Chronic Obstructive Pulmonary Disease Grade Research Articles

Effect of telephone and SMS Follow-up on quality of life and fatigue in patients with chronic obstructive pulmonary disease: A three-month RCT-follow-up study

Background and aims: To compare the effect of telephone and SMS follow-up of an empowerment program on quality of life (QOL) and fatigue in patients with chronic obstructive pulmonary disease (COPD). Methods: Non-blind randomized clinical trial (RCT). Two hospitals and clinics in Shahrekord. 105 patients with COPD grades 2 and 3 were recruited and, after implementation in empowerment sessions, were randomly assigned to three control, telephone follow-up, and SMS follow-up groups (35 individuals in each group). First, the pulmonary empowerment program was designed and implemented for six 90-minute sessions. Then, the patients were randomly assigned to three groups using a random number table. Follow-up ended after three months, and the control group received routine care. Data were collected in the first and sixth sessions of the empowerment program and at the end of the follow-up period using demographic (QOL) and fatigue questionnaires. Eventually, they were analyzed through correlation coefficient and analysis of variance (ANOVA) tests in the SPSS software (Version 20). Results: The study results on QOL showed that the groups were not statistically significantly different before and after the empowerment (respectively: P=0.29 and P=0.56). However, the groups showed statistically significant differences at the end of the quarterly follow-up period (P<0.001). ANOVA results for fatigue indicated no statistically significant differences between the groups before and after the empowerment (respectively: P=0.10 and P=0.32). The results of this study showed that follow-up by SMS and telephone improved patients’ QOL, and SMS had a greater effect in this regard. Conclusion: The findings suggest using follow-up as an essential approach to empowerment using various technology methods and designing more comprehensive empowerment to reduce patient fatigue.

Study of blood eosinophils and plasma periostin as biomarkers for response of COPD patients to ICS/LABA treatment

BackgroundEosinophilic airway inflammation has been detected in up to 40% of chronic obstructive pulmonary disease (COPD) patients during stable periods of the disease, and increased sputum eosinophil count was associated with better lung function, more future exacerbations, and symptoms that responded better to treatment with inhaled and oral corticosteroids.The aim of this work was to investigate the relationship of blood eosinophils and plasma periostin with lung function changes related to ICS and long-acting beta2-agonist combination treatment in stable COPD patients for 3 months.MethodsThis prospective experimental study was carried out on 50 COPD patients with post-bronchodilator FEV1/FVC ratio < 70%. Patients collected from outpatient clinics of Chest Department Tanta University Hospitals, Tanta Chest Hospital, and Mansoura Chest Hospital from February 2020 to February 2022. Patients were subjected to complete history taking, and clinical examinations including general and local examinations and laboratory investigations (complete blood count to assess eosinophilic count, arterial blood gases, and plasma periostin) and spirometry were done for all patients pre- and post-treatment. All patients received 3 months of treatment with a fixed dose of combined inhalers of ICS and LABA, and then they were classified into FEV1 responder and FEV1 non-responder according to improvement in FEV1 at least 12% and 200 mL from baseline of 3 months of combined treatment with ICS/LABA.ResultsBlood eosinophil count had a significant positive correlation with smoking index (pack/year), negative correlations with FEV1% of predicted, FEV1 actual value (L), and FEV1/FVC ratio. Plasma periostin concentration had significant positive correlation with blood eosinophil count, COPD grade, and FVC actual value (L) and significant negative correlations with FEV1% of predicted, FEV1 actual value (L), and FEV1/FVC. Cutoff values of blood eosinophil count > 265 cell/µL, plasma periostin concentration > 15.747 ng/mL, and FEV1% < 40.5% were associated with posttreatment FEV1 response.ConclusionsCOPD patients with poor lung functions regarding FEV1/FVC ratio, FEV1 actual value (L), and FEV1% of predicted as well as high blood eosinophil count and high plasma periostin concentration are predicted to have FEV1 response with fixed-dose ICS/LABA combination treatment.

