    Lu, Yanxia; Nyunt, Ma Shwe Zin; Gwee, Xinyi; Feng, Liang; Feng, Lei; Kua, Ee Heok; Kumar, Rajeev; Ng, Tze Pin

    2012-01-01

    To investigate whether life event stress was associated with greater psychological distress and poorer quality of life in older individuals with chronic obstructive pulmonary disease (COPD), in comparison with their counterparts without COPD. Cross-sectional study. A population-based sample (N=497) of individuals aged 65 and above with COPD (postbronchodilatation FEV1/FVCMental State Examination), and physical and mental health functional status (SF36-PCS, Physical Health Component Summary and SF36-MCS, Mental Health Component Summary) in participants with and without COPD. In two-way analysis of variance controlling for potential confounders, life event stress was associated with significant main effects of worse GDS (p<0.001), SF36-PCS (p=0.008) and SF36-MCS scores (p<0.001), and with significant interaction effects on GDS score (p<0.001), SF36-PCS (p=0.045) and SF36-MCS (p=0.034) in participants with COPD, more than in non-COPD participants. The main effect of COPD was found for postbronchodilator FEV1 (p<0.001) and cognitive symptoms (p=0.02). Our findings indicate that life event stress was associated with more depressive symptoms and worse quality of life in individuals with COPD, much more than in those without COPD. Further studies should explore the role of cognitive appraisal of stress, coping resources and psycho-social support in this relationship.

  15. Systemic effects in COPD

    NARCIS (Netherlands)

    Wouters, E.F.M.; Creutzberg, E.C.; Schols, A.M.W.J.

    2002-01-01

    Systemic effects in COPD. Wouters EF, Creutzberg EC, Schols AM. Department of Pulmonary Diseases, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands. ewo@ms-azm-3.azm.nl The pathogenesis and clinical manifestations of COPD are not restricted to pulmonary inflammation

  16. Progression to chronic obstructive pulmonary disease (COPD): could it be prevented by manual therapy and exercise during the 'at risk' stage (stage 0)?

    Science.gov (United States)

    Engel, Roger M; Vemulpad, Subramanyam

    2009-03-01

    A number of predisposing factors are recognised as increasing the risk of developing chronic pulmonary obstructive disease (COPD). There is increasing recognition that COPD may be an inflammatory disease with systemic consequences. However, the trigger for the transition from 'at risk' (stage 0) to COPD state remains unclear. The current approach to intervention for the 'at risk' group is risk factor avoidance. We propose that if interventions shown to improve chronic respiratory symptoms in COPD sufferers could be applied to the 'at risk' group, then moderation or even reversal of the changes typical of this transition becomes a possibility. Exercise training has been shown to be beneficial at all stages of COPD. Mobility of the chest wall influences lung function. We hypothesise that the application to 'at risk' individuals (stage 0) of therapeutic interventions known to improve chronic respiratory symptoms and cardiovascular function in mild/moderate COPD (stages 1 and 2) could delay progression of the disease (i.e. manifestation of mild/moderate COPD). If the hypothesis were confirmed, the potential to delay or even prevent the onset of COPD would be feasible.

  17. Preclinical Studies of Mesenchymal Stem Cell (MSC) Administration in Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Liu, Xiangde; Fang, Qiuhong; Kim, Huijung

    2016-01-01

    In the last two decades, mesenchymal stem cells (MSCs) have been pre-clinically utilized in the treatment of a variety of kinds of diseases including chronic obstructive pulmonary disease (COPD). The aim of the current study was to systematically review and conduct a meta-analysis on the published pre-clinical studies of MSC administration in the treatment of COPD in animal models. A systematic search of electronic databases was performed. Statistical analysis was performed using the Comprehensive Meta-Analysis software (Version 3). The pooled Hedges's g with 95% confidence intervals (95% CIs) was adopted to assess the effect size. Random effect model was used due to the heterogeneity between the studies. A total of 20 eligible studies were included in the current systematic review. The overall meta-analysis showed that MSC administration was significantly in favor of attenuating acute lung injury (Hedges's g = -2.325 ± 0.145 with 95% CI: -2.609 ~ -2.040, P COPD is through ameliorating airway inflammation (Hedges's g = -2.956 ± 0.371 with 95% CI: -3.683 ~ -2.229, Preview and meta-analysis suggest a promising role for MSCs in COPD treatment. Although the COPD models may not truly mimic COPD patients, these pre-clinical studies demonstrate that MSC hold promise in the treatment of chronic lung diseases including COPD. The mechanisms of MSCs role in preclinical COPD treatment may be associated with attenuating airway inflammation as well as stimulating lung tissue repair.

  18. The evaluation of β-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study

    Directory of Open Access Journals (Sweden)

    Liao KM

    2017-08-01

    Full Text Available Kuang-Ming Liao,1,* Tien-Yu Lin,2,3 Yaw-Bin Huang,2,3 Chen-Chun Kuo,2,* Chung-Yu Chen2,3 1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 2School of Pharmacy, Kaohsiung Medical University, 3Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China *These authors contributed equally to this work Objective: β-Blockers are safe and improve survival in patients with both congestive heart failure (CHF and COPD. However, the superiority of different types of β-blockers is still unclear among patients with CHF and COPD. The association between β-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different β-blockers in patients with concurrent CHF and COPD. Patients and methods: We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were >20 years old and were diagnosed with CHF between January 1, 2005 and December 31, 2012. COPD patients included those who had outpatient visit claims ≥2 times within 365 days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of β-blockers in the study population. Results: We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR] =0.51, 95% confidence interval [CI] =0.29–0.89; hospitalization rate due to CHF exacerbation: aHR =0.48, 95% CI =0.23–1.00. No association was observed between β-blocker use and COPD exacerbation. Conclusion: In patients with concurrent CHF and COPD, β-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was

  19. Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Stellefson, Michael L; Shuster, Jonathan J; Chaney, Beth H; Paige, Samantha R; Alber, Julia M; Chaney, J Don; Sriram, P S

    2017-09-05

    Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients' eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation's National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = -0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients

  20. Peripheral Artery Disease and Its Clinical Relevance in Patients with Chronic Obstructive Pulmonary Disease in the COPD and Systemic Consequences-Comorbidities Network Study.

    Science.gov (United States)

    Houben-Wilke, Sarah; Jörres, Rudolf A; Bals, Robert; Franssen, Frits M E; Gläser, Sven; Holle, Rolf; Karch, Annika; Koch, Armin; Magnussen, Helgo; Obst, Anne; Schulz, Holger; Spruit, Martijn A; Wacker, Margarethe E; Welte, Tobias; Wouters, Emiel F M; Vogelmeier, Claus; Watz, Henrik

    2017-01-15

    Knowledge about the prevalence of objectively assessed peripheral artery disease (PAD) and its clinical relevance in patients with chronic obstructive pulmonary disease (COPD) is scarce. We aimed to: (1) assess the prevalence of PAD in COPD compared with distinct control groups; and (2) study the association between PAD and functional capacity as well as health status. The ankle-brachial index was used to diagnose PAD (ankle-brachial index ≤ 0.9). The 6-minute-walk distance, health status (St. George's Respiratory Questionnaire), COPD Assessment Test, and EuroQol-5-Dimensions were assessed in patients enrolled in the German COPD and Systemic Consequences-Comorbidities Network cohort study. Control groups were derived from the Study of Health in Pomerania. A total of 2,088 patients with COPD (61.1% male; mean [SD] age, 65.3 [8.2] years, GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV: 9.4, 42.5, 37.5, and 10.5%, respectively) were included, of which 184 patients (8.8%; GOLD stage I-IV: 5.1, 7.4, 11.1, and 9.5%, respectively, vs. 5.9% in patients with GOLD stage 0 in the COPD and Systemic Consequences-Comorbidities Network) had PAD. In the Study of Health in Pomerania, PAD ranged from 1.8 to 4.2%. Patients with COPD with PAD had a significantly shorter 6-minute-walk distance (356 [108] vs. 422 [103] m, P COPD Assessment Test: 19.6 [7.4] vs. 17.9 [7.4] points, P = 0.004; EuroQol-5-Dimensions visual analog scale: 51.2 [19.0] vs. 57.2 [19.6], P COPD, 8.8% were diagnosed with PAD, which is higher than the prevalence in control subjects without COPD. PAD was associated with a clinically relevant reduction in functional capacity and health status.

  1. Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Mewes, Ricarda; Rief, Winfried; Kenn, Klaus; Ried, Jens; Stenzel, Nikola

    2016-01-01

    Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal's common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status. Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the 'KKG questionnaire for the assessment of control beliefs about illness and health'. Multiple linear regressions were calculated. The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life. Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.

  2. Understanding COPD-overlap syndromes.

    Science.gov (United States)

    Poh, Tuang Yeow; Mac Aogáin, Micheál; Chan, Adrian Kwok Wai; Yii, Anthony Chau Ang; Yong, Valerie Fei Lee; Tiew, Pei Yee; Koh, Mariko Siyue; Chotirmall, Sanjay Haresh

    2017-04-01

    Chronic obstructive pulmonary disease accounts for a large burden of lung disease. It can 'overlap' with other respiratory diseases including bronchiectasis, fibrosis and obstructive sleep apnea (OSA). While COPD alone confers morbidity and mortality, common features with contrasting clinical outcomes can occur in COPD 'overlap syndromes'. Areas covered: Given the large degree of heterogeneity in COPD, individual variation to treatment is adopted based on its observed phenotype, which in turn overlaps with features of other respiratory disease states such as asthma. This is coined asthma-COPD overlap syndrome ('ACOS'). Other examples of such overlapping clinical states include bronchiectasis-COPD ('BCOS'), fibrosis-COPD ('FCOS') and OSA-COPD ('OCOS'). The objective of this review is to highlight similarities and differences between the COPD-overlap syndromes in terms of risk factors, pathophysiology, diagnosis and potential treatment differences. Expert commentary: As a consequence of COPD overlap syndromes, a transition from the traditional 'one size fits all' treatment approach is necessary. Greater treatment stratification according to clinical phenotype using a precision medicine approach is now required. In this light, it is important to recognize and differentiate COPD overlap syndromes as distinct disease states compared to individual diseases such as asthma, COPD, fibrosis or bronchiectasis.

  3. The coexistence of asthma and chronic obstructive pulmonary disease (COPD: prevalence and risk factors in young, middle-aged and elderly people from the general population.

    Directory of Open Access Journals (Sweden)

    Roberto de Marco

    Full Text Available BACKGROUND: The joint distribution of asthma and chronic obstructive pulmonary disease (COPD has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. METHODS: A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20-44 (n = 5163 45-64 (n = 2167 and 65-84 (n = 1030 in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD study. RESULTS: A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD was reported by 13% and 21% of subjects aged <65 and 65-84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6% and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%. The prevalence of the overlap of asthma and COPD was 1.6% (1.3%-2.0%, 2.1% (1.5%-2.8% and 4.5% (3.2%-5.9% in the 20-44, 45-64 and 65-84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01. Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. CONCLUSION: Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.

  4. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population.

    Science.gov (United States)

    de Marco, Roberto; Pesce, Giancarlo; Marcon, Alessandro; Accordini, Simone; Antonicelli, Leonardo; Bugiani, Massimiliano; Casali, Lucio; Ferrari, Marcello; Nicolini, Gabriele; Panico, Maria Grazia; Pirina, Pietro; Zanolin, Maria Elisabetta; Cerveri, Isa; Verlato, Giuseppe

    2013-01-01

    The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20-44 (n = 5163) 45-64 (n = 2167) and 65-84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%-2.0%), 2.1% (1.5%-2.8%) and 4.5% (3.2%-5.9%) in the 20-44, 45-64 and 65-84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (pCOPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.

  5. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer.

    Science.gov (United States)

    Herr, Christian; Greulich, Timm; Koczulla, Rembert A; Meyer, Silke; Zakharkina, Tetyana; Branscheidt, Meret; Eschmann, Rebecca; Bals, Robert

    2011-03-18

    The role of vitamin D (VitD) in calcium and bone homeostasis is well described. In the last years, it has been recognized that in addition to this classical function, VitD modulates a variety of processes and regulatory systems including host defense, inflammation, immunity, and repair. VitD deficiency appears to be frequent in industrialized countries. Especially patients with lung diseases have often low VitD serum levels. Epidemiological data indicate that low levels of serum VitD is associated with impaired pulmonary function, increased incidence of inflammatory, infectious or neoplastic diseases. Several lung diseases, all inflammatory in nature, may be related to activities of VitD including asthma, COPD and cancer. The exact mechanisms underlying these data are unknown, however, VitD appears to impact on the function of inflammatory and structural cells, including dendritic cells, lymphocytes, monocytes, and epithelial cells. This review summarizes the knowledge on the classical and newly discovered functions of VitD, the molecular and cellular mechanism of action and the available data on the relationship between lung disease and VitD status.

  6. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer

    Directory of Open Access Journals (Sweden)

    Zakharkina Tetyana

    2011-03-01

    Full Text Available Abstract The role of vitamin D (VitD in calcium and bone homeostasis is well described. In the last years, it has been recognized that in addition to this classical function, VitD modulates a variety of processes and regulatory systems including host defense, inflammation, immunity, and repair. VitD deficiency appears to be frequent in industrialized countries. Especially patients with lung diseases have often low VitD serum levels. Epidemiological data indicate that low levels of serum VitD is associated with impaired pulmonary function, increased incidence of inflammatory, infectious or neoplastic diseases. Several lung diseases, all inflammatory in nature, may be related to activities of VitD including asthma, COPD and cancer. The exact mechanisms underlying these data are unknown, however, VitD appears to impact on the function of inflammatory and structural cells, including dendritic cells, lymphocytes, monocytes, and epithelial cells. This review summarizes the knowledge on the classical and newly discovered functions of VitD, the molecular and cellular mechanism of action and the available data on the relationship between lung disease and VitD status.

  7. Experimental rhinovirus infection in COPD: implications for antiviral therapies.

    Science.gov (United States)

    Gunawardana, Natasha; Finney, Lydia; Johnston, Sebastian L; Mallia, Patrick

    2014-02-01

    Chronic obstructive pulmonary disease (COPD) is a major public health problem and will be one of the leading global causes of mortality over the coming decades. Much of the morbidity, mortality and health care costs of COPD are attributable to acute exacerbations, the commonest causes of which are respiratory infections. Respiratory viruses are frequently detected in COPD exacerbations but direct proof of a causative relationship has been lacking. We have developed a model of COPD exacerbation using experimental rhinovirus infection in COPD patients and this has established a causative relationship between virus infection and exacerbations. In addition it has determined some of the molecular mechanisms linking virus infections to COPD exacerbations and identified potential new therapeutic targets. This new data should stimulate research into the role of antiviral agents as potential treatments for COPD exacerbations. Testing of antiviral agents has been hampered by the lack of a small animal model for rhinovirus infection and experimental rhinovirus infection in healthy volunteers has been used to test treatments for the common cold. Experimental rhinovirus infection in COPD subjects offers the prospect of a model that can be used to evaluate the effects of new treatments for virus-induced COPD exacerbations, and provide essential data that can be used in making decisions regarding large scale clinical trials. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Whole-body vibration improves functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease (COPD): a pilot study.

    Science.gov (United States)

    Braz Júnior, Donato S; Dornelas de Andrade, Arméle; Teixeira, Andrei S; Cavalcanti, Cléssyo A; Morais, André B; Marinho, Patrícia Em

    2015-01-01

    Exercise intolerance is a common development in patients with chronic obstructive pulmonary disease (COPD). There is little data on the use of an isolated program using vibration platform training on functional capacity in these patients, which is an area that deserves investigation. To investigate the effect of training on a vibrating platform (whole-body vibration [WBV]) on functional performance and quality of life of subjects with COPD. A randomized controlled crossover pilot study with eleven subjects with COPD (forced expiratory volume in 1 second [FEV1]% predicted =14.63±11.14; forced vital capacity [FVC]% predicted =48.84±15.21; FEV1/FVC =47.39±11.63) underwent a 12-week WBV training program. Participants were randomized into the intervention group (IG) undergoing three sessions per week for a total of 12 weeks and control group (CG) without intervention. We evaluated the 6-minute walk test (6MWT), distance walked (DW), duration of the walk (TW), and index of perceived exertion (IPE), quality of life using St George's Respiratory Questionnaire (SGRQ) and developed a 12-week program of training on a vibrating platform. The mean age was 62.91±8.82 years old (72.7% male). The DW increased at the end of training with a difference between groups of 75 m; all domains of the SGRQ improved at the end of training. The effect size Cohen's d ranged from small to large for all the measured results. These preliminary results suggest that WBV may potentially be a safe and feasible way to improve functional capacity in the 6MWT of patients with COPD undergoing a training program on the vibrating platform as well as in all domains of the SGRQ quality of life. However, further studies with a larger number of patients are needed to establish the long-term effect on functional capacity and quality of life in these patients.

  9. OCCUPATIONAL EXPOSURE AND COPD

    DEFF Research Database (Denmark)

    Würtz, Else Toft

    Chronic Obstructive Pulmonary Disease (COPD) is a common disease. The main risk factor is smoking although 15% of the COPD cases are expected to be preventable if the occupational exposures from vapour, gas, dust, and fume were eliminated; the population attributable fraction (PAF). The thesis...... addresses the association between occupational exposure and COPD in a population-based cohort of Danes aged 45-84-years. 4717 participants were included at baseline and 2624 at the four year follow-up. COPD was defined by spirometry and the occupational exposure was based on specialist defined jobs...... and questionnaires. The main occupational exposure was organic dust and 49% reported no lifetime occupational exposure. The results suggest occupational exposures to be associated to COPD also in never smokers and women. We found an exposure-response relation in the cross sectional analyses. The results...

  10. A comparison of cognitive functions in non-hypoxemic chronic obstructive pulmonary disease (COPD) patients and age-matched healthy volunteers using mini-mental state examination questionnaire and event-related potential, P300 analysis.

    Science.gov (United States)

    Gupta, Prem Parkash; Sood, Sushma; Atreja, Atulya; Agarwal, Dipti

    2013-01-01

    To assess sub-clinical cognitive dysfunctions in stable chronic obstructive pulmonary disease (COPD) patients having no hypoxemia vs. age-matched healthy volunteers using (i) an electrophysiological test: Auditory event related potential, P300 test and (ii) a questionnaire tool: Mini-mental state examination (MMSE) questionnaire. EIGHTY MALE SUBJECTS WERE INCLUDED: 40 stable COPD patients (smoking history >20 pack years) and 40 healthy volunteers (HVs). Age, duration of illness, smoking pack years, and spirometric indices were assessed. MMSE scores were evaluated in these groups. Latency of P300 wave and amplitude of P300 wave were studied in both groups to detect P300 abnormalities in COPD group. Correlations of P300 abnormalities with patient characteristic parameters and MMSE scores were assessed. In addition, individual COPD patients having significant cognitive dysfunctions beyond cut-off value of 99(th) percentile of HVs were analyzed. We observed significantly prolonged P300 latency (P P300 amplitude (P P300 latency, and 27/40 COPD patients had reduced MMSE scores beyond 99(th) percentile of HV. However, we did not observe any statistically significant correlation between P300 abnormalities and patients' characteristics or MMSE scores (P > 0.05 for all). Our study explores cognitive dysfunctions in stable COPD patients with no hypoxemia. This study highlights the relative importance of using MMSE and P300. Cognitive dysfunctions were detected both by MMSE and P300; however, MMSE abnormalities were more frequent compared to P300 abnormalities (27/40 vs. 10/40) in COPD patients.

  11. Direct and indirect economic and health consequences of COPD in Denmark

    DEFF Research Database (Denmark)

    Løkke, Anders; Hilberg, Ole; Tønnesen, Philip

    2014-01-01

    national databases. PARTICIPANTS: 131 811 patients with COPD were identified and compared with 131 811 randomly selected controls matched for age, gender, educational level, residence and marital status. PRIMARY AND SECONDARY OUTCOME MEASURES: Direct and indirect economic and health consequences of COPD......OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is among the leading causes of morbidity and mortality worldwide, but longitudinal studies of the economic consequences of COPD are scarce. This Danish study evaluated for the first time ever the economic consequences of COPD of an entire...... and higher socioeconomic costs. The employment and the income rates of employed patients with COPD were significantly lower compared with controls. The annual net costs, including social transfers were €8572 for patients with COPD. These consequences were present up to 11 years before first-time diagnosis...

