Chronic Obstructive Pulmonary Disease Comorbidities Research Articles

A comparison of two weaning strategies for non-invasive ventilation in chronic obstructive pulmonary disease patients with acute respiratory failure.

Non-Invasive Ventilation (NIV) is a crucial therapy for managing acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) with hypercapnic respiratory failure. Research has shown that NIV can decrease the rate of endotracheal intubation, length of hospital and Intensive Care Unit stays, and mortality. There are three main strategies for weaning patients off NIV: gradual reduction of NIV duration, gradual reduction of NIV pressure support, and immediate cessation of NIV. To compare the rate of successful withdrawal of COPD patients with acute hypercapnic respiratory failure, one group will use a stepwise reduction of duration of NIV, while the other group will use a stepwise reduction of pressure support. This study was a prospective observational study conducted at the Department of Pulmonary Medicine, Institute of Chest Diseases, Government Medical College, Kozhikode, over a period of 15months. The study population consisted of all COPD patients admitted to the Pulmonary Medicine ward or ICU with acute hypercapnic respiratory failure who were managed with non-invasive ventilation (NIV) without the need for invasive mechanical ventilation. Exclusions included patients requiring NIV for respiratory diseases other than COPD, those with significant comorbiditieslike acute left ventricular failure or fluid overload states as in chronic kidney disease, COVID-19 positive patients, patients on home NIV, patients who needed intubation early in treatment, and patients unwilling to participate in the study. The sample size was 140. Initial NIV settings and other management decisions prior to enrolment in the study were made by the treating physician according to standard protocols. Once weaning criteria were met (i.e., arterial pH > 7.35, SpO2 ≥ 90% at an FiO2 ≤ 50%, respiratory rate ≤ 25 breaths per minute, heart rate ≤ 120 beats per minute, systolic BP > 90mm Hg, and no signs of respiratory distress), patients were assigned to either group 1 or group 2 by purposive sampling. Group 1: stepwise reduction of duration of NIV use, with a reduction to 16h per day on day 1 of enrolment, 12h on day 2 (including 6-8h of nocturnal NIV), 6-8h on day 3, and NIV withdrawal on day 4. Group 2: stepwise reduction of pressure support, with pressure support reduced by 2-4cm every 4-6h until Inspiratory Positive Airway Pressure is < 8cm H2O and Expiratory Positive Airway Pressure is < 4cm H2O, followed by NIV withdrawal. The clinical outcome was classified as either improved or weaning failure. Improved was defined as an objective or subjective sense of improvement. Weaning failure was defined as the presence of any of the following: respiratory rate ≥ 25/minute or increase of ≥ 50% from baseline, heart rate ≥ 140/minute or increase of ≥ 20% from baseline, SpO2 ≤ 90% on FiO2 ≥ 50%, arterial pH ≤ 7.35, or respiratory distress. Data was collected using a pro forma that included demographic details, smoking status, GOLD COPD category, comorbidities, and vital signs. ABG parameters, NIV settings at the time of hospital admission, at the time of study enrolment, and 48h after weaning were also recorded. Independent sample t-test was used to test the statistical significance of the difference between means of variables between the two groups. Pearson Chi square test and Fisher's exact test were used to compare categorical variables between the groups. A p-value of < 0.05 was considered statistically significant. NIV was successfully withdrawn in 56/70 (80%) and 50/70 (71.4%) patients in Groups 1 and 2, respectively. This difference was not statistically significant. The length of hospital stay was longer in the stepwise reduction of duration group (Group 1), but this was not statistically significant. On comparison of two methods of NIV withdrawal, it was found that neither method is superior to the other in terms of weaning failure, intubation rates, and average length of hospital stay.

Internet of Things-Based Home Respiratory Muscle Training for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial.

