Non-reversible Airway Obstruction Research Articles

Comorbidities in patients with chronic obstructive pulmonary disease: a comprehensive study.

In recent years, there has been an increasing interest in understanding the systemic nature of COPD and its frequently associated comorbidities. COPD is characterized by chronic lung disease involving local and systemic inflammation and non-reversible airway obstruction. The disease course is marked by recurrent exacerbations and is often accompanied by various comorbidities. This study aimed to evaluate the prevalence of comorbidities among Iraqi patients with COPD and their association with disease severity. A case-control study was conducted at Al-Sader Hospital in Annajaf from October 2019 to October 2020, involving 200 participants. The study population comprised 100 patients with COPD (COPD group) and 100 individuals without COPD serving as the control group. Patients with COPD were divided into four groups according to the disease severity. The prevalence of type 2 diabetes mellitus (T2DM), atherosclerotic cardiovascular diseases (ASCVD), hypertension, and dyslipidemia was determined in all groups. Patients with COPD had a significantly higher prevalence of T2DM, ASCVD, hypertension, and dyslipidemia, and, except for T2DM, the prevalence was significantly higher in the more severe groups. It was concluded that T2DM, ASCVD, hypertension, and dyslipidemia were commonly associated with COPD.

Update in postinfectious bronchiolitis obliterans.

Postinfectious bronchiolitis obliterans (PiBO) is a rare and severe form of chronic obstructive lung disease caused by an infectious injury to the lower respiratory tract. The most commonly recognized inciting stimuli leading to PiBO are airway pathogens, such as adenovirus and Mycoplasma. PiBO is characterized by persistent and nonreversible airway obstruction, with functional and radiological evidence of small airway involvement. The literature has limited information on the aetiology, clinical profile, treatment, and outcome of PiBO.

COPD: the patient perspective.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by nonreversible airway obstruction. Well-characterized symptoms such as exertional dyspnea and fatigue have a negative impact on patients’ quality of life (QoL) and restrict physical activity in daily life. The impact of COPD symptoms on QoL is often underestimated; for example, 36% of patients who describe their symptoms as being mild-to-moderate also admit to being too breathless to leave the house. Additionally, early morning and nighttime symptoms are a particular problem. Methods are available to allow clinicians to accurately assess COPD symptoms, including patient questionnaires. Integrated approaches to COPD management, particularly pulmonary rehabilitation, are effective strategies for addressing symptoms, improving exercise capacity and, potentially, also increasing physical activity. Inhaled bronchodilators continue to be the mainstay of drug therapy in COPD, where options can be tailored to meet patients’ needs with careful selection of the inhaled medication and the device used for its delivery. Overall, an integrated approach to disease management should be considered for improving QoL and subsequent patient outcomes in COPD.

Detection of Chronic Obstructive Pulmonary Disease in Primary Care in Salzburg, Austria: Findings from the Real World

Background: Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed. Objectives: To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting. Methods: The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥40 years. Nonreversible airway obstruction was considered when PBD FEV₁/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations. Results: 60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV₁/FVC <0.7 and FEV₁ <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%). Conclusion: COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.

The challenge of chronic lung disease in HIV‐infected children and adolescents

Until recently, little attention has been given to chronic lung disease (CLD) in HIV-infected children. As the HIV epidemic matures in sub-Saharan Africa, adolescents who acquired HIV by vertical transmission are presenting to health services with chronic diseases. The most common is CLD, which is often debilitating.This review summarizes the limited data available on the epidemiology, pathophysiology, clinical picture, special investigations and management of CLD in HIV-infected adolescents. A number of associated conditions: lymphocytic interstitial pneumonitis, tuberculosis and bronchiectasis are well described. Other pathologies such as HIV-associated bronchiolitis obliterans resulting in non-reversible airway obstruction, has only recently been described.In this field, there are many areas of uncertainty needing urgent research. These areas include the definition of CLD, pathophysiological mechanisms and common pathologies responsible. Very limited data are available to formulate an effective plan of investigation and management.