Annexin A5 derived from lung alleviates brain damage after ischemic stroke

Ischemic stroke is a leading cause of disability and death worldwide. It is now accepted that brain interacts bidirectionally with other organs after brain diseases. However, factors that might mediate crosstalk between brain and other organs are still less reported. Here we reported that plasma level of Annexin A5, not Annexin A1 or A2, was upregulated in stroke patients when compared to controls. In normal mice, the highest levels of Annexin A5 were detected in lung tissues compared with other major organs and lowest level in brain. Moreover, Annexin A5 was increased in brain and decreased in lung after stroke in mice when compared to sham group. Fluorescence in situ hybridization (FISH) assay indicated that Annexin A5 could penetrate the blood–brain barrier (BBB). Treatment with Annexin A5 recombinant protein reduced the infarct volumes and improved neurological function after stroke in mice, while administration of anti-Annexin A5 increased the infarct sizes and aggravated neurological function. In a proof-of-concept analysis, patients with both ischemic stroke and lung diseases had a lower plasma Annexin A5 level than those with only ischemic stroke. Furthermore, Annexin A5 level in bronchoalveolar lavage fluid (BALF) was lower in patients with severe chronic obstructive pulmonary disease (COPD) when compared with those at a less severe grade of COPD, and level of Annexin A5 was positively correlated with forced expiratory volume in 1 s (FEV1) and PaO2. Our results suggest that Annexin A5 could alleviate infarct area and improve general neurological performance post cerebral ischemia. Increased Annexin A5 may derive from lung tissue and permeate across BBB to provide a neuroprotective function. Therefore, Annexin A5 may potentially serve as a therapeutic candidate for defending against IS-induced brain injury.

Prognostic Value of CD14 Expression in Peripheral Blood Mononuclear Cell Membrane in Patients with Severe COPD Complicated with Pulmonary Infection.

Severe chronic obstructive pulmonary disease (COPD) patients with pulmonary infections face higher morbidity and mortality. To investigate mononuclear cell membrane CD14 as a prognostic marker for their outcome. A total of 311 participants were included: 122 in the coinfection group, 127 in the severe COPD group, and 62 in the control group. The patients in the coinfection group were categorized into survival (n=106) and death (n=16) groups based on hospitalization prognosis. The CD14%, CD14MFI, and CD14IND values were compared between the groups. Death risk factors were assessed by COPD grading, FEV1% pred, FEV1/FVC, CD14%, CD14MFI, and CD14IND. Correlations between CD14 parameters and mortality, COPD grade, FEV1%pred, and FEV1/FVC were analyzed. The critical value for CD14IND to predict patient death was determined and survival rates were compared between the high and the low-risk groups. CD14% values were significantly lower in the COPD and co-infection groups than in the control groups (p<0.05). The survival group showed a steady increase in mCD14 expression, while the death group showed fluctuating low levels. Low value of CD14% was identified as a risk factor for death and correlated with mortality and COPD severity (p<0.001). CD14IND≤74.36 predicted death with 91.22% sensitivity and 95.51% specificity. The high-risk group had a significantly lower 30-day survival rate (68.42%) compared with the low-risk group (95.24%) (log-rank χ2=10.067, p=0.002). The CD14 parameters of mononuclear cell membranes prove to be promising markers for predicting prognosis and death in severe COPD patients with lung infection.

Effect of physiotherapy intervention (chest physiotherapy) on chronic obstructive pulmonary disease (COPD) in a 72-year-old patient: a case report

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive obstruction of the airflow that is often fatal if not appropriately managed. COPD is prevalent among older adults worldwide, and diagnosis is often missed in comprehensive geriatric assessment. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, the management approach includes pharmacological, non-pharmacological treatment, and surgery in severe cases. This case report determines the effect of physiotherapy intervention (a non-pharmacological approach) on geriatric patients with COPD.Case presentationThis is a case report of a 72-year-old male patient who presented as an outpatient with COPD grade D (GOLD guidelines) with a forced expiratory volume in 1 s (FEV1) value of 52%. The patient had 3 acute episodes of exacerbation but was stabilized. The first episode of shortness of breath was 2 years ago while taking a brisk walk at home. He was immediately rushed to the hospital where he was placed on hospital admission and managed for about 2 weeks and was discharged but to continue physiotherapy on an outpatient basis due to the proximity of his home from the hospital. On physical examination with chronic obstructive pulmonary assessment test (CAT), 6-min walk test (6MWT), and functional assessment with the Barthel Index, the patient was easily fatigued and had challenges in performing basic activities of daily living (BADL). The patient had 72 sessions of physiotherapy interventions for 6 months which consisted of education, purse-lip breathing, active cycle of breathing technique, incentive spirometry exercise, aerobic exercise, and home exercise aimed at improving activity tolerance, encouraging diaphragmatic breathing, enhancing sputum clearance, improving function, and overall quality of life.Improvement was initially gradual and then significant in about the third month of the intervention. Activity tolerance improved with a 6MWT of 2 laps. The patient developed more confidence in performing ADL and leaving his home despite his lung condition as seen in CAT scores.ConclusionsOverall, results from this study showed that COPD is a treatable condition that is amenable to physiotherapy interventions in a multidisciplinary approach.

