COPD Comorbidities Research Articles

PRO19 CHARACTERISTICS AND HEALTH OUTCOMES OF PEDIATRIC X-LINKED ADRENOLEUKODYSTROPHY PATIENTS IN THE UNITED STATES

Adrenoleukodystrophy (ALD) is a rare debilitating neurodegenerative genetic disorder and is characterized by multiple phenotypes. The most severe phenotypes are the childhood cerebral forms, which can initially display as hyperactivity and can progress to a vegetative state or death. The objective of this study was to characterize pediatric ALD patient inpatient stays and identify differences between age cohorts. The 2016 Kids Inpatient Database (KID) was utilized to identify discharges containing a primary or secondary ICD-10-CM code for ALD (‘E7152’). Patients were divided into age cohorts: child (ages 0-10) and adolescent (ages 11-21). Demographic information was compiled in aggregate, while clinical and economic characteristics were compared between age cohorts using t-tests and chi-squared tests. In total, 161 ALD discharges were identified (52% child, 48% adolescent). The mean age was 11.29 (SD: 4.59), and the majority of patients were male (98.1%). The demographic breakdown revealed an over-representation of Black and Hispanic patients in the sample (White: 27.3%, Black: 22.4%, Hispanic: 24.8%, and Other: 25.5%). The most common primary payer was Medicare (57.8%) followed by Medicaid (37.3%). When stratified by age, adolescents had significantly higher Charlson Comorbidity Index (CCI) scores (0.71 vs. 0.27; p=0.0005) and higher rates of comorbid COPD (21.79% vs. 7.23%; p=0.008) and paralysis (20.51% vs. 8.43%; p=0.026). There were no significant differences between mean length of stay or total charges between age cohorts. While the population was divided by age, there are still important unknowns within the comparison groups. The majority of patients were coded as “X-linked ALD, unspecified type”, which may have resulted in multiple ALD phenotypes being included in the adolescent cohort, such as adolescent patients formerly diagnosed with childhood cerebral ALD. This lack of specificity in coding could potentially lead to ranges of severity within each group, which could be addressed with better coding or clinical detail.

Factors Predicting Treatment Outcome in Hospitalized Patients with Acute Exacerbation of COPD (AECOPD)

Objective: The aim of our study was to study the COPD phenotypes, comorbidities and factors predicting treatment outcomes in patients with acute exacerbations of COPD admitted in hospital. Methodology: A retrospective study of fifty patients with acute exacerbation of COPD admitted in a tertiary care hospital during July 2015 to August 2016 was done. Results: It was observed that the mean duration of hospital stay was 8 ± 7 days with 44% of the patient discharged in less than 7 days (short stay) and 56% of patients in more than 7 days (long stay). The factors favouring longer stay in hospital include history of current smoking, hypoxia and CO2 retention while patients on active COPD treatment and cessation of smoking leads to shorter hospital stay. Conclusion: For patients with acute exacerbations of COPD requiring hospitalization, history of current smoking with hypoxia and CO2 retention are associated with longer stay in hospital while patients on active COPD treatment and cessation of smoking leads to shorter hospital stay.

EFFECT OF COMBINATION PURSED LIP BREATHING AND GUIDED IMAGERY MUSIC ON PEAK EXPIRATORY FLOW PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

ABSTRACTBackground: Peak expiratory flow influenced by several things, such as anxiety, a psychological factor that is becoming a major comorbidities of COPD and affect the occurrence of exacerbations, increase respiration rate, duration expiratory time, and hyperinflation. This study aimed to determine the effect of combination pursed lip breathing and guided imagery music to increase value of peak expiratory flow in patients with COPD. Methods: The study was quasi-experimental design with pretest posttest with control group approach, respondents of this study is 46 patients with COPD with sampling technique, simple random sampling. Results: Pursed lip breathing increase peak expiratory flow values by the significant of p value = 0.000 (p <0.05). The combination of pursed lip breathing and guided imagery music increase peak expiratory flow values by the significant of p value = 0.000 (p <0.05). COPD patients who received a combination of pursed lip breathing and guided imagery music increased peak expiratory flow value higher than the pursed lip breathing without combination with significant of p value = 0.000 (p <0.05).Conclusion:The combination of pursed lip breathing and guided imagery music proved to have an effect on increasing the value of peak expiratory flow higher than pursed lip breathing without combination.

Impact of reduced pulmonary function in the Japanese general population: Lessons from the Yamagata-Takahata study.