Commonalities between the pro-fibrotic mechanisms in COPD and IPF

COPD and IPF are two chronic lung diseases which are characterized by a decline in lung function, resulting in significant morbidity and mortality. Both of these diseases are more commonly associated with an aging population and the duration for which the disease has been underlying is often unknown. Significant matrix deposition occurs, resulting in either non-reversible airways obstruction in the case of COPD and impaired gas exchange and parenchymal consolidation in IPF. There are no approved therapies that have been demonstrated to target these underlying fibrotic changes in the lung. This may in part be due to the challenges of quantitating lung fibrosis in a temporal manner in specific regions of the lung. However, this may also be due to our understanding of aberrant and pathogenic collagen deposition being somewhat limited. The core processes associated with lung fibrosis are often observed in normal wound healing. Moreover, in the extreme fibrotic setting of IPF, the remodelling is sometimes associated with uncontrolled wound healing responses. As wound healing is a critical aspect to maintaining tissue function and homeostasis, targeting this process directly may result in safety concerns. This review therefore describes some of the recent advances in ascertaining pathways promoting lung fibrosis that may be amenable to therapeutic intervention in both COPD and IPF.

Non-reversible airway obstruction in never smokers: Results from the Austrian BOLD study

The presence of non-reversible airway obstruction (AO) in never smokers has only received limited attention until now. We analyzed data from the Austrian Burden of Obstructive Lung Disease (BOLD) study. We defined non-reversible AO as post-bronchodilator FEV(1)/FVC <0.7 which corresponds to COPD I and higher (COPD I+) according to current GOLD guidelines. Significant AO was defined as FEV(1)/FVC <0.7 and FEV(1) <80% predicted (GOLD II and higher, GOLD II+). The prevalence and characteristics of non-reversible AO in never smokers were analyzed in relation to the severity of the disease. Never smokers comprised 47.3% of the study population. Non-reversible AO was seen in 18.2% of never smokers, and 5.5% of never smokers fulfilled criteria for significant non-reversible AO (GOLD stage II+). Therefore, the resulting population prevalence of significant non-reversible AO (GOLD stage II+) was 2.6%. Never smokers with non-reversible AO were predominantly female and slightly older. The airway obstruction was found to be less severe as compared with ever smokers. Despite this, 20% of never smokers with significant non-reversible AO (GOLD stage II+) reported respiratory symptoms and 50% reported impairment of quality of life. This burden of illness in never smokers was similar to that in smokers when severity of AO was taken into account. Approximately every third subject with non-reversible AO has never smoked, yet still demonstrates a substantial burden of symptoms and impairment of quality of life. Never smokers should receive far greater attention when efforts are undertaken to prevent and treat chronic airway obstruction.

Farming and the prevalence of non‐reversible airways obstruction—results from a population‐based study

Occupational exposure to noxious dusts, gases, and fumes most likely contributes to obstructive lung disease. We studied whether self-reported farming work is associated with non-reversible airways obstruction. Following the burden of obstructive lung disease (BOLD) study protocol, we surveyed a gender-stratified population-based sample of 2,200 adults aged 40 years and over. Pre- and post-bronchodilator spirometry, as well as information on smoking, occupation, and reported respiratory disease was recorded. According to GOLD criteria, non-reversible airways obstruction was defined as a post-bronchodilator forced expiratory volume (FEV(1))/forced vital capacity (FVC) < 0.70. Occupational and smoking history was based on questionnaire. Farming was defined as ever working in this occupation for 3 months or longer. For 1,258 participants with complete data (post-bronchodilator spirometry and questionnaire data), 288 (=22.9%) reported farming. Among the 288 participants reporting farming, the prevalence of non-reversible airways obstruction was 30.2%. Farming was significantly associated with airways obstruction: chronic obstructive pulmonary disease (COPD) GOLD stage I or higher (OR 1.5; 95% CI 1.1-2.0) and COPD GOLD stage II or higher (OR 1.8; 95% CI 1.2-2.7). The latter estimate was unchanged when adjustment for competing risks gender, age, and smoking was done. In this population the risk for non-reversible airways obstruction attributable to farming was 7.7%. Farming should be considered a risk factor for non-reversible airways obstruction.

