Mild Chronic Obstructive Pulmonary Disease Research Articles

Sleep Quality and Quality of Life in Patients With COPD

SESSION TITLE: COPD Comorbidities SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 24, 2016 at 04:30 PM - 05:30 PM PURPOSE: Sleep disorders are common in COPD patients, particularly coexisting Obstructive sleep apnoea (OSA). These patients also experience reduced health-related quality of life (HRQoL) caused by dyspnoea, systemic effects and co-morbidities. There is insufficient data assessing sleep quality and quality of life from our region. In this study, we explored quality of sleep in COPD patients without suspected OSA and the relationship between sleep quality and quality of life in these patients. METHODS: In this cross sectional descriptive study performed in a tertiary care hospital, 120 COPD patients completed questionnaires: Berlin questionnaire, Pittsburgh Sleep Quality Index, and St. George Respiratory questionnaires (SGRQ). Patients with suspected OSA were excluded on the basis of result of Berlin questionnaire. Pulmonary function test was done to categorize the patients into 3 groups of mild, moderate and severe COPD based on GOLD guidelines. Student's t-test and ANOVA were used to assess differences in continuous variables between groups (different severities of COPD and patients sex). Association between categorical variables was determined by Chi-square test. Logistic regression analysis was used to investigate the relationship between quality of life as dependent variable and other independent variables. RESULTS: Baseline mean values were: age 61.3 ± 11.2, 56% female, BMI 24.1 ± 4.5 kg/m2, FEV 1.59 ± 1.4 litres. 68.8% had poor sleep quality (PSQI 8.1 ± 6). Quality of sleep was significantly correlated with quality of life (p<0.001). Significant differences were found between the genders for total score and each of three subscores of SGRQ suggesting poorer quality of life in females. Stepwise multiple regression analysis showed that severity of COPD, female gender and sleep quality accounted for the poor quality of life significantly (r2 = 0.11, 0.2, and 0.16, respectively). CONCLUSIONS: Quality of sleep in patients with COPD is poor and worsens with disease progression. The low quality of sleep has an effect on the deterioration of their quality of life, especially in female patients. CLINICAL IMPLICATIONS: The early identification of alteration of the quality of sleep by incorporating objective measures of sleep disturbances, especially by clinicians, could facilitate a preventive approach for COPD patients that could positively affect their HRQoL. Training, counseling, and advocacy programs can be developed to improve the patients' quality of sleep and quality of life. DISCLOSURE: The following authors have nothing to disclose: Krishna Sharma, Titiksha Choyal, Hemant Chaturvedi, Rudra Pandey No Product/Research Disclosure Information

Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure?

Background: Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population.Methods: We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40–80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS).Results: In men aged 40–59 years the severity of depressive symptoms was greater in NYHA classes III–IV compared to NYHA classes I–II and reference group. In men aged 60–80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p ≤ 0.001). In multivariate logistic regression model in men aged 40–59 years advanced NYHA class was associated with higher prevalence of mild depression (OR = 2.14, 95%CI: 1.07–4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR = 69.1, 95%CI: 2.11–2264.3). In men aged 60–80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR = 2.9, 95%CI: 1.3–6.4; OR = 3.6, 95%CI: 1.2–10.63).Conclusion: TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.

Associations between the distance covered in the incremental shuttle walk test and lung function and health status in patients with chronic obstructive pulmonary disease.

Field walk tests such as the incremental shuttle walk test (ISWT) are simple tests for assessing the degree of disability in individuals with chronic obstructive pulmonary disease (COPD). In the present study, the correlations between exercise performance in the ISWT, lung function, and health status were examined in patients with COPD of varying severities. A retrospective examination of 277 COPD patients was performed using the ISWT and lung function tests along with assessment of health status using St. George׳s Respiratory Questionnaire (SGRQ). In addition, we assessed the correlations between the walking distance, lung function parameters, and SGRQ scores. ISWT distances were poorly correlated with lung function parameters and SGRQ scores in mild COPD patients. In contrast, ISWT distances were significantly correlated with pulmonary function parameters, such as vital capacity (%predicted) and forced expiratory volume in one second, and SGRQ scores in moderate and severe COPD patients. The ISWT is more independent of health status and pulmonary function in patients with mild COPD compared to moderate or severe cases. Therefore, the exercise capacity of patients with mild COPD should be estimated by the ISWT.