Regional epidemiological studies for respiratory diseases have been rarely performed in Japan, because spirometry is not regularly conducted in the standard annual health checks. The Yamagata-Takahata Study is an epidemiological study utilizing regional characteristics based on the 21st Century Centers of Excellence (COE) Program and the Global COE Program. Spirometric examination and other specific measurements via blood sampling were performed for the study participants in annual health check-ups held in Takahata, a town in Yamagata Prefecture. The Yamagata-Takahata Study revealed the impact of cigarette smoking habit on pulmonary function, the impact of reduced pulmonary function on mortality, and the situation regarding COPD comorbidities in Japan. Additionally, the study identified biomarkers of decline in pulmonary function among active smokers, and the risk factors for respiratory mortality in Japan. In this review, we summarize the findings of the Yamagata-Takahata study regarding the association between lower pulmonary function and the clinical characteristics of a Japanese general population.

A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population.

BackgroundPatients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis.MethodsProspective analysis performed in a specific healthcare area. Data were obtained from several sources within the “data warehouse of the Galician Healthcare Service” using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0.ResultsA total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA2DS2-VASc (4.21 vs 3.46; P=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P<0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P=0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality.ConclusionAF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.

COPD and Cardiovascular Disease

COPD is one of the major public health problems in people aged 40 years or above. It is currently the 4th leading cause of death in the world and projected to be the 3rd leading cause of death by 2020. COPD and cardiac comorbidities are frequently associated. They share common risk factors, pathophysiological processes, signs and symptoms, and act synergistically as negative prognostic factors. Cardiac disease includes a broad spectrum of entities with distinct pathophysiology, treatment and prognosis. From an epidemiological point of view, patients with COPD are particularly vulnerable to cardiac disease. Indeed, mortality due to cardiac disease in patients with moderate COPD is higher than mortality related to respiratory failure. Guidelines reinforce that the control of comorbidities in COPD has a clear benefit over the potential risk associated with the majority of the drugs utilized. On the other hand, the true survival benefits of aggressive treatment of cardiac disease and COPD in patients with both conditions have still not been clarified. Given their relevance in terms of prevalence and prognosis, we will focus in this paper on the management of COPD patients with ischemic coronary disease, heart failure and dysrhythmia.

Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival

BackgroundChronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. MethodsWe studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. ResultsAfter adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06–1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53–0.83; p ≤.001). ConclusionsOur data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.

Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both?

COPD is a chronic lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Furthermore, COPD is often characterized by extrapulmonary manifestations and comorbidities worsening COPD progression and quality of life. A neglected comorbidity in COPD management is mental health impairment defined by anxiety, depression and cognitive problems. This paper summarizes the evidence for impaired mental health in COPD and focuses on current pharmacological intervention strategies. In addition, possible mechanisms in impaired mental health in COPD are discussed with a central role for inflammation.Many comorbidities are associated with multi-organ-associated systemic inflammation in COPD. Considering the accumulative evidence for a major role of systemic inflammation in the development of neurological disorders, it can be hypothesized that COPD-associated systemic inflammation also affects the function of the brain and is an interesting therapeutic target for nutra- and pharmaceuticals.

