Absence Of Chronic Obstructive Pulmonary Disease Research Articles

Impacts of regular physical activity on hospitalisation in chronic obstructive pulmonary disease: a nationwide population-based study

IntroductionStudies that comprehensively evaluate the association between physical activity (PA) levels, particularly by quantifying PA intensity, and healthcare use requiring emergency department (ED) visit or hospitalisation in patients with chronic...

Impact of chronic obstructive pulmonary disease on right ventricular function and remodeling after aortic valve replacement

BackgroundBoth chronic obstructive pulmonary disease (COPD) and right ventricular (RV) dysfunction are common factors that have been associated with poor prognosis after aortic valve replacement (AVR). Since there is still uncertainty about the impact of COPD on RV function and dilatation in patients undergoing AVR, we sought to explore RV function and remodeling in the presence and absence of COPD as well as their prognostic implications. MethodsPatients who received surgical or transcatheter AVR due to severe AS were screened for COPD. Demographic and clinical data were collected at baseline while echocardiographic measurements were performed at baseline and 1 year after AVR. The study end-point was all-cause mortality. ResultsIn total 275 patients were included, with 90 (33%) patients having COPD. At 1-year follow-up, mild worsening of tricuspid annular planar systolic excursion and RV dilatation were observed in patients without COPD, while there were significant improvements in RV longitudinal strain, RV wall thickness but dilatation of RV outflow tract distal dimension in the COPD group compared to the baseline. On multivariable analysis, the presence of COPD provided significant incremental prognostic value over RV dysfunction and remodeling. ConclusionsAt 1-year after AVR, RV function and dimensions mildly deteriorated in non-COPD group whereas COPD group received significant benefit of AVR in terms of RV function and hypertrophy. COPD was independently associated with >2-fold all-cause mortality and had incremental prognostic value over RV dysfunction and remodeling.

Safety and Risk Factors of Needle Thoracentesis Decompression in Tension Pneumothorax in Patients over 75 Years Old.

There are very few professional recommendations or guidelines on the needle thoracentesis decompression (NTD) for the tension pneumothorax in the elderly. This study aimed to investigate the safety and risk factors of tension pneumothorax NTD in patients over 75 years old based on CT evaluation of the chest wall thickness (CWT). The retrospective study was conducted among 136 in-patients over 75 years old. The CWT and closest depth to vital structure of the second intercostal space at the midclavicular line (second ICS-MCL) and the fifth intercostal space at the midaxillary line (fifth ICS-MAL) were compared as well as the expected failure rates and the incidence of severe complications of different needles. We also analyzed the influence of age, sex, presence or absence of chronic obstructive pulmonary disease (COPD), and body mass index (BMI) on CWT. The CWT of the second ICS-MCL was smaller than the fifth ICS-MAL both on the left and the right side (P < 0.05). The success rate associated with a 7 cm needle was significantly higher than a 5 cm needle (P < 0.05), and the incidence of severe complications with a 7 cm needle was significantly less than an 8 cm needle (P < 0.05). The CWT of the second ICS-MCL was significantly correlated with age, sex, presence or absence of COPD, and BMI (P < 0.05), whereas the CWT of the fifth ICS-MAL was significantly correlated with sex and BMI (P < 0.05). The second ICS-MCL was recommended as the primary thoracentesis site and a 7 cm needle was advised as preferred needle length for the older patients. Factors such as age, sex, presence or absence of COPD, and BMI should be considered when choosing the appropriate needle length.

Lung Microbiota and Metabolites Collectively Associate with Clinical Outcomes in Milder Stage Chronic Obstructive Pulmonary Disease.