Numerous metallic foreign bodies in whole body after acupuncture

A 60-year-old man was referred to our clinic for the evaluation of numerous radio-opaque densities on a screening chest radiograph. He was a former smoker without any significant medical history,...

Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease.

BackgroundIn addition to lung involvement, several other diseases and syndromes coexist in patients with chronic obstructive pulmonary disease (COPD). Our purpose was to investigate the prevalence of idiopathic arterial hypertension (IAH), ischemic heart disease, heart failure, peripheral vascular disease (PVD), diabetes, osteoporosis, and anxious depressive syndrome in a clinical setting of COPD outpatients whose phenotypes (predominant airway disease and predominant emphysema) and severity (mild and severe diseases) were determined by clinical and functional parameters.MethodsA total of 412 outpatients with COPD were assigned either a predominant airway disease or a predominant emphysema phenotype of mild or severe degree according to predictive models based on pulmonary functions (forced expiratory volume in 1 second/vital capacity; total lung capacity %; functional residual capacity %; and diffusing capacity of lung for carbon monoxide %) and sputum characteristics. Comorbidities were assessed by objective medical records.ResultsEighty-four percent of patients suffered from at least one comorbidity and 75% from at least one cardiovascular comorbidity, with IAH and PVD being the most prevalent ones (62% and 28%, respectively). IAH prevailed significantly in predominant airway disease, osteoporosis prevailed significantly in predominant emphysema, and ischemic heart disease and PVD prevailed in mild COPD. All cardiovascular comorbidities prevailed significantly in predominant airway phenotype of COPD and mild COPD severity.ConclusionSpecific comorbidities prevail in different phenotypes of COPD; this fact may be relevant to identify patients at risk for specific, phenotype-related comorbidities. The highest prevalence of comorbidities in patients with mild disease indicates that these patients should be investigated for coexisting diseases or syndromes even in the less severe, pauci-symptomatic stages of COPD. The simple method employed to phenotype and score COPD allows these results to be translated easily into daily clinical practice.

Study of the clinical phenotype of symptomatic chronic airways disease by hierarchical cluster analysis and two-step cluster analyses

To study the distinct clinical phenotype of chronic airway diseases by hierarchical cluster analysis and two-step cluster analysis. A population sample of adult patients in Donghuamen community, Dongcheng district and Qinghe community, Haidian district, Beijing from April 2012 to January 2015, who had wheeze within the last 12 months, underwent detailed investigation, including a clinical questionnaire, pulmonary function tests, total serum IgE levels, blood eosinophil level and a peak flow diary. Nine variables were chosen as evaluating parameters, including pre-salbutamol forced expired volume in one second(FEV1)/forced vital capacity(FVC) ratio, pre-salbutamol FEV1, percentage of post-salbutamol change in FEV1, residual capacity, diffusing capacity of the lung for carbon monoxide/alveolar volume adjusted for haemoglobin level, peak expiratory flow(PEF) variability, serum IgE level, cumulative tobacco cigarette consumption (pack-years) and respiratory symptoms (cough and expectoration). Subjects' different clinical phenotype by hierarchical cluster analysis and two-step cluster analysis was identified. (1) Four clusters were identified by hierarchical cluster analysis. Cluster 1 was chronic bronchitis in smokers with normal pulmonary function. Cluster 2 was chronic bronchitis or mild chronic obstructive pulmonary disease (COPD) patients with mild airflow limitation. Cluster 3 included COPD patients with heavy smoking, poor quality of life and severe airflow limitation. Cluster 4 recognized atopic patients with mild airflow limitation, elevated serum IgE and clinical features of asthma. Significant differences were revealed regarding pre-salbutamol FEV1/FVC%, pre-salbutamol FEV1% pred, post-salbutamol change in FEV1%, maximal mid-expiratory flow curve(MMEF)% pred, carbon monoxide diffusing capacity per liter of alveolar(DLCO)/(VA)% pred, residual volume(RV)% pred, total serum IgE level, smoking history (pack-years), St.George's respiratory questionnaire(SGRQ) score, acute exacerbation in the past one year, PEF variability and allergic dermatitis (P<0.05). (2) Four clusters were also identified by two-step cluster analysis as followings, cluster 1, COPD patients with moderate to severe airflow limitation; cluster 2, asthma and COPD patients with heavy smoking, airflow limitation and increased airways reversibility; cluster 3, patients having less smoking and normal pulmonary function with wheezing but no chronic cough; cluster 4, chronic bronchitis patients with normal pulmonary function and chronic cough. Significant differences were revealed regarding gender distribution, respiratory symptoms, pre-salbutamol FEV1/FVC%, pre-salbutamol FEV1% pred, post-salbutamol change in FEV1%, MMEF% pred, DLCO/VA% pred, RV% pred, PEF variability, total serum IgE level, cumulative tobacco cigarette consumption (pack-years), and SGRQ score (P<0.05). By different cluster analyses, distinct clinical phenotypes of chronic airway diseases are identified. Thus, individualized treatments may guide doctors to provide based on different phenotypes.

