Classification Of COPD Research Articles

An Update on the Global Initiative for Chronic Obstructive Lung Disease 2017 Guidelines With a Focus on Classification and Management of Stable COPD.

The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines offer important changes to the assessment and management of stable COPD of importance to practitioners, respiratory therapists, pharmacists, and nurses who care for patients with COPD. Therapies are now chosen based on the burden of symptoms and the history of COPD exacerbations, and inhaler regimens are modifiable based on continual clinical reassessment. Although identifying the degree of airway obstruction remains important for informing the clinical status of the patient with COPD, FEV1 is no longer used to direct the therapeutic approach. Therapies and modes of inhaled medication delivery for each GOLD grouping have been modified and reflect the need for reevaluation of patient symptoms and COPD exacerbation history as an indicator to add or withdraw therapies. As the knowledge of this important disease continues to expand, exacerbation and symptom prevention in patients with stable COPD will remain as an important target of COPD therapies and research. Novel drug combinations and delivery devices are sure to positively affect the practitioner's approach to patients with stable COPD. The new 2017 GOLD guidelines represent a step toward personalized care of the patient with COPD.

The revised GOLD 2017 COPD categorization in relation to comorbidities

Abstract Introduction The COPD classification proposed by the Global Initiative for Obstructive Lung Disease was recently revised, and the A to D grouping is now based on symptoms and exacerbations only. Potential associations with comorbidities have not been assessed so far. Thus the aim of the present study was to determine the relationship between the revised (2017) GOLD groups A-D and major comorbidities. Methods We used baseline data from the COPD cohort COSYCONET. Comorbidities were identified from patient self-reports and disease-specific medication: gastrointestinal disorders, asthma, sleep apnea, hyperuricemia, hyperlipidemia, diabetes, osteoporosis, mental disorders, heart failure, hypertension, coronary artery disease. The A-D groups were based on either the COPD Assessment Test or the modified Medical Research Council scale. Exacerbations were also categorized as per GOLD recommendations. Results Data from 2228 patients were analyzed. Using GOLD group A as a reference, group D was associated with nearly all comorbidities, followed by group B and C. When groups A-D were dichotomized as AC vs. BD (symptoms) and AB vs. CD (exacerbations), all comorbidities correlated with symptoms and/or exacerbations. This was true for both mMRC- and CAT-based categorizations. Conclusions These findings suggest that the recently modified GOLD categorization is clinically relevant beyond being purely an assessment of symptoms and exacerbations. As the A-D groups correlated with the risk of important comorbidities, with some differences in terms of the correlation with symptoms and exacerbations, the findings underline the importance of identifying comorbidities in COPD, particularly in non-responders to therapy who have high symptoms and/or exacerbation rates.

The revised GOLD 2017 COPD categorization in relation to comorbidities.

The COPD classification proposed by the Global Initiative for Obstructive Lung Disease was recently revised, and the A to D grouping is now based on symptoms and exacerbations only. Potential associations with comorbidities have not been assessed so far. Thus the aim of the present study was to determine the relationship between the revised (2017) GOLD groups A-D and major comorbidities. We used baseline data from the COPD cohort COSYCONET. Comorbidities were identified from patient self-reports and disease-specific medication: gastrointestinal disorders, asthma, sleep apnea, hyperuricemia, hyperlipidemia, diabetes, osteoporosis, mental disorders, heart failure, hypertension, coronary artery disease. The A-D groups were based on either the COPD Assessment Test or the modified Medical Research Council scale. Exacerbations were also categorized as per GOLD recommendations. Data from 2228 patients were analyzed. Using GOLD group A as a reference, group D was associated with nearly all comorbidities, followed by group B and C. When groups A-D were dichotomized as AC vs. BD (symptoms) and AB vs. CD (exacerbations), all comorbidities correlated with symptoms and/or exacerbations. This was true for both mMRC- and CAT-based categorizations. These findings suggest that the recently modified GOLD categorization is clinically relevant beyond being purely an assessment of symptoms and exacerbations. As the A-D groups correlated with the risk of important comorbidities, with some differences in terms of the correlation with symptoms and exacerbations, the findings underline the importance of identifying comorbidities in COPD, particularly in non-responders to therapy who have high symptoms and/or exacerbation rates.