Late Prevalence of Respiratory Symptoms and Pulmonary Function Abnormalities in Gulf War I Veterans

Published reports have documented an increased prevalence of self-reported respiratory symptoms among servicemen deployed during the 1990-1991 Gulf War. We evaluated whether this deployment resulted in long-term adverse respiratory effects. A comprehensive medical history was taken and physical and laboratory evaluations, including pulmonary function tests, were performed in 1036 deployed and 1103 nondeployed veterans of the Gulf War. Participants were classified into 5 groups on the basis of their pulmonary function tests findings: normal pulmonary function; nonreversible airway obstruction; reversible airway obstruction; restrictive lung physiology; and small airway obstruction. Deployed veterans were younger, more commonly white, less educated, single, of lower mean family incomes, and more likely to have enlisted than nondeployed veterans. Deployed veterans were also statistically more likely to self-report a history of smoking and wheezing than nondeployed veterans, but comparisons of reported physician visits for pulmonary complaints, pulmonary hospitalizations, numbers of documented episodes of asthma, bronchitis, or emphysema, and pulmonary medications prescribed in the year prior to evaluation did not reveal any differences between deployed and nondeployed veterans. The distribution of pulmonary function test results was identical among deployed and nondeployed veterans. Among both deployed and nondeployed veterans, about 64% had normal pulmonary function, 16% to 18% had nonreversible airway obstruction, 10% to 12.2% had restrictive lung physiology, 6% to 6.7% had small airway obstruction, and the remaining 0.9% to 1.3% had reversible airway obstruction. Our findings did not confirm the hypothesis that deployment to the Gulf War in 1990-1991 resulted in an increased prevalence of clinically significant pulmonary abnormalities 10 years later.

Influence of Lung Parenchymal Destruction on the Different Indexes of the Methacholine Dose-Response Curve in COPD Patients

The interpretation of nonspecific bronchial provocation dose-response curves in COPD is still a matter of debate. Bronchial hyperresponsiveness (BHR) in patients with COPD could be influenced by the destruction of the parenchyma and the augmented mechanical behavior of the lung. Therefore, we studied the interrelationships between indexes of BHR, on the one hand, and markers of lung parenchymal destruction, on the other. COPD patients were selected by clinical symptoms, evidence of chronic, nonreversible airways obstruction, and BHR, which was defined as a provocative dose of a substance (histamine) causing a 20% fall in FEV(1) (PC(20)) of </= 8 mg/mL. BHR was subsequently studied by methacholine dose-response curves to which a sigmoid model was fitted for the estimation of plateau values and reactivity. Model fits of quasi-static lung pressure-volume (PV) curves yielded static lung compliance (Cstat), the exponential factor (KE) and elastic recoil at 90% of total lung capacity (P90TLC). Carbon monoxide (CO) transfer was measured with the standard single-breath method. Twenty-four patients were included in the study, and reliable PV data could be obtained from 19. The following mean values ( +/- SD) were taken: FEV(1), 65 +/- 12% of predicted; reversibility, 5.6 +/- 3.1% of predicted; the PC(20) for methacholine, 4.3 +/- 5.2 mg/mL; reactivity, 11.0 +/- 5.6% FEV(1)/doubling dose; plateau, 48.8 +/- 17.4% FEV(1); transfer factor, 76.7 +/- 17.9% of predicted; transfer coefficient for carbon monoxide (KCO), 85.9 +/- 22.6% of predicted; Cstat, 4.28 +/- 2.8 kPa; shape factor (KE), 1.9 +/- 1.5 kPa; and P90TLC, 1.1 +/- 0.8 kPa. We confirmed earlier reported relationships between Cstat, on the one hand, and KE (p < 0.0001), P90TLC (p = 0.0012), and KCO percent predicted (p = 0.006), on the other hand. The indexes of the methacholine provocation test were not related to any parameter of lung elasticity and CO transfer. BHR in COPD patients who smoke most probably is determined by airways pathology rather than by the augmented mechanical behavior caused by lung parenchymal destruction.