Chronic Obstructive Pulmonary Disease Morbidity Research Articles

Short-Term Effects of Ambient Air Pollution on Chronic Obstructive Pulmonary Disease Admissions in Jiuquan, China

Recent findings indicate that air pollution contributes to the onset and advancement of chronic obstructive pulmonary disease (COPD). Nevertheless, there is insufficient research indicating that air pollution is linked to COPD in the region of inland northwest China. Daily hospital admission records for COPD, air pollutant levels, and meteorological factor information were collected in Jiuquan for this study between 1 January 2018 and 31 December 2019. We employed a distributed lag non-linear model (DLNM) integrated with the generalized additive model (GAM) to assess the association between air pollution and hospital admissions for COPD with single lag days from lag0 to lag7 and multiday moving average lag days from lag01 to lag07. For example, the pollutant concentration on the current day was lag0, and on the prior 7th day was lag7. The present and previous 7-day moving average pollutant concentration was lag07. Gender, age, and season-specific stratified analyses were also carried out. It is noteworthy that the delayed days exhibited a different pattern, and the magnitude of associations varied. For NO2 and CO, obvious associations with hospitalizations for COPD were found at lag1, lag01–lag07, and lag03–lag07, with the biggest associations at lag05 and lag06 [RR = 1.015 (95%CI: 1.008, 1.023) for NO2, RR = 2.049 (95%CI: 1.416, 2.966) for CO], while only SO2 at lag02 was appreciably linked to hospitalizations for COPD [1.167 (95%CI: 1.009, 1.348)]. In contrast, short-term encounters with PM2.5, PM10, and O3 were found to have no significant effects on COPD morbidity. The lag effects of NO2 and CO were stronger than those of PM2.5 and PM10. Males and those aged 65 years or older were more vulnerable to air pollution. When it came to the seasons, the impacts appeared to be more pronounced in the cold season. In conclusion, short-term encounters with NO2 and CO were significantly correlated with COPD hospitalization in males and the elderly (≥65).

Confounders Effecting Quality of Life of COPD Patients in European Union: A Systematic Review

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disease characterized by restriction in expiratory airflow. It is among one of the major causes of illness and death globally. COPD causes severe negative effects on physical and mental health. It has a drastic effect upon the health-related quality of life of patients. Numerous factors contribute towards morbidity of COPD that include smoking, obesity, air pollutants and comorbid conditions (cardiovascular diseases, diabetes mellitus, arterial hypertension, infections). Aims and Objectives: The current systematic review was conducted with the aim to determine the health-related quality of life of COPD patients as well as the confounders of quality of life. Methodology: A systematic review was conducted of 22 studies. The electronic databases used to search the articles were Pubmed, Scopus, Science Direct, ProQuest, Web of Science. Total 1880 studies were found, out of which only 22 studies met the inclusion criteria. All the studies included are within 2017-2022. Patients met inclusion criteria have less than 70% FEV1/FVC ratio and diagnosis of patients was according to the GOLD staging system. Majority study design were observational, some were cross sectional, experimental and randomized clinical trials. Mean age of patients observed was 40-85 years. To assess the quality of life of COPD patient specific questionnaires has been used like SGRQ, CAT, CCQ, EQ-5D-5L. Results: Included studies shows that the quality of life of COPD is compromised physically as well as mentally. It is due to less physical activities, smoking habits, psychological issues, comorbidities like diabetes mellitus, cardiovascular diseases, arterial hypertension. Conclusion: All the studies concluded that COPD patients diagnosed on basis of GOLD criteria and their quality of life is assessed via disease specific questionnaires that majorly includes SGRQ, CAT, CCQ, EQ-5D-5L. And it shows that quality of life of COPD decreases overall. However, the major confounders of reduced quality of life in COPD patients were: Smoking, raised BMI, high cholesterol, Depression/ anxiety, traffic related air pollutants, malnutrition and co-morbid conditions such as hypertension, asthma, anemia and diabetes mellitus.

