Chronic Obstructive Pulmonary Disease Grade Research Articles

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.

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.

Features of Changes of Vascular Age and Cardiovascular Risk Level in Patients with Arterial Hypertension and Comorbid Chronic Obstructive Pulmonary Disease

The objective: Evaluate changes in vascular age and cardiovascular risk level with reference to the severity of chronic obstructive pulmonary disease (COPD) in patients with arterial hypertension (AH) and COPD. Materials and methods. The study included 120 patients with hypertension stage II, grade 2, 3 and 3 in combination with COPD grade II–III and clinical groups A, B, C, D (group 1), 30 patients with AH without COPD (group 2), 30 patients with COPD without AH (group 3) and 30 healthy individuals (control group) representative by age and sex. Results. In the group of patients with AH and comorbid COPD, more than 50% of patients corresponded to moderate CVR, more than a third to high CVR, and a very high risk was found in isolated cases. The analysis of the obtained data revealed a significant increase in vascular age relative to chronological in groups 1, 2 and 3, but in control group there was only a tendency to ahead of vascular age (p&gt;0.05). The diagnostic value of indicators for determining the exacerbation of COPD in patients with hypertension and comorbid COPD was determined using ROC analysis, which showed the presence of prognostic value for the following factors: age (AUC 0.50; CI 0.41–0.59), pack-years (AUC 0.60; CI0.51–0.69), duration of COPD (AUC 0.60; CI 0.51–0.69). Conclusion. The GP of the family medicine must evaluate the CVR on the SCORE scale as a screening technique. In the presence of comorbid COPD, the factor of disease duration becomes significant, which is an additional risk factor and affects the severity of CVR. Regardless of the comorbid pathology of AH and COPD, patients have a discrepancy between vascular and chronological age, which is a predictor of cardiovascular disease.

Access to, use, knowledge, and preferences for information technology and technical equipment among people with chronic obstructive pulmonary disease (COPD) in Sweden. A cross-sectional survey study

BackgroundThe use of information technology can make pulmonary rehabilitation interventions in people with chronic obstructive pulmonary disease (COPD) more flexible and thereby has the potential to reach a larger proportion of the population. However, the success of using information technology in pulmonary rehabilitation is dependent on the end-user’s competence in information technology and access to the Internet. The aim was to describe the access to, and the use, knowledge, and preferences of information technology and technical equipment among people with COPD.MethodsTelephone interviews were conducted using a standardised questionnaire on information technology and technical devises addressing the household, access to and usage of the Internet, contact with authorities, e-commerce, security, the workplace, digital competence, and disabilities. Questions were also posed regarding participants’ views on a future eHealth tool for COPD, appropriate content, and the potential likelihood for them to use an eHealth tool for exercise training.ResultsIn total 137 persons agreed to participate, 17 dropped out resulting in 120 included participants (response rate 88%). The participants (86 women) were aged 51 to 92 years (mean: 72.5), and all severity grades of COPD according to GOLD A-D were represented. Over 90% had access to the Internet. Smartphones were used by 81%, and over 90% used apps. Participants had high knowledge of how to use the Internet, 91% had used the Internet during the last 3 months, 85% almost every day. The most common requests for a future eHealth tool for COPD were evidence-based and trustworthy information on COPD, (including medication, exercise training, inhalation and breathing techniques), communication (chat) with others and with health carers. Access to individually adjusted exercise training, and support, (motivation via prompts, chat rooms, digital information board) was also desired.ConclusionsThe present study showed that people with COPD in Sweden have high access and ability to use the Internet and information technology. They are frequent users and most of them take part in the digital society, even to a higher extent than the general population. The results show that the use of an eHealth tool could be a suitable strategy for people with COPD.

Video-assisted thoracoscopic surgery for primary lung cancer resections in patients with moderate to severe chronic obstructive pulmonary diseases.