Body weight and mortality in COPD: focus on the obesity paradox.

Level V: Narrative Review.

Association of Serum Uric Acid Levels and Outcomes of Patients With COPD: A Prospective Cohort Study

SESSION TITLE: COPD 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: This study hopes to determine the association between elevated serum uric acid level and outcomes of patients with chronic obstructive pulmonary disease as to mortality within 30 days, length of hospital stay, ICU admission and non-invasive ventilation use. Also, results of this study would help as clinicians on whether high serum uric acid levels should be aggressively treated by pharmacologic means for the prevention of COPD exacerbation. METHODS: All diagnosed COPD in exacerbation who met the selection criteria were included in the study. Serum uric acid level determination was done as part of the routine blood tests obtained during admission. Decisions on treatment and discharge was made by the pulmonology fellow involved in this study, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The principal investigator recorded the length of hospital stay, length of ICU stay and the need for non-invasive ventilation (NIV). Patient was followed-up until discharge and through a telephone conversation 30 days after discharge to determine mortality. RESULTS: A total of 159 patients were included in the study. Fifty-seven (57%) were males and forty-three (43%) were females. The mean age of the study population was 69 years old. Majority of the patients (91%) were smoker, with mean average pack-year-smoker of 25.57±9.03 pack-year. One hundred forty four patients (91%) has no PTB treatment. Majority of the patients (66%) were hypertensive with GOLD Classification C (55%). Patients with high serum uric acid levels required more prolonged hospitalization with a mean average hospital stay of 16.38±6.58 days and presented higher rates of 30-day mortality which was statistically significant (p value 0.005). Moreover, patients with high serum uric acid levels required non-invasive ventilation (NIV) which were both statistically significant (p value <0.001). CONCLUSIONS: In this study we have shown that serum uric acid levels on admission for COPD in exacerbation are associated with increased 30-day mortality and increased risk of non-invasive ventilation use. CLINICAL IMPLICATIONS: In this study we have shown that serum uric acid levels on admission for COPD in exacerbation were an independent predictor of 30-day mortality. Additionally, patients with increased uric acid levels more often required use of non-invasive ventilation. Morover, serum uric acid levels were higher in patients with more severe airflow limitation (COPD classification D). Our results, combined with the fact that serum uric acid is a widely and rapidly available, easy to interpret, low-cost biomarker, suggests a possible role for serum uric acid in the identification of COPD patients at increased risk of adverse outcomes that may need early intensive management. DISCLOSURE: The following authors have nothing to disclose: John Ray Galamay No Product/Research Disclosure Information

Recommendations for the pharmacological treatment of COPD: questions and answers.

ABSTRACTThe treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.

Using Big Data to Assess Prescribing Patterns in Greece: The Case of Chronic Obstructive Pulmonary Disease.

IntroductionChronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients.MethodsThis is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees’ age, gender, percentage of co-payment and social security unique number. Statistical analysis included descriptive statistics and logistic regression.Results174,357 patients received medicines for COPD during the study period. Patients were almost equally distributed between male and female, and age above 55 years was strongly correlated with COPD. Most patients received a long-acting beta agonist plus inhaled corticosteroid combination (LABA +ICS), followed by long-acting muscarinic agonist (LAMA). 63% patients belonging in the 35–54 age received LABA+ICS. LAMA was prescribed more frequently among males and was strongly correlated with COPD.ConclusionThe study provides big data analysis of Greek COPD prescribing patterns. It highlights the need for appropriate COPD classification in primary care illustrating the role of electronic prescribing in ensuring appropriate prescribing. Moreover, it indicates possible gender differences in treatment response or disease severity, and the impact of statutory co-payments on prescribing.

Derivation and validation of clinical phenotypes for COPD: a systematic review.

