Efficacy of interval hypoxic-hyperoxic training on dyspnea in chronic pulmonary diseases

Circadian molecular clock disruption in chronic pulmonary diseases.

Chronic obstructive pulmonary disease exacerbations (acute exacerbation of chronic obstructive pulmonary disease) are characterised by increased sputum volume, purulence and breathlessness. Patients are encouraged to recognise and treat acute exacerbation of chronic obstructive pulmonary disease as part of a self-management plan. Only half of acute exacerbation of chronic obstructive pulmonary disease are caused by bacterial infection, but self-management plans generally advocate use of antibiotics and steroids for all events, hence antibiotics may be overused. Sputum colour relates closely to bacterial load; thus itcould determine whether antibiotics are appropriate. This pragmatic randomised controlled trial tested whether use of a sputum colour chart is safe and effective in United Kingdom primary care. Colour chronic obstructive pulmonary disease was a multicentre, randomised controlled trial in adults with chronic obstructive pulmonary disease who had ≥ 2 acute exacerbations of chronic obstructive pulmonary disease or ≥ 1 hospital admission for acute exacerbation of chronic obstructive pulmonary disease in the preceding year. The primary objective was to demonstrate that the Bronkotest® (London)sputum colour chart is non-inferior to usual care (safe). The primary outcome was rate of hospital admission for acute exacerbation of chronic obstructive pulmonary disease at 12 months; secondary outcomes included requirement for second courses of treatment and quality of life (chronic obstructive pulmonary disease assessment test score). Nested substudies examining daily symptoms via an e-diary and sputum culture assessed untreated acute exacerbation of chronic obstructive pulmonary disease rate and antibiotic resistance, respectively. A process evaluation examined trial fidelity and acceptability of the intervention, employing qualitative research methods incorporating patients as co-researchers. The study was terminated early due to low recruitment (115/2954 planned sample size). One hundred and fifteen patients were recruited and randomised 1 : 1 to colour chart use or usual care; they generally had severe Global Initiative for ChronicObstructive Lung Disease D chronic obstructive pulmonary disease, with significant breathlessness (54% Medical Research Council score of 4 or 5) and poor quality of life (chronic obstructive pulmonary disease assessment test score at baseline 24). Comorbid respiratory and systemic disease was common. Self-management was delivered well in both arms, and the colour chart acceptable to patients and staff; no specific issues for patients with multiple long-term conditions were identified. Hospital admissions for acute exacerbation of chronic obstructive pulmonary disease tended to occur more in colour chart users [32 vs. 16%, relative risk 1.95 (0.92 to 4.18)], and antibiotic courses within 14 days of initial acute exacerbation of chronic obstructive pulmonary disease treatment were also more common [34 vs. 18%, adjusted relative risk 1.80 (0.85 to 3.79)]. Despite this, quality of life was better in colour chart users at 12 months [chronic obstructive pulmonary disease assessment test 19.9 vs. -24.5, adjusted mean difference -2.95 (-5.93 to -0.04)]. Thirty-eight patients consented to the sputum substudy, and 57 samples were received (42 stable state, 15 during acute exacerbation of chronic obstructive pulmonary disease), of which 30% contained a potentially pathogenic bacterium. Sputum was more likely to be purulent in subjects with bronchiectasis, independent of disease state (stable vs. exacerbation) or whether the sample was positive for a potentially pathogenic bacterium, suggesting that colour alone cannot be used to guide antibiotic use. Eleven patients completed the e-diary study, and 42 symptom-defined acute exacerbation of chronic obstructive pulmonary disease events were captured, many of which were untreated, exhibiting lower EXAcerbations of Chronic Pulmonary Disease Tool scores than those which were treated. Untreated events were slower to settle. Differences between study arms were not meaningful to compute due to low numbers. Our results imply that the Bronkotest sputum colour chart is unlikely to be a useful addition to self-management for chronic obstructive pulmonary disease patients in primary care, but further work is required to confirm this. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/128/04.

