Disease In COPD Patients Research Articles

Naloxone combined with non-invasive ventilation for the treatment of chronic obstructive pulmonary disease based on radioactive X-ray image inspection

The purpose of this study was to investigate the application of radiography in patients with COPD and analyze its value in diagnosis and evaluation. During radiological X-rays, patients wear specific lead protective equipment to reduce radiation exposure and obtain images from different angles and fields of view. The obtained X-ray images were evaluated and analyzed to examine the structural and morphological features of the lung tissue. In this study, the treatment scheme of naloxone combined with salbutamol combined with non-invasive ventilator was adopted, which improved the effectiveness and accuracy of treatment by supporting the computer medical image segmentation recognition system. The analysis results showed that the respiratory function of patients in naloxone combined with non-invasive ventilation treatment group was significantly improved after treatment, and the lung image characteristics also had positive changes. Compared with the conventional treatment group, naloxone combined with noninvasive ventilation has significant advantages in improving ventilation function and reducing pulmonary disease in COPD patients. Naloxone combined with non-invasive ventilation based on medical image recognition has the potential to improve the condition of COPD patients and predict treatment response. The results of this study provide a new idea for the treatment of COPD patients and provide a reference for further optimization of treatment.

Frequency of Gastroesophageal Reflux Disease in Chronic Obstructive Pulmonary Disease Patients

Background: About 20% to 30% of the general population, especially in individuals with old age, suffers from gastroesophageal reflux disease. Association between gastroesophageal reflux disease and chronic obstructive pulmonary disease has been reported in numerous studies. Objective: To find out the frequency of gastroesophageal reflux disease in chronic obstructive pulmonary disease patients Methodology: This cross-sectional study was carried out at the department of Pulmonology, Fatima Jinnah Institute of Chest Diseases and Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex Quetta from December 2021 to May 2022. The inclusion criteria for our study were all the patients of either gender in age range 18 to 60 years diagnosed with COPD of any severity level. A proforma developed solely for this research was used to record all the data. All the collected data was analyzed by using SPSS version 23. Results: In our study, totally 180 patients were enrolled. There were 120 (66.67%) male participants and 60 (33.33%) female participants in our study. The overall frequency of gastro-esophageal reflux disease in COPD patients was 93 (51.67%). The frequency of gastro-esophageal reflux disease in mild, moderate severe and very severe COPD patients COPD patients was 4 (44.44%), 39 (48.15%), 38 (52.78%) and 12 (66.66%) respectively. Conclusion: Our study concludes that the frequency of gastroesophageal reflux disease is high in chronic obstructive pulmonary disease patients. Based on our results, every patient who presents with COPD should be screened for GERD. Keywords: Frequency, gastroesophageal reflux disease, chronic obstructive pulmonary disease

Factors associated with coronary heart disease in COPD patients and controls.

COPD and coronary heart disease (CHD) frequently co-occur, yet which COPD phenotypes are most prone to CHD is poorly understood. The aim of this study was to see whether COPD patients did have a true higher risk for CHD than subjects without COPD, and to examine a range of potential factors associated with CHD in COPD patients and controls. 347 COPD patients and 428 non-COPD controls, were invited for coronary computed tomography angiography (CCTA) and pulmonary CT. Arterial blood gas, bioelectrical impedance and lung function was measured, and a detailed medical history taken. The CCTA was evaluated for significant coronary stenosis and calcium score (CaSc), and emphysema defined as >10% of total area <-950 Hounsfield units. 12.6% of the COPD patients and 5.7% of the controls had coronary stenosis (p<0.01), whereas 55.9% of the COPD patients had a CaSc>100 compared to 31.6% of the controls (p<0.01). In a multivariable model adjusting for sex, age, body composition, pack-years, CRP, cholesterol/blood pressure lowering medication use and diabetes mellitus, the OR (95% CI) for having significant stenosis was 1.80 (0.86-3.78) in COPD patients compared with controls. In a similar model, the OR (95% CI) for having CaSc>100 was 1.68 (1.12-2.53) in COPD patients compared with controls. Examining the risk of significant stenosis and CaSc>100 among COPD patients, no variable was associated with significant stenosis, whereas male sex [OR 2.85 (1.56-5.21)], age [OR 3.74 (2.42-5.77)], statin use [OR 2.23 (1.23-4.50)] were associated with CaSc>100, after adjusting for body composition, pack-years, C-reactive protein, use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diabetes, emphysema score, GOLD category, exacerbation frequency, eosinophilia, and hypoxemia. COPD patients were more likely to have CHD, but neither emphysema score, lung function, exacerbation frequency, nor hypoxemia predicted presence of either coronary stenosis or CaSc>100.