AI-Based Model Design for Prediction of COPD Grade from Chest X-Ray Images: A Model Proposal (COPD-GradeNet)

Chronic Obstructive Pulmonary Disease (COPD) ranks high among the leading causes of death, particularly in middle- and low-income countries. Early diagnosis of COPD is challenging, with limited diagnostic methods currently available. In this study, a artificial intelligence model named COPD-GradeNet is proposed to predict COPD grades from radiographic images. However, the model has not yet been tested on a dataset. Obtaining a dataset including spirometric test results and chest X-ray images for COPD is a challenging process. Once the proposed model is tested on an appropriate dataset, its ability to predict COPD grades can be evaluated and implemented. This study may guide future research and clinical applications, emphasizing the potential of artificial intelligence-based approaches in the diagnosis of COPD.

Relationship between burden of cerebral small vessel disease on imaging and cognitive impairment of COPD patients

ObjectiveThis study aims to explore the relationship between the burden of cerebral small vessel disease (CSVD) on imaging and cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD). MethodsThe study included 118 COPD patients admitted to Changxing People’s Hospital between July 2020 and July 2023. All patients received a 1.5 T MRI of the brain and pulmonary function tests. A cognitive function assessment was conducted via the Montreal Cognitive Assessment (MoCA) scale, and patients were divided into two groups. The relationship between the MoCA and CSVD burden score was analyzed by Pearson correlation, and to identify risk factors, multiple logistic regression analysis was performed. ResultsThe study showed a negative correlation between the MoCA and CSVD burden score in COPD patients (r=-0.479, P<0.001). Multiple logistic regression analysis found that age (OR=2.264, 95 % CI: 1.426–3.596, P<0.001), COPD grade (OR=3.139, 95 % CI: 2.012–4.898, P<0.001), as well as CSVD burden score (OR=5.336, 95 % CI: 1.191–23.900, P<0.001) were the independent risk factors for CI in COPD patients (P<0.05). ConclusionWhen screening for cognitive impairment in COPD patients, the CSVD burden score can be used in conjunction with cognitive assessment scales to make judgments.

Computed tomography (CT) quantitative assessment of single lobe emphysema correlates with chronic obstructive pulmonary disease (COPD) severity: a cross-sectional study with retrospective data collection.

In the past, many researchers have studied the correlation between quantitative parameters of computed tomography (CT) and parameters of pulmonary function test (PFT) in patients with chronic obstructive pulmonary disease (COPD) with good results. Most of these studies have focused on the whole-lung level. In this study, we analyzed the biphasic CT lung volume parameters and the percentage of emphysema volume in different lobes of the lungs of patients with different grades of COPD and assessed their relationship with different lung function indices. We retrospectively collected patients who underwent PFTs at The First Affiliated Hospital of Guangzhou Medical University from 1 July 2019 to 27 January 2020, and underwent chest respiratory dual-phase CT scans within 1 week, including 112 non-COPD patients and 297 COPD patients. We quantified the biphasic CT lung volume parameters and the percentage of emphysema volume in different lobes using a pulmonary image analysis tool. One-way analysis of variance (ANOVA) and Kruskal-Wallis H method were used to compare the quantitative CT parameters of each lung lobe in different groups. The correlation between quantitative CT parameters of different lung lobes and lung function indices was assessed using multiple linear regression. Among the 3 biphasic CT lung volume parameters, only volume change/inspiratory lung volume (∆LV/LVin) in the non-COPD control, mildly to moderately severe, and severe to extremely severe groups had statistical differences in each lobe level (all P<0.05). Correlation was significant between LVin and different lung function indices and between low attenuation areas percent below the threshold of -950 in the inspiratory phase [low attenuation area below -950 in the inspiratory phase (%LAA-950in)] and lung function indices in the left lower lobe (all P<0.05). There was statistically significant correlation between expiratory lung volume and ∆LV/LVin and lung function indices in the right lower lung (all P≤0.001). In the remaining lobes, LVin, expiratory lung volume, ∆LV/LVin, and %LAA-950in correlated with only some of the lung function indices. The percentage of emphysema volume did not differ between lobes in the non-COPD control and severe to extremely severe COPD populations. LVin and %LAA-950in in the left upper lobe, expiratory lung volume and ∆LV/LVin in the right lower lobe were more reflective of the changes in lung function indices of the patients, whereas the correlation of the 3 biphasic CT lung volume parameters and the percentage of emphysema volume in the upper lobes of both lungs and the right middle lung with lung function indices was unclear.

