COPD Patients Research Articles

Suboptimal Peak Inspiratory Flow in Patients Hospitalized for COPD Exacerbation: Prevalence and Predictive Factors.

Introduction: Despite the importance of an adequate peak inspiratory flow (PIF) during inhaled therapy in patients with COPD, the available evidence in patients with severe exacerbations and their evolution after admission is limited. We conducted this study to evaluate the PIF during an exacerbation, its variability, and predictors of suboptimal PIF. Material and Methods: A prospective study that included patients admitted for COPD exacerbation. Clinical, demographic, and functional variables were recorded. Using the In-Check DIAL G16®, PIF without resistance (PIF-nr) and that obtained by simulating the resistance of the patients' usual inhalers (PIF) were determined within the first 48 hours of admission and prior to discharge; also assessed during a stable phase in a subgroup of patients. The results were compared and, through a multivariate study, the factors related to a suboptimal PIF were analyzed. Results: A total of 137 patients were included; 27% were women and the mean age was 69.4 ± 9.8 years. Moreover, 30.8% of the participants with dry powder inhalers had a suboptimal PIF at admission and it was independently associated with female sex (odds ratio [OR] = 8.635; 95% confidence interval [CI] [2.007, 37.152]; p < 0.01) and forced expiratory volume in the 1st second (FEV1) (OR = 0.997; 95% CI: [0.995, 0.999]; p = 0.04). At discharge, suboptimal PIF reduced to 17% (p < 0.01). PIF-nr increased from the time of admission to the stable phase. Conclusion: One third of COPD patients admitted with a severe exacerbation had a suboptimal PIF, being female sex and lower FEV1 independent predictors. PIF-nr improved progressively after the exacerbation.

Early and late effects of volatile sedation with sevoflurane on respiratory mechanics of critically ill COPD patients

BackgroundThe objective was to compare sevoflurane, a volatile sedation agent with potential bronchodilatory properties, with propofol on respiratory mechanics in critically ill patients with COPD exacerbation.MethodsProspective study in an ICU enrolling critically ill intubated patients with severe COPD exacerbation and comparing propofol and sevoflurane after 1:1 randomisation. Respiratory system mechanics (airway resistance, PEEPi, trapped volume, ventilatory ratio and respiratory system compliance), gas exchange, vitals, safety and outcome were measured at inclusion and then until H48. Total airway resistance change from baseline to H48 in both sevoflurane and propofol groups was the main endpoint.ResultsSixteen patients were enrolled and were sedated for 126 h(61–228) in the propofol group and 207 h(171–216) in the sevoflurane group. At baseline, airway resistance was 21.6cmH2O/l/s(19.8–21.6) in the propofol group and 20.4cmH2O/l/s(18.6–26.4) in the sevoflurane group, (p = 0.73); trapped volume was 260 ml(176–290) in the propofol group and 73 ml(35–126) in the sevoflurane group, p = 0.02. Intrinsic PEEP was 1.5cmH2O(1–3) in both groups after external PEEP optimization. There was neither early (H4) or late (H48) significant difference in airway resistance and respiratory mechanics parameters between the two groups.ConclusionsIn critically ill patients intubated with COPD exacerbation, there was no significant difference in respiratory mechanics between sevoflurane and propofol from inclusion to H4 and H48.

Evaluating circulating cell-free DNA and DNA integrity index as biomarkers in non-small cell lung cancer

