Pulmonary Disease Patients Research Articles

The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD

The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = −0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = −0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.

Clinical phenotypes of chronic obstructive pulmonary disease in patients treated at the Hospital Neumológico de La Habana.

Introducción: La identificación de fenotipos clínicos es clave en la modulación de la expresión clínica, para un tratamiento integrado de la EPOC. Objetivos: Caracterizar los fenotipos clínicos de la EPOC en pacientes atendidos en el Hospital Neumológico Benéfico Jurídico. Métodos: Se realizó un estudio observacional descriptivo retrospectivo en 172 pacientes con diagnóstico de EPOC en el Hospital Neumológico Benéfico Jurídico en 2017. Resultados:El 38,4% de los pacientes tenían entre 70 y 79 años. Del total de pacientes, el 54,6% eran varones. El 52,9% eran fumadores activos y el 41,3% exfumadores. Aunque las diferencias no fueron significativas, la edad avanzada y el sexo masculino fueron más frecuentes en el fenotipo agudizador enfisematoso y agudizador bronquial crónico. El tabaquismo activo fue más frecuente en el fenotipo enfisematoso exacerbante. Todos los pacientes con el fenotipo de exacerbador bronquial crónico tuvieron dos o más exacerbaciones, mientras que la exacerbación enfisematosa se asoció con una gravedad grave de la EPOC (46,7%). Conclusiones:El sexo masculino y la edad avanzada muestran una tendencia a relacionarse con el fenotipo enfisematoso agudizante y agudizador de la bronquitis crónica, mientras que el tabaquismo activo es más frecuente en el fenotipo enfisematoso agudizante. El fenotipo agudizador de bronquitis crónica se relaciona con mayores exacerbaciones y exacerbaciones enfisematosas con mayor gravedad de la EPOC.

Genetic disorders of the surfactant system: focus on adult disease.

Genes involved in the production of pulmonary surfactant are crucial for the development and maintenance of healthy lungs. Germline mutations in surfactant-related genes cause a spectrum of severe monogenic pulmonary diseases in patients of all ages. The majority of affected patients present at a very young age, however, a considerable portion of patients have adult-onset disease. Mutations in surfactant-related genes are present in up to 8% of adult patients with familial interstitial lung disease (ILD) and associate with the development of pulmonary fibrosis and lung cancer.High disease penetrance and variable expressivity underscore the potential value of genetic analysis for diagnostic purposes. However, scarce genotype-phenotype correlations and insufficient knowledge of mutation-specific pathogenic processes hamper the development of mutation-specific treatment options.This article describes the genetic origin of surfactant-related lung disease and presents spectra for gene, age, sex and pulmonary phenotype of adult carriers of germline mutations in surfactant-related genes.

Predictors of survival in patients with precapillary pulmonary hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although the perceived prognosis of patients with precapillary pulmonary hypertension (PH) is poor, the natural history of this condition is very heterogeneous. In this study we sought to identify predictors of poor outcomes which could help refine prognosis. Methods We studied consecutive patients referred to our centre from 12/2016 to 11/2018 with confirmed precapillary PH. A range of clinical, laboratory, echocardiographic and right heart catheterization (RHC) data variables were collected to assess predictors of survival. Outcome was defined as mortality from any cause. Results Of the 80 included patients, 51 (64%) were female and mean age was 60.5 ± 16.0 years. The majority of patients (45%) had pulmonary arterial hypertension (group 1) and 41% were chronic thromboembolic pulmonary hypertensive disease patients (group 4). During a median follow-up of 18.7 [IQR 12.3 – 26.7] months, 10 patients (12.5%) died. New York Heart Association (NYHA) functional class (HR 19.4 [95% CI 2.56 - 147.5], p = 0.004) was the strongest predictor of mortality, whereas higher haemoglobin (HR 0.70 [0.49 - 0.99], p= 0.047) and 6-minute walking distance (6MWD) expressed as percentage of predicted (HR 0.96 [0.93 - 0.99], p = 0.004) were associated with better survival overall. Echocardiographic parameters such as eccentricity index (HR 3.35 (95% CI 1.11 - 10.0), p = 0.031), short pulmonary acceleration time (HR 0.98 [95% CI 0.96 - 0.99], p = 0.008), the presence of moderate to severe tricuspid regurgitation (HR 6.46 [95% CI 1.67 - 25.0], p = 0.007) and pericardial effusion (HR 3.86 [95% CI 1.12 - 13.4], p = 0.033) were also associated with death. Traditional right ventricular function parameters such as fractional area change, tricuspid annular plane systolic excursion (TAPSE) and S velocity of the lateral annular tricuspid annulus did not predict mortality in these patients. Invasive pressures and pulmonary vascular resistance measured by RHC were also not associated with mortality. In multivariable analysis, NYHA functional class was the only independent predictor of mortality in patients with precapillary PH (HR 14.5 [95% CI 2.3 - 146.8], p = 0.006). Conclusion Eccentricity index, short pulmonary acceleration time, moderate to severe tricuspid regurgitation and pericardial effusion were associated with poor survival. Functional class was the strongest independent predictor of mortality in precapillary PH patients. These parameters may help stratify the risk of death in this heterogenous population.

