Chronic Obstructive Airway Disease Patients Research Articles

A mobile-based airway clearance care system using deep learning-based vision technology to support personalized home-based pulmonary rehabilitation for COAD patients: Development and usability testing.

Excessive mucus secretion is a serious issue for patients with chronic obstructive airway disease (COAD), which can be effectively managed through postural drainage and percussion (PD + P) during pulmonary rehabilitation (PR). Home-based (H)-PR can be as effective as center-based PR but lacks professional supervision and timely feedback, leading to low motivation and adherence. Telehealth home-based pulmonary (TH-PR) has emerged to assist H-PR, but video conferencing and telephone calls remain the main approaches for COAD patients. Therefore, research on effectively assisting patients in performing PD + P during TH-PR is limited. This study developed a mobile-based airway clearance care for chronic obstructive airway disease (COAD-MoAcCare) system to support personalized TH-PR for COAD patients and evaluated its usability through expert validation. The COAD-MoAcCare system uses a mobile device through deep learning-based vision technology to monitor, guide, and evaluate COAD patients' PD + P operations in real time during TH-PR programs. Medical personnel can manage and monitor their personalized PD + P and operational statuses through the system to improve TH-PR performance. Respiratory therapists from different hospitals evaluated the system usability using system questionnaires based on the technology acceptance model, system usability scale (SUS), and task load index (NASA-TLX). Eleven participant therapists were highly satisfied with the COAD-MoAcCare system, rating it between 4.1 and 4.6 out of 5.0 on all scales. The system demonstrated good usability (SUS score of 74.1 out of 100) and a lower task load (NASA-TLX score of 30.0 out of 100). The overall accuracy of PD + P operations reached a high level of 97.5% by comparing evaluation results of the system by experts. The COAD-MoAcCare system is the first mobile-based method to assist COAD patients in conducting PD + P in TH-PR. It was proven to be usable by respiratory therapists, so it is expected to benefit medical personnel and COAD patients. It will be further evaluated through clinical trials.

Effectiveness of educating proper inhaler technique in chronic obstructive airway disease patients visiting pulmonology outpatient department

Effectiveness of educating proper inhaler technique in chronic obstructive airway disease patients visiting pulmonology outpatient department

Emphysema-Predominant COPD Had a Greater 5-Year Mortality and a Worse Annual Decline in Lung Function Than Airway Obstruction-Predominant COPD or Asthma at Initial Same Degree of Airflow Obstruction.

Background and Objectives: We studied whether the extent of exertional oxygen desaturation and emphysema could cause greater mortality in COPD and asthma independent of airflow obstruction. Materials and Methods: We performed a 5-year longitudinal observational study in COPD and asthma patients who matched for airflow obstruction severity. All subjects performed a 6-min walk test (6MWT) and high-resolution computed tomography (HRCT) and followed spirometry and oxygen saturation (SpO2) during the 6MWT every 3–6 months. Overall survival was recorded. Cumulative survival curves were performed according to the Kaplan–Meier method and compared with the log-rank test. Results: The COPD group had higher emphysema scores, higher Δinspiratory capacities (ICs) and lower SpO2 during the 6MWT, which showed a greater yearly decline in FEV1 (40.6 mL) and forced vital capacity (FVC) (28 mL) than the asthma group (FEV1, 9.6 mL; FVC, 1.2 mL; p < 0.05). The emphysema-predominant COPD group had an accelerated annual decline in lung function and worse survival. The nadir SpO2 ≤ 80% and a higher emphysema score were the strong risk factors for mortality in COPD patients. Conclusions: The greater structural changes with a higher emphysema score and greater desaturation during the 6MWT in COPD may contribute to worse yearly decline in FEV1 and higher five-year mortality than in asthma patients with a similar airflow obstruction. The lowest SpO2 ≤ 80% during the 6MWT and emphysema-predominant COPD were the strong independent factors for mortality in chronic obstructive airway disease patients.

