Pulmonary Function In Chronic Obstructive Pulmonary Disease Research Articles

The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: A meta-analysis.

Osteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), of patients with COPD. A PubMed/Medline search was conducted using the search terms "chronic obstructive pulmonary disease", "osteoporosis" and "vertebral compression fracture". Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. PROSPERO registration: CRD42019120335. Of the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883 (24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24; 4.64, I2=89%, P<0.01), decreased FEV1/FVC with a mean difference of -4.80% (95% CI: -6.69; -2.90, I2=83%, P<0.01) and decreased FEV1, with a mean difference of -4.91% (95% CI: -6.51; -3.31, I2=95%, P<0.01) and -0.41 L (95% CI: -0.59; -0.24, I2=97%, P<0.01), compared to control subjects. Apart from FEV1 (liters) in subgroup 1 (P=0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies. Osteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD.

Efficacy of Pippali Rasayana as an Adjuvant Therapy on Pulmonary Function in Patients of Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic, recurrent condition, prevalent in the general population. In modern medicine, treatment modalities are aimed to diminish the incidence and extreme aggravation of clinical features. Nowadays, pippali rasayana being considered as a promising treatment approach for COPD. However, due to methodological limitations, there is no strong evidence to support pippali rasayana. &#x0D; Aim: The goal of the study is to evaluate the efficacy of Pippali Rasayana on pulmonary function in COPD patients&#x0D; Materials and Methods: It is double arm randomized placebo controlled single blind clinical trial. Total 60 patients of COPD will be randomly divided into two groups (each group contain 30). In both groups, standard treatment of modern medicine will be continued. With this, in Group A (Intervention), pippali rasayana 5 gm (25 gm twice a day after meal ) with honey will be given for 45 days and Group B (placebo group) will be given placebo (250 mg twice a day after meal ) with water for 45 days. Assessment will be done on 15th, 30th and 45st day.&#x0D; Results: Result will be declared on the basis of effect of pippali rasayana with pulmonary function test as well as frequency of Dyspnea, Chronic cough, Excessive sputum production.&#x0D; Conclusion: This trial may provide evidence on the efficacy of pippali rasayanaon pulmonary function in COPD.

Serum cadmium positively correlates with inflammatory cytokines in patients with chronic obstructive pulmonary disease.

Cadmium is a ubiquitous toxic heavy metal and environmental toxicant. Inflammation exerts central roles in the process of chronic obstructive pulmonary disease (COPD). However, few epidemiological studies on the correlation between cadmium exposure and COPD are available. The aim of this study was to evaluate the correlations among serum cadmium, inflammatory cytokines and pulmonary function in COPD patients. All 940 COPD patients were finally recruited in this study. Demographic characteristics and clinical information were extracted. Fasting serum was collected. Serum cadmium was detected through graphite furnace atomic absorption spectrophotometry. Serum inflammatory cytokines were measured using enzyme-linked immunosorbent assay. All patients were classified into three groups according to the tertile division of serum cadmium concentration: low (<0.77 μg/L, L), medium (0.77-1.01 μg/L, M), and high (1.01 μg/L, H). Logistic regression analysis found that serum cadmium was inversely correlated with pulmonary function before and after adjusted confounding variables. When stratified by gender, serum cadmium was still negatively correlated with pulmonary function in COPD patients. Moreover, higher serum cadmium elevated CAT (COPD Assessment Test) score before and after adjusted confounding variables. Though a non-linear association between serum cadmium and inflammatory cytokines, serum cadmium was positively associated with inflammatory cytokines (TNF-α and MCP-1). TNF-α and MCP-1 exerted a partial mediator in the association between cadmium exposure and pulmonary function decline in COPD patients. Serum cadmium concentration is inversely correlated with pulmonary function among COPD patients. Inflammatory cytokines may be important mediators for cadmium-induced pulmonary function decline in COPD patients.

The Relationship of Lymphocyte to High-Density Lipoprotein Ratio with Pulmonary Function in COPD.

