Female Chronic Obstructive Pulmonary Disease Research Articles

Management Reality of Female Patients with COPD: A Multicenter Cross-Sectional CAP Study in Japan.

Reports from Europe and North America suggest that female chronic obstructive pulmonary disease (COPD) patients have a higher symptom burden and mortality than male patients. However, little is known about the management reality of female patients with COPD in Japan. We compared the clinical characteristics of female COPD patients with those of male using the cohort of the COPD Assessment in Practice study, which is a cross-sectional multicenter observational study. Of the 1168 patients, 133 (11.4%) were female. A history of never smoking was higher in females than males (p<0.01). Although there was no difference in age or forced expiratory volume in one second (FEV1) % predicted between the groups, modified medical research council dyspnea scale (mMRC) and number of frequent exacerbators were higher in females (mMRC≥2: p<0.01; number of exacerbations≥2: p=0.011). The mean forced vital capacity and FEV1 values in females were lower than those in males (p<0.0001 and p<0.0001, respectively). Females were more likely to use long-term oxygen therapy and inhaled corticosteroids than males (p=0.016 and p<0.01, respectively). The prevalence of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, D (ABCD GOLD 2017 classification), and E (ABE GOLD 2023 classification) was higher in females than in males. The disease burden of female patients with COPD is higher than that of male patients in Japan, suggesting the importance of interventions considering female-dominant features such as lower absolute FVC and FEV1, respiratory failure, and asthma-like conditions.

Reduced Bik expression drives low-grade airway inflammation and increased risk for COPD in females.

Chronic low-grade inflammation is increasingly recognized as a subtle yet potent risk factor for a multitude of age-related disorders, including respiratory diseases, cardiovascular conditions, metabolic syndromes, autoimmunity, and cancer. In this issue of the JCI, Mebratu, Jones, and colleagues shed new light on the mechanisms that promote low-grade airway inflammation and how this contributes to the development of chronic obstructive pulmonary disease (COPD). Their finding that Bik deficiency leads to spontaneous emphysema in female mice, but not in males, marks a notable advancement in our understanding of how inflammatory processes can diverge based on biological sex. This finding is of clinical relevance, given the vulnerability of women to developing COPD.

Barriers and Facilitators to Exercise Compliance for Community Elders with COPD: A Cross-Sectional Study.

Exercise compliance was known as important to improve long-term health conditions for Chronic obstructive pulmonary disease (COPD) patients, however, little was known about the determinants which affect their exercise compliance. This study aimed to investigate factors related to exercise compliance of COPD elderly patients. This cross-sectional study included elderly patients with stable COPD participants. Random cluster sampling and a survey, including the Exercise Compliance Scale, mMRC Dyspnea Index Scale, Social Support Scale, Anxiety Self-Assessment Scale, and Self-rating Depression Scale, were used. Data were analyzed using Spearman correlation and backward logistic regression. 124 participants (45.90%) had poor exercise compliance while 146 had good compliance (54.10%). The backward logistic regression showed household monthly income (¥501-¥1500: OR=21.54, P<0.05; ¥3001-¥5000: OR=32.76, P<0.05), two chronic comorbidities (OR=17.13, P<0.05), and the moderate dyspnea (OR=16.87, P<0.05) might help to improve exercise compliance. While female COPD patients (OR=0.11, P<0.01) who had server dyspnea (OR=0.02, P<0.05) and depression (OR=0.84, P<0.05) might have more difficulties adhering to exercise. Low exercise compliance in community-dwelling elderly COPD patients could be affected by sex, monthly income level, number of chronic comorbidities, dyspnea, and depression.

Female sexual dysfunction in chronic obstructive pulmonary disease.

