Severe Stable COPD Research Articles

Nocturnal Noninvasive Positive Pressure Ventilation in Stable Severe Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease is characterized as a progressive and irreversible inflammatory response in the airways and alveoli because of exposure to noxious particles or gases. Excessive inflammation causes progressive, persistent, and not fully reversible structural changes and airflow limitation. Although COPD is a significant public health problem, diagnosis and treatment stages need to be improved.Nocturnal Noninvasive Positive Pressure Ventilation is one of the treatment modalities of choice for COPD exacerbation, and the role and benefits of NPPV in COPD exacerbation are well defined, but the use of nocturnal NPPV on stable severe COPD individuals is controversial, and the evidence is not sufficient yet. This review evaluates the effects of nocturnal NPPV on stable COPD patients.

Iron Replacement and Redox Balance in Non-Anemic and Mildly Anemic Iron Deficiency COPD Patients: Insights from a Clinical Trial.

In COPD patients, non-anemic iron deficiency (NAID) is a common systemic manifestation. We hypothesized that in COPD patients with NAID, iron therapy may improve systemic oxidative stress. The FACE (Ferinject assessment in patients with COPD and iron deficiency to improve exercise tolerance) study was a single-blind, unicentric, parallel-group, placebo-controlled clinical trial (trial registry: 2016-001238-89). Sixty-six patients were enrolled (randomization 2:1): iron arm, n = 44 and placebo arm, n = 22, with similar clinical characteristics. Serum levels of 3-nitrotyrosine, MDA-protein adducts, and reactive carbonyls, catalase, superoxide dismutase (SOD), glutathione, Trolox equivalent antioxidant capacity (TEAC), and iron metabolism biomarkers were quantified in both groups. In the iron-treated patients compared to placebo, MDA-protein adducts and 3-nitrotyrosine serum levels significantly declined, while those of GSH increased and iron metabolism parameters significantly improved. Hepcidin was associated with iron status parameters. This randomized clinical trial evidenced that iron replacement elicited a decline in serum oxidative stress markers along with an improvement in GSH levels in patients with stable severe COPD. Hepcidin may be a surrogate biomarker of iron status and metabolism in patients with chronic respiratory diseases. These findings have potential clinical implications in the management of patients with severe COPD.

Randomization to Omega-3 Fatty Acid Supplementation and Endothelial Function in COPD: The COD-Fish Randomized Controlled Trial.

Studies suggest a pathogenic role of endothelial dysfunction in chronic obstructive lung disease (COPD). Omega-3 (n-3) polyunsaturated fatty acid (PUFA) supplementation improves endothelial function in other diseases but has not been examined in COPD. We hypothesized that n-3 PUFA supplementation would improve systemic endothelial function in COPD. We performed a pilot randomized, placebo-controlled, double-blind, phase 2 superiority trial (NCT00835289). Adults with moderate and severe stable COPD (79% with emphysema on computed tomography [CT]) were randomized to high-dose fish oil capsules or placebo daily for 6 months. The primary endpoint was percentage change in brachial artery flow-mediated dilation (FMD) from baseline to 6 months. Secondary endpoints included peripheral arterial tonometry, endothelial microparticles (EMPs), 6-minute walk distance, respiratory symptoms, and pulmonary function. Thirty-three of 40 randomized participants completed all measurements. Change in FMD after 6 months did not differ between the fish oil and placebo arms (-1.1%, 95% CI -5.0-2.9, p=0.59). CD31+ EMPs increased in the fish oil arm (0.9%, 95% CI 0.1-1.7, p=0.04). More participants in the fish oil arm reported at least a 4-point improvement in the St George's Respiratory Questionnaire (SGRQ) compared to placebo (8 versus 1; p=0.01). There were no significant changes in other secondary endpoints. There were 4 serious adverse events determined to be unrelated to the study (3 in the fish oil arm and 1 in the placebo arm). Randomization to n-3 PUFAs for 6 months did not change systemic endothelial function in COPD. Changes in EMPs and SGRQ suggest n-3 PUFAs might have biologic and clinical effects that warrant further investigation.

