Prognosis Of Chronic Obstructive Pulmonary Disease Patients Research Articles

Prospective study of protein intake and mortality among US adults with chronic obstructive pulmonary disease.

Protein is crucial for the rehabilitation of patients with chronic obstructive pulmonary disease (COPD), and appropriate daily protein intake is essential for COPD patients. However, the specific role of protein intake in COPD and its impact on mortality remain uncertain. This study aims to ascertain the relationship between protein intake and mortality in COPD patients. This investigation included 522 adult COPD patients from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018, with a focus on evaluating protein intake. Multivariate Cox proportional hazard models were constructed to analyze the correlation between protein intake and the prognosis of COPD patients. Additionally, the restricted cubic spline (RCS) was employed to investigate the potential non-linear association between protein intake and mortality. A total of 522 patients with COPD were categorized into 4 groups based on the quartiles of protein intake: Q1 (< 25th percentile, 11.7-48.5 gm), Q2 (25-50th percentile, 48.5-67.7 gm), Q3 (50-75th percentile, 67.7-94.3 gm), and Q4 (≥ 75th percentile, 94.3-266.6 gm). Cox regression analysis revealed a significant trend in the p value of the Q3 group compared to the Q1 group when adjusting for other variables. The RCS-fitted Cox regression model indicated no non-linear relationship between protein intake levels and COPD mortality. There is no evidence of a non-linear relationship between protein intake and all-cause mortality in COPD patients. Further investigation is warranted to comprehend the intricate relationship between protein intake and COPD outcomes.

Analysis of the Effect of Extracorporeal Diaphragmatic Pacing Combined with Noninvasive Ventilator on the Respiratory Function and Prognosis of COPD Patients

Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 50 COPD patients were selected between January 2023 to December 2023 and randomly grouped into an observation group and a control group, with 25 cases. The observation group was given extracorporeal diaphragm pacing combined with a noninvasive ventilator, while the control group was given a conventional treatment mode. After the treatment, the results of each index in the two groups were compared. Results: Compared with the diaphragm function indexes of the two groups, the data of the observation group were more dominant (P &lt; 0.05). The rehospitalization rate of the observation group was lower than that of the control group (P &lt; 0.05). The COPD assessment test (CAT) and mMRC (Modified Medical Research Council) Dyspnoea scale scores after treatment between the two groups were significantly different (P &lt; 0.05). Compared with the control group, the lung function indexes of the observation group were more dominant (P &lt; 0.05). Conclusion: Extracorporeal diaphragmatic pacing combined with a noninvasive ventilator promoted the improvement of the patient’s prognosis and improved their respiratory function.

Meta-analysis of peripheral blood eosinophils in clinical testing of chronic obstructive pulmonary disease patients.

Meta-analysis was used to investigate the relationship between peripheral blood eosinophil (EOS) levels, clinical characteristics, and prognosis in chronic obstructive pulmonary disease (COPD)patients in previous literature. To analyse the correlation between peripheral blood EOS levels and clinical characteristics and prognosis of patients with COPD using meta-analysis. In databases such as PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wan Fang Data, literature related to the clinical characteristics or prognosis of COPD patients with high-level EOS published before July 2023 was searched for meta-analysis. Through computer search and screening, 29 articles were ultimately included. The meta-analysis results showed that compared to conventional EOS levels, COPD patients with high EOS levels had a lower proportion of GOLD III-IV grade patients (OR = 00.78, 95% CI (0.68, 0.88), p < 0.001), lower CAT scores (OR = -1.01, 95% CI (-1.75, -0.28), p = 0.007), shorter hospital stay (OR = -1.33, 95% CI (-1.52, -1.14), p < 0.001), and lower mortality rate (OR = 0.53, 95% CI (0.42, 0.66), p < 0.001). The readmission rate was low (OR = 0.40, 95% CI (0.33, 0.48), p < 0.001), and there was no statistically significant difference in FEV1%pred (OR = -0.55, 95% CI (-1.33, 0.23), p = 0.17), higher FEV1/FVC values (OR = -0.45, 95% CI (-1.08, 0.18), p = 0.160), and mechanical ventilation usage rate (OR = 0.89, 95% CI (0.65, 1.21), p = 0.450) among COPD patients with different EOS levels. The levels of peripheral blood EOS in COPD patients are related to lung function, respiratory symptoms, etc.; Moreover, COPD patients with high-level EOS have shorter hospital stays, lower mortality and readmission rates. Therefore, ESO can be used as an auxiliary indicator for clinical symptom diagnosis of COPD patients and as an auxiliary indicator for predicting prognosis.

Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.

Prognostic value of oxygen inhalation therapy for simple nocturnal hypoxemia in COPD: a meta-analysis.

Objective: The effect of oxygen therapy on the prognosis of chronic obstructive pulmonary disease (COPD) with nocturnal hypoxemia (NOD) has been controversial. Therefore, this study systematically evaluated the relevant literature and included it into randomized controlled studies for meta-analysis to evaluate the efficacy and prognosis. Methods: We searched PubMed, EMBASE, web of science, Cochrane, China HowNet and Wanfang database for the literature on the prognosis of COPD patients with simple NOD from the establishment of the database to 30 June 2022. The outcome indicators were death and aggravation of the disease. The efficacy evaluation measures were pulmonary function and arterial blood gas results. The publication bias and heterogeneity of the included studies were evaluated. Results: A total of 621 patients from 5 studies were included in this meta-analysis, and there was no publication bias in the included studies. The total mortality of long-term oxygen therapy (LTOT) in COPD patients with simple NOD in oxygen therapy group (RR = 1.04; 95% CI: 0.81-1.33, p = 0.77), mortality (RR = 0.87; 95% CI: 0.58-1.31, p = 0.50), risk of progression to LTOT events (RR = 1.07; 95% CI: 0.76-1.51, p = 0.71). PaO2 in patients with COPD and simple NOD in oxygen therapy group was higher than that in non-oxygen therapy group (mean difference (MD) = 13.47; 95% CI: 3.49-23.46, p = 0.008), the decrease of PaCO2 level was not statistically significant (MD = -10.05; 95% CI: -26.36-6.27, p = 0.23). Conclusion: Oxygen therapy can improve the prognosis of blood oxygen partial pressure in COPD patients with simple NOD, but oxygen therapy has no significant effect on the survival rate, controlling the progression of the disease to LTOT and reducing the partial pressure of carbon dioxide.

THE DECAF SCORE: PREDICTING HOSPITAL MORTALITY IN EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Backgrounds Chronic Obstructive Pulmonary Disease (COPD) represents a major public health challenge and is an important cause of chronic morbidity and mortality worldwide. This study aims to assess the association between Dyspnoea, Eosinopenia, Consolidation, Academia, and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in terms of mortality and length of hospital stay and to explore the effectiveness of different cut-off values in risk stratication of patients with AECOPD. This cross-sectional study was conducted in the hospitals attached to Bangalore me Methods dical college and research Institute. 65 patients with acute exacerbation of COPD who satised the inclusion criteria were included. Data was collected in the form of history, clinical examination, and relevant investigations. Statistical analysis was performed using SPSS software, p value of &lt;0.5 being signicant. Out Results: of 65 patients, 76% were males and 24% were females and majority of the patients (32%) were aged 62 to 71 years. Mean FEV1 was 62.18% predicted, Mean duration of hospital stay 4.26 days, mean BMI was 24.6 kg/m2. 83% had radiographic evidence of consolidation. Chi-square test showed statistically signicant association between DECAF score and in-hospital mortality(p=0.00). Out of the 65 patients,7 patients had DECAF score of 1 ,22 patients had DECAF score of 2, 26 patients had DECAF score of 3, 7 patients had DECAF score of 4 and 3 patients had DECAF score of 5. 72.4% (47)- discharged 27.6% (18) in-hospital mortality. Chi-square test showed statistically signicant association between DECAF score and length of hospital stay (p=0. 005). Hypertension (12.2%) and Type 2 DM (5.8%) were the most common comorbidities. There Conclusions: was signicant correlation between DECAF score and prognosis of COPD patients in terms of in hospital mortality and duration of hospital stay. Hence, our study shows that higher DECAF score at admission indicates higher severity of the disease. It helps clinicians to triage place and level of care to improve outcomes in this common condition

Association of frailty with clinical outcomes in chronic obstructive pulmonary disease: A retrospective longitudinal cohort study

