GOLD Guidelines Research Articles

The effect of endobronchial coil treatment (EBCT) on hemorheological parameters and oxidative stress: a pilot study

Objective: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, curable disease characterized by persistent airflow limitation, respiratory symptoms due to airway and/or alveolar abnormalities caused by severe exposure to harmful particles, gases. During the endobronchial coil treatment (EBCT) process, the volume of the lung parenchyma is reduced by shrinking the elastic recoil. Although there are studies showing worsening of hemorheological parameters in COPD exacerbations, no study investigated whether hemorheological parameters are improved after coil. The aim of this study was to assess the effects of coil therapy on erythrocyte deformability, whole blood viscosity (WBV) measured at autologous, standard (40%) hematocrit and plasma viscosity (PV) in COPD patients. Material and methods: Venous blood samples were taken once from the healthy control group (n=17) and before and 1 month after the treatment from the COPD patients who had been indicated for coil according to GOLD guidelines (n=20). To assess erythrocyte deformability, shear-dependent erythrocyte elongation was measured at 0.3-3.0 Pa by an ektacytometer (LORCA), while WBV, PV were measured using a rotational viscometer. Results: Erythrocyte deformability measured at shear stresses between 0.3-5.33 Pa were found to be higher following treatment compared to pre-coil values. EBCT did not have a statistically significant effect on WBV measured at autologous, 40% hematocrit, PV and oxidative stress indices. Conclusion: Increased erythrocyte deformability determined following EBCT at the shear stresses observed at the pulmonary level is a favourable finding, showing that the procedure may positively affect the hemodynamics of COPD patients as well as causing clinical improvement.

Prevalence and predictors of polypharmacy and comorbidities among patients with chronic obstructive pulmonary disease: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia

ObjectiveThis study aimed to determine the prevalence of polypharmacy, comorbidities and to investigate factors associated with polypharmacy among adult patients with Chronic Obstructive Pulmonary Disease (COPD).MethodsThis was a retrospective single-centre cross-sectional study. Patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 February 2020 and 1 March 2023 were included in this study. Patients were excluded if a pre-emptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Population characteristics were presented as frequency for categorical variable. Logistic regression analysis was used to identify predictors of polypharmacy.ResultsThe study sample included a total of 705 patients with COPD. Most of the study sample were males (60%). The mean age of the study population was 65 years old. The majority of the study population had comorbid diseases (68%), hypertension and diabetes were the most common co-existent diseases. Around 55% of the study sample had polypharmacy. Females were significantly less likely to be on polypharmacy compared to males (OR = 0.68, 95% CI = [0.50–0.92], P-value = 0.012)). On the other hand, older patients aged 65.4 or more (OR = 2.31, 95% CI = [1.71–3.14], P-value ≤ 0.001), those with high BMI (≥ 29.2) (OR = 1.42, 95% CI = [1.05–1.92], P-value = 0.024), current smokers (OR = 1.9, 95% CI = [1.39–2.62], P-value ≤ 0.001), those who are receiving home care (OR = 5.29, 95% CI = [2.46–11.37], P-value ≤ 0.001), those who have comorbidities (OR = 19.74, 95% CI = [12.70–30.68], P-value ≤ 0.001) were significantly more likely to be on polypharmacy (p ≤ 0.05).ConclusionsPolypharmacy is common among patients with COPD. Patients with high BMI, previous ICU hospitalization and older age are more likely to have polypharmacy. Future analytical studies are warranted to investigate outcomes in patients with COPD and polypharmacy.

Ultrasound assessment of diaphragmatic excursion in chronic obstructive pulmonary disease patients with different severities