  12. COPD in Taiwan: a National Epidemiology Survey

    Directory of Open Access Journals (Sweden)

    Cheng SL

    2015-11-01

    of COPD and smoked were designated as “possible COPD”. Participants who did not fit the case definition of COPD were asked only about their personal circumstances and smoking habits. Data from these groups were analyzed and compared.Results: Of the 6,600 participants who completed the survey, 404 (6.1% fulfilled the epidemiological case definition of COPD: 137 with diagnosed COPD and 267 possible COPD. The most common comorbidities of COPD were hypertension or cardiovascular diseases (36.1%. Subjects with definite COPD had significantly higher COPD Assessment Test scores than the possible COPD group (14.6±8.32 vs 12.6±6.49, P=0.01 and significantly more comorbid illnesses (P=0.01. The main risk factors contributing to health care utilization in each COPD cohort were higher COPD Assessment Test scores (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.04–1.26, higher modified Medical Research Council Breathlessness Scale scores (OR 1.97, 95% CI 1.11–3.51, and having more than one comorbidity (OR 5.19, 95% CI 1.05–25.61.Conclusion: With estimated prevalence of 6.1% in the general population, COPD in Taiwan has been underdiagnosed. Symptoms and comorbidities were independent risk factors for health care utilization in subjects with definite or possible COPD. There is an urgent need to raise awareness of the importance of early evaluation and prompt treatment for subjects with chronic airway symptoms. Keywords: Asia, COPD, epidemiology, health care utilization, risk factors

  13. Evaluating the Effectiveness of Written Dry Powder Inhaler Instructions and Health Literacy in Subjects Diagnosed With COPD.

    Science.gov (United States)

    Alsomali, Hana J; Vines, David L; Stein, Brian D; Becker, Ellen A

    2017-02-01

    Improper inhaler use results in decreased drug deposition in the lungs. The impact of health literacy and poor vision on the patient's ability to learn inhaler technique by reading instructions has not been confirmed. This study evaluated the effectiveness of learning inhaler technique from written instructions and the impact of health literacy for patients diagnosed with COPD who used a dry powder inhaler (DPI). This pilot study recruited subjects diagnosed with COPD. A trained assessor scored subjects' inhaler technique before and after reading the appropriate American College of Chest Physicians handouts. Peak inspiratory flows (PIFs) were measured using an InCheck Dial. Health literacy was measured by the S-TOFHLA (Short Test of Functional Health Literacy in Adults), and visual acuity was measured by a Snellen chart. Associations between health literacy and visual acuity and changes in subjects' inhaler technique scores were assessed by Spearman's rho. Inhaler technique change scores were assessed by the Wilcoxon signed-rank test at P = .05. Of the 24 participants enrolled, 63% were female, mean age was 65.6 y, and 83% were Global Initiative for Chronic Obstructive Lung Disease air-flow limitation 2 or 3. Wilcoxon scores were significant for improved total scores for both the Diskus and HandiHaler, with medians improving from 6.5 to 7.0 (interquartile range 6.0-7.8) (P = .047) and from 6.0 to 7.5 (interquartile range 7.0-9.0) (P = .002), respectively. The minimum required PIF was achieved by 93.8% of the Diskus and 94.4% of the HandiHaler groups. There were no associations detected between the handout intervention (Diskus and HandiHaler) and health literacy level and vision. The educational handouts for DPIs helped participants already using a DPI to improve their inhaler technique. Stable participants diagnosed with COPD are able to generate appropriate PIFs to properly use DPIs. Neither vision nor health literacy was associated with the inability to learn

  14. Evidence for aerobic exercise training on the autonomic function in patients with chronic obstructive pulmonary disease (COPD): a systematic review.

    Science.gov (United States)

    Mohammed, Jibril; Derom, Eric; Van Oosterwijck, Jessica; Da Silva, Hellen; Calders, Patrick

    2017-07-22

    To assess evidence for the effectiveness of aerobic exercise training (AET) on the autonomic function (AF) outcomes in patients with chronic obstructive pulmonary disease (COPD). Online databases of PubMed, CINAHL and Web of Science were systematically searched for all years till 26th of January, 2017. Clinical studies assessing any measure of AF following exercise training in patients with COPD were included. Data were extracted from studies with high methodological quality for evidence synthesis. Rating of evidence quality was determined using the GRADE guidelines. The Majority of the included studies utilized continuous exercise training mode with a vigorous level of intensity. Each exercise training session lasted between 30 to 40minutes, and the frequency of intervention was ≥3 times/week. Evidence synthesis of studies with high methodological quality revealed that a high quality evidence level supported a significant increase for time-domain heart rate variability (HRV) analyses and the heart rate recovery (HRR) following AET. The review also found that frequency domain HRV analyses were not significantly affected by AET. The evidence to support the effect of exercise training on baroreceptor sensitivity (BRS) in patients with COPD is very low. Aerobic exercise training demonstrated beneficial but limited effects on the AF in COPD. Presently, it is not clear whether these effects are sustained in the long term. Only a limited number of RCTs were available indicating a significant gap in the literature. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  15. Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2008-08-01

    Full Text Available Abstract Background The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD is well established, but it is unknown whether disease-specific health status measures and multidimensional assessment (MDA have comparable prognostic value. Methods We analyzed data coming from the Salute Respiratoria nell'Anziano (Respiratory Health in the Elderly – SaRA study, enrolling elderly people attending outpatient clinics for respiratory and non-respiratory problems. From this population we selected 449 patients with bronchial obstruction (77.3% men, mean age 73.1. We classified patients' health status using tertiles of the Saint George Respiratory Questionnaire (SGRQ and a MDA including functional (the 6' walking test, WT, cognitive (Mini-Mental State Examination, MMSE and affective status (Geriatric Depression Scale, GDS. The agreement of the classification methods was calculated using the kappa statistic, and survival associated with group membership was evaluated using survival analysis. Results Pulmonary function, expressed by the FEV1, worsened with increasing SGRQ or MDA scores. Cognitive function was not associated with the SGRQ, while physical performance and mood status were impaired only in the highest tertile of SGRQ. A poor agreement was found between the two classification systems tested (k = 0.194. Compared to people in the first tertile of SGRQ score, those in the second tertile had a sex-adjusted HR of 1.22 (0.75 – 1.98 and those in the third tertile of 2.90 (1.92 – 4.40. The corresponding figures of the MDA were 1.49 (95% CI 1.02 – 2.18 and 2.01 (95% CI: 1.31 – 3.08. After adjustment for severity of obstruction, only a SGRQ in the upper tertile was associated with mortality (HR: 1.86; 95% CI: 1.14 – 3.02. Conclusion In elderly outpatients with mild-moderate COPD, a disease-specific health status index seems to be a better predictor of death compared to a MDA.

  16. Severe obstructive disease: Similarities and differences between smoker and non-smoker patients with COPD and/or bronchiectasis

    Directory of Open Access Journals (Sweden)

    J. Rezende Gonçalves

    2013-01-01

    Full Text Available Introduction: Poorly reversible airflow obstruction may or may not be related to smoking. Objectives: To describe patients with severe obstructive lung disease including etiology, imaging, functional aspects, systemic manifestations, and the pattern of bronchodilator response. Methods: Sixty-eight patients (age 55.9 ± 13.7 years, FEV1 [forced expiratory volume in one second] 31.9 ± 10.2% predicted underwent spirometry, evaluation of body mass composition, 6-minute walk test, X-ray, thorax high-resolution CT scanning, and clinical evaluation. Results: Of 68 patients enrolled, 37 had chronic obstructive pulmonary disease (COPD and 31, extensive bronchiectasis. Among COPD patients the CT scans showed emphysema in 78.4%, and bronchiectasis in 48.6%. There were no significant differences between smokers and non-smokers, except for vital capacity, significantly smaller in non-smokers (p  1 = flow responder or 1= respondedor de fluxo, se > 1 respondedor de volume, e 20 RV pelos criterios da ATS/ERS. De acordo com os critérios de Paré et al., existiam 18 pacientes com FEV1< 30% previsto entre os 29 RV, e 12 com FEV1 < 30% previsto entre os 39 sem resposta a uma prova de volume (p = 0,0101. Conclusões: Em pacientes com obstrução grave, o tabagismo não parece ser relevante na determinação de diferenças funcionais ou sistémicas, e os critérios de Paré et al. podem detetar mais RV. A bronquietasia é uma descoberta comum em DPOC grave. Keywords: Airway obstruction, Respiratory function tests, Bronchitis, Bronchiectasis, Bronchodilator tests, Computed tomography of the thorax, Palavras-chave: Obstrução das Vias Respiratórias, Testes de Função Respiratória, Bronquite, Bronquiectasia, Testes de Broncodilatador, Tomografia de tórax

  17. Severe obstructive disease: Similarities and differences between smoker and non-smoker patients with COPD and/or bronchiectasis

    Directory of Open Access Journals (Sweden)

    J. Rezende Gonçalves

    2013-01-01

    Full Text Available Introduction: Poorly reversible airflow obstruction may or may not be related to smoking. Objectives: To describe patients with severe obstructive lung disease including etiology, imaging, functional aspects, systemic manifestations, and the pattern of bronchodilator response. Methods: Sixty-eight patients (age 55.9 ± 13.7 years, FEV1 [forced expiratory volume in one second] 31.9 ± 10.2% predicted underwent spirometry, evaluation of body mass composition, 6-minute walk test, X-ray, thorax high-resolution CT scanning, and clinical evaluation. Results: Of 68 patients enrolled, 37 had chronic obstructive pulmonary disease (COPD and 31, extensive bronchiectasis. Among COPD patients the CT scans showed emphysema in 78.4%, and bronchiectasis in 48.6%. There were no significant differences between smokers and non-smokers, except for vital capacity, significantly smaller in non-smokers (p  1 = flow responder or 1= respondedor de fluxo, se > 1 respondedor de volume, e 20 RV pelos criterios da ATS/ERS. De acordo com os critérios de Paré et al., existiam 18 pacientes com FEV1< 30% previsto entre os 29 RV, e 12 com FEV1 < 30% previsto entre os 39 sem resposta a uma prova de volume (p = 0,0101. Conclusões: Em pacientes com obstrução grave, o tabagismo não parece ser relevante na determinação de diferenças funcionais ou sistémicas, e os critérios de Paré et al. podem detetar mais RV. A bronquiectasias é uma descoberta comum em DPOC grave. Keywords: Airway obstruction, Respiratory function tests, Bronchitis, Bronchiectasis, Bronchodilator tests, Computed tomography of the thorax, Palavras-chave: Obstrução das Vias Respiratórias, Testes de Função Respiratória, Bronquite, Bronquiectasias, Testes de Broncodilatador, Tomografia de tórax

  18. Asthma and chronic obstructive pulmonary disease (COPD) prevalence and health services use in Ontario Métis: a population-based cohort study.

    Science.gov (United States)

    Gershon, Andrea S; Khan, Saba; Klein-Geltink, Julie; Wilton, Drew; To, Teresa; Crighton, Eric J; Pigeau, Lisa; Macquarrie, Jo; Allard, Yvon; Russell, Storm J; Henry, David A

    2014-01-01

    Chronic respiratory diseases cause a significant health and economic burden around the world. In Canada, Aboriginal populations are at increased risk of asthma and chronic obstructive pulmonary disease (COPD). There is little known, however, about these diseases in the Canadian Métis population, who have mixed Aboriginal and European ancestry. A population-based study was conducted to quantify asthma and COPD prevalence and health services use in the Métis population of Ontario, Canada's largest province. The Métis Nation of Ontario Citizenship Registry was linked to provincial health administrative databases to measure and compare burden of asthma and COPD between the Métis and non-Métis populations of Ontario between 2009 and 2012. Asthma and COPD prevalence, health services use (general physician and specialist visits, emergency department visits, hospitalizations), and mortality were measured. Prevalences of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general Ontario population (pCOPD were significantly higher. Emergency department visits and hospitalizations were generally higher for Métis compared to non-Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD (p = 0.01). There is a high burden of asthma and COPD in Ontario Métis, with significant prevalence and acute health services use related to these diseases. Lower rates of physician visits suggest barriers in access to primary care services.

  19. Asthma and chronic obstructive pulmonary disease (COPD prevalence and health services use in Ontario Métis: a population-based cohort study.

    Directory of Open Access Journals (Sweden)

    Andrea S Gershon

    Full Text Available INTRODUCTION: Chronic respiratory diseases cause a significant health and economic burden around the world. In Canada, Aboriginal populations are at increased risk of asthma and chronic obstructive pulmonary disease (COPD. There is little known, however, about these diseases in the Canadian Métis population, who have mixed Aboriginal and European ancestry. A population-based study was conducted to quantify asthma and COPD prevalence and health services use in the Métis population of Ontario, Canada's largest province. METHODS: The Métis Nation of Ontario Citizenship Registry was linked to provincial health administrative databases to measure and compare burden of asthma and COPD between the Métis and non-Métis populations of Ontario between 2009 and 2012. Asthma and COPD prevalence, health services use (general physician and specialist visits, emergency department visits, hospitalizations, and mortality were measured. RESULTS: Prevalences of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general Ontario population (p<0.001. General physician and specialist visits were significantly lower in Métis with asthma, while general physician visits for COPD were significantly higher. Emergency department visits and hospitalizations were generally higher for Métis compared to non-Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD (p = 0.01. CONCLUSION: There is a high burden of asthma and COPD in Ontario Métis, with significant prevalence and acute health services use related to these diseases. Lower rates of physician visits suggest barriers in access to primary care services.

  20. Evaluation of arterial blood flow changes by orbital Doppler in chronic obstructive pulmonary disease and asthma.

    Science.gov (United States)

    Yakut, Zeynep Ilerisoy; Karadağ, Remzi; Ozol, Duygu; Senturk, Aysegul

    2015-01-01

    Both chronic obstructive pulmonary disease (COPD) and asthma are important causes of morbidity and mortality worldwide. They primarily affect the lungs, but they have various extrapulmonary manifestations. The aim of our study was to evaluate the hemodynamic changes in orbital vessels of the patients with COPD and asthma using color Doppler ultrasonography and compare the results with healthy control subjects. Thirty-seven patients with COPD, 37 patients with asthma, and 41 healthy control subjects were included in this study. All patients with COPD were in moderate to severe group according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), and similarly, all patients with asthma were in moderate to severe persistent group according to GINA (Global Initiative for Asthma) 2006 guidelines. End-tidal carbon dioxide, peripheral oxygen saturation, pulse rate, and respiratory rate were measured by using pulse oximeter in all patients. Measurements were performed in only 1 randomly selected eye of each participant. The peak systolic velocity, end diastolic velocity, and resistance index were measured in the central retinal artery, temporal posterior ciliary artery, and nasal posterior ciliary artery using the color Doppler ultrasonography technique. The peak systolic velocity, end diastolic velocity, and resistance index values of temporal posterior ciliary artery and nasal posterior ciliary artery were significantly higher in COPD and asthma than in the control subjects. There was no difference between asthma and COPD. We concluded that retrobulbar hemodynamics change in COPD and asthma is showing 1 of the systemic effects in these diseases.

  1. Anti-cyclic citrullinated peptide (CCP) antibody in patients with wood-smoke-induced chronic obstructive pulmonary disease (COPD) without rheumatoid arthritis.

    Science.gov (United States)

    Sigari, Naseh; Moghimi, Nasrin; Shahraki, Farhad Saber; Mohammadi, Shilan; Roshani, Daem

    2015-01-01

    Citrullination, a post-translational modification of proteins, is increased in inflammatory processes and is known to occur in smokers. It can induce anti-cyclic citrullinated peptide (CCP) antibodies, the most specific serologic marker for rheumatoid arthritis. Thus far, the incidence of autoimmunity in patients with wood-smoke-induced chronic obstructive pulmonary disease (COPD) resulting in anti-CCP production has not been examined. We hypothesise that anti-CCP antibody level in these patients should be higher than that in healthy subjects. A total of 112 non-rheumatoid arthritis patients, including 56 patients with wood-smoke-induced COPD and 56 patients with tobacco-induced COPD, and 56 healthy non-smoker controls were included. The serum anti-CCP antibody levels were measured and compared between the groups and against smoke exposure and clinical characteristics. The mean anti-CCP antibody levels in wood-smoke-induced COPD group were significantly higher than those in tobacco-induced COPD group (p = 0.03) and controls (p = 0.004). Furthermore, 8 (14.2 %) patients with wood-smoke-induced COPD, 4 (7.14 %) with tobacco-induced COPD and 2 (3.57 %) controls exceeded the conventional cut-off of anti-CCP antibody positivity. No relationship was found between the anti-CCP antibody level and age, gender, duration of disease, Pack-years of smoking, and duration of exposure to wood smoke. Moreover, correlations between anti-CCP antibodies and severity of airflow limitation, CAT scores, mMRC scores of dyspnoea, and GOLD staging of COPD severity were not significant. Wood-smoke-induced COPD could significantly increase the anti-CCP antibody level in non-rheumatoid arthritis patients when compared with that in patients with tobacco-induced COPD and healthy controls.

  2. Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Ni, Han; Htet, Aung; Moe, Soe

    2017-06-20

    People with chronic obstructive pulmonary disease (COPD) have poor quality of life, reduced survival, and accelerated decline in lung function, especially associated with acute exacerbations, leading to high healthcare costs. Long-acting bronchodilators are the mainstay of treatment for symptomatic improvement, and umeclidinium is one of the new long-acting muscarinic antagonists approved for treatment of patients with stable COPD. To assess the efficacy and safety of umeclidinium bromide versus placebo for people with stable COPD. We searched the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov, the World Health Organization (WHO) trials portal, and the GlaxoSmithKline (GSK) Clinical Study Register, using prespecified terms, as well as the reference lists of all identified studies. Searches are current to April 2017. We included randomised controlled trials (RCTs) of parallel design comparing umeclidinium bromide versus placebo in people with COPD, for at least 12 weeks. We used standard Cochrane methodological procedures. If we noted significant heterogeneity in the meta-analyses, we subgrouped studies by umeclidinium dose. We included four studies of 12 to 52 weeks' duration, involving 3798 participants with COPD. Mean age of participants ranged from 60.1 to 64.6 years; most were males with baseline mean smoking pack-years of 39.2 to 52.3. They had moderate to severe COPD and baseline mean post-bronchodilator forced expiratory volume in one second (FEV 1 ) ranging from 44.5% to 55.1% of predicted normal. As all studies were systematically conducted according to prespecified protocols, we assessed risk of selection, performance, detection, attrition, and reporting biases as low.Compared with those given placebo, participants in the umeclidinium group had a lesser likelihood of developing moderate exacerbations requiring a short course of steroids, antibiotics, or both (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.46 to 0.80; four

  3. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit

    DEFF Research Database (Denmark)

    Jiménez-Ruiz, Carlos A; Andreas, Stefan; Lewis, Keir E

    2015-01-01

    review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco......Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite...

  4. Dynamics of body composition in male patients during chronic obstructive pulmonary disease (COPD) development.

    Science.gov (United States)

    Makarevich, Aliaksandr Eduard; Lemiasheuskaya, Sviatlana

    2015-01-01

    The various distribution of fat mass (FM) and lean mass (LM) during COPD development is not yet researched. 82 male patients (40-67 years) with acute exacerbation of COPD and 19 comparable healthy males (the control group) were examined by dual-energy X-ray absorptiometry. The patients were divided into 3 groups according to COPD severity: 1st - 19 (GOLD I stage); 2nd - 43 (GOLD II) and 3rd - 20 (GOLD III). The patients of 3rd group had lower indices of FM, LM, bone mineral component (BMC) vs. the control and 1st, 2nd groups. A significant increase in FM share was noted in android and gynoid regions, trunk, legs and arms in 2nd groups vs. the control with the decline of these parameters in the 3rd group below the control level. A greater proportion of FM in 1st and 2nd groups was distributed in android and trunk regions vs. the control. TNF-a and leptin levels were significantly increased by 12%, 15% 17% and by 18%, 75%, 79% respectively in 1st, 2nd, 3rd groups vs. the control, while free testosterone level was lower in these groups vs. the control (by 28%, 30% and 47% respectively; p COPD patients in spite of LM, FM and BMC changes. The level of LM and BMC was decreased during COPD progression, while FM was increased in mild-moderate COPD and then it was decreased in severe COPD.

  5. Natural history of COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Lange, Peter

    2016-01-01

    The natural history of chronic obstructive pulmonary disease (COPD) is usually described with a focus on change in forced expiratory volume in 1 s (FEV1 ) over time as this allows for exploration of risk factors for an accelerated decline-and thus of developing COPD. From epidemiological studies we...... are gradually beginning to better link early life events to subsequent risk of disease in adulthood. Although more complicated, our current understanding of COPD has come a long way from being a simple image of smoking leading to poor lungs....

