Irreversible Airway Obstruction Research Articles

The patient journey in Chronic Obstructive Pulmonary Disease (COPD): a human factors qualitative international study to understand the needs of people living with COPD

BackgroundChronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient’s daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance.The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease.MethodsAdults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs.ResultsThe 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32–70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families.ConclusionsThese results could aid in the creation of new ideas and concepts to improve our patient’s quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.

Modified forced expiration technique using expiratory resistance in adults with cystic fibrosis.

Participation in airway clearance techniques (ACT) is important to minimise development of irreversible airway obstruction in patients with cystic fibrosis (CF). Positive expiratory pressure (PEP) and expiratory resistance devices (ERD) are often used as they can improve collateral ventilation and aid in the shearing of mucus from airways. This project looked to identify whether utilising an ERD during a forced expiration technique (FET) improves ease of expectoration, sputum amount and coughing frequency in patients with CF. Patients with CF admitted for a respiratory exacerbation completed two sessions of 10 cycles of their usual ACT with half of the FET components performed with an ERD, half with FET alone. EOE, sputum wet weight, cough frequency and patient preference were similar between groups. Improved EOE without the ERD was found in participants who usually use PEP for their ACT regime. Combining the FET with a PEP mask did not improve EOE and other outcomes in this small study. Investigating the efficacy of this technique within a larger population is warranted.

Predicting Development of Chronic Obstructive Pulmonary Disease and its Risk Factor Analysis.

Chronic Obstructive Pulmonary Disease (COPD) is an irreversible airway obstruction with a high societal burden. Although smoking is known to be the biggest risk factor, additional components need to be considered. In this study, we aim to identify COPD risk factors by applying machine learning models that integrate sociodemographic, clinical, and genetic data to predict COPD development.Clinical relevance- This study assessed the risk factors of COPD in sociodemographic, clinical, and genetic data. We have determined that sociodemographic factors are highly associate to the development of COPD.

Exposure to second-hand smoke is an independent risk factor of small airway dysfunction in non-smokers with chronic cough: A retrospective case-control study.

ObjectivesThis study aimed to identify the potential risk factors for small airway dysfunction (SAD) in non-smokers with chronic cough.MethodsNon-smokers with chronic cough who underwent lung function tests at Xiangya Hospital from May 2019 to May 2020 were enrolled, and divided into the derivation and validation cohorts based on their hospital admission time. SAD was determined based on the presence of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow at 50% of forced vital capacity (FVC), and forced expiratory flow at 75% of FVC. Clinical data of these patients were collected. Risk factors for SAD were identified by logistic regression analysis in the derivation cohort and further confirmed in the validation cohort.ResultsIn total, 316 patients (152 in the non-SAD group and 164 in the SAD group) were included in the derivation cohort. Compared with the non-SAD group, the SAD group had a higher proportion of female patients (82.3 vs. 59.2%, P < 0.001), was more commonly exposed to second-hand smoke (SHS) (61.6 vs. 27.6%, P < 0.001), and tended to be older (median age, 45.5 vs. 40.0 years old, P = 0.004). The median FVC, forced expiratory volume in one second (FEV1) % pred, FEV1/FVC ratio, and peak expiratory flow (PEF) % pred were slightly lower in the SAD group. Multivariable logistic analysis showed that exposure to SHS was an independent risk factor (OR 4.166 [95% CI 2.090–8.302], P < 0.001) for SAD in non-smokers with chronic cough after adjusting for related variables. In the validation cohort (n = 146), patients with SHS exposure had a relative risk of 1.976 (95% CI 1.246–3.135, P = 0.004) for SAD compared to those without SHS exposure. Multivariable logistic analysis consistently confirmed that exposure to SHS was an independent risk factor (OR 3.041 [95% CI 1.458–6.344], P = 0.003) for SAD in non-smokers.ConclusionsExposure to SHS is independently associated with a higher risk of SAD in non-smokers with chronic cough. Reduction in SHS exposure may ameliorate lung function, thus lowering the risk of irreversible airway obstruction.