BackgroundChronic obstructive pulmonary disease (COPD) is associated with dysfunctional diaphragmatic breathing we assess the diaphragmatic excursion at different stages of COPD patients by transthoracic ultrasound.ObjectiveThe present study aimed to assess the diaphragmatic excursion at different stages of COPD patients by transthoracic ultrasound.Patients and methodsIn this observational case–control study, 80 COPD patients were included according to GOLD guidelines 2020 attending the Chest Clinic in Badr Hospital, Helwan University. All patients were divided equally into 5 groups according to FEV1 measured by spirometer: group (1) normal person; group (2) mild stage FEV1_80% predicted; group (3) moderate stage 50%_FEV1 < 80% predicted; group (4) severe stage 30%_FEV1 < 50% predicted; and group (5) very severe stage FEV1 < 30% predicted. We measured diaphragmatic movement in all these patients using ultrasound.ResultsThe outcomes result of normal, mild, moderate, severe, and very severe groups in terms of post-bronchodilator FEV1/FVC are 0.66 ± 0.05, 0.65 ± 0.05, 0.63 ± 0.04, 0.51 ± 0.068 respectively showed was a significant difference. There was a significant difference of FEV1 are 86.70 ± 5.62, 63.00 ± 13.81, 43.00 ± 6.78, 24.00 ± 4.17, respectively (P < 0.001). There was a significant difference in diaphragmatic thickness at the end of normal expiration are 0.49 ± 0.12, 0.51 ± 0.09, 0.47 ± 0.16, 0.37 ± 0.07, respectively (P < 0.001). There was a significant difference in the diaphragmatic thickness during maximum inspiration are 0.70 ± 0.16, 0.8 ± 0.17, 0.64 ± 0.19, and 0.47 ± 0.08, respectively (P < 0.001). There was a significant difference in the diaphragmatic excursion during normal breathing are 2.45 ± 0.39, 1.78 ± 0.67, 1.86 ± 0.67, 1.09 ± 0.16, respectively (P < 0.001). There was a significant difference in diaphragmatic Excursion during maximum inspiration are 4.41 ± 0.91, 3.83 ± 0.78, 3.36 ± 0.74, 2.36 ± 0.66 respectively (P < 0.001).ConclusionThe use of ultrasonography for assessing the diaphragmatic excursion. Sonographically determined diaphragmatic excursion strongly correlates with FEV1/FVC.

The influence of glucocorticoids on the bone tissue in patients with chronic obstructive pulmonary disease

Background. According to the GOLD guidelines, glucocorticoids (GCs) are recommended for exacerbations of chronic obstructive pulmonary disease (COPD). Bone mineral density (BMD) can be reduced in case of the use of therapeutic doses of GCs. The aim of the study was to determine the influence of GCs on BMD and the frequency of osteoporosis in patients with COPD depending on the prescribed therapy. Materials and methods. We examined 202 patients with COPD (group E) in the acute phase. Group I consisted of 129 patients taking basic dual treatment, group II — 73 patients taking triple therapy with inhaled GCs. During exacerbations, systemic GCs were prescribed at the cumulative dose of 352.94 ± 30.51 mg/year. The bone state was examined using an ultrasound densitometer SONOST-2000. A Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA), Stiffness index (SI), and T- and Z-scores were determined. Results. Decreases in SI, BUA, T- and Z- scores were established in 43.51 % of the patients from the I group and 83.56 % from the II group (p &lt; 0.05). In the II group, SI was lower by 9.54 %, BUA — by 14.35 %, SOS — by 14.57 %, T- score — by 6.9 %, Z- score — by 25.86 %; in subjects with GOLD 3: BUA — by 40.27 %, SI — by 3.25 %, T- score — by 17.9 %; in patients with GOLD 4: SI — by 19.9 %, BUA — by 77.8 %, T- score — by 5.6 % compared to the I group. Conclusions. Glucocorticoid-induced osteoporosis was diagnosed in 10.71 % of patients from the I group and 20.55 % of the II group. Its frequency depended on the stage of COPD: GOLD 3 — in 22.22 % of patients, GOLD 4 — in 50.0 % of the subjects.

Prevalence and Management of Chronic Obstructive Pulmonary Disease in the Gulf Countries with a Focus on Inhaled Pharmacotherapy.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable, progressive disease and the third leading cause of death worldwide. The epidemiological data of COPD from Gulf countries are very limited, as it remains underdiagnosed and underestimated. Risk factors for COPD include tobacco cigarette smoking, water pipe smoking (Shisha), exposure to air pollutants, occupational dusts, fumes, and chemicals. Inadequate treatment of COPD leads to worsening of disease. The 2024 GOLD guidelines recommend use of inhaled bronchodilators, corticosteroids, and adjunct therapies for treatment and management of COPD patients based on an individual assessment of the severity of symptoms and risk of exacerbations. This article reviews COPD pharmacotherapy in the Gulf countries and explores the role of nebulization in the management of COPD in this region. Methods: To review the COPD pharmacotherapy in the Gulf Countries, literature search was conducted using PubMed, Medline, Cochrane Systematic Reviews, and Google Scholar databases (before December 2022), using search terms such as COPD, nebulization, inhalers/inhalation, aerosols, and Gulf countries. Relevant articles from the reference list of identified studies were reviewed. Consensus statements, expert opinion, and other published review articles were included. Results: In the Gulf countries, pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), soft mist inhalers, and nebulizers are used for drug delivery to COPD patients. pMDIs and DPIs are most prone to errors in technique and other common device handling errors. Nebulization is another mode of inhalation drug delivery, which is beneficial in certain patient populations such as the elderly and patients with cognitive impairment, motor or neuromuscular disorders, and other comorbidities. Conclusion: There is no major difference between Gulf countries and rest of the world in the approach to management of COPD. Nebulizers should be considered for patients who have difficulties in accessing or using MDIs and DPIs, irrespective of geographical location.

