Global Initiative For Chronic Obstructive Lung Disease Stage Research Articles

Metabolic Syndrome in Post-Pulmonary Tuberculosis-Associated Obstructive Airway Disease: A Cross-Sectional Analytical Study

BackgroundThe aim of this study is to assess the prevalence of metabolic syndrome in tuberculosis-associated obstructive airway disease (TOPD) patients, as well as the association of its components with the severity of airflow obstruction.MethodologyIn this cross-sectional analytical study, we evaluated the clinical profile, spirometry, waist circumference, blood pressure, lipid profile, fasting plasma glucose, and the association of each component with the severity of airflow obstruction.ResultsThe prevalence of metabolic syndrome in TOPD was found to be was 25.77% (95% confidence interval = 18.11-35.28) among study participants. Reduced high-density lipoprotein was the deranged component and was associated with increased severity in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II compared to GOLD stage IV.ConclusionsThe prevalence of metabolic syndrome in TOPD has a severe impact on patients’ treatment, outcomes, and complications. However, in our study, tuberculosis-associated metabolic syndrome was the same as the general population. Low high-density lipoprotein levels were associated with the severity of the airflow obstruction.

Impaired Ventilatory Efficiency, Dyspnea, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease: Results from the CanCOLD Study.

Rationale: Impaired exercise ventilatory efficiency (high ventilatory requirements for CO2 [[Formula: see text]e/[Formula: see text]co2]) provides an indication of pulmonary gas exchange abnormalities in chronic obstructive pulmonary disease (COPD). Objectives: To determine 1) the association between high [Formula: see text]e/[Formula: see text]co2 and clinical outcomes (dyspnea and exercise capacity) and its relationship to lung function and structural radiographic abnormalities; and 2) its prevalence in a large population-based cohort. Methods: Participants were recruited randomly from the population and underwent clinical evaluation, pulmonary function, cardiopulmonary exercise testing, and chest computed tomography. Impaired exercise ventilatory efficiency was defined by a nadir [Formula: see text]e/[Formula: see text]co2 above the upper limit of normal (ULN), using population-based normative values. Measurements and Main Results: Participants included 445 never-smokers, 381 ever-smokers without airflow obstruction, 224 with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 COPD, and 200 with GOLD 2-4 COPD. Participants with [Formula: see text]e/[Formula: see text]co2 above the ULN were more likely to have activity-related dyspnea (Medical Research Council dyspnea scale ⩾ 2; odds ratio [5-95% confidence intervals], 1.77 [1.31 to 2.39]) and abnormally low peak [Formula: see text]o2 ([Formula: see text]o2peak below the lower limit of normal; odds ratio, 4.58 [3.06 to 6.86]). The Kco had a stronger correlation with nadir [Formula: see text]e/[Formula: see text]co2 (r = -0.38; P < 0.001) than other relevant lung function and computed tomography metrics. The prevalence of [Formula: see text]e/[Formula: see text]co2 above the ULN was 24% in COPD (similar in GOLD 1 and 2 through 4), which was greater than in never-smokers (13%) and ever-smokers (12%). Conclusions: [Formula: see text]e/[Formula: see text]co2 above the ULN was associated with greater dyspnea and low [Formula: see text]o2peak and was present in 24% of all participants with COPD, regardless of GOLD stage. The results show the importance of recognizing impaired exercise ventilatory efficiency as a potential contributor to dyspnea and exercise limitation, even in mild COPD.

What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack?

Background and Objectives: This study aimed to investigate the important factors that affect COPD prognosis. Materials and Methods: We included 160 hospitalized patients with COPD exacerbation in the study. The hemoglobin (HB), hematocrit (HCT), leukocytes, red cell distribution width (RDW), mean platelet volume, platelet distribution width, plateletcrits, platelets, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, eosinophils, uric acid, albumin, C-reactive protein (CRP), procalcitonin, arterial blood gases (PO2 and PCO2), pulmonary function test (FEV1 and FVC), echocardiography (ejection fraction-EF), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Modified Medical Research Council (mMRC) and Borg scales, Charlson comorbidity index, body mass index (BMI), and the length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit (ICU), and mortality during the six months after discharge were evaluated. Results: High CRP and procalcitonin levels were observed in the group with a long hospital stay. In the mortality group, the HB, HCT, BMI, and PO2 values were significantly lower than in the group without mortality, while the age and GOLD stage were higher. The age, Borg and mMRC scores, number of exacerbations experienced in the previous year, RDW, eosinophil count, and PCO2 were significantly higher in the ICU group than that without an ICU stay. The HCT and EF values were lower in the ICU group than that without an ICU stay. The FEV1 and FVC values were significantly lower in the follow-up attack group than those without a follow-up attack. The duration of COPD and the number of attacks that were experienced in the previous year were high. Conclusion: Scoring combining selected biomarkers and other factors is a strong determinant of the prognosis.

