BODE Index Research Articles

Bronchoscopic Lung Volume Reduction: Effect on Symptoms and Lung Function in Patients with Emphysema That Qualify for Lung Transplant

BackgroundBronchoscopic lung volume reduction (BLVR) studies excluded patients meeting the listing criteria for lung transplantation (LT). Research QuestionWhat are the outcomes of BLVR in a sicker group of emphysematous patients compared to patients not meeting the criteria for LT listing? Study Design and MethodsReal-world retrospective study (June 2018 to December 2022) assessing the effect of BLVR in patients with severe emphysema considered for LT. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLco), symptoms, and 6-minute walk distance (6-MWD) were measured at baseline and 45 days and 6 months post-BLVR. ResultsOf 76 fully evaluated patients (median age 62 years old, 60% female), 42 underwent BLVR (30 sicker patients met the criteria for LT listing). At baseline, patients that met the criteria for listing had shorter baseline 6-MWD (234.72 ± 68.86, p < 0.001), higher BODE index (6.79 ± 1.11, p = 0.001), and lower FEV1 (617.5 ± 139.2 mL, p = 0.005). All patients treated with BLVR experienced a decrease in BODE index and Borg dyspnea by -0.5 to -2 points, respectively. DLco %pred increased by 4.5%, FEV1 increased by 115 mL, FVC increased by 450 mL, and 6-MWD increased by 20 meters. In the sicker group, FEV1 at 45 days post-BLVR increased by 180.8 ± 231 mL (FEV1 %pred 5.84 ± 5.66) compared to baseline; a persistent effect was seen at 6 months in 62% of patients with available data (18/30). Median hospital length of stay was 3.27 ± 3.07 days. Valves were removed in 6 patients (3 in each group) due to complications. The pneumothorax rate was 24% (10/42; 5 in each group). InterpretationsImprovement in lung function after BLVR was observed regardless of disease severity. BLVR might represent an alternative to LT for some patients.

Assessment of the BODE Index and Its Association With Inflammatory Mediators in Chronic Obstructive Pulmonary Disease (COPD) Patients

Assessment of the BODE Index and Its Association With Inflammatory Mediators in Chronic Obstructive Pulmonary Disease (COPD) Patients

GOLD-Grade Specific Disease Characterization and Phenotyping of COPD Using Quantitative Computed Tomography in the Nationwide COSYCONET Multicenter Trial in Germany

Introduction: The aim of this study was to apply quantitative computed tomography (QCT) for GOLD-grade specific disease characterization and phenotyping of air-trapping, emphysema, and airway abnormalities in patients with chronic obstructive pulmonary disease (COPD) from a nationwide cohort study. Methods: As part of the COSYCONET multicenter study, standardized CT in ex- and inspiration, lung function assessment (FEV1/FVC), and clinical scores (BODE index) were prospectively acquired in 525 patients (192 women, 327 men, aged 65.7 ± 8.5 years) at risk for COPD and at GOLD1–4. QCT parameters such as total lung volume (TLV), emphysema index (EI), parametric response mapping (PRM) for emphysema (PRMEmph) and functional small airway disease (PRMfSAD), total airway volume (TAV), wall percentage (WP), and total diameter (TD) were computed using automated software. Results: TLV, EI, PRMfSAD, and PRMEmph increased incrementally with each GOLD grade (p < 0.001). Aggregated WP5–10 of subsegmental airways was higher from GOLD1 to GOLD3 and lower again at GOLD4 (p < 0.001), whereas TD5–10 was significantly dilated only in GOLD4 (p < 0.001). Fifty-eight patients were phenotyped as “non-airway non-emphysema type,” 202 as “airway type,” 96 as “emphysema type,” and 169 as “mixed type.” FEV1/FVC was best in “non-airway non-emphysema type” compared to other phenotypes, while “mixed type” had worst FEV1/FVC (p < 0.001). BODE index was 0.56 ± 0.72 in the “non-airway non-emphysema type” and highest with 2.55 ± 1.77 in “mixed type” (p < 0.001). Conclusion: QCT demonstrates increasing hyperinflation and emphysema depending on the GOLD grade, while airway wall thickening increases until GOLD3 and airway dilatation occur in GOLD4. QCT identifies four disease phenotypes with implications for lung function and prognosis.