  6. Evaluation of the relationship between WBC, HS.CRP and secondary pulmonary hypertension in patients with COPD

    OpenAIRE

    Khalil Ansarin; Farid Rashidi; Mohammad Reza Ghaffari; Hossein Namdar; Akbar Sharifi

    2014-01-01

    Background: Inflammatory mechanisms appear to play a major role in pathogenesis of various types of pulmonary hypertension such as idiopatic PAH (iPAH). Although inflammatory factors such as IL6 and TNFa play an important role in IPAH, there is limited information about the relationship between acute phase reactants and pulmonary hypertension occurring secondary to pulmonary diseases such as chronic obstructive pulmonary diseases (COPD). Methods: This cross-sectional study was carried out ...

  7. Genetics of COPD

    Directory of Open Access Journals (Sweden)

    Hidetoshi Nakamura

    2011-01-01

    Full Text Available Previous family studies suggested that genetic variation contributes to COPD susceptibility. The only gene proven to influence COPD susceptibility is SERPINA1, encoding α1-antitrypsin. Most studies on COPD candidate genes except SERPINA1, have not been consistently replicated. However, longitudinal studies of decline in lung function, meta-analyses of candidate gene studies, and family-based linkage analyses suggested that variants in EPHX1, GST, MMP12, TGFB1, and SERPINE2 were associated with susceptibility to COPD. A genome-wide association (GWA study has recently demonstrated that CHRNA3/5 in 15q25 was associated with COPD compared with control smokers. It was of interest that the CHRNA3/5 locus was associated with nicotine dependence and lung cancer as well. The associations of HHIP on 4q31 and FAM13A on 4q22 with COPD were also suggested in GWA studies. Another GWA study has shown that BICD1 in 12p11 was associated with the presence or absence of emphysema. Although every genetic study on COPD has some limitations including heterogeneity in smoking behaviors and comorbidities, it has contributed to the progress in elucidating the pathogenesis of COPD. Future studies will make us understand the mechanisms underlying the polygenic disease, leading to the development of a specific treatment for each phenotype.

  8. Role of epithelial mesenchymal transition (EMT) in chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Sohal, Sukhwinder Singh; Walters, Eugene Haydn

    2013-11-06

    Small airway fibrosis is the main contributor to physiological airway dysfunction in COPD. One potential mechanism contributing to small airway fibrosis is epithelial mesenchymal transition (EMT). When associated with angiogenesis (so called EMT-Type-3) it may well also be the link with the development of cancer, which is closely associated with COPD and predominantly in large airways. In a recent study published in Respiratory Research, Qin Wang and colleagues investigated the role of urokinase plasminogen activator receptor (uPAR) in EMT in small airway epithelium of COPD patients. However, there are some issues with the paper which we wish to comment on.

  9. Associations between BODE index and systemic inflammatory biomarkers in COPD.

    Science.gov (United States)

    Gaki, Eleni; Kontogianni, Konstantina; Papaioannou, Andriana I; Bakakos, Petros; Gourgoulianis, Konstantinos I; Kostikas, Konstantinos; Alchanatis, Manos; Papiris, Spyridon; Loukides, Stelios

    2011-12-01

    COPD is a multicomponent disease and systemic inflammation represents one of the possible mechanisms responsible for its systemic manifestations, including skeletal muscle weakness and cachexia. Fat-free mass index (FFMI) that reflects the skeletal muscle mass, has been shown to be associated with both dyspnoea and exercise capacity. We hypothesized that the multidimensional BODE index, that reflects the multicomponent nature of COPD, might be related to biomarkers of systemic inflammation. We further evaluated associations between FFMI and systemic inflammation. BODE index and FFMI were calculated in 222 stable COPD patients and 132 smokers or ex-smokers with normal lung function. Systemic inflammation was evaluated with the measurement of leptin, adiponectin, CRP, IL-6, and TNF-α in serum samples of COPD patients. In patients with COPD, both BODE index and FFMI presented significant positive and negative associations respectively with leptin levels (R(2) 0.61 and 0.65, respectively), whereas FFMI presented an additional negative association with the levels of TNF-α (R(2) 0.38). No significant associations were observed in smokers or ex-smokers with normal lung function. Both BODE index and FFMI, are related to the circulating levels of leptin in patients with COPD, suggesting a possible role for leptin in the systemic component of COPD. The additional association of FFMI with TNF-α may further support a role of systemic inflammation in muscle wasting in COPD.

  10. Danish version of 'The COPD self-efficacy scale'

    DEFF Research Database (Denmark)

    Emme, Christina; Mortensen, Erik L; Rydahl-Hansen, Susan

    2012-01-01

    Scand J Caring Sci; 2012; 26; 615-623 Danish version of 'The COPD self-efficacy scale': translation and psychometric properties The aim of the study was to translate 'The COPD self-efficacy scale' (CSES) into Danish and to evaluate the psychometric properties of the Danish version (CSES-DK). CSES...... enables assessment of self-efficacy in individuals with chronic obstructive pulmonary disease (COPD). The scale consists of 34 items, describing situations which may cause dyspnoea in patients with COPD. The CSES was translated into Danish using a standard forward-backward translation procedure...... analysis was conducted to compare the internal structure of the Danish version and the American source version. The study included 151 patients with COPD, recruited from three outpatient clinics. Estimates of reliability were in accordance with the original version of CSES (Cronbach's a = 0.97, test...

  11. The Smoke Study: Evaluating the Effectiveness of an Intensive versus a Minimal Smoking Cessation Program for COPD Outpatients. Book of Abstracts of the 12th World Conference on Tobacco or Health: Global Action for a Tobacco free Future.

    NARCIS (Netherlands)

    Christenhusz, Lieke C.A.; Pieterse, Marcel E.; van der Palen, Jacobus Adrianus Maria; van der Palen, J.; Seydel, E.R.

    2003-01-01

    Background: Chronic Obstructive Pulmonary Disease (COPD) is a growing problem due to ageing and changing smoking trends. To quit smoking is the most urgent intervention in COPD management and also the only evidence based treatment to improve COPD prognosis. Therefore, an intensive smoking cessation

  12. Clinical significance of epithelial mesenchymal transition (EMT) in chronic obstructive pulmonary disease (COPD): potential target for prevention of airway fibrosis and lung cancer.

    Science.gov (United States)

    Sohal, Sukhwinder Singh; Mahmood, Malik Quasir; Walters, Eugene Haydn

    2014-12-01

    Unfortunately, the research effort directed into chronic obstructive pulmonary disease (COPD) has been disproportionately weak compared to its social importance, and indeed it is the least researched of all common chronic conditions. Tobacco smoking is the major etiological factor. Only 25% of smokers will develop "classic" COPD; in these vulnerable individuals the progression of airways disease to symptomatic COPD occurs over two or more decades. We know surprisingly little about the pathobiology of COPD airway disease, though small airway fibrosis and obliteration are likely to be the main contributors to physiological airway dysfunction and these features occur earlier than any subsequent development of emphysema. One potential mechanism contributing to small airway fibrosis/obliteration and change in extracellular matrix (ECM) is epithelial mesenchymal transition (EMT), so called Type-II EMT. When associated with angiogenesis (Type-III EMT) it may well also be a link with the development of lung (airway) cancer which is closely associated with COPD. Active EMT in COPD may help to explain why lung cancer is so common in smokers and also the core pathophysiology of small airway fibrosis. Better understanding may lead to new markers for incipient neoplasia, and better preventive management of patients. There is serious need to understand key components of airway EMT in smokers and COPD, and to demarcate novel drug targets for the prevention of lung cancer and airway fibrosis, as well as better secondary management of COPD. Since over 90% of human cancer arises in epithelia and the involvement of EMT in all of these may be a central paradigm, insights gained in COPD may have important generalizable value.

  13. Evaluation of full-length, cleaved and nitrosylated serum surfactant protein D as biomarkers for COPD

    DEFF Research Database (Denmark)

    Duvoix, Annelyse; Miranda, Elena; Perez, Juan

    2011-01-01

    . Serum levels of SP-D are raised in individuals with COPD but there is no correlation between the serum level of SP-D and the severity of airflow obstruction. Serum SP-D is present in different forms that may have more utility as a biomarker for COPD. We report here the development of new monoclonal...

  14. COPD Quiz | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... please turn JavaScript on. Feature: The Challenge of COPD COPD Quiz Past Issues / Fall 2014 Table of Contents ... Only one answer is correct . Questions Question 1. COPD is a lung disease that: usually starts during ...

  15. Characterisation of COPD heterogeneity in the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Agusti, Alvar; Calverley, Peter M A; Celli, Bartolome

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE)....

  16. Evaluation of Genetic Diversity of Candida spp. and Klebsiella spp. Isolated from the Denture Plaque of COPD Patients.

    Science.gov (United States)

    Przybyłowska, D; Piskorska, K; Gołaś, M; Sikora, M; Swoboda-Kopeć, E; Kostrzewa-Janicka, J; Mierzwińska-Nastalska, E

    2017-01-01

    Yeast-like fungi and gram-negative bacilli are the most frequent potential pathogens of the respiratory tract isolated from the denture plaque of patients with chronic obstructive pulmonary disease (COPD). Dominant species among yeast-like fungi are Candida albicans and Candida tropicalis. Significant frequency is also exhibited by Klebsiella pneumoniae and Klebsiella oxytoca. The purpose of this study was to analyze genetic diversity of the strains of C. albicans, C. tropicalis, and Klebsiella spp. present in patients in stable phases of COPD. The analysis was conducted by the random amplified polymorphic DNA (RAPD) method on clinical strains isolated from patients with COPD and control patients in overall good health. Forty one strains of Candida albicans, 12 of Candida tropicalis, as well as 9 strains of K. pneumoniae and 7 of K. oxytoca were scrutinized. The dominant species in clinical material from COPD patients was Candida albicans with a substantial degree of variations of genetic profiles. On the basis of affinity analysis, 19 genetic types were identified within this strain. An analysis of the banding patterns among C. tropicalis strains indicated the existence of 6 genetic types. A considerable diversity of genetic profiles among Klebsiella spp. also was established. The genotype diversity of Klebsiella spp. strains may indicate the endogenic character of the majority of infections, regardless of the therapy applied for the underlying condition.

  17. Endothelial to mesenchymal transition (EndMT): an active process in Chronic Obstructive Pulmonary Disease (COPD)?

    OpenAIRE

    Sohal, Sukhwinder Singh

    2016-01-01

    Small airway fibrosis is the main contributor to physiological airway dysfunction in COPD. One potential mechanism contributing to small airway fibrosis is epithelial mesenchymal transition (EMT). When associated with angiogenesis (so called EMT-Type-3) it may well also be the link with the development of airway epithelial cancer, which is closely associated with COPD and predominantly in large airways. In a recent study published in Respiratory Research, Reimann and colleagues, showed increa...

  18. Echo intensity of the rectus femoris in stable COPD patients

    Directory of Open Access Journals (Sweden)

    Ye X

    2017-10-01

    Full Text Available Xiong Ye,1 Mingjie Wang,2 Hui Xiao2 1College of Clinical Medicine, Shanghai University of Medicine & Health Sciences, 2Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China Objective: The aim of this study was to investigate whether echo intensity of the rectus femoris when measured using ultrasound can distinguish muscles affected by COPD compared with healthy non-COPD affected muscles and whether the severity of ultrasonic abnormalities was associated with health-related quality of life (HRQoL. Methods: Echo intensity, areas of the rectus femoris, and the thickness of quadriceps muscles were measured using ultrasound in 50 COPD outpatients and 21 age-matched non-COPD controls. The results of the 8-Item Short-Form Health Survey and the functional assessment of chronic illness therapy fatigue scales were used to evaluate HRQoL. Results: There was a significantly higher echo intensity of the rectus femoris in all stages of COPD patients than in age-matched non-COPD subjects; the quadriceps muscle thickness and cross-sectional area of the rectus femoris significantly decreased in COPD GOLD III–IV only. Furthermore, in our stable COPD patients, echo intensity of the rectus femoris was associated with HRQoL independently. Conclusion: Quantitative ultrasound distinguishes healthy muscles from those affected by COPD grade I–IV, and quality and quantity of muscles are associated with HRQoL and forced expiratory volume in 1 second. Ultrasonic echo intensity of the rectus femoris may be a useful instrument for assessing disease severity and monitoring the changes of skeletal muscle resulting from disease progression or clinical intervention in patients with COPD. Keywords: echo intensity, ultrasound, rectus femoris, chronic obstructive pulmonary disease

  19. Anxiety and depression among dairy farmers: the impact of COPD

    Directory of Open Access Journals (Sweden)

    Guillien A

    2017-12-01

    Full Text Available Alicia Guillien,1 Lucie Laurent,2 Thibaud Soumagne,3 Marc Puyraveau,4 Jean-Jacques Laplante,5 Pascal Andujar,6 Isabella Annesi-Maesano,7 Nicolas Roche,8,9 Bruno Degano,1,* Jean-Charles Dalphin3,* 1Research Unit EA 3920, Franche-Comté University, Besançon, France; 2Department of Clinical Physiology, University Hospital, Besançon, France; 3Department of Respiratory Diseases, University Hospital, Besançon, France; 4Clinical Methodology Center, University Hospital, Besançon, France; 5Department of Occupational Diseases, Mutualité sociale agricole, Besançon, France; 6University of Medical Sciences, Paris-est Créteil University, Créteil, France; 7Epidemiology of Allergic and Respiratory Diseases Department (EPAR, Saint-Antoine Medical School, Paris, France; 8Respiratory and Intensive Care Medicine, Cochin Hospital (AP-HP, University Paris Descartes, Paris, France; 9Research Unit EA 2511, University Paris Descartes, Paris, France *These authors contributed equally to this work Background: Chronic obstructive pulmonary disease (COPD and farming are two conditions that have been associated with an increased risk of anxiety and depression. Dairy farming is an independent risk factor for COPD.Objective: To test the hypotheses that the prevalence of anxiety and/or depression is higher in dairy farmers with COPD than in farmers without COPD, and higher in dairy farmers with COPD than in non-farmers with COPD.Methods: Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale in 100 dairy farmers with COPD (DF-COPD, 98 dairy farmers without COPD (DF-controls, 85 non-farming patients with COPD (NF-COPD and 89 non-farming subjects without COPD (NF-controls, all identified by screening in the Franche-Comté region of France. Anxiety and depression were considered present when the Hospital Anxiety and Depression Scale score was ≥8. COPD was defined by a post-bronchodilator forced expiratory volume in 1 second/forced vital

  20. Do COPD subtypes really exist? COPD heterogeneity and clustering in 10 independent cohorts

    NARCIS (Netherlands)

    Castaldi, Peter J; Benet, Marta; Petersen, Hans; Rafaels, Nicholas; Finigan, James; Paoletti, Matteo; Marike Boezen, H; Vonk, Judith M; Bowler, Russell; Pistolesi, Massimo; Puhan, Milo A; Anto, Josep; Wauters, Els; Lambrechts, Diether; Janssens, Wim; Bigazzi, Francesca; Camiciottoli, Gianna; Cho, Michael H; Hersh, Craig P; Barnes, Kathleen; Rennard, Stephen; Boorgula, Meher Preethi; Dy, Jennifer; Hansel, Nadia N; Crapo, James D; Tesfaigzi, Yohannes; Agusti, Alvar; Silverman, Edwin K; Garcia-Aymerich, Judith

    2017-01-01

    Background COPD is a heterogeneous disease, but there is little consensus on specific definitions for COPD subtypes. Unsupervised clustering offers the promise of 'unbiased' data-driven assessment of COPD heterogeneity. Multiple groups have identified COPD subtypes using cluster analysis, but there

  1. The development and pilot testing of the self-management programme of activity, coping and education for chronic obstructive pulmonary disease (SPACE for COPD).

    Science.gov (United States)

    Apps, Lindsay D; Mitchell, Katy E; Harrison, Samantha L; Sewell, Louise; Williams, Johanna E; Young, Hannah Ml; Steiner, Michael; Morgan, Mike; Singh, Sally J

    2013-01-01

    There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD. Participants with a confirmed diagnosis of COPD were recruited from primary care. A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks. The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23-1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47-443.03, P COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care.

  2. Psychometric validation of a Hindi version of a chronic obstructive pulmonary disease (COPD) assessment test in patients in northern India.

    Science.gov (United States)

    Aggarwal, Ashutosh N; Lallawmkima, Isak; Basu, Debasish

    2017-01-01

    We aimed to validate a Hindi version of a chronic obstructive pulmonary disease (COPD) assessment test (CAT) for assessing the health status of patients in northern India. Of the 178 patients studied, 171 with COPD self-completed CAT twice at a 4-week interval. The patients also self-completed the Hindi versions of the abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref) and St George's Respiratory Questionnaire (SGRQ) at the initial assessment. Baseline clinical details and spirometric data were recorded. Acceptability, validity, internal consistency, test-retest reproducibility and responsiveness were assessed using standard tools. The study population of 178 had 167 (93.8%) males and 1 59 (89.3%) smokers. One hundred and twenty- seven (71.3%) patients completed the second assessment, of whom the condition of 19 had worsened. Each of the eight CAT items correlated strongly with the total CAT score (Pearson coefficients 0.59-0.73). The total CAT score correlated well with the dyspnoea grade, SGRQ domain scores and the physical domain score of WHOQOL-Bref. Cronbach's alpha coefficient had a high value of 0.83. The intraclass correlation coefficient for 101 patients with stable disease between the two assessments was high (0.83), but the effect size in the 19 patients who recovered from an exacerbation was moderate (0.45). The Hindi version of CAT has good validity and reliability and can be used to quantify the health impact of COPD among patients in northern India.

  3. Oral health-related quality-of-life and mental health in individuals with chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Saltnes, Solfrid Sørgjerd; Storhaug, Kari; Borge, Christine Råheim; Enmarker, Ingela; Willumsen, Tiril

    2015-01-01

    To investigate the association between oral health, oral health-related quality-of-life (OHRQoL) and mental health-related quality-of-life (QoL) in persons with chronic obstructive pulmonary disease (COPD) with respect to demographic, social and clinical oral health variables. One hundred participants were included in a cross-sectional study at a hospital in Norway. Data were collected via the Oral Health Impact Profile (OHIP-14), the SF-36v2 Health Survey Mental Component (MCS), other self-reported factors, an interview and a clinical examination. Multiple regression analyses were performed. The Regional Committee for Medical and Health Research Ethics approved the study. RESULTS. Higher education (p mental health problems. This study demonstrated that oral health and personal factors are related to mental health-related QoL and OHRQoL in individuals with COPD. This finding shows the need to focus on oral care.

  4. Update on the management of COPD.

    Science.gov (United States)

    Celli, Bartolome R

    2008-06-01

    COPD is highly prevalent and will continue to be an increasing cause of morbidity and mortality worldwide. COPD is now viewed under a new paradigm as preventable and treatable. In addition, it has become accepted that COPD is not solely a pulmonary disease but also one with important measurable systemic consequences. Patients with COPD have to be comprehensively evaluated to determine the extent of disease so that therapy can be adequately individualized. We now know that smoking cessation, oxygen for hypoxemic patients, lung reduction surgery for selected patients with emphysema, and noninvasive ventilation during severe exacerbations have an impact on mortality. The completion of well-planned pharmacologic trials have shown the importance of decreasing resting and dynamic hyperinflation on patient-centered outcomes and the possible impact on mortality and rate of decline of lung function. In addition, therapy with pulmonary rehabilitation and lung transplantation improve patient-centered outcomes such as health-related quality of life, dyspnea, and exercise capacity. Rational use of single or multiple therapeutic modalities in combination have an impact on exacerbations and hospitalizations. This monograph presents an integrated approach to patients with COPD and updates their management incorporating the recent advances in the field. The future for patients with COPD is bright as primary and secondary prevention of smoking becomes more effective and air quality improves. In addition, current research will unravel the pathogenesis, clinical, and phenotypic manifestations of COPD, thus providing exciting therapeutic targets. Ultimately, the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health.

  5. Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort.