Long-term variability of impulse oscillometry and spirometry in stable COPD and asthma

BackgroundWhile optimizing spirometry is a challenge for lung function labs, long-term variability if any between IOS (impulse oscillometry) parameters and spirometry is not clearly known in stable COPD (chronic obstructive pulmonary disease) and chronic asthma. The forced oscillation technique is increasingly employed in routine lung function testing. Our aim in this study was to determine the variability in oscillometric parameters between clinic visits over weeks or months in two patient groups during a period of clinical stability. Moreover, the research assessed relationships between IOS parameters long-term variability and COPD severity.MethodsWe used data from 73 patients with stable COPD and 119 patients with stable asthma at the Shanghai Pulmonary Hospital Affiliated to Tongji University. Patients were included if they had three or more clinic visits where spirometry and IOS were performed during a clinically stable period. Data recorded from the first three visits were used. The standard deviation (SDbv), the coefficient of variation (COV), intraclass correlation coefficient (ICC) and the coefficient of repeatability (COR) were calculated, Wilcoxon Mann–Whitney test was used for data that did not conform to normality of distributions, Kruskal Wallis test was used to compare with multiple groups, post hoc comparison was analyzed by Bonferroni, Spearman correlation coefficients for non-parametric data, the multiple regression analyses to determine the relationship between long-term variability and airflow obstruction.Results(1) The repeatability of IOS resistance parameters with ICC values > 0.8 was high in COPD and asthma. ICC values of IOS resistance parameters were higher than IOS reactance parameters; (2) the repeatability of spirometry parameters with ICC values < 0.8 was lower than IOS resistance parameters in different GOLD (the Global Initiative for Chronic Obstructive Lung Disease) stages, the higher the stage the worse the repeatability; (3) the severity of airflow obstruction was correlated with long-term variability of R5 (R at 5 Hz) (P < 0.05) in GOLD4, not with long-term variability of R20 (R at 20 Hz) (P > 0.05) and R5-R20 (P > 0.05).ConclusionIOS resistance parameters have good long-term repeatability in asthma and COPD. Additionally, repeatability of spirometry parameters is lower than IOS resistance parameters in different GOLD stages.

CNN-based Deformable Registration Facilitates Fast and Accurate Air Trapping Measurements at Inspiratory and Expiratory CT.

To develop a convolutional neural network (CNN)-based deformable lung registration algorithm to reduce computation time and assess its potential for lobar air trapping quantification. In this retrospective study, a CNN algorithm was developed to perform deformable registration of lung CT (LungReg) using data on 9118 patients from the COPDGene Study (data collected between 2007 and 2012). Loss function constraints included cross-correlation, displacement field regularization, lobar segmentation overlap, and the Jacobian determinant. LungReg was compared with a standard diffeomorphic registration (SyN) for lobar Dice overlap, percentage voxels with nonpositive Jacobian determinants, and inference runtime using paired t tests. Landmark colocalization error (LCE) across 10 patients was compared using a random effects model. Agreement between LungReg and SyN air trapping measurements was assessed using intraclass correlation coefficient. The ability of LungReg versus SyN emphysema and air trapping measurements to predict Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages was compared using area under the receiver operating characteristic curves. Average performance of LungReg versus SyN showed lobar Dice overlap score of 0.91-0.97 versus 0.89-0.95, respectively (P < .001); percentage voxels with nonpositive Jacobian determinant of 0.04 versus 0.10, respectively (P < .001); inference run time of 0.99 second (graphics processing unit) and 2.27 seconds (central processing unit) versus 418.46 seconds (central processing unit) (P < .001); and LCE of 7.21 mm versus 6.93 mm (P < .001). LungReg and SyN whole-lung and lobar air trapping measurements achieved excellent agreement (intraclass correlation coefficients > 0.98). LungReg versus SyN area under the receiver operating characteristic curves for predicting GOLD stage were not statistically different (range, 0.88-0.95 vs 0.88-0.95, respectively; P = .31-.95). CNN-based deformable lung registration is accurate and fully automated, with runtime feasible for clinical lobar air trapping quantification, and has potential to improve diagnosis of small airway diseases.Keywords: Air Trapping, Convolutional Neural Network, Deformable Registration, Small Airway Disease, CT, Lung, Semisupervised Learning, Unsupervised Learning Supplemental material is available for this article. © RSNA, 2021 An earlier incorrect version of this article appeared online. This article was corrected on December 22, 2021.