Whether Internet of Things (IoT)-based home respiratory muscle training (RMT) benefits patients with comorbid chronic obstructive pulmonary disease (COPD) remains unclear. Therefore, this study aims to evaluate the effectiveness of IoT-based home RMT for patients with COPD. Seventy-eight patients with stable COPD were randomly divided into two groups. The control group received routine health education, while the intervention group received IoT-based home RMT (30 inspiratory muscle training [IMT] and 30 expiratory muscle training [EMT] in different respiratory cycles twice daily for 12 consecutive weeks). Assessments took place pre-intervention and 12 weeks post-intervention, including lung function tests, respiratory muscle strength tests, the mMRC dyspnea scale, CAT questionnaires, the HAMA scale, and 6-month COPD-related readmission after intervention. Seventy-four patients with COPD were analyzed (intervention group = 38, control group = 36), and the mean age and FEV1 of the patients were 68.65 ± 7.40 years, 1.21 ± 0.54 L. Compared to those of the control population, the intervention group exhibited higher FEV1/FVC (48.23 ± 10.97 vs 54.32 ± 10.31, p = 0.016), MIP (41.72 ± 7.70 vs 47.82 ± 10.99, p = 0.008), and MEP (42.94 ± 7.85 vs 50.29 ± 15.74, p = 0.013); lower mMRC (2.00 [2.00-3.00] vs 1.50 [1.00-2.00], p < 0.001), CAT (17.00 [12.00-21.75] vs 11.00 [9.00-13.25], p < 0.001), and HAMA (7.00 [5.00-9.00] vs 2.00 [1.00-3.00], p < 0.001) scores; and a lower incidence rate of 6-month readmission (22% vs 5%, p = 0.033). Compared with no intervention, IoT-based home RMT may be a more beneficial intervention for patients with COPD.

Detection of dynamic lung hyperinflation using cardiopulmonary exercise testing and respiratory function in patients with stable cardiac disease: a multicenter, cross-sectional study.

Many patients with heart disease potentially have comorbid chronic obstructive pulmonary disease (COPD); however, there are not enough opportunities for screening, and the qualitative differentiation of shortness of breath (SOB) has not been well established. We investigated the detection rate of SOB based on a visual and qualitative dynamic lung hyperinflation (DLH) detection index during cardiopulmonary exercise testing (CPET) and assessed potential differences in respiratory function between groups. We recruited 534 patients with heart disease or patients who underwent simultaneous CPET and spirometry (369 males, 67.0 ± 12.9 years) to scrutinize physical functions. The difference between inspiratory and expiratory tidal volume was calculated (TV E-I) from the breath-by-breath data. Patients were grouped into convex (decreased TV E-I) and non-convex (unchanged or increased TV E-I) groups based on their TV E-I values after the start of exercise. Among the recruited patients, 129 (24.2%) were categorized in the convex group. There was no difference in clinical characteristics between the two groups. The Borg scale scores at the end of the CPET showed no difference. VE/VCO2 slope, its Y-intercept, and minimum VE/VCO2 showed no significant difference between the groups. In the convex group, FEV1.0/FVC was significantly lower compared to that in the non-convex group (69.4 ± 13.1 vs. 75.0 ± 9.0%). Moreover, significant correlations were observed between FEV1.0/FVC and Y-intercept (r=-0.343), as well as between the difference between minimum VE/VCO2 and VE/VCO2 slope (r=-0.478). The convex group showed decreased respiratory function, suggesting a potential airway obstruction during exercise. A combined assessment of the TV E-I and Y-intercept of the VE/VCO2 slope or the difference between the minimum VE/VCO2 and VE/VCO2 slopes could potentially detect COPD or airway obstruction.