Application of the homology method for quantification of low-attenuation lung region inpatients with and without COPD.

BackgroundHomology is a mathematical concept that can be used to quantify degree of contact. Recently, image processing with the homology method has been proposed. In this study, we used the homology method and computed tomography images to quantify emphysema.MethodsThis study included 112 patients who had undergone computed tomography and pulmonary function test. Low-attenuation lung regions were evaluated by the homology method, and homology-based emphysema quantification (b0, b1, nb0, nb1, and R) was performed. For comparison, the percentage of low-attenuation lung area (LAA%) was also obtained. Relationships between emphysema quantification and pulmonary function test results were evaluated by Pearson’s correlation coefficients. In addition to the correlation, the patients were divided into the following three groups based on guidelines of the Global initiative for chronic Obstructive Lung Disease: Group A, nonsmokers; Group B, smokers without COPD, mild COPD, and moderate COPD; Group C, severe COPD and very severe COPD. The homology-based emphysema quantification and LAA% were compared among these groups.ResultsFor forced expiratory volume in 1 second/forced vital capacity, the correlation coefficients were as follows: LAA%, −0.603; b0, −0.460; b1, −0.500; nb0, −0.449; nb1, −0.524; and R, −0.574. For forced expiratory volume in 1 second, the coefficients were as follows: LAA%, −0.461; b0, −0.173; b1, −0.314; nb0, −0.191; nb1, −0.329; and R, −0.409. Between Groups A and B, difference in nb0 was significant (P-value = 0.00858), and those in the other types of quantification were not significant.ConclusionFeasibility of the homology-based emphysema quantification was validated. The homology-based emphysema quantification was useful for the assessment of emphysema severity.

An in silico analysis of oxygen uptake of a mild COPD patient during rest and exercise using a portable oxygen concentrator.

Oxygen treatment based on intermittent-flow devices with pulse delivery modes available from portable oxygen concentrators (POCs) depends on the characteristics of the delivered pulse such as volume, pulse width (the time of the pulse to be delivered), and pulse delay (the time for the pulse to be initiated from the start of inhalation) as well as a patient’s breathing characteristics, disease state, and respiratory morphology. This article presents a physiological-based analysis of the performance, in terms of blood oxygenation, of a commercial POC at different settings using an in silico model of a COPD patient at rest and during exercise. The analysis encompasses experimental measurements of pulse volume, width, and time delay of the POC at three different settings and two breathing rates related to rest and exercise. These experimental data of device performance are inputs to a physiological-based model of oxygen uptake that takes into account the real dynamic nature of gas exchange to illustrate how device- and patient-specific factors can affect patient oxygenation. This type of physiological analysis that considers the true effectiveness of oxygen transfer to the blood, as opposed to delivery to the nose (or mouth), can be instructive in applying therapies and designing new devices.

Mild Chronic Obstructive Pulmonary Disease: New Insights of Pathophysiology

By giving their relatively well-preserved spirometry, some have discussed that respiratory symptoms in patients with mild COPD are unlikely to be related to lung function abnormalities. There is emerging physiological and clinical evidence of peripheral airway dysfunction, reduced physical activity levels, and diminished quality of life, and increased exercise intolerance, hospitalization, mortality in patients with mild COPD. The objective of the present review article was to summarized recent studies regarding the pathophysiology of mild COPD.

