Global Obstructive Lung Disease Research Articles

Chronic obstructive pulmonary disease burden, grades and erythrocytosis at a tertiary hospital in western Uganda

BackgroundChronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide among people over 40 years of age, and erythrocytosis is one of the major complications associated with increased mortality among COPD patients. The study aimed to determine the proportion of COPD, associated factors, and the burden of erythrocytosis among COPD participants.Methods and materialsA descriptive cross-sectional study design was used. A consecutive sampling technique was used to obtain study participants at the Fort Portal Regional Referral Hospital outpatient clinic. Focused history and physical examination were carried out to select eligible participants. Participants were screened using the COPD population screener for spirometry after consenting to participate. The study enrolled all adults at risk of having COPD based on the COPD population screener and able to undergo spirometry. Spirometry was carried out according to the Global Chronic Obstructive Lung Disease and European Respiratory Society guidelines, and haemoglobin concentration was measured.ResultsOne hundred eighty participants were enrolled in the study, most of whom were females.The modal and mean age of participants was 60 years with 139 (77.2%) females and primary as the highest education level 149(82.8%). The proportion of COPD was 25% (45) [95% CI 18.9 – 32] and highest among females (68.9%) and those aged 60 years and above (70%). The combined COPD assessment tool groups had a proportion of 55.6%, 37.8%, 4.4%, and 2.2% for groups A, B, C, and D, respectively. Age < 50 years was protective against COPD, while for every additional year of smoking, there was an associated 6.5% increased risk compared to the general population. Additionally, the proportion of erythrocytosis among COPD participants was 6.7%.Conclusions and recommendationsThere was a high proportion of COPD among study participants (25%), with a 6.7% proportion of erythrocytosis. We recommend a complete blood count for every patient in groups C and D of the ABCD COPD GOLD groups.

Cause-specific mortality in COPD subpopulations: a cohort study of 339 647 people in England

BackgroundIdentifying correlates of cause-specific mortality in patients with chronic obstructive pulmonary disease (COPD) may aid the targeting of therapies to reduce mortality. We determined factors associated with causes of death...

Association of Absolute Eosinophil Count and Post-Bronchodilator Reversibility in the Chronic Obstructive Pulmonary Disease Patients

Objective: To look for the relationship between absolute eosinophil count and post-bronchodilator reversibility in chronic obstructive pulmonary disease patients at Pak Emirates Military Hospital, Rawalpindi Pakistan.&#x0D; Study Design: Cross sectional study.&#x0D; Place and During of Study: Pulmonology Department, Pak Emirates Military Hospital Rawalpindi (PEMH) from Jul to Dec 2019.&#x0D; Methodology: The study was conducted on 150 patients suffering from chronic obstructive pulmonary disease admitted in the Medical Ward or reporting in the Outpatient Department. Lung function was assessed using spirometry pre- and postbronchodilation. The presence and severity of chronic obstructive pulmonary disease were assessed using modified Global Obstructive Lung Disease (GOLD) criteria. The presence of significant bronchodilator responsiveness was taken as ≥12% improvement in the forced expiratory volume (FEV) (1) or the forced vital capacity.&#x0D; Results: Of 150 patients in the final analysis, 95 (63.3%) were male, and 55(36.7%) were female. The mean duration of COPD in our target population was 9.13±1.23 years. 68 (45.3%) had &gt;12% improvement after bronchodilator administration, while 82(54.7%) had &lt;12% improvement. The absolute eosinophilic count was &lt;2% in 49(32.7%), while it was raised in 101(67.3%) patients. &#x0D; Conclusion: Raised eosinophilic count emerged as a predictor of good response after administering bronchodilators among patients suffering from chronic obstructive airway disease. Screening patients for this simple blood component may predictresponse to the initial treatment and help in the tailoring of the treatment plan by the treating physician.Keywords: Chronic obstructive pulmonary disease, Eosinophils, Forced expiratory volume.