Factors of Influence on Diabetes Awareness in Older People With Chronic Obstructive Pulmonary Disease Comorbid With Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of mortality in this population. This study was designed to investigate the predictive factors of diabetes awareness (DA), including diabetes knowledge (DK), and diabetes care behaviors (DCB) among older people with both COPD and T2DM. This was a cross-sectional descriptive correlation study. One hundred thirty-three older-age patients with COPD comorbid with T2DM receiving treatment at a chest hospital were enrolled as participants. Both DK and DCB were utilized to measure DA. The Diabetes Knowledge Questionnaire was utilized to measure DK, and the Summary of Diabetes Self-Care Activities was used to evaluate DCB. The average glycated hemoglobin (HbA1c) was 7.68% ( SD = 1.55%), with 74 (55.6%) participants having a level > 7%. The average DA was 46.46% ( SD = 13.34%), the average DK was 53.42% ( SD = 18.91%), and the average DCB was 39.50% ( SD = 16.66%). In terms of demographic variables, age, diabetes education, diabetes shared care, and HbA1c were all significantly associated with DA, DK, and DCB (all p s < .05). The overall variance in DA was significantly explained by diabetes education and HbA1c (all p s < .05). The overall variance in DK was significantly explained by age, diabetes education, and HbA1c. The overall variance in DCB was significantly explained by diabetes education and HbA1c (all p s < .05). Our study findings indicate that older adult patients with COPD comorbid with T2DM are at elevated risks of poor glycemic control and low DA. Healthcare professionals should be aware of these issues and develop appropriate DA plans to prevent poor glycemic control in this population. Providing accurate information on diabetes to older adults with COPD comorbid with T2DM is important to improving their DK and promoting better DCB.

Extrapulmonary Comorbidities Associated with Chronic Obstructive Pulmonary Disease: A Review.

Most patients with chronic obstructive pulmonary disease (COPD) suffer from at least one additional, clinically relevant chronic disease. To a degree, the high global prevalence and mortality rate of COPD is closely related to its extrapulmonary effects. Moreover, the various of comorbidities of COPD and itself interact with each other, resulting in diverse clinical manifestations and individual differences, and thus further influencing the prognosis as well as healthcare burden of COPD patients. This is closely related to the common risk factors of chronic diseases (aging, smoking, inactivity, etc.). Additionally, some pathophysiological mechanisms caused by COPD, including the systemic inflammatory response, hypoxia, oxidative stress, and others, also have an impact on other systems. But comprehensive management and medical interventions have not yet been established. The clinicians should improve their knowledge and skills in diagnosing as well as treating the comorbidities of COPD, and then aim to develop more individualized, efficient diagnostic and therapeutic strategies for different patients to achieve greater clinical benefits. In this article, we will review the risk factors, mechanisms, and treatment strategies for extrapulmonary comorbidities in chronic obstructive pulmonary disease, including cardiovascular diseases, diabetes, anemia, osteoporosis, emotional disorders, and gastroesophageal reflux disease.

HDAC9 inhibition reduces skeletal muscle atrophy and enhances regeneration in mice with cigarette smoke-induced COPD

Cigarette smoke (CS) is the major risk factor for chronic obstructive pulmonary disease (COPD), and sarcopenia is one of the significant comorbidities of COPD. However, the pathogenesis of CS-related deficient skeletal muscle regeneration has yet to be clarified. The impact of CS on myoblast differentiation was examined, and then we determined which HDAC influenced the myogenic process and muscle atrophy in vitro and in vivo. Finally, we further investigated the potential mechanisms via RNA sequencing. Long-term CS exposure activated skeletal muscle primary SCs while inhibiting differentiation, and defective myogenesis was also observed in C2C12 cells treated with CS extract (CSE). The level of HDAC9 changed in vitro and in vivo in CS exposure models as well as COPD patients, as detected by bioinformatics analysis. Our data showed that CSE impaired myogenic capacity and myotube formation in C2C12 cells via HDAC9. Moreover, inhibition of HDAC9 in mice exposed to CS prevented skeletal muscle dysfunction and promoted SC differentiation. The results of RNA-Seq analysis and verification indicated that HDAC9 knockout improved muscle differentiation in CS-exposed mice, probably by acting on the AKT/mTOR pathway and inhibiting the P53/P21 pathway. More importantly, the serum of HDAC9 KO mice exposed to CS alleviated the differentiation impairment of C2C12 cells caused by serum intervention in CS-exposed mice, and this effect was inhibited by LY294002 (an AKT/mTOR pathway inhibitor). These results suggest that HDAC9 plays an essential role in the defective regeneration induced by chronic exposure to CS.