BackgroundThe traditional classification of COPD, which relies solely on spirometry, fails to account for the complexity and heterogeneity of the disease. Phenotyping is a method that attempts to derive a single or combination of disease attributes that are associated with clinically meaningful outcomes. Deriving phenotypes entails the use of cluster analyses, and helps individualize patient management by identifying groups of individuals with similar characteristics. We aimed to systematically review the literature for studies that had derived such phenotypes using unsupervised methods.MethodsTwo independent reviewers systematically searched multiple databases for studies that performed validated statistical analyses, free of definitive pre-determined hypotheses, to derive phenotypes among patients with COPD. Data were extracted independently.Results9156 citations were retrieved, of which, 8 studies were included. The number of subjects ranged from 213 to 1543. Most studies appeared to be biased: patients were more likely males, with severe disease, and recruited in tertiary care settings. Statistical methods used to derive phenotypes varied by study. The number of phenotypes identified ranged from 2 to 5. Two phenotypes, with poor longitudinal health outcomes, were common across multiple studies: young patients with severe respiratory disease, few cardiovascular co-morbidities, poor nutritional status and poor health status, and a phenotype of older patients with moderate respiratory disease, obesity, cardiovascular and metabolic co-morbidities.ConclusionsThe recognition that two phenotypes of COPD were often reported may have clinical implications for altering the course of the disease. This review also provided important information on limitations of phenotype studies in COPD and the need for improvement in future studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-015-0208-4) contains supplementary material, which is available to authorized users.

Hospitalization Due to Co-Morbid Conditions is the Main Cost Driver Among Subjects With COPD–A Report From the Population-Based OLIN COPD Study

Background: Co-morbidities are common in COPD; however, there is a lack of population-based studies evaluating the health economic impact of co-morbid diseases for subjects with COPD. The main objective of this study was to estimate annual direct health-care costs, divided into costs due to non-respiratory and respiratory conditions, comparing subjects with and without COPD. Methods: Subjects with and without COPD derived from population-based cohorts in northern Sweden have been invited to annual examinations involving spirometry and structured interviews since 2005. This paper is based on data from 1472 subjects examined in 2006. COPD classification was based on spirometry. Results: Mean annual costs for both respiratory and non-respiratory conditions were significantly higher for subjects with COPD than non-COPD subjects, in total USD 2139 vs. USD 1276 (p = 0.026), and COPD remained significantly associated with higher costs also after adjustment for common confounders as age, smoking habits, BMI and sex. The mean total cost increased with COPD disease severity and was higher for all severity stages (GOLD) than for non-COPD subjects. Hospitalization due to non-respiratory diseases was the main cost driver in COPD, after adjustment for common confounders amounting to about 46% (unadjusted 62%) of the total COPD-costs. Conclusions: Costs were higher for COPD than non-COPD. In COPD, costs for co-morbid conditions were higher than those for respiratory conditions, and hospitalization due to co-morbid conditions was the main cost driver also when adjusted for common confounders.

Des définitions aux phénotypes de BPCO

COPD is characterized by incompletely reversible airflow limitation (FEV1/FVC < 70%). The historical classification of COPD, which was based on the severity of airflow limitation assessed by the level of FEV1, did not take into account the various aspects of COPD patients. At comparable levels of FEV1, COPD patients show marked heterogeneity in clinical manifestations (dyspnea, rates of exacerbations, exercise capacity, and quality of life), leading to the proposal of the current COPD classification based not only on FEV1, but also on symptoms (dyspnea or quality of life) and history of exacerbations. Limitations of this novel classification of COPD include its relative complexity and the absence of age and comorbidities. Recent identification of clinical COPD phenotypes (i.e., subgroups of COPD patients sharing not only clinical characteristics, but also natural history and/response to therapy) could result in progresses in the pathophysiology of the disease, in the development of specific biomarkers, and could facilitate evaluation of drugs in clinical trials. The development of simple algorithms, using easily available clinical data, will allow identification of phenotypes in clinical practice and may lead to individualized therapies.