Sexual life of women with chronic obstructive pulmonary disease (COPD) can be affected by breathing difficulties, a decrease in functional status, depressive mood and fatigue. To evaluate the sexual dysfunction in female COPD patients and the possible explanatory mechanisms or correlations between these conditions. The study included 70 female patients with COPD aged between 36-65 and 70 age-matched controls. All the subjects completed questionnaires for the Female Sexual Functional Index (FSFI), BECK depression inventory and, spirometry. Statistically significant sexual dysfunction was noted in COPD patients compared to the non-COPD group (p<0.001). BECK depression inventory scores of the COPD patients were also significantly lower (p<0.001). no correlation between FSFI and BECK depression scores in 'patients' characteristics (r=-0.055, p=0.651). No significant difference was found in age, forced expiratory volume (FEV)1%, and exacerbation history of the previous year according to severity of depression (p>0.005). In linear regression analysis determining depression, no statistically significant factor was found among age, number of comorbidities, and FEV1/ forced vital capacity (FVC) % predicted (p>0.05). In multivariable analysis, only fatigue during intercourse was found to be a statistically significant factor in predicting sexual dysfunction among factors like age, presence of comorbidities, duration of the disease, smoking status, FEV1%, m MRCpoints, 6-minutes walk test, BECK depression scores (p=0.008). Sexual dysfunction is reported in many COPD females and seems to be related not to spirometric measures or exercise capacity but to fatigue. Depression is also a common comorbidity, of which both disorders are often neglected.

Hospital Burden of Chronic Obstructive Pulmonary Disease in Hong Kong - The Trend from 2006 to 2014.

Chronic obstructive pulmonary disease (COPD) is a common cause for hospital admission. This study aims to review the hospital burden of COPD in Hong Kong (HK) and the trend from year 2006 to 2014. A multi-center, retrospective study of the characteristics of COPD patients discharged from the public hospitals of HK from year 2006 to 2014. Anonymized data retrieval and analysis were performed. The demographic data of the subjects, use of health-care resources, ventilatory support, medications used and mortality of the subjects were analyzed. Total patient headcount (HC) and admission number reduced from 10,425 and 23,362 in year 2006 to 9613 and 19,771, respectively, in 2014. There was a progressive reduction of female COPD HC from 2193 (21%) in year 2006 to 1517 (16%) in 2014. The utilization of non-invasive ventilation (NIV) increased rapidly and peaked in 2010 (29%) and decreased thereafter. There was a rapid increase in the prescription of long-acting bronchodilators (from 15% to 64%). COPD and pneumonia were the top causes of death, but death due to pneumonia was rapidly increasing while death due to COPD was progressively decreasing over the period. COPD HC and admission number (particularly in female patients) decreased progressively from year 2006 to 2014. There was also a decreasing trend of severity of disease as reflected by lower NIV use (after year 2010) and lower mortality rate due to COPD. Reduced smoking prevalence and tuberculosis (TB) notification rate in the community in the past might have reduced the incidence and severity of COPD and the hospital burden of disease. We observed an increasing trend of mortality due to pneumonia in COPD patients. Appropriate and timely vaccination programs are recommended for COPD patients as in the general elderly population.

Correlation between handgrip strength and nutritional indicators and its influencing factors in patients with stable COPD: a cross-sectional study

This study aimed to explore the Correlation between handgrip strength and nutritional indicators and its influencing factors in patients with stable chronic obstructive pulmonary disease (COPD) to provide evidence for early nutritional intervention. Stable COPD patients who visited the respiratory department clinic of a Tertiary Grade A hospital in Guangxi from January 2021 to March 2022 were chosen using a convenient sampling method. The general information questionnaire and mini nutritional assessment short-form (MNA-SF) were used for investigation, and the HGS, anthropometric, and laboratory indicators were collected. Correlation analysis was used to analyze the relationship between HGS and nutritional indicators in patients with stable COPD. Multiple linear regression analysis was used to examine the factors influencing HGS in patients with stable COPD. A total of 232 patients with stable COPD were included, and the HGS was (25.18±7.95)kg. Correlation analysis showed that height, body weight, body mass index (BMI), calf circumference, hemoglobin concentration, total protein concentration, albumin concentration, prealbumin concentration were positively correlated with HGS in stable COPD patients (P <0.05), whereas age was negatively correlated with HGS in stable COPD patients (P <0.05). Multiple linear regression analysis showed that gender, age, number of concomitant diseases, and nutritional status were the influencing factors of HGS in patients with stable COPD (P <0.05), explaining 31.3% of the total variation of HGS in patients with stable COPD. Patients with stage COPD need to improve their HGS, which correlates with nutrition-related indicators. HGS levels are low in female COPD patients who are older, have multiple comorbidities, and are malnourished. Outpatient medical workers should pay attention to the HGS level of stable COPD patients, quickly screen the nutritional status of COPD patients, implement early nutritional intervention, and improve the overall health level of patients.

MiRNA-mRNA-protein dysregulated network in COPD in women.