Rationale: Chronic obstructive pulmonary disease (COPD) is variable in its development. Lung microbiota and metabolites collectively may impact COPD pathophysiology, but relationships to clinical outcomes in milder disease are unclear. Objectives: Identify components of the lung microbiome and metabolome collectively associated with clinical markers in milder stage COPD. Methods: We analyzed paired microbiome and metabolomic data previously characterized from bronchoalveolar lavage fluid in 137 participants in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), or (GOLD [Global Initiative for Chronic Obstructive Lung Disease Stage 0-2). Datasets used included 1) bacterial 16S rRNA gene sequencing; 2) untargeted metabolomics of the hydrophobic fraction, largely comprising lipids; and 3) targeted metabolomics for a panel of hydrophilic compounds previously implicated in mucoinflammation. We applied an integrative approach to select features and model 14 individual clinical variables representative of known associations with COPD trajectory (lung function, symptoms, and exacerbations). Measurements and Main Results: The majority of clinical measures associated with the lung microbiome and metabolome collectively in overall models (classification accuracies, >50%, P < 0.05 vs. chance). Lower lung function, COPD diagnosis, and greater symptoms associated positively with Streptococcus, Neisseria, and Veillonella, together with compounds from several classes (glycosphingolipids, glycerophospholipids, polyamines and xanthine, an adenosine metabolite). In contrast, several Prevotella members, together with adenosine, 5'-methylthioadenosine, sialic acid, tyrosine, and glutathione, associated with better lung function, absence of COPD, or less symptoms. Significant correlations were observed between specific metabolites and bacteria (Padj < 0.05). Conclusions: Components of the lung microbiome and metabolome in combination relate to outcome measures in milder COPD, highlighting their potential collaborative roles in disease pathogenesis.

High miR203a-3p and miR-375 expression in the airways of smokers with and without COPD

Smoking is a leading cause of chronic obstructive pulmonary disease (COPD). It is known to have a significant impact on gene expression and (inflammatory) cell populations in the airways involved in COPD pathogenesis. In this study, we investigated the impact of smoking on the expression of miRNAs in healthy and COPD individuals. We aimed to elucidate the overall smoking-induced miRNA changes and those specific to COPD. In addition, we investigated the downstream effects on regulatory gene expression and the correlation to cellular composition. We performed a genome-wide miRNA expression analysis on a dataset of 40 current- and 22 ex-smoking COPD patients and a dataset of 35 current- and 38 non-smoking respiratory healthy controls and validated the results in an independent dataset. miRNA expression was then correlated with mRNA expression in the same patients to assess potential regulatory effects of the miRNAs. Finally, cellular deconvolution analysis was used to relate miRNAs changes to specific cell populations. Current smoking was associated with increased expression of three miRNAs in the COPD patients and 18 miRNAs in the asymptomatic smokers compared to respiratory healthy controls. In comparison, four miRNAs were lower expressed with current smoking in asymptomatic controls. Two of the three smoking-related miRNAs in COPD, miR-203a-3p and miR-375, were also higher expressed with current smoking in COPD patients and the asymptomatic controls. The other smoking-related miRNA in COPD patients, i.e. miR-31-3p, was not present in the respiratory healthy control dataset. miRNA-mRNA correlations demonstrated that miR-203a-3p, miR-375 and also miR-31-3p expression were negatively associated with genes involved in pro-inflammatory pathways and positively associated with genes involved in the xenobiotic pathway. Cellular deconvolution showed that higher levels of miR-203a-3p were associated with higher proportions of proliferating-basal cells and secretory (club and goblet) cells and lower levels of fibroblasts, luminal macrophages, endothelial cells, B-cells, amongst other cell types. MiR-375 expression was associated with lower levels of secretory cells, ionocytes and submucosal cells, but higher levels of endothelial cells, smooth muscle cells, and mast cells, amongst other cell types. In conclusion, we identified two smoking-induced miRNAs (miR-375 and miR-203a-3p) that play a role in regulating inflammation and detoxification pathways, regardless of the presence or absence of COPD. Additionally, in patients with COPD, we identified miR-31-3p as a miRNA induced by smoking. Our identified miRNAs should be studied further to unravel which smoking-induced inflammatory mechanisms are reactive and which are involved in COPD pathogenesis.