Assessing Chronic Obstructive Pulmonary Disease (COPD) Mortality and Morbidity: A Review

From PubMed, referencing articles over the previous 4 years, 146 articles addressing morbidity and mortality of chronic obstructive pulmonary disease (COPD) were reviewed. The major topics covered in this article include the epidemiology of COPD, spirometry with ATS/ERS and GOLD staging, scoring Indices (BODE, ADO, FODEP), trajectories in the development of COPD, pathophysiology of COPD, classification of COPD phenotypes, pharmacotherapy of COPD, causes of Acute Exacerbation of COPD (AECOPD), CT Lung imaging in COPD, and COPD comorbidities. All studies are referenced allowing for greater exploration into given areas of interest (76 ref.).

An Applicable Framework for Understanding Successful Aging of People Living with HIV and Comorbid Chronic Obstructive Pulmonary Disease

An Applicable Framework for Understanding Successful Aging of People Living with HIV and Comorbid Chronic Obstructive Pulmonary Disease

Prevalence of coronary artery disease in chronic obstructive pulmonary disease patients- a retrospective observational study

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation that results in progressive and irreversible air flow obstruction usually caused by an inflammatory response of the lungs to noxious particles and gases. There are periods of acute episodes of worsening and exacerbation. COPD was predicted to be the third leading cause of death worldwide by 2020, is a major cause of disability adjusted life years (DALY). Patients with COPD are often complicated by coronary artery disease (CAD), both of which are public health problems. There are probably a lot of mechanisms involved in the co-existence of these comorbidities like ageing, sedentary life style, systemic inflammation, atherosis and arterial stiffness. The confirmation of this comorbidity in COPD is very important as it can have implications in the management of the disease. Methods: This observational study was done in a tertiary care hospital in Central Kerala. It was a retrospective observational study. 100 patients were included in the study. Results: Out of 100 COPD patients that were included in the study, 27% of them had CAD as a comorbidity which implies that all patients with COPD should be screened for CAD as well. Conclusions: All COPD patients should be screened for a coexisting CAD.

Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort

ObjectivesThe impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking.MethodsData...

Oxidative and nitrosative stress — the leading mechanisms of chronic pancreatitis and chronic obstructive pulmonary disease interaction and inducers of their progression

Background. The frequency of chronic pancreatitis (CP) comorbidity with chronic obstructive pulmonary disease (COPD) has significantly increased recently. It may be accompanied by changes in oxidant-antioxidant homeostasis and activates a cascade of reactions of mutual burdening of these pathologies. The purpose of the current research was to evaluate the intensity of lipid peroxidation, oxidative modification of proteins and the state of individual factors of the antioxidant defense system in the development and course of CP, depending on the comorbid COPD. Materials and methods. Three hundred and seventeen patients were examined, including 62 patients with CP alone (group 1), 132 CP patients with comorbid COPD (group 2), 123 patients with COPD alone (group 3). The content in blood of isolated double bonds in compounds, conjugated dienes, ketodienes and conjugated trienes, malonic aldehyde, nitrites/nitrates, reduced glutathione, the activity of catalase, glutathione-S-transferase, glutathione peroxidase were evaluated in all patients. Results. In CP patients with comorbid COPD, the maximum oxidative stress intensity among the compared groups was registered. There was a reliable increase in the content of malonic aldehyde — by 2.0 times (p &lt; 0.05), isolated double bonds — by 2.2 times (p &lt; 0.05), conjugated dienes — by 1.9 times (p &lt; 0.05), ketodienes and conjugated trienes — by 1.9 times (p &lt; 0.05), nitrites/nitrates — by 2.6 times (p &lt; 0.05). A reliable decrease in reduced glutathione content of erythrocytes was detec­ted: in group 1 — by 1.5 times, in group 2 — by 1.9 times (p &lt; 0.05), in group 3 — by 1.2 times (p &lt; 0.05). The compensatory increase in the activity of glutathione-S-transferase, glutathione peroxidase and blood catalase was revealed: in group 1 — by 1.3, 1.2 and 1.5 times (p &lt; 0.05); in group 2 — by 1.5, 1.3 and 1.8 times (p &lt; 0.05), in group 3 — by 1.2, 1.2 and 1.4 times, respectively (p &lt; 0.05). Conclusions. The comorbid course of CP and COPD is accompanied by the maximum intensity of oxidative and nitrosative stress compared to the isolated course of the disease. An increase was detected in intermediate and final metabolites of peroxide oxidation in the blood, oxidative modification of proteins, nitrites/nitrates in the blood against the background of a deep imbalance of antioxidant defense factors, an increase in ceruloplasmin content in the blood, which requires the administration of antioxidant agents to correct detected disorders and prevent the progression of both comorbid diseases.