PurposeThis study aimed to explore the relation between lymphocyte to high-density lipoprotein ratio (LHR) and pulmonary function of chronic obstructive pulmonary disease (COPD) patients compared with neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR).Patients and MethodsIn total, 154 participants (n = 77 with COPD and n = 77 without COPD) were recruited. LHR, NLR, PLR, lung function and other data were collected and compared. Pearson’s correlation test and the receiver operating characteristics curves were used to compare the utility of LHR, NLR and PLR. Besides, univariate and multivariate logistic regression analyses were conducted.ResultsCOPD patients with poorer lung function had a lower LHR level (P < 0.001). In low LHR group, more patients underwent greater airflow limitation than the other group (P = 0.006). LHR positively correlated with forced expiratory volume in 1 second in percent of the predicted value (FEV1%) (r = 0.333, P = 0.003). At a cut-off value of 2.08, the sensitivity and specificity of LHR in predicting FEV1% < 50 were 93.2% and 55.6%, respectively, with an AUC of 0.770 (P = 0.001) better than NLR and PLR. Based on logistic regression analyses, it was proved that LHR was associated with decreased risk of FEV1 <50% predicted in COPD patients (odds ratio = 0.198, 95% CI: 0.048–0.811, P = 0.024).ConclusionIn contrast with NLR and PLR, LHR has higher accuracy for predicting pulmonary function in COPD; lower LHR level is independently associated with poorer pulmonary function.

Management of cardiovascular comorbidities in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) is а highly prevalent, complex and heterogeneous clinical condition which is associated with significant concomitant diseases. COPD and cardiovascular diseases (CVDs) often coexist due to the high prevalence of each of these pathological conditions separately as well as the common risk factors (particularly smoking), mechanisms of interaction and influence of systemic inflammation. In addition, decreased pulmonary function in COPD is closely associated with an increased risk of congestive CVDs. One of the most important pathophysiological markers of COPD—lung hyperinflation—plays a significant role in the appearance of functional limitations of the pumping function of the heart, creating unfavorable conditions by exerting a compression effect on the heart muscle. The latter was confirmed by significant correlation between the COPD severity according to GOLD classification and the basic dimensions of the heart chambers. Several decades ago, the term “microcardia” was commonly used and indicated a radiological sign of emphysema. Some studies demonstrated a close relationship between the chance of occurrence of CVD and the severity of pulmonary dysfunction. Such an association has been demonstrated for the whole spectrum of CVD—including cerebrovascular disease, congestive heart failure (CHF) and rhythm disturbances—and was detected in the early stages of the disease. A large proportion of patients with mild and moderate COPD die due to CVD, which is much more likely than deaths in the same group due to respiratory insufficiency. COPD patients have a higher rate of hospitalization and death, the cause of which are coronary heart disease (CHD), stroke and CHF. Treatment of COPD today is mainly determined by national and international clinical guidelines, which should pay more attention to the problems of the treatment of COPD patients with comorbid conditions.

Measuring Airway Resistance and Characterizing the Flow‐Volume Envelope with External Expiratory Loading in Healthy Adults

