Mortality In COPD Research Articles

Air Pollution, Diet, and Mortality in the NIH-AARP Cohort

Background/Aim: Oxidative stress and systemic inflammation are suggested pathways for air pollution-mediated adverse health outcomes. Recent evidence from dietary supplementation intervention studies suggests that foods rich in antioxidant and anti-inflammatory nutritional content offer protection against air pollution exposures. Methods: Potential interactive effects of long-term air pollution (PM2.5, NO2, and O3) exposures and dietary habits (daily total fat, meat, fruit, vegetable, dairy, fish, and grain consumption) on mortality risks were evaluated in the NIH-AARP Diet and Health Study, a cohort of approximately half million subjects across the contiguous US. The cohort was linked to census tract estimates for PM2.5 and NO2 for 1999-2008, and O3 (8-hr daily maximum) for 2007-2011. Associations between air pollutants and risk of cause-related mortality were evaluated using multivariate Cox proportional hazards models, adjusted for both individual (age, sex, race, education, marital status, smoking history, BMI, diet, and alcohol consumption) and census-level contextual covariates (median census tract household income, % of census tract population with less than a high school level education), and effect modification by diet was assessed by evaluating statistical significance of air pollution-dietary variable interaction terms and conducting stratified analyses. Results: Associations between PM2.5 and NO2 exposures and total cardiovascular disease, ischemic heart disease, and diabetes mortality were found to be significantly reduced (p interaction<0.05) among those who consumed higher levels of fruits, while associations between O3 and total respiratory disease and COPD mortality were observed to be significantly reduced among those who consumed higher levels of vegetables. Conclusions: The results from this analysis reveal that increased intake of natural antioxidants found in fruits and vegetables attenuate mortality risks associated with long-term air pollution exposure, suggesting that promotion of healthy dietary habits can potentially provide an alternative, cost-efficient public health strategy to ameliorate the considerable health and economic burdens imposed by ambient air pollution.

The impact of dual bronchodilation on cardiovascular serious adverse events and mortality in COPD: a quantitative synthesis.

ObjectiveLong-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are burdened by the potential risk of inducing cardiovascular serious adverse events (SAEs) in COPD patients. Since the risk of combining a LABA with a LAMA could be greater, we have carried out a quantitative synthesis to investigate the cardiovascular safety profile of LABA/LAMA fixed-dose combinations (FDCs).MethodsA pair-wise and network meta-analysis was performed by using the data of the repository database ClinicalTrials.gov concerning the impact of approved LABA/LAMA FDCs versus monocomponents and/or placebo on cardiovascular SAEs in COPD.ResultsOverall, LABA/LAMA FDCs did not significantly (P>0.05) modulate the risk of cardiovascular SAEs versus monocomponents. However, the network meta-analysis indicated that aclidinium/formoterol 400/12 µg and tiotropium/olodaterol 5/5 µg were the safest FDCs, followed by umeclidinium/vilanterol 62.5/25 µg which was as safe as placebo, whereas glycopyrronium/formoterol 14.9/9.6, glycopyrronium/indacaterol 15.6/27.5 µg, and glycopyrronium/indacaterol 50/110 µg were the least safe FDCs. No impact on mortality was detected for each specific FDC.ConclusionThis meta-analysis indicates that LABA/LAMA FDC therapy is characterized by an excellent cardiovascular safety profile in COPD patients. However, the findings of this quantitative synthesis have been obtained from populations that participated in randomized clinical trials, and were devoid of major cardiovascular diseases. Thus, post-marketing surveillance and observational studies may help to better define the real impact of specific FDCs with regard to the cardiovascular risk.

Body weight and mortality in COPD: focus on the obesity paradox.

Level V: Narrative Review.

E-cigarettes in patients with COPD: current perspectives.

Conventional cigarette smoking is known to result in significant COPD morbidity and mortality. Strategies to reduce and/or stop smoking in this highly vulnerable patient group are key public health priorities to reduce COPD morbidity and mortality. Unfortunately, smoking cessation efforts in patients with COPD are poor and there is a compelling need for more efficient approaches to cessation for patients with COPD. Electronic cigarettes (ECs) are devices that use batteries to vaporize nicotine. They may facilitate quit attempts and cessation in many smokers. Although they are not risk free, ECs are much less harmful than tobacco smoking. Hence, the use of ECs in vulnerable groups and in patients with challenges to abstain or multiple relapses to this habit may be promising. To date, little is known about health consequences of EC use among COPD smokers and whether their regular use has any effects on subjective and objective COPD outcomes. In the current review, we discuss the current perspectives and literature on the role of ECs in abstaining from conventional smoking and the effects of ECs on the respiratory tract in patients with COPD.