Rationale: Chronic obstructive pulmonary disease (COPD) is a complex disease caused by a multitude of underlying mechanisms, and molecular mechanistic modeling of COPD, especially at a multi-molecular level, is needed to facilitate the development of molecular diagnostic and prognostic tools and efficacious treatments. Objectives: To investigate the miRNA-mRNA-protein dysregulated network to facilitate prediction of biomarkers and disease subnetwork in COPD in women. Measurements and Results: Three omics data blocks (mRNA, miRNA, and protein) collected from BAL cells from female current-smoker COPD patients, smokers with normal lung function, and healthy never-smokers were integrated with miRNA-mRNA-protein regulatory networks to construct a COPD-specific dysregulated network. Furthermore, downstream network topology, literature annotation, and functional enrichment analysis identified both known and novel disease-related biomarkers and pathways. Both abnormal regulations in miRNA-induced mRNA transcription and protein translation repression play roles in COPD. Finally, the let-7-AIFM1-FKBP1A pathway is highlighted in COPD pathology. Conclusion: For the first time, a comprehensive miRNA-mRNA-protein dysregulated network of primary immune cells from the lung related to COPD in females was constructed to elucidate specific biomarkers and disease pathways. The multi-omics network provides a new molecular insight from a multi-molecular aspect and highlights dysregulated interactions. The highlighted let-7-AIFM1-FKBP1A pathway also indicates new hypotheses of COPD pathology.

Metabolic Syndrome and Its Correlates Among Female Chronic Obstructive Pulmonary Disease Patients at a Rural Tertiary Health Care Center in Northern India.

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease that is thought to result from chronic inflammation that may affect other organ systems. Similarly, metabolic syndrome includes central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), hyperglycemia, and hypertension. The prevalence of metabolic syndrome and its associated factors among female COPD patients in northern India needs to be evaluated.Aim and objectives: To find the prevalence of metabolic syndrome and its correlates among female chronic obstructive pulmonary disease patients at a rural tertiary health care center in northern India.Materials and methods: A cross-sectional study was conducted between January 2019 and June 2020 at a rural tertiary health care center in northern India. The female patients who presented with symptoms of COPD and fulfilled the inclusion criteria were included and classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) guideline while the clinical diagnosis of metabolic syndrome was made according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP: ATP III) criteria.Results: A total of 210 female COPD patients were included, the mean age of patients who had metabolic syndrome was 63.38±10.54 years. Metabolic syndrome was diagnosed in 60.48% of patients. There was a significant difference between female COPD patients with and without metabolic syndrome regarding body weight, BMI (body mass index), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP), blood sugar, serum triglyceride, serum HDL-C. Whereas no significant difference was found between patients with and without metabolic syndrome group regarding smoking exposure, biomass fuel exposure, duration of biomass fuel exposure, mMRC (modified Medical Research Council) grading of breathlessness, GOLD grading of airflow limitation, route and duration of corticosteroid used. In our study, we also found a significant association between the severity of airflow limitation of COPD with the duration of biomass fuel exposure and BMI. Also, there was a significant association between biomass fuel exposure and the presence of cough in female COPD patients.Conclusion: Metabolic syndrome is a prevalent entity in female COPD patients among the northern Indian population. Body weight, BMI, waist circumference, SBP, DBP, fasting blood sugar, serum triglyceride, and serum HDL-C have a significant impact on developing metabolic syndrome in female COPD patients. Duration of biomass fuel exposure and BMI also have a significant impact on the severity of airflow limitation in female COPD patients. So early detection and treatment of parameters of metabolic syndrome are important to reduce complications.

COMPARISON OF SPIROMETRY DATA AND SYMPTOMS BETWEEN MALE AND FEMALE SMOKERS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BACKGROUND &amp; OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease, showing the exaggerated response of airways to any injurious stimulus. It is no longer considered as the disease of men as it is becoming increasingly prevalent in females. Evidence suggests that gender affects the clinical presentation of the disease. The objectives of the study is to compare spirometry data between male and female smokers with COPD and to study the association of cough, sputum, and dyspnea with gender in smokers with COPD.&#x0D; METHODOLOGY: This descriptive study was conducted at the University of Health Sciences Lahore. The study sample included 41 COPD patients with a history of smoking. After taking written informed consent, patients were recruited from the outpatient departments of tertiary care hospitals of Lahore by convenience sampling technique. A complete history was taken, and spirometry was done on each subject. The subjects were divided into male and female groups, followed by the comparison of Spirometry data between the groups and association of symptoms with gender using appropriate statistical techniques.&#x0D; RESULTS: The results of this study demonstrated females were significantly younger and exhibited a greater decline of lung functions with similar pack-years history compared to male smokers with COPD. The most common presentation of females was breathlessness compared to male patients, who had sputum production as the most common presentation.&#x0D; CONCLUSION: Significant differences were seen in spirometry and clinical presentation of the disease in male and female COPD groups, showing the onset and symptomology of the disease.

Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006-2017: Evidence from Spanish National Health Surveys.

Certain conditions such as common mental disorders (CMDs), functional limitation (FL) and poor diet quality may affect the lives of individuals who suffer from chronic obstructive pulmonary disease (COPD). This study sought to examine time trends in the prevalence of CMDs, FL and diet quality among male and female COPD patients living in Spain from 2006 to 2017 and to identify which factors were related to CMDs, FL and a poor/improvable diet quality in these patients. We performed a cross-sectional study among COPD patients aged ≥ 40 years old using data from the Spanish National Health Surveys conducted in 2006, 2011 and 2017, identifying a total of 2572 COPD patients. Binary logistic regressions were performed to determine the characteristics related to CMDs, FL and poor/improvable diet quality. Over the years of the study, the prevalence of FL among female COPD patients increased (p for trend <0.001). In addition, CMDs were associated to body mass index (BMI), educational level, physical activity, smoking status, occupation, chronic conditions and alcohol consumption; FL was related to age, living with a partner, educational level, physical activity and chronic conditions; and poor/improvable diet quality was associated to age, smoking status, BMI and physical activity.

Testosterone attenuates pulmonary epithelial inflammation in male rats of COPD model through preventing NRF1-derived NF-κB signaling.

Testosterone deficiency is common in male patients with chronic obstructive pulmonary disease (COPD) and may correlate with the deterioration of COPD. Clinical research suggests that testosterone replacement therapy may slow the COPD progression, but the specific biological pathway remains unclear. In this study, we explored the effect of testosterone on pulmonary inflammation in male COPD rats. The animals were co-treated with lipopolysaccharide (LPS) and cigarette to induce COPD. In COPD rats, nuclear respiratory factor 1 (NRF1) and NF-κB p65 were upregulated. In cigarette smoke extract (CSE)-, LPS-, or the combination of CSE and LPS-treated L132 cells, NRF1 and p65 were also upregulated. Silencing NRF1 resulted in the downregulation of p65. ChIP‒seq, ChIP‒qPCR, and luciferase results showed that NRF1 transcriptionally regulated p65. Both male and female COPD rats showed an upregulated NRF1 level and similar pulmonary morphology. But NRF1 was further upregulated in male castrated rats. Further supplementing testosterone in castrated male rats significantly reduced NRF1, pulmonary lesions, and inflammation. Supplementation of testosterone also reduced the phosphorylation of p65 and IKKβ induced by LPS or CSE in L132 cells. Our results suggest that testosterone plays a protective role in pulmonary epithelial inflammation of COPD through inhibition of NRF1-derived NF-κB signaling and the phosphorylation of p65.

Sexuality and Associated Factors in Chronic Obstructive Pulmonary Disease (COPD) Patients Attending a Referral Hospital in Northeastern Brazil

Objective The aim of this study was to evaluate sexual function in male and female COPD (chronic obstructive pulmonary disease) patients and identify associated factors. Methods: This is a cross-sectional study on 52 COPD patients treated at an outpatient pneumology service of a referral hospital in Northeastern Brazil. Information was collected on demographic, clinical and spirometric variables and exercise capacity. The following instruments and scores were used: modified Medical Research Council (mMRC) for dyspnea, SF-36 for quality of life (QoL), the Beck Depression and Anxiety Inventory, Male and Female Sexual Quotient. Results: Sexual function was satisfactory/excellent in 17% (9/52) and poor/absent in 82% (43/52). Patients with poor/absent sexual function tended to have lower scores on the domain mental health summary score of SF-36 (p = 0.007) and higher anxiety and depression scores than patients with satisfactory/excellent sexual function (p = 0.02 and p = 0.01). In the multivariate analysis, patients with high depression scores displayed a greater likelihood of poor/absent sexual function (OR = 1.13; 95% CI = 1.02–1.25). Conclusion: COPD patients presented a high rate of sexual dysfunction and compromised sexuality was associated with depression

