Mild Chronic Obstructive Pulmonary Disease Research Articles

Automated CT-based Decoupling of the Effects of Airway Narrowing and Wall Thinning on Airway Counts in Chronic Obstructive Pulmonary Disease.

We examine pathways of airway alteration due to wall thinning, narrowing, and obliteration at different COPD severity stages using CT-derived airway metrics. Ex-smokers (N = 649; age mean±std: 69 ± 6years; 52% male) from the COPDGene Iowa cohort (September 2013-July 2017) were studied. Total airway count (TAC), peripheral TAC beyond 7th generation (TACp), and airway wall thickness (WT) were computed from chest CT scans using previously validated automated methods. Causal relationships among demographic, smoking, spirometry, COPD severity, airway counts, WT, and scanner variables were analyzed using causal inference techniques including direct acyclic graphs (DAGs) to quantitatively assess multi-pathway alterations of airways in COPD. TAC, TACp, and WT were significantly lower (p < 0.0001) in mild, moderate, and severe COPD compared to the preserved lung function group. TAC (TACp) losses attributed to narrowing and obliteration of small airways were 4.59, 13.29, and 32.58% (4.64, 17.82, and 45.51%) in mild, moderate, and severe COPD, while the losses attributed to wall thinning were 8.24, 17.01, and 22.95% (12.79, 25.66, and 33.95%) in respective groups. Different pathways of airway alteration in COPD are observed using CT-derived automated airway metrics. Wall thinning is a dominant contributor to both TAC and TACp loss in mild and moderate COPD while narrowing and obliteration of small airways is dominant in severe COPD. This automated CT-based study shows that wall thinning dominates airway alteration in mild and moderate COPD while narrowing and obliteration of small airways leads the alteration process in severe COPD.

Different DLCO Parameters as Predictors of Postoperative Pulmonary Complications in Mild Chronic Obstructive Pulmonary Disease Patients with Lung Cancer.

Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV1) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV1 poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DLCO) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection. From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DLCO, predicted postoperative DLCO (ppoDLCO), and DLCO divided by the alveolar volume (DLCO/VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data. Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DLCO <80%, ppoDLCO <60%, and DLCO/VA <80% significantly influenced PPC occurrence. The model using DLCO/VA had the best fit. Different DLCO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DLCO/VA as the most valuable predictor.

Correlation between Respiratory Symptoms Questionnaire and Pulmonary Function Test in Chronic Obstructive Lung Disease Patients: A Tertiary Care Hospital Study

Abstract Objective: This study aimed to investigate the correlation between respiratory symptoms assessed by the Respiratory Symptoms Questionnaire (RSQ) and pulmonary function test (PFT) results in patients diagnosed with chronic obstructive pulmonary disease (COPD) at a tertiary care hospital. Methods: This analytical, cross-sectional study was conducted at Sree Balaji Medical College and Hospital, Chennai, involving 130 COPD patients presenting with symptoms of breathlessness, chronic cough, and wheeze. Data collection instruments used were: (1) RSQ: The RSQ was utilized to assess respiratory symptoms, including breathlessness, cough, and wheeze, (2) PFT: PFT assessments, including spirometry, were performed to measure lung function impairment objectively. Participants completed the RSQ under supervision, followed by PFT assessments conducted by trained respiratory technologists using standardized procedures. Results: Descriptive statistics were computed for demographic variables and questionnaire scores. Pearson correlation analysis was employed to assess the association between respiratory symptoms measured by RSQ and PFT parameters. The Chi-square analysis determined the overall association between symptom scores and PFT results across the COPD severity groups. Significant correlations were observed between severe COPD and St. George’s Respiratory Questionnaire, moderate COPD and Clinical COPD Questionnaire, and moderate-to-severe COPD and COPD Assessment Test (P &lt; 0.05). Nonsignificant correlations were found between mild COPD and symptom scores (P &gt; 0.05). The Chi-square analysis confirmed a strong association between respiratory symptoms and PFT results (P = 0.04). Conclusion: This study highlights the importance of comprehensive symptom assessment alongside the objective measures of lung function in COPD management. Integrating tools such as RSQ with PFTs enables clinicians to obtain a holistic understanding of patients’ disease status and tailor treatment strategies accordingly.