The relationship between frontal QRS-T angle and the severity of newly diagnosed chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow restriction and respiratory symptoms. Studies demonstrated that cardiac arrhythmias and cardiovascular mortality increased in these patients as a result of altered myocardial repolarization. Frontal QRS-T angle is a novel marker of myocardial depolarization and repolarization heterogeneity. In this study, we aimed to investigate the relationship between frontal QRS-T angle and disease severity in patients with newly diagnosed COPD. A total of 104 newly diagnosed COPD patients were included in this study. Patients were divided into two groups according to GOLD (Global Obstructive Lung Disease) stage as follows: patients with mild and moderate COPD (group I), and severe and very severe COPD (group II). Frontal QRS-T angle was calculated from the automatic report of the electrocardiography device. Frontal QRS-T angle was significantly higher in group II patients compared with in group I patients (43.0 [25.5-60.0] vs. 20.0 [12.0-32.0], P < .001). The best cut-off value of frontal QRS-T angle for predicting severe-very severe COPD was ≥34.5°. Correlation analysis showed that frontal QRS-T angle was negatively correlated with FEV1/FVC (r = -.524, P < .001) and MEF25-75 (r = -.453, P < .001). Multivariate logistic regression analysis was showed that frontal QRS-T angle was the only independent predictor of severe-very severe COPD (OR: 1.051, 95% CI: 1.024-1.079, P < .001). Frontal QRS-T angle is an easily obtainable marker form surface electrocardiography. In this study, we have shown for the first time that frontal QRS-T angle was significantly increased in patients with severe and very severe COPD.

Amfizemli Hastalarda Amfizem Yaygınlığının Arter Kan Gazı, Solunum Fonksiyon Testi ve Hastaların Performanslarıyla Olan İlişkisi: Tanımlayıcı Klinik Araştırma

Objective: In emphysema, changes such as decrease in the maximum expiratory air flow, excessive ventilation and air trapping occur. These changes affect the patients' exercise tolerance and effort capacities in the later period. Our purpose was to determine the relation between the prevalence of emphysema and patients' performance, the level of obstruction in the patients, the changes occurring in patients' artery blood gas (ABG) and other emphysema parameters. Material and Methods: A total of 55 consecutive patients with definite emphysema were included in the study. Patients' demographic and clinical characteristics were recorded. High resolution computed tomography (HRCT), pulmonary function tests, ABG measurement, patient performance evaluation and lung quantitative perfusion scintigraphy were performed to all patients. HRCT and visual emphysema score were used to determine the distribution and prevalence of emphysema. Results: Negative correlation coefficients were found between the emphysema scores and forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, diffusing capacity of the lung for carbon monoxide, oxygen saturation percentage and 6 minutes walking test (6MWT) and positive correlation coefficients were found residual volume (RV), total lung capacity, partial carbon monoxide tension, Global Obstructive Lung Disease stage and Modified Medical Research Council (p<0.05). Conclusion: It was determined that among all the parameters, the strongest negative correlation was with the 6MWT, and the strongest positive correlation was with the RV. It was seen that in terms of the zones, the percentage of perfusion decreased as the emphysema scores increased.

BEAM study (Breathing, Education, Awareness, Movement): a randomised controlled feasibility trial of tai chi exercise in patients with COPD

BackgroundDespite therapeutic advances, the management of chronic obstructive pulmonary disease (COPD) remains complex. There is growing interest in multidimensional, mind-body exercises to improve both physical and psychosocial aspects of COPD...

Comparación de variables clínicas, capacidad funcional, ansiedad/depresión y calidad de vida en pacientes con EPOC de acuerdo a la clasificación GOLD 2018

IntroductionThe Global Obstructive Lung Disease (GOLD) annually updates the COPD management guide, introducing changes in letter classification, symptom assessment, or severity of obstruction. This has motivated interest in investigating differences among groups in clinical variables, quality of life related to health (QOLRH) and functional capacity. ObjectiveTo determine the differences in clinical variables, survival, functional capacity, anxiety/depression and QOLRH in patients with chronic obstructive pulmonary disease (COPD) according to the GOLD 2018 classification in a Clinic in Cali (Colombia). MethodsAn observational, analytical and cross-sectional study including 128 patients (61% men) with a mean age of 71 years and diagnosis of COPD divided into three groups; GOLD-B, GOLD-C and GOLD-D. ResultsHospitalizations were more prevalent in the GOLD-C and GOLD-D groups at 100% and 86% respectively, p value <.001, with significant differences in survival P<.001. Group GOLD-C showed greater functional capacity at 344 meters with a shorter distance for group GOLD-B at 271m, a statistically significant difference was found. No statistically significant differences were found in anxiety and depression. When comparing the three groups the GOLD- C patients had better QOLRH in the SGRQ questionnaire; mean of 37±15, (GOLD-B) of 45±16 and GOLD-D 55±15 with a P value=.002. ConclusionGroup GOLD-C showed greater survival, functional capacity and quality of life and GOLD-D had worse clinical condition, functional capacity and quality of life.