Assessment of nutritional status in chronic obstructive airways disease patients in a tertiary care hospital at Himachal Pradesh, India: a cross sectional study

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortatlity worldwide. Malnourishment in COPD patients is very common and is a prognostic factor in its treatment. The present study has been conducted to assess nutritional status in COPD patients and its correlation with severity of disease.Methods: This institutional based analytical cross sectional study was conducted in the Department of Pulmonary Medicine at tertiary care hospital in Himachal Pradesh (India) from 1 Dec 2017 to 31st May 2018. A total of 52 COPD participants attending the pulmonary Medicine OPD and fulfilling the inclusion criteria were enrolled.Results: All participants reported being smoker since long with the mean years of smoking since 31 years and about 13.6 cigarettes being smoked per day. 22 (42%) of the participants were undernourished as per BMI criteria But when compared with MUAC criteria, a large number 38 (73%) came out to be undernourished. haemoglobin and cholesterol levels were less in patients with severe diseases than mild and moderate category (76.9%).Conclusions: The malnourishment and severity of the disease has direct correlation. More the severity of COPD, more is the malnourishment. Biochemical parameters, although not deranged significantly in any group, but more on the lower side in patients with severe COPD. There is a need for regular nutritional assessment of every COPD patient and recommendation of supplementary food for them.

Accuracy of a New Algorithm to Identify Asthma–COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease

ObjectivesWe aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD). MethodsACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300cells/μl) and/or a very positive bronchodilator response (>400ml and >15% in FEV1). ResultsEighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked <20 pack-years, 100% of asthmatics who smoked ≥20 pack-years, 47.7% of COPD with >200eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771ml), higher than in COPD (1431ml, p<0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305cells/μl) and higher than in COPD (170cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5IU/ml) and lower than in asthma (41.5IU/ml, p<0.05), whereas FeNO levels in ACO were intermediate. ConclusionThis algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids.

Assessment of Sleep and Quality of Life Among Chronic Obstructive Airways Disease Patients

Objective: To assess sleep and quality of life among chronic obstructive airway disease patients. Materials and Methods: Patients with primary, mild-to-moderate, stable chronic obstructive airways disease [asthma and chronic obstructive pulmonary disease (COPD)] on treatment visiting outpatient department of a government hospital were interviewed using a predesigned, pretested, semi-structure schedule. The patients were then administered standardized Pittsburgh sleep quality index (PSQI), St. George’s respiratory questionnaire (SGRQ), and Epworth sleepiness scale (ESS) questionnaires. Patients with any other known chronic disease, chest deformity, or long-term oxygen therapy were excluded. Using purposive sampling frame, 120 chest patients (asthma and COPD) and in addition, 30 ambulatory patients without having any underlying chronic respiratory diseases were also recruited for comparison purpose. Results: Mean age was 50.2 years. Mean duration of sleep during night was 5.40 h [±1.6; 95% confidence interval (CI) = 4.98–5.82] for patients with COPD; 5.53 h (±1.6; 95% CI = 5.11–5.95) for patients with asthma, and 6.97 h (±1.0; 95% CI = 6.57–7.36) for control patients (P < 0.001). It was noticed that 63.3% of control patients had at least 6 h of night sleep in comparison to 23.3% of chest patients (P < 0.01). Good PSQI score (up to 5 points) was found in 86.6% of control patients while it was found only in 35.0% of chest patients (P < 0.01); mean PSQI score among asthma was 8.08, 8.06 (COPD), and 3.46 among control patients, respectively. All the control patients (100%) reported good score for quality of life while chest patients reported good score for SGRQ (activity, impact, and symptoms) as 64.1, 83.3, and 82.5%, respectively (P < 0.01). Based on ESS, none of the patients complained of daytime sleepiness. To conclude, poor sleep was noticed in our study sample.

Accuracy of a New Algorithm to Identify Asthma–COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease

ObjectivesWe aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD). MethodsACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300cells/μl) and/or a very positive bronchodilator response (>400ml and >15% in FEV1). ResultsEighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked <20 pack-years, 100% of asthmatics who smoked ≥20 pack-years, 47.7% of COPD with >200eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771ml), higher than in COPD (1431ml, p<0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305cells/μl) and higher than in COPD (170cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5IU/ml) and lower than in asthma (41.5IU/ml, p<0.05), whereas FeNO levels in ACO were intermediate. ConclusionThis algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids.

