Airflow Obstruction In Patients Research Articles

Role of Screening Lung Function Tests in a Routine Health Checkup.

Background and objectives The lung function test is a gold standard, guideline-recommended test to detect obstructive airway diseases like asthma and COPD. It is of considerable value in detecting the presence and severity of airflow obstruction in patients with respiratory symptoms. However, the role of spirometry in a routine health checkup is controversial.Spirometry, when used in routine health checkup settings as a case-finding tool for all adults with persistent respiratory symptoms or having a history of exposure to risk factors, is likely to label a relatively large proportion of individuals as diseased with airflow obstruction. Conversely, spirometry is normal in a relatively large percentage of adults who report respiratory symptoms including dyspnea, the respiratory symptom having the greatest impact on quality of life.The objective of this study is to determine the utility of spirometry as a screening test to detect airflow obstruction in otherwise healthy subjects undergoing a routine health checkup. Methods This observational study was conducted with 538 health checkup individuals aged 18 and over. A brief history was taken prior to the test. Lung function tests were performed and interpreted as per the Global Initiative for Chronic Obstructive Lung Disease criteria. The anthropometric and spirometric data obtained were compared to other population-based spirometric studies to compare the prevalence of airflow limitation, the risk factors, and smoking history. Results Of the total 538 subjects incorporated in the study, 305 (57%) were males and 233 (43%) were females aged between 18 to 80 years with a mean age of 45 years. The male-to-female ratio was 1.3:1 with a mean BMI of 25.9. The overall yield from lung function tests in detecting airflow obstruction was 63 subjects (11.7%), of which 36 (11.8%) were males and 27 (11.5%) were females. Seventy-three subjects (13.5%) were classified as having a small airway obstruction, of which 34 were males (46.6%), and 39 were females (53.4%). The distribution of airflow obstruction by age was with eight subjects (5.4%) in the 18-35 group, 21 subjects (7.8%) in the 36-55 group, and 34 (25%) in the elderly (>55) age group.Although overall smoking history showed no significant association with developing airflow obstruction, significant association with smoking was found in the elderly (>55) age group. Interpretation and conclusions The results of the study suggest that lung function tests should be included in routine health checkups in the subset of individuals greater than 35 years of age with or without a history of smoking, in all age groups with a family history of asthma, in individuals with respiratory symptoms and inindividuals greater than 55 years of age with a moderate history of smoking.

Clinical significance of normalized airflow obstruction in patients with chronic obstructive pulmonary disease

BackgroundThere is ongoing debate regarding the diagnostic criteria for chronic obstructive pulmonary disease (COPD); recent studies have focused on the early COPD detection and management. Here, we compared clinical features and prognosis in patients with FEV1/FVC<0.70 at baseline, according to normalized airflow obstruction status during follow-up. MethodsWe used the Korea COPD Subgroup Study (KOCOSS) cohort database, a prospective nationwide observational COPD study. Normalized obstruction (NO) was defined as FEV1/FVC ≥0.7 in the 2-year follow-up period, whereas fixed obstruction (FO) was defined as FEV1/FVC <0.7. Demographic and clinical data, 1-year exacerbation risk and difference in FEV1 decline over 2 years were compared between NO and FO groups. ResultsAmong the 670 COPD patients with post-bronchodilator FEV1/FVC <0.7 in this study, 95 (14.2%) displayed NO. Compared with the FO group, the NO group had higher FEV1, and DLCO, body mass index, as well as lower Saint George Respiratory Questionnaire, Beck Depression Index, and Beck Anxiety Index. Blood eosinophil count, IgE level, and FeNO did not significantly differ between two groups. There was no significant difference in exacerbation frequency between the two groups, but the NO group had a significant increase in FEV1 compared with the FO group during follow-up. ConclusionTransient airflow obstruction in the NO group may represent a clinical manifestation of early COPD; close monitoring is needed for such patients.