The aim of this study was to answer the question: is there an effect on the respiratory capacity and activity tolerance of older patients with chronic obstructive pulmonary disease who participate in a pulmonary rehabilitation programme? Pulmonary rehabilitation is now an integral part of chronic obstructive pulmonary disease management. Evidence supports the positive effects of breath training and exercising training on quality of life, exercise tolerance and improved physical condition of individual with chronic obstructive pulmonary disease. Limited empirical documentation exists to support the effectiveness of a nurse managed rehabilitation programme for older patients with chronic obstructive pulmonary disease. The study was done to evaluate the effects of pulmonary rehabilitation provided by nurses on the pulmonary function, gas exchange and exercise tolerance in older patients with chronic obstructive pulmonary disease. A one group pre-test-post-test design was used to evaluate the effects of a pulmonary rehabilitation programme. The sample consisted of 20 patients with chronic obstructive pulmonary disease who participated in a pulmonary rehabilitation programme including breathing exercises, upper-limb exercises and inspiratory muscle training. The findings indicated improvement in exercise performance and a decrease in dyspnea after participation in the pulmonary rehabilitation programme. The clinical nurse can make a significant impact on the illness trajectory and quality of life for patients with chronic obstructive pulmonary disease. The nurse has a critical role in helping patient with chronic obstructive pulmonary disease learn to cope, adjust and adapt to life with a chronic illness. Active nurse involvement with a patient in a pulmonary rehabilitation programme can assist in the identification of factors that motivate the patient, help in establishing realistic out comes expectations and provide patient teaching opportunities. The nurse can assist the patient to develop skills of self-awareness regarding particular symptoms, self-monitoring and health status change identification.

The Prevalence of Comorbid Chronic Disease in Virginia's Adult Patient Population during the Years 2001 and 2004

Objective This study aimed to evaluate the prevalence and type of anemia in patients with different chronic pulmonary diseases and its impact on the quality of life. Patients and methods The current study is a prospective observational study that was conducted at Chest Department, Minia University Hospital during the period from November 2015 to January 2017. A total of 247 patients with chronic pulmonary diseases (97 chronic obstructive pulmonary disease, 45 idiopathic pulmonary fibrosis, 80 bronchial asthma, 25 bronchiectasis) were included in our study. For all included patients the following were done,full history taking, assessment of the grade of dyspnea using modified medical research council dyspnea scale, assessment of BMI, chest ꞉ X ray (CXR), ECG and when indicated echocardiography, pulmonary functions tests, routine laboratory investigations, including complete blood count, liver function test, renal function test, serum electrolytes, erythrocyte sedimentation rate, C-reactive protein, measurement of arterial blood gases, measurements of serum erythropoietin, iron and total iron binding capacity, St George’s Respiratory Questionnaire was used for all patients to assess the health-related quality of life. Results Anemia occurs in 36.4% of all patients. It occurs in 46.4% of chronic obstructive pulmonary disease patients, 37.8% of idiopathic pulmonary fibrosis patients, and 12.5% of patients with asthma and in 68% of patients with bronchiectasis. Normocytic normochromic anemia was the predominant type of anemia in the studied patients. There was a significant difference between anemic patients and patients with normal hemoglobin (Hb) with respect to smoking index, comorbidities, forced expiratory volume 1, forced vital capacity, and PO2. C-reactive protein and erythrocyte sedimentation rate were significantly higher in the anemic group. Serum iron and total iron binding capacity were significantly lower in the anemic patients, whereas erythropoietin was significantly lower in patients with normal Hb. Anemic patients had significantly higher medical research council dyspnea scale and number of exacerbation than patients with normal Hb. Anemic patients had significantly higher score in all the components of St George’s Respiratory Questionnaire. Conclusion Anemia is commonly associated with comorbidity in patients with chronic pulmonary diseases. The presence of anemia has a negative impact on the patient’s quality of life. Anemia was significantly associated with; the severity of impairment of lung functions, level of systemic inflammatory markers, presence of other comorbidities, and the smoking index. It was also associated with increased severity of dyspnea and frequent exacerbations.