Expiratory flow limitation is a key characteristic in chronic obstructive pulmonary disease (COPD). Increased airway resistance occurs due to bronchoconstriction, destruction of elastic tissue in the airways, and mucus hypersecretion from goblet cells caused by irritation of the epithelium. Obstruction can lead to dynamic hyperinflation, dyspnea, and exercise intolerance. However, increased airway resistance is just one of many abnormalities in COPD and asthma ‐ COPD in particular is an exceedingly heterogeneous disease. Therefore, isolating the effects of expiratory airflow limitation is challenging.PURPOSEIn order to study abnormal lung mechanics in isolation, we measured pulmonary function with and without expiratory loading in healthy adults.METHODSForty‐eight volunteers (26±5 yr, 171.8±10.2 cm, 72.2±13.3 kg) completed spirometry and body plethysmography according to the ATS/ERS standards under three randomized conditions: control, expiratory loading of 7 and 11 cmH2O. The expiratory load was added by installing a threshold inspiratory muscle trainer in reverse. We analyzed the shape of the flow‐volume (F‐V) loops with rectangular area ratio (RAR) using custom MATLab software.RESULTSAirway resistance was increased (F[1.5, 27.5]= 446.0, p&lt;0.05) with 7 and 11 cmH2O vs control (9.20±1.02 and 11.76±1.68 cmH2O vs. 2.53± 0.80 cmH2O). RAR (F[1.9, 77.9]= 3.71, p&gt;0.05) was reduced with 7 and 11 cmH2O vs control (0.45±0.07 and 0.47±0.09L vs. 0.48±0.08L). FEV1 was reduced (F[1.6, 60.38.6]= 67.54, p&lt;0.05) with 7 and 11 cmH2O vs control (3.26±0.82 and 3.23±0.79L vs. 4.03±1.04L). FVC was also reduced (F[1.5, 55.31] = 77.71, p&lt;0.05) with 7 and 11 cmH2O vs control (4.15±1.01 and 4.17±1.02L L vs. 5.05±1.33L L). PEF was reduced (F[1.5, 55.99] = 72.69, p&lt;0.05) with 7 and 11 cmH2O vs control (6.02±1.65 and 5.95±1.85L vs. 8.39±2.85L L). FEV1/FVC (F[1.9, 69.17] = 5.5, p&gt; 0.05) and FRC (F[1.863, 33.53]= 0.93, p&lt;0.05) were not different between resistance conditions or compared to the control.CONCLUSIONSExpiratory loading reduced FEV1, FVC, PEF and provided a doseresponse in airway resistance and RAR. There were no differences in FEV1/FVC. While RAR was reduced with expiratory loading, the magnitude was of little clinical importance. Therefore, a concave expiratory F‐V relationship was consistently absent – a key limitation for model comparison with pulmonary function in COPD. This is most likely due to the imposed resistance being applied outside of the airways, leading to higher airway pressures. The higher airway pressures are likely to resist dynamic airway compression and either maintain the equal pressure point position or possibly move it proximally.

Imposed Expiratory Resistance and Pulmonary Function in Young Healthy Volunteers

Expiratory flow limitation is a primary characteristic in chronic obstructive pulmonary disease (COPD) and asthma. High airway resistance results from bronchoconstriction, destruction of elastic tissue, and mucus hypersecretion caused by irritation of the epithelium. As a result, the airways become narrowed. Obstruction can lead to dynamic hyperinflation, dyspnea, and exercise intolerance. However, increased airway resistance is just one of many abnormalities in COPD and asthma – COPD in particular is an exceedingly heterogeneous disease. Isolating the effects of expiratory airflow limitation, alone, is therefore challenging. In order to study abnormal lung mechanics in isolation, we aimed to test whether adjustable imposed external expiratory resistance in young healthy volunteers produced deficits in the flow‐volume relationship similar to that of patients with COPD or asthma.PURPOSEMeasure pulmonary function in young healthy volunteers with and without imposed external expiratory resistance.METHODSThirty‐nine healthy adults (25.6 ± 4.7 years, 171.6 ± 10.5 cm, 72 ± 13.7 kg, 23 men, 16 women) completed standard pulmonary function testing according to the ATS/ERS standards. The testing included four conditions in random order: control, imposed expiratory loading of 7 cmH2O, 11 cmH2O, and 20 cmH2O. Resistance was imposed with a threshold inspiratory muscle trainer (Vacumed, Ventura, CA) installed in reverse in the spirometer (Parvo Medics, Sandy, UT). Volunteers with FEV1/FVC&lt;0.70 were excluded from analysis (n=6).RESULTSParticipants had reduced FEV1 (F[1.6, 51.8] = 68.2, p &lt; 0.05) at 7 and 11 cmH2O vs. control (3.28 ± 0.84 and 3.26 ± 0.83 L, respectively, vs. 4.10 ± 1.08 L). FVC was reduced (F[1.4, 45.6] = 71.6, p &lt; 0.05) at 7 and 11 cmH2O vs control (4.15 ± 1.05 and 4.16 ± 1.05 L, respectively, vs. 5.10 ± 1.36 L). FEV1/FVC was reduced (F[1.5, 46.5] = 5.4, p &lt; 0.05) at 7 and 11 cmH2O vs control (77.6 ± 8.48 and 78.7 ± 6.18 %, respectively, vs. 80.7 ± 5.30 %). PEF was reduced (F[1.6, 51.5] = 74.7, p &lt; 0.05) with 7 and 11 cmH2O vs control (6.12 ± 1.73 and 6.07 ± 1.91 L/s, respectively, vs. 8.70 ± 2.87 L/s).Volunteers with additional imposed expiratory loading of 20 cmH2O (n=7) had reduced FEV1 (F[3, 18] = 10.6, p &lt; 0.05) at 11 and 20 cmH2O vs. control (3.07 ± 0.52, and 3.15 ± 0.63 L, respectively, vs. 4.09 ± 0.91 L). FVC was reduced (F[1.2, 6.9] = 16.7, p &lt; 0.05) at 7, 11, and 20 cmH2O vs control (4.01 ± 0.76, 3.93 ± 0.74, and 4.04 ± 0.85 L, respectively, vs. 5.02 ± 1.14 L). FEV1/FVC was reduced (F[3, 18] = 2.7, p = 0.08) at 20 cmH2O vs control (78.5 ± 5.99 % vs. 81.9 ± 5.48 %, p &lt; 0.05). PEF was reduced (F[1.3, 7.6] = 12.9, p &lt; 0.05) with 7 and 20 cmH2O vs control (5.76 ± 1.22 and 5.50 ± 1.78 L/s, respectively, vs. 8.05 ± 2.47 L/s).CONCLUSIONSImposed expiratory resistance reduced key spirometric variables. A concave expiratory flow‐volume relationship was consistently absent – a key limitation for model comparison with pulmonary function in COPD. This is most likely due to the external imposed loading leading to higher airway pressures. This likely resists dynamic airway compression and either maintains the equal pressure point position or possibly moves it proximally.