DIAPHRAGMATIC MOBILITY, DISEASE SEVERITY, AND EXERCISE TOLERANCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Airflow obstruction in patients with Chronic Obstructive Pulmonary Disease represents the main disabling factor, in a progressive and irreversible manner. Respiratory muscle dysfunction correlates with disease mortality and morbidity and reduces the patient's tolerance to exercise and quality of life. Thus, this study aimed to evaluate diaphragmatic mobility, disease severity, and exercise tolerance in patients with COPD. Methods: The study included clinically stable patients diagnosed with COPD according to the GOLD 2019 guidelines. We excluded patients who had disease exacerbation during the study or in the last two months preceding the study those who were unable to perform any of the study assessments due to lack of understanding or cooperation, and those who had clinical intercurrences of cardiorespiratory and, or musculoskeletal nature during the assessments. The diaphragmatic mobility was measured by ultrasound, curvilinear transducer (1-5Mhz). The 6-minute walk test (6MWT) was performed according to the guidelines suggested by the American Thoracic Society. We used the COPD Assessment Test (CAT) and the modified Borg scale to assess the patient's quality of life and the degree of dyspnea, respectively. Results: Sixty-six patients were included and classified into three groups: mild COPD (n=16), moderate COPD (n=30), and severe/very severe COPD (n=20). The mean age of the patients was 63.7 ± 9.4 years, 53% were female, and the mean BMI was 27.6 ± 5.5 kg/m². Diaphragmatic mobility did not correlate with the distance walked on the 6MWT (p=0.8), CAT scores (p=0.2), and disease severity (p=0.9). It also did not correlate with other clinical and functional variables such as heart and respiratory rate, blood pressure peripheral oxygen saturation (SpO2), and Borg scores. Conclusion: In our study, diaphragmatic mobility measurements seem unable to identify disease severity and to correlate with other clinical and functional parameters.

Quantitative CT parameters correlate with lung function in chronic obstructive pulmonary disease: A systematic review and meta-analysis.

This study aimed to analyze the correlation between quantitative computed tomography (CT) parameters and airflow obstruction in patients with COPD. PubMed, Embase, Cochrane and Web of Knowledge were searched by two investigators from inception to July 2022, using a combination of pertinent items to discover articles that investigated the relationship between CT measurements and lung function parameters in patients with COPD. Five reviewers independently extracted data, and evaluated it for quality and bias. The correlation coefficient was calculated, and heterogeneity was explored. The following CT measurements were extracted: percentage of lung attenuation area <-950 Hounsfield Units (HU), mean lung density, percentage of airway wall area, air trapping index, and airway wall thickness. Two airflow obstruction parameters were extracted: forced expiratory volume in the first second as a percentage of prediction (FEV1%pred) and FEV1 divided by forced expiratory volume lung capacity. A total of 141 studies (25,214 participants) were identified, which 64 (6,341 participants) were suitable for our meta-analysis. Results from our analysis demonstrated that there was a significant correlation between quantitative CT parameters and lung function. The absolute pooled correlation coefficients ranged from 0.26 (95% CI, 0.18 to 0.33) to 0.70 (95% CI, 0.65 to 0.75) for inspiratory CT and 0.56 (95% CI, 0.51 to 0.60) to 0.74 (95% CI, 0.68 to 0.80) for expiratory CT. Results from this analysis demonstrated that quantitative CT parameters are significantly correlated with lung function in patients with COPD. With recent advances in chest CT, we can evaluate morphological features in the lungs that cannot be obtained by other clinical indices, such as pulmonary function tests. Therefore, CT can provide a quantitative method to advance the development and testing of new interventions and therapies for patients with COPD.

Circadian molecular clock disruption in chronic pulmonary diseases.

The circadian clock is the biochemical oscillator with a near 24-h period that is responsible for generating the circadian rhythms in peripheral organs including the lung. Mounting evidence suggests that circadian clock disruption during chronic lung diseases plays an essential role in augmented oxidative stress, inflammatory response, metabolic imbalances, hypoxia/hyperoxia, mucus secretion, dysregulated autophagy, and alters pulmonary function. Here, we review circadian clock disruption and discuss candidate clock genes that are altered at the transcriptional or translational level in chronic pulmonary diseases. This review aims to provide the current knowledge and understanding of the circadian molecular clock disruption in chronic pulmonary diseases which will further advance the development of novel clock-based therapeutics in the future.