Prediction of gold stage in patients hospitalized with COPD exacerbations using blood neutrophils and demographic parameters as risk factors

BackgroundPatients hospitalized with chronic obstructive pulmonary disease (COPD) exacerbations are unable to complete the pulmonary function test reliably due to their poor health conditions. Creating an easy-to-use instrument to identify the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage will offer valuable information that assists clinicians to choose appropriate clinical care to decrease the mortality in these patients. The objective of this study was to develop a prediction model to identify the GOLD stage in the hospitalized exacerbation of chronic obstructive pulmonary disease (ECOPD) patients.MethodsThis prospective study involved 155 patients hospitalized for ECOPD. All participants completed lung function tests and the collection of blood neutrophils and demographic parameters. Receiver operating characteristic (ROC) curve was plotted based on the data of 155 patients, and was used to analyze the disease severity predictive capability of blood neutrophils and demographic parameters. A support vector regression (SVR) based GOLD stage prediction model was built using the training data set (75%), whose accuracy was then verified by the testing data set (25%).ResultsThe percentage of blood neutrophils (denoted as NEU%) combined with the demographic parameters was associated with a higher risk to severe episode of ECOPD. The area under the ROC curve was 0.84. The SVR model managed to predict the GOLD stage with an accuracy of 90.24%. The root-mean-square error (RMSE) of the forced expiratory volume in one second as the percentage of the predicted value (denoted as FEV1%pred) was 8.84%.ConclusionsThe NEU% and demographic parameters are associated with the pulmonary function of the hospitalized ECOPD patients. The established prediction model could assist clinicians in diagnosing GOLD stage and planning appropriate clinical care.

10-Year Follow-Up of Lung Function, Respiratory Symptoms, and Functional Capacity in the COPDGene Study.

Rationale: The course of lung function, respiratory symptoms, and functional status over time in people who smoke cigarettes is still incompletely understood. The COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease [COPD]) study provides a unique cohort to examine these trajectories, and now 10-year follow-up data are available. Objectives: This study aims to provide insight into the progression of spirometric parameters, respiratory symptoms, and functional capacity over 10 years in current and former cigarette smokers. Methods: We analyzed available longitudinal data for COPDGene participants who did not change smoking status over three visits spanning approximately 10 years of follow-up. Change in postbronchodilator forced expiratory volume in 1 second (FEV1), St. George's Respiratory Questionnaire (SGRQ), and 6-minute walk distance (6MWD) from Phase 1 to Phase 3 were examined using linear mixed models. Terms were included in the models to estimate mean progression separately for current and former cigarette smokers. Models were stratified by baseline Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometry stages as well as by new 2019 COPDGene classification. Results: The mean age at enrollment of the 9,103 participants in this analysis was 59.8 years (SD = 9.2 yr); 46.4% were women, and 32.6% were African American. In all GOLD COPD groups, including participants with normal spirometry, and all groups categorized by 2019 COPDGene classification, FEV1 decreased, SGRQ increased (indicating higher symptom burden), and 6MWD decreased over the 10-year follow-up period. Current smokers exhibited a greater mean loss of FEV1 over the study period than former smokers for all groups except those with preserved ratio impaired spirometry. For both SGRQ and 6MWD, rates of progression tended to be similar for former and current smokers except for 6MWD in the highest severity groups, in which former smokers had greater progression. However, this could be impacted by some current smokers with faster progression who had quit smoking and were dropped from analyses. Conclusions: Progression in FEV1, SGRQ, and 6MWD overall appears to be slow, and the change over time in groups traditionally characterized as not having disease closely mirrors that of the groups with COPD at all GOLD stages. Current cigarette smokers had greater loss of FEV1 than former smokers, whereas SGRQ and 6MWD changes were more similar between current and former cigarette smokers.

Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease.