The association between inhalable particulate matter and YLL caused by COPD in a typical city in northern China

BackgroundChronic obstructive pulmonary disease (COPD) has become the fourth-leading cause of death. The association between air pollution and years of life lost (YLL) caused by COPD is currently a hot topic; however, few studies have been published regarding COPD YLL around the world, especially in China, a highly polluted area. AimWe investigated the exposure-response association between ambient particulate matter with an aerodynamic diameter of less than 10 μm (PM10) and COPD YLL. MethodsWe applied a generalized additive model (GAM) to estimate the short-term effects of PM10 on COPD YLL and mortality from 2002 to 2010 in Tianjin. ResultsThe annual mean concentration of PM10 was 111.6 μg/m3. An increase in PM10 was significantly associated with daily YLL and mortality in a single pollutant model. A 10 μg/m3 increase in the two-day moving average of PM10 was associated with the maximum YLL increment of 0.30 (95% confidence interval: 0.06, 0.54) person-years and an excess risk (ER) of mortality of 0.60% (0.20%, 1.01%). For YLL increases, the association is stronger in elderly (0.27 (0.06, 0.48), the cumulative effect) populations than in younger populations. ConclusionsAn increment of COPD YLL is associated with an increased PM10 concentration. Elderly groups are more susceptible to air pollution. Strict air pollutant emission control is needed to protect public health.

Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered

The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n= 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n= 625). Median survival in the fourth quartile of BODE score was 59months (95%CI, 51-77months) in the UNOS cohort and 37months (95%CI, 29-42months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95%CI, 4.0-5.7; P< .001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95%CI, 4.9-7.6; P< .001). Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process.

Within-Trial Cost Analysis of COPD Exacerbations From the Summit Clinical Outcomes Study of Fluticasone Furoate/Vilanterol Inhalation

SESSION TITLE: Respiratory Care SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 08:45 AM - 10:00 AM PURPOSE: To assess the economic benefits of treating COPD patients with cardiovascular (CV) risk using data from a large clinical outcomes study. METHODS: A retrospective economic analysis from the U.S. healthcare system payer perspective was conducted using within-trial data of the intent-to-treat population from the Study to Understand Mortality and Morbidity in COPD (SUMMIT). The objective of the economic analysis was to compare 1-year costs of on-treatment moderate/severe COPD exacerbations between each active treatment comparator, fluticasone furoate 100 mcg/vilanterol 25 mcg (FF/VI), fluticasone furoate 100 mcg (FF), and vilanterol 25 mcg (FF) versus placebo (PBO). Analysis: The total cost of COPD exacerbations were obtained by applying the unit cost estimates obtained from a large US managed care database to the number of events occurring during each patient’s follow-up. These unit costs were determined in a cohort of COPD patients with CV risk. Mean costs for COPD exacerbations were then computed for all the 4 treatment cohorts using inverse probability treatment weighting (IPTW) to account for censoring. The average duration of follow-up was 1.7 years; however the pre-defined follow-up period of observation for estimation of costs was set at 1 year. Bootstrapping was performed to estimate 95% CI around the mean. The incremental mean cost difference from PBO was also estimated using the same boot strapping methods. RESULTS: A total of 16 485 subjects were evaluated (4111 PBO, 4121 FF/VI, 4118 VI and 4135 FF) were assessed, average age of 65 years of age and about 75% male. Mean 1-year cost of moderate/severe exacerbations were significantly lower (p<0.001) for FF/VI ($2468, 95% CI, $2158, $2792), FF ($2592, 95% CI, $2302, $2900) and VI ($2708, 95% CI, $2392, $3073) compared to PBO ($3386, 95% CI, $3015, $3792). Mean difference in 1-year cost from PBO for moderate/severe exacerbations were FF/VI: $981 (95% CI, $934, $902), FF: $794 (95% CI, $810, $779), and VI: $678 (95% CI, $694, $662). CONCLUSIONS: The estimated cost of moderate/severe exacerbations in subjects with COPD and CV risk were lower for all treatments compared to no treatment within the SUMMIT trial. The cost reduction was greatest with FF/VI treatment. (GSK Study HO-15-15547). CLINICAL IMPLICATIONS: Clinicians and payers may be able decrease the cost of COPD care by effectively treating COPD in COPD patients with CV risk. DISCLOSURE: Richard Stanford: Employee: GSK, Shareholder: GSK Anna Coutinho: Employee: Xcenda, which received consulting fees to conduct the research Michael Eaddy: Employee: Xcenda, which received consulting fees to conduct the research Binglin Yue: Employee: Xcenda, which received consulting fees to conduct the research Michael Bogart: Employee: GSK, Shareholder: GSK No Product/Research Disclosure Information