Bu-Shen-Fang-Chuan formula attenuates T-lymphocytes recruitment in the lung of rats with COPD through suppressing CXCL9/CXCL10/CXCL11-CXCR3 axis

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by irreversible airflow limitation. The current medications show limited effects on the decline of pulmonary function in COPD. Our multicenter clinical trial found that Bu-Shen-Fang-Chuan fomula (BSFCF), a Chinese herbal formula, markedly reduced the frequencies of acute exacerbation of COPD and delayed lung function decline. However, the underlying mechanisms are still unclear. In this study, we established a COPD rat model through a 6-month exposure to cigarette smoke (CS) and found that BSFCF (7.2 g/kg) effectively improved CS-induced reduction in pulmonary function and remarkably decreased the numbers of inflammatory cells in bronchoalveolar lavage fluid (BALF). Importantly, BSFCF treatment notably prevented the accumulation of T-lymphocytes (especially CD8+ T-cells) in the lung of COPD rats. RNA sequencing analysis of lung tissue demonstrated that CXCL9/CXCL10/CXCL11-CXCR3 chemokine axis in the lung of CS-exposed rats was significantly suppressed by BSFCF. Moreover, our Real-time PCR data verified that BSFCF evidently inhibited the mRNA expressions of CXCL9, CXCL10, CXCL11 and CXCR3. Conclusively, BSFCF markedly improved pulmonary function and attenuated CD8+ T-cells recruitment in the lung of CS-exposed rats, which were partially through inhibition of CXCL9/CXCL10/CXCL11-CXCR3 axis.