Validation of new predictors of mortality and BODE index variants in patients with COPD at moderate altitude

Validation of new predictors of mortality and BODE index variants in patients with COPD at moderate altitude

The effect of pulmonary rehabilitation on cardiovascular risk, oxidative stress and systemic inflammation in patients with COPD

PurposeChronic obstructive pulmonary disease (COPD) is a leading cause of death, and cardiovascular (CV) comorbidities play a role. Evidence of the pulmonary rehabilitation (PR) effect in reducing the CV risk (CVR) in COPD patients is limited. In this study, we aimed to determine the impact of an 8-week PR program (PRP) on the CVR of the overall population and to compare the impact on the exacerbator versus non-exacerbator patients. Patients and methodsThis was a prospective study that included adults who had post-bronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) ratio <70 % and FEV1 <80 % predicted, had quit smoking for at least 1 year and had a history of tobacco consumption greater than 10 packs/year, and were clinically stable in the last 8 weeks. Pre- and post-PRP assessments included respiratory function evaluation, laboratory tests, and exercise capacity assessment (6-min walking test [6MWT]). CVR was assessed using different risk prediction models. ResultsA total of 50 patients (28 exacerbators and 22 non-exacerbators) completed the PRP (median age: 64.5 years, men: 72 %; arterial hypertension: 70 %, dyslipidemia: 30 %, diabetes: 20 %; CV disease (CVD): 24 %. After the PRP, exacerbator patients showed a significant decrease in the CVR calculated by the COPDCoRi model (p < 0.001); patients with ≥30-m increase on the 6MWT showed statistically significant lower levels of glucose (p = 0.004), HbA1c (p = 0.004) and BODE index score (p = 0.026) compared to patients with <30-m increase. ConclusionsPR reduced certain modifiable CVR factors and CVD risk, especially in exacerbator patients.

Left ventricular concentric remodeling in COPD patients: A cross-sectional observational study

ObjectiveTo investigate the association between left ventricular structure and disease severity in COPD patients. MethodsTwenty-eight COPD patients were stratified according to the disease severity, using the BODE index, into Lower (n=17) and Higher (n=11) groups, composed of patients with lower severity (BODE <5) and higher severity (BODE ≥5), respectively. Left ventricle (LV) was assessed by 2D-echocardiography. BODE index was calculated using body mass index (BMI); forced expiratory volume in the first second (FEV1, %); modified Medical Research Council (mMRC) and distance walked during 6-minute walk test (6MWD). ResultsPatients in the Higher group showed lower oxygen arterial saturation (p=0.02), FEV1 (p<0.01) and 6MWD (p=0.02) and higher value of relative posterior wall thickness (RWT) compared to Lower group (p=0.02). There were significant associations between LV end-systolic diameter (LVESD) and BODE index (r=−0.38, p=0.04), LV end-diastolic diameter (LVEDD) and FEV1 (r=0.44, p=0.02), LVEDD and BMI (r=0.45, p=0.02), LVESD and BMI (r=0.54, p=0.003) and interventricular septal thickness and 6MWD (r=−0.39, p=0.04). ConclusionsMore severe COPD patients, BODE score ≥5, may have higher RWT, featuring a possible higher concentric remodeling of LV in this group. Besides that, a greater disease severity may be related to LV chamber size reduction.

Analysis of Prescription Pattern, Treatment, and Clinical Outcome in Chronic Obstructive Pulmonary Disease Patients at Tertiary Care Teaching Hospital

Background and Aims: A major economic and social burden is associated with chronic obstructive pulmonary disease (COPD), an incurable lung illness that affects people all over the world. With a rising incidence rate, COPD is predicted to overtake all other causes of mortality by 2030. This study employs the BMI, Obstruction, Dyspnea scale, exercise tolerance (BODE) index as a multidimensional staging approach to evaluate the prescription pattern, safety, and efficacy of therapy in patients with COPD. The body mass index (BMI), forced expiratory volume in one second (FEV1), modified british medical research council questionnaire (MMRC) Dyspnoea scale, and the 6-minute walk test are among the factors that the BODE index uses to classify the severity of an illness. Methods: An observational and prospective study was conducted at a government teaching hospital’s outpatient department for one and a half years. Demographic, clinical, and treatment data were collected from patients with COPD, and severity was assessed using the BODE index. The study aimed to evaluate prescription trends, treatment effectiveness, and safety, with primary and secondary objectives. Results: Out of 100 enrolled participants, 79 completed follow-ups. Sociodemographic analysis revealed a male predominance (83.54%), with the highest prevalence in the 51–70 age group. Most patients exhibited moderate COPD severity (51.9%), based on the BODE index. Prescriptions included inhalation therapy (94.94%), predominantly combining corticosteroids and bronchodilators. Assessing treatment effectiveness, the BODE index significantly improved over 6 months ( P = 0.0002), demonstrating reduced disease severity. Adverse drug reactions occurred in 13.92% of participants, primarily mild in nature. Conclusion: The study highlights prevalent prescription patterns, emphasising inhalation therapy, and demonstrates the effectiveness and safety of the selected treatments using the BODE index. The findings underscore the importance of tailored therapeutic approaches in COPD management.

PD-1+ T lymphocyte proportions and hospitalized exacerbation of COPD: a prospective cohort study

ObjectiveTo evaluate the predictive value of PD-1 expression in T lymphocytes for rehospitalization due to acute exacerbations of COPD (AECOPD) in discharged patients.Methods115 participants hospitalized with COPD (average age 71.8 ± 6.0 years) were recruited at Fujian Provincial Hospital. PD1+T lymphocytes proportions (PD1+T%), baseline demographics and clinical data were recorded at hospital discharge. AECOPD re-admission were collected at 1-year follow-up. Kaplan-Meier analysis compared the time to AECOPD readmissions among groups stratified by PD1+T%. Multivariable Cox proportional hazards regression and stratified analysis determined the correlation between PD1+T%, potential confounders, and AECOPD re-admission. ROC and DCA evaluated PD1+T% in enhancing the clinical predictive values of Cox models, BODE and CODEX.Results68 participants (59.1%) were AECOPD readmitted, those with AECOPD readmission exhibited significantly elevated baseline PD-1+CD4+T/CD4+T% and PD-1+CD8 + T/CD8 + T% compared to non-readmitted counterparts. PD1+ T lymphocyte levels statistically correlated with BODE and CODEX indices. Kaplan-Meier analysis demonstrated that those in Higher PD1+ T lymphocyte proportions had reduced time to AECOPD readmission (logRank p < 0.05). Cox analysis identified high PD1+CD4+T and PD1+CD8+T ratios as risk factors of AECOPD readmission, with hazard ratios of 1.384(95%CI [1.043–1.725]) and 1.401(95%CI [1.013–1.789]), respectively. Notably, in patients aged < 70 years and with fewer than twice AECOPD episodes in the previous year, high PD1+T lymphocyte counts significantly increased risk for AECOPD readmission(p < 0.05). The AECOPD readmission predictive model, incorporating PD1+T% exhibited superior discrimination to the Cox model, BODE index and CODEX index, AUC of ROC were 0.763(95%CI [0.633–0.893]) and 0.734(95%CI [0.570–0.899]) (DeLong’s test p < 0.05).The DCA illustrates that integrating PD1+T% into models significantly enhances the utility in aiding clinical decision-making.ConclusionEvaluation of PD1+ lymphocyte proportions offer a novel perspective for identifying high-risk COPD patients, potentially providing insights for COPD management.Trial registrationChinese Clinical Trial Registry (ChiCTR, URL: www.chictr.org.cn/), Registration number: ChiCTR2200055611 Date of Registration: 2022-01-14.

PARTICULAR ASPECTS OF RESPIRATORY REHABILITATION IN PACIENTS WITH COPD

COPD is a complex pathology that has physical, emotional and social aspects, that requires individualized therapeutical intervention and a personalized pulmonary rehabilitation program. Pulmonary rehabilitation in pacients with this pathology reduces the symptoms and increases effort tolerance, improves survival rate and decreases exacerbations frequency, contributes to improving nutritional status in some cases, allows improvement of medication effects and of measurable respiratory performances (6 minutes walking test, reduced dyspnea – BORG scale, BODE index and so on). Pulmonary rehabilitation also contributes to a better life quality, to achieving a functional status that permits independence of the pacient and the need for minimal help from other people, increases pacient’s autonomy even in the most severe cases –oxygenotherapy dependents and it helps physical and mental accommodation to the changes created by the illness. Pulmonary rehabilitation in this category of pacients contributes to reducing hospitalization duration, quick socio-professional reinsertion and also proper integration in the family and in the community. Keywords: rehabilitation, individualised therapeutical program, particularities, important functional benefits.

First in Human Phase 1 Clinical Trial of Stereotactic Irradiation to Achieve Lung Volume Reduction (SILVR) in Severe Emphysema

PurposeOnly a subset of patients with severe emphysema qualify for lung volume reduction surgery or endobronchial valves. We previously demonstrated that Stereotactic Ablative Radiotherapy (SABR) of lung tumors reduces lung volume in treated lobes by creating localized lung fibrosis. We aimed to determine the safety and, secondarily, explore the efficacy of Stereotactic Irradiation for Lung Volume Reduction (SILVR) over 18 months following intervention in patients with severe emphysema. Methods and materialsWe conducted a single-arm prospective clinical trial in eligible patients with severe emphysema treated with unilateral SABR (45 Gy in three fractions) to a target within the most emphysematous region. Primary outcome was safety i.e., incidence of grade≥3 adverse events. Secondary outcomes of efficacy were also explored. ResultsEight subjects received the intervention. Median (range) baseline characteristics were age 73 years (63-78), FEV1% 28.5% (19.0-42.0), DLCO% 40% (24.0-67.0), and BODE index 5.5 (5-9). The incidence of grade≥3 adverse events was 3/8 (37.5%). The relative Δtarget lobe volume was -23.1% (-1.6,-41.5) and -26.5% (-20.6,-40.8) at six and 18 months, respectively. Absolute ΔFEV1% was greater in subjects with BODE index ≤5 vs. ≥6 (+12.0% vs. -2.0%). The mean baseline lung density (in Hounsfield units, reflecting the amount of preserved parenchyma) within the intermediate dose volume (V60BED3) correlated with the absolute Δtarget lobe volume at 18 months. ConclusionsStereotactic Irradiation for Lung Volume Reduction appears to be safe, with a signal for efficacy as a novel therapeutic alternative for patients with severe emphysema. SILVR may be most safe/effective in patients with lower BODE index and/or less parenchymal destruction.

Risk factors for anxiety and its impacts on acute exacerbation in older patients with chronic obstructive pulmonary disease.

Anxiety is common in patients with chronic obstructive pulmonary disease (COPD), especially in older patients with the definition of age over 60 years old. Few studies have focused on anxiety in older COPD patients. This study aimed to analyze the risk factors of anxiety in older COPD patients and the impacts of anxiety on future acute exacerbation. The general information, questionnaire data, previous acute exacerbation and pulmonary function were collected. Hamilton Anxiety Rating Scale (HAMA) was used to evaluate the anxiety of older COPD patients. The patients were followed up for one year, the number and the degrees of acute exacerbations of COPD were recorded. A total of 424 older COPD patients were included in the analysis. 19.81% (N = 84) had anxiety symptoms, and 80.19% (N = 340) had no anxiety symptoms. There were increased pack-years, more comorbidities, and more previous acute exacerbations in older COPD patients with anxiety compared to those without anxiety (P < 0.05). Meanwhile, a higher modified Medical Research Council (mMRC), a higher COPD assessment test (CAT) score and a shorter six-minute walking distance (6MWD) were found in older COPD patients with anxiety (P < 0.05). The BODE index, mMRC, CAT score, comorbidities and acute exacerbations were associated with anxiety. Eventually, anxiety will increase the risk of future acute exacerbation in older COPD patients (OR = 4.250, 95% CI: 2.369-7.626). Older COPD patients with anxiety had worsening symptoms, more comorbidities and frequent acute exacerbation. Meanwhile, anxiety may increase the risk of acute exacerbation in the future. Therefore, interventions should be provided to reduce the risk of anxiety in older COPD patients at an early stage.

Predicting Exacerbations in Alpha-1 Antitrypsin Deficiency Using Clinical and Pulmonary Function Tests: Portuguese EARCO Registry

Introduction: Exacerbations are common in individuals with alpha-1 antitrypsin deficiency (AATD)-related lung disease. This study intended to identify independent predictive factors for exacerbations in AATD using the Portuguese European Alpha-1 Research Collaboration (EARCO) registry. Methods: This study includes patients from the Portuguese EARCO registry, a prospective multicenter cohort (NCT04180319). From October 2020 to April 2023, this registry enrolled 137 patients, 14 of whom were excluded for analysis for either missing 12 months of follow-up or baseline pulmonary function. Results: Among the 123 AATD patients, 27 (22.0%) had at least one exacerbation in the last 12 months of follow-up. Patients with Pi*ZZ phenotype were three times more likely than the rest of the population to experience any exacerbation (32.7 vs. 14.1%, p = 0.014; OR 3.0). BODE index was significantly higher in exacerbators than in non-exacerbators (3.9 ± 2.4 vs. 1.3 ± 1.2; p < 0.001), including on multivariate analysis (p = 0.002). Similar results were found for BODEx (multivariate p < 0.001). DLCO was the only functional parameter independently associated with exacerbations (p = 0.024). Conclusions: DLCO, BODE, and BODEx were independent predictors of exacerbations at 12 months in AATD patients. Understanding these risk factors can aid decision-making on AATD-related lung disease management and improve patient outcomes.

Expression of Siglec-9 in peripheral blood neutrophils was increased and associated with disease severity in patients with AECOPD

BackgroundThe pathogenesis and treatment strategies for chronic obstructive pulmonary disease (COPD) require further exploration. Abnormal neutrophil inflammation and the overexpression of neutrophil extracellular traps (NETs) are closely associated with acute exacerbations of COPD (AECOPD). Siglec-9, a specific receptor expressed on neutrophils that inhibits their function, prompted us to investigate its relationship with NETs found in induced sputum and the severity of the disease. MethodsWe collected clinical data from patients with AECOPD and assessed the expression of Siglec-9 in peripheral blood neutrophils and the presence of NETs in induced sputum. We then observed the correlation between Siglec-9, the inflammatory response, and the severity of AECOPD. ResultsWe observed an increase in the expression of Siglec-9 in the peripheral blood neutrophils of patients with AECOPD. Concurrently, these patients exhibited more severe clinical symptoms, higher systemic inflammation levels, and a reduced quality of life compared to those with induced sputum NET expression. Further subgroup analysis of AECOPD patients with high Siglec-9 expression revealed worsened quality of life and more severe inflammation, particularly in indicators such as the BODE index, CRP, peripheral blood neutrophil count, IL-6, IL-8, TNF-α expression, and others. Furthermore, we noted a significant increase in NET-specific expression in the sputum of patients with high Siglec-9 expression levels. In comparison to patients with low Siglec-9 expression, those with high expression experienced more systemic inflammatory reactions and a lower quality of life. Correlation analysis of the aforementioned indicators revealed that the expression ratio of Siglec-9 in the peripheral blood of patients correlated with lung function, quality of life, and NETs in the induced sputum of patients with AECOPD. ConclusionThe increased expression of Siglec-9 in peripheral blood neutrophils of AECOPD patients leads to elevated NET expression in induced sputum, exacerbating the systemic inflammatory response and worsening lung function and quality of life in these patients.

Study of serum Ykl-40 level and its relationship to BODE index in patients with chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a significant global health concern characterized by growing rates of mortality and morbidity. The purpose of this work was to evaluate the serum YKL-40 level and its relationship to body mass index (BMI), obstruction of airflow, dyspnea, exercise capacity (BODE) index, and the extent of COPD.MethodsThis prospective work was carried out on 70 adult male patients, allocated into three groups: group A—36 smokers with stable COPD with different degrees of severity; group B—19 smokers without COPD; and group C—15 healthy non-smokers as a control group.ResultsThe BODE index was 5.56 ± 2.52. Prebronchodilator forced expiratory volume in 1 s (FEV1) and FVC were substantially decreased in group A contrasted to group B and group C (P value < 0.001). Prebronchodilator forced expiratory volume in 1/forced vital capacity (FEV1/FVC) ratio was substantially decreased in group A contrasted to groups B and C and lower in group B than in group C (P value < 0.001).Chest X-ray (CXR) signs of COPD and mMRC Dyspnea Scale were significantly higher in group A than in groups B and C (P value < 0.001). The 6-min walking test was substantially decreased in group A than in groups B and C and lower in group B than in group C (P value < 0.001 and 0.006 correspondingly). Serum YKL-40 was substantially greater in group A contrasted to group C (P value = 0.005). There was no correlation between serum YKL-40 and (BODE index, O2 saturation, or smoking index) in group A. A substantial positive association existed among serum YKL-40 and [degree of severity and white blood cells (WBCs)] in group A. Serum YKL-40 cannot predict the severity of COPD (P = 0.227 and AUC = 0.584) at cut-off > 0.394 with 80.65% sensitivity, 41.03% specificity, 52.1% PPV, and 72.7% NPV.ConclusionsSerum YKL-40 level was substantially greater in the COPD group contrasted to healthy non-smokers, no substantial association existed between serumYKL-40 and BODE index, O2 saturation, or smoking index. A substantial positive association existed between SerumYKL-40 and the degree of severity and WBCs.

RED CELL DISTRIBUTION WIDTH VALUE AS A PREDICTOR OF COPD SEVERITY: ORIGINAL RESEARCH ARTICLE

Objectives: The purpose of the study is to use the red cell distribution width (RDW) value for predicting chronic obstructive pulmonary disease (COPD) severity. Methods: Three hundred COPD patients are included in this retrospective analysis. Oxygen saturation, BODE index variables, and demographic characteristics were noted. All patients’ survival data were analyzed. RDW measurements were evaluated at the time of inclusion. Results: The patients had an average age of 65.2±8.6 years. The patients were divided into the following stages of COPD: stage 1: 14.66%, stage 2: 56.66%, stage 3: 25.6%, and stage 4: 3%. Red cell distribution width was observed differ significantly between stages. The very high RDW was found in the extremely serious stage (p&lt;0.001). The BODE index has a median of 1 (0–3). RDW increased with the BODE index as it increased (p&lt;0.001). The survival percentages for the groups of patients created based on the laboratory upper limit of RDW was 76% for groups with RDW&lt;14.3% and 29% for groups with RDW&gt;14.3%. Conclusion: Our study’s findings suggest that an elevated level of RDW may be linked to increased mortality and that a quick, non-invasive test could be used as an early biomarker to assess the severity of a disease.

Feasibility of a home-designed respiratory rehabilitation program for chronic obstructive pulmonary disease.

According to international guidelines, respiratory rehabilitation (RR) for patients with chronic obstructive pulmonary disease (COPD) is a cornerstone of standard non-pharmacological treatment. To evaluate feasibility of a home-designed RR program and analyze its medium-term impact on respiratory parameters and quality of life. This was a prospective study involving 74 COPD patients enrolled in January 2019 and put on inhaled bronchodilator treatment associated with RR at home following a written protocol, for 16 weeks. The comparative statistical analysis highlights the difference before and after RR in terms of clinical and functional respiratory parameters as well as in terms of quality of life (assessed on the short form 36 (SF-36) questionnaire). The comparison involves RR-adherent patients versus non-adherent patients. Mean age was 66.7±8.3 years with a median of 67 years. All patients were smokers, out of which 42 patients (57%) did not quit yet. Forty-one percent of patients were frequent exacerbators. The average COPD assessment test (CAT) score in our patients was 23. The average 6-minutes walk distance (MWD) was 304m. The BODE index in our patients was 4.11 on average. The RR program was followed by 36 patients (48%). Thirty patients (40%) applied it at least twice a week. RR-adherent patients had an average CAT score decreasing from 23 to 14.5 (P = 0.011). Their average 6-MWD was 444.6 m by the end of the study, which would be 64.2% of the calculated theoretical value. The average FEV1 increase after RR was 283mL. The majority (69%) of RR-adherent patients were ranked as quartile 1; BODE index ≤2. The average scores of physical, psycho-social, and general dimensions assessed on the SF-36 questionnaire improved in RR-adherent patients. RR is a key non-pharmacological treatment for COPD. Its interest originates from its multidisciplinary nature, hence its effectiveness in several respiratory parameters. Our study reflects the feasibility of home-designed protocols in the absence of contraindications. We highlight also the positive impact on quality of life after RR at home.

Influence of physical activity on the prognosis of COPD patients: the HADO.2 score - health, activity, dyspnoea and obstruction.

The aim of this study was to create a prognostic instrument for COPD with a multidimensional perspective that includes physical activity (PA). The score also included health status, dyspnoea and forced expiratory volume in 1 s (HADO.2 score). A prospective, observational, non-intervention study was carried out. Patients were recruited from the six outpatient clinics of the respiratory service of a single university hospital. The component variables of the HADO.2 score and BODE index were studied, and PA was measured using an accelerometer. The outcomes for the HADO.2 score were mortality and hospitalisations during follow-up and an exploration of the correlation with health-related quality of life at the moment of inclusion in the study. 401 patients were included in the study and followed up for three years. The HADO.2 score showed good predictive capacity for mortality: C-index 0.79 (0.72-0.85). The C-index for hospitalisations was 0.72 (0.66-0.77) and the predictive ability for quality of life, as measured by R2, was 0.63 and 0.53 respectively for the Saint George's Respiratory Questionnaire and COPD Assessment Test. There was no statistically significant difference between the mortality predictive capacity of the HADO.2 score and the BODE index. Adding PA to the original BODE index significantly improved the predictive capacity of the index. The HADO.2 score, which includes PA as a key variable, showed good predictive capacity for mortality and hospitalisations. There were no differences in the predictive capacity of the HADO.2 score and the BODE index.

Ten-year analysis of the efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease

Major problems in the course of chronic obstructive pulmonary disease (COPD) include frequent exacerbations and related deaths. The use of pneumococcal vaccines, primarily a 13-valent polysaccharide conjugate vaccine, is a generally recognized tool for reducing the number of exacerbations.The aim of the study was to analyze the prospective clinical efficacy of vaccine prophylaxis with conjugated pneumococcal vaccine Prevenar-13 (PCV13) in patients with COPD over 10 years.Methods. A total of 362 male patients who were treated or monitored at the Regional Pulmonological Center of Chelyabinsk in 2012 – 2022 were enrolled in the study. The main efficacy endpoints of observation over 10 years were: the dynamics of dyspnea (mMRC score), forced expiratory volume in 1st second, the number of exacerbations, hospitalizations, the number of pneumonias. After confirming the diagnosis of COPD, the patients were divided into two observation groups. The first group (n = 150) included patients vaccinated with PCV13. The second group (n = 212) included patients with COPD who had not received pneumococcal vaccination for various reasons.Results. Severe forms of the disease and frequent exacerbations predominated in both groups. 96 (27%) deaths were recorded in the PCV13-vaccinated group, and 171 (47%) deaths in the unvaccinated group. The difference between vaccinated and unvaccinated is statistically significant (p &lt; 0.05). In the unvaccinated patients, there was a steady progression of shortness of breath with an increase by 12% compared to baseline (p &lt; 0.05) by the 10th year. A positive trend in FEV1 was noted in patients vaccinated with PCV13. They also showed a significant decrease in BODE prognostic index.Conclusion. The use of PCV13 allows for stabilization of the main clinical and functional indicators of the respiratory system in patients with COPD in the long term (at least 10 years of follow-up). Vaccination maintains a low risk of adverse events according to the BODE index; an increase in patient survival was noted over a 10-year horizon (odds ratio – 2.35; 95% confidence interval – 1.45; 3.77), including cases with acute viral damage with COVID-19 (COronaVIrus Disease 2019).

Benefits of a 12-week pulmonary rehabilitation programme in interstitial lung diseases: 1 year post completions

Objectives Evidence on the efficacy of Pulmonary Rehabilitation in the management of ILD is growing. Despite studies reporting benefits, few studies have investigated the long-term effects in such patients, resulting in a call for such research. Therefore, this study aimed to evaluate the effectiveness of a 12-week PR programme on exercise tolerance, quality of life and physical activity, 6- and 12-months post completion. Design An observational, prospective, quasi experimental type of study. Setting Out-Patient Physiotherapy Department. Participants 60 participants diagnosed with Interstitial Lung Disease. Intervention A 12week PR programme was delivered with outcome measures assessed throughout the programme and at the 28th and 52nd week. Main Outcome Measures 6-min walking distance test, Dyspnoea Borg Scale, St George’s Respiratory Questionnaire and Hospital Anxiety and Depression Score were measured. Results Maintenance of effects was noted in SGRQ scores p = 0.005 on completion of the 12week programme, depression scores (p = 0.038 at week 28 and p = 0.008 at week 52) and BODE index resulting in a statistically significant improvement at the 52nd week (p = 0.017). Benefits of in the 6MWT were maintained at 28week but had a statistically significant decline at 52weeks post completion (p = 0.013). Dyspnoea scores increased post completion of the 12week PR programme at both the 28th week (p = 0.008) and 52nd week (p = 0.005). Conclusion Improvements were maintained up to 1 year post completion in most outcome measures or else showed benefits till the 52week.

Effectiveness of rosuvastatin and pulmonary rehabilitation in patients with concurrent course of asthma, chronic obstructive pulmonary disease and diabetes mellitus type 2

The aim of this study was to assess the effectiveness of rosuvastatin and pulmonary rehabilitation in patients with asthma-COPD overlap (ACO) concurrent with type 2 diabetes (T2D).Material and methods. A total of 26 patients with ACO and T2D were examined, with an average age of 61 [55.6; 67.8]. In addition to standard therapy, patients in the main group were prescribed rosuvastatin and a pulmonary rehabilitation program. Treatment efficacy was assessed using questionnaires (CAT, ACQ, SGRQ), dyspnea severity scale (mMRC), BODE index, pulmonary function, bioimpedance analysis, 6-minute walk test, carbohydrate and lipid metabolism status, levels of 8-isoprostane, sCD14, CRP, stable nitric oxide (NO) metabolites - nitrite and nitrate ions, and endothelin-1 in the blood. Results. In the main group, a significant improvement was observed during the treatment course, including a 40% reduction in the BODE index (p&lt;0.05), a 33.4% decrease in dyspnea on the mMRC scale (p&lt;0.05), a 28.5% reduction in CAT, a 40.8% decrease in ACQ, and a 20.6% decrease in SGRQ. Other notable improvements included a 1.3% decrease in BMI, a 13% reduction in body fat percentage, a 23.5% decrease in visceral fat level, a 16% increase in patients' tolerance to physical activity, a 27.5% increase in FEV1 (p&lt;0.05), an 8.1% decrease in fasting blood glucose (p&lt;0.01), a 20% reduction in triglycerides (p&lt;0.05), a 24.9% decrease in LDL cholesterol, and a 27.2% decrease in total cholesterol (p&lt;0.05). Additionally, there was a 23.8% decrease in CRP levels (p&lt;0.05), a two-fold reduction in blood 8-isoprostane levels (p&lt;0.05), a 58% reduction in serum sCD14 levels, a 59.8% increase in stable nitric oxide metabolites (p&lt;0.05), and a 55% decrease in endothelin-1 levels (p&lt;0.05).Conclusions. The use of rosuvastatin and pulmonary rehabilitation significantly improves the quality of life for patients with the concurrent presentation of COPD, asthma, and T2D. It reduces the severity of dyspnea, enhances tolerance to physical activity, improves pulmonary function, lowers visceral fat levels and body fat percentage, enhances lipid profile, and improves endothelial function, all while concurrently reducing oxidative stress and systemic inflammation without worsening carbohydrate metabolism.