Patient Related Outcomes-BODE (PRO-BODE): A composite index incorporating health utilization resources predicts mortality and economic cost of COPD in real life.

using mortality as an outcome, the hypothesis that adding total health care cost to the BODE index would better predict mortality in COPD was investigated. 275 COPD patients were surveyed. Anthropometrics, lung function, the BODE and the Charlson Comorbidity Index were determined. History of exacerbations, ER visits, hospitalizations and mortality were also determined over the next three years, being their rates graded and added to the BODE index according to a simple algorithm. The novel PRO-BODE index ranged 0-10 points; its relationship to annual total COPD cost and survival was assessed by linear regression analysis. total COD cost showed the highest relationship with survival (r=-0.58), even higher than that of age and of BODE index (r=-0.28 and r=-0.21, respectively). The integrated Pro-BODE score proved proportional to the cost of care and inversely proportional to the length of survival. Pro-BODE is a novel composite index which helps in predicting in real life the impact of COPD over three years, both in terms of patients' survival and of COPD economic burden.

Prognostic variables and scores identifying the end of life in COPD: a systematic review.

IntroductionCOPD is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care. We aimed to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, specifically including variables that contribute to risk assessment of patients for death within 12 months.MethodsWe conducted a systematic review on prognostic variables, multivariate score or models for COPD. Ovid MEDLINE, EMBASE, the Cochrane database, Cochrane CENTRAL, DARE and CINAHL were searched up to May 1, 2016.ResultsA total of 5,276 abstracts were screened, leading to 516 full-text reviews, and 10 met the inclusion criteria. No multivariable indices were developed with the specific aim of predicting all-cause mortality in stable COPD within 12 months. Only nine indices were identified from four studies, which had been validated for this time period. Tools developed using expert knowledge were also identified, including the Gold Standards Framework Prognostic Indicator Guidance, the RADboud Indicators of Palliative Care Needs, the Supportive and Palliative Care Indicators Tool and the Necesidades Paliativas program tool.ConclusionA number of variables contributing to the prediction of all-cause mortality in COPD were identified. However, there are very few studies that are designed to assess, or report, the prediction of mortality at or less than 12 months. The quality of evidence remains low, such that no single variable or multivariable score can currently be recommended.

Multiple biomarkers predict disease severity, progression and mortality in COPD

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by multiple subtypes and variable disease progression. Blood biomarkers have been variably associated with subtype, severity, and disease progression. Just as combined clinical variables are more highly predictive of outcomes than individual clinical variables, we hypothesized that multiple biomarkers may be more informative than individual biomarkers to predict subtypes, disease severity, disease progression, and mortality.MethodsFibrinogen, C-Reactive Protein (CRP), surfactant protein D (SP-D), soluble Receptor for Advanced Glycation Endproducts (sRAGE), and Club Cell Secretory Protein (CC16) were measured in the plasma of 1465 subjects from the COPDGene cohort and 2746 subjects from the ECLIPSE cohort. Regression analysis was performed to determine whether these biomarkers, individually or in combination, were predictive of subtypes, disease severity, disease progression, or mortality, after adjustment for clinical covariates.ResultsIn COPDGene, the best combinations of biomarkers were: CC16, sRAGE, fibrinogen, CRP, and SP-D for airflow limitation (p < 10−4), SP-D, CRP, sRAGE and fibrinogen for emphysema (p < 10−3), CC16, fibrinogen, and sRAGE for decline in FEV1 (p < 0.05) and progression of emphysema (p < 10−3), and all five biomarkers together for mortality (p < 0.05). All associations except mortality were validated in ECLIPSE. The combination of SP-D, CRP, and fibrinogen was the best model for mortality in ECLIPSE (p < 0.05), and this combination was also significant in COPDGene.ConclusionThis comprehensive analysis of two large cohorts revealed that combinations of biomarkers improve predictive value compared with clinical variables and individual biomarkers for relevant cross-sectional and longitudinal COPD outcomes.

