Severe Chronic Obstructive Pulmonary Disease Group Research Articles

Assessment of pulmonary function in COPD patients using dynamic digital radiography: A novel approach utilizing lung signal intensity changes during forced breathing

ObjectivesTo investigate the association of lung signal intensity changes during forced breathing using dynamic digital radiography (DDR) with pulmonary function and disease severity in patients with chronic obstructive pulmonary disease (COPD). MethodsThis retrospective study included 46 healthy subjects and 33 COPD patients who underwent posteroanterior chest DDR examination. We collected raw signal intensity and gray-scale image data. The lung contour was extracted on the gray-scale images using our previously developed automated lung field tracking system and calculated the average of signal intensity values within the extracted lung contour on gray-scale images. Lung signal intensity changes were quantified as SImax/SImin, representing the maximum ratio of the average signal intensity in the inspiratory phase to that in the expiratory phase. We investigated the correlation between SImax/SImin and pulmonary function parameters, and differences in SImax/SImin by disease severity. ResultsSImax/SImin showed the highest correlation with VC (rs = 0.54, P < 0.0001), followed by FEV1 (rs = 0.44, P < 0.0001), both of which are key indicators of COPD pathophysiology. In a multivariate linear regression analysis adjusted for confounding factors, SImax/SImin was significantly lower in the severe COPD group compared to the normal group (P = 0.0004) and mild COPD group (P=0.0022), suggesting its potential usefulness in assessing COPD severity. ConclusionThis study suggests that the signal intensity changes of lung fields during forced breathing using DDR reflect the pathophysiology of COPD and can be a useful index in assessing pulmonary function in COPD patients, potentially improving COPD diagnosis and management.

Beta-blockers reduce severe exacerbation in patients with mild chronic obstructive pulmonary disease with atrial fibrillation: a population-based cohort study

Background and objectiveBeta-blockers (BBs) decrease mortality and acute exacerbation (AE) rates in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease; however, information on their effects in patients with...

Correlation of Six Minute Walking Test, Sit to Stand Test and Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Assessment of functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients helps in determining the severity of the disease. While spirometry is the gold standard, six Minutes Walk Test (6MWT) and one minute Sit To Stand Test (STST) are simple and practical tests to assess exercise capacity and physical condition. Aim: To find the diagnostic accuracy of these of 6MWT and one minute STST in comparison with spirometry. Materials and Methods: This cross-sectional study was conducted in the Department of General Medicine at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, from January 2019 to December 2019. All cases of COPD diagnosed using GOLD 2018 criteria were included in the study. Patients performed 6MWT and one minute STST. Heart rate, blood pressure, oxygen saturation, SpO2, dyspnea, and fatigue (Borg scale) were noted pretest and posttest. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. A p-value&lt;0.05 was considered statistically significant. Results: The mean age of the patients was 64.09±8.31,while there were 112 (94.9%) males and 6 (5.1%) female. Overall, 81.54% of the participants had severe/very severe COPD group, walked &lt;332.49 meters, and only 18.46% could walk more than 332.50 m. SpO2 decreased from 93.98±0.82 to 91.75±1.39. During the one minute STST SpO2 decreased from 93.98±0.82 to 91.75±1.39. A positive correlation was observed between the one minute STST, and it had good predictive validity in predicting COPD as compared with spirometry (area under the curve of 0.915 95% CI 0.866 to 0.963, p-value &lt;0.001). 6MWT has a sensitivity of 81.54%, the specificity of 79.25%, and one minute STST had a sensitivity of 89.23%, specificity of 67.92% in predicting COPD. Conclusion: In a remote clinical setting where spirometry is not available, 6MWT and one minute STST are the best methods for assessing COPD severity.