BackgroundAnalysis of free DNA molecules shed from tumour cells in plasma of patients referred as circulating tumour DNA (ctDNA) with reference to physiological circulating cell-free DNA (cfDNA) is nowadays exploited as liquid biopsy and is considered a new emerging promising biomarker for diagnosis, selection of proper treatment, and prognosis of cancer. DNA integrity index (DII) is assessed by calculating the ratio between the concentration of long cfDNA strands released from tumour cells (ALU247) and the short strands released from normal cells (ALU115). The aim of the current study was to evaluate DII as a potential diagnostic and prognostic biomarker of NSCLC.MethodsOur study included 48 NSCLC patients diagnosed as primary NSCLC before starting treatment, 30 COPD patients diagnosed clinically, radiologically, and subjected to chest high-resolution computerized tomography, and 40 healthy controls. cfDNA concentration and DII were measured by quantitative real-time polymerase chain reaction (qPCR).ResultsALU115, ALU247, and DII were significantly higher in NSCLC compared to COPD patients (p < 0.0001) and controls (p < 0.0001) and in COPD patients compared to control subjects (p < 0.0001). DII positively correlated with the stage of tumour (p = 0.01), tumour metastasis (p = 0.004), and with adenocarcinoma compared to other histopathological types (p = 0.02). To evaluate clinical utility of DII in NSCLC, ROC curve analysis demonstrated an AUC of 0.91 at a cut-off value of 0.44 with total accuracy = 85.6%, sensitivity = 90%, specificity = 83%, PPV = 78.1%, and NPV = 92.1%.ConclusioncfDNA and DII represent a promising diagnostic and prognostic tool in NSCLC. This type of noninvasive liquid biopsy revealed its chance in the screening, early diagnosis, and monitoring of NSCLC.

RWD14 Healthcare Resource Utilization and Associated Costs in COPD Patients at High Risk of Exacerbation Despite Treatment With Dual or Triple Inhaled Therapy: Results From the Sirius Observational Study in the US

RWD14 Healthcare Resource Utilization and Associated Costs in COPD Patients at High Risk of Exacerbation Despite Treatment With Dual or Triple Inhaled Therapy: Results From the Sirius Observational Study in the US

Clinic-Functional Assessment of Hemoglobin Desaturation by Oxygen in 6-Minute Walk Test Among Patients with Bronchial Asthma

The main purpose of the study is to assess the prevalence and clinical significance of hemoglobin desaturation by oxygen during the 6-minute walk exercise test in patients with bronchial asthma. Material and methods: 75 patients with exacerbation of mixed (48 %) and allergic (52 %) bronchial asthma were examined. Research explored following methods: collecting complaints and anamnesis, physical examination, spirometry, CO-metry of exhaled air to determine carboxyhemoglobin, transcutaneous 2-wave pulse oximetry (at rest and during 6-minute walk exercise test) with spectral analysis and correction for COHb. 6-minute walk exercise test was performed after relief of asthma exacerbation (before discharge from the hospital), assessing the desaturation-distance ratio (the ratio of the area of oxygen desaturation of hemoglobin to the 6-minute walk exercise test distance), O2-GAP index, the dynamics of fatigue and dyspnea before and after 6-minute walk exercise test. In smoking patients (n = 36, 48 %), the smoker index was calculated. Based on oximetry results during the 6-minute walk exercise test, patients were divided into “desaturators” (n = 28, 37 %) and “non-desaturators” (n = 47, 63 %). Results. The findings of the research illustrated that hemoglobin desaturation by oxygen, detected by reducing SpO2 to &lt; 90 % during 6-minute walk exercise test, was associated with the severity of this disease exacerbation, more pronounced impairment of pulmonary ventilation and blood oxygenation, and the demand for longer hospitalization. The prevalence of tobacco smoking and the magnitude of the smoker index in both groups were identical but in “desaturators” we found a higher prevalence of the combination of asthma and COPD compared to “non-desaturators.” The “desaturators” had significantly higher level of desaturation-distance ratio and increased demand for additional oxygen flow to maintain SpO2 at ≥ 88 % during a 6-minute walk test, which indicates a higher “oxygen price” of physical activity in this group of patients. Conclusion. Thus, the high prevalence of the phenomenon of hemoglobin oxygen desaturation during 6-minute walk exercise test in patients with asthma and associated clinic-functional disorders supports the feasibility and clinical significance of conducting a stress test with a 6-minute walk not only in COPD patients, but also in bronchial asthma patients.