Peripheral leukocyte microRNAs as novel biomarkers for COPD.

COPD is a multifactorial disease caused by environmental determinants as well as genetic risk factors. The prevalence and mortality of COPD continue to increase, and underdiagnosis of COPD remains a critical issue. Previous reports investigated promising microRNAs (miRNAs) to reveal the molecular mechanism for the development of COPD; however, diagnostic and therapeutic markers for COPD have not yet been found. For this study, 20 representative COPD patients were separated into four groups based on increasing severity (A, B, C, and D) and compared to six healthy controls. Small RNA profiles of peripheral leukocytes were differentially expressed miRNAs (analyzed via next-generation sequencing) were validated via quantitative reverse transcriptase-polymerase chain reaction. Compared to healthy controls, 19 differentially expressed miRNAs were found in COPD patients. For all COPD groups, miR-3177-3p was downregulated, while 17 miRNAs were upregulated. Furthermore, the results revealed 21 differentially expressed miRNAs, of which miR-183-5p was continually downregulated from A to B to D. Between respective bronchodilator reversibility positive and negative groups of COPD different groups (A, B, C, and D), 10 miRNAs were differentially expressed, while miR-100-5p was upregulated in the negative groups. In conclusion, miR-106b-5p, miR-125a-5p, miR-183-5p, and miR-100-5p are central for the development of COPD. The severity of COPD was attenuated by miR-106b-5p, thus suggesting this miRNA as potential target for disease treatment.

A Review of the Non Pharmacologic Management of Chronic Obstructive Pulmonary Disease

Over the years, the management of chronic obstructive pulmonary disease has evolved, but given the high mortality and morbidity of COPD, much work still needs to be done. To date, none of the existing pharmacological therapies for COPD has been shown conclusively to modify the long-term decline in lung function. Several trials have been completed to evaluate options that can improve patient symptoms and quality of life. Optimal management of COPD requires both pharmacologic and non-pharmacologic interventions. Some of the non-pharmacologic options for the management of COPD like Oxygen therapy have proven reduction in mortality and mortality, and an improvement in the quality of life. Lung transplant is the only treatment that can stop the decline in lung function. Smoking cessation is the non-pharmacologic intervention with the greatest capacity to influence the natural course of COPD. Pulmonary rehabilitation programs are evidence based, multidisciplinary and comprehensive interventions for patients with COPD. These programs involve patient assessment, exercise training, education, nutrition and psychosocial support. Pulmonary rehabilitation programs are designed to reduce symptoms, optimize functional status, increase participation and reduce health care cost through stabilizing or reversing systemic manifestations of the disease. This article discusses the most used non pharmacologic management of COPD and their usefulness in relieving symptoms and improving the quality of life for patients with severe COPD. These treatment options are used in addition to optimal pharmacologic therapy.

COPD Morbidity and Mortality in Ukraine after Tobacco Control Policies Implementation

Tobacco is a known cause of COPD and smoking cessation is known reduce the risk of developing COPD. Whether tobacco control policies resulting in decreased prevalence of smoking are followed by short-term changes of morbidity and mortality indicators is unknown. We explored how recent successes in tobacco control in Ukraine are reflected in routinely collected data related to COPD. Methods: We used publicly available sources of information: European Mortality database for standardized death rates and aggregated results from panel household surveys with questions on any and respiratory chronic diseases for morbidity. Results: In early 1980s, chronic pulmonary mortality in Ukraine was 25-30 deaths/100 000, it increased to almost 60/100 000 in 1995 and then was steadily declining to 18/100 000 in 2010s. The upward mortality trend in 1987-95 was more expressed in middle-aged people compared with older ones. The declining mortality trend after 1995 was accelerating over time, was similar among men and women and much faster in middle-aged people than in older ones. The accelerated decline of respiratory mortality was observed during the economic recession of late 1990-s and in years of increased cigarette real prices. The dynamics of self-reported major chronic non-communicable diseases reveals the decline in chronic bronchitis and emphysema from 33/1000 in 2008 to 23/1000 in 2012, while no changes were observed in all chronic, cardiovascular diseases and cancer. Conclusion: Major changes in COPD mortality in 1980-2010 were concurrent with changing economic conditions and could only partially be tobacco-related. Tobacco control policies, conducted in Ukraine since 2005 could accelerate then happening COPD mortality decline. In the time of both mortality increase and decrease, middle-aged people reacted faster than those older ones, probably due to greater role of behavioral factors in younger people. COPD morbidity started to decrease only since 2009 when cigarettes became much less affordable.