Review of chronic obstructive airway disease patients admitted at Maamoura Chest Hospital from 2009 to 2012

BackgroundChronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. However, it is often under diagnosed and under treated, resulting in underestimation of the burden of this disease. COPD is defined as a preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. ObjectiveTo review the COPD cases who were admitted at Maamoura Chest Hospital during the period from 2009 to 2012 as regards distribution of the disease, risk factors of the disease, severity and complications of the disease. Patients and methodsThis was a retrospective study that was based upon collecting the data of all COPD patients who were admitted at Maamoura Chest Hospital during the period from 2009 till 2012. The data included the following: personal data, clinical data, methods of diagnosis, intensive care unit admission, management and morbidity and mortality. ResultsIn the present study, 77.3% of the patients’ age ranged between 35 and 70years, 11.4% were <35years and 11.3% were >70years. Also, 97.4% were males and 2.6% were females, 75.6% lived in urban areas and 24.4% lived in rural areas. 86.5% of the studied cases were smokers and 13.5% were non smokers. 12.8% of the studied cases were addicts and 87.2% were not. 57.1% of the addicted persons were addicted to cannabis, 19% were intravenous addicts and 23.8% were addicts to tramadol. The most common co morbidities in COPD patients were respiratory infections in 53.9% of cases, heart failure in 44.5% of cases, IHD in 37.9% of cases, AF in 30.5% of cases, HTN in 26.9% of cases and DM in 19.5% of cases respectively. The overall mortality rate was 5.7%, 8.5% among the patients who received O2 therapy, 85.1% among the patients who were put on CPAP, 63.8% among the patients who were put on invasive mechanical ventilation and 44.7% among the patients who were admitted to the ICU. ConclusionsCOPD is a very dangerous disease that affects the lives of many people. The overall aim of management of stable COPD is to ensure good control of symptoms, to slow down the progression of the disease and to prevent further deterioration or complications. The sooner the diagnosis is made and interventions implemented, the more the long-term prognosis is improved.

Teaching chronic obstructive airway disease patients using a metered-dose inhaler

气喘和长期的妨碍的航线疾病(COAD ) 是通常与被治疗经常减轻的普遍航线阻塞被联系的航线的长期的煽动性的混乱。尾 _ 2-adrenoreceptor 收缩筋和 corticosteriods 是这疾病的管理的支柱。这些代理人的管理的比较喜欢的线路由吸入。这允许这药比全身的线路与更快速的地势和更少副作用直接被送到航线。空气过滤器(MDI ) 使用是正确使用要求好技术的米剂量的主要劣势；主要，与空气过滤器的使活动协调灵感的开始。几研究显示了 24%—当使用 MDI 时， 89% 病人有差的技术。解决这个问题，由医药人员的详细耐心的教育被推荐了。在香港，医生们可以趋于依靠病人“读包裹因为有限咨询时间，插入。在如此的情形下面，护理并且药店职员可以在用 MDI 教病人起活跃作用。

Factores de riesgo vascular en el glaucoma primario de ángulo abierto

To determine whether cardiovascular risk factors distribution differ between primary open-angle glaucoma (POAG) and control subjects. To assess the strength of this association in POAG. To analyze the most frequent pathology in this group of patients for a better selection of medical treatment. Observational cross-sectional study in patients with a diagnosis of POAG. Fifty glaucoma patients were selected with consecutive sampling between those who had been admitted to an tertiary hospital by any reason and compared with fifty admitted to the same hospital patients without POAG diagnosis in the same period of time. The variables age, sex, the reason for admission to hospital classified by diagnosis related group (DRG) and diagnostic mayor criteria (DMC), treatment for glaucoma, stroke, diabetes mellitus, high blood pressure, ischaemic cardiopathy, Raynaud phenomenon, low blood pressure, hypercholesterolemia and tobacco were investigated. An association was found between POAG and stroke (prevalence ratio=2.16;CI al 95%=1.01-2.20; p=0.074*), low blood pressure (prevalence ratio=5; CI=1.14-2.63; p=0.092*) and high blood pressure (prevalence ratio=1.35; p=0.16) but it didn't reach to the statistical level of signification. No association with the remaining variables was found with this size sample. The most frequent reason for hospital admission in the study group were respiratory and circulatory system disease. Circulatory (24 y 22% respectively)with the pneumonia the most frequent DRG (10%). In the control group, the most frequent reason were circulatory and respiratory system disease (24 y 16% respectively). The chronic obstructive airway disease (COAD) was the most frequent DRG in this group (6%). The vascular risk factors most frequently found in both of the groups was high blood pressure (54 and 40% ) and the stroke (26-12%). The medical glaucoma treatment in these patients were the beta-blockers only (24.3%) or in association (18.9%). POAG is associated with stroke and blood pressure variations (high and low). The respiratory (pneumonia and COAD) and circulatory system diseases (congestive heart failure-CHF- and ischaemic cardiopathy) are the most frequently mortality cause in this group of patients. The most frequent medical therapy used for glaucoma are the beta-blockers which are contraindicated in COAD and CHF patients.

Novel PCR-EIA method for the detection of Chlamydia pneumoniae in respiratory specimens

We report the development of a microtitre plate-based PCR-EIA assay (ELAHA; Enzyme Linked Amplification and Hybridization Assay) for the sensitive and specific detection of Chlamydia pneumoniae in sputum samples from patients with chronic obstructive airways disease (COAD). Following PCR amplification of a segment of the chlamydial heat shock 60 protein gene, the 587 bp sized amplicon is captured onto the streptavidin coated surface of a microtitre plate using a C. pneumoniae specific biotinylated probe and the level of captured product is subsequently determined via a colorimetric reaction using an automated plate reader. The ELAHA is a simple, rapid and inexpensive method for detection of low levels of infectious agents and is readily adaptable to current clinical laboratory equipment. The assay was evaluated with a cohort of hospital respiratory patients: (i) COAD patients with acute exacerbation, (ii) COAD patients without exacerbation (stable) and (iii) a non-respiratory control group. The ELAHA produced 6/12 (50%) C. pneumoniae positives in the COAD with exacerbation group, 3/13 (23%) positives in the COAD without exacerbation group and only 1/6 (17%) positives in the control non-respiratory group. This sensitive and robust PCR-EIA method can provide clinically relevant diagnostic evidence of current C. pneumoniae infection contributing to serious respiratory tract diseases such as COAD.

Preflight Evaluation-To the Editor: Patients and Methods

Dr. Dillard and his colleagues have conferred in their article (CHEST 1995; 107:352-57) that a hypoxemic inhalation test at sea level and hypobaric chamber exposure are compatible predictors for altitude hypoxemia. The two groups of COPD patients were different in their spirometric status (FEV1 for group 1 is 41 ±14% and that of group 3 being 31 ±10%); moreover, the presence of normocapnoea (PaCO2-38.0±4.7 mm Hg) in group 3 with FEV1 ≥1 L (0.97±0.32) appears physiologically difficult to appreciate when a rise in PaCO2 is likely. 1 Snider GL Faling LJ Rennard SI Chronic bronchitis and emphysema. in: Murray JF Nadal JA Text book of respiratory medicine. 2nd ed. WB Saunders Co, Philadelphia1994: 1359 Google Scholar The authors have not mentioned how long group 3 patients were given hypobaric chamber exposure and have not qualified the reason for different periods of hypoxic inhalation/hypobaric exposure in subjects from groups 1 and 2 (15 and 30 min respectively). Furthermore, it is unclear that at what point of time the arterial blood gas analysis was done to see altitude hypoxemia. An exposure of 15/30 min may be quite short to see the hypoxemic effect to long air travel since this duration is an important determinant of hypoxemia. 2 California Thoracic Society. Travel at high altitude: informations for physicians. Oakland, Calif: American Lung Association of California, 1989 Google Scholar A subclassification of chronic obstructive airway disease patients into predominant bronchitis vs emphysema would have been better to understand the utility of such tests in these different classes of patients who, pathophysiologically, are distinct from each other.

The characterization of a mutation of the 3' flanking sequence of the alpha 1-antitrypsin gene commonly associated with chronic obstructive airways disease.

A restriction fragment length polymorphism (RFLP) of the 3' flanking region of the alpha 1-antitrypsin (AAT) gene, detected with the restriction enzyme TaqI, occurs in about 17% of patients with chronic obstructive airways disease (COAD). To characterize the mutation the sequence of this region of the normal AAT gene had to be determined. The sequence containing the site of the mutation was amplified by the polymerase chain reaction and the DNA was sequenced in six COAD patients. The mutation is a G to A transition and occurs in a region containing potential regulatory sequences corresponding to enhancer elements. It is as yet unclear if the mutation alters the expression of AAT.

Home oxygen therapy: an audit of survival

A retrospective audit of the medical records and respiratory function data of 186 subjects placed on long term continuous home oxygen therapy between 1979 and 1988 was undertaken. Kaplan-Meier survival curves were constructed for subjects with Chronic Obstructive Airways Disease (COAD) and Interstitial Lung Disease (ILD). There was an almost twofold greater mortality rate for COAD subjects at 12 months when compared to the Medical Research Council Working Party (MRC) and the Nocturnal Oxygen Therapy multicentre clinical trials (NOTT). However, the mean values of the baseline physiological parameters were similar to these major studies of long term oxygen therapy. Survival of ILD patients was significantly less than COAD patients (p less than 0.001). Within both disease categories, females survived significantly longer than males. Within the COAD category the observed sex difference was not abolished when the data was controlled for age, Pco2, Po2 and pack-years (as an estimate of total cigarette consumption). However, prior smoking history appeared to modify the male-female difference in COAD survival. These are the first Australian survivorship data for patients on long term oxygen therapy. The more adverse survival figures compared with the overseas studies may reflect the co-existence of other diseases.

Impairment, disability and handicap in chronic respiratory illness

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. 92 patients suffering from COAD were interviewed in order to assess impairment, disability and handicap. Measures included spirometric tests of lung function; the Fletcher breathlessness grading scale, the oxygen cost diagram and a visual analogue scale of dyspnoea; the Functional Limitations Profile (FLP); and the shortened 12 item General Health Questionnaire (GHQ-12), supplemented by the 7-item GHQ sub-scales of anxiety and severe depression. Low correlations were found between lung function and disability (-0.38, P <0.001), accounting for only 14% of the variance, and high correlations were found to exist between measures of dyspnoea and disability (-0.90, P <0.001). Major areas of disability and handicap included; household management, ambulation, sleep and rest, recreation and pastimes and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper goes on to discuss both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families and for a complementary social perspective and approach to COAD and its treatment.

The effect of pneumococcal vaccine on the disposition of theophylline.

Pneumococcal vaccine is frequently given to chronic obstructive airway disease patients who are maintained on theophylline therapy. Several studies demonstrating the effect of viral and bacterial vaccines on drug metabolism prompted our evaluation of the effect of pneumococcal vaccine on theophylline pharmacokinetics. Six healthy volunteers, acting as their own controls, received 250 mg of theophylline every 8 h for 12 days. Plasma area under the concentration-time curves (AUC) were measured on Days 4, 6, and 12. On Day 5 pneumococcal vaccine (0.5 ml) was given intramuscularly. No significant difference in elimination rate constant, AUC, or apparent oral clearance of theophylline was found at one or seven days after vaccine administration. These results indicate that intramuscular pneumococcal vaccine does not alter the pharmacokinetics of theophylline during chronic oral administration.

Dipyridamole treatment in chronic obstructive airways disease: effect on platelet regeneration time.

The platelet regeneration time (PRT) determined in a group of hypoxaemic patients with chronic obstructive airways disease (COAD), before and after treatment with dipyridamole 150 mg tid, was compared with a group of control subjects. The PRT was computed by a modified non-radioisotope technique and was expressed as t1/2 in days. The patient group showed a significantly shortened PRT as compared to controls of the same age and sex (2.10 +/- 0.16 vs 3.65 +/- 0.26 days; p less than 0.001). One month of dipyridamole administration resulted in prolongation of the PRT in COAD patients (2.10 +/- 0.16 days pre-treatment vs 2.75 +/- 0.20 post-treatment; p less than 0.01), without affecting the platelet cyclo-oxygenase system. This study indicates that dipyridamole may be beneficial in pathological conditions, which are characterized by increased platelet turnover, possibly leading to frequent thromboembolic complications.