Serum laminin levels in eosinophilic and non-eosinophilic chronic obstructive pulmonary disease patients

Aim: To compare serum laminin levels in eosinophilic and non-eosinophilic (neutrophilic) COPD patients and to define its association with disease severity. Material and Method: This prospective study included patients with mild, moderate, severe, and very severe stable COPD and a control group of patients with a history of smoking but with no signs or symptoms of COPD. Spirometric measurements and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, was used to define the disease severity. Blood eosinophil percentage was recorded from complete blood counts. Serum laminin levels were measured in all patients. Results: A total of 216 patients were included in the study. Ninety were in the eosinophilic COPD, 90 were in the non-eosinophilic COPD and 36 were in the control groups. In both COPD groups, serum laminin levels were significantly higher than in the control group (P = 0.001). In the eosinophilic COPD group, serum laminin levels were significantly higher than the non-eosinophilic COPD group (P = 0.001). With an increase in COPD severity, laminin levels were higher in both COPD groups (P = 0.001). In correlation analysis performed in all COPD patients, laminin levels were positively correlated with eosinophilia percentage (r = 0.316, P = 0.001) and negatively correlated with the FEV1/FVC ratio (r = -0.160, P = 0. 032). Conclusion: Laminin has an important role in eosinophilic COPD and increased serum laminin levels are associated with an increase in serum eosinophilia percentage and a decrease in respiratory capacity.

The Differences in the Levels of Oxidative Status Marker and Soluble CD95 in Patients with Moderate to Severe COPD during an Exacerbation and a Stable Period.

Studying the features of changes in markers of oxidative stress (OS) and inflammation indicators in COPD patients depending on the degree of bronchial obstruction is one of the priority directions for improving the prognosis and monitoring of the course of this pathology. We conducted a comparative investigation of changes in markers of OS and apoptosis at the systemic and local levels in patients with moderate to severe COPD during exacerbation and stable phase. 105 patients with COPD aged 46-67 and 21 healthy nonsmoking volunteers comparable in age were examined. COPD patients were divided into four groups: moderate COPD (GOLDII) during the exacerbation (GOLDIIex, n = 25) and in the stable phase (GOLDIIst, n = 27), severe COPD (GOLDIII) during the exacerbation (GOLDIIIex, n = 29), and in the stable phase (GOLDIIIst, n = 24). We studied the levels of such lipid peroxidation (LPO) products as diene conjugates (DC) and Schiff bases (SB) and parameters of induced chemiluminescence (Imax, total light sum-S, Imax/S) in blood serum, as well as sCD95 concentration in blood and exhaled breath condensate (EBC). The relationship between the values of the OS system indicators with sCD95, as well as with the parameters of lung function, was investigated. Multidirectional changes in OS indicator levels in COPD patients depending on the severity of obstructive airway disorders have been established. The maximum values of DC (0.26 ± 0.046 RU), Imax (0.265 ± 0.19 RLU), and Imax/S (0.13 ± 0.05) were typical for patients with moderate COPD, while the highest SB level (5.7 ± 2.3 RU) was observed in severe COPD during an exacerbation. The exacerbation of the disease was characterized by an increase in DC concentration in both GOLDIIex (0.26 ± 0.046 RU) and GOLDIIIex (0.209 ± 0.02 RU) compared to the stable moderate and severe COPD (0.202 ± 0.028 RU and 0.19 ± 0.03 RU, respectively, p < 0.05). The established decrease in high values of DC, Imax, Imax/S, and sCD95 and an increase in SB concentration in GOLD III can serve as quantitative indicators of the prognosis of the severity of the disease. The serum concentration of sCD95 in GOLDIIex (366.4 ± 70.5 U/ml) and GOLDIIst (361.4 ± 72.8 U/ml) did not differ from the control group (393.7 ± 80.9 U/ml, p > 0.05). In patients with FEV1 < 49% during the exacerbation and stable phase, the serum levels of Imax/S (0.058 ± 0.01 and 0.062 ± 0.01) and sCD95 (318.2 ± 66.3 U/ml and 321.4 ± 42.5 U/ml) were lower than the values of healthy volunteers (0.08 ± 0.01 and 393.7 ± 80.9 U/ml, respectively, p < 0.05). A positive correlation between sCD95 concentration and airway obstruction degree in all examined COPD patients was established. The revealed numerous associations between sCD95 and OS marker levels in GOLDIII indicate a relationship between systemic radical stress and apoptosis processes both in the respiratory tract and the whole body under conditions of severe inflammation. The established correlations between the values of DC, Imax, and sCD95 in the blood serum and the lung function parameters in all studied patients allow us to consider these indicators as additional prognostic indicators of disease intensification. Our work results help clarify the participation and detail of FRO and apoptosis processes in developing pathophysiological features in moderate to severe COPD in different periods and, accordingly, improve the efficiency of diagnosis and treatment of the disease.