Relationship between serum sialic acid levels and prolidase activity with airflow obstruction in patients with COPD.

Our aim in this study was to evaluate the prognostic significance of sialic acid (SA) and prolidase activity and to evaluate the association between airflow obstruction severity and these parameters in chronic obstructive pulmonary disease (COPD) patients.Ninety-four patients (84 M, 10 F) and 34 healthy subjects (19 M, 15 F) were included into the study. COPD staging was performed to COPD patients according to new global initiative for chronic obstructive lung disease criteria which includes pulmonary function tests, symptoms and hospitalization; COPD patients were divided into 4 subgroups as group A (n = 25), group B (n = 19), group C (n = 20), and group D (n = 28).SA and C-reactive protein levels were significantly higher than the control group in all COPD groups. SA levels were significantly higher in group B patients than the control and group A. Prolidase activity was significantly lower than control group in total COPD groups (P < .05). There was a weak negative correlation between SA and forced vital capacity (r = -0.217, P = .038) and forced expiratory volume in 1 second (FEV1) (r = -0.210, P = .045), whereas weak positive correlation was present between SA and Creactive protein (r = 0.247, P = .018) in all patient groups. There was weak positive correlation between prolidase and FEV1 (r = 0.222, P = .033) and FEV1/forced vital capacity (r = 0.230, P = .027).Our study shows that systemic inflammation, prolidase activity, and SA levels in stable COPD patients are associated with airflow obstruction severity. In addition to the prolidase activity; SA levels might be associated with inflammation.

HRCT quantitative analysis of airway remodeling and airway trapping in the small airway asthma phenotype and its correlation with pulmonary function

Objectives We aimed to explore whether large airway remodeling and small airway structural changes exist in subjects with small airway asthma phenotype and to evaluate the relationships between quantitative high-resolution computed tomography (qHRCT) parameters and lung function. Methods We enrolled 15 subjects with small airway asthma phenotype and 18 healthy controls. The two groups were matched by age, sex and body square area (BSA) with propensity score matching (PSM). Pulmonary function and qHRCT parameters [wall thickness (WT), wall area (WA), lumen area (LA), wall area percentage (WA%) of the 4th–6th generations in the right upper lobe apical segmental bronchus (RB1), adjusted by BSA, WT/BSA, WA/BSA, and LA/BSA, relative volume change −860 HU to −950 HU (RVC−860 to −950) and the expiration to inspiration ratio of mean lung density (MLDE/I)) were compared between the groups. Correlation analysis was employed to assess the relationship between qHRCT parameters and pulmonary function. Results The small airway asthma phenotype had significantly higher WA%, RVC−860 to −950 and MLDE/I and lower LA/BSA than the healthy control. Additionally, we found moderate to strong correlations between impulse oscillation (IOS) indices and WA6% and WT6/BSA. No significant correlation was found between bronchial parameters and air trapping parameters (p > 0.05). Conclusions Combining physiological tests with imaging approaches can lead to better evaluation of small airway disfunction (SAD) in asthmatic patients. Additionally, despite nonexistent airflow obstruction in patients with small airway asthma phenotype, large airway remodeling and small airway structural changes may appear simultaneously in the early stage of disease.

Fat-free mass index in patients with chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a public health problem because it is a major cause of death in the world. Approximately 25% of patients with moderate disease and 35% with severe disease show a reduced fat-free mass (FFM). Thus, the objective of this study is to define the correlation between fat-free mass index (FFMI), muscle function, respiratory symptoms, number of exacerbations during the last year, and degree of airflow obstruction in patients with COPD. It is a prospective and cross-sectional study. The FFMI was below 32.7% (n=18) and the strength diminished by 56.4% (n=31). In the sample, we found a direct and significant correlation between the FFMI and the FEV1 (predicted %), (p= 0.045). When analysed by sex, men had a direct correlation between FFMI and the FEV1 (predicted %), (p=0.019), an inverse correlation between FFMI and the spirometric classification of the Global Initiative Obstructive Lung Disease (GOLD) (p=0.008), and between the muscular function and the symptoms (p=0.03). In women, no significant correlation was found. In conclusion, the conditions in mass and muscular function were correlated with clinical variables and pulmonary function in men. We did not find a correlation between corporal composition and the number of exacerbations.