Identification of Chronic Obstructive Pulmonary Disease Axes That Predict All-Cause Mortality

Chronic obstructive pulmonary disease (COPD) is a syndrome caused by damage to the lungs that results in decreased pulmonary function and reduced structural integrity. Pulmonary function testing (PFT) is used to diagnose and stratify COPD into severity groups, and computed tomography (CT) imaging of the chest is often used to assess structural changes in the lungs. We hypothesized that the combination of PFT and CT phenotypes would provide a more powerful tool for assessing underlying morphologic differences associated with pulmonary function in COPD than does PFT alone. We used factor analysis of 26 variables to classify 8,157 participants recruited into the COPDGene cohort between January 2008 and June 2011 from 21 clinical centers across the United States. These factors were used as predictors of all-cause mortality using Cox proportional hazards modeling. Five factors explained 80% of the covariance and represented the following domains: factor 1, increased emphysema and decreased pulmonary function; factor 2, airway disease and decreased pulmonary function; factor 3, gas trapping; factor 4, CT variability; and factor 5, hyperinflation. After more than 46,079 person-years of follow-up, factors 1 through 4 were associated with mortality and there was a significant synergistic interaction between factors 1 and 2 on death. Considering CT measures along with PFT in the assessment of COPD can identify patients at particularly high risk for death.

The effect of short-term exposure to ambient NO(2) on lung function and fractional exhaled nitric oxide in 33 chronic obstructive pulmonary disease patients

Objectives: To investigate the effect of short-term exposure to ambient NO(2) has influence on lung function and fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) patients. Methods: A panel of doctor-diagnosed stable COPD patients (n=33) were recruited and repeatedly measured for lung function and FeNO from December 2013 to October 2014. The patients who lived in Beijing for more than one year and aged between 60 and 85 years old were included in the study. We excluded patients with asthma, bronchial tensor, lung cancer and other respiratory disorders other than chronic obstructive pulmonary disease and occupational exposure and chest trauma surgery patients. Because the frequency of each subject visiting to the hospital was different, a total of 170 times of lung function measurements and 215 times of FeNO measurements were conducted. At the same time, the atmospheric NO(2) data of Beijing environmental monitoring station near the residence of each patient during the study period were collected from 1 day to 7 days lag before the measurement. Effects of short-term NO(2) exposure on lung function and FeNO in COPD patients were estimated by linear mixed-effects models. Results: The subjects' forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), peak expiratory flow (PEF), and exhaled NO of subjects were (3.26±0.83) L, (1.66±0.61) L, (4.13±1.77) L/s, and (48.99±14.30) μg/m(3), respectively. The concentration of NO(2) was (70.3±34.2) μg/m(3) and the interquartile range (IQR) was 39.0 μg/m(3). Short-term exposure to NO(2) resulted in a significant decrease in FVC among COPD patients' which was most obvious in 2 days lag. Every quartile range increased in NO(2) (39 μg/m(3), 2 day) would cause a 1.84% (95%CI: -3.20%- -0.48%) reduction in FVC. The effects of exposure to higher concentration of NO(2) (≥58.0 μg/m(3)) on FVC estimate was -2.32% (95%CI: -4.15%- -0.48%)(P=0.02). No significant relevance of FeNO and NO(2) was observed in this study. Conclusions: Short term exposure to ambient NO(2) may bring down pulmonary function in COPD patients.

The Pharmacological Treatment of Chronic Obstructive Pulmonary Disease.

Inhaled corticosteroids (ICS) are markedly less effective against chronic obstructive pulmonary disease (COPD) than against asthma, and also have worse side effects. Whether ICS should be used to treat COPD is currently a matter of debate. This review is based on pertinent articles retrieved by a selective search in PubMed and the Excerpta Medica Database (EMBASE) carried out in May 2015. We analyzed clinical trials of ICS for the treatment of COPD with a duration of at least one year, along with meta-analyses and COPD guidelines. ICS lower the frequency and severity of COPD exacerbations in comparison to monotherapy with a long-acting ß2-agonist, but have no effect on mortality. Compared to placebo, ICS monotherapy lessens the decline of forced expiratory volume in one second (FEV1) over one year by merely 5.80 mL (statistically insignificant; 95% confidence interval: [-0.28; 11.88]) and only marginally improve quality of life. ICS use in patients with COPD increases the risk of pneumonia. A combination of ICS with a long-acting bronchodilator improves FEV1 by 133 mL [105; 161] and lowers the frequency of severe exacerbations by 39% . The frequency of exacerbations is lowered mainly in patients who have many exacerbations; thus, ICS treatment is suitable only for patients with grade III or IV COPD. ICS monotherapy has no clinically useful effect on pulmonary function in COPD. The main form of drug treatment for COPD is with broncho - dilators, either alone or in combination with ICS. ICS can be given to patients with grade III or IV COPD to make exacerbations less frequent. Patients with an asthma-COPD overlap syndrome (ACOS) can benefit from ICS treatment.

Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study.

ABSTRACTBackgroundThere is limited evidence regarding interactions between pulmonary (dys)function, posture, and mobility of the upper body quadrant in patients with chronic obstructive pulmonary disease (COPD).ObjectivesThis exploratory study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to changes in pulmonary function and compare such variables between patients with COPD and healthy individuals.MethodFifteen patients with COPD (67.93±9.71yrs) and 15 healthy controls (66.80±7.47yrs) participated. Pulmonary function (FEV1, FVC) was assessed with spirometry. Alignment and mobility of the head, thoracic spine, and shoulder were assessed using digital photographs. Pectoralis minor muscle (PmM) length and thoracic excursion were assessed with a measuring tape. Groups were compared and linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function.ResultsPatients with COPD were more likely to have a forward head position at maximal protraction (28.81±7.30º vs. 35.91±8.56º, p=0.02) and overall mobility of the head (21.81±10.42º vs. 13.40±7.84º, p=0.02) and a smaller range of shoulder flexion (136.71±11.91º vs. 149.08±11.58º, p=0.01) than controls. Patients’ non-dominant PmM length and maximal head protraction were predictors of FEV1 (r2 adjusted=0.34). These variables, together with the upper thoracic spine at maximal flexion and thoracic kyphosis at maximal extension, were predictors of FVC (r2 adjusted=0.68).ConclusionOur findings suggest that impaired pulmonary function is associated with muscle length and mobility adaptations. Further studies are needed to understand the underlying mechanisms and clinical value of these relationships.

The correlation between the paired inspiratory and expiratory three-dimensional quantitative CT and pulmonary function test in chronic obstructive pulmonary disease

Objective To investigate the correlation between the paired inspiratory and expiratory quantitative CT and pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 84 patients with COPD were enrolled.For each patient,CT scan was performed in deep inspiration and expiration.Using automatic post-processing software,a three-dimension quantitative measurement was employed to assess the CT parameters of emphysema and air trapping.The correlation between CT and PFT was evaluated by the Spearman rank correlation test and multivariate linear regression analysis. Results The percent 1[Perc1,(-984.28±17.93) HU] and percent 15[Perc15,(-948.35±22.26) HU] from the CT parameters of emphysema were positively correlated with the forced expiratory volume in 1 second predicted (FEV 1%,48.69±23,47),the ratio of forced expiratory volume in 1 second over forced vital capacity[FEV1/FVC,(45.89±15.36) %,r=0.45—0.67,P<0.01],was negatively correlated with the ratio of residual volume to total lung capacity[RV/TLC,(61.32±14.48) %].The other CT parameters of emphysema index (EI) and the parameters of air trapping,the change in relative lung volume with attenuation values from-860 to-950 HU[RVC-860—-950,(17.66±22.36) %],the expiration to inspiration ratio of mean lung density (MLDex/in,0.93±0.06),the expiration to inspiration ratio of lung volume (LVex/in,0.71±0.14) had negative correlations with log FEV1%,FEV1/FVC (r=-0.48—-0.69,P<0.01) and positive correlations with RV/TLC (r=0.41—0.66,P<0.01).The further univariate linear regressions showed that EI,Perc1,Perc15,RVC-860—-950,MLDex/in,LVex/inwere correlated with the parameters of PFTs (Rsquare values of the regression equation,ranged from 0.27 to 0.66,P<0.01).After the pairwise combinations of the parameters of emphysema and air trapping,multivariate stepwise regressions showed betterRsquare values from 0.66 to 0.85. Conclusions CT parameters of emphysema and air trapping can reflect pulmonary function in COPD patients.The combinations of the two types of CT parameters are more correlated with the PFTs parameters. Key words: Lung diseases,obstructive; Respiratory function tests; Tomography,X-ray computed