BackgroundProlonged tissue hypoxia caused by chronic pulmonary disease is commonly regarded as an important mechanism in the development of secondary polycythemia, but little clinical data are available to support this hypothesis.ObjectiveTo study the prevalence and severity of erythrocytosis accompanying chronic hypoxic pulmonary disease in dogs.AnimalsForty‐seven dogs with hypoxic chronic pulmonary disease, 27 dogs with nonhypoxic chronic pulmonary disease, and 60 healthy controls.MethodsDogs with chronic pulmonary disease and chronic hypoxemia (partial pressure of arterial oxygen [PaO2] < 80 mm Hg on at least 2 arterial blood gas measurements a minimum of 1 month apart) were identified retrospectively from patient records. Association between arterial oxygen and red blood cell parameters was analyzed using Pearson's correlation coefficients and multivariable linear regression analysis.ResultsRed blood cell parameters measured at the end of the hypoxemia period were within the laboratory reference range in most dogs. In chronically hypoxemic dogs, hematocrit (Hct) was increased in 4/47 (8.5%; 95% confidence interval [CI], 0‐17) dogs, erythrocyte count (Erytr) was increased in 12/47 (26%; 95%CI, 13‐38) dogs and hemoglobin concentration (Hb) was increased in 3/47 (6.4%; 95%CI, 0‐14) dogs. No marked polycythemia (Hct ≥65%) was noted in any of the dogs. Red blood cell parameters were not associated with the severity of hypoxemia (correlation to PaO2: Erytr, r = −.14; Hb, r = −.21; Hct, r = −.14; P > .05 for all).Conclusions and Clinical ImportancePolycythemia is uncommon, and usually mild if present, in dogs with chronic hypoxia caused by pulmonary disease.

Background: The study developed accurate explainable machine learning (ML) models for predicting first-time acute exacerbation of chronic obstructive pulmonary disease (COPD, AECOPD) at an individual level. Methods: We conducted a retrospective case–control study. A total of 606 patients with COPD were screened for eligibility using registry data from the COPD Pay-for-Performance Program (COPD P4P program) database at Changhua Christian Hospital between January 2017 and December 2019. Recursive feature elimination technology was used to select the optimal subset of features for predicting the occurrence of AECOPD. We developed four ML models to predict first-time AECOPD, and the highest-performing model was applied. Finally, an explainable approach based on ML and the SHapley Additive exPlanations (SHAP) and a local explanation method were used to evaluate the risk of AECOPD and to generate individual explanations of the model’s decisions. Results: The gradient boosting machine (GBM) and support vector machine (SVM) models exhibited superior discrimination ability (area under curve [AUC] = 0.833 [95% confidence interval (CI) 0.745–0.921] and AUC = 0.836 [95% CI 0.757–0.915], respectively). The decision curve analysis indicated that the GBM model exhibited a higher net benefit in distinguishing patients at high risk for AECOPD when the threshold probability was <0.55. The COPD Assessment Test (CAT) and the symptom of wheezing were the two most important features and exhibited the highest SHAP values, followed by monocyte count and white blood cell (WBC) count, coughing, red blood cell (RBC) count, breathing rate, oral long-acting bronchodilator use, chronic pulmonary disease (CPD), systolic blood pressure (SBP), and others. Higher CAT score; monocyte, WBC, and RBC counts; BMI; diastolic blood pressure (DBP); neutrophil-to-lymphocyte ratio; and eosinophil and lymphocyte counts were associated with AECOPD. The presence of symptoms (wheezing, dyspnea, coughing), chronic disease (CPD, congestive heart failure [CHF], sleep disorders, and pneumonia), and use of COPD medications (triple-therapy long-acting bronchodilators, short-acting bronchodilators, oral long-acting bronchodilators, and antibiotics) were also positively associated with AECOPD. A high breathing rate, heart rate, or systolic blood pressure and methylxanthine use were negatively correlated with AECOPD. Conclusions: The ML model was able to accurately assess the risk of AECOPD. The ML model combined with SHAP and the local explanation method were able to provide interpretable and visual explanations of individualized risk predictions, which may assist clinical physicians in understanding the effects of key features in the model and the model’s decision-making process.