Population pharmacokinetic/target engagement modelling of tozorakimab in healthy volunteers and patients with chronic obstructive pulmonary disease.

This study describes the pharmacokinetic (PK)/target engagement (TE) relationship of tozorakimab, an anti-interleukin (IL)-33 antibody, by building a mechanistic population PK/TE model using phase 1 biomarker data. The analysis included tozorakimab PK and TE in serum assessed in 60 tozorakimab-treated participants, including healthy adults and patients with mild chronic obstructive pulmonary disease. Scenarios evaluated three dose frequencies (once every 2, 4 or 6weeks) administered subcutaneously at seven doses of tozorakimab (30, 60, 90, 120, 150, 300 or 600 mg). For each dose, simulations were performed with 5000 virtual individuals to predict systemic TE. Inhibition of IL-33/soluble ST2 (sST2) complex levels at trough PK at steady state was assessed in each dosing scenario. The PK/TE modelling analyses were performed using a nonlinear mixed-effect modelling approach. The final two-compartment PK model with tozorakimab binding IL-33 in the central compartment adequately described the systemic PK and TE of tozorakimab at population and individual levels. The mean PK parameter estimates of absorption rate, central volume of distribution and clearance were 0.48 (90% confidence interval [CI]: 0.40-0.59, 1/day), 12.64 (90% CI: 8.60-18.62, L) and 0.87 (90% CI: 0.65-1.16, L/day), respectively. Consistent with the observed value, tozorakimab bioavailability was 45%. For all three dose frequencies, predicted inhibition of systemic IL-33/sST2 levels was more than 95% at doses greater than 90 mg. The PK/TE model reliably quantified the relationship between PK and systemic TE of tozorakimab, with potential utility for predicting clinical dose-response relationships and supporting clinical dose selection.

Impact of Short-Term Diesel Exhaust Exposure on Prothrombotic Markers in COPD: A Randomized, Double-blinded, Crossover Study.

Rationale: Growing evidence suggests that air pollution exposure is a major risk factor in chronic obstructive pulmonary disease (COPD) that is associated with an increased prothrombotic state and adverse cardiovascular outcomes. However, much of this work is based on observational data or human exposure studies involving younger participants. The biological causality and mechanism of air pollution-induced prothrombotic response in patients with COPD remain to be explored. Objective: The main aim of this work was to investigate the impact of short-term diesel exhaust (DE) exposure on circulating prothrombotic markers-fibrinogen and plasminogen activator inhibitor-1 (PAI-1)-and urinary eicosanoids in patients with COPD. Methods: Twenty-nine research participants were recruited in this randomized, double-blinded, crossover, controlled human exposure study to DE. Participants included former smokers with and without mild or moderate COPD (ES and COPD group) and healthy never-smokers without COPD (NS group). Each participant was exposed to DE (300 µg/m3 of PM2.5) and filtered air (FA) for 2 hours on different occasions, in randomized order, separated by a 4-week washout. Blood and urine samples were collected prior to and 24 hours after each exposure. Plasma fibrinogen and serum PAI-1 concentrations were quantified using ELISAs. Urinary eicosanoid concentrations were quantified using ultra- performance liquid chromatography coupled to tandem mass spectrometry. Linear mixed-effects models were used for statistical comparisons. Results: Participants with COPD showed an increase in plasma fibrinogen (effect estimate: 1.27 [1.06 to 1.53], p=0.01) after DE relative to FA, but no significant DE-associated change in serum PAI-1 (0.95 [0.87 to 1.04], p=0.26). In never-smokers and ex-smokers without COPD, fibrinogen (NS group: 1.10 [0.99 to 1.23], p=0.08; ES group: 0.86 [0.68 to 1.09], p=0.08] and PAI-1 (NS group: 1.12 [ 0.96 to 1.32], p=0.15; ES group: 0.90 [0.79 to 1.03], p=0.13) were not changed after DE exposure. COPD participants showed a DE-attributable increase in urinary thromboxane B2 (TXB2) metabolites concentrations as follows: 11-dehydro TXB2 (1.45 [1.02 to 2.08], p=0.04); 2,3-dinor-TXB2 (1.45 [1.05 to 2.00], p=0.03). Conclusions: Participants with COPD had increased plasma fibrinogen and urinary TXB2 metabolites after short-term DE exposure, suggesting they may be more susceptible to pollution-attributable prothrombotic response compared to healthy controls or ex-smokers without COPD. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02236039.