    Science.gov (United States)

    Achelrod, Dmitrij; Schreyögg, Jonas; Stargardt, Tom

    2017-09-01

    Telemonitoring for COPD has gained much attention thanks to its potential of reducing morbidity and mortality, healthcare utilisation and costs. However, its benefit with regard to clinical and economic outcomes remains to be clearly demonstrated. To analyse the effect of Europe's largest COPD telemonitoring pilot project on direct medical costs, health resource utilisation and mortality at 12 months. We evaluated a population-based cohort using administrative data. Difference-in-difference estimators were calculated to account for time-invariant unobservable heterogeneity after removing dissimilarities in observable characteristics between the telemonitoring and control group with a reweighting algorithm. The analysis comprised 651 telemonitoring participants and 7047 individuals in the standard care group. The mortality hazards ratio was lower in the intervention arm (HR 0.51, 95 % CI 0.30-0.86). Telemonitoring cut total costs by 895 € (p patients (-1056 €, p Telemonitoring enrolees used healthcare (all-cause and COPD-related) less intensely with shorter hospital stays, fewer inpatient stays and smaller proportions of people with emergency department visits and hospitalisations (all p telemonitoring for COPD is a viable strategy to reduce mortality, healthcare costs and utilisation at 12 months. Contrary to widespread fear, reducing the intensity of care does not seem to impact unfavourably on health outcomes. The evidence offers strong support for introducing telemonitoring as a component of case management.

  6. Distinctive characteristics of bronchial reticular basement membrane and vessel remodelling in chronic obstructive pulmonary disease (COPD) and in asthma: they are not the same disease

    Science.gov (United States)

    Soltani, Amir; Muller, Hans Konrad; Sohal, Sukhwinder S; Reid, David W; Weston, Steve; Wood-Baker, Richard; Walters, Eugene Haydn

    2012-01-01

    Aims This study compared reticular basement membrane (Rbm) and vascular remodelling within the bronchial mucosa of subjects with chronic obstructive pulmonary disease (COPD) with those from patients with asthma, to test the ‘Dutch hypothesis’ of whether these are essentially the same or different pathological conditions. Methods and results Bronchoscopic biopsies were stained with anti-collagen IV antibody; 18 current smoking COPD, 10 symptomatic asthmatics and 13 healthy non-smoking controls were studied. The Rbm in COPD was fragmented, non-homogeneous, variable in thickness and hypervascular, whereas in asthma the Rbm was compact and homogeneous with no evidence of increased vascularity compared to controls. Length of Rbm splitting presented as percentage of Rbm length was used to measure fragmentation; it was greater in COPD than in controls and asthmatics [median (range) 20.7% (0.4–68.5) versus 5.3% (0.0–21.7) versus 1.5% (0.0–15.1), P < 0.001]. The number of Rbm vessels/mm Rbm [median (range) 10.1 (1.6–23.0) versus 4.5 (0.0–26.4) versus 4.4 (0.4–8.1), P < 0.01] and area of Rbm vessels, μm2/mm Rbm [median (range) 953 (115–2456) versus 462 (0–3263) versus 426 (32–2216), P < 0.05] was also increased in COPD compared to normal subjects and asthmatics. Conclusions The characteristics of Rbm remodelling are quite different in asthma and COPD. PMID:22320998

  7. Exhaled breath condensate pH as a biomarker of COPD severity in ex-smokers

    Directory of Open Access Journals (Sweden)

    Alchanatis Manos

    2011-05-01

    Full Text Available Abstract Endogenous airway acidification, as assessed by exhaled breath condensate (EBC pH, is present in patients with stable COPD. The aim of this study was to measure EBC pH levels in a large cohort of COPD patients and to evaluate associations with functional parameters according to their smoking status. EBC was collected from 161 patients with stable COPD and 112 controls (current and ex-smokers. EBC pH was measured after Argon deaeration and all subjects underwent pulmonary function testing. EBC pH was lower in COPD patients compared to controls [7.21 (7.02, 7.44 vs. 7.50 (7.40, 7.66; p Endogenous airway acidification is related to disease severity and to parameters expressing hyperinflation and air trapping in ex-smokers with COPD. The possible role of EBC pH in COPD needs to be further evaluated in longitudinal studies.

  8. The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis.

    Science.gov (United States)

    Brunton, Lisa; Bower, Peter; Sanders, Caroline

    2015-01-01

    As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake. Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. 705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or empowerment). Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at

  9. Cellular senescence and autophagy in the pathogenesis of chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF).

    Science.gov (United States)

    Kuwano, Kazuyoshi; Araya, Jun; Hara, Hiromichi; Minagawa, Shunsuke; Takasaka, Naoki; Ito, Saburo; Kobayashi, Kenji; Nakayama, Katsutoshi

    2016-11-01

    Aging is associated with impairments in homeostasis. Although aging and senescence are not equivalent, the number of senescent cells increases with aging. Cellular senescence plays important roles in tissue repair or remodeling, as well as embryonic development. Autophagy is a process of lysosomal self-degradation that maintains a homeostatic balance between the synthesis, degradation, and recycling of cellular proteins. Autophagy diminishes with aging; additionally, accelerated aging can be attributed to reduced autophagy. Cellular senescence has been widely implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD), a disease of accelerated lung aging, presumably by impairing cell repopulation and by aberrant cytokine secretion in the senescence-associated secretory phenotype. The possible participation of autophagy in the pathogenic sequence of COPD has been extensively explored. Although it has been reported that increased autophagy may induce epithelial cell death, an insufficient reserve of autophagy can induce cellular senescence in bronchial epithelial cells of COPD. Furthermore, advanced age is one of the most important risk factors for the development of idiopathic pulmonary fibrosis (IPF). Telomere shortening is found in blood leukocytes and alveolar epithelial cells from patients with IPF. Accelerated senescence of epithelial cells plays a role in IPF pathogenesis by perpetuating abnormal epithelial-mesenchymal interactions. Insufficient autophagy may be an underlying mechanism of accelerated epithelial cell senescence and myofibroblast differentiation in IPF. Herein, we review the molecular mechanisms of cellular senescence and autophagy and summarize the role of cellular senescence and autophagy in both COPD and IPF. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  10. Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD in terms of choice of effective empiric antibiotic therapy

    Directory of Open Access Journals (Sweden)

    Aneta Grochowalska

    2017-06-01

    In the performed study, the infections caused by multi-resistant Acinetobacter baumannii, were observed in COPD, which should be taken into consideration in choosing empirical antibiotic therapy. Simultaneously, the local resistance patterns of multi-drug-resistant (MDR Gram-negative strains co-infecting COPD should be considered in empirical treatment. Moreover, both additional clinical complication and co-infections contribute to a more severe course of diseases. In this study, the mortality percent exceeded 29%.

  11. The use of COPD maintenance therapy following spirometry in General Practice

    Directory of Open Access Journals (Sweden)

    Vibeke Gottlieb

    2016-06-01

    Full Text Available Background: Several studies have shown that the use of pulmonary medication is widespread and often initiated without initial spirometry. Early detection of chronic obstructive pulmonary disease (COPD by spirometry in General Practice is essential for an early and correct implementation of medical treatment. Aim: The aim of the present study was to evaluate the use of regular therapy following diagnostic spirometry for COPD in General Practice from February 2008 to February 2009. Method: Spirometry data and results were linked through Statistics Denmark with information from the Register of Medicinal Product Statistics using the unique personal identification code. Data were analysed to evaluate the impact of screening on use of regular COPD therapy. Primary outcome was initiation of regular therapy following COPD diagnosis with spirometry. Results: In a population of 3,376 individuals at risk, 1,458 underwent spirometric assessment with 631 being diagnosed with COPD; 110 of those received regular therapy before assessment with this figure increasing to 161 after spirometry. Of 827 participants not receiving a COPD diagnosis, 36 received regular therapy prior to assessment and 42 received regular therapy after spirometry despite no established COPD diagnosis. Conclusion: There is a significant chance of receiving regular therapy after being diagnosed with COPD. However, a large proportion of subjects diagnosed with COPD did not receive regular therapy following diagnosis. Efforts should be made to ensure correct diagnosis and correct medical treatment according to guidelines in individuals with COPD.

  12. Understanding of COPD among final-year medical students

    Science.gov (United States)

    Mohigefer, Javier; Calero-Acuña, Carmen; Marquez-Martin, Eduardo; Ortega-Ruiz, Francisco; Lopez-Campos, Jose Luis

    2018-01-01

    Objective Several previous studies have shown a suboptimal level of understanding of COPD among different population groups. Students in their final year of Medicine constitute a population that has yet to be explored. The evaluation of their understanding provides an opportunity to establish strategies to improve teaching processes. The objective of the present study is to determine the current level of understanding of COPD among said population. Methods A cross-sectional observational study was done using digital surveys given to medical students in their final year at the Universidad de Sevilla. Those surveyed were asked about demographic data, smoking habits as well as the clinical manifestation, diagnosis and treatment of COPD. Results Of the 338 students contacted, responses were collected from 211 of them (62.4%). Only 25.2% had an accurate idea about the concept of the disease. The study found that 24.0% of students were familiar with the three main symptoms of COPD. Tobacco use was not considered a main risk factor for COPD by 1.5% of students. Of those surveyed, 22.8% did not know how to spirometrically diagnose COPD. Inhaled corticosteroids were believed to be part of the main treatment for this disease among 51.0% of the students. Results show that 36.4% of respondents believed that home oxygen therapy does not help COPD patients live longer. Only 15.0% considered the Body-mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index to be an important parameter for measuring the severity of COPD. Giving up smoking was not believed to prevent worsening COPD among 3.4% of students surveyed. Almost half of students (47.1%) did not recommend that those suffering from COPD undertake exercise. Conclusion The moderate level of understanding among the population of medical students in their final year shows some strengths and some shortcomings. Teaching intervention is required to reinforce solid knowledge among this population. PMID:29343952

  13. A study on quantifying COPD severity by combining pulmonary function tests and CT image analysis

    Science.gov (United States)

    Nimura, Yukitaka; Kitasaka, Takayuki; Honma, Hirotoshi; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi; Mori, Kensaku

    2011-03-01

    This paper describes a novel method that can evaluate chronic obstructive pulmonary disease (COPD) severity by combining measurements of pulmonary function tests and measurements obtained from CT image analysis. There is no cure for COPD. However, with regular medical care and consistent patient compliance with treatments and lifestyle changes, the symptoms of COPD can be minimized and progression of the disease can be slowed. Therefore, many diagnosis methods based on CT image analysis have been proposed for quantifying COPD. Most of diagnosis methods for COPD extract the lesions as low-attenuation areas (LAA) by thresholding and evaluate the COPD severity by calculating the LAA in the lung (LAA%). However, COPD is usually the result of a combination of two conditions, emphysema and chronic obstructive bronchitis. Therefore, the previous methods based on only LAA% do not work well. The proposed method utilizes both of information including the measurements of pulmonary function tests and the results of the chest CT image analysis to evaluate the COPD severity. In this paper, we utilize a multi-class AdaBoost to combine both of information and classify the COPD severity into five stages automatically. The experimental results revealed that the accuracy rate of the proposed method was 88.9% (resubstitution scheme) and 64.4% (leave-one-out scheme).

  14. Accuracy of a New Algorithm to Identify Asthma-COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease.

    Science.gov (United States)

    Pérez de Llano, Luis; Cosío, Borja G; Miravitlles, Marc; Plaza, Vicente

    2017-12-08

    We aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD). ACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300cells/μl) and/or a very positive bronchodilator response (>400ml and >15% in FEV1). Eighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked 200eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771ml), higher than in COPD (1431ml, p<0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305cells/μl) and higher than in COPD (170cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5IU/ml) and lower than in asthma (41.5IU/ml, p<0.05), whereas FeNO levels in ACO were intermediate. This algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare.

    Science.gov (United States)

    Nyberg, André; Wadell, Karin; Lindgren, Helena; Tistad, Malin

    2017-08-01

    The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) reduces healthcare use, improves health-related quality of life (HRQoL) and recovery after acute exacerbations. However, not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted. This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention, the COPD-web. METHODS AND ANALYSIS: The overall design is a pragmatic controlled pilot trial with preassessments and postassessments and a parallel process evaluation. Patients with the diagnosis of COPD will be eligible for the study. The intervention group will be recruited when visiting one of the six participating primary care units in Sweden. The control group will be identified from the unit's computerised registers. The intervention, the COPD-web, is an interactive web page with two sections; one directed at people with COPD and one at healthcare professionals. The sections aim to support patients' self-management skills-and to facilitate the provision of support for self-management strategies, respectively. Effectiveness with regard to patients' symptoms, HRQoL, knowledge of and readiness for COPD-related self-management, health literacy, self-efficacy for physical activity and time spent in physical activity and time being sedentary, and further, healthcare professionals' knowledge of and readiness to support COPD-related self-management strategies will be assessed using questionnaires at 3 and 12 months. The process evaluation will include observations and interviews. Ethical approval has been obtained. Findings will be presented at conferences, submitted for publication in peer-reviewed publications and presented to the involved healthcare professionals, patients and to patient organisations

  16. Models of chronic disease management in primary care for patients with mild-to-moderate asthma or COPD: a narrative review.

    Science.gov (United States)

    Cranston, Josephine M; Crockett, Alan J; Moss, John R; Pegram, Robert W; Stocks, Nigel P

    2008-04-21

    To review the literature for any promising strategies for the primary care management of mild-to-moderate asthma and chronic obstructive pulmonary disease (COPD) in adults. Using "MeSH" terms for COPD, asthma and primary health care, we conducted an extensive literature search for relevant meta-analyses, systematic reviews, narrative reviews, reports and individual studies. Grey literature was also included. We chose a narrative review approach because of substantial heterogeneity of study designs in the literature. 1119 articles of potential relevance were retained, of which 246 were included in our review. There was insufficient evidence to determine whether general practitioners with a special interest (GPwSI) in respiratory care improved the diagnosis and management of mild-to-moderate COPD. An asthma service involving GPwSI increased respiratory drug costs but reduced the costs for less specific drugs. No clear benefit has been shown for practice nurse-run asthma clinics in primary care compared with usual care in altering asthma morbidity, quality of life, lung function or medication use. Evidence to determine the effectiveness of practice nurse-run COPD clinics could not be found. Self-management education, GP review and action plans may produce short-term benefits for asthma patients, particularly those with moderate-to-severe disease, but the evidence for a similar approach to patients with mild-to-moderate COPD is equivocal. There has been poor uptake of respiratory clinical guidelines relevant to primary care - partly because most guidelines are based on moderate-to-severe disease. Spirometry programs in primary care are useful for differential diagnosis of asthma and COPD. Spirometry may alter the management of mild asthma, but there is a lack of evidence that it alters the management of COPD in primary care. The role of primary health care in management of mild-to-moderate asthma and COPD requires further investigation using randomised controlled

  17. The feasibility of a home-based sedentary behaviour intervention for hospitalised chronic obstructive pulmonary disease (COPD patients: Sitting and ExacerbAtions Trial (COPD-SEAT

    Directory of Open Access Journals (Sweden)

    Mark Orme

    2015-10-01

    COPD-SEAT will be one of the first trials aimed at reducing sedentary behaviour at home in patients hospitalised for an acute exacerbation of COPD. This trial will provide valuable insight into the feasibility of implementing an at-home technology-based feedback intervention for reducing sedentary behaviour into patients existing care. Findings will inform a future large-scale trial acting as an adjuvant to pulmonary rehabilitation.

  18. Effect of combined application of tiotropium and Salmeterol and fluticasone propionate powder on disease control in stable COPD patients

    Directory of Open Access Journals (Sweden)

    Xiu-Ping Han

    2016-06-01

    Full Text Available Objective: To analyze the effect of combined application of tiotropium and salmeterol and fluticasone propionate powder on disease control in stable COPD patients. Methods: A total of 116 cases of COPD patients who received treatment in our hospital from September 2012 to June 2015 were included in the research and confirmed to be in stable phase according to relevant detection. According to different treatment methods they received, all included subjects were divided into observation group 58 cases and control group 58 cases. Control group received clinical conventional treatment, observation group received combined treatment of tiotropium and salmeterol and fluticasone propionate powder, and then the levels of illnessrelated indicators in serum and induced sputum were compared between two groups after treatment. Results: γ-GCS, MIP-1α, 8-iso-PGF2, HMGB1, IL-17 and Hbd-2 values in induced sputum of observation group after treatment were lower than those of control group while SP-A value was higher than that of control group; FEF25%-75%, FEV1%, V25 and MMFR values of observation group after treatment were higher than those of control group while serum CXCR3 and CXCL10 values were lower than those of control group; serum copeptin, desmosine, CCL18, CC16 and ANG2 values of observation group after treatment were lower than those of control group. Conclusion: Combined treatment of tiotropium and salmeterol and fluticasone propionate powder for stable COPD patients helps to further stabilize patients’ condition and improve the prognosis.

  19. Opioids a Threat to Seniors with COPD

    Science.gov (United States)

    ... 167057.html Opioids a Threat to Seniors With COPD Odds of heart-related death increased in these ... THURSDAY, July 6, 2017 (HealthDay News) -- Seniors with COPD -- a progressive lung disease that causes breathing problems -- ...

  20. Sleep Problems in Asthma and COPD

    Science.gov (United States)

    ... Mini Series #5 Sleep Problems in Asthma and COPD NORMAL AIRWAY Good quality sleep is important for ... with asthma and/or Chronic Obstructive Pulmonary Disease (COPD) may have sleep issues that can lead to ...

  1. Cognitive performance in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Postma, DS; Beukema, RJ; ten Hacken, NHT; van der Molen, T; Riemersma, RA; van Zomeren, EH; Kerstjens, HAM

    Background: Hypoxemic patients with Chronic Obstructive Pulmonary Disease (COPD) have impaired cognitive performance. These neuropsychological impairments are related to the degree of hypoxemia. So far, cognitive performance has not been tested in non-hypoxemic patients with COPD. Methods: We

  2. Lack of association of ischemic heart disease with COPD when taking into account classical cardiovascular risk factors

    Directory of Open Access Journals (Sweden)

    José Luis Izquierdo

    2010-11-01

    Full Text Available José Luis Izquierdo, Arturo Martínez, Elizabet Guzmán, Pilar de Lucas, José Miguel RodríguezPulmonology Department, Hospital Universitario, Guadalajara, Spain; Pulmonology Department, Hospital Gregorio Marañón, Madrid, SpainAbstract: The aim of our study is to determine whether chronic obstructive pulmonary disease (COPD is an independent risk factor for ischemic heart disease and whether this association is related with a greater prevalence of classical cardiovascular risk factors. Ours is a case-control cross-sectional study design. Cases were hospital patients with ischemic heart disease in stable phase, compared with control hospital patients. All patients underwent post-bronchodilator (PBD spirometry, a standardized questionnaire, and blood analysis. COPD was defined as per GOLD PBD forced expiratory volume in the first second (FEV1/forced vital capacity (FVC < 0.70. In our series of patient cases (n = 204 and controls (n = 100, there were 169 men in the case group (83% and 84 in the control group (84%. Ages were 67 and 64 years, respectively (P < 0.05. There were no significant differences by weight, body mass index (BMI, pack-years, leukocytes, or homocysteine. The abdominal perimeter was significantly greater in cases (mean 101 cm ± standard deviation [SD] 10 versus 96 cm ± 11; P < 0.000. Both groups also had significant differences by C-reactive protein (CRP, fibrinogen, and hemoglobin values. In univariate analysis, increased risks for cases to show with individual classical cardiovascular risk factors were seen, with odds ratio (OR 1.86 and 95% confidence interval (CI (1.04–3.33 for diabetes mellitus, dyslipidemia (OR 2.10, 95% CI: 1.29–3.42, arterial hypertension (OR 2.47, 95% CI: 1.51–4.05, and increased abdominal perimeter (OR 1.71, 95% CI: 1.06–2.78. Percent predicted PBD FEV1 was 97.6% ± 23% in the patient group and 104% ± 19% in the control group (P = 0.01, but the prevalence of COPD was 24.1% in cases and 21

  3. Evaluation of psychological and physiological predictors of fatigue in patients with COPD

    Directory of Open Access Journals (Sweden)

    Bidgood Penelope L

    2009-10-01

    Full Text Available Abstract Background Fatigue in COPD impairs functional status; however there are few studies examining mechanistic pathways of this symptom. The aims of this study are to compare fatigue between COPD patients and healthy age-matched subjects, and to identify predictors of fatigue in COPD. Methods Seventy four COPD patients, mean age 69.9 (49-87 yrs, mean (SD % predicted FEV1 46.5 (20.0 % and FEV1/FVC ratio 0.45 (0.13 and 35 healthy subjects, mean age 67.1 (50-84 yrs completed the Multidimensional Fatigue Inventory (MFI 20. Patients' assessment included Depression (HADS, lung function, BMI, muscle strength, incremental shuttle walk test (ISWT, exercise oxygen saturation (SpO2, Borg breathlessness (CR-10 and exertion (RPE. Serum level of Interleukin 6 (IL-6 was recorded. Differences in MFI 20 between groups were examined and predictors of fatigue identified using logistic regression. Results Significant differences (p 2 (R2 = .62; of Physical Fatigue: depression, % predicted FEV1, ISWT and age (R2 = .57; Reduced Activity: % predicted FEV1, BMI and depression (R2 = .36; Reduced Motivation: RPE, depression and end SpO2 (R2 = .37 and Mental Fatigue: depression and end SpO2 (R2 = .38. Conclusion All dimensions of fatigue were higher in COPD than healthy aged subjects. Predictive factors differ according to the dimension of fatigue under investigation. COPD-RF is a multi component symptom requiring further consideration.