Assessing the impact of long-term inhaled corticosteroid therapy on patients with COVID-19 and coexisting chronic lung disease: A multicenter retrospective cohort study

Background Patients with chronic lung disease (CLD), such as asthma or chronic obstructive pulmonary disease, were expected to have an increased risk of clinical manifestations and severity of COVID-19. However, these comorbidities have been reported less frequently than expected. Chronic treatment with inhaled corticosteroids (ICS) may impact the clinical course of COVID-19. The main objective of this study is to know the influence of chronic treatment with ICS on the prognosis of COVID-19 hospitalized patients with CLD. Methods A multicenter retrospective cohort study was designed, including patients hospitalized with COVID-19. Epidemiological and clinical data were collected at admission and at seven days, and clinical outcomes were collected. Patients with CLD with and without chronic treatment with ICS were compared. Results Two thousand five hundred ninety-eight patients were included, of which 1,171 patients had a diagnosis of asthma and 1,427 of COPD (53.37% and 41.41% with ICS, respectively). No differences were found in mortality, transfer to ICU, or development of moderate-severe ARDS. Patients with chronic ICS had a longer hospital stay in both asthma and COPD patients (9 vs. 8 days, p = 0.031 in asthma patients), (11 vs. 9 days, p = 0.018 in COPD patients); although they also had more comorbidity burden. Conclusions Patients with chronic inhaled corticosteroids had longer hospital stays and more chronic comorbidities, measured by the Charlson comorbidity index, but they did not have more severe disease at admission, evaluated with qSOFA and PSI scores. Chronic treatment with inhaled corticosteroids had no influence on the prognosis of patients with chronic lung disease and COVID-19.

Prognostic Value of Melatonin in Patients with Chronic Obstructive Pulmonary Disease

The article outlines a detailed examination of multiple scientific studies investigating how melatonin affects COPD's advancement and growth. The severity of oxidative stress in COPD, a complex disease with multiple factors, is significantly reduced by melatonin by activating intracellular antioxidants, as suggested by the data acquired. Considering the available data, we can conclude that melatonin has a protective role against oxidative stress in COPD patients in addition to regulating the circadian rhythm.

Association Between COPD and Hearing Loss.

The goal of the present study was to estimate the risk of hearing impairment in patients with COPD using huge nationwide population. A retrospective case-control study was performed using the National Health Insurance Database in South Korea from 2002 through 2019. Totally 614,370 COPD patients and matched 2,170,504 control participants were selected at a 1:4 ratio. Hearing impairment was defined based on the registered data in the Ministry of Health and Welfare of Korea with six levels of severity of hearing impairment. The propensity score was calculated, and overlap-weighted multinomial logistic regression was used to calculate the odds ratios of COPD for hearing impairment. A total of 2.67% of COPD patients and 1.9% of control participants had hearing impairment. The COPD patients indicated 1.10-1.21 times higher odds for hearing impairment according to the severity of hearing impairment than the control group. In accordance with age and sex, the younger age group (<65 years old) and female group demonstrated higher odds for hearing impairment related to the presence of COPD. The high odds for hearing impairment in patients with COPD was consistent in all other subgroups, except for the underweight group. COPD was associated with an increased risk of hearing impairment in the general population in Korea. 3 Laryngoscope, 134:4716-4722, 2024.

In-hospital outcome of type A aortic dissection repair in patients with chronic obstructive pulmonary disease: A population study of National Inpatient Sample from 2015 to 2020

BackgroundChronic obstructive pulmonary disease (COPD) is a common comorbidity that has been linked to higher mortality and respiratory complications in cardiac surgery. However, the postoperative outcomes for COPD patients undergoing Type A Aortic Dissection (TAAD) repair remain unexplored. Thus, this study aimed to assess the impact of COPD on in-hospital outcomes of TAAD repair in a national registry. MethodsPatients undergoing TAAD repair were identified in National Inpatient Sample from the last quarter of 2015–2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without COPD, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer status were adjusted. ResultsThere were 701 (16.37 %) COPD patients and 3581 (83.63 %) non-COPD patients who went under TAAD repair, where the prevalence of COPD was higher than in the general population (6 %). COPD and non-COPD patients have comparable rates of in-hospital mortality (14.69 % vs 15.19 %, aOR 1.016, 95 CI 0.797–1.295, p = 0.9) and there was no indication of delayed surgery. However, COPD patients had a higher risk of mechanical ventilation (37.80 % vs 31.42 %, aOR 1.521, 95 CI 1.267–1.825, p < 0.01) and a higher rate of transferring out to other facilities (38.37 % vs 32.23 %, aOR 1.271, 95 CI 1.054–1.533, p = 0.01). In addition, COPD patients had a longer hospital length of stay (14.28 ± 11.32 vs 13.85 ± 12.78 days, F = 5.61, p = 0.01). ConclusionThe presence of COPD could be a risk factor for the development of aortic dissection. However, outcomes for COPD patients were largely similar to those without COPD. These findings can be valuable for preoperative assessments and tailoring perioperative care for COPD patients undergoing TAAD repair.