Highly absorptive curcumin reduces serum atherosclerotic low-density lipoprotein levels in patients with mild COPD.

PurposeCOPD is mainly caused by tobacco smoking and is associated with a high frequency of coronary artery disease. There is growing recognition that the inflammation in COPD is not only confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs, including blood vessels. α1-antitrypsin–low-density lipoprotein (AT-LDL) complex is an oxidatively modified LDL that accelerates atherosclerosis. Curcumin, one of the best-investigated natural products, is a powerful antioxidant. However, the effects of curcumin on AT-LDL remain unknown. We hypothesized that Theracurmin®, a highly absorptive curcumin with improved bioavailability using a drug delivery system, ameliorates the inflammatory status in subjects with mild COPD.Patients and methodsThis is a randomized, double-blind, parallel-group study. Subjects with stages I–II COPD according to the Japanese Respiratory Society criteria were randomly assigned to receive 90 mg Theracurmin® or placebo twice a day for 24 weeks, and changes in inflammatory parameters were evaluated.ResultsThere were no differences between the Theracurmin® and placebo groups in terms of age, male/female ratio, or body mass index in 39 evaluable subjects. The percent changes in blood pressure and hemoglobin A1c and LDL-cholesterol, triglyceride, or high-density lipoprotein-cholesterol levels after treatment were similar for the two groups. However, the percent change in the AT-LDL level was significantly (P=0.020) lower in the Theracurmin® group compared with the placebo group.ConclusionTheracurmin® reduced levels of atherosclerotic AT-LDL, which may lead to the prevention of future cardiovascular events in mild COPD subjects.

Use of varenicline for more than 12 months for smoking cessation in heavy chronic obstructive pulmonary disease smokers unmotivated to quit: a pilot study.

Introduction:Use of varenicline for as long as necessary to achieve abstinence has not been studied. The aim of this study was to test whether smokers with mild-to-moderate chronic obstructive pulmonary disease (COPD) are able to quit if they use varenicline for a sufficient length of time.Methods:A total of 30 heavy smokers with COPD took varenicline for sufficiently long enough for smoking cessation. Smokers were allowed to smoke without a fixed quit date. The main endpoints were the time of voluntary abstinence (VA) and the continuous abstinence rate (CAR) at 12 and 18 months.Results:Of 28 subjects, eight subjects continued to smoke and 20 subjects stopped smoking, demonstrating a CAR up to 18 months (71%). Median time of treatment was 6 (range 3–24) and 2 (range 1–8) months for abstainers and non-abstainers, respectively, and the median time of VA for abstainers was 4 (range 1–21) months.Conclusions:Use of varenicline for more than the traditional 12 recommended weeks may be a good strategy to increase the cessation rate in heavy smokers with mild COPD.

Implications of the pulmonary artery to ascending aortic ratio in patients with relatively mild chronic obstructive pulmonary disease.

Identifying markers for predicting the course and outcome of chronic obstructive pulmonary disease (COPD) remains important. The relative pulmonary artery enlargement to aorta ratio (PA-A ratio), which is measured using computed tomography (CT), is a reported predictor for COPD exacerbation and mortality. However, little is known about the implications of the PA-A ratio in patients with mild COPD. We investigated the utility of the PA-A ratio as a biomarker in patients with relatively mild COPD. A total of 131 patients with mild to moderate COPD [post-bronchodilator forced expiratory volume in 1 sec (FEV1)/forced vital capacity (FVC) 61.6±6.4, mean post-bronchodilator FEV1 83%±17.8% of predicted value] were selected from a Korean COPD cohort (from 2012 until the end of 2014) and analyzed retrospectively. We determined the correlation between the PA-A ratio and clinical parameters using a linear regression model. The COPD assessment test (P=0.04), FEV1 (P=0.03), and a history of exacerbation in the last year (P=0.03) were significant factors in the univariate linear regression analysis. Post-bronchodilator FEV1 was most significantly associated with the PA-A ratio in the multivariate analysis (P=0.01). The PA-A ratio evaluated by CT imaging was independently correlated with a representative pulmonary function factor (FEV1) in patients with relatively mild COPD. The results suggest that the PA-A ratio may be an important biomarker for clinical outcome in patients with mild COPD.