Does The Mean Platelet Volume (MPV) Have Any Importance In the Evaluation of Cardiovascular Disease In COPD Patients?

Does The Mean Platelet Volume (MPV) Have Any Importance In the Evaluation of Cardiovascular Disease In COPD Patients?

An Assessment of Cognitive Dysfunction among COPD Patients

Introduction: The brain, in particular, may be vulnerable to the systemic effects of COPD. Cognitive dysfunction is associated with increased mortality and disability; however, it remains poorly understood in COPD. The hypoxemia seen in some patients with COPD seems to be a crucial factor for cognitive impairment, because it affects the oxygen dependent enzymes that are important in the synthesis of neurotransmitters such as acetylcholine. Methods and Material: 40 COPD patients were subjected to SMMSE questionnaire, and then statistical analysis were conducted between their FEV1 and SMMSE questionnaire score, and between MMRC dyspnea scale score and SMMSE score. Results: Mild cognitive impairment was found in COPD patients and there was significant positive correlation was found between SMMSE score with FEV1, and significant negative correlation between SMMSE score and MMRC score. Conclusion: Cognitive impairment was significantly correlated with severity of disease in COPD patients. For early identification of cognitive dysfunction of COPD patients by SMMSE will defiantly helpful to physician to assess the cognitive function.

Chronic obstructive pulmonary disease and coronary disease: COPDCoRi, a simple and effective algorithm for predicting the risk of coronary artery disease in COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) is often associated with cardiovascular artery disease (CAD), representing a potential and independent risk factor for cardiovascular morbidity. Therefore, the aim of this study was to identify an algorithm for predicting the risk of CAD in COPD patients. MethodsWe analyzed data of patients afferent to the Cardiology ward and the Respiratory Diseases outpatient clinic of Tor Vergata University (2010–2012, 1596 records). The study population was clustered as training population (COPD patients undergoing coronary arteriography), control population (non-COPD patients undergoing coronary arteriography), test population (COPD patients whose records reported information on the coronary status). The predicting model was built via causal relationship between variables, stepwise binary logistic regression and Hosmer–Lemeshow analysis. The algorithm was validated via split-sample validation method and receiver operating characteristics (ROC) curve analysis. The diagnostic accuracy was assessed. ResultsIn training population the variables gender (men/women OR: 1.7, 95%CI: 1.237–2.5, P < 0.05), dyslipidemia (OR: 1.8, 95%CI: 1.2–2.5, P < 0.01) and smoking habit (OR: 1.5, 95%CI: 1.2–1.9, P < 0.001) were significantly associated with CAD in COPD patients, whereas in control population also age and diabetes were correlated. The stepwise binary logistic regressions permitted to build a well fitting predictive model for training population but not for control population. The predictive algorithm shown a diagnostic accuracy of 81.5% (95%CI: 77.78–84.71) and an AUC of 0.81 (95%CI: 0.78–0.85) for the validation set. ConclusionsThe proposed algorithm is effective for predicting the risk of CAD in COPD patients via a rapid, inexpensive and non-invasive approach.

Evidence of mycobacterial disease in COPD patients with lung volume reduction surgery; the importance of histological assessment of specimens: a cohort study.

BackgroundPatients with COPD are at risk of non-tuberculous mycobacterial infection (NTM). This study examined the histology of lung tissue from COPD patients following lung volume reduction with particular focus on evidence of mycobacterial infection.MethodsRetrospective histological study of 142 consecutive lung volume reduction surgical specimens (126 separate patients) at Royal Brompton Hospital between 2000 – 2013, with prospectively collected preoperative data on exacerbation rate, lung function and body mass index.Results92% of patients had at least one other histological diagnosis in addition to emphysema. 10% of specimens had histological evidence of mycobacterial infection, one with co-existent aspergilloma. Mycobacteria were only identified in those patients with granulomas that were necrotising. These patients had higher exacerbation rates, lower TLCO and FEV1.ConclusionA proportion of severe COPD patients will have evidence of mycobacterial infection despite lack of clinical and radiological suspicion. This may have implications for long-term management of these patients.