Prevalence and timing of chronic obstructive pulmonary disease (COPD) diagnosis among patients newly diagnosed with lung cancer in the US.

118 Background: COPD is one of the most common comorbidities among patients with lung cancer, and an important determinant of their survival. While COPD is frequently under diagnosed in the general population, less is known about the occurrence of COPD underdiagnosis in patients with lung cancer. Objectives: 1) To estimate prevalence and under diagnosis of COPD among patients newly diagnosed with lung cancer. 2) To quantify the association between timing of COPD diagnosis and stage of lung cancer at diagnosis and whether this association is modified by sex, race, and socioeconomic status (SES). Methods: A secondary data analysis was conducted using the SEER-Medicare database. We included Medicare beneficiaries aged 66+years with primary invasive lung cancer diagnosed from 2008 to 2017 who were alive at the time of cancer diagnosis and had continuous Medicare coverage 12 months prior and 3 months after lung cancer diagnosis. Exposure: Comorbid COPD was determined using Medicare claims and classified as early COPD (evidence of COPD related healthcare utilization (HCU) &gt;3 months before lung cancer diagnosis) versus late COPD (evidence of COPD related HCU only during the +/- 3 months from lung cancer diagnosis). Outcome: Early (localized) versus late (regional and distant) stage of lung cancer diagnosis. Statistical analysis: We used generalized linear models to estimate adjusted absolute (prevalence difference PD) and relative (prevalence ratio PR) association. Results: In a population of 185,405 Medicare beneficiaries with lung cancer, 131,230 (71%) had evidence of COPD. Compared to lung cancer patients without COPD, those with COPD were more likely to be younger, male, White, of lower SES, have more comorbidities, higher HCU, and be diagnosed with early stage lung cancer. Patients with early COPD diagnosis constitute 66,867 (51%) of patients with COPD and lung cancer. They were more likely to be older, female, Non-Hispanic White, of lower SES, and to have more comorbidities, acute exacerbation of COPD, and more early-stage lung cancer compared to patients with late COPD diagnosis. We observed a significant positive association between early COPD diagnosis and early-stage lung cancer diagnosis (PR= 1.27, 95% CI= 1.24 to 1.30; PD= 0.062, 95% CI= 0.057 to 0.066) in models adjusted for age, sex, race, SES, HCU, comorbidities, year of cancer diagnosis, SEER region, and histology. In subgroup analyses, this association was stronger for males, Non-Hispanic Black, American Indian Alaskan Native, and patients of lower SES. Conclusions: Approximately seven out of 10 patients with lung cancer have COPD, and late COPD diagnosis is common. Earlier COPD diagnosis is associated with diagnosis of lung cancer at earlier stages. These findings highlight the need for more structured screening of COPD among individuals at high risk for lung cancer.

Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups.

Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups. Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence. We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously. Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.