Physical Rehabilitation in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease

Despite all the efforts of medical services, the socio-economic damage caused by chronic heart failure (CHF) is increasing. Approximately 10-40% of patients with CHF also suffer from chronic obstructive pulmonary disease (COPD). The comorbid course of these pathologies aggravates the prognosis of patients. Moderate physical activity is recommended as a non-drug therapy for both pathologies. The aim of the study: was to evaluate the effectiveness of physical rehabilitation in patients with chronic heart failure and chronic obstructive pulmonary disease by determining the levels of NT-proBNP, high-sensitivity C-reactive protein, IL-1β, IL-6, TNF-α. Methods: The study included 240 patients with CHF. After the initial examination, the patients were divided into groups depending on the presence or absence of COPD and the value of LVEF. Subsequently, each group was divided into a subgroup that took part in physical rehabilitation in addition to standard medical therapy and another one consist of patients that received only standard therapy. A year later, the levels of NT-proBNP, high-sensitivity C-reactive protein, IL-1β, IL-6 and TNF-α were re-determined. Results and Conclusion: CHFpEF patients have higher levels of hs-CRP and pro-inflammatory cytokines compared to patients with CHFrEF. The combination of COPD and CHF enhances systemic inflammation and myocardial remodeling processes, determined by the level of NT-proBNP in comparison with the isolated course of CHF. Physical rehabilitation in patients with a comorbid course of COPD and CHF is accompanied by a significant decrease in the levels of pro-inflammatory cytokines, hs-CRP and NT-proBNP. Keywords: chronic heart failure, chronic obstructive pulmonary disease, physical rehabilitation

Evaluation of the Efficiency of Physical Rehabilitation in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) occupy one of the leading positions among the main causes of morbidity and mortality. Their comorbid course is quite common and adversely affects the prognosis of these patients. To prevent decompensation and reduce hospitalizations in this group of patients, combined methods of management are required. In addition to medical treatment, these methods include physical rehabilitation. The aim of the study: was to evaluate the effectiveness of physical rehabilitation in patients with chronic heart failure and chronic obstructive pulmonary disease using a complex of cardiorespiratory analysis, a monitoring system for patients with chronic heart failure and a 6-minute walk test. Methods: The study included 240 patients with CHF. After the initial examination, the patients were divided into groups depending on the presence or absence of COPD and the value of LVEF. Subsequently, each group was divided into a subgroup that took part in physical rehabilitation in addition to standard medical therapy and another one consist of patients that received only standard therapy. A year later exercise tolerance was re-determined using a complex of cardiorespiratory analysis, a monitoring system for patients with chronic heart failure and a 6-minute walk test (6MWT). Results and Conclusion: Conducting physical rehabilitation in patients with a comorbid course of COPD and CHF is accompanied by a significant improvement in hemodynamic parameters during exercise tests (6MWT). Keywords: chronic heart failure, chronic obstructive pulmonary disease, physical rehabilitation

Optimism is associated with respiratory symptoms and functional status in chronic obstructive pulmonary disease

BackgroundOptimism is the general belief that good things will occur in the future; optimism is modifiable by cognitive behavioral therapy (CBT). Previous studies have associated higher optimism with improved health outcomes and lower all-cause mortality.Research questionInvestigate association between optimism and disease-related characteristics in chronic obstructive pulmonary disease (COPD).Study design and methodsCurrent and former smokers with/without COPD and Preserved Ratio Impaired Spirometry (PRISm) from the 10-year follow-up visit for the Genetic Epidemiology of COPD (COPDGene) study were included. Optimism was assessed at the 10-year visit using the Life Orientation Test-Revised. Models of optimism as a predictor of lung function, COPD-associated phenotypes including exacerbations, and functional assessments, were adjusted for demographic confounders, smoking status, and comorbidities.ResultsAmong 1967 subjects, higher optimism was significantly associated with older age, non-Hispanic white race, marital status, quitting smoking status, absence of COPD, and absence of depression. In multivariable analysis, higher optimism was independently associated with fewer prior exacerbations of COPD (coef = − 0.037, P < 0.001). Higher optimism was also related to better MMRC scores (coef = − 0.041, P < 0.001), CAT scores (coef = − 0.391, P < 0.001), SGRQ scores (coef = − 0.958, P < 0.001), BODE index (coef = − 0.059, P < 0.001), and longer 6-min walk distance (coef = 10.227, P < 0.001). After stratification by severity of COPD, these associations with optimism were still significant in all groups. No significant association was observed for cross-sectional FEV1 (%) or FVC (%) with optimism score.InterpretationFewer exacerbations and less severe respiratory symptoms and higher functional capacity were associated with higher optimism, which may impact health outcomes in current and former smokers with and without COPD. Optimism is a modifiable trait and these results may further support a role for CBT to improve outcomes in COPD.

