Moderate COPD Patients Research Articles

Application research on asthma-COPD overlap using low-dose CT scan and quantitative analysis

The aim of this study was to assess the proximal airway remodeling, emphysema, and air trapping of asthma-COPD Overlap. 20 ACO patients, 55 mild to moderate COPD patients and 38 non-severe asthma patients were participated in low-dose dual phase CT scanning and pulmonary function test, comparative analysis was performed to identify differences in CT measurements among three groups. (Ⅰ) The average age and smoking index of ACO and mild to moderate COPD were both higher than non-severe asthma. ACO and mild to moderate COPD group had a higher proportion of males than non-severe asthma. (Ⅱ) In terms of pulmonary function test, FEV1 (%Pred), FEV1/FVC%, MEF25% (%Pred), MEF 50% (%Pred), MMEF (%Pred), and PEF (%Pred) in ACO were significantly reduced than those in non-severe asthma. (Ⅲ) On proximal airway parameters, ACO exhibited higher WA% and Pi10 compared to mild to moderate COPD. However, there was no statistically significant difference in WA% and Pi10 between ACO and non-severe asthma. (Ⅳ) On CT lung function, the emphysema index VI-910ex of ACO was significantly higher than non-severe asthma.Additionally, ACO demonstrated higher MLDex and VI-856ex compared to non-severe asthma. Compared with non-severe asthma, ACO is more common in male patients with older age and a longer history of smoking, which had more severe airflow obstruction and airway dysfunction than non-severe asthma.ACO showed more obvious proximal airway remodeling than mild to moderate COPD, and was more similar to non-severe asthma.The extent of emphysema and air trapping in ACO were more pronounced compared to non-severe asthma.

The Real-World Efficacy of Fixed Triple Inhalation Therapy in the Treatment of Moderate COPD Patients (RATIONALE Study).

COPD affects more than 300 million people worldwide, requiring inhalation treatment. Novel triple formulations of ICS, LABAs and LAMAs are becoming the mainstay of treatment, however there is still a lack of clinical evidence for personalized therapy. RATIONALE was a non-interventional, prospective, 52 week study, assessing the effectiveness of beclometasone/formoterol/glycopyrronium-bromide (BDP/FF/G), in symptomatic COPD patients, with moderate airflow obstruction. The study included 4 visits, where data on demographic parameters, exacerbations, symptoms, quality of life (based on the EQ-5D-3L questionnaire) and lung function were collected. Data on adherence to treatment, based on prescriptions filled was collected from the database of the National Health Insurance Fund, with the patients' consent. The primary objective was the change of adherence to treatment during the study, compared to baseline. Altogether 613 patients had been enrolled. Their average age was 64.56 years and 50.5% were female. The average CAT score was 20.86, and most patients had suffered minimum one exacerbation (82.2%). Average FEV1 was 59.6%. Most patients had some limitation in one or more dimensions of EQ-5D-3L, with an average visual analogue scale score (VAS) of 60.31. After 12 months of treatment, adherence improved significantly - proportion of patients in the highest adherence group increased from 29.8% to 69.7% (p<0.001). The average CAT score improved by 7.02 points (95% CI 5.82-8.21, p<0.001). There was a significant improvement in all dimensions of EQ-5D-3L, with an average increase of 17.91 (95% CI 16.51-19.31, p< 0.001) points in the VAS score. Exacerbation frequency also decreased significantly. Although limitations of observational studies are present, we observed that early introduction of fixed triple combination results in a marked improvement in adherence to treatment, symptom scores, exacerbation frequency and quality of life. The optimal choice of treatment is crucial for reaching the highest possible adherence.

Clinical response to withdrawal of Inhaled Corticosteroids in stable mild to moderate chronic obstructive pulmonary disease in a tertiary hospital of central Nepal