Serum MMP3 and IL1-RA levels may be useful biomarkers for detecting asthma and chronic obstructive pulmonary disease overlap in patients with asthma

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) is characterized by concurrent features of asthma and COPD. Since disease pathogenesis, severities, and treatments differ between asthma and ACO, it is important to differentiate them. ObjectiveTo clarify and compare the characteristics of ACO and asthma and identify the serum biomarkers for differentiating them, especially in older patients. MethodsThis study used the data of 639 participants from the nationwide cohort study, the NHOM-Asthma study, an asthma registry in Japan, with complete information on smoking history, respiratory function, and serum biomarkers. ACO was defined as the self-reported comorbidity of COPD or emphysema, or with obstructive pulmonary function and smoking history (pack-years≥10). The clinical characteristics of patients with ACO and asthma without COPD were compared. The serum biomarkers for differentiation were examined using receiver operating characteristic curves and multivariable analysis. The associations between the biomarkers and age were also analyzed. ResultsOf the 639 asthma patients, 125 (19.6%) were diagnosed with ACO; these patients were older and male-dominant and had a higher prevalence of comorbidities such as hypertension, diabetes, and stroke. Among the serum biomarkers that were significantly different between ACO and asthma without COPD, the YKL-40/CHI3L1, MMP3, and IL-1RA levels showed a high area under the curve for discriminating ACO. Only the MMP3 and IL-1RA levels were significantly higher among ACO patients, regardless of age and sex; the YKL-40/CHI3L1 levels were not different due to the effect of age. ConclusionMMP3 and IL-1RA may be useful serum biomarkers for distinguishing ACO from asthma.

P063 Long-term Non-invasive Ventilation in Patients with COPD: A Retrospective Cohort Study.

Abstract Introduction Domiciliary long-term non-invasive ventilation (LT-NIV) is an accepted therapy for patients with severe chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. This study aimed to characterise patients with COPD who were commenced on LT-NIV. Methods A retrospective analysis was performed of all patients prescribed LT-NIV with a primary physician-diagnosis of COPD, between June 2016 and March 2022 at an Australian tertiary hospital. Results 333 patients were commenced on LT-NIV, of whom 67 (20%) had COPD. Inpatient LT-NIV Initiation: 53/67 (79%) were commenced on LT-NIV during an inpatient admission with acute exacerbation of COPD. Patients were elderly (age, mean 69± SD 9.5 years), predominantly female (60%) with moderate-severe COPD (FEV1 37±18%) and mild-moderate comorbidity burden (Charlson Comorbidity Index Score 2.1±1.4). Prior to LT-NIV, 64% patients had a sleep study with 15% having severe OSA (AHI≥30 or ODI≥30). 30% previously required acute NIV. Pre-admission non-exacerbated PaCO2 was 58±7.3mmHg During admission, all inpatients demonstrated hypercapnia (PaCO2≥45mmHg). Peak inpatient PaCO2 was 87±20mmHg, with persistent hypercapnia on discharge 58±9.0mmHg. On discharge, IPAP and EPAP settings were 17±3.8 and 7.7cm±2.7cmH2O respectively. There was a non-significant reduction in respiratory-related and all-cause hospitalizations in the 12-months following LT-NIV initiation (p=0.66 and 0.53 respectively). Outpatient LT-NIV Initiation: [Further data collection in progress] Discussion This study illustrates the real-world prescription of LT-NIV for COPD at our centre, with the majority being initiated in the inpatient setting, rather than early outpatient reassessment. A prospective multi-centre analysis is required to better understand the nuances of LT-NIV prescription in patients with COPD.

Sociodemographic correlates with prevalence of comorbidities in patients with chronic obstructive pulmonary disease: a study from a Chinese National Survey

