Stages Of Pulmonary Disease Research Articles

Could “red cell distribution width” predict COPD severity?

Background and objectivesErythrocyte morphology changes not only by primary hematological diseases but also by systemic inflammation, ineffective erythropoiesis and nutritional deficiencies. Red blood cell distribution width (RDW) is a parameter reflecting erythrocyte morphology. We aimed to investigate the relationship of RDW with chronic obstructive pulmonary disease (COPD) stages, BODE index and survival in COPD patients. MethodsMedical records of 385 COPD patients between July 2004 and November 2005 were studied retrospectively. Demographic features, BODE index factors and oxygen saturation were recorded. Survival analysis of all patients by 2014 was performed. Measured RDW values at the time of the inclusion were evaluated. ResultsMean age of the patients was 65.6±9.6 years. Distribution of the COPD stages of the patients were stage 1: 16%, stage 2: 52%, stage 3: 26%, stage 4: 6%. RDW was found significantly different between stages. The highest RDW was observed in the very severe stage (p<0.001). Median of BODE index was 1 (0–3). As the BODE index increased RDW also increased (p<0.001). When the patients were grouped according to the laboratory upper limit of RDW, survival rate was 31% in the RDW >14.3% group and 75% in the RDW <14.3% group. ConclusionThe variability in the size of circulating erythrocytes increases as the COPD severity progresses. Therefore, a simple and noninvasive test, such as RDW, might be used as a biomarker in the evaluation of the severity of COPD. At the same time, there seems to be a correlation between the survival of COPD patients and RDW.

Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease.

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD). In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4weeks, and 130 at 4months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed. At 4weeks and 4months, changes in disease-specific QOL (st. β=-0.35, p<0.001, partial (p) R (2)=11-12%), depression (st. β=-0.32 to -0.36, p<0.001, pR (2)=9-12%), and anxiety (st. β=-0.21 to -0.40, p<0.02-0.001, pR (2)=4-15%) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4months (st. β=0.21, p=0.02, pR (2)=4%), but not with changes in depression. Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.

A role for NGF and its receptors TrKA and p75NTR in the progression of COPD.

Nerve growth factor and its receptors, TrkA and p75NTR, are involved in inflammation and airways diseases, but their role in chronic obstructive pulmonary disease is still unclear and not well investigated. our data indicate the stage dependent variation of nerve growth factor and its receptors in chronic obstructive pulmonary disease progression. In fact, for the first time, this study evaluates the presence of nerve growth factor and its receptors in serum and in peripheral blood mononuclear cells of patients with different stages of chronic obstructive pulmonary disease compared to healthy subjects, non-smoker and current smoker. Serum monocyte chemoattractant protein-1, tumor necrosis factor-α, interleukin-10 and forced expiratory volume in 1 s were also analyzed. Compared to healthy subjects, chronic obstructive pulmonary disease patients presented a staging-dependent increase in serum nerve growth factor, negatively correlated to forced expiratory volume in 1 s and positively to monocyte chemoattractant Protein-1. The percentage of p75NTR+ peripheral blood mononuclear cells increased in early stages of chronic obstructive pulmonary disease (I-II), while TrKA+ peripheral blood mononuclear cells increased in late stages (III-IV). Our data demonstrate the involvement and modulation of nerve growth factor and its receptors in chronic obstructive pulmonary disease and in its staging.