A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa.

PurposeThis study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries.Patients and methodsNon-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ).ResultsA total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p<0.001) in GOLD D than in GOLD C patients at each time during the day. In GOLD D, the mean (±SD) GCSQ score was higher at night (1.6±1.2, p<0.001) and in the morning (1.5±1.0, p<0.001) than in the afternoon (1.3±0.9), suggesting daytime variability of breathlessness and chest tightness. Overall, 60.0% of GOLD D patients (versus 13.6% GOLD C, p<0.0001) had difficulty getting out of bed due to COPD. Patients with symptom variability had significantly more difficulty to get out of bed, especially patients with chest tightness variability (p<0.0001) and wheezing variability (p<0.0001). The CDLM global score was significantly lower (p<0.0001) in GOLD D than in GOLD C patients (3.5±1.1 and 4.6 ± 3.5, respectively). Daily variability in chest tightness and wheezing was also significantly associated with CDLM scores (p<0.0001).ConclusionIn MEA countries, patients with severe stable COPD reported significant daily and weekly symptom variability which affects morning activities, particularly in GOLD D patients.

Impact of Gas Masks on the Work of Breathing and Breathing Pattern in Subjects With Stable COPD.

The gas mask constitutes the main respiratory protective equipment in a chemical, biological, radiological, or nuclear environment. The aim of the study was to evaluate the impact of the gas mask on respiratory pattern, gas exchange, and indexes of respiratory effort in patients with moderate to severe stable COPD. Crossover evaluation with 3 randomized-order, 10-min conditions: at rest and with and without a gas mask using 2 different filtered cartridges, each with a distinct inspiratory resistance (cartridge A = 3.5 cm H2O; cartridge B = 2.2 cm H2O, both at 1 L/s). The study involved 8 subjects with COPD, and breathing patterns, indexes of respiratory effort, and capillary blood gases were evaluated. Comparisons of these parameters were made between the tested conditions. Mean subject age was 69 y, and mean FEV1 = 1.3 L (47% predicted). Short-term utilization of the gas mask was associated with a significant increase in the indexes of effort in comparison to baseline without a mask. The esophageal product-time product significantly increased in comparison with baseline (cartridge A = 281 ± 65 cm H2O/s/min, cartridge B = 253 ± 47 cm H2O/s/min, and baseline = 184 ± 46 cm H2O/s/min, P < .001). There were negligible changes in the breathing pattern and gas exchange. Indexes of respiratory effort increased slightly in subjects with stable COPD while using a gas mask. This effect was likely related to increased inspiratory resistance when the mask was worn. These data are reassuring for the potential short-duration use of such protection for patients with moderate to severe COPD.

Correlation of surface respiratory electromyography with esophageal diaphragm electromyography

ObjectivesTo assess the correlation between surface respiratory electromyography(sEMG) and esophageal diaphragm electromyography(EMGdi) at different levels of neural respiratory drive (NRD). DesignRandomised parallel design controlled trial. SettingThe First Affiliated Hospital of Guangzhou Medical University. Participants15 healthy subjects and 1 severe to very severe stable COPD patients were studied. Interventions15 healthy subjects performed incremental inspiratory threshold loading (ILT) and 15 stable COPD patients underwent noninvasive positive pressure ventilation (NPPV).The correlation between EMGdi and sEMG at different NRD levels was analyzed. EMGdi was performed with a multi-pair esophageal electrode catheter; sEMG were was performed by surface diaphragm EMG(located in right anterior axillary line and left anterior axillary line respectively expressed as sEMGdi(r) andsEMGdi(l))、surface parasternal EMG(sEMGpara),and surface sternocleidomastoid EMG(sEMGsc).Signals were normalized using the peak EMG expressed as EMG%max. Primary and secondary outcome measuresThe mean ± standard deviation resting EMGdi%max was higher in patients with COPD than in healthy subjects (57.26%±15.45% vs13.64% ±4.96%, respectively; p < 0.001).During ILT and NPPV, EMGdi was correlated with sEMGdi (r), sEMGdi (1), sEMGpara and sEMGsc (r = 0.90, 0.87, 0.90, 0.90 and r = 0.92, 0.83, 0.92 and 0.71, respectively; all P < 0.001). ConclusionA strong relationship is present between NRD measured by EMGdi%max and NRD measured by sEMG%max. sEMG%max serves as a non-invasive marker of NRD.