Aims: In contrast to cardiovascular disease, low rather than high ventilatory inefficiency, evaluated by the minute ventilation-carbon dioxide output (V'E-V'CO2)-slope, has been recognized as being related to greater disease severity in chronic obstructive pulmonary disease (COPD). To better care for patients with cardiopulmonary disease, understanding the physiological correlation between ventilatory inefficiency and exercise limitation is necessary, but remains inadequate. Given that oxygen uptake (V'O2) evaluated by cardiopulmonary exercise testing (CPET) depends on both the ventilatory capability and oxygen extraction, i.e., the difference between inspiratory and expiratory oxygen concentration (ΔFO2), the aim of this study was to investigate the correlations between V'E-V'CO2-slope and the ΔFO2 during exercise and their physiological implications in patients with COPD.Methods: A total of 156 COPD patients (mean age, 70.9 ± 7.2 years) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV and 16 controls underwent CPET with blood gas analysis.Results: With the progression of COPD, mechanical ventilatory constraints together with a slower respiratory frequency led to exertional respiratory acidosis. In GOLD IV cases, (1) decrease in the dependence of reduced peak V'O2 on V'E led to an increase in its dependence on peak ΔFO2 during exercise; and (2) the ΔFO2-V'CO2-slope became steeper, correlating with the severity of exertional respiratory acidosis (r = 0.6359, p < 0.0001). No significant differences in peak exercise ΔFO2 or V'E-V'CO2-slope were observed among the various GOLD stages. In all subjects, including controls, peak exercise ΔFO2 had the strongest correlation with the V'E-V'CO2-slope (r = −0.8835, p < 0.0001) and correlated well with body mass index (r = 0.3871, p < 0.0001), although it did not correlate with the heart rate-V'CO2-relationship and V'E.Conclusions: Ventilatory efficiency related to CO2 clearance might depend on exertional oxygen extraction in the body. Measuring ΔFO2 might be a key component for identifying ventilatory inefficiency and oxygen availability. Increasing ΔFO2 would help to improve ventilatory inefficiency and exercise tolerance separately from cardiac and ventilatory capability in COPD patients.

To Study the Prevalence of Osteopenia and Osteoporosis in Patients with COPD and to Correlate Severity of COPD with Prevalence of Osteopenia and Osteoporosis

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory airway disease characterized by both pulmonary and systemic inflammatory response and associated extra-pulmonary complications. Female gender, age and smoking are common pathogenic risk factors for both COPD and osteoporosis. Many other factors like low daily physical activity, chronic malnutrition, hypogonadism, vitamin D deficiency and chronic steroid therapy are risk factors for osteoporosis. Objectives: The study was done to evaluate the prevalence of osteopenia and osteoporosis in patients of COPD and to correlate the severity of COPD with osteopenia/ osteoporosis. Material &amp; Method: The study was conducted at a tertiary care hospital in Delhi after ethical clearance from institutional review board. Total of 76 patients of both genders were taken. COPD diagnosis and staging was done as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Bone mineral density (BMD) was evaluated by DEXA scan in all patients. All data was entered in preformed data sheets. Statistical analysis for association of COPD with osteoporosis was done by chi-square test. Result: Mostly patients were having either osteopenia or osteoporosis, only 6% patients were having normal BMD. COPD stage III-IV were having significant bone mass loss. Those having long smoking history were more osteoporotic as compared to others. Conclusion: There is a very high prevalence of osteopenia and osteoporosis in COPD patients especially those with prolonged smoking history, GOLD stage III-IV. 35.5% of COPD patients had osteopenia and 57.9 % had osteoporosis.

Association of serum vitamin D levels with disease severity, systemic inflammation, prior lung function loss and exacerbations in a cohort of patients with chronic obstructive pulmonary disease (COPD).