Comparison of GOLD classification and modified BODE index as staging systems of COPD

ObjectiveTo compare GOLD classification of COPD versus the modified BODE index as staging systems of COPD. BackgroundChronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation. The degree of airflow limitation was poorly predictive of dyspnea and quality of life. The BODE index was the first multidimensional assessment system for COPD. Cardiopulmonary exercise testing (CPET) is the most comprehensive, and correlates best with the symptoms of COPD. In this regard, two novel mBODE indices were constructed by replacing 6MWT with V̇O2 peak expressed either as the percentage of predicted values (mBODE%) or as the absolute values in ml/min/kg (mBODE). MethodsThis study included 28 patients with a wide range of severities of COPD. Cardiopulmonary exercise test and pulmonary functions were done. GOLD spirometric staging and combined assessment grouping were calculated then compared with the two mBODE indices. ResultsModerate agreement between the GOLD combined assessment grouping and GOLD spirometric staging systems and between mBODE and mBODE% in stratifying severity of COPD patients was observed. Evaluation of mBODE index as predictors of severity of COPD using GOLD spirometric staging as a diagnostic predictor of COPD revealed that mBODE index was 100% sensitive. However, 59.1% and 72.2% specificity were found for mBODE V̇O2ml/min/kg and mBODE V̇O2% predicted, respectively. ConclusionMultidimensional staging system taking into account the exercise pulmonary function tests is better than unidimensional systems based on the resting pulmonary function tests only. Therefore this suggests the need for integration of the novel multidimensional approach in the diagnostic guidelines of COPD.

P129 Skeletal muscle weakness, not arterial stiffness, differs according to GOLD group in COPD

IntroductionIn the GOLD 2011 COPD classification, patients in Group D are considered to be at highest risk of mortality, due to airflow limitation and exacerbations and also to be most...

A New Approach to Classification of Disease Severity and Progression of COPD

Most current classification schemes for COPD use lung function as the primary way of classifying disease severity and monitoring disease progression. This approach misses important components of the disease process. We evaluated existing data to develop a classification scheme for COPD using measures beyond lung function, including respiratory symptoms, exacerbation history, quality-of-life assessment, comorbidity, and BMI. We then applied this scheme to data from the Lung Health Study, calculating a score for study subjects in year 1 and year 5 of the study, along with the difference between year 1 and year 5. We developed a four-point scale ranging from 1.00 (mild) to 4.00 (very severe). In year 1 of the study, the mean COPD score was 1.76; in year 5 it was 1.82. The mean difference from year 1 to year 5 was an increase (worsening) of 0.06 and a range from -1.0 to 1.6. The COPD score at year 1, year 5, and the difference between these scores were all predictive of mortality at follow-up. For example, the 14.0% of subjects whose score improved by at least 0.25 between year 1 and 5 had decreased mortality compared with those with stable scores (between -0.25 and 0.25; hazard ratio, 0.6; 95% CI, 0.4, 0.8). A COPD severity score that includes components in addition to lung function and allows for both improvement and worsening of disease may provide additional guidance to COPD classification, management, and prognosis.

Panorama da doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease is on the rise in the contemporary World. It is a preventable disease and rarely attributed to genetic deficiency. Several factors are responsible for this increased incidence, such as active and passive smoking, environmental pollution and occupational and delay of implementation of effective public policies for its prevention. The prevalence in the World varies greatly from 0.2% to 37%, this wide range is explained in part by cultural characteristics of countries that emitting international epidemiological reports, methods used to establish the diagnosis and classification of COPD. The prevalence and incidence has being higher in men, especially in the elderly above 75 years of age. Mortality has also increased in the last 30 to 40 years, 3-111 deaths per 100,000 populations. In Brazil, in 2011, the National Cancer Institute reported that 15.1% of the population of 190,732,694 million people in Brazil is smokers and about 15% of this population could develop the COPD. Thus, in absolute numbers, 4.32 million people have COPD Brazilian, only related to smoking. COPD is the fourth leading cause of death in the United States, representing 5% of all deaths, with an increase of 8% of the total number of deaths from 116,494 to 126,005 in the period from 2000 to 2005. If the analysis is extended from 1980 to 2000, the percentage of mortality was increased in 67%. This chapter aims to demonstrate the importance of the epidemic, which is characterized by late onset and deterioration of lung function very slow, but that may be controllable by harsher measures of tobacco control in Brazil.

Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores: a cross-sectional analyses

BackgroundThe GOLD 2011 document proposed a new classification system for COPD combining symptom assessment by COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores, and exacerbation risk. We postulated that classification of COPD would be different by the symptom scale; CAT vs mMRC.MethodsOutpatients with COPD were enrolled from January to June in 2012. The patients were categorized into A, B, C, and D according to the GOLD 2011; patients were categorized twice with mMRC and CAT score for symptom assessment, respectively. Additionally, correlations between mMRC scores and each item of CAT scores were analyzed.ResultsClassification of 257 patients using the CAT score vs mMRC scale was as follows. By using CAT score, 60 (23.3%) patients were assigned to group A, 55 (21.4%) to group B, 21 (8.2%) to group C, and 121 (47.1%) to group D. On the basis of the mMRC scale, 97 (37.7%) patients were assigned to group A, 18 (7.0%) to group B, 62 (24.1%) to group C, and 80 (31.1%) to group D. The kappa of agreement for the GOLD groups classified by CAT and mMRC was 0.510. The mMRC score displayed a wide range of correlation with each CAT item (r = 0.290 for sputum item to r = 0.731 for dyspnea item, p < 0.001).ConclusionsThe classification of COPD produced by the mMRC or CAT score was not identical. Care should be taken when stratifying COPD patients with one symptom scale versus another according to the GOLD 2011 document.

Subphenotypes of Mild-to-Moderate COPD by Factor and Cluster Analysis of Pulmonary Function, CT Imaging and Breathomics in a Population-Based Survey

Introduction: Classification of COPD is currently based on the presence and severity of airways obstruction. However, this may not fully reflect the phenotypic heterogeneity of COPD in the (ex-) smoking community. We hypothesized that factor analysis followed by cluster analysis of functional, clinical, radiological and exhaled breath metabolomic features identifies subphenotypes of COPD in a community-based population of heavy (ex-) smokers. Methods: Adults between 50–75 years with a smoking history of at least 15 pack-years derived from a random population-based survey as part of the NELSON study underwent detailed assessment of pulmonary function, chest CT scanning, questionnaires and exhaled breath molecular profiling using an electronic nose. Factor and cluster analyses were performed on the subgroup of subjects fulfilling the GOLD criteria for COPD (post-BD FEV1/FVC < 0.70). Results: Three hundred subjects were recruited, of which 157 fulfilled the criteria for COPD and were included in the factor and cluster analysis. Four clusters were identified: cluster 1 (n = 35; 22%): mild COPD, limited symptoms and good quality of life. Cluster 2 (n = 48; 31%): low lung function, combined emphysema and chronic bronchitis and a distinct breath molecular profile. Cluster 3 (n = 60; 38%): emphysema predominant COPD with preserved lung function. Cluster 4 (n = 14; 9%): highly symptomatic COPD with mildly impaired lung function. In a leave-one-out validation analysis an accuracy of 97.4% was reached. Conclusions: This unbiased taxonomy for mild to moderate COPD reinforces clusters found in previous studies and thereby allows better phenotyping of COPD in the general (ex-) smoking population.

Flow-Volume Parameters in COPD Related to Extended Measurements of Lung Volume, Diffusion, and Resistance.

