Stages Of COPD Research Articles

DO disease stages affect oxidative stress in stable COPD?

BackgroundDetection of oxidative stress level may lead us to understand the pathogenesis of COPD better and to search for new treatments. Oxidative stress levels have also been shown to be elevated in stable COPD patients. We aimed to investigate whether the stage of COPD affects the severity of inflammation-induced oxidative stress in patients with stable COPD. MethodsBetween June 2019 and March 2020, all consecutive patients admitted to COPD-specific outpatient clinics were included. Patients were classified A, B, and E according to the GOLD guideline. ResultsThe median age of 98 patients (Male: 92 (93.9 %)) was 65 (min-max: 49–86). A statistically significant difference was found between the groups in FEV1, FVC, and FEV1/FVC (p < 0.001). age, and thiols (r = −0.168, p = 0.049; r = −0.184, p = 0.035) and DS (r = −0.209, p = 0.019) were found to be negatively correlated at a low level. When adjusted for age, oxidative stress parameters were similar between stages. ConclusionNo difference between stages and oxidative stress parameters according to GOLD classification in stable COPD patients. Our results may be a guide for not using anti-inflammatory therapy except for attacks.

Discriminative potential of exhaled breath condensate biomarkers with respect to chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) affecting 334 million people in the world remains a major cause of morbidity and mortality. Proper diagnosis of COPD is still a challenge and largely solely based on spirometric criteria. We aimed to investigate the potential of nitrosative/oxidative stress and related metabolic biomarkers in exhaled breath condensate (EBC) to discriminate COPD patients.MethodsThree hundred three participants were randomly selected from a 15,000-transit worker cohort within the Respiratory disease Occupational Biomonitoring Collaborative Project (ROBoCoP). COPD was defined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second to Forced Vital Capacity < 0.7 in spirometry validated by an experienced pulmonologist. Discriminative power of biomarker profiles in EBC was analyzed using linear discriminant analyses.ResultsAmongst 300 participants with validated spirometry, 50.3% were female, 52.3 years old in average, 36.0% were current smokers, 12.7% ex-smokers with mean tobacco exposure of 15.4 pack-years. Twenty-one participants (7.0%) were diagnosed as COPD, including 19 new diagnoses, 12 of which with a mild COPD stage (GOLD 1). Amongst 8 biomarkers measured in EBC, combination of 2 biomarkers, Lactate and Malondialdehyde (MDA) significantly discriminated COPD subjects from non-COPD, with a 71%-accuracy, area under the receiver curve of 0.78 (p-value < 0.001), and a negative predictive value of 96%.ConclusionsThese findings support the potential of biomarkers in EBC, in particular lactate and MDA, to discriminate COPD patients even at a mild or moderate stage. These EBC biomarkers present a non-invasive and drugless technique, which can improve COPD diagnosis in the future.

High-Dimensional Mass Cytometry Reveals Emphysema-associated Changes in the Pulmonary Immune System.

Rationale: Chronic inflammation plays an important role in alveolar tissue damage in emphysema, but the underlying immune alterations and cellular interactions are incompletely understood. Objectives: To explore disease-specific pulmonary immune cell alterations and cellular interactions in emphysema. Methods: We used single-cell mass cytometry (CyTOF) to compare the immune compartment in alveolar tissue from 15 patients with severe emphysema and 5 control subjects. Imaging mass cytometry (IMC) was applied to identify altered cell-cell interactions in alveolar tissue from patients with emphysema (n = 12) compared with control subjects (n = 8). Measurements and Main Results: We observed higher percentages of central memory CD4 T cells in combination with lower proportions of effector memory CD4 T cells in emphysema. In addition, proportions of cytotoxic central memory CD8 T cells and CD127+CD27+CD69- T cells were higher in emphysema, the latter potentially reflecting an influx of circulating lymphocytes into the lungs. Central memory CD8 T cells, isolated from alveolar tissue from patients with emphysema, exhibited an IFN-γ response upon anti-CD3 and anti-CD28 activation. Proportions of CD1c+ dendritic cells, expressing migratory and costimulatory markers, were higher in emphysema. Importantly, IMC enabled us to visualize increased spatial colocalization of CD1c+ dendritic cells and CD8 T cells in emphysema in situ. Conclusions: Using CyTOF, we characterized the alterations of the immune cell signature in alveolar tissue from patients with chronic obstructive pulmonary disease stage III or IV emphysema versus control lung tissue. These data contribute to a better understanding of the pathogenesis of emphysema and highlight the feasibility of interrogating the immune cell signature using CyTOF and IMC in human lung tissue. Clinical trial registered with www.clinicaltrials.gov (NCT04918706).