Correlation of six minute walk test and incremental shuttle walk test with severity of airflow obstruction in patients with chronic obstructive pulmonary disease

Context: The field walking tests like 6MWT and ISWT are commonly used indicators of functional capacity in patients with cardiopulmonary diseases. This study was designed to assess the correlation of six minute walk distance (6MWD) and incremental shuttle walk distance (ISWD) with the severity of airflow obstruction (FEV1%) in patients with chronic obstructive pulmonary disease. Aims: Comparison of correlation of six minute walk test and Incremental shuttle walk test with the severity of airflow obstruction in COPD patients.Settings and Design: Hospital-based prospective cross-sectional study in a tertiary care centre. Methods and Material: One hundred and twelve (112) spirometrically confirmed COPD patients underwent 6MWT and ISWT. The diagnosis of COPD and its severity was assessed by the GOLD criteria. 6MWT and ISWT were done on the same patient with a gap of 5–6 hours and the distance walked (6MWD and ISWD) was correlated with the severity of COPD (FEV1). Statistical Analysis Used: One way ANOVA to compare mean distance walked in 6MWT and ISWT with different grades of COPD. Pearson Correlation was done to correlate packyears of smoking and age with 6MWD and ISWD. Results: The mean distance walked in the 6MWT and ISWT was estimated and compared across the four categories of GOLD grading. There was no statistically significant difference between the study subjects of corresponding GOLD grades based on the distance walked in 6MWT and in ISWT. However, a linear correlation was depicted between ISWD and post-bronchodilator FEV1. A model of linear regression showed that ISWD was an independent contributor to post-bronchodilator FEV1 in our study. Conclusions: Incremental shuttle walk test, an externally paced near to standard test with its incremental nature, can be used as an appropriate surrogate for FEV1 in determining the severity of airflow obstruction in COPD patients.

DNA methylation is associated with airflow obstruction in patients living with HIV

IntroductionPeople living with HIV (PLWH) suffer from age-related comorbidities such as COPD. The processes responsible for reduced lung function in PLWH are largely unknown. We performed an epigenome-wide association study...

Oscillometry and computed tomography findings in patients with idiopathic pulmonary fibrosis

Although the utility of oscillometry for predicting disease severity in idiopathic pulmonary fibrosis (IPF) had been researched, little has been reported on the mechanism of why respiratory impedance reflects disease severity. In addition, traction bronchiectasis has been considered to reduce respiratory resistance and correlate negatively with airflow obstruction, but this hypothesis has not been validated. The present study aimed to investigate the correlations between oscillometric parameters and fibrosis-related lung abnormalities in IPF and to assess the utility of oscillometry as a surrogate marker for traction bronchiectasis and airflow obstruction.Eighty Japanese patients with IPF underwent high-resolution computed tomography (HRCT), spirometry, and oscillometry and were retrospectively investigated. Fibrosis-related HRCT findings were scored regarding airspace consolidation, honeycombing, architectural distortion, traction bronchiectasis, and fibrosis. Correlations between the HRCT scores, spirometric parameters, and oscillometric parameters were analysed.Respiratory reactance correlated positively with all fibrosis-related HRCT scores. Vital capacity and forced vital capacity (FVC) correlated negatively with oscillometric parameters and HRCT scores, reflecting the severity of restrictive ventilatory deficiency. Respiratory resistance was not related to any of the HRCT scores or forced expiratory volume in 1 s/FVC. However, forced expiratory volume in 1 s/FVC correlated positively with HRCT scores, which showed that airflow obstruction became milder as the disease progressed.In conclusion, respiratory reactance reflects fibrosis and restrictive ventilatory deficiency in IPF. Moreover, respiratory resistance is independent of traction bronchiectasis and airflow obstruction in patients with IPF, which implies that respiratory resistance might reflect different properties of the airways.