Ultrasonographic evaluation of diaphragm function in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

Some studies have reported using ultrasonic evaluations to assess diaphragm function in patients with chronic obstructive pulmonary disease (COPD). However, they have limitations and thus cannot provide strong evidence to support ultrasound evaluations for diaphragm function and dysfunction severity assessments in this patient population. Additionally, quantitative studies on the relationship between ultrasound evaluations and diaphragm function do not exist. Therefore, we performed a systematic review and meta-analysis to explore the usefulness of ultrasonography for evaluating diaphragm function in patients with COPD. The Cochrane Library, PubMed, Embase, Web of Science, Chinese Biomedical Literature Database, Wanfang Data, China National Knowledge Network, and Chinese Scientific Journal Database (i.e., VIP) databases were searched for literature about ultrasonic evaluations of diaphragm function in patients with COPD for systematic review. We extracted patient demographic, diaphragm mobility, diaphragm thickness, diaphragm thickening score, and other related parameter data using RevMan 5.3 software for the meta-analysis. We included 13 articles in the systematic review, 8 of which (494 participants) were included in the meta-analysis. The degree of diaphragm offset in patients with COPD was significantly lower than that in healthy controls (weighted mean difference [WMD] = -1.34; 95% confidence interval [CI]: -2.15, 0.53; P < .05). The diaphragm deviation was lower in the severe COPD group than in the mild-to-moderate COPD group (WMD = 0.50; 95% CI: -0.01, 1.01; P = .06), but the difference was not significant. Ultrasonography effectively evaluates diaphragm function in patients with COPD. The diaphragm offset can be used as an auxiliary diagnostic index for COPD, which is also related to disease severity.

Investigation of ocular microstructural changes according to disease severity in patients with chronic obstructive pulmonary disease

ObjectifVérifier les variations de l’épaisseur des couches de fibres nerveuses rétiniennes (RNFL) et de la densité vasculaire dans la rétine et le disque optique en présence de bronchopneumopathie chronique obstructive (BPCO). MéthodesAinsi, 66 patients présentant une BPCO et 54 sujets sains appariés pour l’âge et le sexe ont pris part à cette étude transversale prospective. Les patients présentant une BPCO ont été divisés en 3 sous-groupes (atteinte légère, modérée ou grave) d'après les paramètres spirométriques figurant dans les lignes directrices de la Global Initiative for Chronic Obstructive Lung Disease. On a eu recours à l'angiographie-tomographie par cohérence optique (OCTA) pour mesurer l’épaisseur des RNFL, l'aire de la zone fovéale avasculaire (ZFA) de même que la densité vasculaire du plexus capillaire superficiel, du plexus capillaire profond et du plexus capillaire péripapillaire radial. Les résultats ont ensuite été comparés d'un groupe à l'autre. RésultatsOn n'a noté aucune différence significative entre les patients du groupe BPCO et les sujets témoins en ce qui a trait à l'aire de la ZFA ou à l’épaisseur des RNFL (p = 0,891 et p = 0,896, respectivement). La densité vasculaire des patients du sous-groupe BPCO grave était moins élevée dans le plexus capillaire superficiel, comparativement aux autres groupes, mais la différence n’était pas significative (p > 0,05). La densité vasculaire dans le plexus capillaire profond ne différait pas significativement d'un groupe à l'autre dans la région fovéale (p > 0,05), mais était significativement moins élevée dans tous les quadrants parafovéaux chez les patients présentant une BPCO grave. La densité vasculaire dans le plexus capillaire péripapillaire radial était également moins élevée en présence de BPCO grave, surtout dans la région péripapillaire (p = 0,044). ConclusionBien que la BPCO soit d'abord et avant tout une affection pulmonaire, les tissus de l’œil semblent compter parmi ceux qui sont touchés pendant l’évolution naturelle de la maladie. Les effets sont plus prononcés en présence de BPCO grave et se manifestent dans le plexus capillaire profond et dans le plexus capillaire péripapillaire radial.