Comparing the efficacy and safety of theophylline with doxofylline in patients with chronic obstructive pulmonary disease

Background: A significant public health concern, both preventable and treatable, is chronic pulmonary obstructive disorders (Chronic obstructive pulmonary disease [COPD]). It is one of the primary causes of chronic illness and mortality worldwide. The prominent safety concerns in the use of theophylline need to be addressed. Aim and Objective: In Grade 1–2 COPD patients, the efficacy and effectiveness of oral doxofylline should be contrasted with theophylline. Materials and Methods: Two groups of 25 patients, with one group getting theophylline and the other doxofylline, were randomized to a total of 50 patients in addition to the normal treatment for 12 weeks. Each patient was accompanied by a pulmonary function test (PFT), a COPD assessment test (CAT) evaluation questionnaire, and a drug-related safety review at 6 weeks and 12 weeks for the assessment of efficacy parameters. Results: At 6 weeks and 12 weeks within their respective classes, theophylline and doxofylline showed substantial increases in PFT and CAT performance. However, there was no noticeable change relative to the two classes. In theophylline group, the amount of adverse drug reactions is larger relative to patients in the doxofylline community. Dyspnea was the most severe harmful effect of all categories. Conclusion: Doxofylline is also useful in treating Grade 1–2 COPD (global obstructive lung disease criteria), which has a greater safety profile relative to theophylline.

Pulmonary rehabilitation outcome in chronic obstructive pulmonary disease patients with a different body composition

ContextChange in body composition is commonly present in chronic obstructive pulmonary disease (COPD) patients.AimThe aim of this study was to investigate the effects of pulmonary rehabilitation program (PRP) on COPD patients who have a different body composition.Materials and methodsIn this study, we measure;Deg;BM; Deg;I and fat-free mass index (FFMI) using a single-frequency bioelectrical impedance analysis apparatus to classify patients into three categories: Group 1 nonmuscle depleted;Deg;BM;Deg;I greater than or equal to 21 kg/m2 and FFMI greater than or equal to 16. Group 2 muscle depleted; Deg;BM;Deg;I greater than or equal to 21 kg/m2 and FFMI less than 16 in men or FFMI less than 15 in women. Group 3 muscle depleted with cachexia;Deg;BM;Deg;I less than 21 kg/m2 and FFMI less than 16 in men or FFMI less than 15 in women. PRP outcomes were assessed by the improvement in pulmonary function severity, exercise capacity by 6-min walk test, dyspnea score by modified-British Medical Research Council, and health status by combined assessment test score and arterial blood gas improvements.ResultsForty-four patients with FFMI were measured by bioelectrical impedance analysis. The patients were mainly elderly men (N=35; 79%), who have a mean age of 65 years with different global initiative obstructive lung disease stage I–IV. In the nonmuscle depleted group, there were statistically significant improvements in the mean values of FFMI (kg/m2) while in the muscle depleted group there were improvements as regards the mean values of dyspnea score by modified-British Medical Research Council; in the cachectic group there were statistically significant improvements in the mean values of BMI (kg/m2), forced expiratory volume in the first second (FEV1), forced expiratory volume in first second divided by forced vital capacity ratio, combined assessment test score after PRP.ConclusionsA comprehensive PRP outcome change in COPD patients with different body compositions.

Airflow limitation classified with the fixed ratio or the lower limit of normal and cause-specific mortality - A prospective study.