Fixed airflow obstruction in patients with asthma

According to international guidelines in recent years, it has been proposed that bronchial asthma (BA) with fixed airflow obstructions (FAO) be identified as a separate phenotype.The aimof the study was the clinical and functional characterization and identification of risk factors for the formation of the phenotype BA with FAO.Materials.We examined adult outpatients with BA (n = 432) and a combination of BA and chronic obstructive pulmonary disease (COPD) without exacerbation (n = 58). Anamnesis collection, objective examination, spirometry with the assessment of obstruction reversibility (spirograph 2120 Vitalograph, UK), atopic status assessment (skin samples or specific IgE in serum) were performed. The level of eosinophils and neutrophils in peripheral blood was determined (by the impedance method on the automatic haemoanalyzer). Nitric oxide of exhaled air was measured by a chemiluminescent gas analyzer (Logan 4100, UK). BA control and quality of life of patients were evaluated using the Russian language versions of the Asthma Control Questionnaire (ACQ-5) and the St. George's Hospital Respiratory Questionnaire (St. George's Respiratory Questionnaire – SGRQ) respectively. Statistical analysis was carried out using parametric and non-parametric methods using the application program package Statistica 10. The value of bilateral p &lt; 0.05 was considered statistically significant.Results.Among patients with BA without COPD, the incidence of FAO was 31%, with the most frequent (60%) FAO was found in severe BA and less often – in the mild (7%) and medium (36%) course of the disease. Among patients with a combination of BA and COPD, a severe course of the disease prevailed – 77%. Patients with FAO were older and had a longer duration of disease. The presence of FAO was accompanied by lower rates of pulmonary function, a higher frequency of positive markers of eosinophilic inflammation, worse indicators of control over BA and quality of life, a higher need for “emergency” drugs and drugs to support the treatment of BA, including biological therapy, increased use of healthcare resources. The risk factors for FAO in patients with BA include the debut of BA under 25 years of age (odds ratio (OR) – 1.6), sensitization to ticks of house dust (OR – 1.8), passive smoking (OR – 6.5), suffered during the life of pneumonia (OR - 3.0).Conclusion. The combination of BA + FAO can be considered as a separate phenotype of the disease with a more severe course and less favorable prognosis.