Severity of chronic obstructive pulmonary disease and risk of one-year mortality after first-time implantation of implantable cardioverter defibrillator: a nationwide study

Abstract Background Current guidelines, on implantable cardioverter defibrillator (ICD), recommend implantation in patients with an expected survival beyond one year. Information on risk of all-cause mortality among ICD recipients with chronic obstructive pulmonary disease (COPD) according to severity of COPD is lacking. Purpose We examined the association between the severity of COPD and risk of all-cause mortality within one year after first-time ICD implantation. Methods We identified patients ≥18 years old undergoing first-time ICD implantation with COPD using Danish nationwide registries (1 January 2000 to 31 December 2018). All patients were eligible for one-year follow-up. We used concomitant COPD-related pharmacotherapy six months prior to ICD implantation and COPD hospitalisations one year prior to ICD implantation to determine severity of COPD from mild to very severe according to Table 1. Multivariable Cox regression was used to assess risk of one-year all-cause mortality according to severity of COPD. Severity of COPD was adjusted for sex, age, year of implantation, primary prevention, type of ICD, history of atrial fibrillation, stroke, peripheral artery disease, diabetes, cancer, chronic renal disease, and dialysis. Results The study population included 1,536 patients with first-time ICD and COPD. The median age was 69.5 years [25th-75th percentile 63.5–74.3 years], and the majority of patients were males (79.4%). Of these, 896 (58.3%) received an ICD for primary prevention, and 485 (31.6%) had cardiac resynchronisation therapy device with defibrillator (CRT-D). In total, 1,348 (87.8%) patients were diagnosed with heart failure. Patients were grouped according to severity of COPD from mild to very severe: Group 1 (N=666), Group 2 (N=72), Group 3 (N=149), Group 4 (N=445), and Group 5 (N=204). Overall, 154/1,536 (10.0%) ICD recipients with COPD died within one year after first-time ICD implantation. No difference in sex and comorbidities was identified according to the five groups of COPD severity. However, ICD recipients with mild intermittent COPD (Group 1) were the youngest (68.3 years [61.8–73.0 years]). According to our multivariable cox regression in Figure 1, patients with very severe COPD (Group 5) were associated with increased risk of all-cause mortality within one year after first-time ICD implantation (adjusted hazard ratio [HR] 1.90 [95% confidence interval [CI]: 1.21–2.98]), compared with mild intermittent COPD (Group 1). The most common causes of death within one year after ICD implantation were attributed to cardiovascular diseases 95/154 (61.7%), respiratory diseases 15/154 (9.7%), and endocrine disorders 12/154 (7.8%). Conclusion In this nationwide study, very severe chronic obstructive pulmonary disease was associated with increased risk of all-cause mortality within one year after first-time implantation of implantable cardioverter defibrillator. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Independent Research Fund Denmark

Role of Optical Coherence Tomography to Measure Retinal Nerve Fiber Layer Thickness in Patient With Chronic Obstructive Pulmonary Disease.

Aim: This study aimed to measure retinal nerve fiber layer thickness with spectral domain optical coherence tomography in patients diagnosed with stable chronic obstructive pulmonary disease. And, comparing the RNFL thickness of stable patients with mild to moderate COPD and severe to very severe COPD patientsPatients and methods: In this prospective case-control study, a total of 120 patients with chronic obstructive pulmonary disease (COPD) have been selected for measurement of retinal nerve fiber layer on spectral domain-optical coherence tomography (SD-OCT). This study included 120 eyes of participants among which 80 were COPD patients (G1) and 40 were healthy participants (control group: G2). The G1 group is further sub-classified into G1A included 40 eyes of 40 patients with mild to moderate COPD and G1B included 40 eyes of 40 patients with severe to very severe COPD. To determine the hypoxic status of patient arterial blood gas analysis was done. The subfoveal choroidal thickness and retinal nerve fiber thickness were calculated using spectral domain OCT, and these readings of OCT are compared with COPD.Results: There was no statistically significant difference between groups according to demographic data. Mean peripapillary retinal nerve fiber layer (RNFL) thickness on SD-OCT was statistically significantly thinner in mild to moderate COPD (106.76±4.39) group and severe to very severe COPD (100.75±4.66) group than in the control group (108.51±4.39); this thinning was more pronounced with increase in the severity of COPD. On comparing macular thickness between three groups, it was found that there were no statistically significant differences in macular thickness (MT) (p=0.684). Subfoveal choroidal thickness (SFCT) was significantly thinner in the COPD groups compared to the control group.Conclusion: Changes in the SD-OCT and retinal nerve fiber layer (RNFL) thickness could be used as indicators for the severity of COPD. And, it can also aid in the early intervention to hypoxic changes in the retina there by decreasing the chances of visual field defect

Evaluation of retinal microvasculature according to stable chronic obstructive pulmonary disease severity and the correlation of pulmonary parameters with optical coherence tomography angiography findings.