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

BackgroundIt is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD.MethodsCOPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed.ResultsA total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively.ConclusionsPatients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.

Prevalence of different comorbidities in chronic obstructive pulmonary disease among Shahrekord PERSIAN\xa0cohort study in southwest Iran

Comorbidities are common in chronic obstructive pulmonary disease (COPD) patients. This study was conducted to determine the prevalence of common comorbidities in patients with COPD compared with people without COPD. This cross-sectional, population-based study was performed on 6961 adults aged 35–70 years enrolled in the Shahrekord PERSIAN cohort study. Data (demographic and clinical characteristics, comorbidities, anthropometric and blood pressure measurements, laboratory, and spirometry tests) collection was performed according to the cohort protocol from 2015 to 2019. In the present study, 215 (3.1%) patients were diagnosed with COPD and 1753 (25.18%) ones with restrictive lung patterns. The mean age of COPD patients was 52.5 ± 9.76 years. 55.8% of patients were male, 17.7% were current smokers and 12.1% had a history of smoking or were former smokers. 5.6% of patients had no comorbidity and 94.5% had at least one comorbidity. The most common comorbidities in COPD patients were dyslipidemia (70.2%), hypertension (30.2%), metabolic syndrome (22.8%), and diabetes (16.7%). The most common comorbidities in individuals with a restrictive spirometry pattern were dyslipidemia (68.9%), metabolic syndrome (27.2%), hypertension (26.1%), depression (17.6%), and fatty liver (15.5%). The logistic regression analysis with 95% confidence interval (95%CI) of odds ratio (OR) showed that comorbidities of chronic lung diseases (OR = 2.12, 95% CI 1.30–3.44), diabetes (OR = 1.54, 95%CI 1.03–2.29), cardiovascular disease (OR = 1.52, 95%CI 1.17–2.43), and hypertension (OR = 1.4, 95%CI 1.02–1.99) were more likely to occur in COPD patients than in healthy individuals. Knowing these prevalence rates and related information provides new insights on comorbidities to reduce disease burden and develop preventive interventions and to regulate health care resources to meet the needs of patients in primary health care.

GLIMPSE STUDY: IMPACT OF TRIPLE THERAPY ON LUNG FUNCTION, HEALTH STATUS, AND MORTALITY RISK IN PATIENTS WITH ADVANCED CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objectives: The objectives of the study were to estimate the relative impact of triple therapy on lung function, health status, and mortality risk compared with combination inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) therapy in symptomatic chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations in an Indian clinical population.&#x0D; Methodology: The GLIMPSE (Lung Function, Health Status, and Mortality Risk Assessment in COPD using Triple Therapy) was as a prospective, parallel design, single-center observational study comparing 24 weeks of triple therapy (twice-daily combination of budesonide [BUD]-formoterol [FOR] [100/6 μg] and once-daily tiotropium [TIO] [9 μg]) with ICS/LABA (twice daily BUD-FOR [100/6 μg]). The primary outcome was the mean change in forced expiratory volume in the 1st s (FEV1%) predicted and COPD assessment test total score from baseline at week 24. Secondary outcomes were variation in dyspnea grade and BODE total score from baseline.&#x0D; Results: At week 24 in triple therapy (n=70) and ICS/LABA therapy (n=70), mean difference from baseline in FEV1% predicted were 5.40 (95% confidence interval [CI]: 1.29–9.50) and 1.90 (95% CI: –1.87–5.68) respectively, and mean difference in CAT total score from baseline was –5.10 units (95% CI: –3.49–−6.71) and –1.80 units (95% CI: –0.052–−3.548), respectively. In addition, there was a statistically significant reduction in dyspnea grading and BODE score with comparable adverse events in both groups.&#x0D; Conclusion: Overall, the results favored triple therapy over dual therapy in advanced symptomatic COPD patients.