Serum Creatinine to Cystatin C as a Marker for Assessing Sarcopenia in Chronic Obstructive Pulmonary Disease – A Single-Center, Prospective, Observational Study

Abstract Background: Patients with chronic obstructive pulmonary disease (COPD) can develop systemic complications that include skeletal muscle dysfunction among others. Reduction in muscle mass and function is called as sarcopenia. Diagnosing sarcopenia requires the measurement of walking speed, handgrip strength (HGS), and muscular mass. This is cumbersome to both the patient and the examiner. It requires the use of instruments such as the bio-impedance assay (BIA) and hand dynamometer. Serum cystatin-C (Cys C) and creatinine (Cr) are employed as determinants for kidney function. Cr levels decrease in accordance with low muscle mass, while Cys C remains unchanged. It is due to this relationship among creatinine, cystatin C and muscle mass, serum Cr/Cys C is being tested as a determinant for sarcopenia. Objective: The objective of this study is to study the correlation between Cr-to-Cys C ratio and markers for sarcopenia – appendicular skeletal muscle index (ASMI), handgrip strength, gait speed (GS), and severity of COPD. Materials and Methods: This prospective, observational study was carried out at a tertiary care teaching hospital in Southern India and included patients admitted to the departments of medicine and pulmonology. Patients diagnosed to have COPD were classified according to the GOLD guidelines. Serum Cr and Cys C were measured. Sarcopenia was assessed using BIA for the calculation of ASMI, hand dynamometer for HGS, and 6-m walk test for GS. Results: The results from our study are as follows. The mean for Cr/Cys C was 0.71. Cr/Cys C correlated significantly to ASMI, HGS, GS, and severity of COPD. Conclusion: Serum Cr-to-Cys C ratio can be effectively used for the measurement of sarcopenia in individuals with COPD.

The Burden of Chronic Obstructive Pulmonary Disease COPD in Stable Patients and its Association with Inflammatory Biomarkers and Body Mass Index

Background: Chronic obstructive pulmonary disease (COPD) is a progressive airflow limitation that is preventable but not curable. It is associated with persistent symptoms that cause a considerable burden on individual productivity at work, and daily activities, and reduced quality of life, also burdening the healthcare system and society. Objectives: The study aims to measure the burden of COPD on patients in terms of daily activities and work productivity. It also seeks to investigate some inflammatory biomarkers' levels and their correlation with selected outcomes. Patients and Methods: A cross-sectional study on 120 stable COPD patients who were diagnosed and treated according to the GOLD guidelines at Kirkuk General Hospital's chest and Internal Medicine consultation clinics, and in private internist clinics in Kirkuk City, Iraq between January and April 2023. The Work Productivity and Activity Impairment Questionnaire (WPAI-COPD) measured the Burden of COPD. The symptom burden was assessed by the COPD assessment test (CAT). The level of IL-6 monoclonal antibodies was measured via a Roche Cobas 6000 analyzer and TNF-α using the ELISA sandwich technique. All these devices and machines were authorized by the Ministry of Health, Iraq. Results: The mean age was (54.1 ± 8.12) years, 62.5% being males and 37.5% being females; 41.7% were public sector employees, and 39.2% were self-employed. Due to COPD, the overall work loss was (45.9±18.91) days, the mean percentage of absenteeism was (10.9% ± 12.31%), activity impairment was (47.5% ±17.79%) among all patients, presenteeism was (40.8 ± 15.05%,) and COPD-related retirees were 14.2% of the study group. The mean CAT score (19.3±5.63) was high and the most troubling symptom among patients was chest tightness. WPAI-COPD scores were higher in older age and longer disease duration. The levels of biomarkers were above the reference ranges, the mean IL-6 level was (69.4 ± 35.29) pg/ml, and the mean TNF-α was (72.3 ± 22.45) pg/ ml. Conclusions: COPD patients exhibit a disease burden in terms of productivity loss at work and activity impairment that increases with aging and disease duration. COPD patients with low BMI are more prone to a decline in lung functions and to worse symptoms.