Purpose:To evaluate the retinal and optic disc microvascular changes according to disease severity in patients with stable chronic obstructive pulmonary disease (COPD), and the correlation of pulmonary parameters with optical coherence tomography angiography (OCTA) findings.Methods:Forty patients with COPD and 30 age- and sex-matched subjects (control group) were included in this cross-sectional prospective study. The COPD group was then divided into two subgroups according to GOLD classification and disease severity as mild-to-moderate COPD group (group 1) and severe COPD group (group 2). OCTA was performed with 6 mm × 6 mm sections for the macula and 4.5 mm × 4.5 mm sections for the optic disc. Foveal retinal thickness (FRT), peripapillary retinal nerve fiber layer (RNFL) thickness, and vessel density in different sections of the retina and optic disc were analyzed.Results:The mean ages, gender, intraocular pressures, peripapillary RNFL thickness, FRT, and optic disc vessel densities were similar among the groups. Compared to the control group and group 1, group 2 showed significantly lower mean foveal vessel density measurements in superficial and deep capillary plexus (P = 0.014 and P = 0.007, respectively). Cigarette packets/year, exacerbation per year, and Modified Medical Research Council showed significant negative correlations, whereas forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity showed significant positive correlations with foveal vessel densities.Conclusion:COPD severity seems to have a negative effect on OCTA measurements. OCTA may reflect the severity of inflammation and hypoxia in COPD and may provide useful detailed information on the role of retinal vascular changes in the follow-up and progression of patients with COPD.

Relationship between RS time and the severity of chronic obstructive pulmonary disease

Purpose: The aim of our study was to determine whether the RS time measured on an electrocardiogram is associated with the severity of chronic obstructive pulmonary disease (COPD).&#x0D; Materials and Methods: The study population was made up of 100 COPD patients with a mean age of 63 ± 10 years (86% were males). These patients were divided into the mild and moderate COPD (GOLD 1–2) group (n = 45) and the severe and very severe COPD (GOLD 3–4) group (n = 55) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. These groups were compared with each other.&#x0D; Results: Heart rate, P wave axis, QRS axis, RS time, and incidence of right bundle branch block were significantly higher in patients with severe and very severe COPD. In the multivariable analysis, heart rate, P wave axis, and RS time (odds ratio = 1.081) were the independent predictors of severe and very severe COPD. The receiver operating characteristic curve analysis showed that the best RS time cutoff value for the prediction of severe and very severe COPD was 60 ms, with a sensitivity of 69.1% and a specificity of 66.7%.&#x0D; Conclusion: RS time simply measured on an electrocardiogram may be a useful screening test for the quick estimation of patients with severe and very severe COPD.

Long-term macrolide therapy for chronic obstructive pulmonary disease: a population-based time series analysis.

Background:Macrolides are recommended as an adjunctive treatment for patients with moderate to severe chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. The objective of this study was to examine temporal trends in the provision of long-term macrolide therapy, specifically before and after publication of the landmark MACRO trial in August 2011 showing efficacy of macrolides for this indication.Methods:We performed an interrupted time series analysis using population-level health administrative data. The study cohort consisted of all Ontario residents who had COPD, were using at least 1 long-acting inhaler, and were aged 65 years and older between Apr. 1, 2004, and Mar. 31, 2018. We compared the baseline characteristics of eligible patients before and after publication of the MACRO trial. Our primary outcome was overall prevalence of long-term macrolide therapy; secondary outcomes were incidence of COPD-related hospitalizations, emergency department visits and outpatient exacerbations requiring high-dose steroids in each quarter. We performed an interrupted time series analysis to assess for changes in the incidence of macrolide prophylaxis by quarter-year over the study period.Results:The rate of long-term macrolide use increased from 0.8 per 1000 people in 2004 to 13.8 per 1000 people in 2018 (in the severe COPD group, the rate increased from 1.3 to 32.3 per 1000 people). The interrupted time series analysis showed that, before 2011, the prevalence of macrolide prophylaxis increased at a rate of 0.44 (95% confidence interval [CI] 0.39–0.50) per 1000 people per year; after 2011, the rate of increase grew by 1.18 (95% CI 1.07–1.29) per 1000 people to 1.63 (95% CI 1.56–1.69) per 1000 people per year. The seasonal pattern of COPD-related health care visits remained stable over the study period, and there was no detectable reduction in hospitalizations or emergency department visits at the population level.Interpretation:In the past decade, there has been a significant rise in the use of long-term macrolide therapy for patients with COPD. As this practice becomes increasingly common, it will be important to monitor its potential benefits on COPD exacerbations but also its potential effects on adverse events and antimicrobial resistance patterns.