BackgroundVitamin D deficiency has been associated with chronic disorders including chronic obstructive pulmonary disease (COPD) but the relationships with inflammation, exacerbations and disease progression remain unclear.MethodsIn this monocentric cross-sectional observational study we analyzed the disease status, systemic inflammation, prior exacerbation frequency and loss in lung function in relation to serum 25-hydroxyvitamin D (25-OHD) levels in a cohort of 94 patients with COPD. Serum 25-OHD, C-reactive protein, interleukin-6 and tumor necrosis factor-α were quantified. Exacerbation frequencies and sunlight exposure were assessed. These parameters were analyzed in correlation to the current forced expiratory volume in 1 s (FEV1), the individual average 3-year FEV1 decline and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage.ResultsWe observed fair correlation between serum 25-OHD and the current FEV1 (r=0.38, P<0.001). Furthermore, mean serum 25-OHD was significantly altered between patients of GOLD stages I–IV (P=0.013). There was weak negative correlation of 25-OHD and the average annual change of the FEV1 (r=−0.26, P<0.05). Furthermore, we observed fair negative correlation between 25-OHD and C-reactive protein (r=−0.32, P<0.01) as well as weak negative correlation with interleukin-6 (r=−0.23, P<0.05). While the exacerbation frequency significantly differed between GOLD stages (P=0.04), there was no direct association between exacerbations and 25-OHD levels.ConclusionOur data confirm frequent vitamin D deficiency in COPD and point out correlations between 25-OHD levels, systemic inflammation, disease severity and progression.

Automated CT Staging of Chronic Obstructive Pulmonary Disease Severity for Predicting Disease Progression and Mortality with a Deep Learning Convolutional Neural Network

To develop a deep learning-based algorithm to stage the severity of chronic obstructive pulmonary disease (COPD) through quantification of emphysema and air trapping on CT images and to assess the ability of the proposed stages to prognosticate 5-year progression and mortality. In this retrospective study, an algorithm using co-registration and lung segmentation was developed in-house to automate quantification of emphysema and air trapping from inspiratory and expiratory CT images. The algorithm was then tested in a separate group of 8951 patients from the COPD Genetic Epidemiology study (date range, 2007-2017). With measurements of emphysema and air trapping, bivariable thresholds were determined to define CT stages of severity (mild, moderate, severe, and very severe) and were evaluated for their ability to prognosticate disease progression and mortality using logistic regression and Cox regression. On the basis of CT stages, the odds of disease progression were greatest among patients with very severe disease (odds ratio [OR], 2.67; 95% CI: 2.02, 3.53; P < .001) and were elevated in patients with moderate disease (OR, 1.50; 95% CI: 1.22, 1.84; P = .001). The hazard ratio of mortality for very severe disease at CT was 2.23 times the normal ratio (95% CI: 1.93, 2.58; P < .001). When combined with Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging, patients with GOLD stage 2 disease had the greatest odds of disease progression when the CT stage was severe (OR, 4.48; 95% CI: 3.18, 6.31; P < .001) or very severe (OR, 4.72; 95% CI: 3.13, 7.13; P < .001). Automated CT algorithms can facilitate staging of COPD severity, have diagnostic performance comparable with that of spirometric GOLD staging, and provide further prognostic value when used in conjunction with GOLD staging.Supplemental material is available for this article.© RSNA, 2021See also commentary by Kalra and Ebrahimian in this issue.

Hospitalization increases while economic status deteriorates in late stages of chronic obstructive pulmonary disease: the Korean National Health and Nutrition Examination Survey for 2007–2015

BackgroundChronic obstructive pulmonary disease (COPD) is associated with frequent hospitalizations, higher mortality, and healthcare costs. Low-income COPD patients have higher rates of emergency department visits and hospitalization due to COPD exacerbation. However, other causes of admissions and their economic burden have not been well-elucidated.MethodsWe analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) dataset for 2007–2015. The diagnosis and staging of COPD were based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.ResultsAmong the 97,622 participants in KNHANES for 2007–2015, we selected 33,963 participants (4,430 with and 29,533 without COPD) aged ≥40 years, who underwent spirometry, and provided the admission history for the previous year. Participants with COPD had a higher admission rate than those without COPD (12.8% vs. 10.4%, P<0.001). The admission rate increased as the stage of COPD advanced from GOLD 1 to GOLD 4 for total causes (11.5%, 13.6%, 15.1%, and 25.0%, respectively, P<0.001) and respiratory illnesses (0.5%, 1.3%, 4.6%, and 12.5%, respectively, P<0.001). The proportion of the lowest quartile household income increased in the late stages of COPD (GOLD 1–4; 35.2%, 32.1%, 44.9%, and 70.8%, respectively, P<0.01).ConclusionsThe hospitalization rate increased in advanced COPD, while GOLD stages 3 and 4 were associated with deterioration in economic status.

FOOTPRINTS study protocol: rationale and methodology of a 3-year longitudinal observational study to phenotype patients with COPD

IntroductionA better understanding is needed of the different phenotypes that exist for patients with chronic obstructive pulmonary disease (COPD), their relationship with the pathogenesis of COPD and how they may...