Medical rehabilitation of chronic obstructive pulmonary disease in patients with helicobacteriosis

Medical rehabilitation of chronic obstructive pulmonary disease in patients with helicobacteriosis

AGGRAVATING EFFECT OF ARTERIAL HYPERTENSION ON THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN PATIENTS WITH COMORBID PATHOLOGY

The aim: To study the effect of arterial hypertension on the course of chronic obstructive pulmonary disease in patients with comorbid pathology. Materials and methods: The prospective study included 61 patients with COPD: 32 stable male patients with COPD with comorbid arterial hypertension of stage II 1-3 degrees and 29 stable outpatients of men with COPD of clinical groups A-D with impaired respiratory function II-IV according to GOLD. All patients, in accordance with the goals and objectives of the study, were divided into 2 groups: group I consisted of men with isolated COPD, middle age - 56.0 (8.5) years, average duration of the disease - 16.2 (1.3) years, Group II consisted of male patients with COPD and arterial hypertension (AH), middle age - 59.5 (7.5). The patients underwent a general clinical examination, which included an assessment of complaints, anamnestic data, and a physical examination. The severity of COPD was determined on the basis of the frequency of exacerbations during the year, assessment of dyspnea using the mMRS scale, spirographic data. Statistical materials were processed using the STATISTICA 10.0 program. Results: In group I, 20 patients (69%) complained of dyspnea during exercise, in group II - 25 patients (78%) (p = 0.4), 28 patients (96.5%) complained of cough with vague sputum. group and 30 patients in group II (93.8%) (p = 0.09). When assessing the number of exacerbations over the past year, it was determined that patients with isolated COPD had an average of 1.0 (1.0; 2.0) exacerbations, and patients with COPD and AH - 2.0 (1.0; 3.0 ) (p = 0.06). According to the CAT questionnaire, the following data were obtained: in group I - 9.0 (8.0; 11.0) points, and in group II - 17.5 (10.0; 20.0) points (p = 0.02). When conducting spirographic studies, a statistically significant more expressive bronchial obstruction was found in patients with COPD and comorbid hypertension. Conclusions: The presence of comorbid arterial hypertension leads to the intermittent effect of diseases: according to the results of mMRC and SAT test, ailments for COPD were examined, they have a more severe course of underlying seizure in the presence of concomitant arterial hypertension. Clinical manifestations in patients with COPD and H are more severe compared to clinical manifestations in patients without aggravated diseases of the cardiovascular system. Concomitant arterial hypertension enhances the manifestations of bronchial obstruction, in the same way as with patients with isolated COPD.

Study of co-morbidities in patients of chronic obstructive pulmonary disease at a tertiary hospital

Background: Comorbidities are important events in the natural history of the disease and have a negative effect on the morbidity and mortality of COPD patients. It is increasingly recognized that, many patients with COPD have co-morbidities that have a major impact on quality of life and survival. Present study aims at studying the prevalence and effects of comorbidities in COPD patients at a tertiary hospital. Material and Methods: Present study was cross sectional, observational study conducted in COPD patients, diagnosed for more than 5 years, underwent investigations for various comorbidities. Results: In present study, 130 COPD patients were studied for various co-morbidities. Majority of cases were from 50 -64 years age group (49.23 %) and were male (97.69 %). Smoking was major factor noted among cases (73.85 %), out of them 23.96 % were current smoker. Mean duration since quitting of smoking was 7.24 ± 5.83 years. Comorbidities noted in present study were systemic hypertension (42.31 %), GERD and gastric ulceration (31.54 %), type 2 diabetes mellitus (30.77 %), metabolic syndrome (29.23 %), anemia (11.54 %), left sided cardiac abnormalities (10.77 %), depression (8.46 %), obstructive sleep apnea (6.92 %), ischemic heart disease (6.15 %), osteoporosis (4.62 %), bronchiectasis (2.31 %) and lung cancer (0.77 %). Conclusion: Comorbidities noted in present study were hypertension, GERD, type 2 diabetes mellitus, metabolic syndrome, anaemia, left sided cardiac abnormalities and depression.