Influence of frailty on cardiovascular events and mortality in patients with Chronic Obstructive Pulmonary Disease (COPD): Study protocol for a multicentre European observational study.

Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD). Recent studies on COPD have shown that patients living with frailty have an increased risk of mortality. The presence of cardiovascular diseases or conditions are common in COPD and may increase the risk of death. This protocol describes a European prospective cohort study of community-based people, in a stable condition with diagnosis of COPD (as defined by GOLD guidelines) across hospitals in Italy and UK. Frailty prevalence will be assessed using the Clinical Frailty Scale. At 1- and 2-year follow up, primary outcome will be the impact of frailty on the number of cardiovascular events; secondary outcomes: the influence of frailty on cardiovascular mortality, all-cause mortality, and deaths due to COPD. For the primary outcome a zero-inflated Poisson regression will compare the number of cardiovascular events at 1 year. Secondary outcomes will be analysed using the time to mortality. This multicentre study will assess the association between frailty and cardiovascular events and mortality in population with COPD. Data collection is prospective and includes routine clinical data. This research will have important implications for the management of patients with COPD to improve their quality of care, and potentially prognosis. NCT05922202 (www.clinicaltrials.gov).

Does mild chronic obstructive pulmonary disease need a standard pulmonary rehabilitation program? A case report

Background: Patients with mild chronic obstructive pulmonary disease (COPD) are usually not recommended for a standard pulmonary rehabilitation (PR)program based on the GOLD guideline in mild COPD GOLD A classification. Especially, the scientific evidence on exercise capacity that can be identified for recruitment in PR programs has been less reported. Thus, a preliminary case study to identify the exercise capacity under cardiopulmonary responses by aerobic exercise testing among patients in mild COPD GOLD A classification was the aim of this study. Objective: To evaluate the cardiopulmonary responses from exercise capacity testing in individual COPD patients with mild COPD GOLD A Classification. Materials and methods: Four participants with mild COPD GOLD A performed an exercise endurance capacity test at home using Spot Marching Exercise Test (SMT), marching on the spot with high hip and arm raising. The load of SMT was indicated by a controlled stepping rate at 70, 80, 90, 100, and 110 steps/min. Every participant performed Incremental SMT (ISMT) with every 3 min incremental load, and the Constant SMT (CSMT) at the peak load. Both exercise tests were terminated at symptom limit. Resting time between ISMT and CSMT was at least 30 minutes. Cardiopulmonary exercise responses, Borg perceived breathlessness (RPB) and exertion (RPE) were monitored every minute during the exercise test. The duration of exercises was recorded. Results: Peak exercise capacity using ISMT was low with the end exercise load at 70, 80, 80, and 90 steps/min which is equivalent to moderate to high intensity at 81%, 62%, 65% and 93% of age-predicted maximum heart rate (HRmax). The exercise test was stopped by breathlessness at RPB 7, 8, 6, and 5. Respiratory rates (RR) were 36, 26, 38, and 38 breaths/min. With CSMT, the results showed very short exercise duration 1.78, 4.60, 2.15, and 2.47 mins with RPB 7, 8, 5, and 5 and RR of 33, 27, 34, and 41 breaths/min respectively. Conclusion: This preliminary report reveals that all four mild COPD GOLD A show low exercise capacity and very poor exercise endurance that should identify the appropriated standard PR program in the future.

DO disease stages affect oxidative stress in stable COPD?