К ВОПРОСУ О МИТОХОНДРИАЛЬНОЙ ДИСФУНКЦИИ ПРИ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ

The aim is to study structural and functional condition of cell mitochondrial apparatus for evaluating the mitochondrial membrane potential (MMР) and the fatty acids (FA) composition of mitochondrial membranes of blood cells in patients with COPD; to establish the role of mitochondrial dysfunction in the mechanism of COPD. The study involved 27 patients with mild COPD, 21 with moderate COPD of a stable course, and 20 healthy people. MMР of leukocytes was assessed with cytofluorimetry. The composition of FA of mitochondrial membranes was studied with gas-liquid chromatography. As a result of the study it was found out that the worsening of the disease (moderate COPD) leads to the increase of the number of white blood cells with reduced MMP and appearance of deficit of the saturated monoenic and n-3 polyunsaturated fatty acids in the membrane of mitochondria. The revealed changes in the structural and functional state of mitochondria show a violation in energetic activity, membrane permeability and transport of substances, which is a sign of the formation of mitochondrial dysfunction and cell hypoxia development at respiratory diseases.

ЦИРКАДИАННЫЕ РИТМЫ ГАЗОВОГО СОСТАВА КРОВИ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ

Chronobiological aspects of blood gas composition in 24 patients with COPD were studied. To achieve this goal, the gas composition of the arterialized capillary blood simultaneously with the investigation of respiratory function was studied with an interval of 6 hours over 2 days. In healthy individuals and patients with mild COPD two types of gas composition of blood biorhythm – daytime and nighttime – were found. In patients with moderate, severe and very severe disease 3 types of biorhythm of partial oxygen and carbon dioxide tension – morning time, noontime and evening time were registered. In healthy individuals and patients with mild COPD gas composition of blood was characterized by significant degrees of freedom in relation to functioning of the respiratory system, which indicated the stored processes of adaptation to changing conditions of the external and internal environment. In patients with moderate, severe and very severe COPD at the moment of acrophase of circadian rhythm of lung function maximum partial oxygen pressure in the arterialized capillary blood was observed. During the batiphaze of circadian rhythm of the respiratory system the highest values of the partial carbon dioxide tension were revealed. Thus, it was found out that with the growth of the severity of the disease in patients with COPD abnormal rhythms of blood gas composition are registered; the dependence of circadian rhythm of blood gas composition on the functioning of the respiratory apparatus increases.

Prevalence of overlap syndrome in chronic obstructive pulmonary disease patients without sleep apnea symptoms.

The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In this study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients. Forty-five COPD patients (mean FEV1 1671.3 ± 532.0 mL) with mild hypoxemia presenting no sleep apnea symptoms (96% men, mean age 67.7 ± 8.5 years) were involved in this study. Clinical characteristics were recorded, biochemical analysis and polygraphy were performed. Twenty-six patients with a RDI of ≥15 events/h were defined as OS (58%). When OS (n = 26) and COPD without OSA (n = 19) groups were compared, BMI (29.6 ± 6.6 vs 25.6 ± 4.9 kg/m2 ; P = 0.03), TNF-α level (24.8 ± 8.1 vs 3.6 ± 0.8 ng/mL; P = 0.03) and sleep time with SpO2 < 90% (23.9 ± 29.4 vs 9.7 ± 21.9%; P = 0.02) were significantly increased in OS. Univariate analysis showed a correlation between RDI and BMI (P < 0.01), Epworth score (P = 0.050), COPD exacerbation frequency (P = 0.046) and TNF-α (P = 0.048). However, multivariate linear regression analysis revealed a significant correlation only between RDI and BMI (P < 0.01). BMI as a predictor of OSA was examined through ROC curve analysis and the area under curve was 0.691 (P = 0.03). To identify OS patients, BMI > 27.2 kg/m2 had a sensitivity of 73% and specificity of 68%. This findings support that high prevalence (58%) of OS in COPD patients without OSA symptoms is related to BMI. Therefore, sleep study should be considered in especially overweight or obese COPD patients, even in those without sleep apnea symptoms.