Impact of High-Intensity-NIV on the heart in stable COPD: a randomised cross-over pilot study

BackgroundAlthough high-intensity non-invasive ventilation has been shown to improve outcomes in stable COPD, it may adversely affect cardiac performance. Therefore, the aims of the present pilot study were to compare cardiac and pulmonary effects of 6 weeks of low-intensity non-invasive ventilation and 6 weeks of high-intensity non-invasive ventilation in stable COPD patients.MethodsIn a randomised crossover pilot feasibility study, the change in cardiac output after 6 weeks of each NIV mode compared to baseline was assessed with echocardiography in 14 severe stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and health-related quality of life were investigated.ResultsThree patients dropped out: two deteriorated on low-intensity non-invasive ventilation, and one presented with decompensated heart failure while on high-intensity non-invasive ventilation. Eleven patients were included in the analysis. In general, cardiac output and NTproBNP did not change, although individual effects were noticed, depending on the pressures applied and/or the co-existence of heart failure. High-intensity non-invasive ventilation tended to be more effective in improving gas exchange, but both modes improved lung function and the health-related quality of life.ConclusionsLong-term non-invasive ventilation with adequate pressure to improve gas exchange and health-related quality of life did not have an overall adverse effect on cardiac performance. Nevertheless, in patients with pre-existing heart failure, the application of very high inspiratory pressures might reduce cardiac output.Trial registrationThe trial was registered in the Deutsches Register Klinischer Studien (DRKS-ID: DRKS00007977).

A systematic review with meta-analysis of fluticasone furoate/vilanterol combination for the treatment of stable COPD

BackgroundCurrent guidelines recommend the use of inhaled corticosteroids/long-acting beta2-agonists as first-line therapy for COPD patients at risk for acute exacerbations and/or severe airflow limitation. This systematic review assesses available evidence on the efficacy and safety of fluticasone furoate/vilanterol (FF/VI) combination versus each alone, for the treatment of patients with severe to very severe stable COPD. MethodsRandomized, placebo-controlled trials of >8 weeks of duration were included. Primary end points were pulmonary function, COPD exacerbations and serious adverse events. FF/VI was compared with its mono-components. ResultsFive reports with six trials (n = 15,515 patients) met the entry criteria. FF/VI was associated with significant increases in trough FEV1 compared with vilanterol (VI) and fluticasone furoate (FF) (45 mL and 90 mL respectively). FF/VI significantly reduced the number of subjects with at least one moderate to severe exacerbation compared with VI (number needed to treat for benefit [NNTB] = 21) and with FF (NNTB = 26). There were no statistical differences in the rates of serious adverse events, cardiac events and all-cause mortality. On the contrary, FF/VI showed a significant 52% increase in the rate of pneumonia compared with VI monotherapy (5.3% vs. 3.5%). However, there was no difference in the rate of pneumonia when FF/VI was compared with FF alone. ConclusionsFF/VI combination was associated with a decrease of the rate of COPD exacerbations, without affecting mortality or cardiovascular outcomes in patients with moderate to severe stable COPD. Also, the use of FF was associated with an increased risk of pneumonia.

Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation

IntroductionHigh flow nasal cannula (HFNC) was shown to washout the anatomical dead space, permitting a higher fraction of minute ventilation to participate in gas pulmonary exchanges. Moreover, it is able to guarantee the desired inhaled oxygen fraction (FiO2) even at high level of patient's minute ventilation by minimizing the room air entrainment. The effect of HFNC has never been investigated on stable severe COPD patients in term of endurance capacity with standardised laboratory tests. Method/DesignWe performed, in a randomized crossover study, two constant load exercise tests at the 75% of maximum workload achieved at a previous incremental exercise test on cycle-ergometer: with (HFNC-test) and without HFNC (Control-test). Both constant load tests were fulfilled at the same inhaled oxygen fraction (isoFiO2). ResultsThe endurance time significantly increased in the HFNC-test compared to the Control-test (the mean difference between the two groups was 109 ± 104 s, p < 0.015). At iso-time, HFNC-test showed a better oxygen saturation (95 ± 3% vs 89 ± 3%, respectively, p < 0.005) either in the subgroup of patients who used supplemental oxygen and in the subgroup who did not. Moreover, a significantly lower dyspnea (median of 5.5 vs 10, respectively, p = 0.002) and leg fatigue score (median of 5 vs 9.5, p = 0.002) was recorded at iso-time during HFNC-test. ConclusionHFNC may improve the exercise performance in severe COPD patients with ventilatory limitation. This effect is associated to an improvement of SaO2 and perceived symptoms at iso-time. In a Pulmonary Rehabilitation program HFNC may allow a given high intensity load to be sustained for a longer time with less symptoms.

The Efficacy of Non-Invasive Mechanical Ventilation as a Rescue Therapy for Relieving Dyspnea in Patients With Stable Severe COPD

The Efficacy of Non-Invasive Mechanical Ventilation as a Rescue Therapy for Relieving Dyspnea in Patients With Stable Severe COPD

Impact of anaemia on lung function and exercise capacity in patients with stable severe chronic obstructive pulmonary disease

ObjectiveThis study intended to search for potential correlations between anaemia in patients with severe chronic obstructive pulmonary disease (COPD; GOLD stage III) and pulmonary function at rest, exercise capacity as...

Role of oxidative stress and serum lipid levels in stable chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) has been associated with increased oxidative stress or reduced antioxidant resources. The main goal of this study was to evaluate the levels of serum ischemia-modified albumin (IMA), oxidized low-density lipoprotein (ox-LDL), total oxidant status (TOS), and total antioxidant status in patients with stable COPD, compared with a control group. MethodsThis study was performed on 51 patients with stable COPD (42 men and 9 women; mean age 56.92 ± 3.0 years) and 45 healthy control participants (32 men and 13 women; 54.8 ± 3.8 years). The levels of serum lipids, IMA, total antioxidant status, TOS, and ox-LDL were measured in all participants. ResultsThe levels of serum IMA, ox-LDL, and TOS were significantly higher in patients with COPD than those in control individuals. There was no difference between the levels of serum total antioxidant status, triglycerides, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) of patients with COPD and those of control individuals. Serum high-density lipoprotein cholesterol levels were significantly lower in patients with COPD than in control individuals. ConclusionOur study indicated that serum IMA, ox-LDL, and TOS may be increased as a result of chronic hypoxia, inflammation, and oxidative stress in patients with severe and very severe stable COPD. Our findings also revealed that IMA is higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stages II, III, and IV, while TOS and ox-LDL are higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stage IV. Measurements of serum IMA, TOS, and ox-LDL levels may be useful markers in the evaluation of stable COPD.

Non invasive ventilation as an additional tool for exercise training

Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance. Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients. Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking. Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined.

Non invasive ventilation as an additional tool for exercise training.

Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance.Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients.Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking.Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined.

The effects of high intensity exercise during pulmonary rehabilitation on ventilatory parameters in people with moderate to severe stable COPD: a systematic review.