ECONOMIC IMPACT OF EARLY USE OF UMEC/VI COMPARED WITH LATER USE IN PATIENTS WITH COPD

SESSION TITLE: Obstructive Lung Diseases 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Umeclidinium/vilanterol (UMEC/VI) is a combination therapy for once-daily maintenance treatment of airflow obstruction in patients with COPD. UMEC/VI was shown in clinical trials to improve lung function compared to either LAMA or ICS/LABA; yet, there has been no research on the economic impact of this newer therapy, specifically if earlier use results in lower medical cost. The objective of this study was to determine if patients treated as soon as possible with UMEC/VI following a COPD-related physician visit had reduced medical costs compared with patients treated later with UMEC/VI. METHODS: A retrospective analysis of patients with COPD who initiated UMEC/VI between 4/28/2014 to 7/31/2016 was conducted using the Optum Research Database. As the focus was initiation of therapy, the index date was the first COPD visit with a potential prescriber after UMEC/VI was available in the US and on formulary (Commercial 4/28/2014; Medicare Advantage 1/1/2015). Patients were followed for 12-months post-index, and stratified into twelve cohorts corresponding to the month of UMEC/VI treatment initiation following the index date (i.e. Months 1 to 12). Patients initiating >12 months post-index were excluded. Two measures of medical costs were examined for the 12-month period: all cause and COPD-related. Marginal structural models (MSM) were used to adjust for changes in treatment and severity over time, which can impact both the exposure of interest (initiation of UMEC/VI) and the outcome. RESULTS: 2,200 patients initiated UMEC/VI. Patients’ average age was 69.3 years, half were female and 30% commercially insured. In unadjusted analysis, there were no differences in 12-month costs by month of UMEC/VI initiation. After adjustment using MSMs, all-cause medical costs were estimated to increase by 2.8% (95% CI: 0.6%-5.2%; p=0.013) for each month delay. Patients who started UMEC/VI in Month 1 had 12-month predicted all-cause medical costs of $16,727 versus $22,766 for patients who started therapy in Month 12. COPD-related medical costs increased 2.9% (95% CI: 0.1%-5.9%; p=0.044) for each month delay, with 12-month predicted COPD-related medical cost of $9,524 among patients initiating UMEC/VI therapy in Month 1 versus $13,087 for those initiating in Month 12. CONCLUSIONS: The benefit of LAMA/LABA treatment shown in clinical trials and supported by the 2017 GOLD report appears to result in an economic benefit of lower annual medical costs over a 12-month period when initiating therapy earlier compared with a delay in starting therapy. CLINICAL IMPLICATIONS: These results suggest that patients benefit from initiation of therapy with UMEC/VI as soon as possible following a physician visit for COPD. DISCLOSURES: Employee relationship with Optum Please note: $20001 - $100000 Added 02/28/2018 by Amy Anderson, source=Web Response, value=Salary Employee relationship with Optum Please note: >$100000 Added 02/28/2018 by Lee Brekke, source=Web Response, value=Salary Employee relationship with Optum Please note: >$100000 Added 03/06/2018 by Ami Buikema, source=Web Response, value=Salary Employee relationship with GlaxoSmithKline Please note: >$100000 Added 02/28/2018 by Beth Hahn, source=Web Response, value=Salary Employee relationship with Optum Please note: $20001 - $100000 Added 03/01/2018 by Eleena Koep, source=Web Response, value=Salary Employee relationship with Glaxosmithkline Pharmaceuticals Please note: >$100000 Added 02/28/2018 by Riju Ray, source=Web Response, value=Shares Removed 02/28/2018 by Riju Ray, source=Web Response Employee relationship with Glaxosmithkline Pharmaceuticals Please note: >$100000 Added 02/28/2018 by Riju Ray, source=Web Response, value=Salary Employee relationship with Glaxosmithkline Pharmaceuticals Please note: $5001 - $20000 Added 02/28/2018 by Riju Ray, source=Web Response, value=Shares Employee relationship with Optum Please note: >$100000 Added 02/28/2018 by Lucie Sharpsten, source=Web Response, value=Salary Employee relationship with GlaxoSmithKline Please note: >$100000 Added 02/28/2018 by Richard Stanford, source=Web Response, value=Salary Employee of Optum relationship with Optum, inc. Please note: $20001 - $100000 Added 03/05/2018 by Damon Van Voorhis, source=Web Response, value=Salary

Association of Metabolic Syndrome with the Severity of Airflow Obstruction in Patients with Chronic Obstructive Pulmonary Disease.

BackgroundMetabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction.MethodologyThis was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction.Results40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II.ConclusionMetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.

Ability of Exhaled Nitric Oxide to Discriminate for Airflow Obstruction Among Frequent Exacerbators of Clinically Diagnosed Asthma.

Fraction of exhaled nitric oxide (FENO) has been proposed as a non-invasive biomarker for allergic inflammation seen in asthma. Many asthmatics in clinical practice have never had spirometry and recent data report misdiagnoses in patients with physician diagnosed (PD) asthma. The aim of this study was to assess the ability of FENO to discriminate between those with and without airflow obstruction (AO) among patients with PD-asthma. Frequent exacerbators of PD-asthma (with 2 or more asthma exacerbations leading to emergency room visit or hospitalization within last 12 months) were enrolled. All patients underwent diagnostic evaluations including spirometry, FENO testing and serum immunoglobulin (IgE) and eosinophils. Serial spirometry and methacholine challenge testing (MCT) were performed as indicated. AO was defined by a decreased FEV1/FVC ratio (< 70% and/or < LLN), or a positive MCT. Of the 222 patients with PD-asthma, AO was found in 136 (vs. 86 without AO). 81.6% of patients with AO and 66.2% without AO completed FENO testing. There was no significant difference in the mean FENO levels among patients with or without AO (40.8 vs. 30.4ppb, P = 0.10). Likewise, there was no difference in the serum IgE levels and serum eosinophils. Our analyses suggest that FENO levels do not help discriminate between those with and without AO in patients with PD-asthma. Patients who experience symptoms of asthma may have elevated FENO levels above the suggested cut points of 20-25ppb. Objective confirmation of AO should be considered in all patients with PD-asthma, irrespective of FENO levels.