Cannabis may cause chronic pulmonary disease. Prior studies have been limited by low cannabis exposure, lack of data on tobacco cigarettes, and/or limited numbers of those without tobacco cigarette use. To examine whether inhaled cannabis associated with asthma and chronic obstructive pulmonary disease, independent of tobacco cigarettes. Cross-sectional analysis of population-based, nationally representative survey data. Adults 18-74years who participated in the 2016-2020 Behavioral Risk Factor Surveillance System surveys. The exposure was past-30-day cannabis use, from 0 (0/30days) to 1 (30/30days). Outcomes were self-reported diagnoses by a medical professional of asthma or chronic obstructive pulmonary disease. We used multivariable logistic regression to test whether inhaled cannabis was associated with odds of disease, adjusted for sociodemographics and tobacco cigarette use (current/former/never). Pre-specified analyses restricted to those with no lifetime tobacco cigarette use. Among n = 379,049, n = 23,035 reported inhaled cannabis use. Inhaled cannabis was associated with asthma overall (adjusted odds ratio (aOR) 1.44, 95% CI 1.26-1.63 for daily use) and among n = 221,767 with no lifetime tobacco cigarette use (aOR 1.51 for daily use, 95% CI 1.18-1.93). Inhaled cannabis was associated with chronic obstructive pulmonary disease overall (aOR 1.27 for daily use, 95% CI 1.10-1.46), with a non-significant elevated odds of disease among those with no lifetime tobacco cigarette use (aOR 1.54 for daily use, 95% CI 0.92-2.57). Inhaled cannabis was associated with asthma and chronic obstructive pulmonary disease after adjusting for tobacco cigarette use. Among those with no lifetime tobacco cigarette use, the association with asthma persisted. Cannabis may be a potential modifiable risk factor for asthma and chronic obstructive pulmonary disease.

Patent foramen ovale has been associated with multiple pulmonary diseases, such as pulmonary hypertension, platypnea-orthodeoxia syndrome, and chronic obstructive pulmonary disease. A connection between patent foramen ovale and chronic pulmonary disease was first described more than 2 decades ago in case reports associating patent foramen ovale with more severe hypoxemia than that expected based on the severity of the primary pulmonary disease. It has been suggested that patients with both chronic pulmonary disease and patent foramen ovale are subject to severe hypoxemia because of the right-to-left shunt. Furthermore, investigators have reported improved systemic oxygenation after patent foramen ovale closure in some patients with chronic pulmonary disease. This review focuses on the association between chronic pulmonary disease and patent foramen ovale and on the dynamics of a right-to-left shunt, and it considers the potential benefit of patent foramen ovale closure in patients who have hypoxemia that is excessive in relation to the degree of their pulmonary disease.

Chronic liver diseases are very common worldwide and represent a major healthcare issue (GBD 2013 Mortality and Causes of Death Collaborators, 2015). Chronic liver diseases are characterized by inflammation of the liver, which may be secondary to distinct etiological factors, including hepatitis C or B infection, increased alcohol consumption, or non-alcoholic fatty liver disease (NAFLD). This article is protected by copyright. All rights reserved.

Background: Chronic pulmonary diseases are a major cause of morbidity and mortality in our country. Patients with chronic pulmonary diseases have been shown to benefit from pulmonary rehabilitation programs (PRP). The aim of this study is to evaluate the efficacy of an outpatient-based PRP in improving the health outcomes in case of patients with chronic pulmonary diseases. Materials and Methods: This was a prospective study of an outpatient-based PRP in 64 patients with chronic pulmonary diseases conducted over a 2 year period. The evaluations carried out at the baseline and at 4-6 weeks were spirometry, 6 min walk test (6MWT), St. George's Respiratory Questionnaire (SGRQ), Short Form-36 (SF-36), and Borg dyspnea scale. The PRP involved exercise training, education, and psychosocial/behavioral interventions. Statistical Analysis Used: The data were analyzed using SPSS package IBM company. The proportions were compared using Chi-square (c2 ) test. Results: Sixty-four patients with chronic pulmonary diseases were studied, out of which 30 (46.8%) had chronic obstructive pulmonary disease (COPD), 27 (42%) had chronic persistent bronchial asthma, 6 (9.4%) had restrictive lung disease (RLD), and 1 (1.5%) had bronchiectasis. There was a male preponderance of cases (71.3%). After the 6 week PRP, there was a significant improvement in the 6MWT, SGRQ, SF-36, and Borg dyspnea scale in all the patients and in the various subgroups of patients with COPD, asthma, and RLD. Besides, there was a significant change in pulmonary function and oxygen saturation in all the patients with asthma (P < 0.05) but not in those with COPD and RLD. Conclusion: An outpatient-based 6 week PRP in a tertiary care setting resulted in a significant improvement in exercise tolerance, dyspnea, and quality of life in those patients with a chronic pulmonary disease.

Guidelines for chronic obstructive pulmonary disease

Background: Seroprevalence of human herpesvirus type 8 (HHV-8) is high in patients with various immunologic abnormalities. Patients with chronic pulmonary disease (COPD) are immunocompromised, but the prevalence of HHV-8 in COPD patientsremains unclear. Aims and objectives: To compare HHV-8 seroprevalence in COPD patients and healthy controls. Methods: Blood samples collected from 64 COPD patients and 64 age- and sex-matched healthy controls were used to determine hemogram, HHV-8 antibody level, and HHV-8 DNA level. Results: COPD patients had a significantly lower lymphocyte count and a higher monocyte count than the healthy controls ( P = 0.0006 and 0.0003, respectively). The seroprevalence of HHV-8 antibodies was moderately higher in COPD patients than in controls (37.5% vs. 26.6%, P = 0.18). Three patients positive for HHV-8 antibodies (1:40, 1:160, and 1:640) were also positive for HHV-8 DNA (2,090, 133, and 1,450 copies/mL, respectively). Lymphocyte counts were significantly higher in COPD patients positive for HHV-8 antibodies than in negatives (1,609±925/mL vs. 1,106±548/mL, P = 0.014; t test) and in COPD patients positive for HHV-8 DNA than in negatives (2,576±786/mL vs. 1,448±861/mL, P = 0.048; t test). Furthermore, lymphocyte count increased (from 1,688 to 2,856 and 3,184 cells/mL) with increasing HHV-8 viral load (from 133 to 1,450 and 2,090 copies/mL). Conclusions: HHV-8 seroprevalence is moderately higher in COPD patients than in healthy controls, and lymphocyte count is significantly higher in COPD patients positive for HHV-8 antibodies or HHV-8 DNA than in negatives. Lymphocyte count increases with increase in HHV-8 viral load in patients positive for HHV-8 DNA.

The role of neutrophil chemotactic cytokines in the pathogenesis of equine chronic obstructive pulmonary disease (COPD)

Introduction. Alpha-1 antitrypsin deficiency (AATD) is a genetic condition associated with several respiratory diseases in patients with severe protein deficiency. AATD is often late diagnosed or underdiagnosed. Diagnosis frequently occurs in patients with chronic obstructive pulmonary disease and emphysema characterized by frequent exacerbations and over ten years’ duration. The purpose of this study was to evaluate the incidence of alpha-1 antitrypsin deficiency in patients with the chronic pulmonary disease after a thorough screening in the city of Naples in southern Italy. Materials and methods. Two hundred patients suffering from respiratory pathology (chronic obstructive pulmonary disease (COPD), emphysema, asthma, or bronchiectasis) were examined and evaluated in our outpatients’ clinic and tested for serum levels of AAT. Patients who had a respiratory disease suspected of AATD and/or serum AAT < 120 mg/dL underwent genetic testing. Genetic screening was performed on samples from 141 patients. Results. A total of 36 patients had an intermediate deficiency of AAT levels. Among them, 8 were PI*MZ, 6 were PI*MS and 22 had rare pathological mutations. Five patients had a severe AATD, all were composite heterozygous with S or Z allele, while the other allele had a rare pathological mutation. Conclusions. The incidence of genetic defects as AATD in the population of patients affected by chronic respiratory disorders is always a matter of discussion because of the frequent interaction between genes and environmental causes. In our series, numerous rare variants and compound heterozygosity have been described. No homozygous patients have been described. The present is one of few studies available on the incidence of rare variants in the geographic area of the city of Naples. So, our results could be considered interesting not only to know the incidence of AATD and its related rare mutations but also to support early diagnosis and treatments for patients with chronic pulmonary disease and frequent exacerbation and to fight the association with environmental causes of pulmonary damages as smoking.