Efficacy and safety of pembrolizumab as first-line treatment for advanced non-small cell lung cancer complicated with chronic obstructive pulmonary disease: protocol for a prospective, single-arm, single-center, phase II clinical trial.

The first-line standard treatment option for patients with NSCLC complicated with Chronic obstructive pulmonary disease (COPD) is still unclear and relies on the treatment option of NSCLC alone. To date, a limited number of retrospective studies have explored the efficacy and safety of immunotherapy in patients with NSCLC complicated with COPD. We therefore designed this study to further explore the efficacy and safety of first-line immunotherapy in patients with NSCLC complicated with COPD. This study was designed as a single-armed, single-center, prospective, phase II clinical study. It will include 30 advanced (stage IV) NSCLC combined with COPD primary treatment subjects. Each subject's diagnosis will be confirmed by clinical, radiographic, pathologic, and pulmonary function evaluation. A fixed dose of 200 mg pembrolizumab will be administered by intravenous infusion on day1 every 3 weeks (Q3W). The management of stable and acute exacerbations of COPD include home oxygen therapy, and the use of conventional medications are also administered. Imaging evaluation will be performed every 6 weeks for 6 months from the first pembrolizumab dose and approximately every 12 weeks thereafter until disease progression or early withdrawal. COPD status will be evaluated every 3 months by pulmonary function, GOLD grading, mMRC score, CAT score, ABCD grouping, and AECOPD severity. The primary outcome is Progression-free survival. The secondary outcome measures include objective response rate, overall survival, rate of acute exacerbations of COPD (times/year), lung function, mMRC score, CAT score, impact of treatment on patient's health-related quality of life, antibiotic use (including duration and classes), and adverse events associated with immune checkpoint inhibitors. Exploratory endpoint is to explore the association between COPD grade and the degree of immune cell (CD4+ T lymphocytes and CD8+ T lymphocytes) infiltration, as well as the association between COPD grade and the efficacy of immune checkpoint inhibitors. ClinicalTrials.gov, identifier NCT05578222.

Associations of body mass index and oxygen saturation with chronic obstructive pulmonary disease grade in patients.

we aimed to investigate the associations of body mass index (BMI) and oxygen saturation with chronic obstructive pulmonary disease (COPD) grade in COPD patients. the clinical data of 105 COPD patients admitted to and treated in our hospital during January 2021 and January 2022 were acquired for a retrospective analysis, and grade 1 group [n = 15, subjects presenting forced expiratory volume in one second (FEV1) ≥ 80 % of the predicted value], grade 2 group (n = 32, those with FEV1 ≥ 50 % and < 80 % of the predicted value), grade 3 group (n = 34, those with FEV1 ≥ 30 % and < 50 % of the predicted value), and grade 4 group (n = 24, those with FEV1 < 30 % of the predicted value or with FEV1 < 50 % of the predicted value and concomitant respiratory failure) were set up based on COPD grade. the BMI of the 105 patients was 20.39 ± 3.31 kg/m² on average, and it showed differences of statistical significance regarding the subjects with varying COPD grades (p < 0.05). The oxygen saturation was 89.98 ± 4.04 on average in the 105 patients, and it also displayed statistically significant differences among patients with different grades of COPD (p < 0.05). According to pairwise comparison, grade 1 group exhibited the highest oxygen saturation, followed by grade 2, 3, and 4 groups in turn (p < 0.05). Both BMI and oxygen saturation had negative correlations with COPD grade (p < 0.05). In COPD patients, COPD grade is negatively correlated with BMI and oxygen saturation.