There is controversy as to whether airflow limitation should be defined as forced expiratory volume in 1 s (FEV1)/vital capacity (VC) < 0.7 or as FEV1/VC< the lower limit of normal (LLN). The aim was to examine whether different definitions of airflow limitation differ in predicting mortality. Longitudinal prospective study of a national cohort of Swedish workers (199,408 men; 7988 women), aged 20-64 years with spirometry without bronchodilation at baseline followed from 1979 until death, or censorship at 2010. Airflow limitation (AL) by Global Obstructive Lung Disease criteria, ALGOLD, was defined as FEV1/VC < 0.7; ALLLN as FEV1/VC < LLN. All all-cause, COPD and cardiovascular disease mortality was analyzed among men and women in relation to ALGOLD and ALLLN, adjusted for age and smoking. Among men, all-cause mortality risks were similar by airflow limitation criteria: ALGOLD RR = 1.32, 95% CI 1.26-1.38; ALLLN, RR = 1.37, 95% CI 1.31-1.44. The risk estimates were also similar by airflow limitation definition for cardiovascular mortality and for COPD mortality. Among women, all-cause mortality was also similar by airflow limitation criteria, but significantly higher as compared to men: ALGOLD RR = 2.10, 95% CI 1.66-2.66; ALLLN, RR = 2.09, 95% CI 1.66-2.62. Also cardiovascular and COPD mortality by airflow limitation criteria was significantly higher among women as compared to men. Defined either as FEV1/VC < 0.7 or as FEV1/VC < LLN, airflow limitation predicted excess mortality risk of similar magnitude. Mortality in relation to airflow limitation was higher among women compared to men.

The Role of Tiotropium+Olodaterol Dual Bronchodilator Therapy in the Management of Chronic Obstructive Pulmonary Disease.

Bronchodilator therapy is central to the management of chronic obstructive pulmonary disease and are recommended as the preferred treatment by the Global Obstructive Lung Disease Initiative (GOLD). Long acting anti-muscarinics (LAMA) and long acting β2 agonists (LABA) are both more effective than regular short-acting drugs but many patients remain symptomatic despite monotherapy with these drugs. Combination therapy with LAMA and LABA increases the therapeutic benefit while minimizing dose-dependent side effects of long-acting bronchodilator therapy. The TOviTO programme has investigated the benefits of treatment with a combination of tiotropium and olodaterol administered via a single inhaler. Tiotropium+olodaterol 5/5 µg significantly improved forced expiratory volume in 1 second (FEV1) area under the curve from 0 to 3 hours, trough FEV1 health status and breathlessness versus the mono-components and placebo. Tiotropium+olodaterol 5/5 µg also increased endurance time and reduced dynamic hyperinflation during constant work rate cycle ergometry. On the basis of these and other studies the 2017 GOLD report recommends escalating to dual bronchodilator therapy in patients in groups B and C if they remain symptomatic or continue to have exacerbations and as initial therapy for patients in group D.

Examining the Effects of Age on Health Outcomes of Chronic Obstructive Pulmonary Disease: Results From the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease Study and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate Endpoints Cohorts

RationaleThe prevalence of chronic obstructive pulmonary disease (COPD) and its associated comorbidities increase with age. However, little is understood about differences in the disease in patients over 65 years of age compared with younger patients. ObjectivesTo determine disease characteristics of COPD and its impact in older patients compared with younger patients. MethodsWe examined baseline characteristics of patients with COPD (global obstructive lung disease stage II–IV) in 2 large cohorts: Genetic Epidemiology of COPD Study (COPDGene) and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). We compared demographics, indices of disease severity, prevalence of comorbidities, exacerbation frequency, and quality of life scores in patients ≥65 years of age vs patients <65 years of age. We also tested for associations of age with disease characteristics and health outcomes. ResultsIn the COPDGene cohort, older patients (n = 1663) had more severe disease as measured by forced expiratory volume in 1 second (1.22 vs 1.52 L, P < .001), use of long-term oxygen therapy (35% vs 22%, P < .001), 6-minute walk distance (355 vs 375 m, P < .001), and radiographic evidence of emphysema (14% vs 8%, P < .001) and air trapping (47% vs 36%, P < .001) and were more likely to have comorbidities compared with younger patients (n = 2027). Similarly, in the ECLIPSE cohort, older patients (n = 1030) had lower forced expiratory volume in 1 second (1.22 vs 1.34 L, P < .001), greater use of long-term oxygen therapy (7% vs 5%, P = .02), shorter 6- minute walk distance (360 vs 389 m, P < .001), and more radiographic evidence of emphysema (17% vs 14%, P = .009) than younger patients (n = 1131). In adjusted analyses of both cohorts, older age was associated with decreased frequency of exacerbations [odds ratio = 0.52, 95% confidence interval (CI) = 0.43–0.64 in COPDGene, odds ratio = 0.79, 95% CI = 0.64–0.99 in ECLIPSE] and a better quality of life (lower St. Georges respiratory questionnaire score) (β = −8.7, 95% CI = −10.0 to −7.4 in COPDGene, β = −4.4, 95% CI = −6.1 to −3.2 in ECLIPSE). ConclusionsDespite greater severity of illness, older patients with COPD had better quality of life and reported fewer exacerbations than younger patients. Although this observation needs to be explored further, it may be related to the fact that older patients change their expectations and learn to adapt to their disease.