  4. Evaluation of body composition in COPD patients using multifrequency bioelectrical impedance analysis.

    Science.gov (United States)

    de Blasio, Francesca; de Blasio, Francesco; Miracco Berlingieri, Giulia; Bianco, Andrea; La Greca, Marta; Franssen, Frits M E; Scalfi, Luca

    2016-01-01

    Multifrequency bioelectrical impedance analysis (MF-BIA) is a technique that measures body impedance (Z) at different frequencies (5, 10, 50, 100, and 250 kHz). Body composition may be estimated using empirical equations, which include BIA variables or, alternatively, raw BIA data may provide direct information on water distribution and muscle quality. To compare raw MF-BIA data between COPD patients and controls and to study their relationship with respiratory and functional parameters in COPD patients. MF-BIA was performed (Human Im-Touch analyzer) in 212 COPD patients and 115 age- and BMI-matched controls. Fat-free mass (FFM) and fat mass were estimated from BIA data, and low- to high-frequency (5 kHz/250 kHz) impedance ratio was calculated. Physical fitness, lung function and respiratory muscle strength were also assessed in COPD patients. After adjusting for age, weight, and body mass index, FFM and the 5/250 impedance ratio were lower in COPD patients (Pbody composition and nutritional status in COPD patients. In particular, the impedance ratio could give valuable information on cellular integrity and muscle quality.

  5. Non-invasive evaluation of gas exchange during a shuttle walking test vs. a 6-min walking test to assess exercise tolerance in COPD patients.

    Science.gov (United States)

    Onorati, Paolo; Antonucci, Rosa; Valli, Gabriele; Berton, Emanuela; De Marco, Francesca; Serra, Pietro; Palange, Paolo

    2003-05-01

    Walking tests, such as the "shuttle" incremental walking test (SWT) and the 6-min walking test (6'WT), are commonly utilized in evaluating exercise intolerance in patients with chronic obstructive pulmonary disease (COPD) and the distance covered is the variable usually considered. Because lung gas exchange indexes are not measured, little is known about the physiological response elicited by different walking protocols. We compared exercise adaptation during the 6'WT and SWT in 13 male stable COPD patients [mean (SE) age: 70 (1) years; forced expiratory volume in 1 s (FEV(1)): 1.2 (0.1) l; arterial O(2) tension (PaO(2)): 72 (2) mmHg; arterial CO(2) tension (PaCO(2)): 41 (1) mmHg]. Oxygen uptake (.VO(2)), CO(2) output (.VCO(2)), minute ventilation (.V(E)), and heart rate (HR) were monitored by a portable telemetric system. During the SWT a linear response in lung gas exchange indexes was observed while, during the 6'WT, the response was exponential. During the 6'WT, .VO(2), .VCO(2), .V(E), and HR values at steady-state (SS) were significantly lower compared to SWT peak values. For SWT, distance covered correlated with .VO(2PEAK), (R=0.86, p<0.001), .VCO(2PEAK), (R=0.87, p<0.001) and .V(EPEAK) (R=0.74, p<0.01); moreover, distance and .VO(2PEAK) were significantly correlated with peak .VO(2) values obtained during cycle ergometer incremental exercise (R=0.72, p<0.01 and R=0.92, p<0.0001, respectively). For 6'WT, the distance covered did not correlate with any pertinent physiological index. The two walking protocols reveal substantial differences in pathophysiologic adaptations and provide evidence that SWT is more accurate than the 6'WT in the evaluation of maximal exercise tolerance in COPD patients.

  6. Economic and health consequences of COPD patients and their spouses in Denmark-1998-2010

    DEFF Research Database (Denmark)

    Løkke, Anders; Hilberg, Ole; Kjellberg, Jakob

    2014-01-01

    on the economic consequences of COPD patients in Denmark and their spouses as well as displaying the serious health consequences for the individual spouse and society. Second, data shows substantial impact of COPD on income level and health expenses regardless of age and gender. It could be speculated that early......OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of morbidity and mortality worldwide, but longitudinal studies of the economic consequences of COPD are scarce. This study evaluated the economic consequences of COPD patients in Denmark and their spouses...... for age, gender and residence. Direct and indirect costs, including frequency of primary and secondary sector contacts and procedures, medication, unemployment benefits and social transfer payments were extracted from national databases for patients, spouses and controls. RESULTS: COPD patients...

  7. SP-D as a biomarker for COPD in the Lebanese population

    DEFF Research Database (Denmark)

    Akiki, Zeina; Fakih, Dalia; Jounblat, Rania

    2014-01-01

    Background: Surfactant protein D (SP-D), a promising systemic biomarker of chronic obstructive pulmonary disease (COPD) was never evaluated in the Lebanese population. Objective: The validity of serum SP-D as a biomarker for COPD, in comparison with C-reactive protein (CRP) and fibrinogen...... (GOLD 2013), and blood collection were performed. Serum SP-D and CRP, and plasma fibrinogen levels were measured by ELISA. Associations between biological markers with lung function parameters and COPD were estimated by spearman correlation and logistic regression models respectively. Results: Median......-COPD values (aOR=1.8, 1.49-2.16) and SP-D levels above the median value (aOR=3.51, 1.21-10.1) were significantly and independently associated with COPD in patients and healthy controls aged 40 years or above. No associations were found between CRP, fibrinogen levels and COPD, or between SP-D levels and lung...

  8. Feasibility assessment of using oxygen-enhanced magnetic resonance imaging for evaluating the effect of pharmacological treatment in COPD

    Energy Technology Data Exchange (ETDEWEB)

    Morgan, Alexandra R., E-mail: alex.morgan@bioxydyn.com [Bioxydyn Ltd, Manchester (United Kingdom); Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester (United Kingdom); Parker, Geoff J.M.; Roberts, Caleb [Bioxydyn Ltd, Manchester (United Kingdom); Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester (United Kingdom); Buonaccorsi, Giovanni A.; Maguire, Niall C. [Bioxydyn Ltd, Manchester (United Kingdom); Hubbard Cristinacce, Penny L. [Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester (United Kingdom); Singh, Dave; Vestbo, Jørgen [University of Manchester, Medicines Evaluation Unit, Manchester Academic Health Sciences Centre, University Hospital of South Manchester, Manchester (United Kingdom); Bjermer, Leif [Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund (Sweden); Jögi, Jonas [Department of Clinical Physiology, Skåne University Hospital and Lund University, Lund (Sweden); Taib, Ziad; Sarv, Janeli; Bruijnzeel, Piet L.B.; Olsson, Lars E.; Bondesson, Eva [AstraZeneca R and D, Mölndal (Sweden); Nihlén, Ulf [Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund (Sweden); AstraZeneca R and D, Mölndal (Sweden); McGrath, Deirdre M. [Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester (United Kingdom); Young, Simon S. [AstraZeneca R and D, Alderley Park (United Kingdom); and others

    2014-11-15

    Highlights: • We investigate physiologic response to standard COPD treatment regimes using OE-MRI. • We assess the potential role of OE-MRI in future drug development studies. • In COPD, OE-MRI parameters showed response to single-dose formoterol. • OE-MRI parameters showed response to 8-week formoterol/budesonide treatment. • OE-MRI measurements are feasible in a small-scale multi-center trial setting. - Abstract: Objectives: Oxygen-enhanced MRI (OE-MRI) biomarkers have potential value in assessment of COPD, but need further evaluation before treatment-induced changes can be interpreted. The objective was to evaluate how OE-MRI parameters of regional ventilation and oxygen uptake respond to standard pharmacological interventions in COPD, and how the response compares to that of gold standard pulmonary function tests. Materials and methods: COPD patients (n = 40), mean FEV{sub 1} 58% predicted normal, received single-dose inhaled formoterol 9 μg, or placebo, followed by 8 weeks treatment bid with a combination of budesonide and formoterol Turbuhaler{sup ®} 320/9 μg or formoterol Turbuhaler{sup ®}. OE-MRI biomarkers were obtained, as well as X-ray computed tomography (CT) biomarkers and pulmonary function tests, in a two-center study. An ANCOVA statistical model was used to assess effect size of intervention measurable in OE-MRI parameters of lung function. Results: OE-MRI data were successfully acquired at both study sites. 8-week treatment with budesonide/formoterol significantly decreased lung wash-out time by 31% (p < 0.01), decreased the change in lung oxygen level upon breathing pure oxygen by 13% (p < 0.05) and increased oxygen extraction from the lung by 58% (p < 0.01). Single-dose formoterol increased both lung wash-out time (+47%, p < 0.05) and lung oxygenation time (+47%, p < 0.05). FEV{sub 1} was improved by single-dose formoterol (+12%, p < 0.001) and 8 weeks of budesonide/formoterol (+ 18%, p < 0.001), consistent with published studies

  9. Factors associated with work productivity among people with COPD: Birmingham COPD Cohort.

    Science.gov (United States)

    Rai, Kiran K; Adab, Peymané; Ayres, Jon G; Siebert, W Stanley; Sadhra, Steven S; Sitch, Alice J; Fitzmaurice, David A; Jordan, Rachel E

    2017-12-01

    Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. To assess the factors associated with work productivity among COPD patients. Cross-sectional analysis of baseline data from a subsample (those in paid employment) of the Birmingham COPD Cohort study. Absenteeism was defined by self-report over the previous 12 months. Presenteeism was assessed using the Stanford Presenteeism Scale. Logistic regression analysis was used to assess the effects of sociodemographic, clinical and occupational characteristics on work productivity. Among 348 included participants, increasing dyspnoea was the only factor associated with both absenteeism and presenteeism (p for trend<0.01). Additionally, increasing history of occupational exposure to vapours, gases, dusts or fumes (VGDF) was independently associated with presenteeism (p for trend<0.01). This is the first study to identify important factors associated with poor work productivity among patients with COPD. Future studies should evaluate interventions aimed at managing breathlessness and reducing occupational exposures to VGDF on work productivity among patients with COPD. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea (OSA) in moderate to severe chronic obstructive pulmonary disease (COPD): The challenge to predict OSA in advanced COPD.

    Science.gov (United States)

    Soler, Xavier; Liao, Shu-Yi; Marin, Jose Maria; Lorenzi-Filho, Geraldo; Jen, Rachel; DeYoung, Pamela; Owens, Robert L; Ries, Andrew L; Malhotra, Atul

    2017-01-01

    The combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is associated with substantial morbidity and mortality. We hypothesized that predictors of OSA among patients with COPD may be distinct from OSA in the general population. Therefore, we investigated associations between traditional OSA risk factors (e.g. age), and sleep questionnaires [e.g. Epworth Sleepiness Scale] in 44 patients with advanced COPD. As a second aim we proposed a pilot, simplified screening test for OSA in patients with COPD. In a prospective, observational study of patients enrolled in the UCSD Pulmonary Rehabilitation Program we collected baseline characteristics, cardiovascular events (e.g. atrial fibrillation), and sleep questionnaires [e.g. Pittsburgh Sleep Quality Index (PSQI)]. For the pilot questionnaire, a BMI ≥25 kg/m2 and the presence of cardiovascular disease were used to construct the pilot screening test. Male: 59%; OSA 66%. FEV1 (mean ± SD) = 41.0±18.2% pred., FEV1/FVC = 41.5±12.7%]. Male gender, older age, and large neck circumference were not associated with OSA. Also, Epworth Sleepiness Scale and the STOP-Bang questionnaire were not associated with OSA in univariate logistic regression. In contrast, BMI ≥25 kg/m2 (OR = 3.94, p = 0.04) and diagnosis of cardiovascular disease (OR = 5.06, p = 0.03) were significantly associated with OSA [area under curve (AUC) = 0.74]. The pilot COPD-OSA test (OR = 5.28, p = 0.05) and STOP-Bang questionnaire (OR = 5.13, p = 0.03) were both associated with OSA in Receiver Operating Characteristics (ROC) analysis. The COPD-OSA test had the best AUC (0.74), sensitivity (92%), and specificity (83%). A ten-fold cross-validation validated our results. We found that traditional OSA predictors (e.g. gender, Epworth score) did not perform well in patients with more advanced COPD. Our pilot test may be an easy to implement instrument to screen for OSA. However, a larger validation study is necessary before

  11. Hydrogen coadministration slows the development of COPD-like lung disease in a cigarette smoke-induced rat model

    Directory of Open Access Journals (Sweden)

    Liu X

    2017-05-01

    Full Text Available Xiaoyu Liu,1,* Cuiqing Ma,2,* Xiaoyu Wang,1 Wenjing Wang,1 Zhu Li,1 Xiansheng Wang,1 Pengyu Wang,1 Wuzhuang Sun,1 Baojian Xue3 1Department of Respiratory Medicine, The First Hospital of Hebei Medical University, 2Department of Immunology, Hebei Medical University, Shijiazhuang, 3Life Science Research Center, Hebei North University, Zhangjiakou, People’s Republic of China *These authors contributed equally to this work Background: Chronic obstructive pulmonary disease (COPD is a progressive pulmonary disease caused by harmful gases or particles. Recent studies have shown that 2% hydrogen or hydrogen water is effective in the treatment and prevention of a variety of diseases. This study investigated the beneficial effects and the possible mechanisms of different hydrogen concentrations on COPD.Methods: A rat COPD model was established through smoke exposure methods, and inhalation of different concentrations of hydrogen was used as the intervention. The daily condition of rats and the weight changes were observed; lung function and right ventricular hypertrophy index were assessed. Also, white blood cells were assessed in bronchoalveolar lavage fluid. Pathologic changes in the lung tissue were analyzed using light microscopy and electron microscopy; cardiovascular structure and pulmonary arterial pressure changes in rats were observed using ultrasonography. Tumor necrosis factor alpha, interleukin (IL-6, IL-17, IL-23, matrix metalloproteinase-12, tissue inhibitor of metalloproteinase-1, caspase-3, caspase-8 protein, and mRNA levels in the lung tissue were determined using immunohistochemistry, Western blot, and real-time polymerase chain reaction.Results: The results showed that hydrogen inhalation significantly reduced the number of inflammatory cells in the bronchoalveolar lavage fluid, and the mRNA and protein expression levels of tumor necrosis factor alpha, IL-6, IL-17, IL-23, matrix metalloproteinase-12, caspase-3, and caspase-8, but

  12. Referral to palliative care in COPD and other chronic diseases: A population-based study

    NARCIS (Netherlands)

    Beernaert, K.; Cohen, J.; Deliens, L.; Devroey, D.; Vanthomme, K.; Pardon, K.; Block, L.

    2013-01-01

    Aim To describe how patients with COPD, heart failure, dementia and cancer differ in frequency and timing of referral to palliative care services. Methods We performed a population-based study with the Sentinel Network of General Practitioners in Belgium. Of 2405 registered deaths respectively 5%,

  13. Whole-body vibration improves functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease (COPD: a pilot study

    Directory of Open Access Journals (Sweden)

    Braz Júnior DS

    2015-01-01

    Full Text Available Donato S Braz Júnior, Arméle Dornelas de Andrade, Andrei S Teixeira, Cléssyo A Cavalcanti, André B Morais, Patrícia EM Marinho Department of Physical Therapy, Cardiopulmonary Physical Therapy Laboratory, Universidade Federal de Pernambuco, Recife, Brazil Background: Exercise intolerance is a common development in patients with chronic obstructive pulmonary disease (COPD. There is little data on the use of an isolated program using vibration platform training on functional capacity in these patients, which is an area that deserves investigation.Aim: To investigate the effect of training on a vibrating platform (whole-body vibration [WBV] on functional performance and quality of life of subjects with COPD.Methods: A randomized controlled crossover pilot study with eleven subjects with COPD (forced expiratory volume in 1 second [FEV1]% predicted =14.63±11.14; forced vital capacity [FVC]% predicted =48.84±15.21; FEV1/FVC =47.39±11.63 underwent a 12-week WBV training program. Participants were randomized into the intervention group (IG undergoing three sessions per week for a total of 12 weeks and control group (CG without intervention. We evaluated the 6-minute walk test (6MWT, distance walked (DW, duration of the walk (TW, and index of perceived exertion (IPE, quality of life using St George’s Respiratory Questionnaire (SGRQ and developed a 12-week program of training on a vibrating platform.Results: The mean age was 62.91±8.82 years old (72.7% male. The DW increased at the end of training with a difference between groups of 75 m; all domains of the SGRQ improved at the end of training. The effect size Cohen’s d ranged from small to large for all the measured results.Conclusion: These preliminary results suggest that WBV may potentially be a safe and feasible way to improve functional capacity in the 6MWT of patients with COPD undergoing a training program on the vibrating platform as well as in all domains of the SGRQ quality of life

  14. Overdiagnosis of COPD in hospitalized patients

    Directory of Open Access Journals (Sweden)

    Spero K

    2017-08-01

    Full Text Available Kerry Spero,1 Ghiath Bayasi,2 Linda Beaudry,3 Kimberly R Barber,4 Fahim Khorfan2 1Department of Medical Education, Genesys Regional Medical Center, Grand Blanc, 2Department of Pulmonary and Critical Care Medicine, Michigan State University, East Lansing, 3Department of Respiratory Therapy, 4Department of Research, Genesys Regional Medical Center, Grand Blanc, MI, USA Background: The diagnosis of chronic obstructive pulmonary disease (COPD is usually made based on history and physical exam alone. Symptoms of dyspnea, cough, and wheeze are nonspecific and attributable to a variety of diseases. Confirmatory testing to verify the airflow obstruction is available but rarely used, which may result in substantial misdiagnoses of COPD. The aim of this study is to evaluate the use of confirmatory testing and assess the accuracy of the diagnosis. Methods: From January 2011 through December 2013, 6,018 patients with COPD as a principal or leading diagnosis were admitted at a community teaching hospital. Of those, only 504 (8.4% patients had spirometry performed during hospitalization. The studies were reviewed by two board-certified pulmonologists to verify presence of persistent airflow obstruction. Charts of these patients were then examined to determine if the spirometry results had changed the diagnosis or the treatment plan for these patients. Results: Spirometry confirmed the diagnosis of COPD in 270 patients (69.2% treated as COPD during their hospitalization. Restrictive lung disease was found to be present in 104 patients (26.6% and normal in 16 patients (4.2%. Factors predictive of airflow obstruction included smoking status and higher pack-year history. Negative predictive factors included higher body mass index (BMI and other medical comorbidities. These patients were significantly more likely to be misdiagnosed and mistreated as COPD. Conclusion: Up to a third of patients diagnosed and treated as COPD in the hospital may be inaccurately

  15. Defective lung macrophage function in lung cancer ± chronic obstructive pulmonary disease (COPD/emphysema)-mediated by cancer cell production of PGE2?

    Science.gov (United States)

    Dehle, Francis C; Mukaro, Violet R; Jurisevic, Craig; Moffat, David; Ahern, Jessica; Hodge, Greg; Jersmann, Hubertus; Reynolds, Paul N; Hodge, Sandra

    2013-01-01

    In chronic obstructive pulmonary disease (COPD/emphysema) we have shown a reduced ability of lung and alveolar (AM) macrophages to phagocytose apoptotic cells (defective 'efferocytosis'), associated with evidence of secondary cellular necrosis and a resultant inflammatory response in the airway. It is unknown whether this defect is present in cancer (no COPD) and if so, whether this results from soluble mediators produced by cancer cells. We investigated efferocytosis in AM (26 controls, 15 healthy smokers, 37 COPD, 20 COPD+ non small cell lung cancer (NSCLC) and 8 patients with NSCLC without COPD) and tumor and tumor-free lung tissue macrophages (21 NSCLC with/13 without COPD). To investigate the effects of soluble mediators produced by lung cancer cells we then treated AM or U937 macrophages with cancer cell line supernatant and assessed their efferocytosis ability. We qualitatively identified Arachidonic Acid (AA) metabolites in cancer cells by LC-ESI-MSMS, and assessed the effects of COX inhibition (using indomethacin) on efferocytosis. Decreased efferocytosis was noted in all cancer/COPD groups in all compartments. Conditioned media from cancer cell cultures decreased the efferocytosis ability of both AM and U937 macrophages with the most pronounced effects occurring with supernatant from SCLC (an aggressive lung cancer type). AA metabolites identified in cancer cells included PGE2. The inhibitory effect of PGE2 on efferocytosis, and the involvement of the COX-2 pathway were shown. Efferocytosis is decreased in COPD/emphysema and lung cancer; the latter at least partially a result of inhibition by soluble mediators produced by cancer cells that include PGE2.