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

Effects and long-term outcomes of endurance versus resistance training as an adjunct to standard medication in patients with stable COPD: a multicenter randomized trial

BackgroundComparisons between endurance training (ET) and resistance training (RT) have produced equivocal findings in chronic obstructive pulmonary disease (COPD) patients. The purpose of our study is to investigate the effectiveness and long-term outcomes of adding ET and RT to conventional medical treatment in patients with COPD. A secondary objective is to investigate the clinical improvements resulting from exercise training in patients with different disease severities.MethodsThe study was a multicenter, prospective trial in people with stable COPD. The cohort was randomized to three groups: individualized medical treatment group (MT), MT + endurance training group (MT + ET) and MT + resistance training group (MT + RT). Exercise was performed 3 times weekly over a 12-week period. The endpoints of exercise capacity, health-related quality of life, COPD symptoms, lung function, and anxiety and depression questionnaires were re-evaluated at baseline, at the completion of the intervention and at 6 and 12-month follow-up. According to the COPD assessment tool offered by GOLD guidelines, patients were stratified into GOLD A and B groups and GOLD C and D groups for further subgroup analysis.ResultsThe intention-to-treat (ITT) population included 366 patients, 328 of them completed the study protocol over 12 months (the PP-population). There were no significant differences in the primary outcome, quality of life, between patients who underwent medical treatment (MT) alone, MT + endurance training (MT + ET), or MT + resistance training (MT + RT) at the completion of the intervention, 6-, or 12-month follow-up. Additionally, no significant differences were observed between MT, MT + RT, or MT + ET groups concerning the primary outcome, exercise capacity (3MWD), after initial 3 months of intervention. However, a small statistically significant difference was noted in favor of MT + ET compared to MT + RT at 12 months (ITT: Δ3MWD in ET vs RT = 5.53 m, 95% confidence interval: 0.87 to 13.84 m, P = 0.03) (PP: Δ3MWD in ET vs RT = 7.67 m, 95% confidence interval: 0.93 to 16.27 m, P = 0.04). For patients in the GOLD C and D groups, improvement in quality of life following ET or RT was significantly superior to medical intervention alone. Furthermore, upon completion of the exercise regimen, RT exhibited a greater improvement in anxiety compared to ET in these patients (ITT: ΔHAD-A at 3-month: RT = -1.63 ± 0.31 vs ET = -0.61 ± 0.33, p < 0.01) (PP: ΔHAD-A at 3-month: RT = -1.80 ± 0.36 vs ET = -0.75 ± 0.37, p < 0.01).ConclusionsOur study presents evidence of the beneficial effects of ET and RT in combination with standard medical treatment, as well as the long-term effects over time after the intervention. While the statistically significant effect favoring ET over RT in terms of exercise capacity was observed, it should be interpreted cautiously. Patients in severe stages of COPD may derive greater benefits from either ET or RT and should be encouraged accordingly. These findings have implications for exercise prescription in patients with COPD.Trial registrationChiCTR-INR-16009892 (17, Nov, 2016).

Prevalence and risk factors of depression in patients with chronic obstructive airway disease: a tertiary care hospital, outpatient setting.

Chronic obstructive airway disease (COPD) has been found to be associated with depression. An overlap of COPD and depression may cause poor quality of life and an increase in mortality. A meta-analysis found that the prevalence and risk factors of depression in patients with COPD have high heterogeneity and are limited in tertiary care hospital outpatient settings. This study thus aimed to evaluate the prevalence and risk -factors of depression in patients with COPD using personal data in a tertiary care hospital outpatient setting. This cross-sectional study included adult patients who were diagnosed with COPD according to the GOLD guidelines, had stable functional status within the past 4 weeks with the same treatment regimen, and had no history of other serious medical or surgical illness. A diagnosis of depression was made according to a score of 11 or higher on the hospital anxiety and depression scale (HADS). The prevalence and predictors of depression were then computed. The study enrolled and evaluated 150 patients with COPD, out of which 6 (4%) had depression. While the predictive model for depression comprised two factors, only severity of COPD was independently associated with depression. The adjusted odds ratio of severity of COPD was 5.20 (95% confidence interval of 1.75, 15.42; p = 0.003). The prevalence of depression in patients with COPD in a tertiary care outpatient setting was low, at 4%. According to the study's comprehensive assessment, severity of COPD was the only factor associated with depression in patients with COPD.

Long-acting B-2 agonists (LABA) or long-acting muscarinic antagonists (LAMA): which one may be the first option in group A COPD patients?