Impulse Oscillometry Parameters in Childhood Asthma, Childhood Obesity and Childhood Obesity with Asthma

Background: Monitoring of lung function is necessary to detect irreversible airway obstruction in both asthma and obesity. Impulse oscillometry (IOS), a novo non-invasive equipment, is increasing popularity to measure airway resistance in young children worldwide. Aims: To compare IOS parameters among Thai asthmatic children and Thai obese children with and without asthma. Methods: A cross-sectional study was conducted in 120 participants, aged 4-15 years old. Forty children were in each group (asthma, obesity, and obesity with asthma). All volunteers were consented to measure airway resistance by IOS technique (Jaeger, Germany). Results: Seventy-three percent of patients were male with the mean age at 8.8 + 2.61 years old. Mean X5 was found normal in childhood obesity (-0.13) when compared to children with asthma (-0.23) and obesity with asthma (-0.19) (p &lt; 0.001 and 0.013 respectively). The cut-off value of X5, according to ROC curve, for predicting asthma in obese patients was -0.16 kPa/L/s with 70% sensitivity, 70% specificity and 70% accuracy (AUC= 0.69). However, with the bronchodilator effect (adjusted by duration of asthma control), we found significant higher percentage change of IOS parameters, including resonant frequency, area of reactance and R5-R20, in asthma (Fres -24.57 + 15.82, AX -58.28 + 13.37, R5-R20 -51.32 + 20.13) than in asthma with obesity (Fres -13.77 + 16.42, AX -43.35 + 21.4, R5-R20 -34.72 + 18.21), (p = 0.014, 0.004, 0.002 respectively). Conclusions: X5 and percentage changes after bronchodilator of Fres, AX, and R5-R20 are useful parameters to differentiate airway dysfunction in asthmatic children from obese children.

Vascular Endothelial Growth Factor as a Putative Biomarker of Depression in Asthmatics with Reversible Airway Narrowing.

The vascular endothelial growth factor (VEGF) plays a pivotal role in process of angiogenesis in adults. If angiogenesis is not properly controlled, its deregulation may implicate it in various psychosomatic diseases states. The aim of our study was to reveal possible correlation between severity of depression in asthmatics with different degrees of airway narrowing and serum vascular endothelial growth factor levels. The study population included a total of 122 adult subjects: 82 patients with asthma (among them 42 patients with irreversible bronchoconstriction and 40 patients with reversible bronchoconstriction) and 40 healthy participants as a control group. The standardized Beck Depression Inventory (BDI) was used to estimate the depression symptoms. Enzyme-linked immunosorbent assay (ELISA) was used to assess the VEGF serum concentration in all participants. There was a significant difference in depression symptoms in asthmatics with reversible (p = 0.0432) and irreversible airway obstruction (p = 0.00005) in comparison to control group and between these two subgroups of asthmatics (p = 0.0233). Obtained results revealed significant correlation between level of depression and mean VEGF serum concentration in asthmatics with reversible airway obstruction (p = 0.0202). There was no difference between enhanced depression symptoms and VEGF serum concentration in patients with irreversible airway obstruction nor in the total group of asthmatics (in both p > 0.05). The relationship between asthma severity and depression symptoms seems to be certain. VEGF might be considered as a putative biomarker of depression in asthmatics, mainly those with reversible airway narrowing.

Risk factors for irreversible airway obstruction after infant bronchiolitis

BackgroundIncreasing evidence shows that environmental factors in childhood play a role in development of irreversible airway obstruction. We evaluated early-life and preschool-age risk factors for irreversible airway obstruction in adolescence after bronchiolitis in infancy. MethodsThis study is a secondary analysis of data collected during prospective long-term follow-up of our post-bronchiolitis cohort. Risk factor data were collected during hospitalisation and on follow-up visits at 5–7 and 10–13 years of ages. Lung function was measured from 103 participants with impulse oscillometry at 5–7 years of age and from 89 participants with flow-volume spirometry at 10–13 years of age. ResultsAsthma diagnosis at <12 months of age showed a significant association with irreversible airway obstruction at 10–13 years of age independently from current asthma. Irreversible airway obstruction was less frequent in children with variant than wild genotype of the Toll-like receptor 4(TLR4) rs4986790, but the significance was lost in logistic regression adjusted for current asthma and weight status. Higher post-bronchodilator respiratory system resistance at 5 Hz and lower baseline and post-bronchodilator reactance at 5 Hz by impulse oscillometry at 5–7 years of age were associated with irreversible airway obstruction at 10–13 years of age. ConclusionAsthma diagnosis during the first living year and worse lung function at preschool age increased the risk for irreversible airway obstruction at 10–13 years of age after bronchiolitis. TLR4 rs4986790 polymorphism may be protective for development of irreversible airway obstruction after bronchiolitis.

Does peripheral blood eosinophil count predict lung function improvement in adult subjects with asthma?

Previous studies have investigated the contribution of the eosinophilic phenotype, as defined by the peripheral blood eosinophil count, in predicting asthma outcomes. There is evidence that the eosinophilic phenotype predicts uncontrolled symptoms and asthma exacerbations.1,2 We are aware of no prospective study evaluating whether the eosinophilic phenotype is a useful biomarker for predicting lung function trends in subjects with asthma who have used maintenance therapy. This is an important issue, because predicting loss of lung function is a meaningful goal of asthma monitoring, as lung function decline leads to irreversible airway obstruction and worse clinical outcomes.

Chronic obstructive disease and comorbidities (literature review)

Chronic obstructive pulmonary disease (COPD) is a pulmonary disease characterized by irreversible airway obstruction. Systemic involvement of COPD, as well as interactions between COPD and its comorbidities justify the description of chronic systemic inflammatory syndrome. Most patients with COPD have at least one comorbid condition that further complicates the development and management of the disease. The most common comorbidities encountered in association with COPD are cardiovascular diseases, lung cancer, osteoporosis, cachexia, anxiety and depression, diabetes mellitus, metabolic syndrome, gastro-esophageal reflux (GERD), bronchiectasis, obstructive sleep apnea (OSA). Diagnosis and assessment of COPD severity can be difficult in the presence of comorbid conditions, so assessment of lung, cardiovascular and metabolic function, as well as the level of inflammatory circulating markers (C-reactive protein, fibrinogen), could help to establish the clinical concept. The presence of comorbidity should not change the treatment of COPD, and comorbidity should be treated according to normal standards, regardless of the presence of COPD. When COPD is part of a multi-morbidity care plan, care should be taken to ensure simplicity of treatment and to minimize polypharmacy. This review article of literature reflects an overview of the COPD comorbidities, as well as their influence on the quality of life and prognosis.

Alkylating and oxidative stresses in smoking and non-smoking patients with COPD: Implications for lung carcinogenesis

Chronic obstructive pulmonary disease (COPD) is a disease characterized by chronic inflammation and irreversible airway obstruction. Cigarette smoking is the predominant risk factor for developing COPD. It is well-known that the COPD is also strongly associated with an increased risk of developing lung cancer. Cigarette smoke contains elevated concentrations of oxidants and various carcinogens (e.g., tobacco-derived nitrosamines) that can cause oxidative and alkylating stresses, which can also arise from inflammation. However, it is surprising that, except for oxidative stress, little information is available on the burden of alkylating stress and the detoxification efficiency of tobacco-derived carcinogens in COPD patients. In this study, we used LC-MS/MS to measure the archetypical tobacco-specific carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), its major metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), three biomarkers of oxidative stress (8-oxo-7,8-dihydroguanine, 8-oxoGua; 8-oxo-7,8-dihydro-2′-deoxyguanosine, 8-oxodGuo; 8-oxo-7,8-dihydroguanosine, 8-oxoGuo) and two biomarkers of alkylating stress (N7-methylguanine, N7-MeGua and N3-methyladenine, N3-MeAde), in the urine of smoking and non-smoking COPD patients and healthy controls. Our results showed that not only was oxidative stress significantly elevated in the COPD patients compared to the controls, but also alkylating stress. Significantly, levels of alkylating stress (i.e., N7-MeGua) were highly correlated with the COPD severity and not affected by age and smoking status. Furthermore, COPD smokers had significantly higher ratios of free NNAL to the total NNAL than control smokers, implying a lower detoxification efficiency of NNK in COPD smokers. This ratio was even higher in COPD smokers with stages 3–4 than in COPD smokers with stages 1–2. Taken together, our results demonstrated that the detoxification efficiency of tobacco-derived carcinogens (e.g., NNK) was associated with the pathogenesis and possibly the progression of COPD. In addition to oxidative stress, alkylating stress derived from chronic inflammation appears to be also dominant in COPD patients.

Role of ultrasound in the assessment of diaphragm function in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) characterized by irreversible airway obstruction, has numerous systemic complications including skeletal muscle dysfunction. Diaphragm, an important muscle of respiration, is also affected and it has far-reaching impact on morbidity. The study of diaphragm in individuals with COPD is challenging. Although the use of ultrasonography to study the function of diaphragm is in its nascent stage, it seems to be a promising tool for a comprehensive evaluation of diaphragm in COPD patients. This article reviews the available literature on the use of US in study of diaphragm on individuals with stable COPD.

Asthma with Irreversible Airway Obstruction in Smokers and Nonsmokers: Links between Airway Inflammation and Structural Changes

Background: The development of irreversible airway obstruction (IRAO) in asthma is related to lung/airway inflammatory and structural changes whose characteristics are likely influenced by exposure to tobacco smoke. Objective: To investigate the interplay between airway and lung structural changes, airway inflammation, and smoking exposure in asthmatics with IRAO. Methods: We studied asthmatics with IRAO who were further classified according to their smoking history, those with ≥20 pack-years of tobacco exposure (asthmatics with smoking-related IRAO [AwS-IRAO]) and those with <5 pack-years of tobacco exposure (asthmatics with nonsmoking-related IRAO [AwNS-IRAO]). In addition to recording baseline clinical and lung function features, all patients had a chest computed tomography (CT) from which airway wall thickness was measured and quantitative and qualitative assessment of emphysema was performed. The airway inflammatory profile was documented from differential inflammatory cell counts on induced sputum. Results: Ninety patients were recruited (57 AwS-IRAO and 33 AwNS-IRAO). There were no statistically significant differences in the extent of emphysema and gas trapping between groups on quantitative chest CT analysis, although Pi10, a marker of airway wall thickness, was significantly higher in AwS-IRAO (p = 0.0242). Visual analysis showed a higher prevalence of emphysema (p = 0.0001) and higher emphysema score (p < 0.0001) in AwS-IRAO compared to AwNS-IRAO and distribution of emphysema was different between groups. Correlations between radiological features and lung function were stronger in AwS-IRAO. In a subgroup analysis, we found a correlation between airway neutrophilia and emphysematous features in AwS-IRAO and between eosinophilia and both airway wall thickness and emphysematous changes in AwNS-IRAO. Conclusions: Although bronchial structural changes were relatively similar in smoking and nonsmoking patients with asthma and IRAO, emphysematous changes were more predominant in smokers. However, neutrophils in AwS-IRAO and eosinophils in AwNS-IRAO were associated with lung and airway structural changes.

Clinical and biological factors associated with irreversible airway obstruction in adult asthma

Background and objectiveAirway remodeling, as many other factors, may lead to lung function decline and irreversible airflow obstruction (IRAO) in asthma. This study was undertaken in order to highlight predictors of incomplete reversibility of airflow obstruction in adult asthmatics to identify patients with poorer prognosis and improve their care, and decrease morbidity. MethodsA retrospective study was conducted in 973 asthmatics recruited from the University Asthma Clinic of Liege. Patients with IRAO (post-BD FEV1/FVC<0.7 & FEV1<80% predicted) were compared to patients with reversible airway obstruction (RAO) (post-BD FEV1/FVC≥0.7 & FEV1≥80% predicted). TGF-β was measured in sputum supernatant of 85 patients. ResultsSeventeen percent of asthmatics presented with IRAO. These patients were significantly older, more smokers, with a lower proportion of female, a longer disease duration, were more poorly controlled with a lower quality of life. This sub-population of asthmatics also showed more often elevated blood and sputum eosinophils and neutrophils, and higher exacerbation and hospitalisation rates in the previous year. The multivariable analysis revealed male gender, longer disease duration, cigarette smoking, ACQ score, sputum eosinophils and neutrophils, ICS dose and OCS maintenance, BMI, and asthma onset as variables independently linked to IRAO. Total TGF-β levels appeared higher in patients with IRAO (n = 38) compared to patients with RAO (n = 47). ConclusionThese data show that risk factors for IRAO are male gender, smoking, a longer disease duration, uncontrolled asthma, eosinophilic or neutrophilic airway inflammation, lower BMI, and later asthma onset. Moreover, TGF-β levels are higher in IRAO.

Diagnosis and Treatment of Early Chronic Obstructive Lung Disease (COPD).

Chronic obstructive lung disease (COPD) is responsible for substantial rates of mortality and economic burden, and is one of the most important public-health concerns. As the disease characteristics include irreversible airway obstruction and progressive lung function decline, there has been a great deal of interest in detection at the early stages of COPD during the “at risk” or undiagnosed preclinical stage to prevent the disease from progressing to the overt stage. Previous studies have used various definitions of early COPD, and the term mild COPD has also often been used. There has been a great deal of recent effort to establish a definition of early COPD, but comprehensive evaluation is still required, including identification of risk factors, various physiological and radiological tests, and clinical manifestations for diagnosis of early COPD, considering the heterogeneity of the disease. The treatment of early COPD should be considered from the perspective of prevention of disease progression and management of clinical deterioration. There has been a lack of studies on this topic as the definition of early COPD has been proposed only recently, and therefore further clinical studies are needed.

Predictors for the Bronchiolitis Obliterans Syndrome in Lung Transplant Patient

肺移植是治疗终末期肺病的有效方法。目前，肺移植术后1年生存率已达到80%，由于闭塞性细支气管炎综合症（bronchiolitis obliterans syndrome, BOS）的发生，5年生存率维持在50%左右。BOS是一个纤维化的过程，最终导致不可逆的气道闭塞。缺血-再灌注损伤、感染、氧化应激以及急性排斥反应等多个因素参与了BOS的发生。研究证实BOS的早期诊断与预后良好相关。因此，寻找灵敏、特异的BOS预测标记物对于提高肺移植患者长期生存具有重要的科学和临床意义。本文就与BOS发生发展相关的免疫调节细胞、分泌性蛋白质、细胞膜蛋白等指标的变化在BOS早期诊断中的作用进行综述。

Distinct profile of inflammatory and remodelling biomarkers in sputum of severe asthmatic patients with or without persistent airway obstruction

BackgroundBoth inflammatory and remodelling processes are associated with irreversible airway obstruction observed in severe asthma. Our aim was to characterize a group of severe asthmatic patients with or without persistent airway obstruction in relation to specific sputum inflammatory and remodelling biomarkers. MethodsForty-five patients under regular high-dose inhaled corticosteroid/ß-2agonist treatment were studied, after a follow-up period of at least 2 years, with a minimum of 4 visits. Periostin, TGF-ß, RANTES, IL-8, GM-CSF, FGF-2, and cell counts were measured in induced sputum. Serum periostin was also measured. ResultsSputum induction was successfully performed in all but 5 patients. There were no significant differences in demographic and clinical data between patients with non-persistent obstruction (NO: FEV1/VC>88%pred.) and those with persistent obstruction (O: a not completely reversible obstruction with FEV1/VC<88%pred. at each visit before the study visit). Patients with persistent obstruction had significantly higher sputum periostin and TGF-ß concentrations than NO patients and a trend of higher serum periostin levels. GM-CSF and FGF-2 were significantly increased in NO compared to O patients. No differences between groups were found for RANTES, IL-8 and differential cell counts. Sputum periostin inversely correlated with functional parameters (prebronch. FEV1: rho = −0.36, p < 0.05; postbronch. FEV1: rho = −0.33, p = 0.05). Patients with high sputum periostin concentration (>103.3 pg/ml: median value) showed an absolute number of sputum eosinophils significantly higher than patients with low sputum periostin; this behavior was unobserved when serum periostin was considered. ConclusionsOnly periostin and TGF-ß identified a subgroup of severe asthmatic patients with persistent airway obstruction. Sputum periostin was also inversely associated with FEV1 and proved to be a more sensitive biomarker than serum periostin to identify severe asthmatics with higher sputum eosinophilia.

ROLE OF BRONCHODILATOR TESTING IN IDENTIFYING COPD, ASTHMA, AND ASTHMA-COPD OVERLAP SYNDROME: NHANES III ANALYSIS

SESSION TITLE: Asthma: From Blood Biomarkers to Biologics and Disease Burden SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Spirometry with Bronchodilator (BD) testing is not routinely utilized in clinical practice to diagnose chronic obstructive pulmonary disease (COPD) despite the recommendation to use the post BD ratio of forced expiratory volume in the first second (FEV1) over forced vital capacity (FVC).1,2 We aimed to determine the role of BD testing in avoiding COPD overdiagnosis and identifying subjects with possible alternate diagnosis like asthma and asthma-COPD overlap syndrome (ACOS). METHODS: The National Health and Nutrition Examination Survey (NHANES) data was analyzed from 2007-2012.3 Subjects age ≥ 40 years with spirometry studies meeting the American Thoracic Society (ATS) quality standards were included. Blood eosinophil count ≥ 300cells/μL and FEV1 change > 12% and > 200ml with BD testing were used to define blood eosinophilia and BD reversibility (BDR) respectively. Asthma history was identified using NHANES question “Has a doctor or health care professional ever told that you have Asthma?”. Subjects with probable ACOS were identified using two major criteria (Post-BD FEV1/FVC < 0.7, and asthma history or FEV1 change ≥ 400ml in cases without asthma history) along with any one minor criteria (BDR or blood eosinophilia).4 Post-BD FEV1/FVC ≥ 0.7 with BDR and/or blood eosinophilia were used to identify probable asthma cases. We analyzed non-weighted samples using SPSS version 21. RESULTS: We identified 8002 subjects age ≥40 years who completed pre-BD spirometry testing, 625 of them met ATS spirometry quality standards and had a pre-BD FEV1/FVC < 0.7. Of these 625 subjects, 381(61%) had post-BD FEV1/FVC < 0.70 confirming irreversible airway obstruction. Among these 381 subjects with post-BD FEV1/FVC < 0.7, twelve (3.1%) subjects had asthma history and BDR; 16 (4.2%) had asthma history and blood eosinophilia; 2 (0.7%) had FEV1 change ≥ 400ml and blood eosinophilia making ACOS more likely than COPD alone in these subjects. Among the remaining 244 cases (39%) with pre-BD FEV1/FVC < 0.7 but post- BD ratio ≥ 0.7, twenty-four (9.8%) had BDR alone and 10 of these had BDR and eosinophilia making asthma more likely. Moreover, 18 of the 24 subjects with BDR and 6 of the 10 subjects with BDR and eosinophilia had no prior asthma history and would likely be misdiagnosed as COPD if pre-BD FEV1/FVC ratio alone was used. CONCLUSIONS: Routine underutilization of spirometry with BD testing may lead to over diagnose 39% of subjects as having COPD. Further evaluation for potential asthma would be needed in 9.8% of these subjects. Moreover, post-BD spirometry values along with the recommended criteria for ACOS help identify 8% of COPD subjects who likely have ACOS. CLINICAL IMPLICATIONS: Routine use of Post-BD spirometry values will not only prevent over diagnosis of COPD but also help identifying subjects with potential ACOS and asthma. DISCLOSURES: No relevant relationships by Srinadh Annangi, source=Web Response No relevant relationships by Angel Coz Yataco, source=Web Response

MORTALITY PREDICTORS IN PATIENTS WITH ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONRY DISEASES

INTRODUCTION: COPD is a chronic disease which involves the airways, lung parenchyma, and pulmonary vasculature and also has considerable systemic manifestations. This disease is progressive and there is gene–environment interaction and hence can be prevented by avoiding exposure to the noxious particles. Commonest attributing risk factor is cigarette smoking in any form or air pollution.The in-hospital mortality rate for acute exacerbation of COPD may range from 2.5% - 25%; readmission rates from 25% to 55% for those who survived, and 25% -50% of these patients may die within one year. Most important single most crucial parameter to determine the risk of mortality in patients experiencing acute exacerbation of COPD is the forced expiratory volume in one second (FEV1). This DACF score can be useful in severely ill patients to predict mortality. This study was carried out to evaluate the DACF score as a clinical prediction of mortality for patients with acute exacerbation of COPD.&#x0D; MATERIAL AND METHODS: All patients admitted for an acute exacerbation of COPD during study period were included in the study. All included patients were cases of COPD confirmed with pulmonary function test i.e. forced expiratory volume in one second/forced vital capacity &lt;0.7 and irreversible airway obstruction and were treated with a combination of various bronchodilators. The study included patients aged 40 years or older and who were admitted in the hospital and had a primary clinical diagnosis of AECOPD. Sociodemographic data was recorded which includes age, gender, comorbidities, and number of previous AECOPD. Plain chest x-ray, spirometry, electrocardiogram was carried out. Relevant tests such as ABG analysis, complete blood count, kidney function test, liver function test, and serum electrolytes were done. DACF score was calculated.&#x0D; RESULTS: A total of 124 patients were included in the study, out of which 104 (83.88%) survived and were placed in group 2 and 20 (16.12%) patients died during the hospital stay were placed in group 1. Hence, the overall in hospital mortality rate for AECOPD was 16.12%.FEV1 in non-survivors group was 38 ± 12.98 while in survivor group it was 45 ± 11.55. Long-term oxygen therapy was given to 11 (55%) in non-survival group while it was given to 20 (19.23%) in survivors group.DACF score was calculated, most common score was 3 (48, 39%). On DACF score 1 there were 2(10%) non survivors and 34 (33%) survivors.35% mortality was seen in score 4, while no survivor was found on same score, this was statistically significant (P&lt;0.0001). on DACF score three, 25% patients died while 41% survived. Purulent sputum was observed in 90% of non survivors and 49% of survivors. Respiratory rate/min in Non-survivors (n=20) was 29.2±5.4 and in Survivors (n=104) was 25.4±3.8. Arterial blood gases analysis pH in Non-survivors (n=20) was 7.29±0.04 and in Survivors (n=104) was 7.45±0.08. paCO2 (mm Hg) in Non-survivors was 50.78±13.44 and in Survivors was 43.11±11.49. Body mass index (kg/m2) in Non-survivors was 21.65±7.4 and in Survivors was 26.97±8.9.63.&#x0D; CONCLUSION: DACF score can predicts mortality and effectively stratifies COPD patients admitted with acute exacerbations into survivors and non-survivor’s category and clinical tests such as PaCO2, arterial pH, purulent sputum can be used to predict the mortality in AECOPD.

Bronchiolitis Obliterans After Cefuroxime-Induced Stevens-Johnson Syndrome

Patient: Female, 41Final Diagnosis: Bronchiolitis obliterans after SJSSymptoms: DyspneaMedication: —Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaseBackground:Bronchiolitis obliterans is the term used to describe a clinical syndrome of irreversible airflow obstruction. Among the etiologies linked to this entity is the rarely reported association with Stevens-Johnson syndrome, which has had a poor outcome in most of the previously published cases. The optimum management of bronchiolitis obliterans as a complication of Stevens-Johnson syndrome is not well defined.Case Report:A 41-year-old woman developed significant shortness of breath 3 months after recovering from Stevens-Johnson syndrome precipitated by a second-generation cephalosporin. She was found to have severe irreversible airway obstruction on physiology studies, and computed tomography scans of the inspiratory and expiratory phases of respiration showed air trapping that was more prominent on expiratory films. The patient was diagnosed with bronchiolitis obliterans, for which bronchodilators and long-term macrolide therapy were administered. Although she did not recover completely, her follow-up physiology studies showed that the bronchiolitis obliterans was stable.Conclusions:Bronchiolitis obliterans secondary to Stevens-Johnson syndrome is a rare entity that is progressive and can lead to functional impairment. Identifying the disease at an early stage might stabilize or slow its progression. Herein, we describe a case of bronchiolitis obliterans as a complication of Stevens-Johnson syndrome and review the literature to raise awareness of this condition, highlight its course, and discuss the available treatments.

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p&lt;0.0001-0.026). Conclusion. The main BPV indices are higher in patients with asthma and COPD, in comparison with CLAD-free hypertensive patients. ABPM is the most reliable method of BPV assessment in hypertensive patients with CLAD, according to our data. The increase in BPV is associated with irreversible airway obstruction and renal function. Adverse outcomes were associated with both nighttime BPV and nocturnal BP fall, as well as with rhythm disorders and leukocyte count as a marker of systemic inflammation. BPV in patients with CLAD warrants further investigation.