Association of Systemic Endothelial-Derived and Platelet-Derived Microparticles With Clinical Outcomes in Chronic Obstructive Pulmonary Disease.

Endothelial and platelet microparticles (eMPs and pMPs), markers of cellular activation, dysfunction, or apoptosis, have been associated with multiple cardiovascular conditions. Chronic obstructive pulmonary disease (COPD) is associated with cardiovascular comorbidities and platelet/endothelial dysfunction. We analyzed whether eMPs and pMPs are associated with COPD status and/or severity. A total of 58 COPD patients and 19 controls were enrolled and followed for an average of 1.17 years. Characterization of COPD included lung function, Body mass index-airflow Obstruction-Dyspnea-Exercise (BODE) scores, health-related quality of life, exacerbations, comorbidities, and mortality. Plasma collection to measure eMPs and pMPs via flow cytometry was performed at enrollment as well as during acute exacerbation in 17 participants. We measured pMPs (CD31+, CD41+31+, CD 62P+), eMPs (ULEX lectin+, CD51+, CD54+, CD62E+), the apoptotic CD62E+/CD31+ ratio, and Annexin V MP. As a group, COPD participants had no difference in all MP levels studied compared with controls. No significant correlations with diffusion capacity for carbon monoxide, quality of life, and exacerbation status were found in all MPs studied. However, the eMP ULEX and the pMP CD 62P+ were higher among COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3 patients compared to controls. The CD62E+/CD31+ ratio was lower in controls and GOLD stage 1 COPD participants compared with GOLD stage 2/3 COPD participants, suggesting increased apoptosis. eMP ULEX lectin+ decreased during acute exacerbations and pMP41+31+ significantly increased as BODE score increased. After adjusting for comorbidities, most eMPs and pMPs studied do not correlate significantly with COPD status or severity.

Chronic Bronchitis in COPD Patients Creates Worse Symptom Burden Regardless of the Presence of Bronchiectasis in the COPDGene Cohort.

To assess whether the presence or absence of bronchiectasis has an impact on the patient-reported symptoms of chronic obstructive pulmonary disease (COPD) patients. The study included participants from the COPD Genetic Epidemiology Study (COPDGene®) cohort with available high-resolution chest tomography reporting the presence or absence of bronchiectasis (BE+/BE-) and survey data reporting the presence or absence of chronic bronchitis symptoms (CB+/CB-). Patient symptoms based on the St George's Respiratory Questionnaire (SGRQ) were then compared for the different groups. The study population included 7976 participants, mean age 60, Global initiative for chronic Obstructive Lung Disease (GOLD) stages 0 to 4, 18.8% BE+, and 19.5% CB+. The presence or absence of radiographic bronchiectasis was not associated with higher frequency of chronic bronchitis (GOLD 0 group odds ratio [OR] 1.01 [0.78,1.31], GOLD 1-2 group OR 1.19 [0.95, 1.50], GOLD 3-4 group OR 1.26 [0.99, 1.60]). Similarly, CB+ participants had higher SGRQ scores than CB- participants regardless of the presence of BE. Across all GOLD stages, chronic bronchitis symptoms are associated with worse pulmonary symptoms and significant impairment in quality of life. For patients with chronic bronchitis, the presence or absence of bronchiectasis is not associated with a significant difference in SGRQ symptom scores. Symptoms of chronic bronchitis impose a heavy burden on patients and should be treated regardless of the presence or absence of underlying bronchiectasis.

Cardiovascular risk prediction using physical performance measures in COPD: results from a multicentre observational study

ObjectivesAlthough cardiovascular disease (CVD) is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), it is unknown how to improve prediction of cardiovascular (CV) risk in individuals with COPD....

Dysregulation of endocytic machinery and ACE2 in small airways of smokers and COPD patients can augment their susceptibility to SARS-CoV-2 (COVID-19) infections.