High PM10 source regions and their influence on respiratory diseases in Canakkale, Turkey

This study investigates the impacts of high PM10 concentrations on respiratory diseases in Canakkale, Turkey. Daily mean high-PM10 values (> 100 µg m−3) and daily total numbers of chronic obstructive pulmonary disease (COPD) and pneumonia patients are selected for different sexes and age groups (children, adults, and elderly) during the period 2007–2017. Mainly five different source regions of high-PM10 concentration levels are found as a result of implementation of Ward’s minimum clustering technique to HYSPLIT 72-h backward trajectory. From 104 days, 19.2% are categorized as internal sources and are positively linked to COPD in female—adult and elderly patients at lag2 and lag3. The other sources are exhibited as external sources and originated from Europe, Sahara, Mediterranean, and Russia regions with the 34.6%, 22.1%, 13.5%, and 10.6% percentages of all episodes, respectively. During Europe-originated high-PM10 days, anthropogenic pollutants mainly cause an increase in the numbers of the elderly female (r = 0.55) and adult male pneumonia patients (r = 0.39) at lag5. Additionally, accompanied by the interaction between Genoa cyclone and surface high over Caspian Sea, natural dust particles are transferred from Sahara to Canakkale by strong southwesterly winds. As a consequence, obvious increases are shown in hospital admissions based on adult female COPD patients at lag1 (r = 0.50) and lag4 (r = 0.53). While Mediterranean origin particulate matter triggering the numbers of COPD and pneumonia-related diseases at lag2 and lag3, the region is exposed to more pneumonia diseases 2 days after arriving of Russia origin harmful pollutants.

Clinical Characteristics of Chronic Obstructive Pulmonary Disease in Female Patients: Findings from a KOCOSS Cohort.

PurposeThe prevalence of chronic obstructive pulmonary disease (COPD) in females has increased, changing the concept of COPD as a disease mostly limited to males. In this study, the clinical characteristics of COPD in females were investigated.Patients and MethodsThe study was based on a multicenter cohort of COPD patients recruited from 54 medical centers in South Korea. Sex-based differences in general characteristics, exposure risk factors, depression scores, results of pulmonary function tests, COPD exacerbation, symptom scores, and radiologic findings were evaluated. Sex-related differences in the annual FEV1 change over 5 years were analyzed in a linear mixed model.ResultsOf the 2515 patients enrolled in this study, 8.1% were female. Female patients who had a higher BMI and a lower level of education were less likely to be smokers, were more exposed to passive smoking/biomass, and were more depressed compared to males. The rates of bronchiectasis, previous childhood respiratory infection, and asthma were higher in females. Female patients also had more symptoms and a poorer exercise capacity than males, but no significant differences were observed in terms of exacerbations. Radiologic findings revealed that male patients had worse emphysema, and female patients had worse bronchiectasis, as determined based on chest X-ray and computed tomography findings. On pulmonary function tests, female patients had less obstruction and less annual FEV1 loss over 5 years.ConclusionThis study revealed differences in the clinical parameters between male and female patients with COPD, including general characteristics, disease characteristics, and clinical outcomes.