Identifying and treating different phenotypes in COPD

Research into chronic obstructive pulmonary disease (COPD) has identified different phenotypes, which require a variety of approaches to treatment. As a result, the Global Obstructive Lung Disease (GOLD) guidelines group has updated its advice on the diagnosis and management of COPD. The 2017 GOLD guidelines offer a fresh approach to the identification and management of these COPD phenotypes, so that inhaled therapies and other treatments can be offered appropriately both in stable and acute exacerbations of COPD. This article reviews the treatment options as suggested by the GOLD guidelines group and discusses the rationale for taking a risk: benefit approach to treatment decisions. COPD is a disease with a variety of different phenotypes. Beverley Bostock-Cox discusses treatment options for these phenotypes

Identifying and treating different phenotypes in chronic obstructive pulmonary disease

Research into chronic obstructive pulmonary disease (COPD) has identified different phenotypes, which require a variety of approaches to treatment. As a result, the Global Obstructive Lung Disease (GOLD) guidelines group has updated its advice on the diagnosis and management of COPD. The 2017 GOLD guidelines offer a fresh approach to the identification and management of these COPD phenotypes, so that inhaled therapies and other treatments can be offered appropriately both in stable and acute exacerbations of COPD. This article reviews the treatment options as suggested by the GOLD guidelines group and discusses the rationale for taking a risk: benefit approach to treatment decisions.

Multi-component assessment of chronic obstructive pulmonary disease: an evaluation of the ADO and DOSE indices and the global obstructive lung disease categories in international primary care data sets.

Suitable tools for assessing the severity of chronic obstructive pulmonary disease (COPD) include multi-component indices and the global initiative for chronic obstructive lung disease (GOLD) categories. The aim of this study was to evaluate the dyspnoea, obstruction, smoking, exacerbation (DOSE) and the age, dyspnoea, obstruction (ADO) indices and GOLD categories as measures of current health status and future outcomes in COPD patients. This was an observational cohort study comprising 5,114 primary care COPD patients across three databases from UK, Sweden and Holland. The associations of DOSE and ADO indices with (i) health status using the Clinical COPD Questionnaire (CCQ) and St George’s Respiratory Questionnaire (SGRQ) and COPD Assessment test (CAT) and with (ii) current and future exacerbations, admissions and mortality were assessed in GOLD categories and DOSE and ADO indices. DOSE and ADO indices were significant predictors of future exacerbations: incident rate ratio was 1.52 (95% confidence intervals 1.46–1.57) for DOSE, 1.16 (1.12–1.20) for ADO index and 1.50 (1.33–1.68) and 1.23 (1.10–1.39), respectively, for hospitalisations. Negative binomial regression showed that the DOSE index was a better predictor of future admissions than were its component items. The hazard ratios for mortality were generally higher for ADO index groups than for DOSE index groups. The GOLD categories produced widely differing assessments for future exacerbation risk or for hospitalisation depending on the methods used to calculate them. None of the assessment systems were excellent at predicting future risk in COPD; the DOSE index appears better than the ADO index for predicting many outcomes, but not mortality. The GOLD categories predict future risk inconsistently. The DOSE index and the GOLD categories using exacerbation frequency may be used to identify those at high risk for exacerbations and admissions.

What was the Impact of the Spanish COPD Guidelines (GesEPOC) and how can They be Improved?