Pulmonary Abnormalities and Carotid Atherosclerosis in Ex-Smokers without Airflow Limitation

It is well-established that COPD patients have a burden of vascular disease that cannot be fully-explained by smoking history but the mechanistic links between atherosclerosis and pulmonary disease in COPD patients are not well-understood. Moreover, in ex-smokers without symptoms or other evidence of COPD, subclinical pulmonary and vascular disease, although potentially present, has not been described or evaluated. Hence our aim was to use sensitive three-dimensional (3D) pulmonary and carotid imaging to quantify pulmonary airway/parenchyma abnormalities and atherosclerosis in ex-smokers without airflow limitation or symptoms consistent with COPD. We evaluated 61 subjects without airflow limitation including 34 never- (72 ± 6 years) and 27 ex-smokers (73 ± 9 years), who provided written informed consent to spirometry, plethysmography, 3He magnetic resonance imaging (MRI) and carotid ultrasound (US) and, for ex-smokers alone, thoracic X-ray computed tomography (CT). Ex-smokers had significantly greater 3He ventilation defect percent (VDP = 7%, p = 0.001) and carotid total plaque volume (TPV = 250 mm3, p = 0.002) than never-smokers, although there were no significant differences for spirometry or plethysmography, and CT airway and emphysema measurements were normal. There were univariate relationships for 3He VDP with carotid intima media thickness (IMT, r = 0.42, p = 0.004), TPV (r = 0.41, p = 0.006) and vessel wall volume (VWV, r = 0.40, p = 0.007). Multivariate models that included age, BMI, FEV1, DLCO and VDP showed that only VDP significantly predicted IMT (β = 0.41, p = 0.001), VWV (β = 0.45, p = 0.003) and TPV (β = 0.38, p = 0.005). In summary, there was imaging evidence of mild airways disease and carotid plaque burden that were related and significantly greater in ex-smokers without airflow limitation than in never-smokers.

It's the Fracture that Matters –Bone Disease in COPD Patients

It's the Fracture that Matters –Bone Disease in COPD Patients

Hormonal dysfunction in patients with chronic obstructive pulmonary disease

BackgroundSystemic response to chronic disease in COPD patients might cause hormonal imbalance which in turn affects the severity of the disease. The severity of hypoxia in COPD patients causes alterations in thyroid function tests and IGF-1 levels. MethodsThis work was carried on 50 COPD patients diagnosed and classified according to GOLD criteria and 20 healthy controlled subjects. All subjected to full clinical history, examination, chest X-ray and spirometry. Levels of TT3, TT4, FT3, FT4, IGF-1 and insulin were measured. ResultsTT4, FT3, FT4, TSH, and insulin levels were normal in all COPD. Despite the TT3 hormone level were normal in all stages of COPD, there is reduction in hormone levels in stage III and stage IV than control subjects. There is also reduction in TT3/TT4 ratio in severe COPD and there is correlation between TT3/TT4 ratio and PaO2 in stage III and stage IV but no correlation between TT3/TT4 ratio and PaO2 in stage I and stage II. IGF-1 hormone levels were variable among different stages of COPD. ConclusionThere is was no significant difference between some hormonal levels in COPD and in controls, accordingly hormonal replacement therapy in these patients is doubtful.

Using Post-bronchodilator FEV1 is Better Than Pre-bronchodilator FEV1 in Evaluation of COPD Severity