High levels of biomarkers of collagen remodeling are associated with increased mortality in COPD – results from the ECLIPSE study

BackgroundThere is a need to identify individuals with COPD at risk for disease progression and mortality. Lung tissue remodeling is associated with the release of extracellular matrix (ECM) fragments into the peripheral circulation. We hypothesized that ECM remodeling was associated with mortality in COPD and measured neo-epitopes originating from ECM proteins associated with lung tissue remodeling.MethodsBiomarkers of ECM remodeling were assessed in a subpopulation (n = 1000) of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) cohort. Validated immunoassays measuring serological neo-epitopes produced by proteolytic cleavage associated with degradation of collagen type I, III, IV, and VI, elastin, and biglycan, and formation of collagen type VI as well as fibrinogen and C-reactive protein were used. Multivariate models were used to assess the prognostic value of these biomarkers.ResultsThirty subjects (3.0 %) died during follow-up. Non-survivors were older, had reduced exercise capacity, increased dyspnea score, and included fewer current smokers. All collagen biomarkers were significantly elevated in non-survivors compared to survivors. Mortality risk was significantly increased for subjects with collagen remodeling biomarkers in the upper quartile, especially for the degradation fragment of collagen type IV C6M (hazard ratio 6.6 [95 % confidence interval 2.9-15.2], P < 0.0001) after adjusting for relevant confounders.ConclusionsSerological biomarkers of collagen remodeling were strongly associated with mortality in subjects with COPD indicating that assessment of tissue turnover in the parenchyma and small airways may be useful in the prognosis of COPD.Trial registration NCT00292552, GSK Study No. SCO104960.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0440-6) contains supplementary material, which is available to authorized users.

COPD Mortality: A Competing Risk Analysis

COPD Mortality: A Competing Risk Analysis

A Subnational Analysis of Mortality and Prevalence of COPD in China From 1990 to 2013: Findings From the Global Burden of Disease Study 2013

The trends of COPD mortality and prevalence over the past 2 decades across all provinces remain unknown in China. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the mortality and prevalence of COPD during 1990 to 2013 at a provincial level. Following the general analytic strategy used in GBD 2013, we analyzed the age- sex- and province-specific mortality and prevalence of COPD in China. Levels of and trends in COPD mortality and prevalence were assessed for 33 province-level administrative units during 1990 to2013. In 2013, there were 910,809 deaths from COPD in China, accounting for 31.1%of the total deaths from COPD in the world. From 1990 to 2013, the age-standardized COPD mortality rate decreased in all provinces, with the highest reduction in Heilongjiang (70.2%) and Jilin (70.0%) and the lowest reduction in Guizhou (26.8%). In 2013, the death rate per 100,000 was highest in Guizhou (196.0) and lowest in Tianjin (34.0) among men and highest in Gansu (141.1) and lowest in Beijing (23.7) among women. The number of COPD cases increased dramatically from 32.4 million in 1990 to 54.8 million in 2013. The age-standardized prevalence rate of COPD remained stable overall and varied little for all provinces. COPD remains a huge health burden in many western provinces in China. The substantial increase in COPD cases represents an ongoing challenge given the rapidly aging Chinese population. A targeted control and prevention strategy should be developed at a provincial level to reduce the burden caused by COPD.