Introduction: The mainstay treatment according to the Global Initiative for Chronic Obstructive Lung Disease 2023 guidelines for Chronic Obstructive Pulmonary Disease is combination of long acting bronchodilators with addition of inhaled corticosteroids only in patients with increased exacerbations and an eosinophil count of ≥ 300 cells/μL. Despite the recommendations, inhaled corticosteroids are most commonly overprescribed. So, this study aims to follow patients with mild to moderate cases of this disease who are currently on inhaled corticosteroids combination therapy for clinical efficacy after its withdrawal. Methods: The study was a prospective interventional study conducted at Dhulikhel Hospital that followed individuals with mild to moderate COPD for eight weeks after a sudden ICS withdrawal. Forced Expiratory Volume in first second, modified Medical Research Council grading, COPD Assessment Tool score and number of exacerbations were assessed with follow-up either by telephone or face to face. Results: Total of 33 patients were enrolled in the study with mean age 68.9 years and standard deviation 9.3 years. Paired t-test analysis showed no significant mean difference in Forced Expiratory Volume in first second and COPD Assessment Tool values before and eight weeks after the withdrawal of Inhaled Corticosteroids. Conclusions: Our study supported the conclusion of previous larger studies that withdrawing ICS in stable mild to moderate COPD patients makes no difference in clinical symptoms and spirometry.

Effects of Pursed Lip Breathing with Arm Ergometry after Chin Support Position in Copd Patients

Background: COPD is the 4th leading cause of mortality around the globe and is expected to be the 3rdleading cause of mortality by 2020. It is a life limiting condition with symptoms of distress such as dyspnea, fatigue, pain and depression as it reaches the terminal stage. The condition decreases the pulmonary function values and QoL. Aerobic training and breathing maneuvers are essential components of pulmonary rehab improving pulmonary function values and QoL. Objective: To find out the effects of pursed lip breathing with arm ergometry after chin support position on respiratory parameters, spirometry tests and quality of life in patients of COPD.. Methods: It was a Randomized control Trial conducted on mild to moderate stage COPD patients. Purposive sampling was used to gain the study sample and then allocated randomly into two groups by coin toss method. The sample size calculated was 74 with 37 subjects in control group and 37 subjects in interventional group. It was conducted at Rehman Medical Institute Peshawar. Spirometer Testing (FEV1,FVC,PEF), HR,SPO2, RR, BORG dyspnea scale and CAT questionnaire were used as outcome measures to measure breathlessness and QoL respectively. Results: Mann-Whitney U test was used between the two groups to measure the effect of the two interventions. There was significant difference between group results (p-value&lt;0.05) were found post-intervention for HR, FEV1, FVC, PEF, BORG score and CAT score. Freidmann test was used for within group analysis and reported significant results (p-value &gt;0.05) for RR, oxygen saturation along with significant BORG and CAT results. Conclusion: It was concluded that there were significant effects of pursed lip breathing with arm ergometry after chin support position on respiratory parameters, spirometry tests and QoL in patients with COPD. Keywords: Chin Support Position, Arm Ergometry, Oxygen Saturation.

Upper Limb Anaerobic Metabolism Capacity is Reduced in Mild and Moderate COPD Patients

Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3′ and 5′ of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r 2 = 0.604, adjusted r 2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3′ and 5′ of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.

Sleep quality in stable chronic obstructive pulmonary disease patients in Zagazig University Hospitals, Egypt

BackgroundChronic obstructive pulmonary disease (COPD) causes changes in sleep quality with accompanied nocturnal drops in oxygen saturation leading to cardiac dysrhythmias, pulmonary hypertension, and more arousal. However, this sleep disturbance is an aspect of COPD that is still under evaluation. Therefore, this work is designed to detect sleep quality with type and frequency of sleep-related breathing disorders in stable COPD patients.ResultsThis is a cross-sectional study that included 60 stable COPD patients. Full night polysomnographies were performed to all patients with assessment of their sleep quality and presence of sleep-disordered breathing. The studied patients were classified into two groups: group I (COPD with good sleep quality) and group II (COPD with poor sleep quality). The results revealed that the more severe the COPD degree, the worse the sleep quality parameters represented by sleep latency, sleep efficiency, and arousal index with a significant statistical difference (P < 0.05). Furthermore, a highly significant statistical difference was noticed regarding time spent in REM sleep among poor sleep quality patients with different grades of severity (P = 0.003). Additionally, obstructive sleep apnea hypopnea syndrome was the most frequent sleep-disordered breathing (65%), followed by nocturnal oxygen desaturation (17%) among poor quality sleeper.ConclusionAbnormal sleep quality is more common in moderate and severe COPD patients. Obstructive sleep apnea is the most frequent sleep-related breathing disorders among COPD patients. Increased BMI%, higher Berlin scores, and lower values of PaO2 and FOSQ-10 scores are strong predictors of poor sleep quality among COPD patients.