SAFETY AND BENEFITS OF BETA-BLOCKERS IN COPD: A REVIEW OF CURRENT EVIDENCE AND META-ANALYSIS

SESSION TITLE: Medications and the Treatment of Obstructive Lung Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2018 08:45 AM - 09:45 AM PURPOSE: Chronic obstructive pulmonary disease currently ranks high in the top causes of mortality worldwide and is expected to be the third leading cause of death by the year 2020. Most of the mortality in COPD patients are from cardiovascular comorbidities in addition to the underlying lung disease. COPD and cardiovascular disease share the same risk factors especially cigarette smoking. It is very common to find both diseases in a single patient. Beta-blockers clearly decrease mortality among patients with cardiovascular disease. Despite current recommendations that support the use of beta-blockers in COPD, its use remain to be low because of concerns of triggering bronchoconstriction and exacerbations and possibly increasing mortality. Our review therefore appraised current evidence and we performed a meta-analysis on the effect of beta-blockers in the reduction of all-cause mortality and exacerbations among COPD patients. METHODS: This is a review and meta-analysis of current studies that examined mortality between patients with COPD who were and were not given beta-blockers. All studies that were included were either prospective or retrospective cohort studies. There are currently no available randomized controlled trials on this topic. The primary outcome is all-cause mortality. Seocondary outcomes were comparison between mortality and cardio-selectivity of beta-blocker used as well as COPD exacerbations. RESULTS: Twenty-two studies with a total population of 98,813 COPD patients were identified and met the inclusion criteria for analysis. There is a trend toward a reduction in mortality RR 0.79 (0.58-1.06) among COPD patients given beta-blockers compared to those who were not. In examining the effects of cardioselectivity, patients given cardioselective beta-blockers had a trend toward lower mortality RR 0.83 (0.5-1.20) versus non-selective beta-blockers, which showed a trend toward increased mortality RR 1.12 (0.71-1.75). Interestingly, the beta-blocker group had a 12% significantly lower exacerbations RR 0.88 (0.79-0.98) compared to those not given beta-blockers. All outcomes were significantly heterogenous. CONCLUSIONS: In patients with COPD and cardiovascular comorbidities, the use of beta-blockers appear to be safe and confer trends toward reduction of all-cause mortality compared to not giving beta-blockers. Rates of exacerbation were also lower among patients given cardioselective beta-blockers. CLINICAL IMPLICATIONS: It should be emphasized to medical professionals that cardioselective beta-blocker therapy can be safely prescribed and be given to COPD patients provided that adequate monitoring and observation is coupled with standard medical care. Further studies such as randomised clinical trials (RCTs) are required to firmly establish this recommendation. DISCLOSURES: no disclosure on file for Ruth Marie Divinagracia; No relevant relationships by Irene Rosellen Tan, source=Web Response no disclosure on file for Ralph Elvi Villalobos

Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients

This study aimed to generate real-world evidence to assess the burden of comorbidities in COPD patients, to effectively manage these patients and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients using electronic medical record data collected between 2000 and 2014. These patients were studied for prevalence of various comorbidities and for association of these comorbidities with exacerbations, mortality, and healthcare costs compared with an age-, sex-, and comorbidities-matched non-COPD reference population. A total of 17,479 patients with COPD were compared with 84,514 non-COPD reference population. A significantly higher prevalence of various comorbidities was observed in COPD patients 2 years post-diagnosis vs. reference population, with the highest percentage increase observed for cardiovascular diseases (81.8% vs. 30.7%). Among the selected comorbidities, lung cancer was relatively more prevalent in COPD patients vs. reference population (relative risk, RR = 5.97, p < 0.0001). Ischemic heart disease, hypertension, depression, anxiety, sleep disorders, osteoporosis, osteoarthritis, and asthma caused increased mortality rates in COPD patients. Comorbidities that were observed to be significantly associated with increased number of severe exacerbations in COPD patients included heart failure, ischemic heart disease, depression/anxiety, sleep disorders, osteoporosis, lung cancer, and stroke. The cumulative healthcare costs associated with comorbidities over 2 years after the index date were observed to be significantly higher in COPD patients (€27,692) vs. reference population (€5141) (p < 0.0001). The data support the need for patient-centered treatment strategies and targeted healthcare resource allocation to reduce the humanistic and economic burden associated with COPD comorbidities.

Pattern of Cardiovascular Comorbidity in COPD in a Country with Low-smoking Prevalence: Results from Two-population-based Cohorts from Sweden

Cardiovascular diseases are the most common comorbidities in COPD, due to common risk factors such as smoking. The prevalence of current smokers in Sweden has decreased over four decades to around 10%. The aim of the present study was to investigate the prevalence, distribution and associations of cardiovascular comorbidities in COPD by disease severity in two large areas of Sweden, both with low-smoking prevalence. Data from clinical examinations in 2009–2012, including spirometry and structured interview, from two large-scale population studies, the West Sweden Asthma Study (WSAS) and the OLIN Studies in Northern Sweden, were pooled. COPD was defined using post-bronchodilator spirometry according to the fixed ratio FEV1/FVC <0.70 and the lower limit of normal (LLN5th percentile) of the ratio of FEV1/FVC. Of the 1839 subjects included, 8.7% and 5.7% had COPD according to the fixed ratio and the LLN criterion. Medication for heart disease or hypertension among those with moderate-to-severe COPD was more common than among those without COPD (fixed ratio definition of COPD: 51% vs. 23%, p < 0.001; LLN definition: 42% vs. 24%, p = 0.002). After adjusting for known risk factors for COPD, including smoking, age, socio-economic status, and occupational exposure for gas, dust and fumes, only heart failure remained significantly, and independently, associated with COPD, irrespective of the definitions of COPD. Though a major decrease in smoking prevalence, the pattern of cardiovascular comorbidities in COPD still remains similar with previously performed studies in Sweden and in other Westernized countries as well.