  16. COPD: balancing oxidants and antioxidants

    Science.gov (United States)

    Fischer, Bernard M; Voynow, Judith A; Ghio, Andrew J

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most common chronic illnesses in the world. The disease encompasses emphysema, chronic bronchitis, and small airway obstruction and can be caused by environmental exposures, primarily cigarette smoking. Since only a small subset of smokers develop COPD, it is believed that host factors interact with the environment to increase the propensity to develop disease. The major pathogenic factors causing disease include infection and inflammation, protease and antiprotease imbalance, and oxidative stress overwhelming antioxidant defenses. In this review, we will discuss the major environmental and host sources for oxidative stress; discuss how oxidative stress regulates chronic bronchitis; review the latest information on genetic predisposition to COPD, specifically focusing on oxidant/antioxidant imbalance; and review future antioxidant therapeutic options for COPD. The complexity of COPD will necessitate a multi-target therapeutic approach. It is likely that antioxidant supplementation and dietary antioxidants will have a place in these future combination therapies. PMID:25673984

  17. Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease.

    Science.gov (United States)

    Bajc, M; Chen, Y; Wang, J; Li, X Y; Shen, W M; Wang, C Z; Huang, H; Lindqvist, A; He, X Y

    2017-01-01

    Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. 94 COPD patients (aged 43-86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I-IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry. Signs of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages (r=0.63 and -0.60, respectively, PV/P SPECT identified pulmonary embolism in 30 patients (32%). A pattern typical for heart failure was present in 26 patients (28%). Parenchymal changes typical for pneumonia or lung tumor were present in several cases. V/P SPECT, using Technegas as the functional ventilation imaging agent, is a new tool to diagnose COPD and to grade its severity. Additionally, it revealed heterogeneity of COPD caused by pulmonary comorbidities. The characteristics of these comorbidities suggest their significant impact in clarifying symptoms, and also their influence on the prognosis.

  18. Presentation PICASSO for COPD: a Dutch national COPD optimisation platform

    Science.gov (United States)

    Noorlander, Therese

    2008-01-01

    Context A major problem preventing effective counteracting of the projected rise in the burden of COPD is the insufficient awareness of, and nihilism towards this disabling disease among all stakeholders, i.e. general public, patients, healthcare professionals and healthcare payers. Reasons behind this vary from unawareness of the disease by the general public; poor recognition of symptoms as well as underpresentation by patients who simply attribute their symptoms to a mix of smoking and ageing [1] and poor knowledge of the disease among healthcare givers, who overlook symptoms and fail to diagnose the disease, sometimes only until it has considerably progressed. Furthermore at present there is no appreciation of the burden of disease by healthcare payers and finally there is insufficient awareness of the current magnitude of the problem with politicians and especially about the projected rise in morbidity and mortality of COPD [2]. Purpose The current nihilism is a great barrier towards structural improvement of COPD management. So it is important to identify the treatable elements of the disease, to further document and make known and understand that those can be treated, and to make interventions measurable and implementable for the relevant stakeholder groups. Description PICASSO for COPD is a national platform for COPD care optimisation and combines knowledge, experience and resources to support new and existing COPD projects, and stimulates the interaction between these initiatives. After 5 years of working within the field of COPD we have interesting data together with knowledge and structures for improving COPD care. Note: A selection of this abstract was also published as: van Schayck CP, Bindels PJE, Decramer M, Dekhuijzen PNR, Kerstjens HAM, Muris JWM, et al. Marking COPD a treatable disease: an integrated care perspective. Respiratory Medicine 2007 COPD update

  19. Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

    Science.gov (United States)

    Lopez-Campos, Jose Luis; Asensio-Cruz, M Isabel; Castro-Acosta, Ady; Calero, Carmen; Pozo-Rodriguez, Francisco

    2014-01-01

    Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in

  20. The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review.

    Science.gov (United States)

    Schuetz, Philipp; Marlowe, Robert J; Mueller, Beat

    2015-03-01

    Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.

  1. Vitamin D should be supplemented more actively in elderly patients with coronary heart disease combined with COPD

    Directory of Open Access Journals (Sweden)

    Zhang L

    2016-06-01

    Full Text Available Ling Zhang,1 Qiao-ying Yuan2 1Department of Out-patient Clinic, 2Department of Nutriology, Southwest Hospital, The Third Military Medical University, Chongqing, People’s Republic of China Objective: It is not clear whether vitamin D should be actively supplemented in elderly patients suffering from an acute attack of COPD (AECOPD and coronary heart disease (CHD. Patients and methods: The patients were divided into three groups according to specific criteria: patients with AECOPD (group A, patients with COPD combined with CHD (group B, and patients with CHD (group C. We measured the levels of vitamin D and analyzed the correlation between vitamin D and important electrolytes, including prealbumin, creatinine, hemoglobin, cystatin C, blood fat, blood calcium, and blood magnesium, and the nutrition state of the whole body. The serum B-type natriuretic peptide (BNP was measured using an ELISA kit. Results: The vitamin D level in group B was the lowest, followed by group A. When compared with group C, they all had statistical significance (P<0.05, but there was no statistical difference between groups A and B. There was no difference among the three groups when prealbumin, creatinine, hemoglobin, cystatin C, blood fat, blood calcium, and blood magnesium were compared. The level of BNP in the three groups increased, but it had no obvious correlation with the level of vitamin D (P>0.05. Conclusion: When elderly patients have coronary artery disease with AECOPD, vitamin D levels were obviously lower and were negatively correlated with the BNP. Low vitamin D levels, as well as poor nutrition, affect cardiopulmonary function and quality of living of elderly patients, especially female patients. Therefore, vitamin D should be supplemented more actively in the female patients suffering from AECOPD and CHD. Keywords: COPD, CHD, cardiac function, vitamin D, nutrition

  2. Measurement of exhaled volatile organic compounds from patients with chronic obstructive pulmonary disease (COPD) using closed gas loop GC-IMS and GC-APCI-MS.

    Science.gov (United States)

    Allers, M; Langejuergen, J; Gaida, A; Holz, O; Schuchardt, S; Hohlfeld, J M; Zimmermann, S

    2016-04-08

    Due to its high sensitivity, compact size and low cost ion mobility spectrometry (IMS) has the potential to become a point-of-care breath analyzer. Therefore, we developed a prototype of a compact, closed gas loop IMS with gas chromatographic (GC) pre-separation and high resolving power of R  =  90. In this study, we evaluated the performance of this GC-IMS under clinical conditions in a COPD study to find correlations between VOCs (10 ppbv to 1 ppmv) and COPD. Furthermore, in order to investigate possible correlations between ultra-low concentrated breath VOCs (0.1 pptv to 1 ppbv) and COPD, a modified mass spectrometer (MS) with atmospheric pressure chemical ionization (APCI) and GC pre-separation (GC-APCI-MS) was used. The GC-IMS has been used in 58 subjects (21 smokers with moderate COPD, 12 ex-smokers with COPD, 16 healthy smokers and 9 non-smokers). GC-APCI-MS data were available for 94 subjects (21 smokers with moderate COPD, 25 ex-smokers with COPD, 25 healthy smokers and 23 non-smokers). For 44 subjects, a comparison between GC-IMS and GC-APCI-MS data could be performed. Due to service intervals, subject availability and corrupt data, patient numbers were different for GC-APCI-MS and GC-IMS measurements. Using GC-IMS, three VOCs have been found showing a significant difference between healthy controls and patients with COPD. In the GC-APCI-MS data, we only observed one distinctive VOC, which has been identified as 2-pentanone. This proof-of-principle study shows the potential of our high-resolution GC-IMS in the clinical environment. Due to different linear dynamic response ranges, the data of GC-IMS and GC-APCI-MS were only comparable to a limited extent.

  3. Stage 1 development of a patient-reported experience measure (PREM) for chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Walker, Susan; Andrew, Sharon; Hodson, Matthew; Roberts, C Michael

    2017-07-24

    chronic lung disease will help develop a new patient reported experience scale. Healthcare services are aiming to provide effective patient-centered care for those with chronic obstructive pulmonary disease (COPD). Such care strategies require structured, validated patient feedback scales to facilitate accurate communication between patients, carers and healthcare professionals. Susan Walker at Anglia Ruskin University in Chelmsford, UK, and co-workers analyzed qualitative data from interviews with 64 COPD patients in London and Essex regarding their emotions and perceptions of living with COPD, with the aim of creating a patient reported experience measure, or PREM. Initial results identified five themes-including 'journey to diagnosis' and 'everyday life'-and twenty-one affective responses, ranging from negative to positive. The team will take these results forward for further validation.

  4. Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis.

    Science.gov (United States)

    Rothnie, Kieran J; Yan, Ruoling; Smeeth, Liam; Quint, Jennifer K

    2015-09-11

    Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD. Systematic review and meta-analysis. MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible. Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40). There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD.

    Science.gov (United States)

    Miravitlles, Marc; García-Sidro, Patricia; Fernández-Nistal, Alonso; Buendía, María Jesús; Espinosa de Los Monteros, María José; Esquinas, Cristina; Molina, Jesús

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) exacerbations have a negative impact on the quality of life of patients and the evolution of the disease. We have investigated the prognostic value of several health-related quality of life questionnaires to predict the appearance of a composite event (new ambulatory or emergency exacerbation, hospitalization, or death) over a 1-year follow-up. This was a multicenter, prospective, observational study. Patients completed four questionnaires after recovering from an exacerbation (COPD Assessment Test [CAT], a Clinical COPD Questionnaire [CCQ], COPD Severity Score [COPDSS], and Airways Questionnaire [AQ20]). Patients were followed-up until the appearance of the composite event or for 1 year, whichever came first. A total of 497 patients were included in the study. The majority of them were men (89.7%), with a mean age of 68.7 (SD 9.2) years, and a forced expiratory volume in 1 second of 47.1% (SD 17.5%). A total of 303 (61%) patients experienced a composite event. Patients with an event had worse mean scores of all questionnaires at baseline compared to patients without event: CAT=12.5 vs 11.3 (P=0.028); CCQ=2.2 vs 1.9 (P=0.013); COPDSS=12.3 vs 10.9 (P=0.001); AQ20=8.3 vs 7.5 (P=0.048). In the multivariate analysis, only previous history of exacerbations and CAT score ≥13.5 were significant risk factors for the composite event. A CAT score ≥13.5 increased the predictive value of previous exacerbations with an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.829-0.899; P=0.001). The predictive value of previous exacerbations significantly increased only in one of the four trialled questionnaires, namely in the CAT questionnaire. However, previous history of exacerbations was the strongest predictor of the composite event.

  6. Validity and Usability of Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease (COPD)

    OpenAIRE

    Tobias Boeselt; Marc Spielmanns; Christoph Nell; Jan Hendrik Storre; Wolfram Windisch; Lena Magerhans; Bjoern Beutel; Klaus Kenn; Timm Greulich; Peter Alter; Claus Vogelmeier; Andreas Rembert Koczulla

    2016-01-01

    Background A large proportion of COPD patients do not achieve the recommended level of physical activity. It is suggested that feedback on the level of activity by using an activity monitoring device (PAM) increases awareness and may stimulate patients to increase their physical activity in daily life. Our objective was to assess the validity and usability of a simple and low-cost physical activity monitor (Polar A300?) when compared with the validated and established Bodymedia-SenseWear? (SW...

  7. Budesonide/formoterol combination in COPD: a US perspective

    Directory of Open Access Journals (Sweden)

    Amir Sharafkhaneh

    2010-10-01

    Full Text Available Amir Sharafkhaneh1,2, Amarbir S Mattewal1, Vinu M Abraham1, Goutham Dronavalli1, Nicola A Hanania11Section of Pulmonary, Critical Care Medicine and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; 2Section of Pulmonary, Critical Care Medicine and Sleep Medicine, Medical Care Line, Michael E DeBakey VA Medical Center, Houston, Texas, USAAbstract: Chronic obstructive pulmonary disease (COPD is a preventable and treatable disease of the lung caused primarily by exposure to cigarette smoke. Clinically, it presents with progressive cough, sputum production, dyspnea, reduced exercise capacity, and diminished quality of life. Physiologically, it is characterized by the presence of partially reversible expiratory airflow limitation and hyperinflation. Pathologically, COPD is a multicomponent disease characterized by bronchial submucosal mucous gland hypertrophy, bronchiolar mucosal hyperplasia, increased luminal inflammatory mucus, airway wall inflammation and scarring, and alveolar wall damage and destruction. Management of COPD involves both pharmacological and nonpharmacological approaches. Bronchodilators and inhaled corticosteroids are recommended medications for management of COPD especially in more severe disease. Combination therapies containing these medications are now available for the chronic management of stable COPD. The US Food and Drug Administration, recently, approved the combination of budesonide/formoterol (160/4.5 µg; Symbicort™, AstraZeneca, Sweden delivered via a pressurized meter dose inhaler for maintenance management of stable COPD. The combination also is delivered via dry powder inhaler (Symbicort™ and Turbuhaler™, AstraZeneca, Sweden but is not approved for use in the United States. In this review, we evaluate available data of the efficacy and safety of this combination in patients with COPD.Keywords: inhaled steroid, bronchodilator, ß2-agonist, lung function, quality of life

  8. Chronic obstructive pulmonary disease self-management activation research trial (COPD-SMART): design and methods.

    Science.gov (United States)

    Ashmore, Jamile; Russo, Rennie; Peoples, Jennifer; Sloan, John; Jackson, Bradford E; Bae, Sejong; Singh, Karan P; Blair, Steven N; Coultas, David

    2013-07-01

    Treatment of COPD requires multiple pharmacological and non-pharmacological intervention strategies. One target is physical inactivity because it leads to disability and contributes to poor physical and mental health. Unfortunately, less than 1% of eligible patients have access to gold-standard pulmonary rehabilitation. A single-site parallel group randomized trial was designed to determine if a self-management lifestyle physical activity intervention would improve physical functioning and dyspnea. During the first six weeks after enrollment patients receive COPD self-management education delivered by a health coach using a workbook and weekly telephone calls. Patients are then randomized to usual care or the physical activity intervention. The 20 week physical activity intervention is delivered by the health coach using a workbook supported by alternating one-on-one telephone counseling and computer assisted telephone calls. Theoretical foundations include social cognitive theory and the transtheoretical model. Primary outcomes include change in Chronic Respiratory Questionnaire (CRQ) dyspnea domain and 6-minute walk distance measured at 6-, 12-, and 18-months after randomization. Secondary outcomes include other CRQ domains (fatigue, emotion, and mastery), SF-12, and health care utilization. Other measures include process outcomes and clinical characteristics. This theory driven self-management lifestyle physical activity intervention is designed to reach patients unable to complete center-based pulmonary rehabilitation. Results will advance knowledge and methods for dissemination of a potentially cost-effective program for patients with COPD. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Detection of COPD in a high-risk population

    DEFF Research Database (Denmark)

    Kjeldgaard, Peter; Dahl, Ronald; Løkke, Anders

    2015-01-01

    BACKGROUND: Underdiagnosis of chronic obstructive pulmonary disease (COPD) is widespread. Early detection of COPD may improve the outcome by timely smoking cessation, a change in lifestyle, and treatment with an inhaled bronchodilator (BD). The objective of this study was to evaluate the diagnostic...... role of BD reversibility testing in early COPD case finding. METHODS: General practitioners (n=241) consecutively recruited subjects aged ≥35 years with relevant exposure (history of smoking, and/or occupational exposure) and at least one respiratory symptom. Information on age, smoking status, body.......20 L and >12%. Asthma and COPD were, respectively, defined as an FEV1 increase >0.50 L and a post-BD FEV1/FVC

  10. Results of an outpatient multidisciplinary COPD rehabilitation programme obtained in two settings: primary and secondary health care

    DEFF Research Database (Denmark)

    Vest, Susanne; Moll, Lill; Petersen, Marelis

    2011-01-01

    There is limited experience with implementation of chronic obstructive pulmonary disease (COPD) rehabilitation in primary care settings. We aimed to evaluate the implementation of a COPD rehabilitation programme in a primary care setting and compare the effects with those obtained in a secondary...

  11. Evaluation of the relationship between WBC, HS.CRP and secondary pulmonary hypertension in patients with COPD

    Directory of Open Access Journals (Sweden)

    Khalil Ansarin

    2014-01-01

    Full Text Available Background: Inflammatory mechanisms appear to play a major role in pathogenesis of various types of pulmonary hypertension such as idiopatic PAH (iPAH. Although inflammatory factors such as IL6 and TNFa play an important role in IPAH, there is limited information about the relationship between acute phase reactants and pulmonary hypertension occurring secondary to pulmonary diseases such as chronic obstructive pulmonary diseases (COPD. Methods: This cross-sectional study was carried out on 94 patients with COPD. Patients with a recent history of systemic corticosteroid use, infection, trauma or surgery, and gastrointestinal bleeding were excluded. Body plethysmography and transthoracic echocardiography were performed. Blood samples were taken from all patients and sent for complete blood count (CBC and hsCRP tests. Results: Twenty patients (28.6% had pulmonary hypertension. There was a significant difference between the mean of WBC in patients with and without pulmonary hypertension (8505 mic/lit vs. 7044 mic/lit (p=0.04. There was also a significant difference between the hs.CRP in patients with and without pulmonary hypertension (8.8pg/ml vs. 4.07pg/ml (p=0.032. After adjustment of age, sex, serum hemoglobin, hematocrit, O2sat, FEV1 and FVC, the relationship between the IL6, white blood cell count, HS.CRP and pulmonary hypertension remained significant (p=0.018, p=0.022. Conclusion: Inflammatory factors such as white blood cell and HS.CRP are independent risk factors of pulmonary hypertension in COPD patients.

  12. COPD control: Can a consensus be found?

    Directory of Open Access Journals (Sweden)

    M. Guimarães

    2016-05-01

    Full Text Available There are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of “well-controlled disease”, a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life.Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments. Keywords: COPD assessment, Control, Symptoms control, Spirometry, COPD, Treatment

  13. Directly measured secondhand smoke exposure and COPD health outcomes

    Directory of Open Access Journals (Sweden)

    Balmes John

    2006-06-01

    Full Text Available Abstract Background Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD, secondhand smoke (SHS exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. Methods We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL, and dyspnea measured at one year follow-up. Results The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9 and dyspnea (1.0 pts; 95% CI 0.4 to 1.7 after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054, disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063, and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p Conclusion Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.

  14. Gender differences in the adipose secretome system in chronic obstructive pulmonary disease (COPD): a pivotal role of leptin.

    Science.gov (United States)

    Breyer, Marie-Kathrin; Rutten, Erica P A; Vernooy, Juanita H J; Spruit, Martijn A; Dentener, Mieke A; van der Kallen, Carla; vanGreevenbroek, Marleen M J; Wouters, Emiel F M

    2011-07-01

    COPD is characterized by a multi-component character involving a state of low-grade systemic inflammation and an increased prevalence of cardiovascular co-morbidity. The role of circulating leptin and other adipokines in the involvement of the systemic inflammation in COPD is only studied scarcely. To investigate gender related differences in the adipokine metabolism in relation to systemic inflammatory biomarkers in clinically stable subjects with COPD. In total, 91 clinically stable COPD patients and 35 healthy control subjects, matched for body mass index (BMI) with the COPD subjects, were included. Lung function measurement and body composition were performed in patients with COPD. In the total group, plasma concentration of the adipokines (leptin, adiponectin and resistin) and systemic inflammatory biomarkers C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor α (TNFα), and its soluble receptors 55 and 75 (sTNFα-R55, R75) were analyzed. The COPD group was characterized by increased levels of CRP, IL-6 and leptin. Plasma adiponectin and resistin concentrations were not different between the COPD and the control group. Within the COPD group, there was a significant interaction between gender and BMI on the leptin/fat mass ratio. In COPD women, a significant correlation between leptin and CRP was present. In men with clinically stable COPD, leptin, adiponectin and resistin appear to be physiologically regulated, while in women, leptin metabolism is altered. Leptin secretion is increased in COPD women when compared to healthy women and compared to COPD men, and to a greater extent in overweight women with COPD. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. The development and pilot testing of the Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD

    Directory of Open Access Journals (Sweden)

    Apps LD

    2013-07-01

    Full Text Available Lindsay D Apps,1 Katy E Mitchell,1 Samantha L Harrison,1 Louise Sewell,1 Johanna E Williams,1 Hannah ML Young,1 Michael Steiner,1 Mike Morgan,1 Sally J Singh1,2 1National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS, Leicester, UK; 2Applied Research Centre, Health and Lifestyle Interventions, Coventry University, Coventry, UK Purpose: There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD. The aim of this project was to develop and test a novel self-management manual for individuals with COPD. Patients: Participants with a confirmed diagnosis of COPD were recruited from primary care. Methods: A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24 during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT; measurements were taken at baseline and 6 weeks. Results: The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23–1.11, P = 0.005. ESWT score increased by 302.25 seconds (95% confidence interval 161.47–443.03, P < 0.001. Conclusion: This article describes the development and

  16. 013. Complementary role of 6-minutes walking test (6MWT) in the assessment of functional status of patients with chronic obstructive pulmonary disease (COPD)

    Science.gov (United States)

    Mathioudakis, Alexander G.; Evangelopoulou, Efstathia I.; Karapiperis, Georgios C.; Perros, Elias I.; Simou, Georgia; Kiritsi, Evridiki; Chatzimavridou-Grigoriadou, Victoria; Mathioudakis, Georgios A.