The study of the correlations between the mass and fat infiltration of intercostal muscles and the severity of airflow obstruction in patients with chronic obstructive pulmonary disease by quantitative CT

Objective To investigate the correlations between the mass and fat infiltration of intercostal muscles and their severity of airflow obstruction in patients with chronic obstructive pulmonary disease(COPD). Methods One hundred and sixty-three COPD patients and 102 normal subjects between August 2015 to March 2017 underwent chest MSCT scans and all data were analyzed retrospectively. All subjects underwent pulmonary function tests (PFT). According to the global initiative for chronic obstructive lung disease(GOLD, updated 2015), the COPD patients were classified into GOLD 1(n=37), GOLD 2(n=46), GOLD 3 (n=48), GOLD 4 (n=32) by pulmonary function results, respectively. The mass and fat infiltrations of intercostal muscles were quantified as the cross-sectional area (CSA) and attenuation of these muscles using CT histogram analysis. Intercostal indexes and attenuation indexes were defined as intercostal CSA and attenuation divided by body mass index(BMI). Comparison of intercostal indexes and attenuation indexes between the COPD and control groups was perfomed using t test. The comparisons between the 4 COPD subgroups were carried out using ANOVA test, and comparison between the two groups by LSD. The correlation between intercostal indexes and attenuation indexes and PFT were evaluated by the Spearman rank correlation test. Results The CSA and attenuation indexes of COPD patients groups were (4.3±2.1) mm2·m2·kg-1, (-1.6±6.9) HU·m2·kg-1, respectively,both were significantly lower than that of the control group [ (6.9±1.7) mm2·m2·kg-1, (11.6±5.7) HU·m2·kg-1]. The difference was statistically significant (t=12.82, 10.87, P<0.01) . The CSA and attenuation indexes of COPD patients in any subgroups and the control group were of significant difference(F=92.79, 8.80, P<0.01) .The CSA and attenuation indexes were negatively correlated with the GOLD grades, the difference was statistically significant (r=-0.615,-0.551, P<0.05) . Conclusions Mass and fat infiltration of intercostal muscles of COPD patients measured by CT histogram analysis were correlated with their severity of airflow obstruction. In other words, a decrease in intercostal mass and an increase in intercostal fat are associated with worsening of COPD severity. Key words: Pulmonary disease, chronic obstructive; Intercostal muscles; Respiratory function tests; Tomography, X-ray computed

Sputum cell IL-1 receptor expression level is a marker of airway neutrophilia and airflow obstruction in asthmatic patients

Various clinical, biologic, or physiologic markers of asthma have been used to identify patient clusters and potential targets for therapy. However, these identifiers frequently overlap among the different asthma groups. For instance, both eosinophil and neutrophil counts are often increased in the airways of asthmatic patients despite their typical association with type 2 and type 17 immune response, respectively. We sought to determine whether inflammatory gene expression is related to patterns of airway inflammation and lung function and identify molecular markers for neutrophilic asthma. Expression levels of 17 genes characterizing type 1, type 2, and type 17 lymphocytes were measured in sputum samples from 48 participants with asthma. The relationships between gene expression levels and sputum cell differentials or measures of pulmonary function were examined by using partial least squares regression. Gene expression levels were strongly associated with cell differentials, explaining 71% of variation in eosinophil counts and 64% of variation in neutrophil counts. The 3 genes with the strongest relationships to sputum neutrophil counts were IL1R1 (standardized regression coefficient [β]=+0.27, P=.005), IL1RAP (β=+0.32, P=.0004), and IL4R (β=+0.29, P=.002). Higher expression levels of IL1R1, IL1RAP, and IL4R were associated with reduced FEV1/forced vital capacity ratio (β=-0.11, -0.08, and -0.10; P=.005, .07, and .05). IL-1 receptor appears to be a marker of neutrophilic inflammation and airflow obstruction in patients with asthma, who have a wide range of disease severity. The IL-1 pathway might contribute to airway neutrophilia and is a potential therapeutic target in patients with neutrophilic asthma.