BackgroundFrailty is a clinical syndrome and common phenomenon in the elderly, particularly when it coexists with chronic obstructive pulmonary disease (COPD). However, the relationship between frailty and its prognosis in COPD patients has not been clearly elucidated. MethodsWe collected electronic data of inpatients who were diagnosed with COPD in the First Affiliated Hospital with Nanjing Medical University (NJMU) from January 2018 to December 2020. In further, we divided them into different groups based on Frailty Index Common Laboratory Tests (FI-LAB). Binary logistic regression was performed to analyze the risk factors associated with COPD. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were applied to validate FI-LAB's value in prognosis. Primary clinical outcomes contained 30-day mortality and readmission. Moreover, we also compared the prognositic value of FI-LAB with Hospital Frailty Risk Score (HRS) by ROC curve, significance was set at P < 0·05. FindingsThe final study included 826 COPD patients, among of them, 30-day mortality and readmission of frailty group was 11·2%, 25·9%, the robust group was 4·3%, 16·0%, and p value was 0·001, 0·004 respectively. Multivariate analysis revealed that smoking, CCI≥3, oral drug≥5, pneumonia, abnormal lymphocyte, abnormal haemoglobin were independent risk factors with frailty. As for the prediction of FI-LAB about frailty in 30-day mortality, the AUC was 0·832, and 30-day readmission was 0·661. As for the prognositic value, FI-LAB and HRS showed no difference in predicting clinical outcomes. InterpretationCOPD individuals have a higher rate of frailty and pre-frailty. There exists a strong correlation between frailty and 30-day mortality in COPD patients, and FI-LAB has good prognostic value in clinical outcomes of patients with COPD.

Impact of Body Composition and Sarcopenia on Mortality in Chronic Obstructive Pulmonary Disease Patients

Patients with chronic obstructive pulmonary disease (COPD) have alterations in body composition, such as low cell integrity, body cell mass, and disturbances in water distribution evidenced by higher impedance ratio (IR), low phase angle (PhA), as well as low strength, low muscle mass, and sarcopenia. Body composition alterations are associated with adverse outcomes. However, according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), the impact of these alterations on mortality in COPD patients is not well-established. Our aims were to evaluate whether low strength, low muscle mass, and sarcopenia impacted mortality in COPD patients. A prospective cohort study performance was conducted with COPD patients. Patients with cancer, and asthma were excluded. Body composition was assessed by bioelectrical impedance analysis. Low strength and muscle mass, and sarcopenia were defined according to EWGSOP2. 240 patients were evaluated, of whom 32% had sarcopenia. The mean age was 72.32 ± 8.24 years. The factors associated with lower risk of mortality were handgrip strength (HR:0.91, CI 95%; 0.85 to 0.96, p = 0.002), PhA (HR:0.59, CI 95%; 0.37 to 0.94, p = 0.026) and exercise tolerance (HR:0.99, CI 95%; 0.992 to 0.999, p = 0.021), while PhA below the 50th percentile (HR:3.47, CI 95%; 1.45 to 8.29, p = 0.005), low muscle strength (HR:3.49, CI 95%; 1.41 to 8.64, p = 0.007) and sarcopenia (HR:2.10, CI 95%; 1.02 to 4.33, p = 0.022) were associated with a higher risk of mortality. Low PhA, low muscle strength, and sarcopenia are independently associated with poor prognosis in COPD patients.

Changes in health-related quality of life as a marker in the prognosis in COPD patients.

Chronic obstructive pulmonary disease (COPD) is understood as a complex, heterogeneous and multisystem airway obstructive disease. The association of deterioration in health-related quality of life (HRQoL) with mortality and hospitalisation for COPD exacerbation has been explored in general terms. The specific objectives of this study were to determine whether a change in HRQoL is related, over time, to mortality and hospitalisation.Overall, 543 patients were recruited through Galdakao Hospital's five outpatient respiratory clinics. Patients were assessed at baseline, and the end of the first and second year, and were followed up for 3 years. At each assessment, measurements were made of several variables, including HRQoL using the St George's Respiratory Questionnaire (SGRQ).The cohort had moderate obstruction (forced expiratory volume in 1 s 55% of the predicted value). SGRQ total, symptoms, activity and impact scores at baseline were 39.2, 44.5, 48.7 and 32.0, respectively. Every 4-point increase in the SGRQ was associated with an increase in the likelihood of death: “symptoms” domain odds ratio 1.04 (95% CI 1.00–1.08); “activity” domain OR 1.12 (95% CI 1.08–1.17) and “impacts” domain OR 1.11 (95% CI 1.06–1.15). The rate of hospitalisations per year was 5% (95% CI 3–8%) to 7% (95% CI 5–10%) higher for each 4-point increase in the separate domains of the SGRQ.Deterioration in HRQoL by 4 points in SGRQ domain scores over 1 year was associated with an increased likelihood of death and hospitalisation.

