Features Of Chronic Obstructive Pulmonary Disease Research Articles

Sex differences in chronic obstructive pulmonary disease characteristics: the Korea National Health and Nutrition Examination Survey 2007-2018.

Chronic obstructive pulmonary disease (COPD) is less prevalent in females than males, but it affects mortality in females. There may be sex differences in the clinical characteristics of COPD. We analyzed the Korea National Health and Nutrition Examination Survey dataset from 2007 to 2018. We compared the clinical characteristics and comorbidities in subjects with COPD according to sex. We adjusted the multivariate logistic regression of lung cancer prevalence according to COPD and sex by age and smoking amount. Females with COPD tended to be older than males with COPD (64.1 ± 0.4 yr vs. 62.3 ± 0.2 yr, respectively, p < 0.001). Approximately 89% of males with COPD had a smoking history, while 86% of females with COPD were non-smokers (p < 0.001). Household income was lower (p < 0.001) and asthma and overall malignancy were more prevalent in females with COPD than males with COPD (25.5 vs. 11.6%, respectively, p < 0.001; (6.3 vs. 5.4%, respectively, p < 0.001). However, lung cancer was more common in males with COPD than females with COPD (0.9 vs. 0.1%, respectively, p < 0.001). Lung cancer prevalence increased in males with moderate COPD compared to subjects without COPD (OR, 4.409; 95% CI, 1.741-9.419). Females with COPD had a lower smoking rate, household income, and lung cancer prevalence than males with COPD. More active COPD screening is needed for women of low socioeconomic status, even if they do not smoke.

Chronic obstructive pulmonary disease features in patients visiting primary respiratory clinic and tertiary hospital in Japan

Pulmonologists in primary care clinics are positioned between those in tertiary hospitals and general practitioners in clinics and are anticipated to promote hospital-clinic collaboration for patients with chronic obstructive pulmonary disease (COPD). However, the clinical features of patients in primary respiratory clinics are unclear. This multicenter study cross-sectionally compared the characteristics of patients with COPD in a respiratory clinic (n = 69) with those in a university hospital (n = 124). More patients visited the clinic for symptom relief without a referral, whereas more visited the hospital for consultation of abnormal spirometry/computed tomography (CT). The patients in the clinic showed female predilection, higher prevalence of current smokers, severe dyspnea, and concomitant heart failure, and higher CT-measured cross-sectional area ratio of pectoralis muscle to adjacent subcutaneous adipose tissue compared to those in the hospital (all p < 0.05). The observed differences between the two groups suggest the need to establish the role of primary pulmonologists in hospital-clinic collaboration for better COPD management.

PECULIARITIES OF THE COMBINED COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND TYPE 2 DIABETES MELLITUS

The aim of the research was to study the features of chronic obstructive pulmonarydisease (COPD) with concomitant diabetes mellitus (DM) type 2 by analyzing clinicaldata, external respiratory function (FAD), bioimpedance analysis, exercise tolerance,quality of life of patients and integrated index BODE.Material and methods. 102 patients with COPD and concomitant type 2 diabetes,divided into 2 groups: 53 patients with COPD (first group) and 49 patients with COPDand concomitant type 2 diabetes were examined. In addition to that COPD assessmenttest (CAT test), a 6-minute walk test were performed. The BODE integrated index wasused to assess the COPD severity of and prognosis. According to spirometry, the studyincluded COPD patients with a FEV1 / FJEL ratio less than 0.7 and with II, III and IVdegrees of bronchial obstruction according to the spirometric classification GOLD. Toassess the body composition the method of bioimpedance analysis (portable device BC-601 (TANITA, Japan) was used.Results. In the study of COPD clinical features with concomitant type 2 diabetes, therelationship between exacerbation frequency and the level of diabetes compensation (p&lt;0.05) was revealed. The duration of inpatient treatment of patients with COPD withconcomitant type 2 diabetes was higher than in patients with COPD (p &lt;0.05). It hasbeen also found that the main spirometric parameters and exercise tolerance in patientswith COPD with concomitant type 2 diabetes were significantly lower than in the groupof COPD patients, and muscle and bone mass, percentage of fat mass, visceral fat andmetabolic age were significantly higher than in the group of COPD patients. Whenassessing the quality of life of patients with COPD by CAT test, there was no significantdifference between groups of patients.Conclusions. In patients with COPD in the presence of concomitant type 2 diabetesthere are more frequent and prolonged exacerbations with severe clinical symptoms, aswell as lower basic spirometric parameters, tolerance to exercise (according to the testwith 6-minute walk) with significantly higher bioimpedance analysis (BMI, % fat mass,visceral fat, bone, muscle mass and metabolic age).Key words: chronic obstructive pulmonary disease, diabetes mellitus, spirometry,bioimpedance analysis, exercise tolerance.

Sputum neutrophil counts are associated with more severe asthma phenotypes using cluster analysis

Clinical cluster analysis from the Severe Asthma Research Program (SARP) identified 5 asthma subphenotypes that represent the severity spectrum of early-onset allergic asthma, late-onset severe asthma, and severe asthma with chronic obstructive pulmonary disease characteristics. Analysis of induced sputum from a subset of SARP subjects showed 4 sputum inflammatory cellular patterns. Subjects with concurrent increases in eosinophil (≥2%) and neutrophil (≥40%) percentages had characteristics of very severe asthma. To better understand interactions between inflammation and clinical subphenotypes, we integrated inflammatory cellular measures and clinical variables in a new cluster analysis. Participants in SARP who underwent sputum induction at 3 clinical sites were included in this analysis (n = 423). Fifteen variables, including clinical characteristics and blood and sputum inflammatory cell assessments, were selected using factor analysis for unsupervised cluster analysis. Four phenotypic clusters were identified. Cluster A (n = 132) and B (n = 127) subjects had mild-to-moderate early-onset allergic asthma with paucigranulocytic or eosinophilic sputum inflammatory cell patterns. In contrast, these inflammatory patterns were present in only 7% of cluster C (n = 117) and D (n = 47) subjects who had moderate-to-severe asthma with frequent health care use despite treatment with high doses of inhaled or oral corticosteroids and, in cluster D, reduced lung function. The majority of these subjects (>83%) had sputum neutrophilia either alone or with concurrent sputum eosinophilia. Baseline lung function and sputum neutrophil percentages were the most important variables determining cluster assignment. This multivariate approach identified 4 asthma subphenotypes representing the severity spectrum from mild-to-moderate allergic asthma with minimal or eosinophil-predominant sputum inflammation to moderate-to-severe asthma with neutrophil-predominant or mixed granulocytic inflammation.

Is there a role for airway clearance techniques in chronic obstructive pulmonary disease?

Chronic cough and sputum production are common features of chronic obstructive pulmonary disease (COPD) and have a significant impact on exacerbation frequency and quality of life. Despite this, techniques to assist with removal of sputum from the airway do not have a well-defined role in COPD management. Clinical trials of airway clearance techniques (ACTs) in COPD have shown mixed results with little evidence of long-term benefit. However many studies have failed to account for the heterogeneity of COPD lung disease, particularly with regard to the presence of bronchiectasis. Analysis of short-term studies suggests that there may be a cohort of patients who will benefit from prescription of a sputum clearance regimen. This review proposes a physiological rationale for the use of ACTs in COPD, taking into consideration the presence of bronchiectasis, the amount of sputum produced, the degree of airflow obstruction and the presence of decreased lung elastic recoil. The selection of an optimal ACT for individuals with COPD should take into account its effects on lung vloumes, expiratory flow and dynamic airway compression. Care should be taken to avoid airway collapse during forced expirations in patients with reduced lung recoil pressure; positive expiratory pressure therapy or autogenic drainage may prove effective in this patient group. The acceptability of ACTs to patients should also be considered, especially where long-term adherence is required. Future research should focus on more appropriate matching of the physiological effects of individual ACTs to the pathophysiology of lung disease in COPD.