ObjectiveThe objective of this systematic review was to determine whether people with moderate to severe COPD who are participating in pulmonary rehabilitation and exercising at high intensity demonstrate the changes in ventilatory parameters that are associated with decreased dyspnea.Data sourcesThe authors searched EMBASE, The Cochrane Library, and CINAHL databases up to December 2013 for relevant randomized control trials, systematic reviews, and observational studies. References of identified studies were also screened.Study selectionStudies conducted in a pulmonary rehabilitation setting that included education and exercise were included. Symptom-limited, graded exercise testing that measured tidal volume, respiratory rate, minute ventilation, and inspiratory capacity was required. The studies that contained these keywords in the title or the abstract were selected for further evaluation of the text. Disagreements between reviewers were resolved by consensus. Four studies met these inclusion criteria.Data extractionQuality assessment and data extraction were performed independently by two reviewers. Risk of bias and quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.Data synthesisParticipants in three studies trained at high intensity (70%–80% maximum workload), demonstrating statistically significant changes in tidal volume and respiratory rate. One study did not demonstrate positive ventilatory benefits; however, participants may not have met the desired training intensity. Two studies reported improvement in dyspnea at submaximal exercise intensities. One study noted an increased maximum workload with no significant change in dyspnea at peak exercise.ConclusionPeople with moderate to severe, stable COPD were able to perform high intensity exercise, which was associated with positive changes in ventilatory parameters and dyspnea. A number of factors limit the generalizability of these results to people participating in pulmonary rehabilitation.

Innate immunity but not NLRP3 inflammasome activation correlates with severity of stable COPD

BackgroundIn models of COPD, environmental stressors induce innate immune responses, inflammasome activation and inflammation. However, the interaction between these responses and their role in driving pulmonary inflammation in stable COPD...

A Survey on Thyroid Hormonal Status among Moderate to Severe Stable Chronic Obstructive Pulmonary Disease

Background:COPD is one of the common diseases in pulmonary medicine. Current knowledge indicated that there was a link between COPD with thyroid hormonal abnormalities. Thyroid function disturbances can be able to affect on the COPD through upper airway obstruction,respiratory muscle weakness, development of central and obstructive sleep apnea,alveolar hypoventilation, and pleural effusion. Thyroid abnormalities are often both detectable and treatable. The aim of the study is to assessserum levels of thyroid hormones among moderate to severe stable COPD patients.Methods: 34 men were enrolled consecutive among established and stable COPD patients with moderate to the severe stages. Their selection constructed on the ATS/GOLD guidelines. Thyroid functions and hormonal concentrations measured according to manufacturer's instructions.Results:Mean age of sample was 51.7±5.76SD years. It ranged over 42–60 years (Mode=49). Significant thyroid hormonal abnormalities were detected among established moderate to the severe COPD patients. The mean±SD of TSH, TT4 and free T3 concentrations in the focus population was 2.36±1.53 microIU/ml, 12.15±2.15 Micro/dl and 2.20±0.45 pg/ml, respectively. Frequency distribution of thyroid disorders included euthyroid functions 76.5%; three subjects of those had euthyroid sick syndrome, subclinical hyperthyroidism 20.6% and over hypothyroidism 2.9%, respectively. Grades of goiter on WHO classifications observed 0=44% and 1=41%.Conclusion:Frequent exacerbations of thyroid disorders were detected among stable, moderate to severe COPD patients. Subclinical hyperthyroidism and euthyroid sick syndrome were significant. Despite that prevalence of hypothyroidism is considerable in age-rang of Iranian’s population.

Variability of Respiratory Symptoms in Severe COPD

Introduction While it is known that asthma symptoms have a very variable pattern, the general belief is that the respiratory symptoms in COPD patients usually present little or no variability. Nevertheless, COPD patients report having “bad days”. The objective of this present study was to evaluate the variability of the respiratory symptoms and their impact on the daily activities of a cohort of Spanish COPD patients. Method We present the results of the Spanish patients who participated in a cross-sectional epidemiological study carried out in 17 European countries. Pulmonologists and Family Care physicians recruited patients with stable severe COPD (FEV1 < 50%). The perception of the patients on the variation in their symptoms was recorded by telephone interviews. Results A total of 472 patients provided data that were valid for analysis. Mean age was 68.6; 93% were men; mean FEV1(%) was 41%. 84.1% of the patients experimented at least one respiratory symptom in the previous week and 60.9% affirmed that their symptoms varied over the course of the day or week. The moment of the day when the symptoms were perceived to be more intense was during the morning. Conclusions An important proportion of severe COPD patients perceive variability in their respiratory symptoms, with a greater intensity in the morning. The observation can have implications in treating patients with severe COPD as variability can be an initial sign of decompensation of the disease.