Obesity in COPD: Comorbidities with Practical Consequences?

COPD and obesity often coexist and there is a complex interaction between them. Our aim was to evaluate the prevalence of obesity in a secondary care COPD population. Furthermore, the presence of comorbidities in obese (COPDOB) and non-obese COPD (COPDNO) individuals was studied. In 1654 COPD patients (aged ≥18 years) who visited a pulmonologist between January 2015 and December 2015, patient characteristics, pulmonary function tests and comorbidities were obtained from the medical records. Subjects were categorized according their BMI as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2) or obese (BMI ≥30.0 kg/m2). The Charlson comorbidity index and COTE index were used to quantify comorbidities. The prevalence of obesity was 21.8% in our COPD population. Obesity was significantly less common in GOLD stage IV (10.1%) compared to GOLD I (20.5%), II (27.8%) and III (18.9%). COPDOB had different comorbidities compared with COPDNO. Hypertension, diabetes mellitus, atrial fibrillation and congestive heart failure were significantly more prevalent in COPDOB compared with COPDNO. Osteoporosis and lung cancer were significantly more common in COPDNO compared with COPDOB. Obesity is common in patients with COPD and is most prevalent in COPD GOLD I-II and least prevalent in COPD GOLD IV. Obese COPD patients have different comorbidities than non-obese COPD patients. Cardiovascular and metabolic comorbidities, especially hypertension and diabetes mellitus, are highly prevalent in obese COPD patients. Active screening for these conditions should be a priority for physicians treating obese COPD patients.

The interrelations among aspects of dyspnea and symptoms of depression in COPD patients – a network analysis

BackgroundDepression is a frequent comorbidity in COPD. COPD symptoms such as dyspnea may play an important role in the causal relationship between COPD and depression. We investigated the interrelations among different aspects of dyspnea and other COPD parameters and symptoms of depression in COPD patients. MethodsThis is a secondary analysis of N = 590 COPD patients. At the beginning (T0) and the end (T1) of a 3-week inpatient pulmonary rehabilitation, dyspnea aspects intensity (BORG scale), frequency (2 CCQ items), functioning (CCQ-function) and cognitive/emotional response (2 SGRQ items) as well as cough (2 CCQ items), functional capacity (6MWD), lung function (FEV1) and symptoms of depression (PHQ-9) were assessed. Regression analyses with PHQ-9 sum score as dependent variable as well as network analysis using PHQ-9 single items were performed. Structural invariance over time was examined. ResultsDyspnea frequency, function, and cognitive/emotional response showed conditional independent relationships with PHQ-9 sum score. Network analysis showed that dyspnea frequency and dyspnea functioning were primarily associated with somatic depression symptoms (for example, sleep problems, loss of energy), while cognitive/emotional response was primarily related to cognitive-affective depression symptoms (for example, feeling down/depressed/hopeless). Regression parameters, network structure and network global strength did not differ between T0 and T1. LimitationsModels are based on between-person relationships. Results should be confirmed using time-series data. ConclusionsDyspnea and depression seem to be interrelated through a variety of different and complex pathways in COPD patients. Results may be used to explain intervention effects and develop new intervention strategies to reduce depression in COPD.

Clinical, functional and molecular characteristics of anemia with comorbid chronic obstructive pulmonary disease

The aim was to investigate an impact of different COPD phenotypes on clinical course of anemic syndrome. Methods. This was a single-center prospective observational cohort study. Patients with stable COPD and anemia were involved (n = 215). COPD was diagnosed according to GOLD criteria and anemia was diagnosed according to WHO criteria. The control group included 90 healthy subjects. COPD patients with anemia were stratified according to pathogenic variants of anemia and serum erythropoietin level. COPD symptoms, exacerbations, lung function, pulmonary hemodynamics, the type of airway inflammation, hematology parameters, serum erythropoietin, hepcidin 25, vitamin B12, folate, and iron homeostasis were assessed. Statistical analysis was performed using SPSS 24 software. The groups were compared using chi square test for nominal variables and Kruskal-Wallis test for continuous variables. Logistic regression was used to explore the relationships between variables. Results. Anemia was diagnosed in 63 (29.3%) of patients including common pathogenetic variants of anemia in 12 (19.0 %) of patients: iron deficiency 9 (14.3%) and vitamin B12 deficiency 3 (4.8%). This anemia variants were associated with shorter duration of respiratory symptoms and was not related to COPD phenotype. The clinical course of anemia was modified due to comorbid COPD in 51 (81.0%) of patients. Anemia with normal / high erythropoietin level was found in 31 (49.2%) of COPD patients and was hypochromic, microcytic and hyperregeneratory. Those patients had low serum levels of iron, vitamin B12, and folate, low total and latent iron-binding capacity of serum, and high levels of ferritin and hepcidine. This type of anemia was associated with frequent COPD exacerbations. Anemia with low erythropoietin level 20 (31.7%) was normochromic, normocytic, and normoregeneratory, with normal serum iron and ferritin levels, low iron-binding capacity of serum, and low hepcidine level. This type of anemia was associated with combined pulmonary fibrosis and emphysema and with pulmonary hypertension. Conclusion. Anemic syndrome in COPD patients is associated with COPD phenotype.