Before reading any further, the reader should be advised that the author of this editorial has a clear intellectual conflict with its contents, as he has collaborated intensively in drawing up the Spanish COPD Guidelines (GesEPOC).1 Therefore, it is highly likely that the opinions expressed below are biased by a view conditioned by the guideline drafting process. Nevertheless, this view does not prevent the author from seeing, hearing and valuing the sincere, although not always favourable, opinions of many colleagues. If this introduction has not discouraged the reader, I hope that the time spent reading this editorial will be worthwhile. GesEPOC does not stand in opposition to anyone or anything, but follows the trend set by a very relevant article published in 2010.2 It is true that GesEPOC sought to innovate, based on the widely accepted concept that we had to go beyond the forced expiratory volume in the first second (FEV1), and that types (or phenotypes) of patients who share characteristics and responses to treatments had to be identified.3 Innovation is always a risk, but we thought that sufficient evidence had been gathered to justify launching a proposal of this type. Almost simultaneously, the Global Obstructive Lung Disease (GOLD) initiative also launched its proposal to go beyond the FEV1, albeit differently. 4 The concurrence of these different ways of addressing the same reality has generated considerable debate and, sincerely, I believe that COPD in general has benefitted, even at the risk of adding to the confusion. There is no doubt that the GOLD document is a global reference, but it is not unanimously accepted5; GesEPOC is, or should be, the reference guide in Spain, but it is also true that it is not unanimously accepted nationally. What has publication of the Spanish COPD guidelines meant? We can list a number of answers: (a) recognition and dissemination of the complexity of COPD. There is not one COPD, but several, and it is the clinician’s responsibility to recognize these different profiles or phenotypes; (b) it has encouraged multidimensional evaluation of COPD severity with the BODE/BODEx indices; (c) dissemination of the mixed COPD-asthma phenotype (better known as asthma-

Prognostic evaluation of COPD patients: GOLD 2011 versus BODE and the COPD comorbidity index COTE

BackgroundThe Global Obstructive Lung Disease (GOLD) 2011 revision recommends the multidimensional assessment of COPD including comorbidities and has developed a disease categories system (ABCD) attempting to implement this strategy. The...

The Relationship Between Chronic Obstructive Pulmonary Disease and Lung Cancer in African American Patients

RationaleAirflow obstruction and/or emphysema have been associated with lung cancer risk; however, this relationship and the joint occurrence of these conditions are not well studied in the African American population ObjectiveTo describe the prevalence of airflow obstruction and/or emphysema in African Americans with lung cancer and to evaluate their impact on the management and outcome of lung cancer. MethodsMedical records of 114 African Americans who had participated in population-based case-control studies of lung cancer and who sought medical care at the Karmanos Cancer Center in Detroit, Michigan, were reviewed. The medical records of these patients were reviewed for demographics, type and stage of lung cancer, spirometry, treatment, and outcome. Computed tomographies (CT) of the chest about the time of the diagnosis of lung cancer were reviewed by a radiologist for evidence of emphysema. COPD was diagnosed when there were changes consistent with emphysema on CTs and/or airflow obstruction by spirometry. ResultsThere were no differences by sex for age at lung cancer diagnosis (P = .78) and tumor histology (P = .43). The men were more likely to present at a later stage of lung cancer diagnosis compared with the women (P = .04), and the women were more likely to have surgery than the men (P = .03). Overall, 94% of the men and 78% of the women in this population had spirometry and/or CT evidence of COPD. The men were somewhat more likely to have COPD diagnosed by either CT or spirometry than were the women (P = .06), but the Global Obstructive Lung Disease Classification scores did not differ by sex among those with spirometry-diagnosed COPD (P = .34). Seventy-eight percent of individuals who did not report a previous diagnosis of COPD had clinical evidence of COPD, whereas 94% of individuals who reported a previous diagnosis of COPD also had clinical evidence of COPD (P = .03). Among individuals who had both spirometry and CT data available, 29% had CT evidence of emphysema but normal spirometry. No differences in COPD diagnosis (P = .82) or emphysema diagnosis (P = .51) were noted by tumor histology. Stage at diagnosis also did not differ by COPD or emphysema diagnosis (P = .30 and P = .06, respectively), nor did treatment modality (P = .54 and P = .10, respectively). Patients with lung cancer and with COPD, diagnosed either via spirometry or CT, did not show an increased risk of death compared with patients with lung cancer and without COPD after adjusting for age at diagnosis, sex, and stage (hazard ratio, 1.31 [95% CI, 0.68-2.53]). ConclusionThere is a high incidence of COPD, emphysema in particular, in a selected group of African American patients with lung cancer. A significant number of these patients were not aware that they had COPD. There was no significant difference in the outcome of lung cancer in relation to the presence or absence of COPD.