Accuracy and consequences of same-day, invasive lung cancer workup – a retrospective study in patients treated with surgical resection

BackgroundThough widely used, little is known about accuracy and efficacy of same-day, invasive workup of suspected lung cancer.ObjectiveTo evaluate the accuracy and efficacy of same-day, invasive lung cancer workup (diagnosis and mediastinal staging), and to identify differences between patients without (Group A) or with (Group B) need for resampling.MethodsA retrospective study was performed on all consecutive patients referred for surgical treatment for localised lung cancer after invasive diagnostic and staging workup at our unit. Data were extracted from electronic medical files. Surgical specimens served as gold standard for correct diagnosis and stage.ResultsA total of 129 patients (peripheral lesion: 84%; mediastinal staging: 97%) were included. After same-day, invasive workup, 71% had no need for further invasive workup (Group A), while 29% had (Group B). Group A differed significantly from Group B in fewer invasive tests, fewer days from referral to surgery, and lower pneumothorax incidence, while no differences were observed in diagnostic accuracy, cancer subtype, tumour size, tumour stage, peripheral lesion, nodal involvement, gender, or presence of chronic obstructive pulmonary disease. Tumour located in right upper lobe was associated with need for resampling.DiscussionOur retrospective study suggests that same-day, invasive workup for lung cancer is safe, accurate, and efficacious in reducing time to therapy, even in patients with small lesions and low tumour burden.

Evaluation of the Severity of Sleep Complaints According to the Stages of Chronic Obstructive Pulmonary Disease

Evaluation of the Severity of Sleep Complaints According to the Stages of Chronic Obstructive Pulmonary Disease

Two cases of COPD benefitting from therapy with roflumilast

Two clinical cases of chronic obstructive pulmonary disease (COPD) stage II patients are reported here. One case refers to a patient with hypoxemia associated to severe air flow limitation, chronic bronchitis and frequent exacerbation events. A significant improvement of patient’s conditions was observed after pharmacological treatment with roflumilast. The second case refers to a patient who refused to adhere to prescribed therapy but adhered to roflumilast therapy, eventually achieving a good response. Both cases highlight roflumilast’s efficacy in improving health conditions of COPD patients.

WS16.4 Non invasive liver elastography (LSM) and computed tomography (CT) for evaluation of liver disease in 57 cystic fibrosis adult patients

Objectives Portal hypertension (PHT) is the main complication of cystic fibrosis liver disease (CFLD) but severe liver dysfunction occurred only in 0.5% of the patients. The early diagnosis of CFLD is elusive and a gold standard for diagnosis of liver disease is lacking. The aim of this study was to evaluate liver stiffness measurement (LSM) and CT with IV injected contrast medium in CF adult patients. Median LSM in 241 CF patients was 5.9 kPa. Methods 57 CF patients (28F, 33 yrs −18; 51) had LSM and CT done for lung transplant assessement or after lung transplantation. Results LSM was obtained in 53 patients (92%). PHT was evident on CT in 25 patients (portosystemic collaterals 12, splenomegaly 19, proeminent portal vein 25). PHT was present in 60% of the patients when LSM was >5.9 and in 12% when LSM was Conclusion CFLD with PHT could be present in patient with low LSM. Decompensation of PHT is unfrequent even in adults with end stage pulmonary disease or after lung transplantation. Portal venopathy without cirrhosis could explain PHT. The mechanism remains obscure but could explain the rare occurence of hepatocellular deficiency in CFLD.

Changes in GOLD: today and tomorrow

In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee published a major revision of the GOLD document (a key resource for the staging of chronic obstructive pulmonary disease [COPD]).1 The new GOLD 2011 document no longer evaluated only forced expiratory volume in 1 s (FEV1) as GOLD 2007 did, but also included an analysis of the symptom load and exacerbation history. The rationale for these inclusions was that the correlation between FEV1 and patient-reported outcomes is poor, exacerbation history seems strongly predictive of future exacerbations, and the goals of therapy are reduction of symptoms and prevention of future risks.

(950) - Outcomes After Lung Transplantation for Pulmonary Hypertension Associated With End Stage Pulmonary Disease

(950) - Outcomes After Lung Transplantation for Pulmonary Hypertension Associated With End Stage Pulmonary Disease

P0591 : HBV vaccination status in patients with end stage pulmonary disease evaluated for lung transplantation

P0591 : HBV vaccination status in patients with end stage pulmonary disease evaluated for lung transplantation

HBV vaccination status in patients with end stage pulmonary disease evaluated for lung transplantation

Background: In times of limited donor resources, anti-HBc positive organs can be accepted for lung transplantation in order to increase the number of donors. Transplant recipients should be vaccinated against hepatitis B during transplant evaluation to prevent HBV infection. However, response after HBV vaccination has not been evaluated in patients with end stage pulmonary disease.