Screening and staging of chronic obstructive pulmonary disease with deep learning based on chest X-ray images and clinical parameters

BackgroundChronic obstructive pulmonary disease (COPD) is underdiagnosed with the current gold standard measure pulmonary function test (PFT). A more sensitive and simple option for early detection and severity evaluation of COPD could benefit practitioners and patients.MethodsIn this multicenter retrospective study, frontal chest X-ray (CXR) images and related clinical information of 1055 participants were collected and processed. Different deep learning algorithms and transfer learning models were trained to classify COPD based on clinical data and CXR images from 666 subjects, and validated in internal test set based on 284 participants. External test including 105 participants was also performed to verify the generalization ability of the learning algorithms in diagnosing COPD. Meanwhile, the model was further used to evaluate disease severity of COPD by predicting different grads.ResultsThe Ensemble model showed an AUC of 0.969 in distinguishing COPD by simultaneously extracting fusion features of clinical parameters and CXR images in internal test, better than models that used clinical parameters (AUC = 0.963) or images (AUC = 0.946) only. For the external test set, the AUC slightly declined to 0.934 in predicting COPD based on clinical parameters and CXR images. When applying the Ensemble model to determine disease severity of COPD, the AUC reached 0.894 for three-classification and 0.852 for five-classification respectively.ConclusionThe present study used DL algorithms to screen COPD and predict disease severity based on CXR imaging and clinical parameters. The models showed good performance and the approach might be an effective case-finding tool with low radiation dose for COPD diagnosis and staging.

Impact of COPD stage on self management with COPD patients: The mediating role of symptoms management.

It is extremely important to determine the relationship between COPD and self-management (SM) in the disease process. However, the impact of symptom management (SpM) on this relationship is still unclear. The study aimed to examine the mediating role of SpM in the effect of the COPD stage on SM. A predictive correlational study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study was conducted between 15 February 2023 and 15 June 15 2023, with 306 patients. Data were collected using the Symptom Management Scale for Self-Efficacy and the Chronic Disease Self-Management Scale. Descriptive statistics and Process Macro Model 4 in the SPSS program were used for data analysis. Most of the patients were in the moderate stage of COPD; their SM scores were at low levels; SpM scores were at moderate levels. The model was significant, and the variables explained 65% of the model. The COPD stage was significantly positively correlated with SpM and negatively correlated with SM. There was a significant positive impact between SpM and SM. The positive and significant standardised indirect effect of SpM on SM evidenced a full mediating effect. Symptom management has a full mediating role in the effect of the COPD stage on SM. It was revealed that the level of SM can be increased by achieving SpM. Symptoms are vital in COPD. Progression of COPD increases symptom severity. Being successful in SpM greatly contributes to the achievement of self-management. Therefore, nurses should definitely consider symptom control in strengthening self-management in the care of patients with COPD. Patients' COPD stage was determined by a pulmonologist involved in the study. Voluntary patients with COPD hospitalised in the pulmonology clinic were included in the study.

COPD and Smoking Status - It Does Matter: Characteristics and Prognosis of COPD According to Smoking Status.

Chronic obstructive pulmonary disease is a chronic, often progressive disease, which in most patients is caused by tobacco smoking. Our study focuses on differences in COPD-related outcomes between never smokers, former smokers, and current smokers. A nationwide, population-based cohort study utilizing Danish health registries. Clinical and socioeconomic variables including smoking status, comorbidities, and dyspnea were obtained. Poisson and Cox Regression were used to calculate the impact of these clinical parameters on the risk of moderate and severe exacerbations and mortality during 12 months of follow-up. A total of 49,826 patients ≥40 years of age, with a hospital diagnosis of COPD in 2008-2017, were identified (mean age 69.2 years, 52% females). A total of 2127 (4%) were never smokers, 29,854 (60%) were former smokers and 17,845 (36%) current smokers. Compared to former and current smokers, never smokers reported a lower modified Medical Research Council score and had a milder COPD stage according to the Global Initiative for Chronic Obstructive Lung Disease classification. During follow-up, never smokers had a significantly lower risk of severe exacerbations (hazard ratio 0.87, 95% confidence interval [CI] 0.78-0.97) and a lower rate of death (mortality ratio 0.75, 95% CI 0.70-0.81) compared to patients with a smoking history. Our nationwide study showed that COPD in never smokers is characterized by a lower level of dyspnea, milder lung function impairment, and a lower risk of exacerbations and death. At the same time, we found active smokers to have the highest risk. These findings highlight the need for campaigns to prevent smoking and may help general practitioners as well as other health care professionals to motivate patients with COPD to stop smoking.