Atrial electromechanical delay and p wave dispersion associated with severity of chronic obstructive pulmonary disease.

The aim of this study was to evaluate atrial electromechanical delay (AEMD) with both electrocardiography (ECG) and echocardiography in patients with Chronic Obstructive Pulmonary Disease (COPD). Total of 110 patients were included in this cross-sectional case-control study. P-wave dispersion (PWD) was measured on a 12-lead ECG. Atrial electromechanical intervals (PA) were measured as the time interval between the onset of the P wave on the ECG and the beginning of the late diastolic A wave. PWD was found to be 40.9±9.2 ms in the healthy control group, 45.6±8.2 ms in the mild COPD and 44.8±8.7 ms in the severe COPD group (p<0.05). Intra-right atrial EMD was found to be 10.7±5.8 ms in mild COPD, 11.0±7 ms in severe COPD, and it was 16.4±7.3 ms in healthy control group (p<0.001). Interatrial EMD was detected to be 29.5±9.1 ms in the control group, 24.1±9 ms in mild COPD group, and 23.9±11.1 ms in the severe COPD group (p<0.001). Both mild and severe COPD groups decreased PWD, increased tricuspid PA and significantly decreased interand right intra-AEMD times in comparison to the control group.

Impact of severe-to-very severe chronic obstructive pulmonary disease on the prognosis of patients with non-small cell lung cancer who received chemotherapy.

Chronic obstructive pulmonary disease (COPD) is associated with poor prognosis in non-small cell lung cancer (NSCLC) patients. There are limited data aboutthe impact of severe-to-very severe COPD on prognosis in patients with NSCLC receiving first-line chemotherapy. To investigate whether severe-to-very severe COPD impacted survival of patients with NSCLC receiving first-line chemotherapy. A retrospective review was performed on 513 consecutive NSCLC patients receiving first-line chemotherapy between February 2014 and May 2018. Prognostic impact of severe-to-very severe COPD was analysed using regression analyses. Totally 258 NSCLC patients (118 non-COPD, 96 mild-to-moderate COPD and 44 severe-to-very severe COPD) were evaluated retrospectively. Kaplan-Meier analysis showed that the median overall survival times in the severe-to-very severe COPD, mild-to-moderate COPD and non-COPD groups were 14.0 months [95% confidence interval (CI): 11.0-17.0], 18months (95% CI: 14.8-21.2) and 19months (95% CI: 15.3-22.7), respectively. The difference was significant between patients with severe-to-very severe COPD and those without COPD (χ2 =6.8, P=0.009) and between patients with severe-to-very severe COPD and those with mild-to-moderate COPD (χ2 =4.0, P=0.045). Multivariate analysis showed that survival time was significantly shorter in the severe-to-very severe COPD group than in the non-COPD group (adjusted hazard ratio: 1.876, 95% CI: 1.161-3.030, P=0.01) and mild-to-moderate COPD group (adjusted hazard ratio: 1.782, 95% CI: 1.046-3.034, P=0.033). Severe-to-very severe COPD may worsen the prognosis of NSCLC patients who received first-line chemotherapy.

Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study.