Metabolic Syndrome in South Korean Patients with Chronic Obstructive Pulmonary Disease: A Focus on Gender Differences

PurposeThis study investigated the relationship between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS), focusing on gender differences and using large-scale data on the Korean general population. MethodsThe total sample included 9,079 eligible participants aged ≥ 40 years who participated in the fifth Korea National Health and Nutrition Examination Survey, conducted between 2010 and 2012. Complex sampling methods, including strata sampling, clustering, and sample weighting were used to allow generalization of the findings to the Korean population. For the bivariate analysis, chi-square tests were conducted to compare differences in general/behavioral characteristics, individual MetS components, the prevalence of COPD, and the number of MetS components according to the presence or absence of COPD and gender. Finally, a multiple logistic regression analysis adjusted for variables was conducted. ResultsThe prevalence rates of COPD and MetS were 13.6% and 26.0%, respectively. The prevalence rate of MetS in the COPD group was 23.0% for the total sample, 18.5% for men, and 38.5% for women. After sample weighting and adjusting for covariates, there were no significant relationships among COPD, MetS, and the individual MetS components. ConclusionAlthough MetS components were not significantly associated with COPD, the results indicate that health care professionals should recognize that two conditions, respiratory symptoms and MetS, may coexist in patients, women in particular, or healthy general populations encountered even if a patient has a normal body mass index and does not drink or smoke at all.

Influence of COPD on outcomes of patients hospitalized with heart failure: Analysis of the Spanish National Hospital Discharge Database (2001–2015)

ObjectiveTo examine trends in incidence and outcomes of heart failure (HF) hospitalizations among patients with or without chronic obstructive pulmonary disease (COPD) in Spain (2001–2015). MethodsWe used national hospital discharge data to select hospital admissions for HF as primary diagnosis. Incidence, comorbidities, diagnostic and therapeutic procedures, length of hospital stay (LOHS), readmissions rate, costs and in hospital mortality (IHM) was analyzed according to the presence or absence of COPD. Charlson comorbidity index (CCI) was used to assess comorbidity. ResultsWe identified 1,501,811 admissions for HF (19.55% with COPD). Incidence was significantly higher in COPD patients for all years analyzed. We found a significant increase in crude incidence over time in both groups of patients. Overall the incidence was 2.42-times higher among COPD patients (IRR 2.42; 95%CI 2.39–2.46). The joinpoint analysis showed that among men with COPD admissions for HF increased by 2.90% per year. Time trend analyses showed a significant decrease in IHM for both groups. Factors independently associated with higher IHM in both groups included: female gender, higher age, comorbidities according to CCI, longer LOHS and readmissions. The presence of COPD was not associated with a higher IHM in patients hospitalized with HF (OR0.98, 95%CI 0.96–1.01). ConclusionsAmong men suffering COPD the incidence of HF hospitalizations increased from 2001 to 2015. Incidence of hospitalizations was more than twice higher in the COPD population. IHM decreased over time in both groups. Female gender and readmission predict higher IHM. There were no differences in mortality between patients with and without COPD.