    2015-01-01

    Background Despite its limited repeatability, spirometry is the most widely used method of assessment of the pulmonary ventilation. However, it is not a safe measure of the functional reserve of chronic obstructive pulmonary disease (COPD) patients with multiple comorbidities. Consequently, a stress test that would include cardiovascular and neuromuscular variables would be a useful complimentary test. Objective The aim of this observational study was to investigate the correlation between FEV1 and 6MWT, in patients with stable COPD (mean FEV1% pred =43.9%, SD =15.3). Methods 174 male ex-smokers with stable COPD, with a mean age of 63±6.7 years, mean height of 171.4 and weight of 73.9 were included and grouped according to their GOLD severity staging. A control group consisting of 87 healthy volunteers (mean age: 64±6.2, height: 175.2 and weight: 70.5) was also included. All the patient and controls had spirometry before and after bronchodilatation, on a daily scaled turbine spirometer, and 6MWT, on a 10-meter straight corridor. Elapsed distance (eD), haemoglobin saturation (Sats) and heart rate (HR) were continuously monitored during the 6MWT. All the data of our study were imported in an excel sheet for statistical analysis. Results Among the main results of our study, FEV1 decrease by year of age was less pronounced among healthy volunteers (21 mL/year, r2=0.4) compared to COPD patients (53 mL/year, r2=0.06). Similarly, volunteers had a significantly lower decrease by year of age in eD (2.3 m/year, r2=0.4) compared to COPD patients (7.7 m/year, r2=0.7). A more pronounced decrease of eD by year of age was recognized in patients with later COPD stages, while weight was more significantly correlated to eD compared to age. Post-bronchodilatation FEV1 was correlated to eD in COPD patients (r2=0.7); for each 1% decrease in the FEV1, COPD patients also lose approximately 7 m of walking distance in 6MWT. Conclusions 6MWT is a reliable measure of COPD progression and

  17. A new quantitative index of lobar air trapping in chronic obstructive pulmonary disease (COPD): Comparison with conventional methods

    Energy Technology Data Exchange (ETDEWEB)

    Nagatani, Yukihiro, E-mail: yatsushi@belle.shiga-med.ac.jp [Department of Radiology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 (Japan); Murata, Kiyoshi; Takahashi, Masashi; Nitta, Norihisa [Department of Radiology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 (Japan); Nakano, Yasutaka [Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 (Japan); Sonoda, Akinaga; Otani, Hideji [Department of Radiology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 (Japan); Okabe, Hidetoshi [Department of Clinical Laboratory, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 (Japan); Ogawa, Emiko [Health Administration Center, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga 520-2192 (Japan)

    2015-05-15

    Highlights: • In the total lung field, AVI had excellent correlation with FEV{sub 1}/FVC. • AVI showed differences between three groups classified by the COPD severity. • In a lobe-based analysis, AVI did not mostly correlated with volume decrease ratio. • In a lobe-based analysis, coefficient of variation was relatively small in AVI. • In some lobes, AVI associated with the COPD severity despite respiratory level. - Abstract: Purpose: To determine the usefulness of newly-proposed index (attenuation–volume index, AVI: increase in mean value of lung attenuation (MVLA) divided by volume decrease ratio (VDR)) for quantitative assessment of lobar air trapping (LAT) using expiratory/inspiratory (E/I) computed tomography (CT) by minimizing influence of respiratory level. Materials and methods: Institutional review board approved study protocol. Twenty-one moderate or severe COPD (group A), 16 mild COPD (group B) and 26 normal volunteers (group C) underwent both E/I scans via 320-row CT and pulmonary functional test (PFT). Volume image data were automatically segmented into six lung lobes with minimal manual intervention. AVI, pixel index (PI), air trapping ratio (ATR) and relative volume change (RVC{sub 860–950}) were calculated in total lung (TL) and each lobe. Four indices in TL were correlated with both PFT result and VDR and those in TL and each lobe were compared between three groups. Results: Similar to ATR, AVI correlated with both FEV{sub 1}/FVC (r = 0.772, p < 0.01) and RV/TLC (r = −0.726, p < 0.01) and demonstrated a significant difference between three groups in both TL (group A: 1.69 ± 0.45, group B: 2.21 ± 0.45 and group C: 2.80 ± 0.44) and five lobes except for left lingular segment. In a lobe-based analysis regarding relationship with VDR, AVI was much less dependent than ATR, although regression lines of groups A and C were separated for AVI as well as ATR. Coefficient of variation of either PI or RVC{sub 860–950} was significantly

  18. Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD

    National Research Council Canada - National Science Library

    Rai, Kiran K; Jordan, Rachel E; Siebert, W Stanley; Sadhra, Steven S; Fitzmaurice, David A; Sitch, Alice J; Ayres, Jon G; Adab, Peymané

    2017-01-01

    ...: Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. Methods...

  19. Validity and Usability of Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Boeselt, Tobias; Spielmanns, Marc; Nell, Christoph; Storre, Jan Hendrik; Windisch, Wolfram; Magerhans, Lena; Beutel, Bjoern; Kenn, Klaus; Greulich, Timm; Alter, Peter; Vogelmeier, Claus; Koczulla, Andreas Rembert

    2016-01-01

    A large proportion of COPD patients do not achieve the recommended level of physical activity. It is suggested that feedback on the level of activity by using an activity monitoring device (PAM) increases awareness and may stimulate patients to increase their physical activity in daily life. Our objective was to assess the validity and usability of a simple and low-cost physical activity monitor (Polar A300™) when compared with the validated and established Bodymedia-SenseWear™ (SWA) device. To assess the diagnostic equivalent, two different PAM devices were used in parallel in 20 COPD patients GOLD I to IV during 3 consecutive days of daily life. Both systems were compared in terms of steps, calories burned, daily activity time and metabolic equivalents using linear regression analysis and Bland-Altman plots. Practical usability was examined by a 16-item-questionnaire. High correlations of both devices were observed with regard to the sensed step count (r = 0.96; p < 0.01) and calories burned (r = 0.74; p < 0.01), and a lower correlation of daily activity (r = 0.25; p < 0.01) was found. Data analysis over 3 days showed that 90% of the steps (95% CI -4223 to 1887), 100% of the calories (95% CI -2798 to 1887), 90% of the daily activity data (95% CI -12.32, 4065) and 95% of the MET (95% CI -3.11 to 2.75) were within the limits of agreement. A favorable usability (system-, information- and interface quality) of the A300™ device was shown (p < 0.01). The A300™ device with easy practical usability was shown not to be inferior for assessment of physical activity time, step count and calorie consumption in COPD patients when compared with the SWA. It is suggested to consider widespread available devices as commonly used for monitoring recreational sporting activities also in patients for assessment of physical activity in daily life.

  20. Relationship of airway dimensions with airflow limitation or lung volumes in chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Masaru Hasegawa

    2006-12-01

    Full Text Available We have recently developed new software to obtain longitudinal images and accurate short axis images of airways with an inner diameter > 2 mm located anywhere in the lung, using curved multiplanar reconstruction. Using this software, we demonstrated in patients with COPD that FEV1 (%predicted was highly correlated with airway dimensions and the correlation coefficients improved as the airway became smaller in size (3. In this study, our aims are to further confirm the significant relationship between airway dimensions and airflow limitation in larger number of subjects, and to examine the relationship of airway dimensions with lung volumes in 95 patients with COPD (stage 0, 10; stage I, 23; stage II, 35; stage III, 24; stage IV, 3. We analyzed the airway dimensions from the 3rd to the 6th generations of the apical bronchus (B1 of the right upper lobe and the anterior basal bronchus (B8 of the right lower lobe. Lung volumes were measured by the helium closed circuit method. Both airway luminal area (Ai and wall area percent (WA% of all the generations, except a few, from the two bronchi were significantly correlated with RV and RV/TLC, but not with TLC or FRC. More importantly, the correlation coefficients (r between airway dimensions and RV/TLC improved as the airways became smaller in size from the 3rd to 6th generations in both bronchi (r = –0.483, –0482, –0.553, –0.624 for Ai of B8; r = 0.316, 0.380, 0.499, 0.551 for WA% of B8. These findings provide further evidence that distal (small airways rather than proximal (large airways are the determinants for airflow limitation in COPD.

  1. Managing Your COPD Medications

    Science.gov (United States)

    ... Lookup > COPD > Diagnosing and Treating COPD Managing Your COPD Medications There are a range of treatment options ... each use . Types of medicines often prescribed for COPD: Bronchodilator Bronchodilators relax the muscles around the airways ...

  2. INDOOR AND OUTDOOR SOURCE CONTRIBUTIONS TO PERSONAL PM2.5 FOR A PANEL OF INDIVIDUALS WITH CARDIOVASCULAR DISEASE OR COPD LIVING IN BOSTON, MA

    Science.gov (United States)

    Repeated personal, home indoor, home outdoor, and ambient particulate and gaseous pollutant levels were characterized for individuals with cardiovascular disease or COPD and their partners living in the Boston area. Health status was determined by self-reported history of myoc...

  3. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT.

    Science.gov (United States)

    Jögi, Jonas; Ekberg, Marie; Jonson, Björn; Bozovic, Gracijela; Bajc, Marika

    2011-07-01

    Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV(1)). FEV(1) does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV(1), symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD. Thirty patients with stable COPD were evaluated with the Medical Research Council dyspnoea questionnaire (MRC) and the clinical COPD questionnaire (CCQ). Spirometry was performed. The extent of emphysema was assessed using HRCT. V/P SPECT was used to assess V/P patterns, total reduction in lung function and degree of obstructive disease. The total reduction in lung function and degree of obstructive disease, assessed with V/P SPECT, significantly correlated with emphysema extent (r = 0.66-0.69, p emphysema extent and spirometric lung function was weaker. No correlation between MRC, CCQ and objective measurements was found. V/P SPECT is sensitive to early changes in COPD. V/P SPECT also has the possibility to identify comorbid disease. V/P SPECT findings show a significant correlation with emphysema extent and spirometric lung function. We therefore recommend that scintigraphic signs of COPD, whenever found, should be reported. V/P SPECT can also be used to categorize the severity of functional changes in COPD as mild

  4. Embolization of a Bronchial Artery Aneurysm in a Chronic Obstructive Pulmonary Disease (COPD) Patient with Non-Massive Hemoptysis.

    Science.gov (United States)

    Salamone, Ignazio; Cavallaro, Marco; Visalli, Carmela; Velo, Mariano; Barbaro, Ugo; Galletta, Karol; Andò, Filippo

    2017-01-01

    Bronchial artery aneurysm (BAA) is a rare condition with a reported prevalence of less than 1% of all selective bronchial arterial angiograms. Despite its low incidence, BAA represents a potential cause of hemoptysis. We describe the case of a 63-year-old man suffering from chronic obstructive pulmonary disease (COPD), who presented with non-massive hemoptysis. CT angiography revealed a single bronchial artery aneurysm of 9 mm in diameter, abutting the esophageal wall. Other CT findings included hypertrophy of the bronchial arteries along the mediastinal course, diffuse thickening of the walls of numerous bronchial branches and a "ground glass" opacity in the anterior segment of the right upper pulmonary lobe suggestive of alveolar hemorrhage. The final diagnosis was established based on selective angiography, which was followed by transcatheter arterial embolization (TAE) of the BAA and of the pathological bronchial circulation. Follow-up CT scans revealed a total exclusion of the aneurysm from the systemic circulation, resolution of the parenchymal "ground glass" opacity and absence of further episodes of hemoptysis over a period of two years. An incidental finding of a bronchial artery aneurysm necessitates prompt treatment. CT angiography and TAE represent the methods of choice for an appropriate diagnosis and treatment, respectively. In case of a BAA associated with chronic inflammatory diseases, such as COPD, in patients with hemoptysis, TAE of the BAA and of the pathological bronchial circulation, in association with the treatment of the underlying disease, represents a valid approach that can improve the pulmonary status and prevent further episodes of hemoptysis.

  5. Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD outpatients

    Directory of Open Access Journals (Sweden)

    Siafakas Nikolaos

    2010-04-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients. Methods The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20, Spielberger Trait Anxiety Inventory (STAI, and Beck Depression Inventory (BDI, respectively. Results The mean BDI score was 12.88 (SD: 7.7, mean STAI score 41.8 (SD: 11.0 and mean TAS-20 score 48.2 (SD: 11.5. No differences were observed between genders regarding age and alexithymia (t test P > 0.05, while female patients presented higher depression and trait anxiety scores than males (t test P P Conclusions This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients.

  6. Risk of empyema in patients with COPD

    Directory of Open Access Journals (Sweden)

    Lu HY

    2018-01-01

    Full Text Available Hsueh-Yi Lu,1 Kuang-Ming Liao2 1Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, 2Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan Objective: Pneumonia is one of the most common infectious diseases in patients with COPD. The risk of empyema in COPD is controversial, and its incidence has not been reported. The aim of our study was to determine the risk of empyema in COPD patients and to assess its risk factors. Patients and methods: We used the National Health Insurance Research Database in Taiwan to conduct an observational cohort study. This study analyzed patients who were diagnosed with COPD between January 1, 2003 and December 31, 2009. The earliest date of COPD diagnosis was designated the index date. Patients who were younger than 40 years or had empyema before the index date were excluded. Results: We analyzed 72,085 COPD patients in our study. The incidence of empyema was higher in the COPD group than in the non-COPD group (15.80 vs 4.34 per 10,000 person-years. The adjusted hazard ratio for empyema was 3.25 (95% CI =2.73–3.87 in patients with COPD compared with patients without COPD. COPD patients with only comorbidity of stroke, cancer, and chronic renal disease had adjusted hazard ratios of 1.88, 4.84, and 3.90, respectively. Conclusion: The likelihood of developing empyema is higher in patients with COPD than in those without COPD. Some comorbidities, such as stroke, cancer, and chronic renal disease, are associated with an elevated risk for empyema in COPD patients. Keywords: risk factors, empyema, COPD

  7. Czech multicenter research database of severe COPD

    Directory of Open Access Journals (Sweden)

    Novotna B

    2014-11-01

    Full Text Available Barbora Novotna,1 Vladimir Koblizek,1 Jaromir Zatloukal,2 Marek Plutinsky,3 Karel Hejduk,4 Zuzana Zbozinkova,4 Jiri Jarkovsky,4 Ondrej Sobotik,5 Tomas Dvorak,6 Petr Safranek71Department of Pneumology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, 2Department of Pulmonology, University Hospital, Palacky University, Olomouc, 3Department of Pulmonology, University Hospital, Masaryk University, Brno, 4Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, 5Department of Pulmonology, University Hospital Motol, Charles University, Praha, 6Department of Pulmonology, Hospital Bulovka, Praha, 7Department of Pulmonology, University Hospital, Charles University, Plzen, the Czech RepublicPurpose: Chronic obstructive pulmonary disease (COPD has been recognized as a heterogeneous, multiple organ system-affecting disorder. The Global Initiative for Chronic Obstructive Lung Disease (GOLD places emphasis on symptom and exacerbation management. The aim of this study is examine the course of COPD and its impact on morbidity and all-cause mortality of patients, with respect to individual phenotypes and GOLD categories. This study will also evaluate COPD real-life patient care in the Czech Republic.Patients and methods: The Czech Multicentre Research Database of COPD is projected to last for 5 years, with the aim of enrolling 1,000 patients. This is a multicenter, observational, and prospective study of patients with severe COPD (post-bronchodilator forced expiratory volume in 1 second ≤60%. Every consecutive patient, who fulfils the inclusion criteria, is asked to participate in the study. Patient recruitment is done on the basis of signed informed consent. The study was approved by the Multicentre Ethical Committee in Brno, Czech Republic.Results: The objective of this paper was to outline the methodology of this study.Conclusion: The establishment of the

  8. Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease

    Directory of Open Access Journals (Sweden)

    Bajc M

    2017-05-01

    Full Text Available M Bajc,1 Y Chen,2 J Wang,3 XY Li,4 WM Shen,4 CZ Wang,3 H Huang,2 A Lindqvist,5 XY He6 1Department of Clinical Science Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden; 2Respiratory Department, Changzheng Hospital, Shanghai, 3Respiratory Department, Xinqiao Hospital, Chongqing, 4Respiratory Department, Huadong Hospital, Shanghai, China; 5Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland; 6Suzhou University Affiliated Tumor Hospital, Wuxi, China Introduction: Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT using Technegas as the functional ventilation imaging agent.Methods: 94 COPD patients (aged 43–86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD stages I–IV were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry.Results: Signs of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages (r=0.63 and −0.60, respectively, P<0.0001. V/P SPECT identified pulmonary embolism in 30 patients (32%. A pattern typical for

  9. Drugs Used in COPD.

    Science.gov (United States)

    Plummer, Nancy; Michael, Nancy, Ed.

    This module on drugs used in chronic obstructive pulmonary disease (COPD) is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first.…

  10. Burden of COPD in Nepal

    DEFF Research Database (Denmark)

    Adhikari, Tara Ballav; Neupane, Dinesh; Kallestrup, Per

    2018-01-01

    Background: COPD is a globally significant public health problem and is the second leading cause of mortality. This study presents the health burden of COPD in Nepal using the Global Burden of Disease (GBD) study 2016 dataset. Methods: This study used the data from the GBD repository presenting...... morbidity and mortality attributed to COPD, by sex and age. In GBD 2016, due to a lack of the primary source of data in Nepal, estimations on morbidity and mortality of COPD were based on its predictive covariates. Years of life lost (YLLs) were calculated based on the cause of death estimations, applying...... age-standardized mortality rate due to COPD was decreasing for both genders, but the decline was much higher among males. Unlike the high rate of incidence among males, the age-standardized DALYs were found to be high among females (2,274.9 [95% UI: 1,702.0-2,881.5] per 100,000). YLLs contributed...

  11. Occupational Therapy intervention for patiens with COPD, Rehabilitation at home

    DEFF Research Database (Denmark)

    Larsen, Stina Meyer; Petersen, Anne Karin

    Describe and demonstrate Occupational Therapy (OT) intervention for patients with Chronic Obstructive Pulmonary Disease (COPD).......Describe and demonstrate Occupational Therapy (OT) intervention for patients with Chronic Obstructive Pulmonary Disease (COPD)....

  12. Occupational Therapy intervention for patiens with COPD, Rehabilitation at home

    DEFF Research Database (Denmark)

    Larsen, Stina Meyer; Petersen, Anne Karin

    2011-01-01

    Describe and demonstrate Occupational Therapy (OT) intervention for patients with Chronic Obstructive Pulmonary Disease (COPD).......Describe and demonstrate Occupational Therapy (OT) intervention for patients with Chronic Obstructive Pulmonary Disease (COPD)....

  13. Novel anti-inflammatory agents in COPD

    DEFF Research Database (Denmark)

    Loukides, Stelios; Bartziokas, Konstantinos; Vestbo, Jørgen

    2013-01-01

    Inflammation plays a central role in chronic obstructive pulmonary disease (COPD). COPD related inflammation is less responsive to inhaled steroids compared to asthma. There are three major novel anti-inflammatory approaches to the management of COPD. The first approach is phosphodiesterase...... on these strategies exist at the moment. A third potential approach involves novel agents whose mechanism of action is closely related to COPD mechanisms and pathophysiology. Such novel treatments are of great interest since they may treat both COPD and co-morbidities. Several novel agents are currently under...