Chronic obstructive pulmonary disease in patients with stable heart failure: Prevalence and associated factors

Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow limitation in the lungs. COPD frequently coexist with Heart Failure (HF) but most patients go undiagnosed because of similarity of symptoms. Data on prevalence of COPD in HF are discrepant and scarce.

Comparison of Prevalence and Risk Factors in COPD Patients With and Without History of Smoking

A prospective cross-sectional study to compare the prevalence and risk factors in chronic pulmonary obstructive disease (COPD) patient with and without a history of smoking. This was an observational study conducted in the department of respiratory medicine, Chettinad Hospital and Research Institute (CHRI), Kancheepuram. A total of 206 patients with COPD, diagnosed as per GOLD criteria were enrolled in the study. Out of 206 COPD patients, 164 (79.61%) were men, and 42 (20.4%) were women and their mean age was 62.88 (± 9.53). The prevalence of COPD patients in smokers/ex-smokers were 125 (60.7%) and 81 (39.3%) in never smokers. There were 75 patients (92.59%) in the never smoker cohort and 72 patients (57.6%) in the ex-smoker/smoker cohort found to have at least one non-smoking risk factor for COPD. Biomass Exposure (39.50%), Passive Smoking (22.22%, P=), Co-existing Asthma (22.22%) were the non-smoking risk factors which were found to be present significantly higher in never smokers than smokers/ex-smokers, and the difference was statistically significant (&lt;0.05). A higher proportion of severe patients were in smokers/ex-smokers than non- smokers (41.6% vs 27. 1%). Patients with moderate disease in both groups were found to be of equal proportion (12% vs 11. 11%). The results of the study reiterate that a significant proportion of COPD patients were never smokers and prevalence of non-smoking risk factors were more common in that population.

Prevalence of TB associated chronic obstructive pulmonary disease in patients with COPD attending at tertiary care hospital in Ahmedabad: A case control study

Background: Apart from tobacco smoke, COPD has been known to occur in patients with previous pulmonary TB. Present study was performed with an aim to conduct a study to discover out the hospital based prevalence of TB‑associated COPD among COPD patients and to assess its distinguishing features in Ahmedabad, Gujarat, India. Present study was conducted at the Department of Tuberculosis and Reparatory Medicine, in a tertiary care hospital over a period of 7 months. Seventy-four consecutive patients of stable COPD attending chest OPD were enrolled as cases. An equivalent number of healthy subjects with comparable age and gender distribution were taken as controls. Specific points such as number of anti‑tubercular treatment (ATT) courses, total duration of treatment, time elapsed since completion of treatment and their final outcome were recorded. The prevalence of TB‑associated COPD group was calculated, and its different parameters were compared with rest of COPD patients. Results: Median duration of onset of symptoms was 4.1 years. The unadjusted odds ratio for previous TB in the COPD group in comparison to controls was 3.95. Most of the patients 21/24 had taken a single course of ATT. TB‑associated COPD patients were significantly younger in age as compared to the rest of COPD patients (P ? 0.05) with more proportion of females. On multivariate analysis, duration of dyspnea retained positive correlation with hospitalizations after adjusting for pack years, age, and BMI. Conclusions: TB‑associated COPD constitutes a substantial proportion of COPD in a hospital setting. It is a distinct clinical entity different from a larger smoking related COPD and hence may require different management. Keywords: COPD; Odds ratio; Prevalence; TB.

Is there enough room for non-invasive ventilation in pulmonary rehabilitation?

Pulmonary rehabilitation (PR) is a non-pharmacological intervention addressed to chronic obstructive pulmonary disease (COPD) and non-COPD chronic respiratory patients, a key management strategy scientifically demonstrated to improve exercise capacity, dyspnoea, health status and psychological wellbeing. The main body of literature comes from COPD patients, as they provide the core evidence for PR programmes. PR is recommended even to severe patients having chronic respiratory failure; their significant psychological impairment and potential for greater instability during the PR programme will be carefully considered by the multidisciplinary team. Optimizing medical management (e g, inhaled bronchodilators, oxygen therapy, non- invasive ventilation) may enhance the results of exercise training. Patients who already receive long-term domiciliary non- invasive ventilation (NIV) for chronic respiratory failure might exercise with NIV during exercise training if acceptable and tolerable to the patient. It is not advisable to offer long-term domiciliary NIV with the only aim to improve outcomes during PR course. There are different attempts to use both negative and positive NIV in limited clinical studies. Long-term adherence to exercise is an important goal of PR programmes and teams, targeting to translate all-domain gains of PR into increased physical activity and participation to real life. Being a reliable alternative for the future, studies should focus on pressure regimens, type of devices, acceptability and portability for everyday activities.

Frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis.

Objectives: To assess the frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis. Study Design: Cross Sectional study. Setting: Department of Medicine, Independent University Hospital, Faisalabad. Period: 01-07-2017 to 30-06-2018. Material &amp; Methods: 100 patients having diagnosis of COPD according to the operational definition were selected from medical opd of hospital after consent of patients. All patients were given tablet azithromycin 250mg thrice weekly for 12 months, then these patients were followed up for episodes of exacerbations in one year. All patients were properly instructed to report in any change in their symptoms. Any episode of acute exacerbation was noted. There was no conflict of interest. Results: Frequency of acute exacerbation of chronic obstructive pulmonary disease was seen in 70 out of 100(70%) patients taking low dose azithromycin prophylaxis. In female patients frequency of acute exacerbation was high as compared to male patients. i.e. 62.9% vs. 37.1%. Frequency of acute exacerbation was higher in patients whose duration of disease was longer. i.e. 7-10 years followed by patients whose duration of disease was 4-6 years (28.6%) and 1-3 years (25.7%). Presence of acute exacerbation was significantly associated with decline in lung functions. Highest frequency of acute exacerbation was seen in patients who had 3-4 episodes. Conclusion: Results of this study showed a high frequency of acute exacerbation of COPD even with the prophylaxis of low dose azithromycin. However literature reported effectiveness of low dose azithromycin for acute exacerbation in patients of COPD. So further study in the form of randomized trail is needed to prove the efficacy of azithromycin.

The impact of chronic obstructive pulmonary disease in patients' lives: The perception of the health professionals.

The perception of health professionals about chronic obstructive pulmonary disease (COPD) has not been thoroughly investigated. To analyze the perception of health professionals about the impact of COPD on the lives of affected individuals. Qualitative and cross-sectional study with five health professionals: two nurses, two physiotherapists, and one medical doctor. They participated in a focus group (FG) session, with semistructured questions covering: definition of COPD, activities of daily living (ADL), and physical activity of daily living (PADL), as well as the importance of these outcomes in the lives of individuals with COPD. The FG was recorded, transcribed, and analyzed according to the content analysis. The FG highlighted four main themes: physical-functional and emotional impairment of individuals, the importance of patient-health professional contact, repercussions of COPD on the patients' physical activity, and strategies for promoting physical activity. Based on the four themes exposed, the health professionals reported that there is a progression in the lives of individuals' with COPD, which is divided into three phases: adaptation, reluctance, and dependence. There was a negative perception of the health professionals regarding the functionality and emotion of patients with COPD. Emotional aspects, family support, and architectural structure can positively or negatively influence patients' ADL and PADL. Finally, there was a perception of progression in the life of patients with COPD, since their initial adaptation, evolving to physical and emotional dependence.

Cardio-pulmonary-exercise testing, stress-induced right ventricular diastolic dysfunction and exercise capacity in non-severe chronic obstructive pulmonary disease

Abstract Background Data regarding echocardiographic structural and functional abnormalities in right ventricular diastolic dysfunction (RVDD), cardio-pulmonary exercise testing (CPET) abnormalities and their association with exercise capacity among non-severe chronic obstructive pulmonary disease (COPD) patients without pulmonary arterial hypertension (PAH) at rest is limited. Purpose The aim of the study was to find echocardiographic parameters of the right ventricle that may be predictors for stress RVDD in non-severe COPD patients without PAH and to determine their correlation with the 6-minute walking test (6-MWT). Methods We applied a ramp protocol of CPET in 104 patients. Dynamic hyperinflation (ICdyn) was measured. Emphysema was evaluated by Goddard score. Echocardiography was performed before and 1–2 minutes after peak CPET. Stress RVDD was assumed if peak E/e'&amp;gt;6.0. Exercise capacity was evaluated by the 6-MWT. ROC analysis detected the best cut-off values of the RV echocardiographic predictors for stress RVDD. Multivariate analysis with covariates left ventricle (LV) (LV E/A at rest; LV E/e' at rest; stress LV E/A; stress LV E/e'), lung function (FEV1), ICdyn, Goddard score, age, sex, and BMI was performed. A p-value &amp;lt;0.05 was accepted of statistical significance. Results 78% of the patients had stress RVDD. RV wall thickness (RVWT), right atrial volume index (RAVI) and exercise systolic PAH were significantly higher in COPD patients with stress RVDD. After multivariable regression analysis RAVI and rest RV E/e' ratio &amp;gt;5.1 remained independent predictors for stress RVDD; RAVI and RVWT were independent predictors for diminished exercise capacity (6-MWT). Conclusion There is a high prevalence of stress induced RVDD in non-severe COPD patients without PAH at rest. RAVI and rest RV E/e'&amp;gt;5.1 are the best predictors for stress E/e' &amp;gt;6; RAVI and RVWT are associated with decrements in exercise capacity. Funding Acknowledgement Type of funding source: None