Obesity as a susceptibility factor to indoor particulate matter health effects in COPD

Our goal was to investigate whether obesity increases susceptibility to the adverse effects of indoor particulate matter on respiratory morbidity among individuals with chronic obstructive pulmonary disease (COPD). Participants with COPD were studied at baseline, 3 and 6 months. Obesity was defined as a body mass index ≥30 kg·m(-2). At each time point, indoor air was sampled for 5-7 days and particulate matter (PM) with an aerodynamic size ≤2.5 μm (PM2.5) and 2.5-10 μm (PM2.5-10) was measured. Respiratory symptoms, health status, rescue medication use, exacerbations, blood biomarkers and exhaled nitric oxide were assessed simultaneously. Of the 84 participants enrolled, 56% were obese and all were former smokers with moderate-to-severe COPD. Obese participants tended to have less severe disease as assessed by Global Initiative for Chronic Obstructive Pulmonary Disease stage and fewer pack-years of smoking. There was evidence that obesity modified the effects of indoor PM on COPD respiratory outcomes. Increases in PM2.5 and PM2.5-10 were associated with greater increases in nocturnal symptoms, dyspnoea and rescue medication use among obese versus non-obese participants. The impact of indoor PM on exacerbations, respiratory status and wheeze also tended to be greater among obese versus non-obese participants, as were differences in airway and systemic inflammatory responses to indoor PM. We found evidence that obesity was associated with exaggerated responses to indoor fine and coarse PM exposure among individuals with COPD.

Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation

BackgroundAge-related loss of muscle, sarcopenia, is recognised as a clinical syndrome with multiple contributing factors. International European Working Group on Sarcopenia in Older People (EWGSOP) criteria require generalised loss of...

Macitentan reverses early obstructive pulmonary vasculopathy in rats: early intervention in overcoming the survivin-mediated resistance to apoptosis.

It remains unknown whether current disease-targeting therapy can histologically reverse obstructive pulmonary vasculopathy and how the timing of the therapy influences the antiremodeling effects of the compound. We test the hypothesis that a novel endothelin receptor antagonist macitentan reverses the early and/or late stages of occlusive pulmonary vascular disease (PVD) in rats. Rats with pulmonary arterial hypertension (PAH), which were produced by combined exposure to a vascular endothelial growth factor receptor inhibitor Sugen 5416 and hypobaric hypoxia for 3 wk, were assigned to receive macitentan or vehicle during 3-5 wk (early study) or during 5-8 wk (late study) after Sugen injection. Compared with vehicle-treated PAH rats and PAH rats evaluated before treatment initiation, the macitentan-treated rats showed decreases in the proportion of occlusive lesions in the early study, a finding consistent with the reversal of right ventricular systolic pressure and indexes of right ventricular hypertrophy and medial wall thickness. Macitentan ameliorated but did not reverse the proportion of occlusive lesions in the late study. Although macitentan decreased the proportion of Ki67+ lesions in both studies, macitentan increased the proportion of cleaved caspase 3+ lesions and suppressed an antiapoptotic molecule survivin expression in the early study but not in the late study. In conclusion, macitentan reversed early but not late obstructive PVD in rats. This reversal was associated with the suppression of survivin-related resistance to apoptosis and proliferation of cells in PVD.

