BODE Index Research Articles

Endobronchial Valve (Zephyr) Treatment in Homogeneous Emphysema: One-Year Results from the IMPACT Randomized Clinical Trial

Rationale: The long-term safety and effectiveness of bronchoscopic lung volume reduction with Zephyr endobronchial valves in subjects with severe homogeneous emphysema with little to no collateral ventilation beyond 3 months have yet to be established. Methods: Ninety-three subjects were randomized to either bronchoscopic lung volume reduction with Zephyr valves or standard of care (SoC) (1:1). Zephyr valve subjects were assessed at 3, 6, and 12 months. SoC subjects were assessed at 3 and 6 months; they were then offered crossover to Zephyr valve treatment. Results: The mean group difference (Zephyr valve – SoC) for change in FEV1 from baseline to 6 months was 16.3 ± 22.1% (mean ± SD; p < 0.001). Secondary outcomes showed the mean between-group difference for the six-minute walk distance of +28.3 ± 55.3 m (p = 0.016); St. George’s Respiratory Questionnaire, −7.51 ± 9.56 points (p < 0.001); modified Medical Research Council, −0.42 ± 0.81 points (p = 0.019); BODE index, −0.85 ± 1.39 points (p = 0.006); and residual volume of −430 ± 830 mL (p = 0.011) in favor of the Zephyr valve group. At 6 months, there were significantly more responders based on the minimal clinically important difference for these same measures in the Zephyr valve versus the SoC group. The clinical benefits were persistent at 12 months. The percentage of subjects with respiratory serious adverse events was higher in the Zephyr valve group compared to SoC during the first 30 days post-procedure but not statistically different for the Zephyr valve and SoC groups from 31 days to 6 months, and stable in the Zephyr valve group out to 12 months. There were 2 deaths in the SoC group in the 31-day to 6-month period and none in the Zephyr valve group out to 12 months. Conclusions: Bronchoscopic lung volume reduction with Zephyr valves in subjects with severe homogeneous emphysema and little to no collateral ventilation provides clinically meaningful change from baseline in lung function, quality of life, exercise capacity, dyspnea, and the BODE index at 6 months, with benefits maintained out to 12 months.

Study of red cell distribution width levels and its correlation with severity of disease in patient with chronic obstructive pulmonary disease

Background:COPD has been accepted as component of systemic inflammatory syndrome. Red cell distribution width (RDW) is a measure of coefficient of variation of mean corpuscular volume which increases in chronic systemic inflammation. The aim of the study was to evaluate the RDW as a predictor of severity of COPD using BODE index.Methods:In this cross-sectional study 107 COPD patients were evaluated by measuring RDW and this was correlated with the severity of disease using GOLD staging.Results:RDW correlates well with COPD patients. Significant correlation of RDW with BODE index (r=0.650, p and It; 0.001), gold staging (r=0.459, p and It; 0.001), 6MWT (r=0.697, p and It; 0.001) were observed.Conclusions: RDW was found to increase in patients with increasing severity of COPD. Hence its potential role as a marker of severity of disease and in predicting risk of cardiovascular disease can be explored.

Comparison of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease

To compare the practicability and clinical value of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease (COPD). We retrospectively analyzed the clinical data of 28 patients with acute exacerbation of COPD admitted to our hospital between November, 2020 and January, 2021. All the patients were assessed with percentage of predicted forced expiratory volume in 1 second (FEV1% pred), COPD assessment test (CAT), modified British Medical Research Council (mMRC), baseline dyspnea index (BDI), clinical COPD questionnaire (CCQ), St. George's respiratory questionnaire (SGRQ), BODE index, Hamilton Depression Rating Scale (HDRS) at admission and with CAT, mMRC, transition dyspnea index (TDI), CCQ, SGRQ, and HDRS at 1 month after discharge. The correlations among FEV1% pred, CAT, mMRC, BDI, CCQ, SGRQ, BODE and HDRS at admission were analyzed. We also compared the TDI and scores of CAT, mMRC, CCQ, SGRQ, and HDRS at 1 month after discharge among the patients using single (n=8), dual (n=10) or triple inhaled medications (n=10) after discharge. Among these patients, FEV1% pred was moderately correlated with SGRQ and BDI (r=-0.66, r=0.61; P < 0.01), and CCQ activity score was closely correlated with mMRC, SGRQ activity score and BDI (r=0.82, r=0.92, r=-0.89; P < 0.01). SGRQ activity score was closely correlated with mMRC and BDI (r=0.84, r=-0.91; P < 0.01), and SGRQ symptom score was closely correlated with BODE (r=0.80, P < 0.01). SGRQ impact score was moderately correlated with HDRS (r=0.57, P < 0.01). In all the 28 patients, all the evaluation scores except for CCQ mental score and HDRS improved significantly after treatment (P < 0.05). At 1 month after discharge, CCQ total score decreased significantly in single therapy group (P < 0.05); CAT, mMRC, CCQ and SGRQ improved obviously in dual therapy group (P < 0.05); CCQ and SGRQ scores decreased significantly in triple therapy group (P < 0.05); the TDI did not differ significantly among the 3 groups (P>0.05). For patients with COPD, BDI and TDI are recommended over mMRC for assessing dyspnea. CAT, CCQ and SGRQ allow sensitive assessment of the treatment efficacy to serve as routine evaluation tests, and among them SGRQ is the most comprehensive and is thus recommended when sufficient time is allowed. BODE is relatively complex but highly valuable for predicting the patients'survival outcomes. HDRS is recommended for routine screening of depression in patients with COPD.

Two-Stage Bronchoscopic Endobronchial Valve Treatment Can Lead to Progressive Lung Volume Reduction and May Decrease Pneumothorax Risk.

BackgroundSince successful development of endobronchial valves (EBV) as treatment for severe emphysema, its main complication, pneumothorax, remains an important concern.ObjectiveWe hypothesized that a two-step EBV implantation, during two distinct iterative procedures could lead to a more progressive target lobe volume reduction (TLVR) and thus ipsilateral lobe re-expansion, resulting in a significant decrease in the pneumothorax rate.MethodsThis retrospective bi-center study carried out by Limoges and Toulouse University Hospitals included patients following the inclusion criteria established by the BLVR expert panel. All patients were treated by two distinct procedures: first, EBVs were placed in all but the most proximal segment or sub-segment. The remaining segment was treated subsequently. All patients had a complete evaluation before treatment, and 3 months after the second procedure.ResultsOut of 58 patients included, only 4 pneumothoraxes (7%) occurred during the study. The other complications were pneumonia and severe COPD exacerbation (8.6% and 13.7% of patients, respectively). Significant improvement was found for FEV1 (+19.6 ± 25%), RV (−468 ± 960mL), 6MWD (30 ± 85m), BODE Index (−1.4 ± 1.8 point) and TLVR (50.6 ± 35.1%). Significant TLVR (MCID) was obtained in 74.1% of patients (43/58).ConclusionThis new approach using EBV could reduce the incidence of pneumothorax without increasing other complication rates. Clinical and physiological outcomes are similar to those reported in studies using the conventional single-step treatment.

Association between frailty index, lung function, and major clinical determinants in chronic obstructive pulmonary disease.

Airflow limitation alone is unable to capture the complexity of chronic obstructive pulmonary disease (COPD), better explained by comprehensive disease-specific indexes. Frailty is a clinical condition characterized by high vulnerability to internal and external stressors and represents a strong predictor of adverse outcomes. Primary objective was to test the association between indexes of lung function and COPD severity with frailty index (FI), and secondary to evaluate the association between FI and comorbidities, cognitive and physical function, BODE index, and mortality. 150 stable COPD outpatients were enrolled and followed up to 4years. At baseline, participants performed a geriatric multidimensional assessment, pulmonary function tests, arterial blood gas analysis, 6-min walking test, and bioimpedance analysis. BODE and FI were calculated. Spearman's ρ was used to assess correlations. Mortality was assessed using Kaplan-Meier curves. Participants were followed up for a median of 39months. Mean age was 73years and median frailty index 0.15 (IQR 0.11-0.19). FI was higher in frequent exacerbators (≥ 2/year) (mean 0.18 vs 0.15, p 0.01) and dyspnoeic patients (mMRC ≥ 2) (mean 0.21 vs 0.14, p < 0.01) and correlated with lung volumes, expiratory flows, and pressure of arterial oxygen. FI was positively correlated with the number of comorbidities, depressive symptoms, cognitive decline, and BODE index. Mortality was higher in patients with BODE higher than 3 (HR 3.6, 95% CI 1.2-10.9), and not associated with FI. FI positively correlates with all clinical drivers orienting the choice of treatment in COPD. FI associates with lung function and COPD severity, but does not associate with mortality.

Multidimensional Evaluation of Pulmonary Function and Exercise Capacity by BODE Index in Patients with On-Pump Coronary Artery Bypass Grafting

Coronary artery bypass grafting (CABG) often causes physiological changes in patients. Although functional changes, such as lung function and exercise capacity changes, are observed in patients, there are no detailed studies examining this. The aim was to compare preoperative and postoperative pulmonary function and exercise capacity in patients undergoing on-pump CABG with a multidimensional index (BODE index). Demographic and surgical characteristics of patients were recorded. Pulmonary function test, six-minute walk test (6MWT), and modified Medical Research Council (mMRC) dyspnea score were assessed and BODE index were calculated in preoperative and at six months postoperatively. A total of 75 patients were included with a mean ± standard deviation age of 59.8±10.0 years. The male to female ratio was 57/18. There was a statistically significant decrease in the forced expiratory flow at 25-75% (FEF25-75%) value after CABG. Other pulmonary function test values were also lower in the postoperative period compared to the preoperative period, but these changes were not significant. The mean distance achieved in the 6MWT (p=0.02) and the mMRC dyspnea score (p=0.001) were significantly better postoperatively. The BODE index, which combines these parameters, had increased in the postoperative period. Age (OR 1.09; 95% CI: 1.008-1.181) and postoperative FEF25-75% (OR -0.96; 95% CI: 0.938-0.988) were the independent predictors of BODE score ≥3 in multivariate analysis. Despite the decrease in pulmonary function in patients undergoing CABG, there was an improvement in exercise capacity and dyspnea score.

Endoscopic lung volume reduction coils for patients with severe emphysema-a single-centre retrospective analysis.

Patients with chronic obstructive pulmonary disease and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol coil-based ELVR techniques have been ambiguous. The analysis was done to analyse outcomes of ELVR with nitinol coils in patients with severe pulmonary emphysema. From September 2013 to November 2014, our centre performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anaesthesia. Twelve out of 29 patients received staged contralateral treatments up to 112 days later to avoid bilateral pneumothorax. Lung function and 6-min walking distance were assessed 1 week prior, 1 week after as well as 6-12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort. While coil-based ELVR led to significant short-term improvement of vital capacity (VC, +0.14 ± 0.39 l, P = 0.032) and hyperinflation (Δ residual volume/total lung capacity -2.32% ± 6.24%, P = 0.022), no significant changes were observed in 6-min walking distance or forced expiratory volume in 1 s. Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in forced expiratory volume in 1 s or residual volume after 6 months. Adverse events included haemoptysis (40%) and pneumothorax (3.4%), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment. ELVR with coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.

Psoas Muscle Density Evaluated by Chest CT and Long-Term Mortality in COPD Patients

RationalePoor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. MethodsAt baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48–119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. ResultsPsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02–1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94–0.99, p=0.023) were the variables independently associated with all-cause mortality. ConclusionsIn COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.

Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD

The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored. Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients? GOLD stage I COPD patients (n= 360) were enrolled and followed over 109 ± 50months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. A Dlco cutoff value of<60%predicted was associated with all-cause mortality (Dlco≥ 60%: 9%vsDlco< 60%: 23%, P= .01). At a same FEV1%predicted and Charlson score, patients with Dlco< 60%had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco< 60%is associated with all-cause mortality (hazard ratio [HR], 95% CI= 3.37, 1.35-8.39; P= .009) INTERPRETATION: In GOLD I COPD patients, a Dlco< 60%predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.

The Maugeri daily activity profile: a tool to assess physical activity in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) report reduced physical activity (PA). There are only few tools available to assess PA and sedentary behavior in these patients, and none of them aims to differentiate between sedentary and active patterns. The aim of the study was to evaluate an easy tool to profile daily activity time in a cohort of patients with COPD, compared to healthy subjects; the study was set at the Istituti Clinici Scientifici Maugeri (ICS), IRCCS of Tradate and Lumezzane, Italy, and at the Ente Ospedaliero Cantonale Novaggio, Switzerland (Italian Speaking). The populations were inpatients with COPD, healthy subjects. The items of the Maugeri Daily Activity (MaDA) profile were chosen based on literature, interviews with patients and health professionals. Time spent during sleep (ST), when awake (AT), active (ACT) or in sedentary behavior (SET) were recorded. Lung function tests, arterial blood gases, the modified Medical Research Council (mMRC), the six-minute walking distance test (6MWD), the COPD Assessment Test (CAT), and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index were also assessed in patients. Sixty patients with COPD and 60 healthy controls filled in the questionnaire. As compared to controls, patients showed longer AT and SET. Active time of patients was significantly correlated with mMRC, CAT, Bode Index and 6MWD, but not with demographics, anthropometrics or stages of disease. Using this tool, we found that patients with COPD spent longer time awake and in sedentary behavior. The MaDA may be useful to evaluate PA in patients with COPD.

Evaluation of respiratory parameters in patients with chronic obstructive lung disease during physical exercises

To study the relationship between the indicators of dynamic capnography and pulse oximetry with the indicators of the 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD). 67 patients of both sexes were examined: 45 patients with COPD (age 60.02.74 years) and 25 patients of the control group (age 47.603.46 years). The study of the functional capabilities of the patients respiratory system was carried out before, during and after the 6MWT on the equipment LifeSense LS1-9R capnograph-pulse oximeter (MedAir AB). In the comparison group, the parameters of dyspnea at rest were higher than the control group (p0.05), the spirometry indices were significantly lower (p0.05). Shortness of breath as a reason for stopping/slowing down the pace during the 6MWT was noted by patients of both groups (p0.05). When analyzing the PETCO2 trend graphs, periodic breathing (PВ) was revealed. In the group of patients with COPD, signs of PВ in the analysis of the PETCO2 trend were found in 80.95% (p0.05). Regression analysis of Cox proportional risks of mortality in patients with COPD revealed the prognostic value of the following parameters of a comprehensive assessment of the patient: body mass index (BMI), BODE index, dyspnea index on the mMRS scale, Borg, forced expiratory volume in 1 second (FEV1), index Tiffno, signs of PВ, distance 6MWT, signs of PВ and desaturation during 6MWT. At the same time, the total contribution of these indicators to the risk of a lethal event was assessed (p=0.003). When analyzing the correlation dependence, it was revealed that the presence of PВ was a prognostically unfavorable sign in patients with COPD. Predictors of an unfavorable course of COPD were BMI (23.0 kg/m2), BODE index, dyspnea indices on the mMRS, Borg, FEV1 scales, Tiffnos index, signs of PH, distance 6MST, signs of PD and desaturation during 6MST (reliability of the model coefficient p=0.003) in terms of forecast.

Role of Depression in Chronic Obstructive Pulmonary Disease Patients

Abstract Chronic obstructive pulmonary disease is a progressive lung disease characterized by chronic obstruction of the lung airflow that interferes with normal bleeding and is not fully reversible. Chronic smoking is the most common risk factor for COPD causing severe cough, wheezing, labored breathing and reduced functionality. COPD not only exerts pulmonary symptoms but also has a spill over the extra pulmonary effects. Owing to the impact of the disease, it may lead to conditions like osteoporosis, cardiovascular complications as well as to psychological effects such as depression and anxiety. Such comorbidities are hidden and are not effectively treated. Depression, one of the most common hidden comorbidities is known to be present but never diagnosed. Various scales like HAM-D and Bode Index can be used to diagnose the extent of depression. Our review mainly focuses on the various studies conducted worldwide and comparing the results of the same. Based on the worldwide analysis, depression is known to affect a COPD patient at later stages and requires immediate diagnosis and appropriate treatment.

Telomere length dynamics over 10-years and related outcomes in patients with COPD

BackgroundChronic obstructive pulmonary disease (COPD) has been proposed as a disease of accelerated aging. Several cross-sectional studies have related a shorter telomere length (TL), a marker of biological aging, with COPD outcomes. Whether accelerated telomere shortening over time relates to worse outcomes in COPD patients, is not known.MethodsRelative telomere length (T/S) was determined by qPCR in DNA samples from peripheral blood in 263 patients at baseline and up to 10 years post enrolment. Yearly clinical and lung function data of 134 patients with at least two-time measures of T/S over this time were included in the analysis.ResultsAt baseline, T/S inversely correlated with age (r = − 0.236; p < 0.001), but there was no relationship between T/S and clinical and lung function variables (p > 0.05). Over 10 years of observation, there was a median shortening of TL of 183 bp/year for COPD patients. After adjusting for age, gender, active smoking and mean T/S, patients that shortened their telomeres the most over time, had worse gas exchange, more lung hyperinflation and extrapulmonary affection during the follow-up, (PaO2 p < 0.0001; KCO p = 0.042; IC/TLC p < 0.0001; 6MWD p = 0.004 and BODE index p = 0.009). Patients in the lowest tertile of T/S through the follow-up period had an increased risk of death [HR = 5.48, (1.23–24.42) p = 0.026].ConclusionsThis prospective study shows an association between accelerated telomere shortening and progressive worsening of pulmonary gas exchange, lung hyperinflation and extrapulmonary affection in COPD patients. Moreover, persistently shorter telomeres over this observation time increase the risk for all-cause mortality.

Subclinical Hepatitis C Virus Infection in Patients with Chronic Obstructive Pulmonary Disease: Evidence from a Cross-Sectional Multicenter Observation Study

Background: Patients with hepatitis virus C (HCV) infection have declined levels of forced expiratory volume (FEV), which is a prognostic marker for chronic obstructive pulmonary disease (COPD). Objectives: The current study primarily aimed to investigate the incidence of subclinical HCV infection (clinical signs are absent but positive HCV RNA test performed by polymerase chain reaction) in patients with COPD of Zhejiang province, China, and its secondary aim was to investigate the clinical influence of HCV infection on COPD severity by body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) scoring index and pulmonary function tests (PFT). Methods: A total of 252 patients with COPD (confirmed by routine lab tests, BODE index, and PFT) were included in a cross-sectional multicenter study. An anti-HCV antibody test was used to diagnose HCV infection. Hepatitis virus C RNA was tested for patients with a HCV antibody-positive test. Results: Twelve patients had a positive anti-HCV antibody test. Of 12 anti-HCV antibody positive test patients, 10 were positive for the HCV RNA. The prevalence of anti-HCV antibody positivity and HCV RNA positivity was 12/ 252 and 10/ 252, respectively. The partial arterial pressure of oxygen was the same for patients with HCV RNA positive test compared to those with a negative anti-HCV antibody test (59.70 ± 5.50 mmHg vs. 63.84 ± 15.63 mmHg, P = 0.791). Patients with a positive HCV RNA test had a higher partial arterial pressure of carbon dioxide compared to those with a negative anti-HCV antibody test (43.70 ± 1.89 mmHg vs. 49.42 ± 7.33 mmHg, P = 0. 007). BODE index was higher for patients with HCV RNA positive test than those with anti-HCV antibody test negative (6 (3 - 7) vs. 4 (2 - 6), P &lt; 0.0001). Among the variables of BODE index scoring, the values of distance walked in 6 min (P &lt; 0.0001) and % predicted forced expiratory volume in 1 s (P &lt; 0.0001) were fewer for patients with HCV RNA positive test than those with a negative anti-HCV antibody test. Conclusion: This study demonstrated that subclinical HCV infection may be observed in COPD patients.

Clinical impact of forced vital capacity on exercise performance in patients with chronic obstructive pulmonary disease

BackgroundForced vital capacity (FVC) has been suggested to be a good biomarker for decreased exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, as FVC is highly correlated with forced expiratory volume in 1 second (FEV1), the relationship between FVC and exercise capacity should be assessed within the category of FEV1, i.e., COPD severity. However, this was not considered in previous studies. Thus, limited data are available on the association between reduced FVC and exercise capacity measured by 6-min walk distance (6MWD) based on COPD severity.MethodsWe performed a cross-sectional study using data from the Korean COPD Subgroup Study (KOCOSS) cohort. We evaluated 1,386 patients with moderate (n=895) and severe-to-very severe (n=491) COPD. Reduced FVC was defined as FVC <80% predicted and short 6MWD as <350 m. Multivariable logistic regression was used to evaluate the association between reduced FVC and short 6MWD.ResultsThere were no significant differences in respiratory symptoms and quality of life between the patients with reduced FVC and those with preserved FVC. However, patients with reduced FVC had shorter 6MWD (30.5 cm in moderate and 34.5 cm in severe-to-very severe COPD) and higher BODE index scores than those with preserved FVC. The cubic spline model revealed 6MWD peaked around 93% predicted of FVC in moderate COPD, whereas FVC showed a positive association with 6MWD in severe-to-very severe COPD. Multivariable analyses showed that reduced FVC was significantly associated with short 6MWD in both moderate [adjusted odds ratio (aOR) =1.44, 95% confidence interval (CI): 1.03–2.02] and severe-to-very severe (adjusted OR =1.55, 95% CI: 1.01–2.40) COPD.ConclusionsReduced FVC was significantly associated with shorter 6MWD in moderate-to-very severe COPD patients, suggesting that reduced FVC might be reflective of 6MWD-measured exercise capacity in moderate-to-very severe COPD.

Improving clinical disease subtyping and future events prediction through a chest CT-based deep learning approach.

PurposeTo develop and evaluate a deep learning (DL) approach to extract rich information from high‐resolution computed tomography (HRCT) of patients with chronic obstructive pulmonary disease (COPD).MethodsWe develop a DL‐based model to learn a compact representation of a subject, which is predictive of COPD physiologic severity and other outcomes. Our DL model learned: (a) to extract informative regional image features from HRCT; (b) to adaptively weight these features and form an aggregate patient representation; and finally, (c) to predict several COPD outcomes. The adaptive weights correspond to the regional lung contribution to the disease. We evaluate the model on 10 300 participants from the COPDGene cohort.ResultsOur model was strongly predictive of spirometric obstruction (r2 = 0.67) and grouped 65.4% of subjects correctly and 89.1% within one stage of their GOLD severity stage. Our model achieved an accuracy of 41.7% and 52.8% in stratifying the population‐based on centrilobular (5‐grade) and paraseptal (3‐grade) emphysema severity score, respectively. For predicting future exacerbation, combining subjects’ representations from our model with their past exacerbation histories achieved an accuracy of 80.8% (area under the ROC curve of 0.73). For all‐cause mortality, in Cox regression analysis, we outperformed the BODE index improving the concordance metric (ours: 0.61 vs BODE: 0.56).ConclusionsOur model independently predicted spirometric obstruction, emphysema severity, exacerbation risk, and mortality from CT imaging alone. This method has potential applicability in both research and clinical practice.

Dynamic hyperinflation, chronotropic intolerance and abnormal heart rate recovery in non-severe chronic obstructive pulmonary disease patients-reflections in the mirror

BackgroundThe presence of abnormal heart rate recovery (HRR) and chronotropic incompetence (CI) suggests autonomic dysfunction (AD) and is associated with diminished physical activity and increased cardio-vascular (CV) risk. AimOur aim is to analyse the correlation between AD and airflow obstruction - forced expiratory volume in 1s (FEV1), dynamic hyperinflation (DH) and disease prognosis - the BODE ... index (BMI; Obstruction ... FEV1;Dyspnea ... mMRC;E ... exercise capacity) in non-severe COPD patients without overt CV comorbidities. MethodsWe used cardio-pulmonary exercise testing (CPET) with 67 subjects. Inspiratory capacity (IC) manouevres were performed for DH assessment. Echocardiography was executed before CPET and 1...2min after peak exercise. Stress left ventricular diastolic dysfunction (LVDD) was assumed if stress E/e...>15.Wilkoff method calculated the metabolic-chronotropic relationship (MCR). Chronotropic incompetence (CI) and abnormal HR recovery (HRR) were determined. Main resultsCI was detected in 44% of the mild and 65% of the moderate COPD patients. Abnormal HRR was present in 75% of the mild and 78% of the moderate COPD subjects. Multivariate regression analysis showed no association between FEV1, CPET parameters, BODE index, stress LVDD and AD. DH was the only independent predictor for both abnormal HRR and CI. ConclusionEvaluation of AD during incremental CPET unravels lung hyperinflation as a potential mechanism of attenuated HR response and diminished physical activity in non-severe COPD free of overt CV comorbidities. This multifaceted approach to dyspnea may facilitate the discrimination of its pathogenesis and improve its proper clinical management.

«OBESITY PARADOX» IN COMORBID STABLE ISCHEMIC HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

The aim: Was to find the possible relationship between spirometry tests, the BODE index (body mass index (BMI), airflow obstruction, dyspnea, and exercise tolerance) with bioimpedance parameters in overweight and class I obese patients. Materials and methods: 47 patients with stable ischemic heart disease (IHD) (I-II functional class), chronic obstructive pulmonary disease (COPD) (GOLD II, III, IV; groups B, C, D) were divided into 3 groups: G1: 15 normal-weight patients, G2: 15 overweight subjects, and G3: 17 class I obese patients. Spirometry tests, bioimpedance parameters, 6MWT (6-minute walk test) were measured. Results: FEV1 was significantly higher in overweight (p = 0.033) and class I obese (p = 0.049) subjects, the BODE index was lower in overweight (p = 0.033) and class I obese (p = 0.037) patients, compared with normal-weight subjects. The statistically significant positive relationship was between BMI and FEV1 and the negative correlation was between BMI and the BODE index in all groups of patients (p < 0.05). Conclusions: In our study, we found better FEV1, 6MWT, the BODE index, the statistically significant association between FEV1 and the BODE index with BMI in overweight and class I obese patients. That's why we can suppose the presence of the "obesity paradox" in comorbid overweight or class I obese stable IHD, COPD patients.

Microalbuminuria and serum CRP: potential biomarkers for cardiovascular risk among stable COPD

Background: Cardiovascular disease is one of the major causes of mortality in chronic obstructive pulmonary disease (COPD) patients. Both microalbuminuria (MAB) and raised serum C-reactive protein (CRP) levels have strong association with cardiovascular events as they reflect generalized endothelial vascular dysfunction. The objectives of the study are (i) to assess the prevalence of MAB and serum CRP levels in stable COPD patients and (ii) to find out the relationship of MAB and serum CRP with clinical and physiological parameters in COPD patients. Methods: This comparative cross-sectional study was carried out on COPD patients attending OPD at Institute of Respiratory Diseases, Jaipur during the year from 2019 to 2020. Forty stable COPD patients and 40 healthy controls were enrolled in the study. Spot urinary albumin/creatinine ratio, serum CRP levels, smoking history, spirometry, blood gases, body mass index, and BMI, Obstruction (FEV1% predicted), Dyspnea (mMRC grading), Exercise Capacity (6 MWD) (BODE) index were assessed. Results: Out of 40 cases, 23(56%) had MAB and 38 (95%) had serum CRP levels >3 mg/L. There was a negative correlation between forced expiratory volume in one second (FEV1), partial pressure of oxygen in arterial blood (PaO2) levels and 6 MWD with both MAB levels and S.CRP levels respectively. There was a positive correlation between BODE Index and modified British Medical Research Council grading with both MAB levels and serum C reactive protein (S.CRP) levels respectively. There was a positive correlation between BODE index and modified British Medical Research Council grading with both MAB and S.CRP levels. Conclusion: COPD patients of varying severity should be screened regularly with MAB and serum CRP levels to determine the risk and progression of cardiovascular consequences so that adequate decision of interventional strategies can be taken out to prolong survival in COPD patients.

Health status can predict diaphragmatic muscle thickness in COPD: pilot study

Abstract Introduction: Among the systemic implications of chronic obstructive pulmonary disease (COPD) there are changes in the diaphragm and impact on health status. However, there are few studies on the possible relationship between these variables, and whether health status could predict diaphragmatic muscle thickness (DMT). Objective: To investigate whether there is a relationship between DMT and the prognostic mortality index Body Mass-Index, Airway Obstruction, Dyspnea and Exercise Capacity (BODE), dyspnea and health status, and to investigate whether health status can predict DMT in patients with COPD entering a pulmonary rehabilitation program. Methods: This is a pilot study with a cross-sectional design. Diaphragmatic muscle thickness was evaluated using ultrasound; health status through the COPD Assessment Test (CAT); the sensation of dyspnea by the modified Medical Research Council scale; and mortality, using the BODE index. Results: The sample consisted of 13 patients (68.69 ± 9.3 years) classified as having moderate to severe COPD. There was a strong and inverse correlation between diaphragmatic muscle thickness and health status (r = -0.735; p = 0.004). Simple regression analysis demonstrated that health status influenced diaphragmatic muscle thickness (β = -0.002; IC 95% - 0.004 to -0.001; p = 0.004), explaining 49% of the variance. However, no correlations were observed between diaphragmatic muscle thickness with dyspnea (r = 0.005; p = 0.985) or with the BODE mortality index (r = -0.219; p = 0.472). Conclusion: This pilot study demonstrated a strong inverse correlation between health status and DMT. In addition, health status was able to predict DMT in patients with COPD.