Effect of Fluticasone With and Without Salmeterol on Pulmonary Outcomes in Chronic Obstructive Pulmonary Disease

Inhaled corticosteroids (ICSs) and long-acting beta(2)-agonists (LABAs) are used to treat moderate to severe chronic obstructive pulmonary disease (COPD). To determine whether long-term ICS therapy, with and without LABAs, reduces inflammation and improves pulmonary function in COPD. Randomized, placebo-controlled trial. (ClinicalTrials.gov registration number: NCT00158847) 2 university medical centers in The Netherlands. 114 steroid-naive current or former smokers with moderate to severe COPD. Cell counts in bronchial biopsies and sputum (primary outcome); methacholine responsiveness at baseline, 6, and 30 months; and clinical outcomes every 3 months. Random assignment by minimization method to receive fluticasone propionate, 500 microg twice daily, for 6 months (n = 31) or 30 months (n = 26); fluticasone, 500 microg twice daily, and salmeterol, 50 microg twice daily, for 30 months (single inhaler; n = 28); or placebo twice daily (n = 29). 101 patients were greater than 70% adherent to therapy. Fluticasone therapy decreased counts of mucosal CD3(+) cells (-55% [95% CI, -74% to -22%]; P = 0.004), CD4(+) cells (-78% [CI, -88% to 60%]; P < 0.001), CD8(+) cells (-57% [CI, -77% to -18%]; P = 0.010), and mast cells (-38% [CI, -60% to -2%]; P = 0.039) and reduced hyperresponsiveness (P = 0.036) versus placebo at 6 months, with effects maintained after 30 months. Fluticasone therapy for 30 months reduced mast cell count and increased eosinophil count and percentage of intact epithelium, with accompanying reductions in sputum neutrophil, macrophage, and lymphocyte counts and improvements in FEV(1) decline, dyspnea, and quality of life. Reductions in inflammatory cells correlated with clinical improvements. Discontinuing fluticasone therapy at 6 months increased counts of CD3(+) cells (120% [CI, 24% to 289%]; P = 0.007), mast cells (218% [CI, 99% to 407%]; P < 0.001), and plasma cells (118% [CI, 9% to 336%]; P = 0.028) and worsened clinical outcome. Adding salmeterol improved FEV(1) level. The study was not designed to evaluate clinical outcomes. Measurement of primary outcome was not available for 24% of patients at 30 months. ICS therapy decreases inflammation and can attenuate decline in lung function in steroid-naive patients with moderate to severe COPD. Adding LABAs does not enhance these effects. .

Neural respiratory drive in healthy subjects and in COPD

The aim of the present study was to use the diaphragm electromyogram (EMG(di)) to compare levels of neural respiratory drive (NRD) in a cohort of healthy subjects and chronic obstructive pulmonary disease (COPD) patients, and to investigate the relationship between NRD and pulmonary function in COPD. EMG(di) was recorded at rest and normalised to peak EMG(di) recorded during maximum inspiratory manoeuvres (EMG(di) % max) in 100 healthy subjects and 30 patients with COPD, using a multipair oesophageal electrode. EMG(di) was normalised to the amplitude of the diaphragm compound muscle action potential (CMAP(di,MS)) in 64 healthy subjects. The mean+/-sd EMG(di) % max was 9.0+/-3.4% in healthy subjects and 27.9+/-9.9% in COPD patients, and correlated with percentage predicted forced expiratory volume in one second, vital capacity and inspiratory capacity in patients. EMG(di) % max was higher in healthy subjects aged 51-80 yrs than in those aged 18-50 yrs (11.4+/-3.4 versus 8.2+/-2.9%, respectively). Observations in the healthy group were similar when peak EMG(di) or CMAP(di,MS) were used to normalise EMG(di). Levels of neural respiratory drive were higher in chronic obstructive pulmonary disease patients than healthy subjects, and related to disease severity. Diaphragm compound muscle action potential could be used to normalise diaphragm electromyogram if volitional inspiratory manoeuvres could not be performed, allowing translation of the technique to critically ill and ventilated patients.