The Association between Chronic Obstructive Pulmonary Disease (COPD) and Atrial Fibrillation: A Review

COPD is one of the leading causes of Mortality & Morbidity in the US and is associated with a wide variety of cardiovascular diseases especially arrhythmias, angina, myocardial infarction and congestive heart failure and is directly associated with the severity of COPD described in the GOLD initiative. COPD is an independent risk factor for AF/AFL. Smoking, hypoxia and inflammation all contribute to AF in COPD patients mainly via atrial remodeling while hypercapnia contributes to it via increasing refractoriness of the atrial musculature and a delay in the return of the refractoriness to normal after resolution of the hypercapnia. The most common EKG abnormality found in patients with COPD is P pulmonale and the PQ interval is the strongest predictor of developing AF. The P wave Dispersion (PwD) was also an independent risk factor for the development of AF and was found to be more in the acute phase than in the stable phase. The BODE index, an important prognostic score among patients hospitalized with a COPD exacerbation has a direct co relation with the prevalence of AF/AFL while the DECAF score, which was found to be superior to the CURB 65 score as a mortality predictor for hospitalized patients, includes AF as one of the criteria. Chronic hypoxemia is one of the main reasons for altered pulmonary vein anatomy and hence the presence of COPD was identified as an independent risk factor for the recurrence of atrial tachyarrhythmias after catheter ablation in patients with COPD and the absence of COPD was also found to be an independent predictor for a successful electro-cardioversion. These patients were also found to have an increased incidence of non-PV foci for the arrhythmias. Oral glucocorticoids were associated with an increased risk of developing AF especially high dose steroids. It is recommended to correct the underlying respiratory decompensation while treating patients with AF as they render the treatment of AF ineffective. Non-dihydropyridine calcium channel blockers should be used as first line rate control agents for AF in patients with concomitant COPD while the β-blockers, sotalol, propafenone can be used in patients with obstructive lung disease who do not have bronchospasm.

Atypical aetiology in patients hospitalised with community-acquired pneumonia is associated with age, gender and season; a data-analysis on four Dutch cohorts.

BackgroundMicroorganisms causing community-acquired pneumonia (CAP) can be categorised into viral, typical and atypical (Legionella species, Coxiella burnetii, Mycoplasma pneumoniae, and Chlamydia species). Extensive microbiological testing to identify the causative microorganism is not standardly recommended, and empiric treatment does not always cover atypical pathogens. In order to optimize epidemiologic knowledge of CAP and to improve empiric antibiotic choice, we investigated whether atypical microorganisms are associated with a particular season or with the patient characteristics age, gender, or chronic obstructive pulmonary disease (COPD).MethodsA data-analysis was performed on databases from four prospective studies, which all included adult patients hospitalised with CAP in the Netherlands (N = 980). All studies performed extensive microbiological testing.ResultsA main causative agent was identified in 565/980 (57.7 %) patients. Of these, 117 (20.7 %) were atypical microorganisms. This percentage was 40.4 % (57/141) during the non-respiratory season (week 20 to week 39, early May to early October), and 67.2 % (41/61) for patients under the age of 60 during this season. Factors that were associated with atypical causative agents were: CAP acquired in the non-respiratory season (odds ratio (OR) 4.3, 95 % CI 2.68–6.84), age <60 year (OR 2.9, 95 % CI 1.83–4.66), male gender (OR 1.7, 95 % CI 1.06–2.71) and absence of COPD (OR 0.2, 95 % CI 0.12–0.52).ConclusionsAtypical causative agents in CAP are associated with respectively non-respiratory season, age <60 years, male gender and absence of COPD. Therefore, to maximise its yield, extensive microbiological testing should be considered in patients <60 years old who are admitted with CAP from early May to early October.Trial registrationNCT00471640, NCT00170196 (numbers of original studies).Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1641-9) contains supplementary material, which is available to authorized users.

Association between Th17-related cytokines and risk of non-small cell lung cancer among patients with or without chronic obstructive pulmonary disease.