BACKGROUNDThere is a growing evidence regarding an increased risk of inflammatory bowel disease (IBD) among patients with airway diseases.AIMTo investigate the influence of chronic obstructive pulmonary disease (COPD) on the risk of IBD.METHODSA nationwide, population-based study was conducted using data from the National Health Insurance Service database. A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified. The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria. The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models. The cumulative incidences of IBD were compared between the groups.RESULTSThe COPD group had higher incidences of IBD compared to non-COPD controls (incidence rate, 9.98 vs 7.18 per 100000 person-years, P < 0.001). The risk of IBD in the COPD group was increased by 1.38 (adjusted hazard ratio (HR); 95%CI: 1.25-1.52). The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group (12.39 vs 9.77 per 100000 person-year, P < 0.001). The severity of COPD was associated with an increased risk of IBD (adjusted HR 1.70 in severe COPD, 95%CI: 1.27-2.21 and adjusted HR 1.35 in mild COPD, 95%CI: 1.22-1.49)CONCLUSIONThe incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.

The expression and clinical significance of migration inhibitory factor in human pulmonary tissues with chronic obstructive pulmonary disease

Objective To investigate the expression of macrophage migration inhibitory factor (MIF) in pulmonary tissues from patients with chronic obstructive pulmonary disease (COPD) and the relationship with its clinical features. Methods One hundred and eighty patients who underwent pulmonary bullectomy lobectomy due to pneumatocele from January 2015 to September 2018 in Longgang Central Hospital were enrolled and classified into patients without COPD (control group)and patients with COPD (COPD group), with 90 patients each group. According to the lung function parameters, 90 patients with COPD were divided into the mild COPD group, the moderate COPD group, and the severe COPD group. The levels of mRNA and protein of MIF were measured with RT-PCR, ELISA and Western blot. One-way ANOVA, Pearson correlation analysis and SNK-q test were used to analyze the results with SPSS 18.0, and P<0.05 was considered statistically significant. Results The level of MIF in pulmonary tissues from the control group was obviously lower than those in the COPD group (P<0.05). The level of MIF in pulmonary tissues in the severe COPD group was obviously higher than those in pulmonary tissues in the mild COPD, moderate COPD and control groups (P<0.05). MIF was positively correlated with the lung function parameters (P<0.05). Conclusion The high expression of MIF in pulmonary tissues is closely related to the severity of COPD. Key words: Migration inhibitory factor; Chronic obstructive pulmonary disease; Real time-PCR; ELISA; Western blot

Relationship of chronic obstructive pulmonary disease severity with early and late mortality in elderly patients with hip fracture

IntroductionWe conducted a comparative study to compare patients with and without chronic obstructive pulmonary disease (COPD) and to analyze the effect of COPD severity on mortality in elderly patients with hip fractures who were diagnosed by pulmonologists. The purposes of this study were to compare early and late mortality after hip fracture between COPD and non-COPD patients and to assess risk factors of mortality after hip fractures in elderly patients with COPD. MethodsThis study included 1294 patients (1294 hips) who were diagnosed as having unilateral femoral neck or intertrochanteric fractures and who underwent surgery at two hospitals between 2004 and 2017. The patients were categorized into a non-COPD group (853 patients) and a COPD group (441 patients; mild-to-moderate [354 patients] and severe-to-very severe COPD subgroups [87 patients]). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the non-COPD and COPD groups. Logistic regression analysis was conducted to identify independent factors associated with mortality. ResultsThe 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were 1.3%, 2.5%, 3.5%, 6.6%, and 10.7%, respectively, in the non-COPD group, and 2.9%, 5.7%, 7.7%, 11.8%, and 16.6%, respectively, in the COPD group (p = 0.049, p = 0.004, p = 0.002, p = 0.002, and p = 0.004, respectively). The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates in the severe-to-very severe COPD group were 4.6%, 6.9%, 11.5%, 20.7%, and 26.4%, respectively. In elderly patients with hip fracture, COPD increased the risk of mortality for 1.6 times and 1.7 times at 3 months and 1 year postoperative, respectively. In subgroup analysis, severe-to-very severe COPD was associated with 1.55-fold and 1.65-fold increased postoperative mortality risk at 6 months and 1 year respectively, as compared with mild-moderate COPD. ConclusionsIn elderly patients with hip fracture, the comparison between the COPD and non-COPD patients revealed that COPD was an independent factor of mortality at a minimum of 1-year follow-up, and COPD severity in patients with hip fracture was also a risk factor of 6-month and 1-year mortality.