Expression of the Autoantigen Topoisomerase-1 is Enriched in the Lung Tissues of Patients With Autoimmune Interstitial Lung Disease: A Case Control Study.

BackgroundAmong the autoimmune rheumatic diseases, it is striking that autoantibodies targeting ubiquitously expressed proteins (eg, topoisomerase‐1) associate with specific clinical complications (eg, interstitial lung disease [ILD]). It has been proposed that enriched antigen expression in inflamed target tissue may play a role in focusing the autoimmune response. We sought to determine whether topoisomerase‐1 expression is enriched in lungs from patients with autoimmune/inflammatory diseases relative to normal lung.MethodsWe used a 99‐core lung tissue microarray (TMA) containing lung tissue from 40 patients with autoimmune inflammatory ILD (cases) and 46 control subjects with normal lungs. We stained the TMA with antibodies to compare topoisomerase‐1 and CD8 expression between patients and control subjects and evaluated whether expression is enriched in specific cell types. Staining was analyzed, and statistical comparisons were performed.ResultsCases were more likely to have global topoisomerase‐1 expression (53% vs 21%; P = 0.003), specifically in pneumocytes (47% vs 16%; P = 0.003) and stromal/immune cells (32% vs 5%; P = 0.002) compared with control subjects. CD8 cell density (223 cells/mm2 vs 102 cells/mm2; P = 0.018) was significantly higher in topoisomerase‐1–positive lung tissues compared with topoisomerase‐1–negative lung tissues. Interestingly, topoisomerase‐1 expression was significantly more common in scleroderma compared with normal lung (67% vs 21%; P = 0.036) and was present more frequently in pneumocytes in these patients (67% vs 16%; P = 0.018).ConclusionsPulmonary expression of topoisomerase‐1 is increased in the setting of autoimmune ILD relative to normal lung, specifically in pneumocytes. This may contribute to the amplification of pulmonary disease in patients with scleroderma with a loss of tolerance to topoisomerase‐1.

Chronic obstructive pulmonary disease in patients with coronary heart disease of elderly age groups

Background. Among the combinations of comorbid conditions, a special role belongs to the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD). Because COPD is often associated with CHD, most authors believe that there is a direct link between COPD, progression of bronchial obstruction, and pathological conditions of the cardiovascular system, including mortality from myocardial infarction. In elderly patients, according to some researchers, the link between COPD and CHD is most pronounced.&#x0D; Objective. To establish the frequency of COPD in patients with CHD in older age groups.&#x0D; Materials and methods. The studies are based on the results of a comprehensive survey of 635 patients with CHD aged 60-89 years, who were observed for a long time of the State Institution “Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine”.&#x0D; Results and discussion. The share of patients with CHD in whom COPD was detected in the group of elderly people is 19.4 %. This is much more than the average population. The frequency of COPD in patients with CHD decreases significantly with further aging. The prevalence of COPD among elderly patients is much lower than among elderly patients. This can most likely be explained by the fact that a significant proportion of patients with CHD with COPD do not live to old age. The analysis revealed that in elderly patients there is bronchial obstruction of more severe stages. This is due to the fact that CHD patients with COPD who live to old age have worsening bronchial patency due to the longer duration of the disease. It has been established that the majority of patients with CHD with COPD, both elderly and senile, are male. This can be explained by the negative effects of smoking.&#x0D; Conclusions. The incidence of COPD in patients with CHD in the elderly is much higher than in the population. At the same time, the incidence of COPD among patients with CHD in the elderly is much lower than among the elderly. In patients of advanced age bronchial obstruction is more expressed.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment

Introduction Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. Objective To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. Method Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon's test. Results Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. Conclusion HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.