CD4 (+) T helper 17 (Th17) cells play critical roles in inflammation and tumor development. The involvement of Th17 cells in chronic obstructive pulmonary disease (COPD)-type inflammation-associated lung cancer has also been confirmed in animal models. However, to the authors' knowledge, it is unknown whether the role of Th17 cells is different in patients with lung cancer complicated with COPD compared with those without COPD. In the current study, the authors attempted to determine the association between the circulating levels of Th17-related cytokines and the clinical characteristics of non-small cell lung cancer (NSCLC) in patients with or without COPD. The authors designed a matched case-control study that included 70 patients with NSCLC with COPD, 148 patients with NSCLC without COPD, and 148 healthy controls. The data regarding the clinicopathological features of these participants were collected. Circulating levels of Th17-related cytokines, including interleukin (IL) 23 (IL-23), IL-17A, IL-17F, IL-22, and tumor necrosis factor-α, were measured. The circulating levels of IL-23, IL-17A, IL-17F, IL-22, and tumor necrosis factor-α were found to be significantly higher in the patients with NSCLC compared with the healthy controls (P<.05). The elevated levels were found to be significantly associated with lung cancer risk (P<.05). However, no significant differences were found between patients with NSCLC with COPD and patients without COPD. It is interesting to note that, among patients with NSCLC without COPD, the levels of these cytokines were consistently higher among patients with stage I to stage IIIA disease compared with those with stage IIIB to stage IV disease (P<.05). In addition, the 5 Th17-related cytokines demonstrated pairwise correlations, with Spearman rank correlation coefficients of 0.646 to 0.888 (P<.05). The results of the current study indicate a clear association between the Th17-related cytokine profile and the risk of NSCLC complicated by the presence or absence of COPD.

Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome

ObjectiveAnalyse 2-year outcomes after MitraClip therapy and identify predictors of outcome.MethodsConsecutive patients (n=74) undergoing MitraClip therapy were included in the MitraSWISS registry and followed prospectively.ResultsA reduction of mitral regurgitation (MR)...

Does presence of chronic obstructive pulmonary disease (COPD) influence clinical behavior in patients with early-stage non-small cell lung cancer (ESNSCLC)?

e18530 Background: CDPD and lung cancer sometimes occurs simultaneously. COPD has been recognized as an inflammatory disease and may potentially affect biology of the accompanying tumor. It is not fully understood whether presence of CDPD influences clinical characteristics, pathological findings and/or clinical outcomes in patients with ESNSCLC. Methods: Retrospective and consecutive data were collected from the medical records of patients who underwent surgical resections at Kinki-chuo Chest Medical Center, Japan, between January 2009 and December 2010. CDPD status was classified as absence of COPD, stage I and II COPD based on the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD). Histology, vascular / lymphatic invasion and the status of epidermal growth factor receptor (EGFR) were determined using the surgical materials. Results: A total of 319 cases was included with median age of 67 (range, 36 - 89). There were 81 cases of relapse and 40 cases of death during the median follow up of 28 months (11 days to 49 months). In the subgroup of non-COPD, stage I and II COPD, the median age, the number of case in gender (male/female), performance status (PS, 0/1), histology (squamous cell carcinoma [SQ] /non SQ), smoking status (never/ever), and EGFR status (wild type/mutant) were 67, 72, 72 (p&lt;0.001) and 105/110, 48/12, 38/6 (p&lt;0.001) and 170/40, 53/7, 27/14 (p=0.029) and 31/184, 12/48, 14/28 (p&lt;0.001) and 89/122, 7/53, 2/39 (p=0.002) and 47/37, 21/3, 9/3 (p=0.013), respectively. No significant difference was observed in disease-free survival (DFS, log-rank p=0.411) and overall survival (OS, log-rank p=0.127) between the patients with and without COPD. In multivariate analysis adjusted for age, gender, PS, histology, smoking status, pathological stage, vascular / lymphatic invasion and EGFR status, presence of COPD did not affect DFS (HR=1.457, p = 0.279) nor OS (HR=0.993, p = 0.990).Conclusions: Although COPD was significantly associated with the elderly, male gender, presence of symptoms, SQ histology, ever smoking, and wild type EGFR, it did not add values of prognostic factors in patients with ESNSCLC.