An increase in the prevalence of comorbidities has been reported in patients with chronic obstructive pulmonary disease (COPD). However, contemporary estimates of the overall prevalence of the sociodemographic correlates of COPD comorbidities are scarce and inconsistent in China. This study aimed to investigate the prevalence of sociodemographic correlates of comorbidities in patients with COPD across China. This was a cross-sectional study. We used data from the Enjoying Breathing Program between May 2020 and April 2022. Participants with COPD from 17 provinces (or equivalent) were included. Comorbidity clusters were stratified based on the number of comorbidities per person. Univariable and multivariable analyses were used to determine the sociodemographic associations of patients with COPD with specific clusters of comorbidities after adjusting for age, sex, and other prespecified covariates. Tetrachoric correlation analyses were performed to determine the associations between specific comorbidities. A total of 3913 participants with COPD were included, of whom 1744 (44.7%) had at least one comorbidity; 25.4% had one comorbid disease, 12.9% had two, and 6.4% had three or more concurrent diseases. The most common comorbidities were hypertension (17.8%), asthma (9.9%), bronchiectasis (8.2%), diabetes (8.2%), and coronary artery disease (7.7%). In the logistic regression models adjusted for a broad set of factors, patients with COPD residing in the east region of China and having health insurance experienced a decreased likelihood of comorbidities (from OR=0.70 [95% confidence interval [CI], 0.53-0.93] to OR=0.50 [95% CI, 0.25-0.99]). However, patients over 80 years had increased risk (OR 1.43 [95% CI 1.01-2.03]), as did those in all Modified Medical Research Council (mMRC) grade categories (grade 1: OR=1.30 [95% CI, 1.02-1.65]; grade 2: OR=1.39 [95% CI, 1.07-1.8]; grade 3: OR=1.67 [95% CI, 1.23-2.26]; and grade 4: OR=1.81 [95% CI, 1.00-3.28]) and in Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 classification (OR=1.30 [95% CI, 1.03-1.65]) relative to their respective references. The associations observed in these subgroups were consistent regardless of the number of comorbidities per person. Tetrachoric correlations demonstrated negative associations in pairwise comparisons of the top five comorbidities, ranging from-0.03 to-0.31 (p<0.001 in all groups). In China, comorbidities are highly prevalent among patients with COPD, with older age, higher mMRC grade, and lung function decline being the major risk factors. Studies with larger sample sizes are required to elucidate the complex mechanisms underlying COPD comorbidities. This study was funded by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-049 and 2022-I2M-C&T-B-107).

Chronic Obstructive Pulmonary Disease, Part 5: Clinical Pearls for Comorbid COPD.

Chronic obstructive pulmonary disease (COPD) is often diagnosed with other comorbid conditions. This can complicate therapy overall by contributing to adverse events leading to poor outcomes to not only COPD, but other comorbid conditions. This manuscript will discuss common comorbid conditions often seen with COPD, update vaccination recommendations for COPD patients, and provide information regarding smoking cessation in COPD. The senior care pharmacist has an important role where they can recommend medication adjustments to potentially avoid these adverse events, immunize their patients appropriately, and provide assistance with smoking cessation to improve not only COPD outcomes but outcomes associated with other comorbid conditions.

Chronic Respiratory Diseases as a Risk Factor for Herpes Zoster Infection

IntroductionHerpes zoster (HZ) is a condition that results from the reactivation of the varicella zoster virus (VZV). Several diseases have been reported to increase the risk of developing HZ and postherpetic neuralgia (PHN). The objective of this study is to analyze the prevalence and risk factors for HZ and PHN in the most frequent chronic respiratory diseases, which are chronic obstructive pulmonary disease (COPD), asthma, lung cancer and obstructive sleep apnea (OSA). MethodsWe conducted an observational, retrospective, non-interventional study between January 2012 and December 2020 based on data from the Castilla-La Mancha Regional Health System in Spain. We used the Savana Manager 3.0 artificial intelligence-enabled system to collect information from electronic medical records. Results31765 subjects presented a diagnosis of HZ. Mean age was 64.5 years (95%CI 64.3–64.7), and 58.2% were women. The prevalence of HZ showed an increasing trend in patients over the age of 50. A risk analysis adjusted for sex and comorbidities in COPD, asthma, lung cancer and OSA presented a higher risk of developing HZ in the first three (OR 1.16 [95%CI 1.13–1.19], 1.67 [1.63–1.71], 1.68 [1.60–1.76], respectively), which further increased in all three when associated with comorbidities. Regarding postherpetic neuralgia, an increased risk was only observed related to COPD and lung cancer (OR 1.24 [95%CI 1.23–1.25], 1.14 [1.13–1.16], respectively), further increasing when associated with comorbidities. ConclusionsIn a standard clinical practice setting, the most prevalent respiratory diseases (asthma, COPD and lung cancer) are related to a higher risk of HZ and PHN. These data are fundamental to assess the potential impact of vaccination in this population.

Predictors of Mortality in Pulmonary Embolism: A Real-Life Study

Objective: The primary aim of this study was to investigate the mortality and associated factors in patients with pulmonary embolism. Methods: A retrospective analysis was performed on adult patients with pulmonary embolism who applied to X University Hospital between January 1, 2017, and January 1, 2023. All-cause mortality and related factors in pulmonary embolism patients were determined. Results: This study included 152 patients with a median age of 59 years and 81 (53.3%) women. The all-cause mortality rate was 25.7%, and pulmonary embolism-related deaths were 1.3%. Age (p&lt;0.001), chronic obstructive pulmonary disease (COPD) (p=0.013), heart failure (p=0.018), atrial fibrillation (p=0.015), massive pulmonary embolism (p=0.029), hemoglobin level (p&lt;0.001) and NT-Pro BNP level (p&lt;0.001) were significantly associated with increased all-cause mortality. In binary logistic regression analysis, for each unit of increasing pulmonary embolism severity index (PESI) score, mortality increased 2.2-fold (95% CI:1.03-5.09), massive PTE 1.6-fold (95% CI:0.14-17.86), anticoagulant duration (daily) 0.98-fold (95% CI:0.98-0.99) and Hb level (per unit Hb reduction) 0.67-fold (95% CI:0.45-1.02) mortality was increasing. There was no statistical difference between the number of hospitalization days for patients with low and high PESI and simplified PE severity index (sPESI) scores. Conclusions: All-cause mortality in patients with pulmonary embolism increased with age, cardiac diseases, and COPD comorbidities. The PESI and sPESI scores used in the acute phase of PTE were found to be highly reliable in predicting all-cause mortality in PE patients. The diagnosis of massive PE and elevated NT-proBNP levels, a marker of right ventricular dysfunction, were factors that increased mortality.

Sarcopenia predicts 5-year mortality in older adults with intellectual disabilities.

People with intellectual disabilities (ID) have a lower life expectancy than their peers without ID. A contributing factor to the lower life expectancy and early mortality could be sarcopenia: low muscle mass and low muscle function. In the general population, sarcopenia strongly predicts early mortality, but this association is unknown in people with ID. Therefore, this study aims to explore the association between sarcopenia and 5-year mortality in older adults with ID. In the Healthy Ageing and Intellectual Disabilities (HA-ID) study, the prevalence of sarcopenia was measured at baseline among 884 older adults (≥50years) with ID. All-cause mortality was measured over a 5-year follow-up period. Univariable and multivariable Cox proportional hazard models were applied to determine the association between sarcopenia (no sarcopenia, pre-sarcopenia, sarcopenia, severe sarcopenia) and early mortality, adjusted for age, sex, level of ID, presence of Down syndrome, and co-morbidity (chronic obstructive pulmonary disease, diabetes type 2 and metabolic syndrome). The unadjusted hazard ratio (HR) for sarcopenia was 2.28 [95% confidence interval (CI) 1.48-3.42], P<0.001), and 2.40 (95% CI 1.40-4.10, P=0.001) for severe sarcopenia. When adjusted for age, sex, level of ID, and Down syndrome, sarcopenia (HR=1.72, 95% CI 1.08-2.75, P=0.022) and severe sarcopenia (HR=1.86, 95% CI 1.07-3.23, P=0.028) were significantly associated with early mortality. When additionally adjusted for co-morbidity, the adjusted HR decreased to 1.62 (95% CI 1.02-2.59, P=0.043) and 1.81 (95% CI 1.04-3.15, P=0.035) for sarcopenia and severe sarcopenia, respectively. Sarcopenia is an independent risk factor for early mortality in older adults with ID over a 5-year follow-up period. Our results stress the need to delay the incidence and development of sarcopenia in older adults with ID.