  14. Tomographic and functional findings in severe COPD: comparison between the wood smoke-related and smoking-related disease

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez-Garcia, Mauricio; Maldonado Gomez, Dario; Torres-Duque, Carlos A.; Barrero, Margarita; Jaramillo Villegas, Claudia; Perez, Juan Manuel; Varon, Humberto, E-mail: mgonzalez@neumologica.org [Colombian Pulmonology Foundation, Bogota (Colombia); Department of Radiology and Diagnostic Imaging, Children' s Cardiology Foundation, Cardiology Institute, Bogota (Colombia)

    2013-11-01

    Objective: Wood smoke exposure is a risk factor for COPD. For a given degree of airway obstruction, the reduction in DLCO is smaller in individuals with wood smoke-related COPD than in those with smoking-related COPD, suggesting that there is less emphysema in the former. The objective of this study was to compare HRCT findings between women with wood smoke-related COPD and women with smoking-related COPD. Methods: Twenty-two women with severe COPD (FEV1/FVC ratio < 70% and FEV1 < 50%) were divided into two groups: those with wood smoke-related COPD (n = 12) and those with smoking-related COPD (n = 10). The two groups were compared regarding emphysema scores and airway involvement (as determined by HRCT); and functional abnormalities-spirometry results, DLCO, alveolar volume (VA), the DLCO/VA ratio, lung volumes, and specific airway resistance (sRaw). Results: There were no significant differences between the two groups in terms of FEV1, sRaw, or lung hyperinflation. Decreases in DLCO and in the DLCO/VA ratio were greater in the smoking-related COPD group subjects, who also had higher emphysema scores, in comparison with the wood smoke-related COPD group subjects. In the wood smoke-related COPD group, HRCT scans showed no significant emphysema, the main findings being peribronchial thickening, bronchial dilation, and subsegmental atelectasis. Conclusions: Female patients with severe wood smoke-related COPD do not appear to develop emphysema, although they do show severe airway involvement. The reduction in DLCO and VA, with a normal DLCO/VA ratio, is probably due to severe bronchial obstruction and incomplete mixing of inspired gas during the determination of single-breath DLCO. (author)

  15. Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Matsuura, Yukiko, E-mail: matsuyuki_future@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Kawata, Naoko, E-mail: chumito_03@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Yanagawa, Noriyuki, E-mail: yanagawa@ho.chiba-u.ac.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sugiura, Toshihiko, E-mail: sugiura@js3.so-net.ne.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sakurai, Yoriko, E-mail: yoliri@nifty.com [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sato, Misuzu, E-mail: mis_misuzu@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Iesato, Ken, E-mail: iesato_k@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Terada, Jiro, E-mail: jirotera@chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sakao, Seiichiro, E-mail: sakao@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tada, Yuji, E-mail: ytada@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tanabe, Nobuhiro, E-mail: ntanabe@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Suzuki, Yoichi, E-mail: ysuzuki@faculty.chiba-u.jp [Department of public Health, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tatsumi, Koichiro, E-mail: tatsumi@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan)

    2013-10-01

    Objectives: Structural and functional changes in pulmonary vessels are prevalent at the initial stages of chronic obstructive pulmonary disease (COPD). These vascular alterations can be assessed using cross-sectional area (CSA) of small pulmonary vessels. However, neither in non-COPD smokers nor in COPD patients it has been defined whether the structural changes of pulmonary vessels detected by paired inspiratory and expiratory CT scans are associated with emphysematous changes. We quantified the CSA and low attenuation area (LAA) and evaluated the changes in these parameters in the inspiratory and expiratory phases. Materials and methods: Fifty consecutive non-COPD smokers and COPD patients were subjected to multi detector-row CT and the percentage of vessels with a CSA less than 5 mm{sup 2} as well as the percentage LAA for total lung area (%CSA < 5, %LAA, respectively) were calculated. Results: The %CSA < 5 correlated negatively with %LAA. The %CSA < 5 was lower in COPD patients with emphysema as compared with non-COPD smokers and COPD patients with or without mild emphysema. In addition, the %CSA < 5 was lower in the no/mild emphysema subgroup as compared with non-COPD smokers. The respiratory phase change of %CSA < 5 in COPD patients was greater than that in non-COPD smokers. Conclusion: The percentage of small pulmonary vessels decreased as emphysematous changes increase, and this decrease was observed even in patients with no/mild emphysema. Furthermore, respiratory phase changes in CSA were higher in COPD patients than in non-COPD smokers.

  16. Inflammatory biomarkers and radiologic measurements in never-smokers with COPD: A cross-sectional study from the CODA cohort.

    Science.gov (United States)

    Lee, Hyun; Hong, Yoonki; Lim, Myoung Nam; Bak, So Hyeon; Kim, Min-Ji; Kim, Kyunga; Kim, Woo Jin; Park, Hye Yun

    2017-01-01

    Various biomarkers have emerged as potential surrogates to represent various subgroups of chronic obstructive pulmonary disease (COPD), which manifest with different phenotypes. However, the biomarkers representing never-smokers with COPD have not yet been well elucidated. The aim of this study was to evaluate the associations of certain serum and radiological biomarkers with the presence of COPD in never-smokers. To explore the associations of serum and radiological biomarkers with the presence of COPD in never-smokers, we conducted a cross-sectional patient cohort study composed of never-smokers from the COPD in Dusty Areas (CODA) cohort, consisting of subjects living in dusty areas near cement plants in South Korea. Of the 131 never-smokers in the cohort, 77 (58.8%) had COPD. There were no significant differences in the number of subjects with high levels of inflammatory biomarkers (>90th percentile of never-smokers without COPD), including white blood cell count, total bilirubin, interleukin (IL)-6, IL-8, and C-reactive protein, or radiologic measurements (including emphysema index and mean wall area percentage) between never-smokers with COPD and those without COPD. However, the number of subjects with high uric acid was significantly higher in never-smokers with COPD than never-smokers without COPD (31.2% (24/77) vs. 11.1% (6/54); p = 0.013). In addition, multivariate analysis revealed that high uric acid was significantly associated with the presence of COPD in never-smokers (adjusted relative risk: 1.63; 95% confidence interval: 1.21, 2.18; p = 0.001). Our study suggests that high serum levels of uric acid might be a potential biomarker for assessing the presence of COPD in never-smokers.

  17. Adaptive control of a pressure-controlled artificial ventilator: a simulator-based evaluation using real COPD patient data.

    Science.gov (United States)

    De Keyser, Robin; Ionescu, Clara

    2011-12-01

    The paper discusses the application of a direct adaptive controller to a pressure controlled artificial ventilation problem. In pressure controlled ventilators, the manipulated variable is the maximum flow applied to the patient during the active phase (inspiration), and the regulated variable is the peak pressure at end-inspiration. This simulation case study focuses on patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD), which require artificial/mechanical ventilation. An adaptive PID controller ensures peak pressures below critical values, by manipulating the flow delivered by the ventilator. The simulation study is performed on fractional-order models of the respiratory impedance identified from lung function data obtained from 21 COPD patients. Additional simulation studies show the robustness of the controller in presence of varying model parameters from the respiratory impedance of the patient. Possibilities to implement the control strategy as an online adaptive algorithm are also explored. The results show that the design of the control is suitable for this kind of application and provides useful insight on realistic scenarios. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Determinants of poor 6-min walking distance in patients with COPD: the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Spruit, Martijn A; Watkins, Michael L; Edwards, Lisa D

    2010-01-01

    BACKGROUND: The 6-min walking test (6MWT) is widely used to assess exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Given the prognostic significance of the 6MWT, it is important to identify why some COPD patients perform poorly in terms of this outcome. We aimed...... for Epidemiologic Studies of Depression Scale; COPD-specific St Georges Respiratory Questionnaire; modified Medical Research Council (mMRC) dyspnea scale as part of the baseline assessment of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. RESULTS: Patients...... with COPD have significant differences in performance in the 6MWT even after stratification for GOLD stages. Moreover, severe airflow limitation by GOLD stage, degree of emphysema by CT, oxygen use during/after the 6MWT, presence of depressive symptoms and moderate to severe symptoms of dyspnea (mMRC grade...

  19. Validity and Usability of Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease (COPD.

    Directory of Open Access Journals (Sweden)

    Tobias Boeselt

    Full Text Available A large proportion of COPD patients do not achieve the recommended level of physical activity. It is suggested that feedback on the level of activity by using an activity monitoring device (PAM increases awareness and may stimulate patients to increase their physical activity in daily life. Our objective was to assess the validity and usability of a simple and low-cost physical activity monitor (Polar A300™ when compared with the validated and established Bodymedia-SenseWear™ (SWA device.To assess the diagnostic equivalent, two different PAM devices were used in parallel in 20 COPD patients GOLD I to IV during 3 consecutive days of daily life. Both systems were compared in terms of steps, calories burned, daily activity time and metabolic equivalents using linear regression analysis and Bland-Altman plots. Practical usability was examined by a 16-item-questionnaire.High correlations of both devices were observed with regard to the sensed step count (r = 0.96; p < 0.01 and calories burned (r = 0.74; p < 0.01, and a lower correlation of daily activity (r = 0.25; p < 0.01 was found. Data analysis over 3 days showed that 90% of the steps (95% CI -4223 to 1887, 100% of the calories (95% CI -2798 to 1887, 90% of the daily activity data (95% CI -12.32, 4065 and 95% of the MET (95% CI -3.11 to 2.75 were within the limits of agreement. A favorable usability (system-, information- and interface quality of the A300™ device was shown (p < 0.01.The A300™ device with easy practical usability was shown not to be inferior for assessment of physical activity time, step count and calorie consumption in COPD patients when compared with the SWA. It is suggested to consider widespread available devices as commonly used for monitoring recreational sporting activities also in patients for assessment of physical activity in daily life.

  20. Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review.

    Science.gov (United States)

    Rosa, Francesca; Bagnasco, Annamaria; Aleo, Giuseppe; Kendall, Sally; Sasso, Loredana

    2017-04-01

    This paper was a report of the synthesis of evidence on examining the origins and definitions of the concept of resilience, investigating its application in chronic illness management and exploring its utility as a means of understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease. Resilience is a concept that is becoming relevant to understanding how individuals and families live with illness, especially long-term conditions. Caregivers of adults with Chronic Obstructive Pulmonary Disease must be able to respond to exacerbations of the condition and may themselves experience cognitive imbalances. Yet, resilience as a way of understanding family caregiving of adults with COPD is little explored. Literature review - integrative review. CINAHL, PubMed, Google Scholar and EBSCO were searched between 1989-2015. The principles of rapid evidence assessment were followed. We identified 376 relevant papers: 20 papers reported the presence of the concept of resilience in family caregivers of chronic diseases patients but only 12 papers reported the presence of the concept of resilience in caregivers of Chronic Obstructive Pulmonary Disease patients and have been included in the synthesis. The term resilience in Chronic Obstructive Pulmonary Disease caregiving is most often understood using a deficit model of health.

  1. Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD).

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    Horita, Nobuyuki; Goto, Atsushi; Shibata, Yuji; Ota, Erika; Nakashima, Kentaro; Nagai, Kenjiro; Kaneko, Takeshi

    2017-02-10

    Three classes of inhaler medications are used to manage chronic obstructive pulmonary disease (COPD): long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS). When two classes of medications are required, LAMA plus LABA (LAMA+LABA) and LABA plus ICS (LABA+ICS) are often selected because these combinations can be administered via a single medication device. The previous Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidance recommended LABA+ICS as the first-line treatment for managing stable COPD in high-risk people of categories C and D. However, the updated GOLD 2017 guidance recommends LAMA+LABA over LABA+ICS. To compare the benefits and harms of LAMA+LABA versus LABA+ICS for treatment of people with stable COPD. We performed an electronic search of the Cochrane Airways Group Specialised Register (2 February 2016), ClinicalTrials.gov (4 June 2016), and the World Health Organization Clinical Trials Search Portal (4 June 2016), followed by a handsearch (5 June 2016). Two review authors screened and scrutinised the selected articles. We included individual randomised controlled trials, parallel-group trials, and cross-over trials comparing LAMA+LABA and LABA+ICS for stable COPD. The minimum accepted trial duration was one month and trials should have been conducted in an outpatient setting. Two review authors independently extracted data and evaluated risk of bias. We resolved any discrepancies through discussion. We analysed dichotomous data as odds ratios (OR), and continuous data as mean differences (MD), with 95% confidence interval (CI) using Review Manager 5. Exacerbations were measured by counting the number of people experiencing one or more exacerbation. We included 11 studies comprising 9839 participants in our quantitative analysis. Most studies included people with moderate to severe COPD, without recent exacerbations. One pharmaceutical sponsored trial that included only people with

  2. Activity restriction in mild COPD: a challenging clinical problem

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    O'Donnell DE

    2014-06-01

    Full Text Available Denis E O'Donnell,1 Kevin B Gebke2 1Division of Respiratory and Critical Care Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada; 2Primary Care Sports Medicine Program, Indiana University School of Medicine, Indianapolis, IN, USA Abstract: Dyspnea, exercise intolerance, and activity restriction are already apparent in mild chronic obstructive pulmonary disease (COPD. However, patients may not seek medical help until their symptoms become troublesome and persistent and significant respiratory impairment is already present; as a consequence, further sustained physical inactivity may contribute to disease progression. Ventilatory and gas exchange impairment, cardiac dysfunction, and skeletal muscle dysfunction are present to a variable degree in patients with mild COPD, and collectively may contribute to exercise intolerance. As such, there is increasing interest in evaluating exercise tolerance and physical activity in symptomatic patients with COPD who have mild airway obstruction, as defined by spirometry. Simple questionnaires, eg, the modified British Medical Research Council dyspnea scale and the COPD Assessment Test, or exercise tests, eg, the 6-minute or incremental and endurance exercise tests can be used to assess exercise performance and functional status. Pedometers and accelerometers are used to evaluate physical activity, and endurance tests (cycle or treadmill using constant work rate protocols are used to assess the effects of interventions such as pulmonary rehabilitation. In addition, alternative outcome measurements, such as tests of small airway dysfunction and laboratory-based exercise tests, are used to measure the extent of physiological impairment in individuals with persistent dyspnea. This review describes the mechanisms of exercise limitation in patients with mild COPD and the interventions that can potentially improve exercise tolerance. Also discussed are the

  3. Worldwide burden of COPD in high- and low-income countries. Part I. The burden of obstructive lung disease (BOLD) initiative.

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    Buist, A S; Vollmer, W M; McBurnie, M A

    2008-07-01

    Burden of Obstructive Lung Disease (BOLD) Initiative sites worldwide. To measure the prevalence of chronic obstructive pulmonary disease (COPD) and its risk factors, investigate variation in prevalence across countries and develop standardized methods that can be used in industrialized and developing countries. Non-institutionalized adults aged > or =40 years were recruited using population-based sampling plans. Each site targeted a minimum of 600 participants (300 women, 300 men), who filled out questionnaires and performed spirometry before and after administration of 200 mug salbutamol using standardized methods. Random effects meta-analysis models were used to estimate pooled prevalence estimates and risk factor effects and to test for heterogeneity across sites and sex. Data published from 12 sites (n = 8775) showed that the estimated population prevalence of COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stage II and higher) was 10.1 +/- SE = 4.8% overall (11.8 +/- 7.9% for men and 8.5 +/- 5.8% for women). Prevalence increased with age and pack-years of smoking, but other less understood risk factors, such as biomass heating and cooking exposures, occupational exposures and tuberculosis, also contribute to the location-specific variations in disease prevalence that BOLD is finding. BOLD has estimated the social and economic burden of COPD in 12 countries to date. BOLD and the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (the PLATINO study) are developing a growing database of COPD prevalence. Cigarette smoking and age are the most important COPD risk factors, but other risk factors should also be explored.

  4. Fragility Fracture Incidence in Chronic Obstructive Pulmonary Disease (COPD) Patients Associates With Nanoporosity, Mineral/Matrix Ratio, and Pyridinoline Content at Actively Bone-Forming Trabecular Surfaces.

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    Paschalis, Eleftherios P; Gamsjaeger, Sonja; Dempster, David; Jorgetti, Vanda; Borba, Victoria; Boguszewski, Cesar L; Klaushofer, Klaus; Moreira, Carolina A

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is associated with low areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) and altered microstructure by bone histomorphometry and micro-computed tomography. Nevertheless, not all COPD patients sustain fragility fractures. In the present study, we used Raman microspectroscopic analysis to determine bone compositional properties at actively forming trabecular surfaces (based on double fluorescent labels) in iliac crest biopsies from 19 postmenopausal COPD patients (aged 62.1 ± 7.3 years). Additionally, we analyzed trabecular geometrical centers, representing tissue much older than the forming surfaces. Eight of the patients had sustained fragility fractures, and 13 had received treatment with inhaled glucocorticoids. None of the patients had taken oral glucocorticoids. The monitored parameters were mineral/matrix ratio (MM), nanoporosity, and relative glycosaminoglycan (GAG), lipid, and pyridinoline contents (PYD). There were no significant differences between the glucocorticoid-treated patients and those who did not receive any. On the other hand, COPD patients sustaining fragility fractures had significantly lower nanoporosity and higher MM and PYD values compared with COPD patients without fragility fractures. To the best of our knowledge, this is the first study to discriminate between fracture and non-fracture COPD patients based on differences in the material properties of bone matrix. Given that these bone material compositional differences are evident close to the cement line (a major bone interface), they may contribute to the inferior bone toughness and coupled with the lower lumbar spine bone mineral density values result in the fragility fractures prevalent in these patients. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

  5. A randomized controlled trial evaluating the effectiveness of a web-based, computer-tailored self-management intervention for people with or at risk for COPD

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    Voncken-Brewster, V.; Tange, H.; Vries, H. de; Nagykaldi, Z.; Winkens, B.; Weijden, T.T. van der

    2015-01-01

    INTRODUCTION: COPD is a leading cause of morbidity and mortality. Self-management interventions are considered important in order to limit the progression of the disease. Computer-tailored interventions could be an effective tool to facilitate self-management. METHODS: This randomized controlled

  6. Evaluation of brain stem auditory evoked potentials in stable patients with chronic obstructive pulmonary disease

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    Gupta Prem

    2008-01-01

    Full Text Available Though there are few studies addressing brainstem auditory evoked potentials (BAEP in patients with chronic obstructive pulmonary disease (COPD, subclinical BAEP abnormalities in stable COPD patients have not been studied. The present study aimed to evaluate the BAEP abnormalities in this study group. Materials and Methods : In the present study, 80 male subjects were included: COPD group comprised 40 smokers with stable COPD with no clinical neuropathy; 40 age-matched healthy volunteers served as the control group. Latencies of BAEP waves I, II, III, IV, and V, together with interpeak latencies (IPLs of I-III, I-V, and III-V, and amplitudes of waves I-Ia and V-Va were studied in both the groups to compare the BAEP abnormalities in COPD group; the latter were correlated with patient characteristics and Mini-Mental Status Examination Questionnaire (MMSEQ scores to seek any significant correlation. Results: Twenty-six (65% of the 40 COPD patients had BAEP abnormalities. We observed significantly prolonged latencies of waves I, III, V over left ear and waves III, IV, V over right ear; increased IPLs of I-V, III-V over left ear and of I-III, I-V, III-V over right side. Amplitudes of waves I-Ia and V-Va were decreased bilaterally. Over left ear, the latencies of wave I and III were significantly correlated with FEV 1 ; and amplitude of wave I-Ia, with smoking pack years. A weak positive correlation between amplitude of wave I-Ia and duration of illness; and a weak negative correlation between amplitude of wave V-Va and MMSEQ scores were seen over right side. Conclusions : We observed significant subclinical BAEP abnormalities on electrophysiological evaluation in studied stable COPD male patients having mild-to-moderate airflow obstruction.

  7. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

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    Annemarije L Kruis

    Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

  8. Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

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    Menezes, A.M.B.; Perez-Padilla, R.; Hallal, P.C.; Jardim, J.R.; Muino, A.; Lopez, M.V.; Valdivia, G.; Pertuze, J.; de Oca, M.M.; Talamo, C. [Universidade Federal de Pelotas, Pelotas (Brazil)

    2008-07-15

    The objective of the paper is to describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America. Five Latin American cities were investigated, namely, Sao Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela. This is a multi Centre study. Post-bronchodilator spirometry was used and the main outcome me