USE OF THE FEV1/FEV6 RATIO IN THE DIAGNOSIS OF COPD: INFLUENCE OF GENDER

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: FVC is a difficult maneuver for many patients, and forced expiratory volume in 6 seconds (FEV6) has been proposed as a surrogate for FVC for the diagnosis of chronic obstructive pulmonary disease (COPD). It has been suggested that FEV1/FEV6 can be substituted for FEV1/FVC in diagnosing airflow obstruction and may better predict COPD-related pathology and morbidity. We wanted to study the influence of gender in a real world community based setting in the discrepancy between these 2 spirometric measures of COPD. METHODS: The study was done at a community based pulmonary practice setting. Airflow obstruction was assessed by performing pre- and postbronchodilator spirometry, total lung volumes and diffusion capacity (DLCO) based on standard ATS criteria using body plethysmography. For purpose of this study we only included patients who had a postbronchodilator FEV1/FVC ratio of less than 70% and were smokers (either at present or in the past). We excluded patients with a history of asthma or other pulmonary conditions, and nonsmokers. Concordance between the two ratios in diagnosing COPD was compared as difference in absolute % between post BD FEV1/FVC and FEV1/FEV6. Standard statistical tests were employed for deriving comparisons. RESULTS: We reviewed a total of 600 consecutive PFTs. A total of 83 patients - 42M and 41F - met our inclusion criteria for COPD. The mean difference between post-BD FEV1/FVC % and post BD FEV1/FEV6 % was 7.9 +/- 4.7 %. When we compared across genders, there was a consistently greater disparity in these values between men and women (5.8 +/- 4.2% vs 10 +/- 4.2% respectively). Mean and women were comparable in terms of age (70 +/- 7 vs 71 +/- 8) BMI (26.2 +/- 9 vs 27 +/- 5; p 0.35). There was also no gender difference in lung volumes in terms of Total Lung Capacity TLC % (110 +/- 23 vs 103 +/- 18; p = 0.18) and diffusion capacity DLCO measurements (50 +/- 22 vs 50 +/- 23% p = 0.8). 24% of females would have been classified as normal using post BD FEV1/FEV6 (ratio < 0.7) vs only 7% in males (p = 0.03). CONCLUSIONS: In a real world community setting there is significant disparity in the values of post DB FEV1/FEV6 and FEV1/FVC %. There is a strong gender influence with this disparity seen to be very pronounced in females despite there being no differences in age, BMI, as well as TLC and DLCO to account for this difference. CLINICAL IMPLICATIONS: Routine use of FEV1/FEV6 ratio may lead to a significant degree of underdiagnosis of COPD in females. The physiology underlying these differences in spirometric characterisitcs needs to be better understood. DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response No relevant relationships by Ishan Aiyer, source=Web Response No relevant relationships by Paul Schaefer, source=Web Response No relevant relationships by Zoya Surani, source=Web Response Speaker/Speaker's Bureau relationship with Astra Zaneca, Sunovian, Paratek Please note: $1001 - $5000 Added 01/13/2019 by Salim Surani, source=Web Response, value=Consulting fee

Dysregulation of the Tryptophan Pathway Evidences Gender Differences in COPD.

Increased activity of indoleamine 2,3-dioxygenase (IDO) and tryptophan hydroxylase (TPH) have been reported in individuals with chronic obstructive pulmonary disease (COPD). We therefore investigated the effect of gender stratification upon the observed levels of tryptophan metabolites in COPD. Tryptophan, serotonin, kynurenine, and kynurenic acid were quantified in serum of never-smokers (n = 39), smokers (n = 40), COPD smokers (n = 27), and COPD ex-smokers (n = 11) by liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS). The individual metabolite associations with lung function, blood, and bronchoalveolar lavage (BAL) immune-cell composition, as well as chemokine and cytokine levels, were investigated. Stratification by gender and smoking status revealed that the observed alterations in kynurenine and kynurenic acid, and to a lesser extent serotonin, were prominent in males, irrespective of COPD status (kynurenine p = 0.005, kynurenic acid p = 0.009, and serotonin p = 0.02). Inferred serum IDO activity and kynurenine levels decreased in smokers relative to never-smokers (p = 0.005 and p = 0.004, respectively). In contrast, inferred tryptophan hydroxylase (TPH) activity and serotonin levels showed an increase with smoking that reached significance with COPD (p = 0.01 and p = 0.01, respectively). Serum IDO activity correlated with blood CXC chemokine ligand 9 (CXCL9, p = 0.0009, r = 0.93) and chemokine (C-C motif) ligand 4 (CCL4.(p = 0.04, r = 0.73) in female COPD smokers. Conversely, serum serotonin levels correlated with BAL CD4+ T-cells (%) (p = 0.001, r = 0.92) and CD8+ T-cells (%) (p = 0.002, r = −0.90) in female COPD smokers, but not in male COPD smokers (p = 0.1, r = 0.46 and p = 0.1, r = −0.50, respectively). IDO- and TPH-mediated tryptophan metabolites showed gender-based associations in COPD, which were primarily driven by smoking status.

Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal

Introduction: Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life.&#x0D; Methods: This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17.&#x0D; Results: Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for &lt; 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients.&#x0D; Conclusion: The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients.