Differential Activation of Killer Cells in the Circulation and the Lung: A Study of Current Smoking Status and Chronic Obstructive Pulmonary Disease (COPD)

BackgroundCD8+ T-lymphocytes, natural killer T-like cells (NKT-like cells, CD56+CD3+) and natural killer cells (NK cells, CD56+CD3−) are the three main classes of human killer cells and they are implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD). Activation of these cells can initiate immune responses by virtue of their production of inflammatory cytokines and chemokines that cause lung tissue damage, mucus hypersecretion and emphysema. The objective of the current study was to investigate the activation levels of human killer cells in healthy non-smokers, healthy smokers, ex-smokers with COPD and current smokers with COPD, in both peripheral blood and induced sputum.Methods/Principal FindingsAfter informed consent, 124 participants were recruited into the study and peripheral blood or induced sputum was taken. The activation states and receptor expression of killer cells were measured by flow cytometry. In peripheral blood, current smokers, regardless of disease state, have the highest proportion of activated CD8+ T-lymphocytes, NKT-like cells and NK cells compared with ex-smokers with COPD and healthy non-smokers. Furthermore, CD8+ T-lymphocyte and NK cell activation is positively correlated with the number of cigarettes currently smoked. Conversely, in induced sputum, the proportion of activated killer cells was related to disease state rather than current smoking status, with current and ex-smokers with COPD having significantly higher rates of activation than healthy smokers and healthy non-smokers.ConclusionsA differential effect in systemic and lung activation of killer cells in COPD is evident. Systemic activation appears to be related to current smoking whereas lung activation is related to the presence or absence of COPD, irrespective of current smoking status. These findings suggest that modulating killer cell activation may be a new target for the treatment of COPD.

Spirometric Thresholds for Diagnosing COPD: 0.70 or LLN, Pre- or Post-dilator Values?

In absence of a gold standard for chronic obstructive pulmonary disease (COPD) it remains difficult to compare the true diagnostic characteristics of the forced expiratory volume in 1 second to the forced vital capacity (FEV1/FVC) <0.70 and < lower limit of normal (LLN). COPD is a clinical diagnosis, based on symptoms signs and lung function results combined, and an expert panel assessment would be an adequate reference standard. We compared the diagnostic properties of FEV1/FVC <LLN and <0.70 against this panel diagnosis: 342 participants, aged >50, consulting for persistent cough, but without physician-diagnosed COPD, were prospectively enrolled. All underwent extensive history taking, physical examination, spirometry and diffusion testing. An expert panel, including a board certified respiratory physician, assessed all diagnostic information to determine the presence or absence of COPD and served as reference standard. Then, 104 participants were diagnosed with COPD by the panel. The reproducibility of the panel diagnosis was high (kappa of 0.94). Sensitivity estimates of <0.70 were significantly higher than that of <LLN (0.73 and 0.47, respectively, p < 0.001). The fixed approach was less specific than the LLN (0.95 and 0.99, respectively, p < 0.001). There was no significant difference in diagnostic property when using pre- or post-bronchodilator FEV1/FVC (p = 0.615). In a symptomatic primary care population, the FEV1/FVC <0.70 was more accurate to detect COPD.

Clinical correlates of immediate success and outcome at 1-year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey

In atrial fibrillation (AF) cardioversion is the cornerstone of the rhythm management strategy despite the lack of contemporary data on acute and long-term success. We aim to describe present-day cardioversion of AF and identify characteristics associated with immediate and long-term outcome. Based on the 5333 AF patients enrolled in the multi-centre prospective Euro Heart Survey on AF we selected the 1801 patients undergoing cardioversion at enrolment. Sinus rhythm (SR) was restored in 630 of 712 (88%), 458 of 643 (71%), and 333 of 446 (75%) (P< 0.001) of the electrical (ECV), intravenous (ivCCV), and oral (oCCV) chemical cardioversions, respectively, at the cost of few (4.2%) major complications. In multivariate analysis, absence of chronic obstructive pulmonary disease (COPD) (P< 0.001), presence of paroxysmal AF (PAF) (P= 0.013), and use of biphasic waveform (P= 0.018) were predictors of successful ECV. For ivCCV PAF (P< 0.001), absence of valvular heart disease (P= 0.004), and heart failure (P= 0.009), the presence of hypertension (P= 0.018) and coronary artery disease (P= 0.007) were predictive. Success of oCCV was driven by PAF (P< 0.001) and a smaller left atrial dimension (P= 0.001). At 1-year follow-up 893 of 1271 (70%) patients were in SR. Multivariate analysis revealed PAF (P< 0.001), shorter total AF history (P< 0.001), continuous use of Class Ic drugs or amiodarone during follow-up (P< 0.001), absence of COPD (P= 0.003), younger age (P= 0.004), and smaller left atrial dimension (P= 0.005) as independent predictors of SR at 1-year follow-up. Contemporary cardioversion of AF is routinely successfully and safely performed with a high proportion of patients in SR at 1-year follow-up.

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

Numerous decision aids have been developed recently, but the value they add above that of the initial clinical assessment is not well known. To quantify whether a formal decision aid for chronic obstructive pulmonary disease (COPD) adds diagnostic information, above the physician's clinical assessment. Subanalysis of a diagnostic study in Dutch primary care. Sixty-five primary care physicians included 357 patients who attended for persistent cough and were not known to have COPD. The physicians estimated the probability of COPD after short history taking and physical examination. After this, the presence or absence of COPD was determined using results of extensive diagnostic work-up. The extent to which an 8-item decision aid for COPD, which included only symptoms and signs, added diagnostic value above the physician's estimation was quantified by the increase of the area under the receiver operating characteristic curve (ROC area), and the improvement in diagnostic risk classification across two classes: 'low probability of COPD' (<20%) and 'possible COPD' (≥20%). One hundred and four patients (29%) had COPD. Adding the decision aid to the clinical assessment increased the ROC area from 0.75 (95% confidence interval [CI] = 0.70 to 0.81) to 0.84 (95% CI = 0.80 to 0.89) (P<0.005), and improved the diagnostic risk classification of the patients, such that 35 fewer patients needed spirometry testing and eight fewer COPD cases were missed. A short decision aid for COPD added diagnostic value to the physician's clinical assessment.

Role of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary disease

Elderly subjects are characterized by a high prevalence of chronic obstructive pulmonary disease (COPD) and frailty. This study examined the predictive role of frailty on long-term mortality in elderly subjects with and without COPD. The study assessed mortality after a 12-year follow-up in 489 subjects with COPD and 799 subjects without COPD, selected in 1992. Frailty was assessed according to the Frailty Staging System scores ranging from 1 to 7. After 12 years' follow-up, mortality was 48.1% in subjects without and 60.7% in subjects with COPD (p<0.001). With increasing frailty, mortality increased from 41.7% to 75.1% (p for trend <0.01) in subjects without and from 54.3% to 97.0% in subjects with COPD (p for trend <0.001). Multivariate analysis showed that both COPD [hazard ratio (HR)=1.34; 95% confidence interval (95% CI)=1.02-1.81; p=0.042] and frailty score (HR=1.69 for each unit of increase; 95% CI=1.42- 2.00; p<0.001) were predictive of long-term mortality. The frailty score also increased the risk of long-term mortality by 34% in the absence of COPD (HR=1.34 for each unit of increase; 95% CI=1.02-1.81; p<0.05) and by 80% in its presence (HR=1.80 for each unit of increase; 95% CI=1.28-2.53; p<0.001). Long-term mortality was higher in elderly subjects with than in those without COPD. The clinical frailty score also significantly predicted mortality in subjects without and, even more, in those with COPD. Thus, clinical frailty may be considered a new prognostic factor to identify COPD subjects at high risk of mortality.