Assessment of pulmonary function in COPD patients using dynamic digital radiography: A novel approach utilizing lung signal intensity changes during forced breathing

ObjectivesTo investigate the association of lung signal intensity changes during forced breathing using dynamic digital radiography (DDR) with pulmonary function and disease severity in patients with chronic obstructive pulmonary disease (COPD). MethodsThis retrospective study included 46 healthy subjects and 33 COPD patients who underwent posteroanterior chest DDR examination. We collected raw signal intensity and gray-scale image data. The lung contour was extracted on the gray-scale images using our previously developed automated lung field tracking system and calculated the average of signal intensity values within the extracted lung contour on gray-scale images. Lung signal intensity changes were quantified as SImax/SImin, representing the maximum ratio of the average signal intensity in the inspiratory phase to that in the expiratory phase. We investigated the correlation between SImax/SImin and pulmonary function parameters, and differences in SImax/SImin by disease severity. ResultsSImax/SImin showed the highest correlation with VC (rs = 0.54, P < 0.0001), followed by FEV1 (rs = 0.44, P < 0.0001), both of which are key indicators of COPD pathophysiology. In a multivariate linear regression analysis adjusted for confounding factors, SImax/SImin was significantly lower in the severe COPD group compared to the normal group (P = 0.0004) and mild COPD group (P=0.0022), suggesting its potential usefulness in assessing COPD severity. ConclusionThis study suggests that the signal intensity changes of lung fields during forced breathing using DDR reflect the pathophysiology of COPD and can be a useful index in assessing pulmonary function in COPD patients, potentially improving COPD diagnosis and management.

Role of exhaled carbon monoxide in assessment of chronic obstructive airway disease severity

BackgroundChronic obstructive pulmonary disease (COPD) is a critical public health issue. Spirometric measurements are used to diagnose chronic obstructive lung disease, as per the guidelines of the GOLD initiative. Post-bronchodilator forced expiratory volume in 1 s (FEV1) is a predictor of mortality from COPD and helps to classify the disease’s severity. Smoking contributes to the high levels of exhaled CO. Evidence suggests that the exhaled CO level in COPD patients varies with degree of blockage and can be used to assess treatment response. Estimating the exhaled CO level can help assess airway inflammation and severity of airflow obstruction in individuals with COPD.AimEvaluate role of exhaled CO in assessment of severity of COPD.Materials and methodsThis cross-sectional study included 132 patients who visited the outpatient clinics or were admitted to the Chest Department, Kasr Alainy Hospital, Faculty of Medicine, Cairo University. The study participants were divided into three groups: group 1 nonsmoker healthy control, group 2 smoker non-COPD, and group 3 smoker COPD which further divided according to GOLD 2023 into mild, moderate, and severe COPD. The smoking status, exhaled CO, and spirometry test including FEV1/FVC and FEV1 were measured for each patient.ResultsExhaled CO was significantly increased in the smoker group (mean 9.69, SD 3.11) compared to the nonsmoker group (mean 2.19, SD 0.98) with p-value < 0.001. Exhaled CO was also statistically significantly higher in the smoker COPD group (mean 10.45, SD 3.03) compared to the smoker non-COPD group (mean 7.05, SD 1.56) with p-value < 0.001. Although exhaled CO was increased in the severe COPD group compared to the mild and moderate group, there is no statistically significant difference between them.ConclusionExhaled CO is a fast, sensitive, noninvasive, and well-established method test that can be used to identify smokers from nonsmokers with 98.9% sensitivity at 4.5 cutoff value. Also, exhaled CO levels in COPD patients vary with different degrees of airway obstruction.

The Long-Term Benefit of Exercise With and Without Manual Therapy for Mild Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.

Chronic obstructive pulmonary disease (COPD) is characterized by decreasing exercise capacity and deteriorating quality of life (QoL). Recent evidence indicates that combining exercise with manual therapy (MT) delivers greater improvements in exercise capacity than exercise alone in moderate COPD. The aim of this study was to investigate whether this combination delivers similar results in mild COPD. A total of 71 participants aged 50-65yr with mild COPD were randomly allocated to two groups: exercise only (Ex) or MT plus exercise (MT+Ex). Both groups received 16wk of exercise with the MT+Ex group also receiving 8 MT sessions. Lung function (forced vital capacity [FVC] and forced expiratory volume in the 1 st sec [FEV 1 ]), exercise capacity (6-min walk test [6MWT]), and QoL (St George's Respiratory Questionnaire [SGRQ] and Hospital Anxiety and Depression Scale [HADS]) were measured at baseline, 4, 8, 16, 24, 32, and 48wk. Although there was no difference in the mean effect over time between groups for lung function (FEV 1 , P =.97; FVC, P =.98), exercise capacity (6MWT, P =.98), and QoL (SGRQ, P =.41; HADS anxiety, P =.52; and HADS depression, P =.06), there were clinically meaningful improvements at 48wk for 6MWT (30 m; 95% CI, 10-51 m; P <.001), SGRQ (6.3 units; 95% CI, 2.5-10.0; P <.001), and HADS anxiety (1.5 units; 95% CI, 0.3-2.8 units; P =.006) across the entire cohort. While adding MT to Ex did not produce any additional benefits, exercise alone did deliver sustained modest improvements in exercise capacity and QoL in mild COPD.

Chronic Obstructive Pulmonary Disease Exacerbations Increase the Risk of Subsequent Cardiovascular Events: A Longitudinal Analysis of the COPDGene Study.

Cardiovascular disease (CVD) is the most important comorbidity in patients with chronic obstructive pulmonary disease (COPD). COPD exacerbations not only contribute to COPD progression but may also elevate the risk of CVD. This study aimed to determine whether COPD exacerbations increase the risk of subsequent CVD events using up to 15 years of prospective longitudinal follow-up data from the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study. The COPDGene study is a large, multicenter, longitudinal investigation of COPD, including subjects at enrollment aged 45 to 80 years with a minimum of 10 pack-years of smoking history. Cox proportional hazards models and Kaplan-Meier survival curves were used to assess the risk of a composite end point of CVD based on the COPD exacerbation rate. Frequent exacerbators exhibited a higher cumulative incidence of composite CVD end points than infrequent exacerbators, irrespective of the presence of CVD at baseline. After adjusting for covariates, frequent exacerbators still maintained higher hazard ratios (HRs) than the infrequent exacerbator group (without CVD: HR, 1.81 [95% CI, 1.47-2.22]; with CVD: HR, 1.92 [95% CI, 1.51-2.44]). This observation remained consistently significant in moderate to severe COPD subjects and the preserved ratio impaired spirometry population. In the mild COPD population, frequent exacerbators showed a trend toward more CVD events. COPD exacerbations are associated with an increased risk of subsequent cardiovascular events in subjects with and without preexisting CVD. Patients with COPD experiencing frequent exacerbations may necessitate careful monitoring and additional management for subsequent potential CVD. URL: https://www.clinicaltrials.gov; Unique identifier: NCT00608764.

A novel method for chronic obstructive pulmonary disease detection using comprehensive respiratory impedance and electrocardiogram-derived respiration

Currently, pulmonary function test is the only standard method for diagnosing COPD, but it often involves high testing costs, poor compliance, and a high dependence on patient cooperation. Other new detection methods, such as CT and FOT, also have disadvantages such as radiation exposure and high usage costs. Existing non-invasive COPD detection methods consider the impact of COPD on the lungs or heart, thus they can only roughly detect COPD in individuals, without the ability to grade COPD. Therefore, this study proposed a method for COPD detection using comprehensive respiratory impedance (CRI) and electrocardio-derived respiration (EDR) signals. The method measured both respiratory impedance and ECG synchronously, and the CRI and EDR signals were obtained through an algorithm. The effects of COPD on respiratory pattern were studied by taking CRI and EDR signal morphology as objects, from which characteristic parameters were extracted and input into the supervised classifier to fuse the information of COPD on the changes of respiratory signal morphology pattern in the heart and lungs. The final result is accurate detection of normal, mild COPD and moderate COPD. The experimental results of 46 subjects showed that the accuracy, sensitivity and specificity of CRI and EDR signal characteristics for COPD detection by different classifiers were up to 93.5 %, 90.5 % and 96.5 %, and the AUC values of different classifiers were all > 0.88. Therefore, the method can not only effectively distinguish COPD patients from healthy people, but also provide differentiated detection capabilities for different COPD clinical grades, providing strong support for the early diagnosis and treatment of COPD, and can be applied to the development of portable medical devices for the detection of COPD.

A leaky gut contributes to postural imbalance in male patients with chronic obstructive pulmonary disease

AimsPatients with chronic obstructive pulmonary disease (COPD) frequently exhibit an inability to maintain postural balance. However, the contribution of increased intestinal permeability or leaky gut to the postural imbalance in COPD is not known. MethodsWe measured plasma zonulin, a marker of leaky gut, with relevance to postural balance in male controls (n = 70) and patients with mild (n = 67), moderate (n = 66), and severe (n = 58) COPD. We employed a short physical performance battery to evaluate postural balance in supine, tandem, and semi-tandem positions. We also measured handgrip strength (HGS), gait speed, plasma c-reactive proteins (CRP), and 8-isoprostanes as potential mechanistic connections between postural imbalance and leaky gut. ResultsCOPD patients demonstrated higher plasma zonulin, CRP, and 8-isoprostanes levels and lower balance, HGS, and gait speed than controls (all p < 0.05). These findings were more robust in patients with moderate and severe than mild COPD. In addition, plasma zonulin exhibited significant potential in diagnosing poor balance, low HGS, and gait speed in COPD patients (all p < 0.05). We also found significant correlations of plasma zonulin with CRP and 8-isoprostanes, providing heightened inflammation and oxidative stress as mechanistic connections between leaky gut and postural imbalance. ConclusionPlasma zonulin may be helpful in evaluating postural imbalance in COPD patients. Repairing intestinal leaks can be a therapeutic target to improve postural control in COPD.

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.

Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality.MethodsA retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio.ResultsThere were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death.ConclusionsEvidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.

Discriminative potential of exhaled breath condensate biomarkers with respect to chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) affecting 334 million people in the world remains a major cause of morbidity and mortality. Proper diagnosis of COPD is still a challenge and largely solely based on spirometric criteria. We aimed to investigate the potential of nitrosative/oxidative stress and related metabolic biomarkers in exhaled breath condensate (EBC) to discriminate COPD patients.MethodsThree hundred three participants were randomly selected from a 15,000-transit worker cohort within the Respiratory disease Occupational Biomonitoring Collaborative Project (ROBoCoP). COPD was defined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second to Forced Vital Capacity < 0.7 in spirometry validated by an experienced pulmonologist. Discriminative power of biomarker profiles in EBC was analyzed using linear discriminant analyses.ResultsAmongst 300 participants with validated spirometry, 50.3% were female, 52.3 years old in average, 36.0% were current smokers, 12.7% ex-smokers with mean tobacco exposure of 15.4 pack-years. Twenty-one participants (7.0%) were diagnosed as COPD, including 19 new diagnoses, 12 of which with a mild COPD stage (GOLD 1). Amongst 8 biomarkers measured in EBC, combination of 2 biomarkers, Lactate and Malondialdehyde (MDA) significantly discriminated COPD subjects from non-COPD, with a 71%-accuracy, area under the receiver curve of 0.78 (p-value < 0.001), and a negative predictive value of 96%.ConclusionsThese findings support the potential of biomarkers in EBC, in particular lactate and MDA, to discriminate COPD patients even at a mild or moderate stage. These EBC biomarkers present a non-invasive and drugless technique, which can improve COPD diagnosis in the future.

QUALITY OF LIFE IN PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A TERTIARY CARE CENTRE- A HOSPITAL-BASED STUDY

Background:Chronic obstructive pulmonary disease (COPD) is a major and increasing global health problem .Analyzing the mental, physical and social aspects of this disease is necessary to improve the quality of life (QOL) of COPD patients. Methodology: This study was carried out in 100 stable COPD patients.Detailed history ,general and systemic examination were done.Routine blood investigations, Chest x-ray and spirometry were done.Patients were asked to complete St. Georges Respiratory Questionnaire for COPD patients (SGRQ-C) (simple malayalam version) as honestly as they can.Statistical analysis:Descriptive statistical tools like mean, standard deviation, median was used. Result:A total of 100 COPD patientswith a mean age of 66.91 years and a standard deviation of 7.93 yearswere included in the study in which 95% were males. Study showedsignificant difference between the mild and moderate groups (p &lt;0.001), mild and severe groups (p &lt;0.001), mild and very severe groups (p &lt;0.001). No significant difference between moderate and severe groups, moderate and very severe groups and between severe and very severe groups was found.So we can conclude that the median SGRQ score in the mild COPD group was significantly less compared to all the other groups and that there was no significant difference between the other groups.

CT trachea surface roughness is associated with chronic obstructive pulmonary disease symptoms

Abstract Background Trachea structural abnormalities occur in patients with chronic obstructive pulmonary disease (COPD), yet there are few methods for quantifying trachea surface topology. Purpose To develop a method to quantify trachea surface roughness on CT imaging and investigate the association with airflow limitation and symptoms in COPD. Materials and Methods Participants from the multicenter prospective Canadian Cohort Obstructive Lung Disease study between 2009 and 2015 underwent CT imaging and analysis. Established CT measurements included: tracheal index (TI), defined as the smallest ratio of coronal-to-sagittal trachea diameter, low attenuation areas below –950 HU, and wall thickness of a theoretical 10-mm airway. Trachea surface roughness shape (SRS) was calculated as the percent fraction of the measurement box filled by the surface mesh. Multivariable regression models were used to determine association for CT measurements with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and Medical Research Council dyspnea scale (MRC)≥3, adjusting for covariates. Results A total of 1253 participants (mean age, 66 ± 10 years; 727 men) from 9 centers were investigated: n = 267 never smokers, n = 369 ever smokers, n = 352 mild COPD, and n = 265 moderate-to-severe COPD. There were no differences between groups for age or race (P &amp;lt; .05). In models including SRS and TI, a 1-standard deviation (SD) increase in SRS was independently associated with a 0.11-SD decrease in FEV1 (β = –0.11; P &amp;lt; .001) and a 0.16-SD decrease in FEV1/FVC (β = –0.16; P &amp;lt; .001); a 1-point increase in SRS was associated with a 13% increased likelihood of MRC ≥ 3 (odds ratio = 1.13; P = .003). In models including SRS, low attenuation areas below –950 HU and wall thickness of a theoretical 10-mm airway, a 1-SD increase in SRS was associated with a 0.21-SD decrease in FEV1 (β = –0.21; P &amp;lt; .001) and a 0.13-SD decrease in FEV1/FVC (β = –0.13; P &amp;lt; .001); a 1-point increase in SRS was associated with a 12% increased likelihood of MRC ≥ 3 (odds ratio = 1.12; P = .006). Conclusion Increased trachea surface shape roughness is independently associated with worse airflow and increased symptom burden in COPD.

Haemodynamic compensations for exercise tissue oxygenation in early stages of COPD: an integrated cardiorespiratory assessment study

BackgroundCardiovascular comorbidities are increasingly being recognised in early stages of chronic obstructive pulmonary disease (COPD) yet complete cardiorespiratory functional assessments of individuals with mild COPD or presenting with COPD risk...

Association of Urinary Incontinency with COPD Severity: An Analytical Cross-sectional Study

Large number of patients suffers from urinary incontinence (UI) with COPD leading to urine leakage and affecting their quality of life. Objective: To determine the prevalence and association of UI among with the severity of COPD patients. Methods: The cross sectional study was conducted from February 2023 to June 2023 in Ghurki Teaching Trust Hospital, Shalimar Hospital and Gangaram Hospital. 230 male patients of age 45-65 years suffering with COPD were selected by using convenient sampling technique. The demographic data and International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) were used collected. SPSS version 26.0 along with Chi-square was used for analysis with p-value &lt;0.05. Results: The results showed that 36 (15.7%) suffering with mild COPD, 142 (61.7%) had moderate COPD and 52 (22.6%) had severe COPD in which 33 (14.3%) experience have no urine incontinency, 25 (10.9%) had urge Incontinence, 154 (67%) had stress Incontinence and 18 (7.8%) had mixed Incontinence. Additionally; moderate COPD had shown significant association with stress incontinency with Chi-square value of 188.58 and p-value =0.00 and with the leakage of urine on coughing/ sneezing, during any physical activity/ exercise and all the time with value of 143.37, p-value = 0.00. Conclusions: The study concluded that UI is highly prevalent in COPD patients as stress and urge incontinency is highly prevalent among moderate and severe patients respectively, associated with coughing/ sneezing and physical activity/ exercises.

Alternative Splicing Is a Major Factor Shaping Transcriptome Diversity in Mild and Severe Chronic Obstructive Pulmonary Disease.

The role of alternative splicing in chronic obstructive pulmonary disease (COPD) is still largely unknown. We aimed to investigate the differences in alternatively splicing events between patients with mild-to-moderate and severe COPD compared with non-COPD control subjects and to identify splicing factors associated with aberrant alternative splicing in COPD. For this purpose, we performed genome-wide RNA-sequencing analysis of bronchial brushings from 23 patients with mild-to-moderate COPD, 121 with severe COPD, and 23 non-COPD control subjects. We found a significant difference in the frequency of alternative splicing events in patients with mild-to-moderate and severe COPD compared with non-COPD control subjects. There were from two to eight times (depending on event type) more differential alternative splicing events in the severe than in the mild-to-moderate stage. The severe COPD samples showed less intron retention and more exon skipping. It is interesting that the transcript levels of the top 10 differentially expressed splicing factors were significantly correlated with the percentage of many alternatively spliced transcripts in severe COPD. The aberrant alternative splicing in severe COPD was predicted to increase the overall protein-coding capacity of gene products. In conclusion, we observed large and significant differences in alternative splicing between bronchial samples of patients with COPD and control subjects, with more events observed in severe than in mild-to-moderate COPD. The changes in the expression of several splicing factors correlated with prevalence of alternative splicing in severe COPD. Alternative splicing can indirectly impact gene expression by changing the relative abundance of protein-coding isoforms potentially influencing pathophysiological changes. The results provide a better understanding of COPD-related alternative splicing changes.

Tiotropium reduces clinically important deterioration in patients with mild-to-moderate chronic obstructive pulmonary disease: A post hoc analysis of the Tie-COPD study

BackgroundClinically important deterioration (CID) is a composite endpoint used to holistically assess the complex progression of chronic obstructive pulmonary disease (COPD). Tiotropium improves lung function and reduces the rate of COPD exacerbations in patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate). However, whether tiotropium reduces CID risk in patients with mild-to-moderate COPD remains unclear. MethodsThis was a post hoc analysis of the 24-month Tie-COPD study comparing 18 μg tiotropium with placebo in patients with mild-to-moderate COPD. CID was defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 s, an increase of ≥2 unit in COPD Assessment Test (CAT) score, or moderate-to-severe exacerbation. The time to the first occurrence of one of these events was recorded as the time to the first CID. Subgroup analyses were conducted among patients stratified by CAT score, modified Medical Research Council (mMRC) dyspnea score, and GOLD stage at baseline. ResultsOf the 841 randomized patients, 771 were included in the full analysis set. Overall, 643 patients (83.4 %) experienced at least one CID event. Tiotropium significantly reduced the CID risk and delayed the time to first CID compared with placebo (adjusted hazard ratio = 0.58, 95 % confidence interval = 0.49–0.68, P < 0.001). Significant reductions in CID risk were also observed in various subgroups, including patients with a CAT score <10, mMRC score <2, and mild COPD. ConclusionsTiotropium reduced CID risk in patients with mild-to-moderate COPD, even in patients with fewer respiratory symptoms or mild disease, which highlights tiotropium's effectiveness in treating COPD patients with mild disease. Trial registrationThis study is registered at ClinicalTrials.gov (Tie-COPD, NCT01455129).