Long-acting muscarinic antagonists (LAMA) or beta-2 agonists (LABA) have been recommended for symptom control in group A COPD patients as a first-line bronchodilator treatment in GOLD guidelines. However, there is no mention of priority/superiority between the two treatment options. We aimed to compare the effectiveness of these treatments in this group. The study cohort was formed of all subjects from six pulmonology clinics with an initial diagnosis of COPD who were new users of a LAMA or LABA from January 2020 to December 2021. Seventy-six group A COPD patients, in whom LABA or LAMA therapy had been started in the last 1month as a first-line treatment, were included in our study. Participants were evaluated with spirometry, COPD Assessment Test (CAT), mMRC scale, and St. George Respiratory Questionnaire (SGRQ) for three times (baseline, 6-12th months). There were 76 group A COPD patients with LAMA (67.1%) and LABA (32.9%). The number of patients who improved in CAT score at the end of the first year was significantly higher in patients using LAMA than those using LABA (p = 0.022); the improvement at minimum clinically important difference (MCID) in CAT score of LAMA group at 1st year was also significant (p = 0.044). SGRQ total and impact scores were found to be statistically lower at 1st year compared to baseline in patients using LAMA (p = 0.010 and 0.006, respectively). Significant improvement was detected in CAT and SGRQ scores at the 6th month visit in the LAMA group having emphysema (p = 0.032 and 0.002, respectively). According to significant improvements in CAT and SGRQ score, LAMA may be preferred over LABA as a bronchodilator agent in group A COPD patients, especially in emphysema-dominant phenotype.

Impact of Frailty on Symptom Burden in Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnoea. Frailty is a complex clinical syndrome associated with an increased vulnerability to adverse health outcomes. The aim of this review was to explore the current evidence of the influence of frailty on symptoms in patients with a confirmed diagnosis of COPD according to GOLD guidelines. Fourteen studies report a positive association between frailty and symptoms, including dyspnoea, assessed with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale. Data were analysed in a pooled a random-effects meta-analysis of mean differences (MDs). There was an association between COPD patients living with frailty and increased CAT score versus COPD patients without frailty [pooled SMD, 1.79 (95% CI 0.72-2.87); I2 = 99%]. A lower association was found between frailty and dyspnoea measured by the mMRC scale versus COPD patients without frailty [pooled SMD, 1.91 (95% CI 1.15-2.66); I2 = 98%]. The prevalence of frailty ranged from 8.8% to 82% and that of pre-frailty from 30.4% to 73.7% in people living with COPD. The available evidence supports the role of frailty in worsening symptom burden in COPD patients living with frailty. The review shows that frailty is common in patients with COPD. Future research is needed to have further details related to the data from CAT to improve our knowledge of the frailty impact in this population.

ОНОВЛЕНИЙ ПОГЛЯД НА ЛІКУВАННЯ ХОЗЛ: ЗАПОБІГАННЯ ПЕРЕДЧАСНОЇ СМЕРТІ ЧЕРЕЗ ПОПЕРЕДЖЕННЯ ЗАГОСТРЕНЬ ЗАВДЯКИ РАННЬОМУ ОПТИМІЗОВАНОМУ ЛІКУВАННЮ

Chronic obstructive pulmonary disease (COPD) causes significant burden for all mankind: according to WHO data (2023) about 384 million people suffer from this disease worldwide. COPD is a third leading cause of death. The cost of COPD treatment reaches 100 billion US dollars per year. This review focuses on key changes of 2023-2024 COPD guidelines. Particularly, GOLD guidelines give new definitions of COPD and its exacerbation considering the grade of severity; initial treatment is prescribed based on ABCD assessment has been changed for ABE, based on the number of exacerbations in previous year. New etiotypes, like PRISm and preCOPD, etc have been introduced. The information on chronic bronchitis as an essential from clinician’s perspective component of COPD have been reflected in GOLD 2024 guidelines. Rome classification of COPD exacerbation has been also presented in updated GOLD document. Four special variants of COPD, requiring attention, have been characterized: early COPD, mild COPD, COPD in younger persons and pre-COPD. Despite a significant advance in respiratory medicine COPD diagnosis remains challenging and sometimes inadequate even today, causing the difficulties with therapy (wrong medications or no treatment at all). In contrast, timely and adequate COPD diagnosis may improve public health. Key words: chronic obstructive pulmonary disease (COPD), clinical symptoms, dyspnea, cough, exacerbations, diagnosis, treatment.

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies.