BackgroundLung cancer patients with chronic obstructive pulmonary disease (COPD) are considered a high-risk population to receive radical surgical treatment due to the high incidence of cardiopulmonary complications. The aim of this study was to evaluate the clinical factors associated with postoperative complications in primary lung cancer patients with moderate to extremely severe grades of COPD.MethodsFrom December 2015 to June 2020, 138 patients with moderate to extremely severe COPD who underwent video-assisted thoracoscopic surgery (VATS) lung cancer resection (lobectomy or sublobar resection) were retrospectively reviewed. Patients’ postoperative complications were collected from clinical records. Clinical factors (such as COPD severity or surgical approaches, etc.) were evaluated to investigate the association with postoperative complications.ResultsOf the 138 patients included in the study, the mean age was 67 (63–74) years, the mean preoperative forced expiratory volume in one second (FEV1) was 1.33±0.39 L, the mean FEV1% was 51.23% (41.43–60.00%). 33% patients (46/138) had postoperative complications, and no mortality occurred. Univariate analysis revealed that incidence of overall complications (OCs) and respiratory complications (RCs) was markedly higher in extremely severe COPD patients compared to moderate (OCs, P=0.033; RCs, P=0.050) and severe (OCs, P=0.015; RCs, P=0.008) COPD patients, respectively. Multivariate analysis showed that COPD grade was an independent risk factor of RCs (P=0.024). Furthermore, the grades of COPD (moderate, P=0.029; severe, P=0.028; extremely severe, P=0.019) and the surgical procedure (lobectomy or sublobar resection, P=0.043) were independent risk factors for atelectasis, which was the most common postoperative complication.ConclusionsThe aggravation of COPD was accompanied by an increase in the incidence of respiratory system complications postoperatively, especially atelectasis. For patients with moderate to extremely severe grades of COPD, careful perioperative evaluation should be performed to identify the indicators that influence the surgical choice between lobectomy and sublobar resection.

Evaluation of Cardiac function in COPD patients and correlation with disease severity: A cross sectional study

Background: Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, non-invasive portable, and almost accurate method to evaluate the right ventricle function, right ventricular filling pressure, tricuspid regurgitation, left ventricular function, and valvular functions. Early diagnosis and intervention for cardiac comorbidities would reduce mortalities in COPD.&#x0D; Aims and Objectives: This study was undertaken to evaluate cardiac function with echocardiography in COPD patients which may further help to assess the prognosis and assist in identifying the individuals likely to suffer increase morbidity and mortality.&#x0D; Materials and Methods: A hospital based cross sectional study in which 100 patients over a period of 1 year were selected according to inclusion and exclusion criteria and cardiac comorbidities were observed in COPD patients by 2D echocardiography. All patients were studied on the basis of following variables- Demographic evaluation, Clinical evaluation, Pulmonary function test, echocardiography.&#x0D; Results: Distribution of the study population showed that a large number of COPD patients developed cardiac complication - Right and left ventricular dysfunction and pulmonary arterial hypertension especially in higher grades of COPD patients which can contribute to increased morbidity and mortality.&#x0D; Conclusion: Cardiac dysfunction is quite common in COPD patients, especially in the higher grades of COPD. So, we recommend that echocardiography should be included in routine evaluations of all COPD patients for early diagnosis and management of cardiac complications.

Construct validity of the brief physical activity assessment tool for clinical use in COPD.

Low physical activity (PA) levels are associated with poor health-related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice. This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD and explored differences in age, sex and COPD grades. After linguistic adaptation of the tool to Portuguese, 110 patients (66.4±9.6yrs, 72.7% male, FEV1 =59.3±25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous- and moderate-intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA=1952-5724 counts-per-min [CPM]); vigorous PA, VPA=5725-∞CPM; moderate-to-vigorous PA, MVPA=1952-∞CPM; daily steps), through: Spearman's correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data. The BPAAT identified 73.6% patients as "insufficiently active" and 26.4% as "sufficiently active". The BPAAT was weakly to moderately correlated with accelerometry (0.394≤ρ≤0.435, P<0.05), except for VPA (P=0.440). This was also observed in age (<65/≥65yrs), COPD grades (GOLD 1-2/3-4) and in male patients (0.363≤ρ≤0.518, P<0.05 except for VPA). No significant correlations were found in female patients (P>0.05). Agreement was fair to moderate (0.36≤κ≤0.43; 73.6%≤%agreement≤74.5%; 0.50≤sensitivity≤0.52; 0.84≤specificity≤0.91, 0.55≤PPV≤0.79, 0.72≤NPV≤0.82). The BPAAT may be useful to screen patients' PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients.

Health-related quality of life in patients with chronic obstructive pulmonary disease: A hospital-based study.

Background & objectives:Chronic obstructive pulmonary disease (COPD) adversely affects various functional and structural domains of the lungs, in addition to having an array of extra-pulmonary effects which affect overall well-being of a patient. This study was aimed at measuring the health-related quality of life (HRQOL) in COPD patients and relating the severity of disease and other factors with the degree of impairment of HRQOL.Methods:This cross-sectional study was conducted on 100 individuals with established COPD aged 45 yr or above. COPD severity was graded based on the Global Initiative for Obstructive Lung Disease (GOLD) staging system. Pulmonary function test was carried out as per the American Thoracic Society and European Respiratory Society task force standardised lung function testing guidelines. The quality of life was measured using the COPD-specific version of the St. George's Respiratory Questionnaire (SGRQ). The three component scores (activity, impact and symptoms) and the total score were compared across the various categories of age, gender and COPD grades. Using multivariable linear regression analysis, the relationship between COPD grades and various component scores, adjusting for age and gender, was determined.Results:The mean total SGRQ Classification score was found to be 48.5±17.1. There was a significant increase in the symptom, activity and impact component scores and the total scores of the participants with worsening of COPD grade. The activity, impact component scores and total score showed an increasing trend with age. However, the values of these three scores were lower in participants in the age group of 56-65 yr in comparison to those in the 45-55 yr age group. There was a significant increase in the symptom component score with increasing age across the study population. The difference in the various scores between males and females was not significant.Interpretation & conclusions:HRQOL is impaired in patients with COPD, and it deteriorates with increasing severity of the disease. The onset of COPD at a younger age has a much more significant deterioration of HRQOL, due to the early onset of symptoms and complications. These findings call for better early care and integration of pulmonary rehabilitation programmes into current health policies.

Plasma Levels of Fetuin B and Fibrinogen in Chronic Obstructive Pulmonary Disease: A Preliminary Cross-sectional Study

Introduction: Recent exploratory proteomics study reported increased blood levels of Fetuin B (FETUB) in Chronic Obstructive Pulmonary Disease (COPD). Growing body of evidence demonstrates fibrinogen not only as acute phase reactant but also possesses features advocating as biomarker of COPD. Aim: To determine the blood levels of FETUB and fibrinogen independently as well as in combination COPD and among severity of COPD. Materials and Methods: A single-centred cross-sectional study of eight months duration was conducted during May to December 2017. A total of 76 blood samples (38 COPD patients and 38 controls) were recruited. Based on distribution, parametric and non parametric statistical tools were used. Analysis of co-variance and multiple multivariate linear regression models were utilised to assess the influence of clinical data on FETUB. Steel-Dwass-Critchlow- Fligner method was employed for multiple pairwise comparisons. Receiver Operating Characteristic (ROC) curve were generated to compute cut-off of FETUB, fibrinogen and their combination. Results: The median age of subjects were 57 years with an IQR of 50-66 years for controls whereas 58 years (IQR 50-65 years) for COPD subjects. In comparison to controls, a significant increase in blood levels of both FETUB and fibrinogen in COPD and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages of COPD was prominent. Among COPD grades, differences of FETUB levels were significant in GOLD I vs II and GOLD IV vs I, II and III whereas fibrinogen levels in GOLD III from GOLD IV. FETUB showed independent correlation with Forced Expiratory Volume (FEV) 1% pred and severity of COPD. A moderate improvement in combined (FETUB+fibrinogen) analysis of control vs COPD was noticed. Conclusion: The present study demonstrates significant increase in blood levels of FETUB in COPD and among the severity of COPD in comparison to fibrinogen. Hence, FETUB can be a more promising probable inflammatory biomarker in COPD.

Extra pulmonary boosting in chronic obstructive pulmonary disease: leverage of piracetam as an adjunctive therapy on respiratory and neuropsychiatric functions in patients with chronic obstructive pulmonary disease

Background Promotion of central control of respiration might contribute in minimization of chronic obstructive lung disease disability. Objectives Our study was done to evaluate the effect of oral supplementation of piracetam tablets in low dose (400 mg twice daily) versus high dose (1200 mg twice daily) in patients with chronic obstructive pulmonary disease grade IV with type II respiratory failure, on respiratory parameters (spirometric, respiratory muscle strength, and diaphragmatic echographic measurements; velocity and excursion), in addition to neuropsychiatric parameters (cognitive functions and brain changes with MRI). Patients and methods This randomized controlled study was conducted on 126 patients who were subjected to oral piracetam and classified into group A (42 patients received 800 mg daily for 3 months), group B (44 patients received 2400 mg daily for 3 months) for 3 months, and group C (40 patients) as a control group. Pulmonary evaluation, by spirometry and respiratory muscle study by Pimax, Pemax, Sniff test, and diaphragmatic echography, was conducted in addition to neuropsychiatric evaluation by Alzheimer disease 8 cognitive score assessment and brain MRI. Results Total pulmonary fractional functional progress of piracetam was higher in group B (28.12%) than group A (23.27%) and the control group (5.68%). On the contrary, neuropsychiatric fractional functional progress was higher in group B (29.11%) than group A (15.7%), and lastly, the control group ( Conclusion Oral piracetam demonstrated enhanced spirometric parameters and improved cognition with low dose, but with high dose, it enhanced both spirometric and respiratory muscle strength and cognitive parameters with brain MRI and apparent diffusion coefficient changes.

COPD burden on sexual well-being

BackgroundSexual function is often affected in patients suffering from chronic diseases especially chronic obstructive pulmonary disease (COPD). However, the effect of COPD on sexual satisfaction is underappreciated in clinical practice. The aim of this study is to evaluate the impact of COPD on patient’s sexuality and the explanatory variables of sexual dissatisfaction.MethodsQuestionnaires were emailed to participants and they submitted their responses on the Santé Respiratoire France website. Data about sexual well-being (Arizona Sexual Experience Scale, ASEX), Quality of life (VQ11), anxiety, depression (Hospitalized anxiety and depression, HAD) and self-declared COPD grade were collected.ResultsSeven hundred and fifty one subjects were included and were characterized as follows: women—51%, mean age—61 years, in a couple—62% and 70%—retired. Every grade of COPD was represented. Out of 751 participants, 301 participants (40%) had no sexual activity and 450 (60%) had sexual activity. From the 450 participants, 60% needed to change their sexual life because of their disease (rhythm, frequency and position). Subjects often used medications to improve sexual performance (43% used short-acting bronchodilator and 13% -specific erectile dysfunction drugs). ASEX questionnaire confirmed patients’ dissatisfaction (diminution of sexual appetite for 68% and sexual desire for 60%) because of breathlessness and fatigue. Eighty one percent of the responders had an altered quality of life (VQ11 mean score 35) and frequent suspected anxiety or depression (HAD mean score 10.8). Ninety percent declared that sexual dysfunction had never been discussed by their doctors, while 36% of patients would have preferred to undergo a specialized consultation.ConclusionSexual dysfunction is frequent among COPD patients and leads to an altered well-being, however being a cultural taboo, it remains frequently neglected. Sexual guidance should be a part of patient’s consultations improve quality of sexual life.