Associations of the Serum KL-6 with Severity and Prognosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

As a biomarker of alveolar-capillary basement membrane injury, Krebs von den Lungen-6 (KL-6) is involved in the occurrence and development of pulmonary diseases. However, the role of the KL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has yet to be elucidated. This prospective study was designed to clarify the associations of the serum KL-6 with the severity and prognosis in patients with AECOPD. This study enrolled 199 eligible AECOPD patients. Demographic data and clinical characteristics were recorded. Follow-up was tracked to evaluate acute exacerbation and death. The serum KL-6 concentration was measured via an enzyme-linked immunosorbent assay. Serum KL-6 level at admission was higher in AECOPD patients than in control subjects. The serum KL-6 concentration gradually elevated with increasing severity of AECOPD. Pearson and Spearman analyses revealed that the serum KL-6 concentration was positively correlated with the severity score, monocyte count and concentrations of C-reactive protein, interleukin-6, uric acid, and lactate dehydrogenase in AECOPD patients during hospitalization. A statistical analysis of long-term follow-up data showed that elevated KL-6 level at admission was associated with longer hospital stays, an increased risk of future frequent acute exacerbations, and increased severity of exacerbation in COPD patients. Serum KL-6 level at admission is positively correlated with increased disease severity, prolonged hospital stay and increased risk of future acute exacerbations in COPD patients. There are positive dose-response associations of elevated serum KL-6 with severity and poor prognosis in COPD patients. The serum KL-6 concentration could be a novel diagnostic and prognostic biomarker in AECOPD patients.

Increasing exercise capacity and physical activity in the COPD patient.

Higher levels of exercise capacity and physical activity are desired outcomes in the comprehensive management of the COPD patient. In addition, improvements in exercise capacity and physical activity are instrumental to optimising other important therapeutic goals, such as improved health status, reduced healthcare utilisation and increased survival. Four general approaches towards increasing exercise capacity and physical activity in individuals with COPD will be discussed in this review: 1) pharmacological intervention, especially the administration of long-acting bronchodilators; 2) pulmonary rehabilitation, including exercise training and collaborative self-management; 3) behavioural interventions; and 4) web-based interventions. These are by no means the only approaches, nor are they mutually exclusive: indeed, combining them, as necessary, to meet the needs of the individual respiratory patient may promote optimal outcomes, although further research is necessary in this area.

Effect of noninvasive ventilation combined with pulmonary rehabilitation on diaphragm function and serum inflammatory factors in COPD patients with hypercapnia.

Effect of noninvasive ventilation combined with pulmonary rehabilitation on diaphragm function and serum inflammatory factors in COPD patients with hypercapnia.

EPH172 Humanistic and Economic Burden Among COPD Patients in China: How Does It Compare With Other Common NCDs?

EPH172 Humanistic and Economic Burden Among COPD Patients in China: How Does It Compare With Other Common NCDs?

Inspiratory verses expiratory muscles Kinesio taping effect on dyspnea perception in COPD patient

Inspiratory verses expiratory muscles Kinesio taping effect on dyspnea perception in COPD patient

Elevated C-reactive protein and mortality risk among COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive disease associated with autoimmune systemic inflammation. The evidence on the role of C-reactive protein (-CRP) in predicting mortality among people with COPD remains mixed.MethodsData from the National Health and Nutrition Examination Survey (1999–2010) were linked with mortality files up to December 31st, 2019, from the National Death Index. Adults ages 20 years or older were included in the analytic sample to assess the relationship between physician-diagnosed self-reported COPD and mortality based on blood CRP levels. Multivariate complex samples Cox regression analyses were conducted to determine the hazards ratios (with 95% CI).ResultsA total of 30,669 individuals comprised of the final sample with 2215 deaths observed upon follow-up for an average of 10.2 years. Compared to individuals without COPD or elevated CRP, individuals with COPD but without elevated CRP (HR = 1.25, 95% CI = 0.97–1.61) did not have a significantly higher risk of mortality. However, those with both COPD and elevated CRP had a significantly higher risk of mortality (HR = 2.70, 95% CI = 1.08–6.81). Age, health insurance status, and a history of comorbidities modified these relationships.ConclusionsBiomarkers such as CRP continue to show promise for long-term COPD-related outcomes. Additional prospective assessments of individuals with airway obstruction are warranted to understand if CRP levels predict the occurrence or worsening of COPD and if those relate to long-term health outcomes.

CO1 The Rate of Ward to Intensive Care Transfer and Its Predictors Among Hospitalized COPD Patients: A Retrospective Study in a Local Tertiary Center in Saudi Arabia

CO1 The Rate of Ward to Intensive Care Transfer and Its Predictors Among Hospitalized COPD Patients: A Retrospective Study in a Local Tertiary Center in Saudi Arabia

The Accuracy of PUMA Questionnaire in Combination With Peak Expiratory Flow Rate to Identify At-risk, Undiagnosed COPD Patients

IntroductionThe English PUMA questionnaire emerges as an effective COPD case-finding tool. We aimed to use the PUMA questionnaire in combination with peak expiratory flow rate (PEFR) to improve case-finding efficacy in Chinese population. MethodsThis cross-sectional, observational study included two stages: translating English to Chinese PUMA (C-PUMA) questionnaire with linguistic validation and psychometric evaluation, followed by clinical validation. Eligible participants (with age ≥40 years, respiratory symptoms, smoking history ≥10 pack-years) were enrolled and subjected to three questionnaires (C-PUMA, COPD assessment test [CAT], and generic health survey [SF-12V2]), PEFR measurement, and confirmatory spirometry. The C-PUMA score and PEFR were incorporated into a PUMA-PEFR prediction model applying binary logistic regression coefficients to estimate the probability of COPD (PCOPD). ResultsC-PUMA was finalized through standard forward–backward translation processes and confirmation of good readability, comprehensibility, and reliability. In clinical validation, 240 participants completed the study. 78/240 (32.5%) were diagnosed with COPD. C-PUMA exhibited significant validity (correlated with CAT or physical component scores of SF-12V2, both P<0.05, respectively). PUMA-PEFR model had higher diagnostic accuracy than C-PUMA alone (area under ROC curve, 0.893 vs. 0.749, P<0.05). The best cutoff values of C-PUMA and PUMA-PEFR model (PCOPD) were ≥6 and ≥0.39, accounting for a sensitivity/specificity/numbers needed to screen of 77%/64%/3 and 79%/88%/2, respectively. C-PUMA ≥5 detected more underdiagnosed patients, up to 11.5% (vs. C-PUMA ≥6). ConclusionC-PUMA is well-validated. The PUMA-PEFR model provides more accurate and cost-effective case-finding efficacy than C-PUMA alone in at-risk, undiagnosed COPD patients. These tools can be useful to detect COPD early.

The association between six-minute walk test and one minute sit to stand test in patients with acute exacerbations of COPD

ABSTRACT Aim: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major complication of COPD and a leading cause of hospitalization, detrimentally affecting functional exercise capacity. The 6-minute walk test (6MWT) is a reliable measure of exercise capacity in chronic lung diseases. Conversely, the 1-minute sit-to-stand test (1STST) offers a simpler assessment of physical function. The aim was to demonstrate the association of functional exercise capacity assessed by 1STST and 6MWT in COPD patients with acute exacerbation. Materials and Methods: In this study, 37 hospitalized patients with acute exacerbation COPD (mean age:66 years) underwent assessments including pulmonary function testing, 6MWT, 1STST and modified Medical Research Council (MMRC). Parameters such as heart rate, oxygen saturation, and perceived dyspnea (via the modified Borg scale) were monitored during tests. Results: The results showed a significant correlation between 6MWT and 1STST performance (r=0.656, p&amp;lt;0.001). Notably, end-tidal oxygen saturation differed between tests, with the 6MWT showing higher end-tidal dyspnea scores. During recovery, 1STST induced increased heart rate and decreased oxygen saturation. Both 6MWT and 1STST were negatively associated with age and MMRC. Positive correlations were observed between 6MWT and FEV1(L) and PEF(L). Conclusions: Similar to the 6MWT, the 1STS test may be used to evaluate how well patients with AECOPD perform during functional exercise. We propose that the 1STST is a suitable alternative to the 6MWT for the assessment of functional exercise performance during hospitalization in AECOPD patients.

The effect of inhaler prescription on the development of lung cancer in COPD: a nationwide population-based study

BackgroundCOPD is associated with the development of lung cancer. A protective effect of inhaled corticosteroids (ICS) on lung cancer is still controversial. Hence, this study investigated the development of lung cancer according to inhaler prescription and comorbidties in COPD.MethodsA retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database. The development of lung cancer was investigated from the index date to December 31, 2020. This cohort included COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer during screening period or a switch of inhaler after the index date were excluded.ResultsOf the 63,442 eligible patients, 39,588 patients (62.4%) were in the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) group, 22,718 (35.8%) in the ICS/LABA group, and 1,136 (1.8%) in the LABA group. Multivariate analysis showed no significant difference in the development of lung cancer according to inhaler prescription. Multivariate analysis, adjusted for age, sex, and significant factors in the univariate analysis, demonstrated that diffuse interstitial lung disease (DILD) (HR = 2.68; 95%CI = 1.86–3.85), a higher Charlson Comorbidity Index score (HR = 1.05; 95%CI = 1.01–1.08), and two or more hospitalizations during screening period (HR = 1.19; 95%CI = 1.01–1.39), along with older age and male sex, were independently associated with the development of lung cancer.ConclusionOur data suggest that the development of lung cancer is not independently associated with inhaler prescription, but with coexisting DILD, a higher Charlson Comorbidity Index score, and frequent hospitalization.

Defining the role of exertional hypoxemia and pulmonary vasoconstriction on lung function decline, morbidity, and mortality in patients with chronic obstructive lung disease – the PROSA study: rationale and study design

BackgroundChronic obstructive lung disease (COPD) has diverse molecular pathomechanisms and clinical courses which, however, are not fully mirrored by current therapy. Intermittent hypoxemia is a driver of lung function decline and poor outcome, e.g., in patients with concomitant obstructive sleep apnea. Transient hypoxemia during physical exercise has been suggested to act in a similar manner. The PROSA study is designed to prospectively assess whether the clinical course of COPD patients with or without exertional desaturation differs, and to address potential pathophysiological mechanisms and biomarkers.Methods148 COPD patients (GOLD stage 2–3, groups B or C) will undergo exercise testing with continuous pulse oximetry. They will be followed for 36 months by spirometry, echocardiography, endothelial function testing, and biomarker analyses. Exercise testing will be performed by comparing the 6-min walk test (6MWT), bicycle ergometry, and a 15-sec breath-hold test. Exertional desaturation will be defined as SpO2 < 90% or delta-SpO2 ≥ 4% during the 6MWT. The primary endpoint will be the rate of decline of FEV1(LLN) between COPD patients with and without exertional desaturation.DiscussionThe PROSA Study is an investigator-initiated prospective study that was designed to prove or dismiss the hypothesis that COPD patients with exertional desaturation have a significantly more rapid rate of decline of lung function as compared to non-desaturators. A 20% difference in the primary endpoint was considered clinically significant; it can be detected with a power of 90%. If the primary endpoint will be met, exercise testing with continuous pulse oximetry can be used as a ubiquitously available, easy screening tool to prospectively assess the risk of rapid lung function decline in COPD patients at an early disease stage. This will allow to introduce personalized, risk-adapted therapy to improve COPD outcome in the long run. PROSA is exclusively funded by public funds provided by the European Research Council through an ERC Advanced Grant. Patient recruitment is ongoing; the PROSA results are expected to be available in 2028.Trial registrationThe PROSA Study has been prospectively registered at clinicaltrials.gov (register no. NCT06265623, dated 09.02.2024).