Which metrics are preferred to evaluate left ventricular function during successive stages of COPD?

Which metrics are preferred to evaluate left ventricular function during successive stages of COPD?

Minimal-Resource Home Exercise Program Improves Activities of Daily Living, Perceived Health Status, and Shortness of Breath in Individuals with COPD Stages GOLD II to IV

Home exercises (HE) with minimal resources seem to be useful in individuals with COPD. The objective was to evaluate the effects of HE, on activities of daily living (ADL), dyspnea, on the health status(CAT) and quality of life (HRQoL) of individuals with COPD GOLD II to IV. Quasi-experimental study of the effects of HE, for 2 months, 3 times a week. Individuals with COPD(n = 45) were recruited, 37 started the protocol(9 did not complete it). 28 individuals (mean age 62.04 ± 5.8 years, FEV1: 44.7 ± 2.25%, FEV1/FVC 59.8 ± 6.9%) were evaluated before and after training. We observed improvements in the ADL-Glittre (4.9 ± 1.4 vs 3.9 ± 1.1 min; mean difference: −0.9 ± 0.2 min [95%CI: −1.3 to −0.2]; p = 0.008), as well as the mMRC score(2.8 ± 1.1 vs 2.07 ± 0.81; mean difference: 0.7 ± 0.3 [95%CI: −1.20.18 to −0.2]; p = 0.009), and in the CAT (25.6 ± 4.8 vs 18.9 ± 3.1; mean difference: −6.6 ± 3.4 [95%CI: −10.6 to −1.6]; p = 0.042). Analyzing the mean change before and after the intervention, a weak correlation was observed between ADL-Glittre and mMRC (r = 0.35; [95% CI 0.09; 0.56]; p = 0.009); moderate between ADL-Glittre and CAT (r = 0.52; [95% CI 0.30; 0.69]; p < 0.001) and between ADL-Glittre and SGRQ (r = 0.50; [95% CI 0 .27; 0.67]; p < 0.001). Individuals with COPD can benefit from HE performed autonomously and with minimal resources, as this proposal improves functional capacity for ADL, health perception and dyspnea.

Metabolic syndrome (mets) as one of the major comorbidities of chronic obstructive pulmonary disease (copd)

Aim: We aimed to investigate the association between COPD and MetS, the relation to the severity of airflow limitation. Methods: This is a cross-sectional study including 220 patients with initially diagnosed COPD (IG), aged 40 to 75 years and 58 non-COPD subjects matched by age, smoking status, body mass index, as controls (CG). All study participants underwent anthropometric measurements, fasting blood sugar (FBS), lipid profile, pulmonary evaluation (dyspnea severity assessment, baseline and postbronchodilator spirometry, gas analyses, chest X-ray). Results: Results presented statistically significant difference in presence of MetS in COPD patients compared to controls (32.27% vs 10.34%; P=0.0009). According to the GOLD classification, the frequencies of MetS in COPD patients were categorized in stages I, II, III, IV (17.54%, 37.10%, 34.62%, 40.82%, respectively). The proportion of patients with increased glycemic values was: a) GOLD1 - 18 (31.58%); b) GOLD 2 - 32 (51.61%); c) GOLD3 - 29 (55.77%); and d) GOLD4 - 31 (63.27%). There was no significant difference between IG and CG patients regarding HDL level. According to arterial hypertension the highest proportion was observed in GOLD3 - 22 (42.31%) followed by GOLD4 - 20 (40.82%), and GOLD3 - 22 (35.48 %), smallest in GOLD1 - 17 (29.82%). Conclusion: We found higher prevalence of MetS in patients with COPD even in early COPD stages compared to non-COPD. Our findings suggest an urgent need to develop comprehensive strategies for prevention, screening and start of treatment in early stage.