Determinants of Smoking Cessation in Patients With COPD Treated in the Outpatient Setting

The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical and sociodemographic determinants of smoking cessation in 3,233 patients with COPD who smoked on outpatient contact during 2008 to 2012. Using multivariate Cox regression, we calculated hazard ratios (HRs) of quitting. Within 1 and 5 years from first outpatient contact, the probability of quitting was 19%and 45%, respectively. In adjusted analyses, patients were less likely to quit if they were younger, with an HR of 0.84 (95%CI, 0.71-0.99) for patients aged 50 to 69 years and 0.53 (95%CI, 0.37-0.76) for patients aged 30 to 49, compared with those aged 70 years or older, who had lower income (HR, 0.79; 95%CI, 0.67-0.94), lived alone (HR, 0.75; 95%CI, 0.64-0.88), were unemployed (HR, 0.70; 95%CI, 0.54-0.90), had milder COPD with an HR of0.67 (95%CI, 0.53-0.84) for Global Initiative for Chronic Obstructive Lung Disease (GOLD) A and 0.61 (95%CI, 0.47-0.80) for GOLD B compared with GOLD D, had Medical Research Council (MRC) dyspnea scale score< 4 (HR 0.80, 95%CI 0.68-0.95), or no history of exacerbations treated on an outpatient basis. (HR, 0.80; 95%CI, 0.68-0.93). These findings reinforce that young and socioeconomically disadvantaged patients have more difficulties achieving timely smoking cessation. A novel finding is that patients with milder COPD are less likely to quit. The findings suggest a need for interventional studies focusing on these subgroups to ensure abstinence to halt disease progression.

An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014

Introduction: GOLD guideline recommendations are currently the “gold standard” for the treatment of COPD patients.Objectives: The objective of this analysis was to evaluate compliance with GOLD guidelines in managing COPD patients’ treatment by general practitioners (GPs) and pulmonologists. Since inhaled corticosteroid (ICS) use is defined as inappropriate in mild and moderate COPD patients, special attention was paid to ICS therapy use in these classes.Methods: The study was based on the Italian GP database IMS Health Longitudinal Patient Database (IMS Health LPD) and on the Patient Analyzer specialist IMS Health database. The observed cohort included all patients with a diagnosis of COPD, aged 40 years or more, with at least one ATC R03 class prescription, visited by GPs and pulmonologists during four timeframes: October 2012 – March 2013 (cohort 1), April 2013 – September 2013 (cohort 2), October 2013 – March 2014 (cohort 3); April 2014 – September 2014 (cohort 4). Patients were classified into disease severity groups following 2008 GOLD guidelines, based on FEV1 value.Results: Cohorts were quite similar in size (about two thousand patients per cohort). Pulmonologists visited more severe patients than GPs. About 50% of GPs’ mild and moderate patients received treatments containing inhaled corticosteroids. Pulmonologists were more adherent to guidelines, with smaller percentages of mild patients treated with therapies containing ICS (ranging from 19.0% to 30.1%). An improvement in adherence was observed during the four time periods, with a decrease in the use of therapies containing ICS in mild and moderate patients. In absolute terms, it emerged that GPs more often prescribe ICS improperly to patients in the mild and moderate severity classes than pulmonologists.Conclusion: Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists.

English

AIM OF THE STUDY: Smokers with suspected COPD seek medical attention when they become dyspnoeic on mild to moderate exertion, but by than half of the ventilator reserves are lost irreversibly. Hence it seems logical to diagnose COPD early before development of significant symptoms. Since smoking cessation in COPD is found to reduce rapid decline of ventilator function in smokers and to make an attempt to quit smoking in south Indian population. MATERIALS AND METHODS: Patients attending outpatient department at MGM Govt. Hospital attached to KAPV Govt. Medical College, Tiruchirappalli. EASY ONE spirometer. TYPE OF STUDY: Unicentric Prospective description study. USEFULNESS OF THE STUDY: Chronic obstructive pulmonary disease (COPD) is a major case of chronic morbidity and mortality. Third leading cause of death in 2020Smoking cessation will improve quality of life and decrease the morbidity and mortality. CONCLUSION: 1. The most common age of first smoking is 18 years and all participants had started smoking by 26 years. 2. The youngest age of first smoking is at 16 years 3. The age of first smoking does not have significance with airflow limitation 4. The most common age group found is 39-49 years 5. The most prevalent BMI is 18.5-24.9 and does not have significance in respect to airflow obstruction . 6. SI has significant negative correlation with FEV1/FVC and Significant positive correlation coefficient with age. 7. The quantum of smoking correlates with severity of airflow obstruction as indicated by SI 8. There is 17.8% of asymptomatic smokers have airflow limitation in the form of obstructive lung disease. 9. There is 61.29% of asymptomatic smokers had mild COPD and 38.7% had moderate COPD as per GOLD guidelines 10. The FEV1/FVC ratio as a screening tool to detect the presence of COPD in asymptomatic smokers is established 11. Handheld in office spirometry is useful for screening the smokers for presence of airflow obstruction before significant symptoms. 12. MEF 25-75 also has significant positive correlation coefficient with FEV1/FVC ratio and significant negative correlation with SI

Vitamin D deficiency impairs skeletal muscle function in a smoking mouse model.

Chronic obstructive pulmonary disease (COPD) is associated with skeletal muscle dysfunction. Vitamin D plays an important role in muscle strength and performance in healthy individuals. Vitamin D deficiency is highly prevalent in COPD, but its role in skeletal muscle dysfunction remains unclear. We examined the time-course effect of vitamin D deficiency on limb muscle function in mice with normal or deficient vitamin D serum levels exposed to air or cigarette smoke for 6, 12 or 18 weeks. The synergy of smoking and vitamin D deficiency increased lung inflammation and lung compliance from 6 weeks on with highest emphysema scores observed at 18 weeks. Smoking reduced body and muscle mass of the soleus and extensor digitorum longus (EDL), but did not affect contractility, despite type II atrophy. Vitamin D deficiency did not alter muscle mass but reduced muscle force over time, downregulated vitamin D receptor expression, and increased muscle lipid peroxidation but did not alter actin and myosin expression, fiber dimensions or twitch relaxation time. The combined effect of smoking and vitamin D deficiency did not further deteriorate muscle function but worsened soleus mass loss and EDL fiber atrophy at 18 weeks. We conclude that the synergy of smoking and vitamin D deficiency in contrast to its effect on lung disease, had different, independent but important noxious effects on skeletal muscles in a mouse model of mild COPD.

Sex Differences in Airway Remodeling in a Mouse Model of Chronic Obstructive Pulmonary Disease.

After adjustment for the amount of smoking, women have a 50% increased risk of chronic obstructive pulmonary disease (COPD) compared with men. The anatomic basis and/or mechanism(s) of these sex-related differences in COPD are unknown. To characterize the impact of female sex hormones on chronic cigarette smoke-induced airway remodeling and emphysema in a mouse model of COPD. Airway remodeling and emphysema were determined morphometrically in male, female, and ovariectomized mice exposed to 6 months of cigarette smoke. Antioxidant- and transforming growth factor (TGF)-β-related genes were profiled in airway tissues. The selective estrogen receptor modulator tamoxifen was also administered during smoke exposure in a short-term model. Airway wall thickness of male and female human smokers at risk of or with mild COPD was measured using optical coherence tomography. Small airway wall remodeling was increased in female but not male or ovariectomized mice and was associated with increased distal airway resistance, down-regulation of antioxidant genes, increased oxidative stress, and activation of TGF-β1. These effects were prevented by ovariectomy. Use of tamoxifen as a therapeutic intervention mitigated smoke-induced increase in oxidative stress in female mice. Compared with male human smokers, female human smokers had significantly thicker airway walls. The excess risk of small airway disease in female mice after chronic smoke exposure was associated with increased oxidative stress and TGF-β1 signaling and also was related to the effects of female sex hormones. Estrogen receptor antagonism might be of value in reducing oxidative stress in female smokers.