The Laboratory-Based Intermountain Validated Exacerbation (LIVE) Score Identifies Chronic Obstructive Pulmonary Disease Patients at High Mortality Risk.

Background: Identifying COPD patients at high risk for mortality or healthcare utilization remains a challenge. A robust system for identifying high-risk COPD patients using Electronic Health Record (EHR) data would empower targeting interventions aimed at ensuring guideline compliance and multimorbidity management. The purpose of this study was to empirically derive, validate, and characterize subgroups of COPD patients based on routinely collected clinical data widely available within the EHR.Methods: Cluster analysis was used in 5,006 patients with COPD at Intermountain to identify clusters based on a large collection of clinical variables. Recursive Partitioning (RP) was then used to determine a preferred tree that assigned patients to clusters based on a parsimonious variable subset. The mortality, COPD exacerbations, and comorbidity profile of the identified groups were examined. The findings were validated in an independent Intermountain cohort and in external cohorts from the United States Veterans Affairs (VA) and University of Chicago Medicine systems.Measurements and Main Results: The RP algorithm identified five LIVE Scores based on laboratory values: albumin, creatinine, chloride, potassium, and hemoglobin. The groups were characterized by increasing risk of mortality. The lowest risk, LIVE Score 5 had 8% 4-year mortality vs. 56% in the highest risk LIVE Score 1 (p < 0.001). These findings were validated in the VA cohort (n = 83,134), an expanded Intermountain cohort (n = 48,871) and in the University of Chicago system (n = 3,236). Higher mortality groups also had higher COPD exacerbation rates and comorbidity rates.Conclusions: In large clinical datasets across different organizations, the LIVE Score utilizes existing laboratory data for COPD patients, and may be used to stratify risk for mortality and COPD exacerbations.

Hospitalisation and mortality outcomes of patients with comorbid COPD and heart failure: a systematic review protocol

IntroductionChronic obstructive pulmonary disease (COPD) and heart failure (HF) often coexist in patients. Many studies have explored the short-term and long-term outcomes of patients with comorbid COPD and HF; however,...

High prevalence of bronchiectasis in emphysema-predominant COPD patients.

BackgroundCOPD has been identified as an etiology or related disease of bronchiectasis, and bronchiectasis has been classified as a comorbidity of COPD. In this study, we investigated the prevalence of bronchiectasis in different phenotypes of COPD subjects and the correlation between bronchiectasis and different phenotypes, especially emphysema.MethodsCOPD patients were recruited from April 2012 to December 2015. The presence of bronchiectasis and related information were statistically analyzed. COPD subjects were separated into subgroups in two ways: COPD with and without bronchiectasis groups and emphysema-predominant (emphysema index, EI≥9.9%) and non-emphysema-predominant (EI<9.9%) groups.ResultsIn total, 1,739 COPD patients were incorporated into the study, among which 140 cases (8.1%) were accompanied with radiological bronchiectasis. COPD patients with concomitant bronchiectasis presented worse pulmonary function (FEV1% predicted, P<0.001), higher EI (15.0% vs 13.4%, P<0.001), and higher proportion of pulmonary hypertension and cor pulmonale (6.4% vs 2.4%, P=0.005 and 23.6% vs 16.1%, P=0.022) than patients without bronchiectasis. Of all the COPD patients, 787 with EI data were divided into emphysema-predominant (n=369) and non-emphysema-predominant groups (n=418). The proportion of bronchiectasis was 16.5% and 10.3% (P=0.01), respectively. Severity of bronchiectasis increased as the degree of airflow limitation (r=−0.371, P<0.001) and emphysema increased (r=0.226, P=0.021). After adjusting confounding factors, FEV1% predicted (OR, 1.636; 95% CI, 1.219–2.197; P=0.001) and EI (OR, 1.993; 95% CI, 1.199–3.313; P=0.008) were significantly related with the presence of bronchiectasis in COPD patients.ConclusionThe proportion of bronchiectasis is higher in emphysema-predominant COPD subjects. Emphysema measured by EI and FEV1% predicted are independent predictors for bronchiectasis in COPD subjects, while the underlying mechanism deserves further investigation.