Impact of smoking, COPD and comorbidities on the mortality of COVID-19 patients

The prognosis of the coronavirus disease 2019 (COVID-19) patients is variable and depends on several factors. Current data about the impact of chronic obstructive pulmonary disease (COPD) and smoking on the clinical course of COVID-19 are still controversial. This study evaluated the prevalence and the prognosis of COPD patients and smokers in a cohort of 521 patients admitted to four intermediate Respiratory Intensive Care Units (Puglia, Italy) with respiratory failure due to COVID-19 pneumonia. The prevalence of COPD and current smokers was 14% and 13%, respectively. COPD patients had a higher 30-day all-cause mortality than non-COPD patients. Former smokers compared to never smokers and current smokers had higher 30-day all-cause mortality. COPD patients and former smokers had more comorbidities. This study described the prevalence and the outcomes of COPD patients and smokers in a homogenous cohort of COVID-19 patients. The study showed that the prevalence of COPD and current smokers was not high, suggesting that they were not at increased risk of getting the infection. However, when SARS-CoV-2 infection occurred, COPD patients and former smokers were those with the highest all-cause mortality, which seemed to be mainly related to the presence of comorbidities and not to COPD and smoking itself.

Evaluation of Relaxant effect in Methanolic Extract of Aegle marmelos on Isolated Sprague Dawley Bronchial Tissue

Introduction: Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow obstruction with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Oxygen deficiency (hypoxia) causes an increase in Reactive Oxygen Species (ROS). ROS can be neutralized with antioxidants, one of which is Bael leaf. Objective: To evaluate the antibacterial activity of plant leaf extract against the common isolated bacteria [Psuedomonas aeruginosa]. To know the Relaxant effect of bael leaf (Aegle marmelos) on oxidative stress in Sprague Dawley lung induced chronic systemic hypoxia. Methods: The study was conducted in SIMATS and Sri Akilandeswari Pharma College for the period of Six months from April 2020 to September 2020. 110 sputum samples were analysed for testing antibacterial activity. Neutralization of ROS has been determined by DPPH radical scavenging method. Contractile effect was done by the Organ bath method. Results: Among gram negative bacteria predominantly Pseudomonas aeruginosa is the commonest bacteria. The other important organisms are Klebsiella pneumoniae, E. coli, Acinetobacter species. Antibiotics showing high activity against Pseudomonas aeruginosa are Piperacillin tazobactam, Carbapenemase, and Quinolones. mucA gene mutation of P. aeruginosa could be used as predictors to identify poor prognosis in COPD patients. Analysis of antioxidant activity in Aegle marmelos shows 79.8% of reductions in DPPH free radicals for 100μg/ml. The minimum inhibitory concentration (MIC) value of the methanolic extract is around 256 μg/ml. 1mg/ml and 2mg/ml doses of the methanolic extract of this plant produced a positive relaxant effect in an isolated mouse bronchial rings, respectively. Conclusion: Methanolic extracts elicited the antagonistic effect against histamine and also relaxed the histamine-induced contractions, it can be concluded that relaxations induced by A. marmelos in mouse broncheal chain were due to the depression of H1-receptors. This study shows that Aegle marmelos can be effectively used in the treatment of COPD disorders.

Forecast the Exacerbation in Patients of Chronic Obstructive Pulmonary Disease with Clinical Indicators Using Machine Learning Techniques.

Preventing exacerbation and seeking to determine the severity of the disease during the hospitalization of chronic obstructive pulmonary disease (COPD) patients is a crucial global initiative for chronic obstructive lung disease (GOLD); this option is available only for stable-phase patients. Recently, the assessment and prediction techniques that are used have been determined to be inadequate for acute exacerbation of chronic obstructive pulmonary disease patients. To magnify the monitoring and treatment of acute exacerbation COPD patients, we need to rely on the AI system, because traditional methods take a long time for the prognosis of the disease. Machine-learning techniques have shown the capacity to be effectively used in crucial healthcare applications. In this paper, we propose a voting ensemble classifier with 24 features to identify the severity of chronic obstructive pulmonary disease patients. In our study, we applied five machine-learning classifiers, namely random forests (RF), support vector machine (SVM), gradient boosting machine (GBM), XGboost (XGB), and K-nearest neighbor (KNN). These classifiers were trained with a set of 24 features. After that, we combined their results with a soft voting ensemble (SVE) method. Consequently, we found performance measures with an accuracy of 91.0849%, a precision of 90.7725%, a recall of 91.3607%, an F-measure of 91.0656%, and an AUC score of 96.8656%, respectively. Our result shows that the SVE classifier with the proposed twenty-four features outperformed regular machine-learning-based methods for chronic obstructive pulmonary disease (COPD) patients. The SVE classifier helps respiratory physicians to estimate the severity of COPD patients in the early stage, consequently guiding the cure strategy and helps the prognosis of COPD patients.

Study on association between echocardiographic findings in COPD patients with severity of COPD

Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing cardiovascular disease. Echocardiography (ECHO) carries information about cardiac diseases and prognosis in COPD patients.&#x0D; Objective: To find out the Echocardiography changes in COPD patients and to assess Right ventricular (RV) dysfunction by echocardiography and correlate with the disease severity.&#x0D; Methods: A prospective study was conducted on 70 patients admitted with symptoms and signs suggestive of COPD in the Department of Medicine, Gazi Medical College and Hospital (GMCH), Khulna from January 2017 to December 2018. Patients were diagnosed clinically as having COPD with confirmation by spirometry. The patients with asthma, bronchiectasis, tuberculosis, pneumoconiosis, restrictive lung disease like kyphoscoliosis, rheumatic, congenital, ischemic heart disease and hypertension were excluded from the present study.&#x0D; Results: Regarding symptoms, majority 65 (92.9%) patients had breathlessness, 58 (82.9%) had cough with sputum, 25 (35.7%) had swelling of feet. Regarding signs, 68 (97.1%) patients had tachypnea, 24 (34.3%) had raised JVP, 23 (32.9%) had loud P2 suggestive of pulmonary arterial hypertension. Regarding echocardiographic findings, 42 (60.0%) patients had Cor pulmonale, 32 (45.7%) had LVDD, 31 (44.3%) had RVH, 30 (42.9%) had PAH, 29 (41.4%) patients had RA/RV dilation, 11 (15.7%) had RVSD and 9 (12.9%) had LVH. Table 08 shows RA/RV dilatation, RVH, Cor pulmonale, PAH and LVDD were statistically significant (p&lt;0.05) when compared with severity of COPD. Conclusion: High occurrence of cardiac co morbidities such as PAH, RV dysfunction and LV dysfunction accompanied COPD patients. The severity of complications increased with severity of COPD which makes a linear relation. The 2D-echocardiography is more sensitive than radiography and clinical methods in detecting cardiovascular complications like PAH, ‘p’ pulmonale and RV dysfunction in COPD patients.&#x0D; Mediscope Vol. 7, No. 1: Jan 2020, Page 44-50

Influence of Pneumonia on the Survival of Patients with COPD

Background: Pneumonia is a frequent infection. Chronic obstructive pulmonary disease (COPD) can present with comorbidities, including pneumonia. It is known that COPD worsens the evolution of pneumonia, but few studies describe the impact of pneumonia on COPD evolution. This study analyzes the influence of pneumonia on the survival of COPD patients. Methods: Observational study of a cohort of 273 patients with COPD who attended spirometry in 2011, with a prospective follow-up of six years. Patients were divided into two groups according to their acquisition of pneumonia during follow-up. The difference in survival between the two groups was analyzed. Results: Survival was lower in the group with pneumonia compared with that without pneumonia (p = 0.000), both globally and after stratification by COPD phenotype. Pneumonia (Hazard Ratio -HR- 2.65; 95% Confidence Interval -CI- 1.57–4.48), advanced age (HR 1.08; 95% CI 1.03–1.09), and high Charlson index (HR 1.31; 95% CI 1.17–1.47) were identified as risk factors independently associated with mortality, while a high body mass index (HR 0.92; 95% CI 0.87–0.96) was identified as a protective factor. Conclusions: Pneumonia is associated with worse prognosis in COPD patients. It is important to take into account this comorbidity for a comprehensive care of these patients.

Clinical and Echocardiographic Profile of Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a disease formal categorized by airflow limitation that is not fully reversible. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease. Electrocardiography (ECG) carries information about cardiac disease and prognosis in COPD patients. However, Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Methods: 125 patients of COPD fulfilling the inclusion criteria coming to OPD/ wards of Medicine, Civil Hospital, Ahmedabad were recruited. They were staged by pulmonary function test (PFT) and evaluated by electrocardiography and echocardiography. Statistical analysis of correlation was done with chi square test and statistical significance was taken p&lt;0.05. Results: Mean age was 56.24±9.41years, with male preponderance, male to female ratio 4.43:1. Mean duration of disease was 6.22±4.28years. The common symptoms were Breathlessness (100%). Most common ECG and ECHO finding was RAD (51.2%) and PAH (54.4%) respectively. Statistically Right axis deviation and Poor ‘r’ wave progression were significantly correlated with disease severity by ECG findings while R.A. dilatation, R.V.dilatation and Pulmonary hypertensionwere significantly correlated with disease severity by ECHO findings (p&lt;0.05). Conclusions: COPD is more common in males and in the 5th and 6th decadeof life. Most of the patients have fairly advanced disease at presentation. The incidence of abnormalities of ECG and echocardiography increases with COPD severity. ECG and echocardiography are better tools than clinical methods in detecting R.V. dysfunction in COPD.

Risk factors for mortality in patients with Pseudomonas aeruginosa pneumonia: Clinical impact of mucA gene mutation.

Pseudomonas aeruginosa frequently colonizes the lungs of chronic obstructive pulmonary disease (COPD) patients. Mucoid conversion is a hallmark of chronic P. aeruginosa infection, which is mediated by mucA gene mutations. The aim of this study is to identify predictive factors for mortality and the influence of mucA gene mutation in COPD patients with P. aeruginosa pneumonia. This study assessed 75 COPD patients with P. aeruginosa pneumonia at two university hospitals. The clinical and laboratory data were collected, and the P. aeruginosa isolates analyzed for the presence of mucA gene mutations. MucA gene mutation of P. aeruginosa was an independent predictor of mortality (odds ratio [OR] 10.43, 95% confidence interval [CI]: 1.53-70.90, p = 0.017). In addition, the APACHE II score and C-reactive protein/Albumin (CA) ratio were independent predictive factors for mortality (OR 1.25, 95% CI: 1.07-1.46, p = 0.004; and OR 1.06, 95% CI: 1.02-1.10, p = 0.003, respectively). The optimal cutoff value of CA ratio for the greatest sensitivity and specificity was calculated as 31.27 (sensitivity, 85.7%; specificity, 80.3%). CA ratio and mucA gene mutation of P. aeruginosa could be used as predictors to identify poor prognosis in COPD patients with P. aeruginosa pneumonia.

Prevalence of pulmonary hypertension in COPD

Background: Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality in adults all over the world. Pulmonary hypertension (PH) is a severe disorder defined by a mean pulmonary artery pressure of ≥25 mmHg at rest. Pulmonary hypertension can occur as an isolated disease or as a consequence of a number of underlying diseases and conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). The aim of our study was to study the prevalence of pulmonary hypertension in COPD patients and to highlight the importance of early diagnosis of pulmonary hypertension to prevent further complications.Methods: This was a retrospective observational hospital based study conducted at Integral Institute of Medical Sciences and Research Lucknow U P, during 1st January to 31st December 2017. A total of 210 patients were evaluated for presence of pulmonary hypertension using chest X-ray, electrocardiogram, 2D echocardiography.Results: The present study finding reveals 38.02 % patients of various severity of COPD have findings of pulmonary hypertension, that is similar in prevalence of previous studies.Conclusions: The prevalence of PH in patients with COPD was 38.02%. As PH has an important role in the prognosis of COPD patients, it should be evaluated in as many COPD patients as possible.

Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease and its correlation with disease severity

Background: Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a disease state characterized by airflow limitation that is not fully reversible. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease. Electrocardiography (ECG) carries information about cardiac disease and prognosis in COPD patients. Present study was undertaken to correlate ECG changes with severity of COPD.Methods: 100 patients of COPD fulfilling the inclusion criteria coming to OPD/wards of NMCH, Kota were recruited. They were staged by pulmonary function test (PFT) and evaluated by electrocardiography. Statistical analysis of correlation was done with chi square test and statistical significance was taken p&lt;0.05.Results: Mean age was 63.18±8.66 years, with male preponderance, male to female ratio 6.14:1. Mean duration of disease was 7.58±2.92 years, mean exposure to smoking of 25.06 pack years. Most common ECG finding was RAD which was present in 69% of cases, other ECG findings are P. pulmonale (45%), incomplete RBBB (15%), PPRW (35%), RVH (53%). All ECG findings except incomplete RBBB significantly correlated with disease severity (‘p’ value &lt;0.05).Conclusions: COPD is more common in male in 5th to 7th decade of life, with a smoking history of more than 20 pack years. The occurrence of ECG findings increase as severity and duration of disease increase. It can be inferred that ECG is a useful bedside test to assess the severity of COPD.

Application of the 6-Minute Walking Test and Shuttle Walking Test in the Exercise Tests of Patients With COPD

Exercise training improves the management of stable chronic obstructive pulmonary disease (COPD). COPD patients benefit from exercise training programs in terms of improved VO2 peak values and decreased dyspnea, fatigue, hospital admissions, and rates of mortality, increasing exercise capacity and health-related quality of life (HRQOL). COPD is often associated with impairment in exercise tolerance. About 51% of patients have a limited capacity for normal activity, which often further degrades exercise capacity, creating a vicious circle. Exercise testing is highly recommended to assess a patient's individualized functions and limitations in order to determine the optimal level of training intensity prior to initiating an exercise-training regimen. The outcomes of exercise testing provide a powerful indicator of prognosis in COPD patients. The six-minute walking test (6MWT) and the incremental shuttle-walking test (ISWT) are widely used in exercise testing to measure a patient's exercise ability by walking distances. While nursing-related articles published in Taiwan frequently cite and use the 6MWT to assess exercise capacity in COPD patients, the ISWT is rarely used. This paper introduces the testing method, strengths and weaknesses, and application of the two tests in order to provide clinical guidelines for assessing the current exercise capacity of COPD patients.

Interleukin-17 expression and clinical significance in the lung tissue of patients with stable chronic obstructive pulmonary disease

To observe the interleukin-17 (IL-17) expression in lung tussiue of patients with stable chronic obstructive pulmonary disease (COPD) and investigate the clinical significance. A total of 50 patients receiving lung resections in General Hospital, Tianjin Medical University for lung cancer from October 2010 to October 2011 were included and divided into non-smoking COPD group (NS group), smoking non-COPD group (S group), smoking COPD group (COPD group) according to smoking status and 2013 COPD diagnosis standard. The expression of IL-17 was detected by immumohistochemical staining. The volume of IL-17 in the airway and lung parenchyma was calculated by immumohistochemical staining scores which was product of dyeing cells positive rate and intensity. Pearson correlation analysis was used to analyze the relationships between expression of IL-17 in the airway and lung parenchyma and forced expiratory volume in 1 second/predicted value (FEV1%pred), carbon monoxide diffusion amount accounting for the percentage of the expected value (DLCO%pred), COPD assessment test (CAT) score, body mass index (BMI). The expressions of IL-17 in airway and lung parenchyma in S group (5.6±3.1, 6.4±2.5) were higher than those in NS group (1.6±1.4, 1.4±1.2) (both P<0.05), while expressions in COPD group (7.3±2.5, 7.8±2.1) were further higher than S group (both P<0.05). In the S group and COPD group, the expressions of IL-17 in the airway and lung parenchyma were positively correlated with smoking (r=0.453, P=0.007 and r=0.573, P<0.001); In the COPD group, the expressions of IL-17 in the airway and lung parenchyma were negatively correlated with FEV1%pred (r=-0.729, P=0.001 and r=-0.489, P=0.039), negatively related with DLCO%pred (r=-0.493, P=0.038 and r=-0.520, P=0.027), positively correlated with COPD CAT score (r=0.730, P=0.001 and r=0.644, P=0.004) and negatively related with BMI (r=-0.653, P=0.003 and r=-0.485, P=0.041). Smoking increases inflammation of lung tissue, increases IL-17 expression in airway and lung parenchyma; the expression of IL-17 is closely related to the severity of disease, the quality of life and prognosis in COPD patients.