While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short- (≤7 days) and long- (>7 days) corticosteroid regimens in adults with acute exacerbations of COPD. MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eligible studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as ORs (odds ratios) or MDs (mean differences) whenever possible and qualitatively described otherwise. A total of 11532 participants from eight RCTs and three retrospective cohort studies were included, with 1296 from seven RCTs and two cohort studies eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR (using short duration as the treatment arm) for mortality was 0.76 (95% CI = 0.40-1.44, n = 1055). The MD for hospital length-of-stay was -0.91 days (95% CI = -1.81--0.02 days, n = 421). The OR for re-exacerbations was 1.31 (95% CI = 0.90-1.90, n = 552). The OR for hyperglycemia was 0.90 (95% CI = 0.60-1.33, n = 423). The OR for infection incidence was 0.96 (95% CI = 0.59-1.156, n = 389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI = -111.80-75.01 mL, n = 161). The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines. Trial registration: Our protocol is registered in PROSPERO: CRD42023374410.

The rate of ward to intensive care transfer and its predictors among hospitalized COPD patients, a retrospective study in a local tertiary center in Saudi Arabia

ObjectiveTo investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients.MethodsAn observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis.ResultsA total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41–2.62)), smoking (OR; 1.60 (1.17–2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45–2.71)), Diabetes mellitus (OR; 1.42 (1.04–1.93)), GERD (OR; 2.81 (1.99–3.96)), Ischemic heart disease (OR; 3.22 (2.19–4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38–3.33)), stroke (OR; 4.51 (2.20–9.26))) were predictors of ICU admissions among patients with COPD.ConclusionsOur study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units.

Management of COPD and Comorbidities in COPD patients by Dispensing Pharmaceutical Care following Global Initiative for chronic Obstructive Lung Disease-Guidelines (GOLD guidelines 2020): A study protocol for a Prospective Randomized Clinical Trial

COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.

Therapy pattern of bronchodilators in chronic obstructive pulmonary disease (COPD) patients with acute exacerbations

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a worsening condition of acute respiratory symptoms caused by microbial infection, increased air pollution, and fatigue. Objective: This study determines the pattern of bronchodilators in patients with acute exacerbations of COPD. Method: This study was observational, using the health medical records of patients with COPD at the Universitas Airlangga Hospital, Surabaya. It was conducted between January-December 2019 on male patients who received bronchodilator therapy until discharge and were from age 40 and older. Result: A total of 48 patients met the inclusion criteria. The most commonly used bronchodilator therapy for inpatients was the combination of ipratropium bromide/salbutamol sulfate 0.5 mg/2.5 mg through inhalation in 63.64%. The most frequently used bronchodilator for discharge was salbutamol sulfate 2-4 mg orally in 87.50%. Conclusion: Therapy for acute exacerbation of COPD using a combination of ipratropium bromide/salbutamol sulfate as a preventive therapy is in line with the GOLD guidelines.

Cardiac abnormalities in stable chronic obstructive pulmonary disease: correlations and predictors

Abstract Background Patients with stable chronic obstructive pulmonary disease (COPD) are more likely to have cardiac abnormalities, which increase morbidity and mortality. The aim of the study is to explore correlations and probable predictors for these abnormalities in stable COPD patients. Patients and methods We conducted a prospective cohort study including 91 stable COPD cases, who were admitted to a tertiary health-care center during the period from August 2021 to January 2022. Spirometry, arterial blood gas, and ECG were performed for all participants. They were categorized using GOLD guidelines (2021) and assessed by two-dimensional Doppler echocardiography using the American and European Association of Echocardiography ASE recommendations. Results The study included 91 COPD patients; their mean age was 60.5 years with male predominance (62.6%). Of the patients, 76.9% were smokers and 49.5% of patients have respiratory failure type II. The most common abnormal ECG findings were P pulmonale, ventricular ectopic, and ischemic changes, which were more detected in severe COPD patients (94.29%). Echocardiographic assessment showed abnormal findings in almost 65%, more in the severe group. The most frequent findings were signs of pulmonary hypertension (PH) (72.5%), right ventricular dilatation (49.5%), and hypokinesia (21.98%). Risk factors of cardiac abnormalities were respiratory failure, COPD duration, comorbidities, and COPD stage. Conclusion Right ventricle dilatation, hypokinesia, and PH showed a positive correlation with echocardiographic findings and COPD severity. Respiratory failure and COPD duration were independent predictors of arrhythmia; COPD stage and the number of comorbidities were predictors of cardiac ischemia, while respiratory failure and comorbidities were predictors of PH.