Effects of guided deep breathing on breathlessness and the breathing pattern in chronic obstructive pulmonary disease: A double-blind randomized control study

ObjectiveTo investigate whether guided deep breathing using a device improves breathlessness, quality of life, and breathing pattern in moderate and severe stage of chronic obstructive pulmonary disease (COPD). MethodsIn total, 150 patients participated in a double-blind randomized controlled trial in a four-week intervention and a four-month follow-up. Participants were randomized into a guided deep breathing group (GDBG), music listening group (MLG), or sitting still group (SSG). The patients’ symptom score using the St George's Respiratory Questionnaire (SGRQ), and a Global Rating Change scale (GRC) was applied to measure breathlessness as primary outcome. The activity score and impact score of SRGQ, and breathing pattern were secondary outcomes. ResultsPositive effects of the GDBG were detected in GRC scale in breathlessness at four weeks (p=0.03) with remaining effect compared to MLG (p=0.04), but not to SSG at four months follow-up. GDBG showed positive effect for respiratory rate (p<0.001) at four weeks follow-up. A positive significant change (p<0.05–0.01) was found in all groups of SGRQ symptom score. ConclusionGDBG had a beneficial effect on respiratory pattern and breathlessness. MLG and SSG also yielded significant improvements. Practice implicationsGuided deep breathing may be used as a self-management procedure.

"The unpredictable death"-The last year of life for patients with advanced COPD: Relatives' stories.

The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives. Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis. All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable. The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.

Assessing the performance of two lung age equations on the Australian population: using data from the cross-sectional BOLD-Australia study.

Lung age, a simple concept for patients to grasp, is frequently used as an aid in smoking cessation programs. Lung age equations should be continuously updated and should be made relevant for target populations. We observed how new lung age equations developed for Australian populations performed when utilizing the Burden of Obstructive Lung Disease (BOLD)-Australia dataset compared to more commonly used equations. Data from a cross-sectional population study of noninstitutionalized Australians aged ≥40 years with analysis restricted to Caucasians <75 years. Lung age calculated using equations developed by Newbury et al. and Morris and Temple was compared with chronological age by smoking status and within smoking status. There were 2,793 participants with a mean age of 57 (±10 SD) years. More than half (52%) ever smoked, and 10.4% were current smokers. Prevalence of chronic obstructive pulmonary disease stage I or higher was 13.4% (95% confidence interval = 12.2, 14.7). For both genders, newer Newbury equations estimated lung ages significantly higher than actual age across all smoking groups (p < .05). Morris and Temple equations resulted in lung age estimates significantly lower than chronological age for nonsmokers (p < .05) but no difference among current smokers. Both equations showed exposure to smoking had lung ages higher than never-smokers (p < .001). Lung age also increased with increased pack-years. This supports the use of updated equations suited to the population of interest. The Australian Newbury equations performed well in the BOLD-Australia dataset, providing more meaningful lung age profile compared to chronological age among smokers. Using equations not developed or ideally suited for our population is likely to produce misleading results.

The surgical technique of bilateral sequential lung transplantation.

Since the first successful lung transplant performed three decades ago, the technique of lung transplantation has evolved with acceptable short- and long-term outcomes such that it has become the standard for those with end stage pulmonary disease. Herein, we describe our current favored approach and discuss some of the current areas in need of further investigation as they relate to the technical aspects of the operation.

Optimization of distal landing zone for TEVAR in chronic dissection.

A 57-year-old male presented four years earlier with bilateral lower extremity pain with signs of malperfusion and hypertension. He was treated with emergency axillofemoral bypass followed by aortobifemoral reconstruction. He was then treated with anti-impulse therapy and followed with regularly scheduled imaging. Comorbidities include severe obstructive pulmonary disease, atrial fibrillation, and early stage prostate cancer. He was referred for evaluation of aneurysmal degeneration in the setting of this chronic dissection. Computed tomography (CT) demonstrated a distal aortic dissection with the proximal entry tear in the descending aorta just beyond the left subclavian artery. The dissection extends retrogradely into the arch to the level of the innominate artery and distally into the iliofemoral arteries. His ascending aorta was dilated to approximately 51 mm and the proximal descending aorta expanded to 60 mm but tapered down to a normal caliber at the level of the diaphragm.

Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation

Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation