Abstract
Timely diagnosis of acute exacerbations of COPD (AECOPD) is challenging as it depends on patients' reports. AECOPD are characterised by increased airway obstruction, mucus and air trapping, which results in changes in lung acoustics. Thus, adventitious respiratory sounds (ARS) may be useful to detect/monitor AECOPD. To evaluate computerised ARS changes during AECOPD. 25 non-hospitalised patients with AECOPD (16♂, 70 [62.5-77.0]yrs, FEV1 59 [31.5-73.0]%predicted) and 34 healthy volunteers (17♂, 63.5 [57.7-72.3]yrs, FEV1 103.0 [88.8-125.3]%predicted) were enrolled. ARS at anterior and posterior right and left chest were recorded at hospital presentation (T1), 15 days (T2) and 45 days (T3) after hospital presentation from patients with AECOPD and only once from healthy participants. A subsample of 9 patients (7♂; 66 [60.0-76.0]yrs; FEV1 62 [26.5-74.0]%predicted) was also included to study ARS pre-AECOPD (T0). Number of crackles and wheeze occupation rate (%Wh) were processed using validated algorithms. During AECOPD, patients presented more inspiratory crackles at T1 than T3 (p = 0.013) and more inspiratory %Wh at T1 than T2 (p = 0.006), at posterior chest. Patients with stable COPD presented more inspiratory crackles (p = 0.012), at posterior chest, and more expiratory %Wh, both at anterior (p < 0.001) and posterior (p = 0.001) chest, than healthy participants. No differences were observed for the remaining ARS parameters or subsamples (p > 0.05). Inspiratory crackles seem to persist until 15 days post exacerbation whilst inspiratory %Wh decreased after this period. ARS seem to be sensitive to monitor AECOPD. This information may allow advances in monitoring the recovery time of patients with AECOPD across all clinical and non-clinical settings.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease frequently punctuated by acute exacerbations (AECOPD) [1], i.e., “acute worsening of respiratory symptoms that result in additional therapy” [2]
34 patients refereed with acute exacerbations of COPD (AECOPD) were excluded because at T1 they had pulmonary function test not compatible with a diagnosis of COPD (n = 22), did not meet the definition for AECOPD (n = 1), presented lung neoplasia (n = 2), severe heart failure (n = 1), were unable to comply with data collection (n = 3), or declined to participate in the study (n = 5)
The main findings of this study were that inspiratory crackles and wheezes change significantly during the course of AECOPD and patients with stable COPD presented significantly more inspiratory crackles and expiratory wheezes than healthy peers
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease frequently punctuated by acute exacerbations (AECOPD) [1], i.e., “acute worsening of respiratory symptoms that result in additional therapy” [2]. These events account for half of the total respiratory admissions for COPD [3] and are closely related with increases in healthcare costs (AECOPD related costs vary approximately from $88 to $7.757 per exacerbation worldwide) [4]. Most exacerbations are still not timely treated as the diagnosis/monitoring relies exclusively on patients' reports of symptoms worsening [2]. This information may allow advances in monitoring the recovery time of patients with AECOPD across all clinical and non-clinical settings
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