Guideline for the management of chronic obstructive pulmonary disease – 2011 update

To revise the South African Guideline for the Management of Chronic Obstructive Pulmonary Disease (COPD) based on emerging research that has informed updated recommendations. (1) Smoking is the major cause of COPD, but exposure to biomass fuels and tuberculosis are important additional factors. (2) Spirometry is essential for the diagnosis and staging of COPD. (3) COPD is either undiagnosed or diagnosed too late, so limiting the benefit of therapeutic interventions; performing spirometry in at-risk individuals will help to establish an early diagnosis. (4) Oral corticosteroids are no longer recommended for maintenance treatment of COPD. (5) A therapeutic trial of oral corticosteroids to distinguish corticosteroid responders from non-responders is no longer recommended. (6) Primary and secondary prevention are the most cost-effective strategies in COPD. Smoking cessation as well as avoidance of other forms of pollution can prevent disease in susceptible individuals and ameliorate progression. Bronchodilators are the mainstay of pharmacotherapy, relieving dyspnoea and improving quality of life. (7) Inhaled corticosteroids are recommended in patients with frequent exacerbations and have a synergistic effect with bronchodilators in improving lung function, quality of life and exacerbation frequency. (8) Acute exacerbations of COPD significantly affect morbidity, health care units and mortality. (9) Antibiotics are only indicated for purulent exacerbations of chronic bronchitis. (10) COPD patients should be encouraged to engage in an active lifestyle and participate in rehabilitation programmes. Treatment recommendations are based on the following: annual updates of the Global Obstructive Lung Disease (GOLD), initiative, that provide an evidence-based comprehensive review of management; independent evaluation of the level of evidence in support of some of the new treatment trends; and consideration of factors that influence COPD management in South Africa, including lung co-morbidity and drug availability and cost. Holistic management utilising pharmacological and nonpharmacological options are put in perspective. Working groups of clinicians and clinical researchers following detailed literature review, particularly of studies performed in South Africa, and the GOLD guidelines. BENEFITS, HARMS AND COSTS. The guideline pays particular attention to cost-effectiveness in South Africa, and promotes the initial use of less costly options. It promotes smoking cessation and selection of treatment based on objective evidence of benefit. It also rejects a nihilistic or punitive approach, even in those who are unable to break the smoking addiction. These include primary and secondary prevention; early diagnosis, staging of severity, use of bronchodilators and other forms of treatment, rehabilitation, and treatment of complications. Advice is provided on the management of acute exacerbations and the approach to air travel, prescribing long-term oxygen and lung surgery including lung volume reduction surgery. The COPD Working Group comprised experienced pulmonologists representing all university departments in South Africa and some from private practice, and general practitioners. Most contributed to the development of the previous version of the South African guideline. GUIDELINE SPONSOR: The meeting of the Working Group of the South African Thoracic Society was sponsored by an unrestricted educational grant from Boehringer Ingelheim and Glaxo-Smith-Kline.

Comparison of health-related quality of life measures in chronic obstructive pulmonary disease

BackgroundThe aims of this study were: (1) to compare the discriminative ability of a disease-specific instrument, the St. George's Respiratory Questionnaire (SGRQ) to generic instruments (i.e., EQ-5D and SF-36); and (2), to evaluate the strength of associations among clinical and health-related quality of life (HRQL) measures in chronic obstructive pulmonary disease (COPD).MethodsWe analyzed data collected from 120 COPD patients in a Veterans Affairs hospital. Patients self-completed two generic HRQL measures (EQ-5D and SF-36) and the disease-specific SGRQ. The ability of the summary scores of these HRQL measures to discriminate COPD disease severity based on Global Obstructive Lung Disease (GOLD) stage was assessed using relative efficiency ratios (REs). Strength of correlation was used to further evaluate associations between clinical and HRQL measures.ResultsMean total scores for PCS-36, EQ-VAS and SGRQ were significantly lower for the more severe stages of COPD (p < 0.05). Using SGRQ total score as reference, the summary scores of the generic measures (PCS-36, MCS-36, EQ index, and EQ-VAS) all had REs of <1. SGRQ exhibited a stronger correlation with clinical measures than the generic summary scores. For instance, SGRQ was moderately correlated with FEV1 (r = 0.43), while generic summary scores had trivial levels of correlation with FEV1 (r < 0.2).ConclusionsThe SGRQ demonstrated greater ability to discriminate among different levels of severity stages of COPD than generic measures of health, suggestive that SGRQ may provide COPD studies with greater statistical power than EQ-5D and SF-36 summary scores to capture meaningful differences in clinical severity.