Dynamic hyperinflation, chronotropic intolerance and abnormal heart rate recovery in non-severe chronic obstructive pulmonary disease patients-reflections in the mirror

BackgroundThe presence of abnormal heart rate recovery (HRR) and chronotropic incompetence (CI) suggests autonomic dysfunction (AD) and is associated with diminished physical activity and increased cardio-vascular (CV) risk. AimOur aim is to analyse the correlation between AD and airflow obstruction - forced expiratory volume in 1s (FEV1), dynamic hyperinflation (DH) and disease prognosis - the BODE ... index (BMI; Obstruction ... FEV1;Dyspnea ... mMRC;E ... exercise capacity) in non-severe COPD patients without overt CV comorbidities. MethodsWe used cardio-pulmonary exercise testing (CPET) with 67 subjects. Inspiratory capacity (IC) manouevres were performed for DH assessment. Echocardiography was executed before CPET and 1...2min after peak exercise. Stress left ventricular diastolic dysfunction (LVDD) was assumed if stress E/e...>15.Wilkoff method calculated the metabolic-chronotropic relationship (MCR). Chronotropic incompetence (CI) and abnormal HR recovery (HRR) were determined. Main resultsCI was detected in 44% of the mild and 65% of the moderate COPD patients. Abnormal HRR was present in 75% of the mild and 78% of the moderate COPD subjects. Multivariate regression analysis showed no association between FEV1, CPET parameters, BODE index, stress LVDD and AD. DH was the only independent predictor for both abnormal HRR and CI. ConclusionEvaluation of AD during incremental CPET unravels lung hyperinflation as a potential mechanism of attenuated HR response and diminished physical activity in non-severe COPD free of overt CV comorbidities. This multifaceted approach to dyspnea may facilitate the discrimination of its pathogenesis and improve its proper clinical management.

Comparison of sitting calisthenics vs respiratory muscle stretch gymnastics to desensitize dyspnea in moderate COPD patients

Comparison of sitting calisthenics vs respiratory muscle stretch gymnastics to desensitize dyspnea in moderate COPD patients

Resistance Exercise and Knee Osteoarthritis

Resistance Exercise and Knee Osteoarthritis

Autonomic Function Tests in Chronic Obstructive Pulmonary Disease (COPD) and their Correlation with Disease Severity

Background: Chronic hypoxemia in COPD patients, predispose them to cardiovascular autonomicneuropathy and cause sudden cardiorespiratory arrest. COPD patients without hypoxemia can also developcardiovascular autonomic neuropathy. Similarly, cardiovascular autonomic neuropathy, though observedmore often in patients with moderate and severe COPD, can also occur in patients with mild COPD. Thereis paucity of literature, revealing the relationship of autonomic function tests with disease severity in COPDpatients.Objective: In our study we intended to assess, autonomic function tests among different stages of COPDand also to identify the association of these autonomic function tests with disease severity.Method: It is a Cosssectional studydone on (n=130) male COPD patients (who could maintain oxygensaturation above 88%). Anthropometric parameters, autonomic function tests and Pulmonary function testwere assessed. Later, based on the GOLD stage criteria they were divided into 4 sub-groups. Data wereanalysed by SPSS 19.0 version software. One-way ANOVA was used to find Statistical difference betweenthe groups. Correlations between the variables were done using Pearson correlation test.Results: 30/15 ratio and E/I ratio levels were significantly decreased in very severe, severe and moderateCOPD patients when compared to mild COPD patients. The ?DBPIHG levels were significantly increasedduring isometric handgrip in very severe, severe and moderate COPD patients when compared to mildCOPD patients. E/I ratio (r=-0.463), 30/15 ratio (r=-0.496) negatively correlated with disease severity and?DBPIHG levels (r=0.687) positively correlated with disease severityConclusion: In our study group of COPD patients, we found increase in the sympathetic vascular BPresponse which gets increased as the disease severity is increased.30/15 ratio and E/I ratio levels negativelycorrelated with disease severity and ?DBPIHG levels positively correlated with disease severity.

Effects of Neuromuscular Electrical Stimulation [NMES] On Quadriceps Muscle to Improve the Functional Exercise Capacity and Quality Of Life in Mild to Moderate COPD Patients

Background: Prevalence of COPD is common in INDIA, though there are various means used for the treatment of this condition; NMES is still not included in usual rehabilitation of these patients. Since the beneficial effects of NMES on functional capacity are evident through various studies, we would like to evaluate the effect of the same in short treatment duration. Specific Objective: To find out the effectiveness of Neuromuscular electrical stimulation with usual pulmonary rehabilitation on functional exercise capacity and quality of life in mild to moderate COPD patients. Study Design: Quasi experimental study (pre-test and post-test with control group) Study Setting: Institute of Pulmonology -Pulmonology Rehabilitation, PSG Hospitals, Coimbatore. Participants: 30 mild to moderate COPD patients. Sampling: Convenience Sampling Study Duration: 6 months Treatment Duration: Group A – 45 minutes of usual pulmonary rehabilitation (short term package of PSG Institute of pulmonology) daily for 6 days. Group B – 30 minutes of NMES and 45 minutes of usual pulmonary rehabilitation (short term package of PSG Institute of pulmonology) for 6 days Measurement Tools: Six minute walk test (6MWT), Peak expiratory flow rate (PEFR),Modified BORG dyspnea scale, Physical activity index Results: The pre and post-test values for SMWT, PEFR, modified BORG dyspnea scale and PAI of Group A and Group B were documented and analyzed using paired ‘t’ test to compare the outcomes within the group and between the groups it was analyzed and compared using independent ‘t’ test. The calculated values of paired ‘t’ test for SMWT. PWFR, modified BORG dyspnea scale and PAI for group A is 8.910, 4.465, 3.205, 3.22 and that of group B is 7.898, 7.534, 10.738, 4.039 which are more than the table value at p<0.05 and this shows there is a significant difference within the groups. Based on SWMT, PEFR, and Modified BORG dyspnea scale, calculated ‘t’ values for independent ‘t’ test 3.901, 2.44, and 3.638 are greater than the ‘p’ value, and the value of PAI is 0.735 which is lesser than the ‘p’ value indicating there is significant improvement in functional exercise capacity and quality of life in mild to moderate COPD patients. Conclusion: Based on the paired and independent test results of the study, it is concluded that combination of NMES with usual pulmonary rehabilitation shows significant improvement in functional exercise capacity and quality of life in mild to moderate COPD patients.

Adenosine Metabolism in COPD: A Study on Adenosine Levels, 5′-Nucleotidase, Adenosine Deaminase and Its Isoenzymes Activity in Serum, Lymphocytes and Erythrocytes

Adenosine is a signaling molecule which is produced in high concentrations during airway inflammation. Airway inflammation is a characteristic feature of COPD. Therefore, the current study was designed to evaluate the changes in adenosine metabolism in COPD and correlate these changes with severity of the disease.The study was conducted on 50 healthy controls (25 healthy non-smokers and 25 healthy smokers) and 46 COPD patients (21 moderate, 15 severe and 10 very severe). The patients were sub-divided into moderate, severe and very severe categories as per the GOLD spirometric classification. Blood was collected from each subject and serum, lymphocytes and erythrocytes were separated. The adenosine levels and activities of 5′-nucleotidase, adenosine deaminase and its isoenzymes were assessed in serum, lymphocytes and erythrocytes. The data were analyzed statistically. A p value < 0.05 was considered as significant.In healthy smokers and COPD patients the adenosine levels increased. In COPD patients 5′-nucleotidase activity increased significantly in serum, lymphocytes and erythrocytes. The activities of ADA and isoenzymes decreased significantly in serum of healthy smokers and COPD patients, in lymphocytes and erythrocytes of very severe COPD patients and of ADA and ADA2 in lymphocytes and erythrocytes of moderate and severe COPD patients. The FEV1 (% of predicted) showed a significant negative correlation with adenosine levels and 5′-nucleotidase activity in serum, lymphocytes and erythrocytes and significant positive correlation with ADA and isoenzymes activity in serum and lymphocytes of COPD patients.We conclude that the adenosine metabolism changes in COPD. The adenosine levels and 5′-nucleotidase activity increase, and ADA activity decreases with severity of the disease.

PRS23 - PERSISTENCE TO COPD THERAPIES AND IMPACT ON COSTS RELATED TO HEALTHCARE CONSUMPTION: A FRENCH CLAIMS DATA STUDY

Adherence to COPD therapies and impact on healthcare use is poorly documented in France. Our objective was to describe persistence in newly treated COPD patients in France, and to assess a potential impact of non-persistence on costs related to healthcare use. All patients aged 45 and over, having at least one delivery of bronchodilator over 3 consecutive quarters between 2007 and 2014, and without asthma markers, were selected in the Echantillon Généraliste des Bénéficiaires (EGB). It is a 1/97e random sample of the French claims database which collects details of healthcare reimbursed, for each beneficiary. Persistence was measured at 12 months in newly treated patients and assessed by non-interruption of deliveries during at least 90 days. Healthcare-related costs were compared between persistent and non-persistent patients, after matching and adjustment for available confounding factors. In 721 persistent patients to new therapy for COPD and 721 non-persistent patients, numbers of COPD therapies and visits to healthcare professionals were similar. However, medical procedures were less frequent in non-persistent patients than in persistent patients, especially pulmonary function testing, X-rays and chest scan. The total annual health care cost was higher for persistent than for non-persistent patients (€3,677 vs. €3,460), due to higher drug costs (€542 vs. €178). Hospitalisation costs were similar in both groups (€2,138 for persistent patients vs. €2,181 for non-persistent patients). In this population of mild to moderate COPD patients, no difference on health care costs was observed between persistent and non-persistent patients. It can be explained by the similar numbers of exacerbations in both groups and, as is always the case with observational data, residual confounding factors could explain part of the results (e.g. disease severity).

COMPARISON OF THE EFFECTIVENESS OF VISUAL IMAGERY TECHNIQUE AND PROGRESSIVE RELAXATION TECHNIQUE ON ANXIETY AND DEPRESSION IN SUBJECTS WITH MODERATE CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objectives: (1) To determine the effectiveness of visual imagery technique (VIT) on anxiety and depression in moderate chronic obstructive lung disease, (2) to determine the effectiveness of progressive relaxation technique (PRT) on anxiety and depression in moderate chronic obstructive lung disease (COPD), and (3) to compare the effectiveness of VIT and PRT on anxiety and depression in moderate COPD.Methods: Ethical clearance was obtained from the institutional ethical committee. A total of 45 stable moderate COPD patients were selected by simple random sampling, according to inclusion and exclusion criteria. 22 patients of Group A received VIT and 23 of Group B received PRT with a baseline treatment of conventional physiotherapy in both groups for 60 minutes twice a day for 5 days in the Pulmonology Department, Krishna Hospital, Karad.Result: Statistics was analyzed using paired t-test and unpaired t-test. In pre-intervention, there was no statistically significant difference seen for depression anxiety stress scale (DASS21) (p=D 0.0189, A 0.0002, S &lt;0.0001) (t=D 2.440, A 4.053, S 5.105), hospital anxiety depression scale (HADS) (p=D 0.7677, A 0.5121) (t=D 0.2973, A 0.6610), and 6-min walk test (6MWT) (p=D 0.5948, RPE 0.0658) (t=D 0.5359, RPE 1.888). On comparing, the post-interventional values between the two groups using unpaired t-test proved that there was extremely statistically significant difference seen for DASS21 (p=D 0.0011, A &lt;0.0001, S &lt;0.0001) (t=D 3.504, A 9.220, S 13.508), HADS (p=D &lt;0.0001, A &lt;0.0001) (t=D &lt;0.0001, A &lt;0.0001), and 6MWT (p=distance 0.7041, RPE &lt;0.0001) (t=distance 0.3824, RPE &lt;0.0001).Conclusion: VIT along with conventional physiotherapy was significant both statistically and clinically compared to PRT on anxiety and depression in moderate COPD patients.

Indacaterol/glycopyrronium reduces the risk of clinically important deterioration after direct switch from baseline therapies in patients with moderate COPD: a post hoc analysis of the CRYSTAL study.

PurposeCOPD is a progressive disease characterized by exacerbations and a decline in health status and lung function. Clinically important deterioration (CID) is a composite endpoint used to evaluate treatment efficacy. This analysis evaluated the impact of a direct switch to once-daily indacaterol/glycopyrronium 110/50 µg (IND/GLY) from previous monotherapy with a long-acting β2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) or with an LABA and an inhaled corticosteroid (LABA + ICS) on reducing CID.MethodsCRYSTAL was a 12-week, prospective, multicenter, randomized, open-label study conducted in clinical practice settings. Three definitions of CID (D1–D3) were used, including: 1) ≥100 mL decrease in trough forced expiratory volume in 1 second (FEV1), 2) ≥1 point decrease in transition dyspnea index (TDI) and/or ≥0.4 points increase in clinical COPD questionnaire score (CCQ), or 3) an acute moderate/severe exacerbation (AECOPD). In D1 and D2, either TDI or CCQ was evaluated along with FEV1 and AECOPD, whereas in D3, all 4 parameters were included. ClinicalTrials.gov number: NCT01985334.ResultsOf the 2,159 patients analyzed, 1,622 switched to IND/GLY and 537 continued their baseline treatments. The percentage of patients with a CID was significantly lower after a direct switch to IND/GLY versus LABA or LAMA using all 3 CID definitions (D1: odds ratio [OR] 0.41 [95% CI: 0.30–0.55]; D2: OR 0.41 [95% CI: 0.31–0.55]; D3: OR 0.39 [95% CI: 0.29–0.52]). Compared with LABA + ICS, IND/GLY also reduced the risk of CID (D1: OR 0.76 [95% CI: 0.56–1.02]; D2: OR 0.75 [95% CI: 0.56–1.00]; D3: OR 0.67 [95% CI: 0.51–0.89]).ConclusionIn this analysis, IND/GLY reduced the risk of a CID in moderate COPD patients after direct switch from LABA + ICS or LABA or LAMA in real-life clinical practice.

Indacaterol/glycopyrronium (IND/GLY) reduces the risk of clinically important deterioration (CID) in patients with moderate COPD: Results from the CRYSTAL study

Introduction: Decline in health status, lung function, and exacerbations are important determinants of disease progression of COPD patients (pts). CID has been proposed as a composite endpoint to evaluate COPD treatment effects. We report effect of IND/GLY on CID in pts with moderate COPD, after direct switch from LABA+ICS, or a LABA or a LAMA monotherapy. Methods: CRYSTAL, a 12-week, prospective, multicentre, randomised, open-label, pragmatic trial, evaluated the effect of IND/GLY or GLY after a direct switch from previous treatments in moderate COPD pts. CID was defined as a ≥100 mL decrease in trough FEV 1 or a ≥1 point decrease in transition dyspnoea index (TDI) or a ≥0.4 point increase in clinical COPD questionnaire (CCQ) score or a moderate/severe exacerbation. Results: Of 2,159 pts analysed in the IND/GLY treatment arms, 1,622 switched to IND/GLY and 537 continued their baseline treatment. The percentage of pts experiencing a CID was significantly lower in pts who switched to IND/GLY vs pts who continued on LABA+ICS, or on a LABA or a LAMA, using different CID definitions (Table) . Subgroup analyses according to different baseline characteristics were consistent with the overall results. Conclusion: Indacaterol/glycopyrronium significantly reduced the risk of CID in moderate COPD patients, after direct switch from LABA/ICS, or a LABA or a LAMA.

SC13.03 Limitation by COPD for Diagnostic Procedures

Limitation by COPD for Diagnostic Procedures Ostoros, Gy. Varga, J. and Kerpel-Fronius A. National “Korányi” Institute for Pulmonology Hungary, Budapest Lung cancer and COPD are smoking dependent diseases. Smoking cessation is crucial before and during the diagnostic procedures because of the consequences of smoking (e.g. sputum retention, mucociliary dysfunction and potential other more serious complications after the procedures). Severe obstructive or restrictive pulmonary disorders limit the diagnostic possibilities in patients with malignant pulmonary diseases. The screening of lung cancer with low-dose CT has become the gold standard in the past decade. The two imaging-based phenotypes of COPD can be well distinguished by this technique. CT screening can also help to identify non-diagnosed emphysema patients and may lead to early treatment of the disease. It has been showed that non-smoker emphysema patients have a similar risk of lung cancer as smokers with emphysema. Thus, patients with emphysema may be an eligible subgroup for a more intensive lung cancer screening program. However, once a suspicious lesion is found severe COPD, it can limit the choices available for differential diagnosis seriously - CT guided lung biopsies in COPD patients carry a higher risk of hemorrhage and pneumothorax. Patients with severe COPD and respiratory failure with decreased oxygen saturation limit the indication of diagnostic bronchoscopic procedures as well. The examination of exhaled breath condensate (EBC) is a noninvasive process. There are efforts to discriminate lung cancer and COPD with EBC. Lung tumors have influence on lung function. Besides the severity of COPD, the result of the lung function test (LFT) depends on the size and position of the pulmonary tumor as well. In the case of a big central tumor or a huge amount of pleural fluid, the LFT will show rather restrictive than obstructive character. A small peripheral malignancy will not change the shape and volume of the LFT. If the tumor is in the trachea or compresses it's wall, the inspiratory phase of the flow-volume chart could be flat. Sometimes the lung tumors could lead a misdiagnosis of COPD. A centrally located small tumor which is not visible on the chest X-ray but compresses the trachea or any of the pulmonary vessels can cause breathlessness, fatigue and decreased oxygen saturation. A mediastinal conglomerate of lymph nodes can cause similar symptoms. Low physical activity, obesity, smoking and comorbidities are significant negative factors for risk stratification before any pulmonary diagnostic procedure as well. Pulmonary rehabilitation can improve functional reserves if functional capacity is at borderline. Pulmonary rehabilitation has positive effect on cardiovascular function, metabolism, muscle-function and lung mechanics. As for lung function parameters, we need to focus on forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO). We can follow the common agreement of minimum criteria of the European Society of Chest Surgeon and European Respiratory Society for risk stratification before a diagnostic pleuroscopy. Based on this protocol, FEV1 and DLCO need to be >35%pred. In the case of 35%pred< FEV1 and DLCO<75%pred, we need to consider VO2/kg during a cardiopulmonary exercise test. If VO2 is <10 ml/kg/min, the patient need a pulmonary rehabilitation program to improve functional reserves. Regarding lung function, we need to focus on lung mechanics and lung kinematics as well. Lung mechanics can be monitored by resting functional reserve capacity (FRC) and residual volume (RV). Lung kinematics can be monitored by chest expansion. Improved resting or dynamic hyperinflation and lung kinematics of the patients with chest physiotherapy and complex pulmonary rehabilitation is also suggested. As a general effect of rehabilitation, training programs can improve the cardiovascular response, oxygen uptake and the metabolism. We may also focus on physical activity, which is a general prognostics marker. Physical activity can be monitored by pedometer. Obesity can influence the complications of the surgical procedure and it has some effect on lung mechanics as well. If we have time, in case of an obese patient we may also consider improving their body composition before the invasive procedure. To sum up, comorbidities have to be considered before an invasive diagnostic procedure of lung cancer. Patients with impaired pulmonary hemodynamics, ischemic heart disease, diabetes or obesity have to be carefully evaluated. de Torres JP. Casanova C. et al.: Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: A pilot study. Respiratory Medicine, 107, 5, 702-707. 2013. Wiener RS. Schwarcz LM. et al. Population-Based Risk of Complications Following Transthoracic Needle Lung Biopsy of a Pulmonary Nodule. Annals of Internal Medicine, 155, 3, 137-144. 2011. GOLD-www.goldcopd.org Brunelli, A. Charloux, A. et al.: ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients Eur. Resp. J., 34, 1, 2009. diagnosis, copd, lung cancer

PRS18 - One-Year Follow-Up of Medication Regimen Complexity Among Moderate Copd Patients with or Without Earlier Use Of Inhaled Corticosteroids

PRS18 - One-Year Follow-Up of Medication Regimen Complexity Among Moderate Copd Patients with or Without Earlier Use Of Inhaled Corticosteroids

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.

Beta-blockers in patients with chronic obstructive disease and coexistent cardiac illnesses

Chronic obstructive pulmonary disease is prevalent condition commonly associated with cardiovascular diseases. When both are combined the prognosis of the patient worsens. One cornerstone therapy for most cardiac diseases is beta-blockade, however concerns about its potential harmful effects on airways function often restrains their use in patients with COPD and coexistent cardiac diseases. While selective beta1 adrenergic blockers seem to have a better safety profile, other non-selective beta-blockers can be securely utilized in stable COPD patients with no or little reactivity when they are indispensable and used with caution. Evidence provided by post hoc analysis of clinical trials and large observational studies suggests a beneficial effect of beta-blockers on mortality and exacerbations in mild to moderate COPD patients. Benefits are less obvious in severe COPD. Studies on the actual use of beta-blockers suggest that many cardiac patients with COPD (or vice versa) who can benefit from beta-blocker utilization do not receive such medication as it is recommended in the guidelines because of die-hard, not justified in most cases, concerns on safety.