Lungs of smokers and chronic obstructive pulmonary disease (COPD) are severely compromised and are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attack. The dangerous combination of enhanced SARS-CoV-2 attachment receptor protein ACE2 along with an increase in endocytic vacuoles will enable viral attachment, entry, and replication. The objective of the study was to identify the presence of SARS-CoV-2 host attachment receptor angiotensin-converting enzyme-2 (ACE2) along with endocytic vacuoles, early endosome antigen-1 (EEA1), late endosome marker RAB7, cathepsin-L, and lysosomal associated membrane protein-1 (LAMP-1) as lysosome markers in the airways of smokers and COPD patients. The study design was cross-sectional and involved lung resections from 39 patients in total, which included 19 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I or GOLD stage II COPD, of which 9 were current smokers with COPD (COPD-CS) and 10 were ex-smokers with COPD (COPD-ES), 10 were normal lung function smokers, and 10 were never-smoking normal controls. Immunostaining for ACE2, EEA1, RAB7, and cathepsin-L was done. A comparative description for ACE2, EEA1, RAB7, and cathepsin-L expression pattern is provided for the patient groups. Furthermore, staining intensity for LAMP-1 lysosomes was measured as the ratio of the LAMP-1-stained areas per total area of epithelium or subepithelium, using Image ProPlus v7.0 software. LAMP-1 expression showed a positive correlation to patient smoking history while in COPD LAMP-1 negatively correlated to lung function. The active presence of ACE2 protein along with endocytic vacuoles such as early/late endosomes and lysosomes in the small airways of smokers and COPD patients provides evidence that these patient groups could be more susceptible to COVID-19.

Predictors of pulmonary rehabilitation completion in the UK

IntroductionPulmonary rehabilitation has been shown to improve dyspnoea, fatigue, quality of life and exercise capacity in individuals with chronic obstructive pulmonary disease (COPD). Our aim was to determine the characteristics of people with COPD associated with completion of pulmonary rehabilitation.MethodsThis was a cross-sectional analysis of 7060 people with COPD enrolled in pulmonary rehabilitation between January 1, 2017 and March 31, 2017. Data were from a UK national audit of COPD care. Factors associated with pulmonary rehabilitation completion were determined using mixed effects logistic regression with a random intercept for pulmonary rehabilitation service. Factors chosen for assessment based on clinical judgement and data availability were age, sex, country, socioeconomic status, body mass index, referral location, programme type, start within 90 days, smoking status, oxygen therapy, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) dyspnoea grade, any exercise test and any health status questionnaire.Results4635 (66%) people with COPD completed a pulmonary rehabilitation programme. People that were aged ≥60 years, resident in Wales, referred within 90 days, an ex- or never-smoker, received an exercise test, or received a health status questionnaire had significantly greater odds of completing pulmonary rehabilitation. People that were in the most deprived quintile, underweight or very severely obese, enrolled in a rolling rather than a cohort programme, had a higher GOLD stage and had a higher MRC grade had significantly lower odds of completing pulmonary rehabilitation.ConclusionsPeople with COPD were more likely to complete pulmonary rehabilitation when best practice guidelines were followed. People with more severe COPD symptoms and those enrolled in rolling rather than cohort programmes were less likely to complete pulmonary rehabilitation. Referring people with COPD in the earlier stages of disease, ensuring programmes follow best practice guidelines and favouring cohort over rolling programmes could improve rates of pulmonary rehabilitation completion.

Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease.

PurposeDysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD.MethodParticipants were 28 adults aged 41–79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD/ > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters).ResultsParticipants with COPD did not display greater frequencies of penetration–aspiration, but they were significantly more likely (p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue.ConclusionThis analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.

The Correlation of Sit-to-Stand Tests with COPD Assessment Test and GOLD Staging Classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD classification tool has been used to assess the symptom burden and exacerbation risk of patients with chronic obstructive pulmonary disease (COPD). An area requiring further exploration is the relationship between the GOLD classification's basic components and the measurements acquired by Sit-to-Stand tests (STST). We aimed to study the relationship between STST and the component of the GOLD classification tool. This study was conducted on a sample of 42 COPD subjects with patient history, COPD assessment test (CAT) and spirometry. 5STST performance time and the number 30s-STST repetitions showed differences of statistical significance in COPD subjects considered to be more symptomatic and in subjects with high risk of future exacerbations. Both STSTs correlated significantly with forced expiratory volume in one second % predicted (FEV1%), CAT, number of acute exacerbations in the past year and number of hospitalized exacerbations in the past year. STST performance correlates significantly with items of the CAT questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy. Using multivariate analysis, age, FEV1% and CAT score manifested the strongest negative association with STST performance. 5STST performance time and the number 30s-STST repetitions in COPD patients correlates with the level of symptoms and the risk of future exacerbations that define groups A-D based on GOLD 2018 classification tool (at the time of data acquisition). The correlation of STST performance with CAT score involves specific items of the questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy.