Majority Of Chronic Obstructive Pulmonary Disease Patients Research Articles

A ferret model of COPD-related chronic bronchitis.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the US. The majority of COPD patients have symptoms of chronic bronchitis, which lacks specific therapies. A major impediment to therapeutic development has been the absence of animal models that recapitulate key clinical and pathologic features of human disease. Ferrets are well suited for the investigation of the significance of respiratory diseases, given prior data indicating similarities to human airway physiology and submucosal gland distribution. Here, we exposed ferrets to chronic cigarette smoke and found them to approximate complex clinical features of human COPD. Unlike mice, which develop solely emphysema, smoke-exposed ferrets exhibited markedly higher numbers of early-morning spontaneous coughs and sporadic infectious exacerbations as well as a higher level of airway obstruction accompanied by goblet cell metaplasia/hyperplasia and increased mucus expression in small airways, indicative of chronic bronchitis and bronchiolitis. Overall, we demonstrate the first COPD animal model exhibiting clinical and pathologic features of chronic bronchitis to our knowledge, providing a key advance that will greatly facilitate the preclinical development of novel treatments for this disease.

Lean BMIs as markers of malnutrition in chronic obstructive pulmonary disease patients

Malnutrition is common in chronic obstructive pulmonary disease (COPD) and a relevant concern that may even affect prognosis. A significant number of COPD patients with normal weight also suffer muscle wasting. The aim of this study was to assess the nutritional status of COPD patients with chronic respiratory failure. The present prospective analytic case–control study was conducted in the Chest Department, Assiut University Hospital, during the period from January 2013 to February 2014. Sixty-seven COPD patients with chronic respiratory failure and 68 controls were studied according to their nutritional status and body composition using creatinine height and fat-free mass indices. The majority of COPD patients were found to be overweight. As regards body composition, the lean body mass using the fat-free mass index and the creatinine height index was significantly decreased in COPD patients compared with controls. Malnutrition is a common feature among COPD patients. COPD patients have significantly decreased lean body mass.

COPD: Is there evidence to support a role for resistance training in improving measurable health-related quality of life in pulmonary rehabilitation?

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. As such, the disease places a significant burden on health care services. Although the pathogenesis of COPD is complex, progressive airflow limitation and a chronic inflammatory response are two hallmark characteristics of the disease. In addition, systemic manifestations such as peripheral muscle dysfunction have recently received considerable attention in the literature. Pulmonary rehabilitation is an evidence-based multidisciplinary intervention that has been shown to produce clinically relevant outcomes. One important component of rehabilitation is exercise. With the majority of COPD patients presenting with muscle weakness and exercise intolerance, the inclusion of resistance training into a pulmonary rehabilitation programme would seem appropriate. Compared with other exercise/training modalities only a small number of studies have investigated the effects of resistance training in COPD patients. Although further research is required to identify the optimal mode, intensity and frequency, it appears that resistance training may prove to be a valuable intervention for COPD patients enrolled in pulmonary rehabilitation programmes.

Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden

BackgroundPulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden.MethodsA cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support.ResultsA total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients – neither in primary care nor at hospitals.ConclusionDespite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is considered as a major health problem, associated with mortality and morbidities. Various disease management strategies have been established to optimize patient's longevity and functional status where patient adherence to the prescribed treatment plays a key role. Poor adherence to medication is common among COPD patients and is affected by number of factors like number of medicines, delivery devices and patient-related factors. This study aims to investigate the adherence pattern in the management of COPD and factors affecting patient adherence to the prescribed treatment. This study is a cross-sectional study which was conducted in a tertiary care hospital. Those patients suffering from COPD of all age were enrolled in this study and prior informed consent was obtained from patients. The structured questionnaire was used to interview those patients. Total 100 patients were enrolled in this study, among which most patients (45%) were of age groups 60-70 years. Unintentional non-adherence to medication attributed for 65% of patients and the major reason was forgetfulness (52.3%). Most patients had discontinued the medication due to experience of side effects (63.3%). The result showed significant association between adherence and polypharmacy (p=0.00). However, there was no significant association between adherence and age, sex, mode of administration of drugs, technics to use delivery devices etc. Majority of COPD patients were elderly (mean age= 68.4 years). Forgetfulness was associated with medication non-adherence. Most of the patients had discontinued medication because of side effects. Polypharmacy is one of the major factors associated with non-adherence to medication in COPD.

The relationship between chronic obstructive pulmonary disease and comorbidities: A cross-sectional study using data from KNHANES 2010–2012

Multiple comorbidities related to chronic obstructive pulmonary disease (COPD) make it a difficult disease to treat. The relationship between these comorbidities and COPD has not been fully investigated. We aimed to determine whether COPD was independently associated with various comorbidities. This was a cross-sectional study, which used data from the Korean National Health and Nutrition Examination Survey (KNHANES) V conducted between 2010 and 2012. Survey design analysis was employed to determine the association between COPD and 15 comorbidities. A COPD patient was defined as a smoker with forced expiratory volume in 1s (FEV1)/forced vital capacity (FVC)<0.7 and comorbidities were defined based on objective laboratory findings and questionnaires. Of a total of 9488 patient who underwent spirometry, 744 (7.84%) COPD cases and 3313 non-COPD controls were included in the analyses. Although the prevalence rates of the majority of the comorbidities were high among the COPD patients, only hypertension (adjusted odds ratio [aOR], 1.63; 95% CI, 1.13-2.33 in Stage 1 COPD group; aOR, 1.92; 95% CI, 1.36-2.72 in Stage 2-4 COPD group) and a history of pulmonary tuberculosis (aOR, 3.38; 95% CI, 1.90-5.99 in Stage 2-4 COPD group) were independently associated with COPD after adjustment for age, smoking status, and confounders. Only hypertension and a history of pulmonary tuberculosis were independently associated with COPD after adjustment for confounders among 15 comorbidities. The results suggest that majority of COPD patients might have similar risk factors with its comorbidities, including age and smoking status.

Primary Care COPD Patients Compared with Large Pharmaceutically-Sponsored COPD Studies: An UNLOCK Validation Study

BackgroundGuideline recommendations for chronic obstructive pulmonary disease (COPD) are based on the results of large pharmaceutically-sponsored COPD studies (LPCS). There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care.ObjectiveWe aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD) on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials.MethodsBaseline data of seven primary care databases (n = 3508) from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria.ResultsOverall, patients included in the LPCS were younger (mean difference (MD)-2.4; p = 0.03), predominantly male (MD 12.4; p = 0.1) with worse lung function (FEV1% MD -16.4; p<0.01) and worse quality of life scores (SGRQ MD 15.8; p = 0.01). There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥1 and ≥2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥1 exacerbations per year and 12% had ≥2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN) to 42% (ECLIPSE, UPLIFT).ConclusionPrimary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care populations in their recommendations.

Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease

Background. Chronic obstructive pulmonary disease (COPD) is associated with several extrapulmonary effects that contribute to the severity of the disease. Vitamin D is suggested to play a role in COPD and its related extrapulmonary effects. Aims. To determine the prevalence of vitamin D deficiency and its relation with bone density, muscle strength, and exercise capacity in patients with COPD. Methods. Our cross-sectional study included patients with moderate to very severe COPD. We collected data on lung function, body composition, bone density, quadriceps muscle strength, 6-minute walking distance, and plasma 25-hydroxyvitamin D (25(OH)D) concentration. Vitamin D deficiency was defined as plasma 25(OH)D concentration below 50 nmol/L. Results. In total, 151 COPD patients were included; 87 patients (58%) had vitamin D deficiency. Plasma 25(OH)D concentration was positively associated with bone density (P = 0.005) and 6-minute walking distance (P < 0.001) after adjustment for potential confounders. Plasma 25(OH)D concentration was not associated with quadriceps muscle strength. Conclusions. The majority of COPD patients had vitamin D deficiency. Plasma 25(OH)D concentration was positively associated with bone density and exercise capacity. Intervention studies are necessary to determine whether vitamin D supplementation is of benefit in the prevention or treatment of osteoporosis and poor exercise capacity in patients with COPD.

Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world

Chronic obstructive pulmonary disease (COPD) is a multicomponent disorder that leads to substantial disability, impaired quality of life, and increased mortality. Although the majority of COPD patients are first diagnosed and treated in primary care practices, there is comparatively little information on the management of COPD patients in primary care. A web-based pilot survey was conducted to evaluate the primary care physician’s, or general practitioner’s (GP’s), knowledge, understanding, and management of COPD in twelve territories across the Asia-Pacific region, Africa, eastern Europe, and Latin America, using a 10-minute questionnaire comprising 20 questions and translated into the native language of each participating territory. The questionnaire was administered to a total of 600 GPs (50 from each territory) involved in the management of COPD patients and all data were collated and analyzed by an independent health care research consultant. This survey demonstrated that the GPs’ understanding of COPD was variable across the territories, with large numbers of GPs having very limited knowledge of COPD and its management. A consistent finding across all territories was the underutilization of spirometry (median 26%; range 10%–48%) and reliance on X-rays (median 14%; range 5%–22%) for COPD diagnosis, whereas overuse of blood tests (unspecified) was particularly high in Russia and South Africa. Similarly, there was considerable underrecognition of the importance of exacerbation history as an important factor of COPD and its initial management in most territories (median 4%; range 0%–22%). Management of COPD was well below guideline-recommended levels in most of the regions investigated. The findings of this survey suggest there is a need for more ongoing education and information, specifically directed towards GPs outside of Europe and North America, and that global COPD guidelines appear to have limited reach and application in most of the areas studied.

Survival impact of lung transplantation for COPD

Chronic obstructive pulmonary disease (COPD) is the primary indication for lung transplantation (LTx), but survival benefit is still under debate. We analysed the survival impact of LTx in COPD with a new approach, using the BODE (body mass index, airway obstruction, dyspnoea, exercise capacity) index. We retrospectively reviewed 54 consecutive lung transplants performed for COPD. The pre-transplant BODE score was calculated for each patient and a predicted survival was derived from the survival functions of the original BODE index validation cohort. Predicted and observed post-transplant survival was then compared. In the subgroups with a BODE score >or=7 and <7, a majority of patients (66% and 69%, respectively) lived for longer after LTx than predicted by their individual BODE index. The median survival was significantly improved in the entire cohort and in the subgroup with a BODE score >or=7. 4 yrs after LTx a survival benefit was only apparent in patients with a pre-transplant BODE score of >or=7. In conclusion, while a majority of COPD patients had an individual survival benefit from LTx regardless of their pre-transplant BODE score, a global survival benefit was seen only in patients with more severe disease. This supports the use of the BODE index as a selection criteria for LTx candidates.

Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component

Chronic obstructive pulmonary disease (COPD) patients are at increased risk of osteoporosis. Osteoporosis is under diagnosed and under treated in these patients and the underlying mechanisms remain unclear. To date, screening recommendations for osteoporosis in COPD patients are not available. To examine the prevalence of drug treatment of bone abnormalities as well as the clinical determinants of osteoporosis in COPD. COPD patients (n=554) consecutively entering pulmonary rehabilitation were included in this cross-sectional study. Medical history, current medication use, smoking status, lung function, bone mineral density, body composition and other clinical characteristics were assessed before entering pulmonary rehabilitation. Univariate- and multivariate multinomial logistic regression analyses were used to determine correlates of osteoporosis. Twenty-one percent of patients had osteoporosis and 41% had osteopenia. Osteoporosis was pharmacologically under treated (82% of osteoporotic patients were not receiving bone medication). Independent predictors of osteoporosis were cachexia (OR: 12.1; 95%CI: 4.5-32.7; p<0.001), age between 55 and 65 years (OR: 6.0; 95%CI: 2.2-16.3; p<0.001) and over 65 years (OR: 11.7; 95%CI: 4.1-33.1; p=<0.001). Overweight (OR: 0.1; 95%CI: 0.05-0.4; p=0.001) and obesity (OR: 0.78; 95%CI: 0.02-0.4; p=0.002) showed a substantial protective effect. The majority of COPD patients with osteoporosis entering pulmonary rehabilitation did not receive pharmacological treatment for osteoporosis. Cachectic COPD patients should be screened for osteoporosis, especially when over 55 years of age.

COPD: Is there evidence to support a role for resistance training in improving measurable health-related quality of life in pulmonary rehabilitation?

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. As such, the disease places a significant burden on health care services. Although the pathogenesis of COPD is complex, progressive airflow limitation and a chronic inflammatory response are two hallmark characteristics of the disease. In addition, systemic manifestations such as peripheral muscle dysfunction have recently received considerable attention in the literature. Pulmonary rehabilitation is an evidence-based multidisciplinary intervention that has been shown to produce clinically relevant outcomes. One important component of rehabilitation is exercise. With the majority of COPD patients presenting with muscle weakness and exercise intolerance, the inclusion of resistance training into a pulmonary rehabilitation programme would seem appropriate. Compared with other exercise/training modalities only a small number of studies have investigated the effects of resistance training in COPD patients. Although further research is required to identify the optimal mode, intensity and frequency, it appears that resistance training may prove to be a valuable intervention for COPD patients enrolled in pulmonary rehabilitation programmes.

Helium–oxygen ventilation in the presence of expiratory flow-limitation: A model study

A comparison between air and heliox (80% helium-20% oxygen) ventilation was performed using a mathematical, non-linear dynamic, morphometric model of the respiratory system. Different obstructive conditions, all causing expiratory flow limitation (EFL), were simulated during mechanical ventilation to evaluate and interpret the effects of heliox on tidal EFL and dynamic hyperinflation. Relative to air ventilation, intrinsic positive end-expiratory pressure did not change with heliox if the obstruction was limited to the peripheral airways, i.e. beyond the seventh generation. When central airways were also involved, heliox reduced dynamic hyperinflation (DH) if the flow-limiting segment remained in the fourth to seventh airway generation during the whole expiration, but produced only minor effects if, depending on the contribution of peripheral to total apparent airway resistance, the flow-limiting segment moved eventually to the peripheral airways. In no case did heliox abolish EFL occurring with air ventilation, indicating that any increase in driving pressure would be without effect on DH. Hence, to the extent that chronic obstructive pulmonary disease (COPD) affects primarily the peripheral airways, and causes EFL through the same mechanisms operating in the model, heliox administration should not be expected to appreciably reduce DH in the majority of COPD patients who are flow-limited at rest.

Comparison of the Serological Responses toMoraxella catarrhalisImmunoglobulin D-Binding Outer Membrane Protein and the Ubiquitous Surface Proteins A1 and A2

Moraxella catarrhalis immunoglobulin D-binding protein (MID) is a complex antigen with unique immunoglobulin D (IgD)-binding, adhesion, and hemagglutination properties. Previous studies have shown that antibodies raised against MID764-913 in rabbits inhibited M. catarrhalis adhesion to human alveolar epithelial cells, and immunization with MID764-913 resulted in an increased pulmonary clearance in a murine model. Strong immune responses against MID have also consistently been shown in humans. Here, the MID-specified IgG responses were compared to those of ubiquitous surface proteins A1 and A2 (UspA1/A2) using a series of recombinant fragments that spanned all three proteins. Sera were obtained from young children, aged 6 months to 1 year (n=8) and 2 to 3 years (n=15), and healthy adults (n=16). Acute- and convalescent-phase sera from chronic obstructive pulmonary disease (COPD) patients with M. catarrhalis infective exacerbations (n=23) were also analyzed. Young children, who are at risk of M. catarrhalis infection, had low levels of anti-MID and anti-UspA1/A2 antibodies. Healthy adults and the majority of COPD patients (16/23) had high levels of antibodies directed against, among others, the adhesive domain of MID and the fibronectin- and C3-binding domains of UspA1/A2. Among eight COPD patients in whom a rise in antibody levels could be detected, these functional domains were also the main regions targeted by the antibodies. In addition, human IgG directed against MID was bactericidal and anti-MID antibodies were additive to antibodies targeting UspA1/A2. Hence, the functional domains in these three antigens may have significant potential in a future vaccine against M. catarrhalis.

Hyperreactivity and Bronchial Obstruction

The main obstructive components in bronchial asthma and chronic obstructive pulmonary disease (COPD) are discussed. It is underscored that bronchospasm plays a significant role also in COPD, and that it merits specific treatment (beta 2-stimulants, antimuscarinics, theophylline) even when, in some cases, obstruction appears to be 'irreversible'. The majority of COPD patients react positively, although to a lower degree than asthmatics, not only to chemical agents (histamine, methacholine), but also to 'osmotic' stimuli, such as ultrasonically nebulized distilled water. Geometric factors seem to be in part responsible for the anomalous response. Considering the potent antireactive activity of bronchodilators (beta 2-stimulants in particular), this finding is a further indication for a regular bronchodilator treatment in COPD. Whether such a therapy serves also to improve the prognosis of COPD in the long run has not yet been established.