Classification of COPD into different GOLD stages is based on forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) but has shown to be of limited value. The aim of the study was to relate spirometry values to more advanced measures of lung function in COPD patients compared to healthy smokers. The lung function of 65 COPD patients and 34 healthy smokers was investigated using flow-volume spirometry, body plethysmography, single breath helium dilution with CO-diffusion, and impulse oscillometry. All lung function parameters, measured by body plethysmography, CO-diffusion, and impulse oscillometry, were increasingly affected through increasing GOLD stage but did not correlate with FEV1 within any GOLD stage. In contrast, they correlated fairly well with FVC%p, FEV1/FVC, and inspiratory capacity. Residual volume (RV) measured by body plethysmography increased through GOLD stages, while RV measured by helium dilution decreased. The difference between these RV provided valuable additional information and correlated with most other lung function parameters measured by body plethysmography and CO-diffusion. Airway resistance measured by body plethysmography and impulse oscillometry correlated within COPD stages. Different lung function parameters are of importance in COPD, and a thorough patient characterization is important to understand the disease.

CT technique could improve COPD classification

CT technique could improve COPD classification

Pre- and post-bronchodilator lung function as predictors of mortality in the Lung Health Study

BackgroundChronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of post-bronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality.MethodsWe limited our analysis to subjects who were of black or white race, on whom we had complete data, and who participated at either the 1 year or the 5 year follow-up visit. We classified subjects based on their baseline lung function, according to COPD Classification criteria using both pre- and post-bronchodilator lung function. We conducted a survival analysis and logistic regression predicting death and controlling for age, sex, race, treatment group, smoking status, and measures of lung function (either pre- or post-bronchodilator. We calculated hazard ratios (HR) with 95% confidence intervals (CI) and also calculated area under the curve for the logistic regression models.ResultsBy year 15 of the study, 721 of the original 5,887 study subjects had died. In the year 1 sample survival models, a higher FEV1 % predicted lower mortality in both the pre-bronchodilator (HR 0.87, 95% CI 0.81, 0.94 per 10% increase) and post-bronchodilator (HR 0.84, 95% CI 0.77, 0.90) models. The area under the curve for the respective models was 69.2% and 69.4%. Similarly, using categories, when compared to people with "normal" lung function, subjects with Stage 3 or 4 disease had similar mortality in both the pre- (HR 1.51, 95% CI 0.75, 3.03) and post-bronchodilator (HR 1.45, 95% CI 0.41, 5.15) models. In the year 5 sample, when a larger proportion of subjects had Stage 3 or 4 disease (6.4% in the pre-bronchodilator group), mortality was significantly increased in both the pre- (HR 2.68, 95% CI 1.51, 4.75) and post-bronchodilator (HR 2.46, 95% CI 1.63, 3.73) models.ConclusionsBoth pre- and post-bronchodilator lung function predicted mortality in this analysis with a similar degree of accuracy. Post-bronchodilator lung function may not be needed in population studies that predict long-term outcomes.

Right Ventricular Function Assessment Using Speckle Tracking Method In Chronic Obstructive Pulmonary Disease

Background In daily practice, evaluation of RV useful in patients with COPD because of its affect prognostic value. Invasive and non-invasive imaging in the evaluation of RV function has several limitations because RV geometry. Speckle tracking is a modality of echocardiography. Speckle tracking can determine strain of myocardium. When compared with strain derived Tissue Doppler, Speckle tracking strain independent of angle so that the measurement of strain to be more reliable. And so far RV assessment with Speckle tracking is still a less investigated. Is there any difference between RV function on echocardiography examination using Speckle tracking methods with varying degrees of COPD? Methods Cross-sectional study conducted in 59 people with COPD who had performed spirometry examination for the classification of severity COPD. Then the patient performed an echocardiography examination using Speckle tracking methods. Then Data will analyze by testing the difference between Speckle tracking and the severity of COPD and also between Speckle tracking and pulmonary hypertension Result There COPD subjects 10.2% and 37.3% mild COPD subject was, with men more than women. There were no significant differences between the severity of COPD and right ventricular function using Speckle tracking method. There is a global strain value was higher in non-pulmonary hypertension subjects when compared with pulmonary hypertension subjects but the difference was not significant (p = 0.09) Conclusion There were no significant differences between the severity of COPD and RV function using Speckle tracking methods. (J Kardiol Indones. 2010;31:156-64) Keywords: COPD, 2D Speckle Tracking,Global Strain, Pulmonary hypertension