Effect of A High Intensive Preoperative Rehabilitation on the Perioperative Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible for Lung Cancer Surgery

背景与目的慢性阻塞性肺病(chronic obstructive pulmonary diseases, COPD)降低患者心肺功能，可导致患者围手术期风险增加。本研究拟探讨术前短期高强度肺康复训练对肺癌合并COPD患者肺功能及术后并发症的影响。方法分析2016年6月-2016年12月101例肺癌合并COPD患者的临床资料，其中肺康复训练组43例，常规治疗组58例，比较两组患者肺功能、术后肺部并发症、住院时间等指标，同时比较肺康复训练组训练前后肺功能相关指标。结果两组患者术前一般资料及肺功能无显著差异，康复训练组住院时间更长[(17.23±4.18) d vs (14.41±4.03) d]，但术后住院时间与常规治疗组无显著差异[(8.93±3.78) d vs (9.62±3.98) d]，两组患者术后肺部感染[8例(18.6%) vs 17例(29.3%)]、肺不张[1例(2.3%) vs 1例(1.7%)]、呼吸衰竭[1例(2.3%) vs 2例(3.4%)]等无显著差异。肺康复训练组训练前后FEV1[(2.06±0.45) L vs (2.15±0.45) L, P < 0.001]、PEF[(4.32±0.90) L/s vs (5.15±1.05) L/s, P < 0.001]、PCO2[(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009]改善明显，按亚组分析，康复训练后中-重度COPD亚组FEV1[(0.16±0.05) L (8.6%) vs (0.06±0.05) L (2.8%)]增加值较轻度COPD亚组更明显。结论术前短期肺康复训练可改善肺癌合并COPD患者肺功能，其中中-重度COPD患者肺功能改善更明显。

Evaluation of Left Ventricular Function, Contractility and Ejection Fraction in COPD Patients by Echocardiography

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. According to global initiative for chronic obstructive lung disease, COPD is defined as FEV1/FVC<70% by spirometry. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle, leading to development of pulmonary hypertension, cor-pulmonale, right ventricular dysfunction as well as left ventricular dysfunction. The significance of the right ventricular performance is recognized as one of the factors determining the clinical course and prognosis in COPD, but a potential role of the left ventricle is, however, less studied. The aim of this study was primarily to evaluate left ventricular function in COPD patients by echocardiography and to study the correlation between echocardiography findings and the severity of COPD based on GOLD1 criteria. A total of 100 patients were selected for this study, including 72 male patients and 28 female patients, aged 50–70 years, from outpatient department of medicine department, medical wards, TB and chest ward of Dr Baba Sahib Ambedkar Hospital, Delhi, considering the exclusion and inclusion criteria. In mild COPD group, only one patient was found to have systolic dysfunction out of 52 patients (1.92%), in moderate COPD group, 2 patients had systolic dysfunction out of 32 patients (6.25%), whereas in severe COPD, six patients had systolic dysfunction out of 16 patients (37.5%). So, in total, 9% patients had systolic dysfunction. 28% of patients were found to have left ventricular diastolic dysfunction in our study. COPD patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. A clear correlation was found between value of fractional shortening (FS) of left ventricle (a measure of contractility), and severity of COPD and FS value significantly decreased as the severity of COPD increased. In this study, ejection fraction (EF) was found to be preserved in mild and moderate COPD, albeit mean EF was found to be reduced in moderate COPD. In severe COPD group, EF was significantly lowered.