Incidence of heart failure with preserved ejection fraction (HFpEF) in COPD patients during acute exacerbation in Ain Shams University Hospitals

Abstract Background Cardiovascular comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and are associated with a worse prognosis, and the presence of COPD has a negative impact on cardiovascular disease and heart failure The available estimates of the prevalence of diastolic dysfunction vary widely, probably due to different diagnostic approaches and small sample sizes. Aim Perspective analytical comparison of ECHO findings (done or will be done) within a 3-month interval of acute exacerbations. Outcomes Previous or prospective comparison of EF with current findings at the examination station or grade of diastolic dysfunction, Left atrial dimension, E/A, E/e′ ratios, and slope findings among the 3-month follow-up period perceptively (incidence) in the following two groups, namely Group A: the patient group with prior EHCO findings showing no heart failure with preserved ejection fraction (HFpEF) before enrollment but develop HFpEF during acute exacerbations. Group B: the patient group with ECHO findings of HFpEF following acute exacerbations within 3 months or thereafter. Patients and methods Patients with confirmed COPD by spirometry were evaluated by echocardiography initially as baseline and 3 months after for the assessment of diastolic dysfunction grades. Those patients are divided into two groups as inpatients and outpatients. Results An observational cross-sectional study including 36 COPD diagnosed patients: 33 males and 3 females with a mean age of (58.5 ± 7.7 years). The patients were divided into 17 inpatients and 19 outpatients. These patients were divided according to COPD severity into groups A, B, and C (outpatient group) and D (inpatient group) as 7, 9, 3, and 17 patients, respectively. Comparisons between baseline echocardiographic findings and after 3 months’ follow-up were processed. There were significant increases of tricuspid regurgitation (TR) and diastolic dysfunction in COPD group D compared with the other group at baseline and in the same group after a 3-month follow-up and significant correlation with COPD grade D cases and high-grade diastolic dysfunction. There were significant decrease of TR and decrease of diastolic dysfunction grades after a 3-month follow-up of acute exacerbations compared with baseline. It was found that spirometry parameters were nonstatistically different at baseline concerning the existing diverse diastolic dysfunction. However, only a significant negativecorrelation was found between baseline left atrial dimension and forced expiratory volume in first second/percentage of forced vital capacity. Conclusion COPD severity influences the HFpEF with tendency to increase diastolic dysfunction and TR, which could be improved with COPD management. Assessment of left ventricular diastolic dysfunction is pivotal.

Increased neutrophil-lymphocyte ratio in patients with COPD: case-control study

Chronic obstructive pulmonary disease (COPD) is one of the major causes of chronic morbidity and mortality and one of the major public health problems worldwide that affects millions of people all over the world. It is characterized by persistent airflow obstruction associated with enhanced inflammation in the airways and the lungs in response to noxious particles or gases. The main objective of this study is to investigate the neutrophil-lymphocyte ratio in patients with COPD as a case-control study. Between November 01, 2022, and February 28, 2023, patients were admitted to Al Hussain Teaching Hospital in Al Muthanna Governorate, Department of Medicine. The study included 51 patients with an approved diagnosis of COPD the mean age was 51.5 years, and 51 patients as control with other diseases mean age was 51.3 years). The subjects in all groups were 32 male and 19 female. Complete blood count (CBC) was measured from blood samples taken from patients. In the present study 51 COPD cases and 51 controls. No significant difference was observed between COPD cases and controls regarding age (p = 0.092); the average age of COPD cases was 51.5 years. No significant differences were observed between COPD cases and controls regarding gender (p = 0.085). At baseline, 21.0%, 40.3%, 25.7%, and 13% were diagnosed as COPD grade 1, 2, 3, and 4, respectively based on the (GOLD) classification. Baseline NLR significantly increased with the severity of COPD grade (1.3 vs. 2.7 vs. 2.2 vs. 2.9), p = 0.002). The cutoff for neutrophil-to-lymphocyte ratio, CRP, WBC, and ESR were 3.28, 2.32, 1.22, and 4.21 respectively. It has 85% sensitivity for detection of COPD exacerbation. and 89% specificity (AUC 0.798, p = 0.001). In conclusion, Blood NLR is a simple, inexpensive, widely available index that has been intensively evaluated in recent years in several clinical applications and in various diseases, including COPD.

Correlation of Body Mass Index and Oxygen Saturation in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Center in Nepal: A Cross-Sectional Study.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. COPD is associated with clinically relevant pulmonary and extrapulmonary manifestations, including hypoxemia and weight loss. The correlation of body mass index (BMI) and oxygen saturation (SpO2) with COPD grades may provide a useful additional marker for understanding and managing the disease. The aim of the study was to study the correlation of BMI and oxygen saturation with COPD in patients presenting to a tertiary care center in Nepal. A descriptive cross-sectional study was conducted among 145 COPD patients visiting the Department of Medicine in Shree Birendra Hospital between 1 March 2019 and 28 February 2020. A non-probability purposive sampling method was used and data were analyzed using SPSS version 21. A p-value of <0.05 was considered significant. Out of 145 COPD patients, 58 (40%) were underweight, 53 (36.55%) were of normal weight, 20 (13.79%) were overweight, and 14 (9.6%) were obese. The number of underweight patients was highest in COPD grade 4 and lowest in COPD grade 1. The proportion of subjects with underweight BMI and hypoxia increased with COPD severity, and both were statistically significant (p-values <0.01). Our study shows that BMI and oxygen saturation have an inverse association with COPD severity. The correlation of BMI and oxygen saturation with COPD grade could provide a supplementary marker of disease severity, which could be useful in the understanding of the disease process and subsequent management of COPD.

Can CT-Based Arterial and Venous Morphological Markers of Chronic Obstructive Pulmonary Disease Explain Pulmonary Vascular Remodeling?

We analyzed changes in quantitative pulmonary artery and vein parameters to investigate pulmonary vascular remodeling characteristics in chronic obstructive pulmonary disease (COPD) patients. This retrospective study recruited healthy volunteers and COPD patients. Participants undergoing standard-of-care pulmonary function testing (PFT) and computed tomography (CT) evaluations were classified into five groups: normal and Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4. Artery and vein analyses (volumes, numbers, densities, and fractions) were performed using artificial intelligence. Among 139 subjects (136 men; mean age, 64years±8 [SD]) with GOLD grade 1 (n=13), grade 2 (n=49), grade 3 (n=42), grade 4 (n=17) and control subjects (n=18) enrolled, differences in arterial volumes (BV5-10, BV10+, pulmonary arterial volume) and venous densities (BV5 density, BV10+ density, pulmonary venous density, pulmonary venous branch density) among control and GOLD grades 1-4 were statistically significant (P<.05). Higher pulmonary arterial volumes and lower number were observed with more advanced COPD. The number and volumes of pulmonary veins were lower in GOLD grades 2 and 3 than in GOLD grade 1 but higher in GOLD grade 4 than in GOLD grade 3. The numbers and volumes of pulmonary arteries and veins showed varying positive correlations (γ=0.18-0.96, P<.05). Pulmonary vascular densities were mildly to moderately correlated with PFT results (γ=0.236-0.495, P<.05) and were moderately negatively correlated with the emphysema percentage (γ=-0.591 to -0.315, P<.05). Patients with COPD exhibited pulmonary vascular remodeling, which occurred in the arteries at the early grade of COPD and in the veins at the late grade. CT-based quantitative analysis of pulmonary vasculature may become an imaging marker for early diagnosis and assessment of COPD severity.

Osteopontin in patients with chronic obstructive pulmonary disease and coronary heart disease

Background: Osteopontin is a protein expressed by various cell types, such as endothelial and epithelial cells, osteoclasts, hepatocytes, smooth muscle cells, activated macrophages, and T-cells. Cardiomyocytes, heart fibroblasts, endothelial cells of coronary arteries express osteopontin in response to hypoxia, inflammation, toxic factors, mechanical strain, and other stimuli.&#x0D; Aim: To study osteopontin levels in patients with chronic obstructive pulmonary disease (COPD) depending on concomitant ischemic heart disease (IHD), to identify an association between osteopontin levels with severity of COPD and functional lung test parameters.&#x0D; Materials and methods: This open-label, prospective, non-randomized comparative study with parallel groups included 99 patients with COPD grades AD by GOLD, with 49 of them having confirmed comorbid stable IHD. Serum osteopontin levels were measured by immunoenzyme assay (Human Osteopontin Platinum ELISA; Bender MedSystems, Austria). The data is given as medians and quartiles (Me [Q1; Q3]). In all patients we performed functional lung tests with bronchodilation, a 6-minute walking test, BODE index assessment, as well as CAT and mMRC questionnaires were used.&#x0D; Results: In the patients with COPD and IHD, the osteopontin levels were higher than in the patients with COPD without IHD (85.55 [46.86; 110.91] vs 55.43 [20.76; 89.64] ng/mL, respectively; p = 0.027). Osteopontin levels in the patients with all COPD grades and IHD were higher than in those without IHD, but the difference was significant only in GOLD grade B patients (91.28 [73.04; 110.91] vs 37.81 [22.54; 82.95] ng/mL, respectively, р = 0.028) and GOLD grade D patients (80.79 [34.65; 111.11] vs 37.46 [13.32; 109.5] ng/mL, respectively, р = 0.027).&#x0D; Conclusion: A significant increase of osteopontin levels in comorbid patients with COPD and stable IHD found in this study has not been previously known. It is necessary to perform further studies to identify a threshold level of osteopontin predictive of the risk of COPD exacerbations or cardiovascular events. This would help to improve medical treatment of COPD patients, as well as to identify the risk groups.

Prevalence and Associated Factors of Osteoporosis in Chronic Obstructive Pulmonary Disease Patients

Background: Chronic Obstructive Pulmonary Disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease and a major cause of morbidity and mortality globally. In this study, we evaluated the prevalence and associated factors of osteopenia and osteoporosis in COPD patients.&#x0D; Methods:A total of 91 COPD patients were recruited from October 2017 and December 2018. Lung function test, CAT score, 6-minutes’ walk test, Modified Medical Research Council (MMRC) dyspnea score and body mass index, air flow obstruction, dyspnea, and exercise capacity (BODE index) were evaluated in the patients. Bone Mineral Density (BMD) measurements of the femoral neck, total femur (including femoral neck, trochanter, and intertrochanter area), and lumbar spine were conducted using dual-energy X-ray absorptiometry. A T-score which was 2.5 standard deviations (SDs) below the average value was indicative of osteoporosis, in accordance with the World Health Organization criteria. We excluded COPD patients who had asthma, malignancy, and fracture.&#x0D; Results: There were 86 males (mean age ± SD: 66.49±9.40 years) and 5 females (mean age±SD: 65.40±12.40 years). Among all the patients, 46 (51.1 %) patients had osteopenia and 36 (40 %) had osteoporosis. Comparing COPD grades showed grade 2 was a more prevalent grade (41.1 %). There was no statistically association between femoral neck T score (mean±SD: -2.21±0.89) and COPD grade (P= 0.58), while lumber spine T score (mean±SD: -2.13±1.11) was statistically decreased with increasing severity of COPD (p= 0.02).&#x0D; Conclusion: The results of our study demonstrated that osteoporosis is common among COPD patients. Moreover, we found significant correlations between BMI, walking test, FEV1, MMRC, and BODE index.

Cleavage of Occludin by Cigarette Smoke-Elicited Cathepsin S Increases Permeability of Lung Epithelial Cells.

Chronic obstructive pulmonary disease (COPD) is an irreversible disease mainly caused by smoking. COPD is characterized by emphysema and chronic bronchitis associated with enhanced epithelial permeability. Lung biopsies from smokers revealed a decreased expression level of occludin, which is a protein involved in the cohesion of epithelial tight junctions. Moreover, the occludin level correlated negatively with smoking history (pack-years), COPD grades, and cathepsin S (CatS) activity. Thus, we examined whether CatS could participate in the modulation of the integrity of human lung epithelial barriers. Cigarette smoke extract (CSE) triggered the upregulation of CatS by THP-1 macrophages through the mTOR/TFEB signaling pathway. In a co-culture model, following the exposure of macrophages to CSE, an enhanced level of permeability of lung epithelial (16HBE and NHBE) cells towards FITC-Dextran was observed, which was associated with a decrease in occludin level. Similar results were obtained using 16HBE and NHBE cells cultured at the air-liquid interface. The treatment of THP-1 macrophages by CatS siRNAs or by a pharmacological inhibitor restored the barrier function of epithelial cells, suggesting that cigarette smoke-elicited CatS induced an alteration of epithelial integrity via the proteolytic injury of occludin. Alongside its noteworthy resistance to oxidative stress induced by cigarette smoke oxidants and its deleterious elastin-degrading potency, CatS may also have a detrimental effect on the barrier function of epithelial cells through the cleavage of occludin. The obtained data emphasize the emerging role of CatS in smoking-related lung diseases and strengthen the relevance of targeting CatS in the treatment of emphysema and COPD.