Prevalence of airflow obstruction in patients with stable systolic heart failure

BackgroundChronic obstructive pulmonary disease (COPD) is an important differential diagnosis in heart failure (HF). However, routine use of spirometry in outpatient HF clinics is not implemented. The aim of the present study was to determine the prevalence of both airflow obstruction and non obstructive lung function impairment in patients with HF and to examine the effect of optimal medical treatment for HF on lung function parameters.MethodsConsecutive patients with HF (ejection fraction (EF) < 45%) and New York Heart Association (NYHA) functional class II-IV at 10 different outpatient heart failure clinics were examined with spirometry at their first visit and after optimal medical treatment for HF was achieved. airflow obstruction was classified and graded according to the GOLD 2011 revision.ResultsBaseline spirometry was performed in 593 included patients and 71 (12%) had a clinical diagnosis of COPD. Mean age was 69 ± 11 years and mean EF was 30 ± 9%. Thirty-two % of the patients were active smokers and 53% were previous smokers. Mean FEV1 and FVC was 77.9 ± 1.7% and 85.4 ± 1.5% of predicted respectively. Obstructive pattern was observed in 233 (39%) of the patients. Of these, 53 patients (9%) had mild disease (GOLD I) and 180 (30%) patients had moderate to very severe disease (GOLD II-IV). No difference in spirometric variables was observed following up titration of medication.ConclusionIn stable patients with HF airflow obstruction is frequent and severely underdiagnosed. Spirometry should be considered in all patients with HF in order to improve diagnosis and treatment for concomitant pulmonary disease.

The A’s Have It: Developing Apolipoprotein A-I Mimetic Peptides Into a Novel Treatment for Asthma

New treatments are needed for patients with asthma who are refractory to standard therapies, such as individuals with a phenotype of "type 2-low" inflammation. This important clinical problem could potentially be addressed by the development of apolipoprotein A-I (apoA-I) mimetic peptides. ApoA-I interacts with its cellular receptor, the ATP-binding cassette subfamily A, member 1 (ABCA1), to facilitate cholesterol efflux out of cells to form nascent high-density lipoprotein particles. The ability of the apoA-I/ABCA1 pathway to promote cholesterol efflux from cells that mediate adaptive immunity, such as antigen-presenting cells, can attenuate their function. Data from experimental murine models have shown that the apoA-I/ABCA1 pathway can reduce neutrophilic airway inflammation, primarily by suppressing the production of granulocyte-colony stimulating factor. Furthermore, administration of apoA-I mimetic peptides to experimental murine models of allergic asthma has decreased both neutrophilic and eosinophilic airway inflammation, as well as airway hyperresponsiveness and mucous cell metaplasia. Higher serum levels of apoA-I have also been associated with less severe airflow obstruction in patients with asthma. Collectively, these results suggest that the apoA-I/ABCA1 pathway may have a protective effect in asthma, and support the concept of advancing inhaled apoA-I mimetic peptides to clinical trials that can assess their safety and effectiveness. Thus, we propose that the development of inhaled apoA-I mimetic peptides as a new treatment could represent a clinical advance for patients with severe asthma who are unresponsive to other therapies.

Combination Treatment for COPD

The FDA has approved a fixed-dose dual bronchodilator that combines glycopyrrolate and formoterol fumarate in a pressurized, metered-dose inhaler. The drug, marketed as Bevespi Aerosphere, is indicated for long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD) (http://1.usa.gov/1qVyi94). Glycopyrrolate is a long-acting muscarinic antagonist (LAMA) while formoterol fumarate is a long-acting β2-agonist (LABA). Manufacturer AstraZeneca said in a statement that the combination medication is the first FDA-approved product using its unique technology that distributes drug crystals in a uniform suspension formed with porous, low-density phospholipid particles. The technology prevents the drug crystals from settling or intermingling, allowing consistent doses of different drugs to be dispensed from a single pressurized metered-dose inhaler (http://bit.ly/1VBpmTq).