Association between depression and COPD: results from the NHANES 2013–2018 and a bidirectional Mendelian randomization analysis

ABSTRACT Background Observational studies showed a bidirectional association between depression and chronic obstructive pulmonary disease (COPD). However, it is unclear whether the observed association is causal. Thus we estimated the relationship using observational studies combined with bidirectional Mendelian randomization [MR]. Materials and methods The study included 9977 participants from the 2013–2018 National Health and Nutrition Examination Survey and used weighted logistic regression analysis to assess the association between depression and COPD, followed by a bidirectional Mendelian randomization analysis to verify their causality. Results Adjusted-weighted logistic regression in observational studies showed a significant association between COPD and mild depression (OR (95% CI): 1.81 (1.30, 2.52), P = 0.002) and COPD and depression (OR (95% CI): 1.93 (1.49, 2.50), P < 0.001). MR suggested depression may play a causal role in COPD risk (OR (95% CI): 1.45 (1.32, 1.60), P < 0.001), but more evidence for reverse causation is lacking (reverse MR OR (95% CI): 1.03 (0.99, 1.07), P = 0.151). Conclusion In conclusion, our study found depression may play a potential causal role in the morbidity of COPD suggesting depression might be the etiology of COPD. This finding needs to be validated in further prospective cohort studies with large sample sizes and adequate follow-up time.

The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020–50: a health-augmented macroeconomic modelling study

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and imposes a substantial economic burden. Gaining a thorough understanding of the economic implications of COPD is an important prerequisite for sound, evidence-based policy making. We aimed to estimate the macroeconomic burden of COPD for each country and establish its distribution across world regions. In this health-augmented macroeconomic modelling study we estimated the macroeconomic burden of COPD for 204 countries and territories over the period 2020-50. The model accounted for (1) the effect of COPD mortality and morbidity on labour supply, (2) age and sex specific differences in education and work experience among those affected by COPD, and (3) the impact of COPD treatment costs on physical capital accumulation. We obtained data from various public sources including the Global Burden of Disease Study 2019, the World Bank database, and the literature. The macroeconomic burden of COPD was assessed by comparing gross domestic product (GDP) between a scenario projecting disease prevalence based on current estimates and a counterfactual scenario with zero COPD prevalence from 2020 to 2050. Our findings suggest that COPD will cost the world economy INT$4·326 trillion (uncertainty interval 3·327-5·516; at constant 2017 prices) in 2020-50. This economic effect is equivalent to a yearly tax of 0·111% (0·085-0·141) on global GDP. China and the USA face the largest economic burdens from COPD, accounting for INT$1·363 trillion (uncertainty interval 1·034-1·801) and INT$1·037 trillion (0·868-1·175), respectively. The macroeconomic burden of COPD is large and unequally distributed across countries, world regions, and income levels. Our study stresses the urgent need to invest in global efforts to curb the health and economic burdens of COPD. Investments in effective interventions against COPD do not represent a burden but could instead provide substantial economic returns in the foreseeable future. Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, Chinese Academy of Medical Sciences and Peking Union Medical College project, and Horizon Europe. For the Chinese and German translations of the abstract see Supplementary Materials section.

Chronic Obstructive Pulmonary Disease – Recent Updates

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death and disability globally as well as in Bangladesh. Continuing research is essential to combat the threat posed by rising prevalence of COPD. Here we present recent updates in the field of COPD research. The revised definition of COPD emphasizes COPD as a heterogeneous disease affecting the bronchi, bronchioles, alveoli and pulmonary vasculature. The traditional view of COPD as a smoker’s disease with a late onset has been replaced by the new concept of COPD etiotypes, which recognizes the contribution of developmental, genetic, environmental, infective and idiopathic contributions to COPD. Vaping has also been proposed as a risk factor for COPD. Two precursors to COPD – pre-COPD and PRISm – have also been proposed to highlight the opportunity of early detection and management. Clinical classification of COPD has been updated to the simplified ABE approach. New recommendations for treatment prioritize the initial use of a fixed dose LABA+LAMA combination. A more judicious use of ICS in COPD patients is recommended, in those with specific indications (exacerbation-prone, high eosinophil counts, or concomitant asthma). In this population, single-inhaler triple-therapy of LABALAMA- ICS has replaced previous recommendations of LABA-ICS. A strong emphasis has been placed on appropriate, individualized choice of inhaler device and training on technique for each patient. Interventional pulmonology and minimally invasive surgery also have a growing role in management of selected patients. Small airways disease is a key cause of morbidity in COPD. Newer diagnostic techniques, such as impulse oscillometry, and novel drug formulations (extra-fine particles, cosuspension forms, soft mist inhalers) are under study. The monoclonal antibody dupilumab has also shown promise in reducing COPD exacerbation. Finally, COPD is a multisystem disease and any management plan must include steps to identify and treat associated co-morbidities. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 197

Estimating individual treatment effects on COPD exacerbations by causal machine learning on randomised controlled trials

RationaleEstimating the causal effect of an intervention at individual level, also called individual treatment effect (ITE), may help in identifying response prior to the intervention.ObjectivesWe aimed to develop machine learning...

The Effects and Pathogenesis of PM2.5 and Its Components on Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD), a heterogeneous disease, is the leading cause of death worldwide. In recent years, air pollution, especially particulate matter (PM), has been widely studied as a contributing factor to COPD. As an essential component of PM, PM2.5 is associated with COPD prevalence, morbidity, and acute exacerbations. However, the specific pathogenic mechanisms were still unclear and deserve further research. The diversity and complexity of PM2.5 components make it challenging to get its accurate effects and mechanisms for COPD. It has been determined that the most toxic PM2.5 components are metals, polycyclic aromatic hydrocarbons (PAHs), carbonaceous particles (CPs), and other organic compounds. PM2.5-induced cytokine release and oxidative stress are the main mechanisms reported leading to COPD. Nonnegligibly, the microorganism in PM 2.5 may directly cause mononuclear inflammation or break the microorganism balance contributing to the development and exacerbation of COPD. This review focuses on the pathophysiology and consequences of PM2.5 and its components on COPD.

Association of Occupational Exposures and Chronic Obstructive Pulmonary Disease Morbidity.

The aim of the study is to determine whether aggregate measures of occupational exposures are associated with chronic obstructive pulmonary disease (COPD) outcomes in the Subpopulations and Intermediate Outcome Measures in COPD study cohort. Individuals were assigned to six predetermined exposure hazard categories based on self-reported employment history. Multivariable regression, adjusted for age, sex, race, current smoking status, and smoking pack-years determined the association of such exposures to odds of COPD and morbidity measures. We compared these with the results of a single summary question regarding occupational exposure. A total of 2772 individuals were included. Some exposure estimates, including "gases and vapors" and "dust and fumes" exposures resulted in associations with effect estimates over two times the estimated effect size when compared with a single summary question. Use of occupational hazard categories can identify important associations with COPD morbidity while use of single-point measures may underestimate important differences in health risks.

Frequency of Hypomagnesemia in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Objective: The purpose of this study is to assess the prevalence of hypomagnesemia among COPD patients (COPD). Study design: A cross sectional study. Place and duration of study: I have been offered a position in the Medicine &amp; Pulmonology Department at Nishtar Hospital in Multan, Pakistan, which I will begin in March 2016 and remain in until February 2018. Methodology: The non-probabilistic sequential sampling technique used to choose the final pool of 137 cases. Quantitative variables' means and standard deviations were determined. Quantitative evaluation included frequency counts and percentages for qualitative factors. Several effect modifiers have been taken into consideration via stratification, including age, diabetes, body mass index, COPD, high blood pressure, smoking, socioeconomic status, place of residence (race/ethnicity), and gender. A chi-square test for stratification was used to examine the data, and a P value of 0.05 was considered statistically significant. Results: 30.81±14.74 Nearly eighty-one percent of the sample had illnesses that lasted more than 18 months, and the median duration of illness was also months (112). Fifty patients, or 36.5% of the total, were found to have low magnesium levels, with a mean blood magnesium level of 1.520.54 meq/liter. Practical Implementation: There is a lack of data on the function of magnesium in preventing COPD exacerbations. Hypomagnesemia may prove to be helpful in establishing COPD exacerbation as a predictive factor, according to the research that is now being conducted. This could lead to the development of COPD intervention strategies other than the standard treatments, enhancing COPD patients' life quality, morbidity, and mortality. Conclusion: Our results provide evidence that hypomagnesemia is common among people with COPD. Male gender, greater age, lower socioeconomic status, diabetes, hypertension, tobacco use, and longer disease duration were all associated with low magnesium levels. Keywords: Chronic Obstructive pulmonary disease (COPD), frequency, hypomagnesemia.

Airway and Systemic Prostaglandin E2 Association with COPD Symptoms and Macrophage Phenotype.

Polymorphisms and products of the cyclooxygenase (COX) pathway have been associated with the development of chronic obstructive pulmonary disease (COPD) and adverse outcomes. COX-produced prostaglandin E2 (PGE-2) may play a role in the inflammation observed in COPD, potentially through deleterious airway macrophage polarization. A better understanding of the role of PGE-2 in COPD morbidity may inform trials for therapeutics targeting the COX pathway or PGE-2. Urine and induced sputum were collected from former smokers with moderate-severe COPD. The major urinary metabolite of PGE-2 (PGE-M) was measured, and ELISA was performed on sputum supernatant for PGE-2 airway measurement. Airway macrophages underwent flow cytometry phenotyping (surface CD64, CD80, CD163, CD206, and intracellular IL-1β, TGF-β1). Health information was obtained the same day as the biologic sample collection. Exacerbations were collected at baseline and then monthly telephone calls. Among 30 former smokers with COPD (mean±SD age 66.4±8.88 years and forced expiratory volume in 1 second [FEV1] 62.4±8.37 percent predicted), a 1 pg/mL increase in sputum PGE-2 was associated with higher odds of experiencing at least one exacerbation in the prior 12 months (odds ratio 3.3; 95% confidence interval: 1.3 to15.0), worse respiratory symptoms and health status. PGE-M was not associated with exacerbations or symptoms. Neither airway PGE-2 nor urinary PGE-M was uniformly associated with an M1 or M2 polarization. Elevated levels of sputum PGE-2, rather than systemic PGE-2, is associated with increased respiratory symptoms and history of exacerbation among individuals with COPD. Additional studies focused on mechanism of action are warranted.

Decreased Cardiac Autonomic Function is Associated with Higher Exacerbation Risk and Symptom Burden in Chronic Obstructive Pulmonary Disease.

Current measures of chronic obstructive pulmonary disease (COPD) severity, including lung function, do not fully explain symptom burden, and there is a need to identify predictors of exacerbation risk and morbidity. Autonomic dysfunction may be implicated in both cardiovascular and respiratory morbidity in COPD and convey risk for exacerbations. Heart rate variability (HRV) is a marker of cardiac autonomic function that is predictive of cardiovascular health and has promise as a non-invasive COPD biomarker. The CLEAN AIR Heart study provided an opportunity to investigate the association between HRV and COPD morbidity among former smokers with moderate-severe COPD. Eighty-five participants, contributing 305 HRV measurements, underwent repeated clinical assessments over 4 study periods that included a 24-Holter monitoring assessment of HRV. HRV measures of interest were standard deviation of normal-to-normal intervals, (SDNN) (overall HRV) and root-mean-square of successive differences (RMSSD) (parasympathetic function). Exacerbation risk was assessed using negative binomial models, and mixed-effects models analyzed associations between HRV and symptoms. Decreases in SDNN (incidence rate ratio [IRR]1.40; 95% confidence interval [CI] 1.13 to1.74) and RMSSD (IRR 1.60; 95% CI 1.07 to 2.37) were associated with severe exacerbation risk. Decreases in SDNN were associated with higher St George's Respiratory Questionnaire scores, COPD Assessment Test scores, and chronic bronchitis symptoms. Findings demonstrate that HRV is associated with COPD symptom burden and exacerbation risk. HRV may represent an important biomarker with the potential to identify high-risk COPD populations.

A retrospective study on pattern of pulmonary embolism in chestdepartment-Assiut University

BackgroundPulmonary embolism (PE) is a severe and fatal disease, and its incidence varies widely between countries.AimTo determine the frequency of PE in the Chest Department of Assiut University Hospital, to determine the risk factors and effective treatment, and to study the outcome of the disease in this locality.Patients and methodsIn this retrospective study, 222 patients suspected to have PE were screened for PE and underwent computed tomography-pulmonary angiogram to confirm or exclude a clinical suspicion of PE. All of the following were collected from patient data sheets: history, clinical examination data, ECG abnormalities, chest radiograph, Doppler ultrasound, echocardiography, chest ultrasound, laboratory reports, treatment lines, and the outcome in the form of mortality, ICU admission, length of hospital stay, and discharge to home.ResultsOf the included PE cases, all of them received heparin followed by warfarin, except for 10 patients who received rivaroxaban without any toxicity. Warfarin dose needed to reach therapeutic international normalized ratio (between 2 and 3) was 3–9 mg in –85% of the patients. A total of 71 patients needed admission to ICUs, and of them, 24 patients died, but there were no recorded deaths in the ward. Housewives represented 43.7%. The most common symptoms were dyspnea (84%) and chest pain (62%). Tachypnea was the most frequent sign (72%), and hypotension was observed in 13.5%. PE was common in patients with diabetes mellitus, patients with chronic obstructive pulmonary disease (COPD), patients with deep-vein thrombosis, and those who use oral contraceptive pills (18.5, 17.5, 17.1, and 14.4%, respectively). Regarding echocardiography findings, 16.4% of our patients were cardiomyopathic, 74.4% had mild to moderate pulmonary hypertension, with severe pulmonary hypertension detected in only 7% of patients. Computed tomography-pulmonary angiogram revealed main pulmonary artery embolism in 49.09% of the patients, and in 60 (27%) patients, it was bilateral.ConclusionPE is frequent in Upper Egypt. Diabetes and COPD are the most important risk factors of PE. Death owing to PE is markedly associated with OHS and COPD morbidity.

Black carbon content in airway macrophages is associated with increased severe exacerbations and worse COPD morbidity in SPIROMICS

BackgroundAirway macrophages (AM), crucial for the immune response in chronic obstructive pulmonary disease (COPD), are exposed to environmental particulate matter (PM), which they retain in their cytoplasm as black carbon (BC). However, whether AM BC accurately reflects environmental PM2.5 exposure, and can serve as a biomarker of COPD outcomes, is unknown.MethodsWe analyzed induced sputum from participants at 7 of 12 sites SPIROMICS sites for AM BC content, which we related to exposures and to lung function and respiratory outcomes. Models were adjusted for batch (first vs. second), age, race (white vs. non-white), income (<$35,000, $35,000~$74,999, ≥$75,000, decline to answer), BMI, and use of long-acting beta-agonist/long-acting muscarinic antagonists, with sensitivity analysis performed with inclusion of urinary cotinine and lung function as covariates.ResultsOf 324 participants, 143 were current smokers and 201 had spirometric-confirmed COPD. Modeled indoor fine (< 2.5 μm in aerodynamic diameter) particulate matter (PM2.5) and urinary cotinine were associated with higher AM BC. Other assessed indoor and ambient pollutant exposures were not associated with higher AM BC. Higher AM BC was associated with worse lung function and odds of severe exacerbation, as well as worse functional status, respiratory symptoms and quality of life.ConclusionIndoor PM2.5 and cigarette smoke exposure may lead to increased AM BC deposition. Black carbon content in AMs is associated with worse COPD morbidity in current and former smokers, which remained after sensitivity analysis adjusting for cigarette smoke burden. Airway macrophage BC, which may alter macrophage function, could serve as a predictor of experiencing worse respiratory symptoms and impaired lung function.

Prevalence, incidence, morbidity and mortality rates of COPD in Saudi Arabia: Trends in burden of COPD from 1990 to 2019.

BackgroundThe available data to determine the chronic obstructive pulmonary disease (COPD) burden in Saudi Arabia are scarce. Therefore, this study closely examines and tracks the trends of the COPD burden in Saudi Arabia from 1990 to 2019 using the dataset of the Global Burden of Disease (GBD) 2019.MethodsThis study used the GBD 2019 dataset to analyse the COPD prevalence, incidence, morbidity and mortality rates in the Saudi Arabian population from 1990 to 2019, stratified by sex and age. The age-standardised rate was used to determine the prevalence, incidence, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths.ResultsIn 2019, an estimated 434,560.64 people (95% Uncertainty Interval (UI) 396,011.72–473,596.71) had COPD in Saudi Arabia, corresponding to an increase of 329.82% compared with the number of diagnosed people in 1990 [101,104.05 (95% UI 91,334.4–111,223.91)]. The prevalence rate of COPD increased by 49%, from 1,381.26 (1,285.35–1,484.96) cases per 100,000 in 1990 to 2,053.04 (1918.06–2194.29) cases per 100,000 in 2019, and this trend was higher in males than females. The incidence rate of COPD in 2019 was 145.06 (136.62–154.76) new cases per 100,000, representing an increase of 43.4% from the 1990 incidence rate [101.18 (95.27–107.86)]. In 2019, the DALYs rate was 508.15 (95% UI 434.85–581.58) per 100,000 population. This was higher in males than females, with a 14.12% increase among males. In 2019, YLLs contributed to 63.6% of DALYs due to COPD. The death rate due to COPD was 19.6 (95% UI 15.94–23.39) deaths per 100 000 in 2019, indicating a decrease of 41.44% compared with the death rate in 1990 [33.55 deaths per 100 000 (95% UI 25.13–47.69)]. In 2019, COPD deaths accounted for 1.65% (1.39–1.88) of the total of deaths in Saudi Arabia and 57% of all deaths caused by chronic respiratory diseases.ConclusionOver the period 1990–2019, the prevalence and incidence of COPD in Saudi Arabia have been steadily rising. Even though COPD morbidity and death rates have been decreasing, they remain higher in men and older age. The holistic assessment and interventions with careful attention to optimising the community-based primary care management, such as screening for early diagnosis, smoking cessation programs and pulmonary rehabilitation, are likely to be the most successful strategies to reduce the burden of COPD in Saudi Arabia.

PRIMUS - Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation.

PurposePatients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation.Patients and MethodsThis retrospective observational study of US healthcare claims included patients ≥40 years old with COPD who initiated triple therapy (1/1/2011–3/31/2020) after ≥2 moderate or ≥1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤30 days post-index), delayed (31–180 days), very delayed (181–365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics.ResultsA total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10–1.13] and 1.07 [1.05–1.08]), a 4.3% (95% CI: 3.9–4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3–2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6–2.6%) increase in COPD-related costs during follow-up.ConclusionPromptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.

An observational study of metabolic syndrome in patients with chronic obstructive pulmonary disease

Introduction: This observational study was done to study the patients having metabolic syndrome with chronic obstructive pulmonary disease (COPD). Methodology: A cross-sectional observational study was done which included all the patients having COPD by convenience sampling presented at the Respiratory Medicine Department in Acharya Vinoba Bhave Rural Hospital, a tertiary hospital in Sawangi (Meghe), Wardha, India, from November 2021 to January 2022. The patients having metabolic syndrome as per definition were studied, and appropriate statistical tests were applied. Observation and Results: A total of 124 patients were studied in total out of which 40 patients had metabolic syndrome. Out of 124 patients studied, 70 were females and 54 were males. Almost half of the patients were above 70 years of age and above. Out of 40 patients having metabolic syndrome, 18 were females and 22 were males. Conclusion: The study concluded that metabolic syndrome was present in a significant population of COPD; hence, with appropriate interventions, the morbidity and mortality of COPD may be reduced by reducing the occurrence of metabolic syndrome.

Focus on Early COPD: Definition and Early Lung Development.

Chronic obstructive pulmonary disease (COPD) is a disease with high incidence rate and mortality rates worldwide. It is the third leading cause of death in the world. Nevertheless, little progress has been made in treating and preventing the disease. Under these circumstances, the concept of “early COPD” was proposed. Although this concept is not new, most health-care workers do not fully understand early COPD and tend to confuse it with mild COPD. In this review, we mainly discuss the definition of early COPD and the developmental trajectory of lung function. Although patients with early COPD have no symptoms, their lung function is already lower than that of normal people. A relatively complete definition is needed to identify this group of people. Reduced lung function is the diagnostic criterion for COPD, but lung development is a long-term dynamic process. In addition to smoking and air pollution, we should pay more attention to prenatal and childhood risk factors, for example, parents smoking, birth weight, preterm birth, mode of delivery, childhood respiratory infections and childhood asthma. Health-care workers need to be fully aware of early COPD, to reduce the morbidity of COPD and take effective measures to prevent these risk factors.

Clinical outcomes of chronic obstructive pulmonary disease phenotypes. One center prospective study.

The clinical outcome of different chronic obstructive pulmonary disease (COPD) phenotypes is still unclear. This study was designed to detect the effect of different COPD phenotypes on disease outcomes. One hundred stable COPD patients were included. They were divided into 3 phenotypes; 45 patients in exacerbator phenotype, 37 patients in non-exacerbator, and 18 patients in asthma COPD overlap (ACO) phenotype. Patient demo-graphics, respiratory symptoms, grading of COPD, co-morbidities, spirometry, six minute walk test, and systemic inflammatory markers were measured. Also, exacerbation frequency and severity were assessed throughout the study period. COPD Assessment Test (CAT) score was significantly higher in exacerbator phenotype versus the other phenotypes(14.7 ± 1.5; p = 0.04).In addition, about 60% and 42% of exacerbator phenotype were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) class D and C respectively which were significantly higher than the other phenotypes(p = 0.001), while 58% and 50% of non-exacerbator and ACO patients respectively were in class B of GOLD. Twenty eight percent of patients of ACO had no comorbidity and this was significantly higher versus the other phenotypes (p = 0.03), while 40% of non-exacerbator had one comorbidity (p = 0.003) and 86% of exacerbator had ≥ 2 comorbidities (p = 0.002). COPD comorbidity index was significantly higher in exacerbator phenotype (2.5 ± 0.8; p = 0.01). Although patients of exacerbator phenotype had more and severe form of exacerbations than the other phenotypes, no significant difference in in-hospital outcome was found (p = 0.3). Exacerbator phenotype has worse disease outcome than those of non-exacerbator and ACO phenotypes. These results support the need for more treatment options to alleviate the morbidity of COPD especially among exacerbator phenotype.

English

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a global issue with smoking being the most important risk factor. Co-existence of both COPD and cardiovascular diseases is very common and has diagnostic, therapeutic and prognostic implications. The cardiac manifestations of chronic obstructive pulmonary disease are numerous. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle leading to the development of pulmonary hypertension, cor pulmonale, right ventricular dysfunction and left ventricular dysfunction. Because cardiac abnormalities clearly contribute to overall morbidity of COPD, an understanding of their role and potential for treatment is vital. The purpose of this study was to evaluate various cardiac manifestations in chronic obstructive pulmonary disease patients and to observe correlation with its severity. METHODS This hospital based observational study was done in Gauhati Medical College and Hospital attending in-patient department (IPD) and out-patient department (OPD) of Department of General Medicine from 1st July 2018 to 30th June 2019. A total of 140 patients were included in this study. RESULTS Majority of the patients were in the age group of 60 - 70 years. Cardiovascular manifestations were most commonly observed in very severe stage of COPD (GOLD IV). Overall, 91 patients had ECG changes. The most common ECG findings were P pulmonale and right ventricular hypertrophy (RVH). Pulmonary arterial hypertension (PAH) and tricuspid regurgitation (TR) were common echocardiography findings. CONCLUSIONS Cardiac manifestations were more prevalent in COPD GOLD III and IV stages and therefore with increasing severity of COPD, occurrence and severity of cardiac complications becomes more prevalent. ECG and echocardiography are essential investigational tools for diagnosing COPD patients with cardiac complications and assessing their severity. However, a prospective study including a larger sample size is required to arrive at a definite conclusion. KEYWORDS COPD, Cardiac manifestations, ECG, Echocardiography, PAH, RVH

Comparative Impact of Depressive Symptoms and FEV1% on Chronic Obstructive Pulmonary Disease.

Rationale: Individuals with chronic obstructive pulmonary disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions. Objectives: Examine the impact of depressive symptoms compared with FEV1% on COPD morbidity. Methods: Using longitudinal data from individuals with COPD in the Subpopulations and Intermediate Outcome Measures in COPD Study, longitudinal growth analysis was performed to assess COPD morbidity by assessing differences in baseline 6-minute walk distance and patient reported outcomes (PROs) and their rate of change over time explained by depressive symptoms or lung function, as measured by Hospital Anxiety and Depression Scale or FEV1% respectively. PROs consisted of in-person completion of St. George's Respiratory Questionnaire, COPD Assessment Test, Functional Assessment of Chronic Illness Therapy Fatigue, and Modified Medical Research Council Dyspnea Scale measures. Results: Of the individuals analyzed (n = 1,830), 43% were female, 81% Caucasian with mean ± SD age of 65.1 ± 8.1, and 52.7 ± 27.5 pack-years smoking. Mean ± SD FEV1% was 60.9 ± 23.0% and 20% had clinically significant depressive symptoms. Adjusted models showed higher Hospital Anxiety and Depression Scale scores and lower FEV1% each were associated with worse PROs at baseline (P ⩽ 0.001). Depression accounted for more baseline variance in St. George's Respiratory Questionnaire, COPD Assessment Test, and Functional Assessment of Chronic Illness Therapy Fatigue than FEV1%, explaining 30-67% of heterogeneity. FEV1% accounted for more baseline variance in Modified Medical Research Council Dyspnea Scale and 6-minute walk distance than depression, explaining 16-32% of heterogeneity. Depressive symptoms accounted for 3-17% variance in change over time in PROs. In contrast, FEV1% accounted for 1-4% variance over time in PROs. Conclusions: Depression is more strongly associated with many PROs at baseline and their change over time compared with FEV1%. Recognizing and incorporating the impact of depressive symptoms into individualized care may improve COPD outcomes.