Association Between Chronic Obstructive Pulmonary Disease and All-Cause Mortality After Aortic Valve Replacement for Aortic Stenosis

Chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS) are the most common diseases in which age plays a major role in the increase of their prevalence and when they co-exist, the outcomes prognosis worsens significantly. The aim of the present study was to evaluate the association between pulmonary functional parameters and all-cause mortality after aortic valve replacement (transcatheter or surgical). A total of 400 patients with severe AS and preoperative pulmonary functional test were retrospectively analyzed. Echocardiography and pulmonary functional parameters before aortic valve replacement were collected. COPD severity was defined according to criteria from the Society of Thoracic Surgeons. COPD was present in 128 patients (32%) with severe AS. Patients without COPD had smaller left ventricular (LV) mass and LV end-systolic volume and better LV function than the group with COPD. During a median follow-up of 32months, 92 patients (23%) died. The survival rates were significantly lower in patients with moderate and severe COPD (log-rank p=0.003). In the multivariable Cox regression analysis, any grade of COPD was associated with an approximately 2-fold increased risk of all-cause mortality (hazard ratio 1.933; 95% confidence interval 1.166 to 3.204; p=0.011 for mild COPD and hazard ratio 2.028; 95% confidence interval 1.154 to 3.564; p=0.014 for moderate or severe COPD). In addition to other clinical factors, any grade of COPD was associated with 2-fold increased risk of all-cause mortality.

Quantification of Emphysema in Chronic Obstructive Pulmonary Disease by Volumetric Computed Tomography of Lung

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with small airway inflammation and emphysema. Emphysema is permanent enlargement of air spaces distal to terminal bronchioles accompanied by destruction of alveolar walls. These morphological changes can be studied on quantitative computed tomography (CT). Thirty-four patients diagnosed to have COPD as per Global Initiative for Chronic Obstructive Lung Disease guidelines underwent chest CT using full inspiration with low dose radiation protocol. Pulmo-CT software was used to analyse the scans. The primary aim was to quantify emphysema and emphysema clusters and secondary aim was to assess correlation between percentage emphysema and lung function. Their mean [standard deviation (SD)] age was 66.4 (7.0) years; 11 (32.4%) were current smokers (median pack years 45.5). Their mean (SD) forced expiratory volume in the first second (FEV1%) was 55.6 (17.6), mean (SD) %emphysema was 26.8 (11.1), mean (SD) lung density was -848.35 (29.5) Hounsfield units (HU), median (interquartile range) %cluster class 4 emphysema was 22.4 (13.5-32.6). There was no significant difference in %low attenuation volume (%LAV) in current and exsmokers (p=0.4); across various severity grades of COPD (p=0.15). Further, no significant correlation was observed between %emphysema and post-bronchodilator FEV1%. Volumetric CT can detect and quantify emphysema. Majority of emphysema clusters in COPD are >25mm. The %emphysema does not correlate to the severity of the disease. Quantitative CT is a good objective method to study emphysema and can be used to phenotype COPD radiologically.

Associations of Medication Regimen Complexity with COPD Medication Adherence and Control.

IntroductionMedication adherence is often low among people with chronic obstructive pulmonary disease (COPD) and medication regimen complexity may be a contributing factor. In this study, we sought to examine the role of medication regimen complexity in COPD medication adherence among patients with multimorbidity.MethodsWe performed cross-sectional analysis of data on COPD patients in primary care and pulmonary practices in New York City and Chicago (n=400). Regimen complexity was represented by the medication regimen complexity index (MRCI) and simple medication count. Adherence was measured by self-report and inhaler dose counts. Disease control measures included the COPD severity score (COPDSS) and the Medical Research Council (MRC) severity index.ResultsMean age of study participants was 69 years, 66% had MRC grades 4 or 5, and 45% had low medication adherence. MRCI scores did not differ significantly between those with and without adequate medication adherence. Patients with higher MRCI scores were more likely to have severe COPD (OR 5.00, 95% CI 1.46–17.1, p=0.01) and dyspnea grades 3 or 4 (OR 2.27, 95% CI 1.03–5.03, p=0.04). Significant associations of medication count with COPD severity were also observed.DiscussionThese findings demonstrate that among patients with COPD and comorbid hypertension and diabetes, higher medication regimen complexity is associated with worse COPD control but not with COPD medication adherence.