English

Chronic Obstructive Pulmonary Disease (COPD), the third leading cause of death in the world, causes 3.1 million deaths worldwide1 and represents an important public health challenge that is both preventable and treatable. Globally, the COPD burden is projected to increase in coming decades because of continued exposure to COPD risk factors and ageing of the population. The four factors that predicted the severity most were the body-mass index (B), the degree of airflow obstruction (O), dyspnea (D), and exercise capacity (E), measured by the six-minute-walk test. These variables were used to construct the BODE index, a multidimensional 10-point scale in which higher scores indicate a severe disease and higher risk of death.A total of 60 cases have been studied in ASRAM Medical College, Eluru, during the period between January 2013 and July 2014. A total of 20 controls were selected randomly from the patients who attended master checkup. This prospective study was conducted after the approval from the Ethical Committee of the institution. In this study 56.66% of cases are between age groups of 50 to 70.Mean age of severe disease group is 66 years (SD-11.8). This study also shows a significant decrease in BMI as BODE score increases. Smoking is a well-recognized risk factor for COPD. This study shows a significant association between smoking and BODE index. This study revealed that there was a significant increase in the BODE index in patients with a longer duration of smoking (Pack years). BODE index is a very good predictor of hospitalization. In this study there is a positive correlation between higher BODE index and longer period of hospitalization. This study also elaborates that the distance walked by patients with higher BODE scores is less when compared to other groups and controls. In this study FEV1 levels of BODE score in severe COPD group correlates well. This study concludes that BODE index is a useful tool in assessing the severity of COPD in terms of hospitalization and mortality. As the variables included in BODE index are easy, economical and can be done with ease, it is a reliable method to classify COPD patients and treat them accordingly, especially in situations with resource constraints as in developing countries like India.

Identification of MMP-9 as a biomarker for detecting progression of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a complex immunological disease with multiple pathological features that is primarily induced by smoking together with additional genetic risk factors. COPD is frequently underdiagnosed; forced expiratory volume in the first second (FEV1) is considered to be the main diagnostic measure for COPD, yet it is insufficiently sensitive to monitor disease progression. Biomarkers capable of monitoring COPD progression and severity are needed. In this report, we evaluated matrix metalloproteinase-9 (MMP-9) as an early marker for the detection and staging of COPD, by assessing the mRNA levels of MMP-9 in peripheral blood samples collected from 22 COPD patients, 6 asymptomatic smokers, and 5 healthy controls. Our results demonstrate that the mRNA levels of MMP-9 increased more than two-fold in severe COPD relative to non-COPD smokers or moderate COPD groups. Moreover, in the very severe COPD group, MMP-9 mRNA levels showed a 4-fold increase relative to the non-COPD smokers or the moderate COPD groups, while there was a mild increase (∼40%) when compared to the severe COPD group. Taken together, our results suggest that MMP-9 serves as a biomarker for the grade and severity of COPD.

Association of vitamin D status in the pathogenesis of chronic obstructive pulmonary disease

BackgroundThe most important pathogenic mechanisms involved in the development of chronic obstructive pulmonary disease (COPD) are protease–antiprotease imbalance, inflammation, lung remodeling and oxidative stress. Interestingly, lower vitamin D levels have been related to regulation of each of these processes, that is, higher expression of proteases, modulation of inflammation, modulation of extracellular matrix turnover, and increased oxidative stress. Thus, one can speculate that lower vitamin D levels may be linked to increased risk of developing COPD. In some clinical studies, lower levels of vitamin D, measured as plasma 25-hydroxyvitamin D (25(OH)D), have been associated with lower lung function and faster lung function decline, but the results are conflicting. Aim of the studyThe aim of this study is to evaluate the evidence of the effect of vitamin D on COPD. Subjects and methodsThe present study, included 120 subjects, 80 patients diagnosed as COPD and 40 healthy volunteers (20 smokers and 20 nonsmokers). Plasma 25-OHD was measured by Enzyme Linked Immunosorbent Assay (DiaSorin, Stillwater, Minnesota, USA) in all study participants. ResultsThe mean concentration of 25-OH-D was significantly higher in the reference groups (smokers and nonsmokers) compared with severe COPD group (p=0.001, 0.001) respectively.The mean concentration of 25-OH-D was significantly higher in the reference groups (smokers and nonsmokers) compared with moderate COPD group (p=0.029, 0.049) respectively.The mean concentration of 25-OH-D was not significantly higher in the reference groups (smokers and nonsmokers) compared with the mild COPD group. ConclusionWe observed a novel association of lower plasma 25(OH)D levels with a higher risk of COPD.