Background: The current standards for the diagnosis and treatment of patients with COPD clearly rely on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria based on post-bronchodilator spirometric values. However, clinical evidence for using the post-bronchodilator FEV1 in the severity classification has not been fully investigated. Methods: Patients with COPD were enrolled and followed up prospectively between October 2006 and January 2011. We compared the observed 3-year risk of all causes and respiratory mortality with the risk predicted by the pre- and post-bronchodilator percent predicted FEV1. Other important phenotypes including BMI, MMRC dyspnea scale, ECOG performance status and severe AECOPD (acute exacerbation) were also compared between the two groups. The different severity classifications of COPD, measured according the GOLD guidelines by post- and pre-bronchodilator percent predicted FEV1 were compared for prediction of mortality. Results: There were 35 deaths among the 300 COPD patients (11.7%). Multivariate analysis showed that the post-bronchodilator percent predicted FEV1 was a significant independent predictor of mortality but pre-bronchodilator percent predicted FEV1 was not (p = 0.008 vs 0.126) and it was more strongly correlated with all studied predictors of outcome than the pre-bronchodilator percent predicted FEV1. Kaplan-Meier analysis showed that the discrimination ability to predict mortality from the GOLD criteria using post bronchodilator percent predicted FEV1 (p = 0.009) was better than using pre-bronchodilator percent predicted FEV1 (p = 0.131). Conclusions: The post-bronchodilator percent predicted FEV1 is better than the pre-bronchodilator percent predicted FEV1 in the evaluation of the severity of disease in COPD patients and is more accurate in predicting the risk of death by the GOLD classification.

P46 Gender differences in the prevalence of comorbidities in COPD patients

IntroductionEffective recognition and appropriate management of comorbidities is an important aspect of modern COPD care. In particular, cardiovascular diseases are a leading cause of morbidity and mortality. There is increasing...

Bronchodilation and Smoking Interaction in COPD: A Cohort Pilot Study to Assess Cardiovascular Risk

Background: Smoking and bronchodilator treatment are both extensively studied as key elements in patients with chronic obstructive pulmonary disease. However, little is known about whether or not these elements interact in terms of developing cardiovascular diseases in patients with COPD. Objectives: To explore to what extent the risk of developing ischemic cardiovascular disease in COPD patients is mediated by smoking status, use of bronchodilators and – specifically – their interaction. Methods: We performed an observational pilot study on a relatively healthy Dutch COPD cohort from a primary care diagnostic center database with full information on spirometry tests, smoking status, bronchodilator use and other prescribed medication. We defined first ischemic cardiovascular events as primary outcome, measured by first prescription of antiplatelet drugs and/or nitrates. Unadjusted analyses by Kaplan-Meier were followed by adjusted Cox’ proportional hazards. Results: 845 COPD patients, totaling 2,169 observation years, were included in the analyses. We observed an increased risk for nonfatal ischemic cardiovascular events by smoking (adjusted HR = 3.58, p = 0.001) and a protective effect of bronchodilators (adjusted HR = 0.43, p = 0.01). Although the protective effect of bronchodilators appears to be substantially minimized in patients that persist in smoking, we could not statistically confirm a hazardous interaction between bronchodilators and smoking (HR 2.50, p = 0.21). Conclusion: Our study reveals bronchodilators may protect from ischemic cardiovascular events in a relatively ‘healthy’ COPD population. We did not confirm a hazardous interaction between bronchodilators and smoking, although we observed current smokers benefit substantially less from the protective effect of bronchodilators.

Hospitalized Acute Exacerbation of COPD Impairs Flow and Nitroglycerin-Mediated Peripheral Vascular Dilation

Vascular function, as measured by flow mediated dilation (FMD) and nitroglycerin mediated dilation (NMD), is impaired in COPD. Increases in systemic inflammatory mediators during acute exacerbations of COPD (AECOPD) may further impair vascular function and may account for the increased prevalence of cardiovascular disease in COPD patients. Similarly it may account for the increased morbidity and mortality in COPD patients hospitalized with acute exacerbations. We hypothesized that FMD and NMD would be impaired during AECOPD requiring hospitalization and that vascular function would improve upon AECOPD resolution. We used FMD and NMD to evaluate vascular function in 19 patients hospitalized with AECOPD. FMD and NMD were repeated approximately three months later in 8 of these patients. In these eight patients significant improvements were observed in FMD (2.6 ± 1.5% vs 5.1 ± 2.4%, p = 0.04) and NMD (5.0 ± 2.6% vs 13.3 ± 4.5, p = 0.02) after resolution of their exacerbation. We conclude that endothelial and vascular smooth muscle function is markedly impaired during AECOPD requiring hospitalization and improves following resolution. The systemic vascular impairment that occurs during AECOPD may partially explain the observed increased in cardiac morbidity and mortality that occur in this population.