Effect of add-on therapy of tiotropium in COPD treated with theophylline

Although combination therapy with bronchodilators is recommended for chronic obstructive pulmonary disease (COPD), there is insufficient evidence for the efficacy of some combinations of long-acting bronchodilators. We investigated the effects of a combination therapy with tiotropium and theophylline in COPD patients. In a 12-week, open-labeled, parallel-group randomized study, pulmonary functions and dyspnea scores were compared between the combination and theophylline alone therapy at baseline, and 4 and 8 weeks after randomization in COPD. Sixty-one COPD patients completed the trial (31 combination therapy, 30 theophylline alone; mean age 70 years; 58 males; mean dyspnea score 2.0 and forced expiratory volume in one second (FEV1) 1.5 L [62.5% predicted]). FEV1 in the combination group, but not in the theophylline alone, was significantly increased at 4 (1.56 +/- 0.13 L, p < 0.001) and 8 weeks (1.60 +/- 0.13 L, p < 0.001) from the baseline (1.40 +/- 0.12 L). In the combination group, but not the theophylline alone group, the dyspnea score was significantly improved after 4 (p < 0.01) and 8 weeks (p <0.05) compared with baseline. In 17 patients who did not receive theophylline at screening, treatment with 4 or 8 weeks of theophylline alone did not improve dyspnea score or FEV1. Addition of tiotropium therapy to theophylline treatment can improve dyspnea and pulmonary function in COPD. Although this study did not assess whether there was any benefit of adding theophylline to patients treated with tiotropium, tiotropium can be a useful addition in COPD already treated with theophylline.

Interleukin-18 production and pulmonary function in COPD

Interleukin (IL)-18 production and pulmonary function were evaluated in patients with chronic obstructive pulmonary disease (COPD) in order to determine the role of IL-18 in COPD. Immunohistochemical techniques were used to examine IL-18 production in the lungs of patients with very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage IV, n = 16), smokers (n = 27) and nonsmokers (n = 23). Serum cytokine levels and pulmonary function were analysed in patients with GOLD stage I-IV COPD (n = 62), smokers (n = 34) and nonsmokers (n = 47). Persistent and severe small airway inflammation was observed in the lungs of ex-smokers with very severe COPD. IL-18 proteins were strongly expressed in alveolar macrophages, CD8+ T-cells, and both the bronchiolar and alveolar epithelia in the lungs of COPD patients. Serum levels of IL-18 in COPD patients and smokers were significantly higher than those in nonsmokers. Moreover, serum levels of IL-18 in patients with GOLD stage III and IV COPD were significantly higher than in smokers and nonsmokers. There was a significant negative correlation between serum IL-18 level and the predicted forced expiratory volume in one second in patients with COPD. In contrast, serum levels of IL-4, IL-13 and interferon-gamma were not significantly increased in any of the three groups. In conclusion, overproduction of interleukin-18 in the lungs may be involved in the pathogenesis of chronic obstructive pulmonary disease.

Assessment of Pulmonary Function in COPD

Pulmonary function testing is used in the diagnosis of chronic obstructive pulmonary disease (COPD) and the staging of COPD severity. The current diagnostic criterion for airflow obstruction is a ratio of forced expiratory volume in 1 second (FEV (1)) to forced vital capacity (FVC) < 70%. However this absolute definition can lead to false-negative determinations in younger patients and false-positive determinations in the elderly. Nevertheless, screening spirometry is advocated and becomes feasible in the physician office setting with the availability of compact, relatively affordable apparatus that meets the appropriate technical specifications. Spirometry should be complemented by measurement of lung volumes using body plethysmography in those with evidence of airflow obstruction. Small airways disease can be detected by various techniques that measure airway and total respiratory system resistance. There is renewed interest in the forced oscillation technique and impulse oscillometry because of their noninvasiveness and potential ability to distinguish small from larger airway disease. Finally, pulmonary function testing has an important role in preoperative risk assessment; for example, in patients being considered for lung volume reduction surgery or resection of a lung nodule.