Acute exposure to sulfur dioxide and mortality: a case-crossover analysis of power plant emissions

Purpose: Short-term exposure to sulfur dioxide has been associated with mortality; however, most studies have been conducted in metropolitan areas and do not account for point source emissions (e.g., proximity to power plants). During a three-year period, an administratively ordered air quality monitoring program captured sulfur dioxide (SO2) and particulate matter (PM2.5) emissions in communities within close proximity to a coal-fired power plant. This offered a unique opportunity to assess the health impacts in non-urban communities from this point source. Methods: We used a time-stratified case-crossover design to examine the impact of short-term exposure to SO2 on all-cause, respiratory, circulatory, stroke, and COPD mortality. Conditional logistic regression models were adjusted for PM2.5 exposure, daily average temperature, daily average dew point temperature, weekdays vs. weekends, and holidays. We assessed the influence of wind direction and peak exposures on mortality. Results: 4,693 deaths were included in our analysis. A one-unit increase in SO2 on the preceding day was associated with an increased risk in all-cause mortality [OR=1.03 (95% CI: 1.004,1.06)] and circulatory mortality [OR=1.05 (95% CI: 1.004,1.09)] during the summer season. However, after restricting the analysis to days when the wind trajectory blew from the power plant to impacted communities, SO2 exposure on the day of death and preceding day were significantly associated with all-cause, circulatory, respiratory, and stroke mortality during spring, summer, and winter. Persons over age 65 were more susceptible to these effects than those 65 and under. Conclusions: Communities in non-urban and rural areas can sustain significant health impacts from point source emissions of SO2, such as coal-fired power plants. Epidemiology studies of such sources should account for meteorological conditions, including wind direction.

Malnutrition screening in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease and its association with patient outcomes

ABSTRACTObjectives: There is a paucity of information on the prevalence and clinical implications of malnutrition in patients hospitalised for management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to fill this gap in knowledge.Methods: We performed a retrospective observational cohort study of 100 hospitalised AECOPD patients. The Malnutrition Screening Tool (MST) was used to identify patients at risk of malnutrition (MST ≥2). Patient characteristics, length of stay, readmission rate, 12-month survival and overall survival were collected using a proforma.Results: MST scores were available in 90 patients, of whom 22% of patients had a MST score of ≥2. There were no significant differences in COPD severity, treatment received and biochemical parameters between the groups of patients ‘at risk of malnutrition’ and those ‘not at risk of malnutrition’. Length of stay in hospital was longer in patients ‘at risk of malnutrition’ (median (IQR): 3.5 (2–7.5) vs. 3.0 (1–5), p = 0.048). Overall survival was significantly reduced in patients with ‘at risk of malnutrition’ compared to those patients ‘not at risk of malnutrition’ (337 ± 245 vs. 670 ± 292, p < 0.001).Conclusions: Using the MST we found that one-fifths of our hospitalised AECOPD patients are at ‘at risk of malnutrition’. Moreover, this cohort of patients had worse outcomes both during and extending beyond hospitalisation compared to patients ‘not at risk of malnutrition’. Our study illustrates the need for routine malnutrition screening for hospitalised AECOPD patients because it has implications for potentially reducing morbidity and mortality in COPD.

Muscle strengthening activity associates with reduced all-cause mortality in COPD.

Objective Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality. Methods Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis. Results Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04). Conclusion Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.

Inflammatory Biomarkers in Chronic Obstructive Pulmonary Disease

Abstract Chronic obstructive lung disease (COPD) is a severe progressive disease associated with high morbidity and mortality. Early diagnosis and correct treatment improve the symptoms, quality of life and survival in COPD. Exacerbations of the disease are acute events that cause worsening of COPD symptoms (dyspnea, cough and/or sputum) and may require modification of stable COPD therapy. COPD exacerbations add inflammation, damage the quality of life, deteriorate the lung function, increase mortality and associate high socio-economic costs. Accurate early prediction of exacerbation and mortality risk facilitates patient selection upon risk, in order to provide appropriately targeted early treatment. The risk of having frequent exacerbations is clearly demonstrated by recognized studies in patients with specific criteria: previous exacerbation in the last year, decrease in FEV1s, increase in the score of St. George Questionnaire (life quality decline), high levels of several inflammatory biomarkers, such as neutrophils, C-reactive protein (CRP), fibrinogen, pro-calcitonin, eosinophils, IL-6, IL-8, chemokine ligand 18 (CCL-18/PARC), surfactant protein D (SP-D). Simultaneously elevated levels of CRP, fibrinogen and leukocyte count in COPD patients were associated with an increased risk for exacerbations. At the same time, elevated levels of the three biomarkers are associated with an increased risk of major comorbidities in COPD. Biomarker detection may be an additional tool for assessment and management of COPD comorbidities. Detection of pathologic levels of inflammatory biomarkers improves the ability to predict the risk mortality in COPD alongside with BODE index (BMI, obstruction in lung function, dyspnea scale, 6-minute walk test) and may provide a targeted treatment.