Preliminary results from the COPE study using primary-care electronic health records and environmental modelling to examine COPD exacerbations

BackgroundChronic Obstructive Airway Disease (COPD) is marked by often severely debilitating exacerbations. Efficient patient-centric research approaches are needed to better inform health management primary-care.AimThe ‘COPE study’ aims to develop a method of predicting COPD exacerbations utilising personal air quality sensors, environmental exposure modelling and electronic health records through the recruitment of patients from consenting GPs contributing to the Clinical Practice Research Datalink (CPRD).MethodThe study made use of Electronic Healthcare Records (EHR) from CPRD, an anonymised GP records database to screen and locate patients within GP practices in Central London. Personal air monitors were used to capture data on individual activities and environmental exposures. Output from the monitors were then linked with the EHR data to obtain information on COPD management, severity, comorbidities and exacerbations. Symptom changes not equating to full exacerbations were captured on diary cards. Linear regression was used to investigate the relationship between subject peak flow, symptoms, exacerbation events and exposure data.ResultsPreliminary results on the first 80 patients who have completed the study indicate variable susceptibility to environmental stressors in COPD patients. Some individuals appear highly susceptible to environmental stress and others appear to have unrelated triggers.ConclusionRecruiting patients through EHR for a study is feasible and allows easy collection of data for long term follow up. Portable environmental sensors could now be used to develop personalised models to predict risk of COPD exacerbations in susceptible individuals. Identification of direct links between participant health and activities would allow improved health management thus cost savings.

Clinical characteristics and related risk factors of depression in patients with early COPD.

Background and objectiveAlthough depression is considered one of the comorbidities of COPD, the clinical characteristics of depression in patients with early COPD remain unknown. We aimed to use national-level data to identify the clinical features and risk factors of depression in patients with early COPD.MethodsWe examined 7,550 subjects who were registered in the Korean National Health and Nutrition Examination Survey database of 2014 because that was the only year in which the Patient Health Questionnaire-9 for depression status was administered. Spirometry was used to identify patients with COPD whose forced expiratory volume in 1 second was 50% or more, and these patients were included in the analysis.ResultsOf the 211 subjects with early COPD, 14.2% also had depression, whereas 85.8% did not. The patients with depression were predominantly living alone and had a greater prevalence of diabetes compared with the patients without depression. The overall quality of life of the subjects with depression was lower than that of those without depression, and only the quality of life index correlated significantly with depression severity. In the multivariate regression analysis, female sex (adjusted OR, 1.79; 95% CI, 1.38–2.31; p<0.01), living alone (adjusted OR, 1.86; 95% CI, 1.37–2.51; p<0.01), and low income (adjusted OR, 2.17; 95% CI, 1.55–3.04; p<0.01) were identified as significant risk factors for depression.ConclusionIn patients with early COPD, depression was associated with a low quality of life, and female sex, living alone and low income were significant risk factors for depression.

СОСТОЯНИЕ СОСУДОДВИГАТЕЛЬНОЙ ФУНКЦИИ ЭНДОТЕЛИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ В СОЧЕТАНИИ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА

The aim of the study is to investigate a vasomotor function of patients with COPD against the development of acute myocardial infarction (AMI) with an elevation of the ST segment of the electrocardiogram. The brachial artery reactivity was studied in 42 patients with COPD during the course of treatment in the Amur Regional Clinical Hospital. All the patients were divided into two groups: 1st group (22 patients) with COPD and AMI with an elevation of the ST segment; 2nd group (20 patients) - with moderate COPD. The control group included 15 healthy people without cardiovascular diseases and respiratory pathology. The study was done at the ultrasonic device Toshiba Aplio XG with the linear probe of 10MHz using the method by D.S.Celermajer et al. (1992). The following results were obtained: the majority of COPD patients demonstrate vasomotor endothelial dysfunction that can cause atherosclerosis; in case of COPD and AMI comorbidity an endothelial dysfunction redoubles; development of AMI coincides with the “peak” of endothelial dysfunction determined with the help of endothelium-dependent vasodilatation. The method of endothelial dysfunction determination is non-invasive and accurate to predict cardiovascular diseases in COPD patients.