Gender differences in chronic obstructive pulmonary disease: an analysis of hospitalization indicators

Compared to the last two decades, an increase in chronic obstructive pulmonary disease (COPD) prevalence, morbidity, mortality and disability has clearly emerged among women both in Europe and in all other countries. Despite this evidence, in the international guidelines for COPD there are no sex-specific recommendations. The aim of this study is to evaluate gender differences in patients hospitalized for COPD in Puglia (Italy), with regard to number of admissions, mean age, average length of stay in hospital (ALOS), hospital mortality, re-hospitalization and presence of comorbidities. To identify COPD hospitalized patients, we relied on the Puglia Hospital Discharge Register Database. We included all patients discharged with principal diagnosis of COPD with or without exacerbation (respectively ICD-9-CM codes 491.21 and 491.20) between 2005 and 2016. There has been an increase in the proportion of women’s hospitalizations for COPD, from 2005 [31.9%, 95% confidence interval (CI) 31.1-32.7] to 2016 (37.9%, 95%CI 36.0-40.0). Women need longer hospitalization and in 2016 the proportion of women’s re-hospitalization was greater compared to men. Despite these data, women are less treated with respiratory therapy (ICD-9- CM 93.9x) than men in all the examined years and wards. The prevalence of most common comorbidities is higher among women. The number of COPD hospitalized patients had been reduced in Puglia between 2005 and 2016, with an important increase of female COPD patients, female average age, ALOS and re-hospitalization. Women are treated less and have more comorbidities with a negative impact on clinical progression of COPD, survival and quality of life.

Quadriceps strength in patients with chronic obstructive pulmonary disease

Background:Skeletal muscle dysfunction is well known in chronic obstructive pulmonary disease (COPD). The muscle strength is altered in various muscles variedly. Lower-limb muscle strength is very important for walking distance. Reduced lower-limb strength can affect the physical quality of life.Objectives:The aim of the study was to assess and compare the quadriceps strength in COPD patients and age-matched healthy controls and to study the correlation between lung function parameters and the quadriceps strength in patients with COPD.Methodology:Thirty nonsmoker male patients; thirty nonsmoker female patients with COPD; and sixty age-, BMI-, and gender-matched healthy controls were studied. Quadriceps muscle strength was measured using a quadriceps dynamometer. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEF 25–75, and peak expiratory flow rate were measured using Helios 702 Spirometer. The quadriceps muscle strength between the two groups was compared using the unpaired Student's t-test. Correlations between FVC and FEV1 with muscle strength were analyzed using the Pearson's coefficient.Results:The mean unilateral and bilateral quadriceps strength in both male and female COPD patients was significantly lesser than the healthy controls (P < 0.05). There was a significant positive correlation between muscle strength and FVC and muscle strength and FEV1 in patients with COPD.Conclusion:The study shows that there is quadriceps weakness in COPD patients, and pulmonary functions have a direct impact on skeletal muscle strength. Identifying those patients who have reduced strength will allow early interventions targeted at improving the quality of life of the patient.

Sex differences in COPD-related quadriceps muscle dysfunction and fibre abnormalities.

In chronic obstructive pulmonary disease (COPD), lower limb dysfunction is associated with reduced exercise capacity, increased hospitalizations and mortality. We investigated sex differences in the prevalence of quadriceps dysfunction and fibre abnormalities in a large COPD cohort, controlling for the normal sex differences in health. We compared existing data from 76 male and 38 female COPD patients where each variable was expressed as a function of gender-specific normal values (obtained from 16 male and 14 female controls). Female COPD patients had lower quadriceps muscle strength and peak workload on a maximal incremental cycle ergometry protocol compared to male patients. Female patients had a smaller type II fibre cross-sectional area (CSA) compared to male patients, suggesting a greater female preponderance to fibre atrophy, although this result was largely driven by a few male patients with a large type II fibre CSA. Female patients had significantly higher concentrations of a number of plasma pro-inflammatory cytokines including tumour necrosis factor alpha and interleukin 8 (IL8), but not lower levels of physical activity or arterial oxygenation, compared to males. Our data confirm results from a previous small study and suggest that female COPD patients have a greater prevalence of muscle wasting and weakness. Larger studies investigating sex differences in COPD-related muscle atrophy and weakness are needed, as the results will have implications for monitoring in clinical practice and for design of clinical trials evaluating novel muscle anabolic agents.