Lymphoid Follicle Transcriptome Reveals Maladaptive Immune Responses In Severe Chronic Obstructive Pulmonary Disease (COPD).

Abstract Rationale: Increases in the number and size of lymphoid follicles (LFs) are present in severe stages of COPD and have not been fully characterized. HLA complex is crucial in enabling the immune system to recognize “self” versus “non-self” antigens and plays a major role in immune responses to cigarette smoke exposure. Methods: Lung follicles from COPD patients with milder (GOLD I–II) and more severe (GOLD III–IV) COPD were sampled using GeoMX® Digital Spatial Transcriptional Profiling. Data were analyzed and normalized using GeoMx® DSP Analysis Suite. Results: Pathway analysis showed that B cell activation pathways had the highest fold enrichment. GOLD I–II compared to GOLD III–IV COPD patients had the highest expression of HLA-Cand its ligands (KIR2DS2, KIR2DS1, KIR3DL1; p&amp;lt;0.0001) which facilitate CD8-mediated cytotoxicity, and HLA-Gand its receptor LILRB4(p=0.01) which are key modulators of immune tolerance. GOLD III–IV COPD patients had the highest HLA enrichment in LFs, with upregulation of transcription factors (HIF1A, IRF1, NFYBand NFYC) and assembly components (CALR, TAPBP, ERP27, MARCHF1, B2M, and CIITA) of HLA (p&amp;lt;0.01). Compared to GOLD I–II, LFs from GOLD III–IV COPD patients had much higher expression of HLAs involved in autoimmune responses to self-antigens and adaptive immune evasion, such HLA-DRA, HLA-DRB1, HLA-DPA1, HLA-DPB1, HLA-DQA1, HLA-DQB1, HLA-Eand HLA-B(p&amp;lt;0.0001). Conclusions: We show for the first time that LFs from patients with severe COPD are characterized by expression of HLAs associated with immune evasion and autoimmune responses, whereas LFs in milder stages of COPD are characterized by induction of immune responses controlled by tolerance mechanisms R01 HL 149744-04/06

COPD and Depression Analysis in Regard to Obstructive Pulmonary Levels.

Depression symptoms take place recurrently in patients suffering from COPD. This study aims to assess the effects of antidepressant therapy in patients with COPD and a depressive disorder in relation to COPD levels. The study population consisted of N = 87 patients diagnosed with COPD, according to the GOLD criteria, and a depressive disorder. All of the patients were subjected to clinical and psychiatric exploration according to psychiatric assessment instruments, which was followed by SSRI therapy for the duration of 8 weeks. The main methods used were descriptive statistics and analysis of variance. The results showed a different distribution of depressive symptoms at a different stage of COPD by FEV1 (χ2 = 30.47, df = 6, p < 0.01) and by mMRC (χ2 = 34.6, df = 6, p < 0.01). After the application of SSRIs, there was a significant improvement in HDRS scores in all stages of COPD by FEV1 (χ2 = 251.62, df = 9, p < 0.01) and by mMRC (χ2 = 919.17, df = 9, p < 0.01). This study contributes to the improvement in the quality of life of patients by the targeted application of SSRI therapy and, therefore, more precise and better overall treatment results.

Fractional Dynamics Foster Deep Learning of COPD Stage Prediction (Adv. Sci. 12/2023)

Deep Learning Analyzing physiological signals with fractional dynamics reduces the learning complexity for automated diagnosis with deep learning. In article number 2203485, Mihai Udrescu, Paul Bogdan, and co-workers show that fractional-order dynamical modeling can extract distinguishing signatures from the physiological signals recorded in COPD patients, then use fractional signatures to develop and train a deep neural network that accurately predicts COPD stages—a robust alternative to spirometry.

Possibilities of treatment of patients with chronic obstructive pulmonary disease: long-term follow-up results after the use of beta-glucans

Objective — to study long-term follow-up results after the use of beta-glucans in сhronic obstructive pulmonary disease (COPD) patients with frequent exacerbations. Materials and methods. 42 patients with COPD (group C according to the GOLD classification) were under our supervision for 2 years. Patients had 2 to 4 clinical exacerbations during the previous year. They have been randomized into 2 groups with beta-glucans treatment and without it. Results and discussion. In the patients with COPD a significant decrease in the indicators of cellular immunity was observed, which was manifested primarily by a decrease in the number of cells with natural killer activity and cells of the monocyte-macrophage series, as well as a significant decrease in the immunoregulatory ratio CD4+/CD8+. As a result, after 1 year of observation 2 patients progressed to a more severe COPD stage (from the second to the third due to repeated infectious exacerbations), and after 2 years — another 3 (15.0 %). The prescription of beta-glucans leads to the increasing of cells with the activity of natural killers (p &lt; 0.05) and cells of the monocyte-macrophage pull (CD14+, p &lt; 0.05), and to the normalization of the CD4+/CD8+ index (p &lt; 0.05). These changes were largely leveled off by the end of the second year of observation. The use of Immunsil D3 (Nutrimed, Ukraine) for 1 month reduced the number of exacerbations of COPD (p &gt; 0.05) and significantly reduced the need for antibiotics prescription in patients with COPD (p &lt; 0.05) within 1 year after treatment. During the next year of observation, the difference between the groups was significantly less pronounced. Conclusions. Prescription of beta-glucans can be recommended for patients with COPD with frequent clinical exacerbations (groups C and D). It is needful to repeat the course of treatment with beta-glucans annually in patients with frequent clinical exacerbations of COPD.

Revealing EXPH5 as a potential diagnostic gene biomarker of the late stage of COPD based on machine learning analysis

Chronic obstructive pulmonary disease is a kind of chronic lung disease characterized by persistent air flow obstruction, which was the third leading cause of death in China. The incidence of COPD is steadily and increasing and has been a globally sever disease. Accordingly, it is urgently needed to explore how to diagnose and treat COPD timely. This study aims to find key genes to diagnose COPD as soon as possible to avoid COPD processing and analyze immune cell infiltration between COPD early stage and late stage. Two GEO datasets were merged as the merge data for analyses. 157 DEGs were used for GSEA analysis to find the pathway between COPD early stage and late stage. Above all, gene EXPH5 stood out from the screen as the most likely candidate diagnosis biomarker of COPD indicating the late-stage by least LASSO and SVM-RFE. ROC curves of EXPH5 were applied to represent the discriminatory ability through the area under the curve which is the gold standard to evaluate the accuracy of diagnosis and survival rate. The CIBERSORT algorithm was used to assess the distribution of tissue-infiltrating immune cells between two COPD stages. The diagnosis biomarker, gene EXPH5 had a positive correlation with NK cells resting; mast cell resting, eosinophils, and negative correlation with T cell gamma delta, macrophages M1, which underscore the role of gene and immune cell infiltration. To make results more reliable, we further analyzed the gene EXPH5 expression in single-cell transcriptome data and showed again that EXPH5 genes significantly downregulated in the late stage of COPD especially in the main lung cell types AT1 and AT2. In a word, our study identified genes EXPH5 as a marker gene, which adds to the knowledge for clinical diagnosis and pharmaceutical design of COPD.

Body Mass Index as a Predictor of Quality of life of Patients with Chronic Obstructive Pulmonary Disease

Background and Aim: Studies have reported that excessive weight and obesity are common in the early stages ofCOPD, and malnutrition is common in moderate and severe COPD. COPD is known to show “obesity paradox”i.e., obese and overweight COPD patients have better outcome of disease as compared to underweights. The aimof the study was to assess the BMI of COPD patients, its distribution and relationship with various factors.Material and Methods: Present study was conducted at tertiary care institute of India for the duration of oneyear. Total 400 COPD patients were selected to assess their body mass index (BMI) using Quetelet’s formula.Study subjects were selected using a systematic random sampling method. Study subjects were categorized as perWHO’s classification of BMI for Asian populations.Results: Out of a total of 400 subjects enrolled in the study, majority (49%) were obese followed by 35% overweightsand 7% underweights. Health-related quality of life of undernourished patients was most affected. A statisticallysignificant relation was seen across all the components of SGRQ.Conclusion: Present research established that, the disease related malnutrition is common in COPD patients,therefore, BMI might be a useful indicator to predict the prognosis of disease. This calls for an urgent need by ourprimary care physicians to provide simultaneous weight management interventions in COPD patients so as toimprove their nutritional status, enhance the strength of respiratory muscles and reduce the inflammation whichwill be effective in long-term management of the disease.

Implementation of a pharmacist-led spirometry clinic

BackgroundChronic obstructive pulmonary disease (COPD) is one of the most common chronic conditions, with spirometry serving as the gold standard for diagnosis. However, a lack of available resources, providers, and time limits appropriate diagnosis of COPD and disease staging. These factors culminate in suboptimal therapeutic management of the disease and often pharmacotherapy regimens that are not supported by Global Initiative for Chronic Obstructive Lung Disease guidelines. ObjectivesThe primary objective of the study was to develop and implement a pharmacist-led spirometry clinic to assess the confirmation of COPD diagnosis and pharmacotherapy management. Practice descriptionTwo federally qualified health centers (FQHCs) in Ohio: Family Health Services of Darke County (FHS) and Rocking Horse Community Health Center (RHCHC). Both FQHCs have clinical pharmacists on staff who provide disease state management services for chronic disease states through a collaborative practice agreement. Practice innovationAt each FQHC, a pharmacist-led COPD and spirometry management service was implemented. This service consisted of disease state education, therapy modifications, and spirometry services for annual and confirmation of diagnosis for COPD patients. Evaluation methodsA retrospective chart review was conducted. Data collection occurred from December 2021 to May 2022. Patients included were 18 years and older with a confirmed diagnosis of COPD. Therapies before spirometry services, COPD assessment test scores, age, gender, and history of exacerbations within the last 12 months were collected. ResultsEight patients at FHS and 1 patient at RHCHC were included in the data analysis. Two patients had their disease state confirmed after postbronchodilator spirometry. Five pharmacotherapy modifications were made for patients evaluated in the analysis. ConclusionPharmacists in FQHC’s are crucial resources to design, implement, and lead spirometry services for the management of COPD within the primary care setting, therefore increasing adherence to guideline recommendations.

CORRELATION OF 6MWD WITH FEV1% &amp; DLCO% IN COPD PATIENTS

BACKGROUND: Chronic obstructive pulmonary disease is the third leading cause of death worldwide, causing 3.23 million deaths in 2019 according to WHO. Nearly 90% of COPD deaths in those under 70 years of age occur in low and middle income countries (LMIC). There may be a considerable nancial burden due to limitation of workplace and home productivity, and costs of medical treatment. Spirometry is used not only for conforming the diagnosis but also for grading the severity of COPD. 6MWD test has gained importance's in the assessments of functional exercise capacity in patients with COPD and other Respiratory diseases. Diffusion Capacity of the Lung for Carbon Monoxide (DLCO) has been employed as an additional investigation to aid in assessing the properties of gas transfer in many respiratory diseases. It is a hospital based cross sectional and analytic MATERIALS AND METHODS: al study performed over a period of 12 months (June 2021-june 2022) in the department of Respiratory medicine, Narayana medical college and hospital, Nellore, in 30 patients diagnosed with COPD and patients were subjected to 6MWD, spirometry and DLCO. RESULTS: Correlation between FEV1% &amp; DLCO%, FEV1% &amp; 6MWD and DLCO% &amp; 6MWD were done respectively. Among the rst correlation(FEV1% &amp; DLCO%) there is a statistically signicant moderate and strong positive correlation observed in severe and very severe patients respectively. Among the second correlation (FEV1% &amp; 6MWD) only in the whole sample there is statistically signicant moderate positive correlation observed. Among the third correlation (DLCO% &amp; 6MWD) only in severe patients of COPD there is a statistically signicant moderate positive correlation observed. There is a slightly greater correlation for DLCO% &amp; 6MWD compared to FEV1%. In CONCLUSION: severe COPD patients decline in 6MWD can be used to monitor the disease progression where as the decline in DLCO% can be used to keep track of the severe and very severe stages of COPD. Incorporating of DLCO in grading COPD severity can help as a marker of exercise capacity limitation.

The Lognormal Lung: A new approach to quantifying lung inhomogeneity in COPD.

Early diagnosis and disease phenotyping in COPD are currently limited by the use of spirometry, which may remain normal despite significant small-airways disease and which may not fully capture a patient's underlying pathophysiology. In this study we explored the use of a new non-invasive technique that assesses gas-exchange inhomogeneity in patients with COPD of varying disease severity (according to GOLD Stage), compared with age-matched healthy controls. The technique, which combines highly accurate measurement of respiratory gas exchange using a bespoke molecular flow sensor and a mechanistic mathematical model of the lung, provides new indices of lung function: the parameters σCL, σCd, and σVD represent the standard deviations of distributions for alveolar compliance, anatomical deadspace and vascular conductance relative to lung volume, respectively. It also provides parameter estimates for total anatomical deadspace and functional residual capacity (FRC). We demonstrate that these parameters are robust and sensitive, and that they can distinguish between healthy individuals and those with mild-moderate COPD (stage 1-2), as well as distinguish between mild-moderate COPD (stage 1-2) and more severe (stage 3-4) COPD. In particular, σCL, a measure of unevenness in lung inflation/deflation, could represent a more sensitive non-invasive marker of early or mild COPD. In addition, by providing a multi-dimensional assessment of lung physiology, this technique may also give insight into the underlying pathophysiological phenotype for individual patients. These preliminary results warrant further investigation in larger clinical research studies, including interventional trials.

Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity

Introduction: The COPD is a serious epidemic-level public health issue. Patients with COPD have been found to have low vitamin D serum levels in a number of studies. Aim: The goal of the study was to determine whether there was a relationship between vitamin D serum levels and the severity of COPD by comparing the levels in COPD patients at stages II, III, and IV to those in the control group. Study Design: A Cross-sectional study Place and Duration: In the Pulmonology department of Lady Reading Hospital, Peshawar and District Headquarter Hospital, Timergara Dir-Lower KPK during the period from January 2022 to June 2022. Methods: The study included 140 participants in total, including 70 COPD patients and 70 controls for comparison. Patients were included from the outpatient department and medical wards. According to GOLD guidelines, advanced COPD staging II, III, and IV were done. In SPSS 21.0, inferential and descriptive statistics were accomplished. Results: COPD was found in 34.3%, 37.1%, and 28.6% of people in stages II, III, and IV, respectively. There was a statistically significant relationship between lower vitamin D levels and advanced COPD patients, with the mean vitamin D serum concentration in COPD patients being 16.01 ng/ml and the vitamin D mean concentration in healthy controls being 35.98 ng/ml. (p&lt;0.0001). The severity of COPD was supposed to be inversely related with vitamin D serum levels. Conclusions: The vitamin D serum levels were found lesser in patients with advanced COPD (stages II, III, and IV) than in the general population correlated with GOLD staging. Keywords: Global initiative for chronic obstructive lung diseases; Chronic obstructive pulmonary disease and Vitamin D levels

سوء وظيفة البطين الأيسر عند مرضى الداء الرئوي الانسدادي المزمن

Objective: studying the effects of chronic obstructive pulmonary disease on left ventricle (LV) systolic and diastolic functions. Patients and Methods: A total of 70 cases of diagnosed chronic obstructive pulmonary disease patients (Current smokers or quitters) with 70 age, sex matched healthy control subjects were included in this study. This study was conducted at the Cardiology and pulmonolgy departments in Tishreen University Hospital in Lattakia Syria. All patients with COPD underwent for 2D Echocardiography and the same was done for the controls. . Results: We note a decrease in the mean values of the left ventricular ejection fraction (LVEF) in patients (53.85±6.5) compared to the controls (63.12 ± 4.1%) with (P&lt;0.05). And within the group of cases, it was decreasing with the increasing stage of COPD. Diastolic dysfunction was noticed in patients with COPD. In patients, there was a statistically significant increase in IVRT [ 93.87±12.4 ms] VS.[ 77.49±1.6 ms] in control group (P&lt;0.05) and it is increasing with the increasing stage of COPD. We noticed a statistically significant increase in Myocardial Performance Index(MPI) in COPD patients [0.49±0.05] VS. [0.37±0.01] in control group (P&lt;0.05) and also increases with the increasing stage of COPD. Conclusion: In patients with chronic obstructive pulmonary disease, LV systolic function decreases, LV diastolic dysfunction increases and MPI also increases which reflect both systolic and diastolic LV dysfunction and both of them increases with increasing stage of COPD.