Stable COPD Patients Research Articles

Assessment of Oral Bacterial Microflora in Patients with Stable Chronic Obstructive Pulmonary Disorders

Background & Objectives: Chronic obstructive pulmonary disorder is an inflammatory disease characterized by the progressive deterioration of pulmonary function and increasing airway obstruction, includes chronic bronchitis and emphysema. The oral cavity has been considered a potential reservoir for respiratory pathogens. Oral bacteria may play a vital role in the exacerbation of chronic obstructive pulmonary diseases. Hence, we intend to study the bacterial microflora of oral cavity in stable COPD patients. Methods: In this study 20 patients aged between 20 to 60 years diagnosed with stable COPD and 20 normal healthy controls were selected based on the set inclusion and exclusion criteria. A detailed case history, physical examination and investigations and all the subjects were examined for gingival and periodontal status by recording the Oral hygiene which comprises debris index and calculus index and periodontal index and Quantitative oropharyngeal cultures were obtained by oral washing using isotonic saline as the collecting fluid. Results: A significant higher score of OHI(S) and PI was observed in COPD patients. There is a direct correlation between periodontal pathogens with the severity of COPD. Conclusion: The predominant organisms found in the oropharyngeal secretions were porphyromonas gingivalis and haemophilus influenza, in COPD patients.

Circadian pattern of blood pressure in patients with stable COPD

ObjectiveTo describe the circadian blood pressure (BP) pattern in stable COPD patients. MethodsWe included stable COPD patients from Internal Medicine Departments. Office BP and ambulatory BP monitoring were performed. Patients were classified as BP reducers (dipper or extreme dipper) or non-reducers (non-dipper or riser). ResultsWe included 43 patients (5 women, mean age 69.5 ± 9.5 years). Among them, 11 had sustained normotension, 13 sustained hypertension, 2 white coat hypertension, and 17 masked hypertension. Arterial stiffness was observed in 12 (27.9%) patients. Overall, 26 (60.5%) exhibited a non-reducer BP profile. Non-reducers had a higher frequency of previous major cardiovascular events (50% vs. 11.8%, p = 0.020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, p = 0.009). ConclusionsHypertension is often masked in COPD patients, who frequently display an altered circadian BP pattern. Longitudinal studies with larger samples are needed to evaluate the impact of these patterns on COPD progression.

Beneficial Bacteria in the Gut Microbiota May Lead to Improved Metabolic and Immunological Status in Chronic Obstructive Pulmonary Disease.

We included 16 stable COPD patients and 16 healthy volunteer CTLs. The relative abundances of Bifidobacterium spp. (Bf) and Akkermansia muciniphila (Akk) bacteria and the Bacteroidetes and Firmicutes phyla were assessed by qPCR. Pulmonary function was evaluated by spirometry, biochemical parameters by colorimetric methods and plasma cytokine levels by cytometric bead array analysis. The Firmicutes/Bacteroides ratio was related to emergency hospital visits and six-minute walk test (6MWT) results. Furthermore, the relative abundance of Bf was associated with plasma concentrations of glucose, triglycerides, HDL-C and IL-10. In addition, Firmicutes levels and the Firmicutes/Bacteroidetes ratio were associated with the IL-12/IL-10 ratio, while Akk abundance was linked to IL-12 levels. The present findings suggest that the abundance of beneficial bacteria in the GM could influence clinical presentation and immunoregulation in COPD.

Relationship between Respiratory Microbiome and Systemic Inflammatory Markers in COPD: A Pilot Study.

The respiratory microbiome may influence the development and progression of COPD by modulating local immune and inflammatory events. We aimed to investigate whether relative changes in respiratory bacterial abundance are also associated with systemic inflammation, and explore their relationship with the main clinical COPD phenotypes. Multiplex analysis of inflammatory markers and transcript eosinophil-related markers were analyzed on peripheral blood in a cohort of stable COPD patients (n = 72). Respiratory microbiome composition was analyzed by 16S rRNA microbial sequencing on spontaneous sputum. Spearman correlations were applied to test the relationship between the microbiome composition and systemic inflammation. The concentration of the plasma IL-8 showed an inverted correlation with the relative abundance of 17 bacterial genera in the whole COPD cohort. COPD patients categorized as eosinophilic showed positive relationships with blood eosinophil markers and inversely correlated with the degree of airway obstruction and the number of exacerbations during the previous year. COPD patients categorized as frequent exacerbators were enriched with the bacterial genera Pseudomonas which, in turn, was positively associated with the severity of airflow limitation and the prior year's exacerbation history. The associative relationships of the sputum microbiome with the severity of the disease emphasize the relevance of the interaction between the respiratory microbiota and systemic inflammation.

Effects of Baduanjin Exercise on lung function and 6 min walk in COPD patients: a systematic review and meta-analysis

COPD is a public health problem of global concern, which seriously affects the quality of life of patients and is also the third leading cause of death from non-communicable diseases. To investigate the effect of Ba duan jin exercise on lung function and the results of a 6-min walking trial in patients with stable COPD. Literature databases such as Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Literature (CBM), CNKI, Wanfang Data and VIP were searched by computer, the search period is up to January 2024. Literature screening, quality evaluation and data extraction were carried out independently by two researchers. And use RevMan 5.3 software and StataMP 18 (64-bit) software to process the relevant outcome indicators. A total of 16 RCT studies with 1184 patients were included. The meta-analysis results showed that compared with the control group, Ba Duan Jin exercise could improve FEV1 (MD = 0.29, 95% CI (0.20, 0.37), P < 0.0001), FEV1/FVC (%) (MD = 3.86, 95% CI (2.24, 5.47), P < 0.00001), and 6-min walking distance (MD = 45.41, 95% CI (33.93, 56.89), P < 0.00001) in stable COPD patients. The results of subgroup analysis based on the duration of the intervention cycle, research quality, and intervention frequency showed that periodic Ba Duan Jin exercise can significantly improve the relevant lung function levels to varying degrees. At the same time, the intervention effect of Ba Duan Jin exercise during the implementation process is also affected by the duration of the exercise cycle, exercise frequency, and the completion of the exercise plan. Ba Duan Jin exercise has a positive improvement effect on lung function and 6-min walking distance in stable COPD patients. In the process of exercise implementation, attention should be paid to cultivating exercise habits, stabilizing and improving attendance rates, and strictly implementing training techniques to achieve the best clinical outcomes for these patients.

Predictive role of platelets to lymphocytes ratio and neutrophil to lymphocytes ratio in COPD exacerbation

BackgroundThe hallmark of COPD is the progressive destruction of the lung parenchyma, which is frequently brought on by the body's inflammatory reaction to external stimuli (such as smoking cigarettes or pollution). According to reports, the peripheral blood's essential immune-related cell populations' absolute counts and ratios can accurately represent chronic inflammatory diseases. Complex interactions between immune-related cells, such as lymphocytes and neutrophils, are involved in inflammation, which can cause irreversible damage and loss of respiratory tissue. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), two hematological indicators of inflammation, have been studied in a variety of disease states, including solid tumors, systemic lupus erythematosus, coronary artery disease, retinal artery occlusion, chronic kidney disease, and stable COPD.AimCorrelation between NLR and PLR and outcome of COPD exacerbation.Materials and methodsThis cross-sectional study included 80 patients with COPD exacerbation who visited the outpatient clinic or were admitted to the Chest Department. CRP and calculation of NLR and PLR within 24 h from admission and 1 month after discharge were obtained to identify the prognostic value of NLR and PLR for the exacerbation, hospitalization, mechanical ventilation, and mortality in patients with COPD.ResultsDuring COPD exacerbation PLR, NLR showed a statistically significant correlation with the need for hospitalization with a p value < 0.001. As regards correlation with mortality NLR was statistically significant with a p value of 0.006 while PLR showed a non-significant p value of 0.077. PLR and NLR were correlated with CRP as an inflammatory marker and both were statistically significant with p value 0.004 and < 0.001 respectively. During exacerbation, PLR and NLR were correlated with the need for mechanical ventilation and the results were statistically significant with p value < 0.001. PLR and NLR showed a significant increase during exacerbation compared to stable COPD patients 1 month after discharge with p value of < 0.001.ConclusionPLR and NLR are simple tests that could be used to predict the severity of COPD exacerbation and the need for hospitalization, MV, and mortality prediction.

Exploration of quantitative-effectiveness association between acupuncture temporal parameters and stable chronic obstructive pulmonary disease: A systematic review and dose-response meta-analysis of randomized controlled trials

IntroductionChronic Obstructive Pulmonary Disease (COPD) is a globally common chronic respiratory disease with a high morbidity and mortality rate. Acupuncture has been proven effective for COPD. A dose-response meta-analysis was conducted to assess the correlation between the acupuncture temporal parameters(session, frequency, and duration) and its effectiveness in patients with stable COPD. MethodsAcupuncture randomized controlled trials on COPD were searched in eight databases from their inception to June 2023. The "doses" were defined as the acupuncture session, frequency, and duration. The outcomes mainly included Forced Expiratory Volume in one-second rate (FEV1%) and Six-minute Walking Distance (6MWD). The assessment of bias risk and literature quality were conducted independently using the Cochrane risk of bias tool and the Standards for reporting interventions in clinical trials of acupuncture. The dose-response relationship was modeled using robust error element regression, and meta-analysis was operated by R 4.3.1 and Stata 15.0. The protocol was registered in PROSPERO with the registration number CRD42023401406. ResultOut of 1669 records, 17 RCTs with 1165 participants were finally included in the meta-analysis. There was notable heterogeneity among the studies, but sensitivity analysis demonstrated good robustness. The findings revealed a significant improvement in the following outcomes for stable COPD patients in the acupuncture group: FEV1% (MD=3.50, 95%CI: 2.05–4.95), 6MWD (MD=47.39, 95%CI: 29.29–65.50), St. George's respiratory questionnaire (SGRQ; MD=−8.25, 95%CI: −11.38 to −5.12); COPD assessment test (CAT; MD=−2.91, 95%CI: −3.99 to −1.83). The relationship between the acupuncture session, duration, and FEV1%, 6MWD followed a "Λ" curve pattern, while the relationship between acupuncture frequency and FEV1%, 6MWD exhibited logarithmic growth. Firstly, After 12 acupuncture sessions, FEV1% and 6MWD increased by 7.06% (95%CI: 4.56–9.55) and 36.28 m (95%CI: 20.37–52.20), respectively. The peak improvement in FEV1% and 6MWD was observed after 18 acupuncture sessions (MD=7.89, 95% CI: 5.33–10.45) and 45 sessions (MD=125.43, 95% CI: 72.80–178.07) each. Additionally, weekly acupuncture resulted in a 4.14% improvement in FEV1% (95% CI: 2.55–5.72) and a 42.49 m increase in 6MWD (95%CI: 17.16–67.81). Notably, the maximum effects on FEV1% and 6MWD improvement were achieved with different acupuncture frequencies, specifically three times a week (MD=6.00, 95% CI: 5.34–6.66) and once a day(MD=112.41, 95% CI: 77.27–147.56), respectively. Furthermore, after a 28-day duration of acupuncture treatment, FEV1% increased by 4.74% (95% CI: 3.73–5.75) and 6MWD increased by 47.34 m (95%CI: 22.01–72.67). During 60 days of acupuncture treatment, the FEV1% and 6MWD improvement reached their highest levels at 8.76% (95% CI: 7.05–10.47) and 88.06 m (95% CI: 45.96–130.16), respectively. ConclusionAcupuncture was effective in improving FEV1%, 6MWD, SGRQ, and CAT in patients with stable COPD. There was a dose-response relationship between the time parameters of acupuncture (session, frequency, and duration) and the efficacy of COPD treatment (FEV1% and 6MWD). The minimal clinically important difference could be achieved after 12 acupuncture sessions. Acupuncture with a medium-frequency (2–3 times per week) over 60 days may result in the greatest improvement in FEV1%, while higher-frequency acupuncture (5–7 times per week) for 2 months may lead to the maximum improvements in 6MWD. It indicated that the optimal acupuncture duration for different indicators remains consistent, while the optimal frequencies may differ. To confirm these results, it is necessary to conduct multicenter, large-scale randomized controlled trials. Ethics and disseminationEthical approval is not required for literature-based studies. The results will be published in peer-reviewed journals or conferences.

Real-life evaluation of NIV to CPAP switch in patients with chronic respiratory failure. A case control study

BackgroundNon-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea syndrome (OSA) frequently contributes to hypoventilation in CRF patients. CPAP improves hypercapnia in selected COPD and obese patients, like NIV. We aimed to describe the profile of patients switching from NIV to CPAP in a cohort of patients on long-term ventilation and to identify the factors associated with a successful switch. MethodsIn this case-control study, 88 consecutive patients who were candidates for a NIV-CPAP switch were compared with 266 controls among 394 ventilated patients treated at the Dijon University Hospital between 2015 and 2020. They followed a standardized protocol including a poly(somno)graphy recorded after NIV withdrawal for three nights. CPAP trial was performed if severe OSA was confirmed. Patients were checked for recurrent hypoventilation after 1 and 23[14–46] nights under CPAP. ResultsPatients were 53% males, median age 65 [56–74] years, and median BMI 34 [25–38.5] kg/m2. Sixty four percent of patients were safely switched and remained on long-term CPAP. In multivariate analysis, the probability of a NIV-CPAP switch was correlated to older age (OR: 1.3 [1.01–1.06]), BMI (OR: 1.7 [1.03–1.12]), CRF etiology (OR for COPD: 20.37 [4.2–98,72], OR for obesity: 7.31 [1.58–33.74]), circumstances of NIV initiation (OR for acute exacerbation: 11.64 [2.03–66.62]), lower pressure support (OR: 0.90 [0.73–0.92]), lower baseline PaCO2 (OR: 0.85 [0.80–0.91]) and lower compliance (OR: 0.76 [0.64–0.90]). Among 72 patients who went home under CPAP, pressure support level was the only factor associated with the outcome of the NIV-CPAP switch, even after adjustment for BMI and age (p=0.01) with a non-linear correlation. Etiology of chronic respiratory failure, age, BMI, baseline PaCO2, circumstances of NIV initiation, time under home NIV or NIV compliance were not predictive of the outcome of the NIV-CPAP switch. ConclusionsA NIV-CPAP switch is possible in real life conditions in stable obese and COPD patients with underlying OSA.

DO disease stages affect oxidative stress in stable COPD?

BackgroundDetection of oxidative stress level may lead us to understand the pathogenesis of COPD better and to search for new treatments. Oxidative stress levels have also been shown to be elevated in stable COPD patients. We aimed to investigate whether the stage of COPD affects the severity of inflammation-induced oxidative stress in patients with stable COPD. MethodsBetween June 2019 and March 2020, all consecutive patients admitted to COPD-specific outpatient clinics were included. Patients were classified A, B, and E according to the GOLD guideline. ResultsThe median age of 98 patients (Male: 92 (93.9 %)) was 65 (min-max: 49–86). A statistically significant difference was found between the groups in FEV1, FVC, and FEV1/FVC (p < 0.001). age, and thiols (r = −0.168, p = 0.049; r = −0.184, p = 0.035) and DS (r = −0.209, p = 0.019) were found to be negatively correlated at a low level. When adjusted for age, oxidative stress parameters were similar between stages. ConclusionNo difference between stages and oxidative stress parameters according to GOLD classification in stable COPD patients. Our results may be a guide for not using anti-inflammatory therapy except for attacks.

Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score

BackgroundThe objective of this study was to determine whether the concomitant presence of poor health status (COPD Assessment Test, CAT ≥ 10 points) and low exercise tolerance (6-Minute Walking Test, 6MWT < 350 m) is associated with worse clinical characteristics in patients with COPD. In addition, we aimed to develop a readily applicable diagnostic model to discriminate COPD patients with these conditions. MethodsA cross-sectional multicenter study involving 208 stable COPD patients (FEV1/FVC < 0.7, smoking history of at least 10 pack-years, and chronic respiratory symptoms) was carried out. The outcome measures were the 6MWT, CAT score, 5-repetition sit-to-stand test (5STS) and modified Medical Research Council Dyspnea Scale (mMRC). Patients were categorized into three groups: no condition (6MWT ≥ 350 m and CAT < 10 points), one condition (6MWT < 350 m or CAT ≥ 10 points), and both conditions (6MWT < 350 m and CAT ≥ 10 points). ResultsA total of 26 patients (12,5%) presented both conditions. These patients experienced a higher degree of dyspnea (p = 0.001), smoking pack-years (p = 0.011), severe obstruction (p = 0.006), and time on 5STS (p = 0.001). The probability of having both conditions directly increased with the time spent on the 5STS (β=0.188; p = 0.010) and the degree of dyspnea (β=1.920; p < 0.001) (R2=0.413). The scoring system, using the 5STS and dyspnea as surrogate measures, demonstrated adequate calibration between the predicted and observed risk (linear R2=0.852). ConclusionsCOPD patients with concurrent conditions have worse clinical status. The diagnostic model developed to discriminate these patients shows good internal validation.

Factors limiting exercise capacity in COPD patients

Introduction: Impaired exercise capacity in COPD patients leads to deterioration in their physical activity and quality of life. The aim of our study was to assess the exercise capacity of COPD patients using the 6-minute walk test (6MWT) and to determine the factors limiting their exercise capacity. Methods: Stable COPD patients were included in this study to assess their exercise capacity using the 6-minute walk test (6MWT) and to investigate the relationship between exercise capacity, functional status (FEV1), quadriceps muscle dysfunction (strength and endurance), and fat free mass index (FFMI). Results: 175 COPD patients (166 males and 9 females) aged between 40 and 86 years with a mean age of 67.95 years. The functional stages distribution according to GOLD was GOLDI: 19.43%, GOLDII: 30.29%, GOLDIII: 33.71%, GOLD IV: 16.57%. 25% of patients received long-term oxygen therapy (LTOT). The mean distance covered by COPD patients was 432.26 ± 129.731 meters, corresponding to 64.71 ± 19.04%. 56 (32%) COPD patients had exercise intolerance as assessed by the distance walked over 6 minutes (6MWD). A significant correlation was found between the 6MWD, quadriceps endurance (P&lt;0.000) and FEV1 (p&lt;0.002), whereas no correlation was found with MVC (P&lt;0.039) and (FFMI) (P&lt;0.062). Conclusion: Muscle dysfunction and the severity of bronchial obstruction are the factors most associated with impaired exercise capacity in COPD patients.

Effect of respiratory muscle training in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis

ObjectivesChronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder characterized by progressive airflow limitation. This meta-analysis aims to evaluate the effectiveness of respiratory muscle training (RMT) on key pulmonary function parameters, inspiratory muscle strength and quality of life in patients with stable COPD. MethodsA comprehensive search was conducted in the databases including PubMed, Cochrane, Web of Science, Embase, and ClinicalTrials.gov, from their inception to June 12, 2023. Randomized controlled trials (RCTs) evaluating the impact of RMT on stable COPD were included for meta-analysis. ResultsIn total, 12 RCTs involving 453 participants were included in the meta-analysis. RMT demonstrated a significant increase in maximal inspiratory pressure (PImax, MD, 95% CI: 14.34, 8.17 to 20.51, P < 0.001) but not on maximal expiratory pressure (PEmax). No significant improvement was observed in 6-Min walk test (6MWT), dyspnea, forced expiratory volume in 1 s (FEV1), forced vital capacity ratio (FVC) and quality of life between RMT and control groups. However, subgroup analysis revealed a significant negative effect of RMT alone on FEV1/FVC (MD, 95% CI: 2.59, −5.11 to −0.06, P = 0.04). When RMT was combined with other interventions, improvements in FEV1/FVC and FEV1 were found, although not statistically significant. ConclusionRMT can effectively improve maximal inspiratory pressure in stable COPD patients, but the effect is slight in improving lung function, dyspnea and quality of life. It is recommended to combine with other treatment strategies to comprehensively improve the prognosis of COPD patients.

The clinical association of programmed death-1/PD-L1 axis, myeloid derived suppressor cells subsets and regulatory T cells in peripheral blood of stable COPD patients.

Myeloid-derived suppressor cells (MDSCs) have crucial immunosuppressive role in T cell dysfunction in various disease processes. However, the role of MDSCs and their impact on Tregs in COPD have not been fully understood. The aim of the present study is to investigate the immunomodulatory role of MDSCs and their potential impact on the expansion and function of Tregs in COPD patients. Peripheral blood samples were collected to analyze circulating MDSCs, Tregs, PD-1/PD-L1 expression to assess the immunomodulatory role of MDSC and their potential impact on the expansion and function of Treg in COPD. A total of 54 COPD patients and 24 healthy individuals were enrolled in our study. Flow cytometric analyses were performed to identify granulocytic MDSCs (G-MDSCs), monocytic MDSCs (M-MDSCs), Tregs, and the expression of PD-1/PD-L1(L2) on MDSCs and Tregs in peripheral blood. Our results revealed a significantly higher percentage of G-MDSCs and M-MDSCs (p < 0.001) in COPD patients compared to the healthy controls. Additionally, a significantly higher proportion of peripheral blood Tregs was observed in COPD patients. Furthermore, an increased expression of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) on Tregs (p < 0.01) was detected in COPD patients. The expression of PD-1 on CD4+ Tcells and Tregs, but not CD8+Tcells, was found to be increased in patients with COPD compared to controls. Furthermore, an elevated expression of PD-L1 on M-MDSCs (p < 0.01) was also observed in COPD patients. A positive correlation was observed between the accumulation of M-MDSCs and Tregs in COPD patients. Additionally, the percentage of circulating M-MDSCs is positively associated with the level of PD-1 (r = 0.51, p < 0.0001) and CTLA-4 (r = 0.42, p = 0.0014) on Tregs in COPD. The recruitment of MDSCs, accumulation of Tregs, and up-regulation of CTLA-4 on Treg in COPD, accompanied by an increased level of PD-1/PD-L1, suggest PD-1/PD-L1 axis may be potentially involved in MDSCs-induced the expansion and activation of Treg at least partially in COPD.

ĐÁNH GIÁ CHẤT LƯỢNG CUỘC SỐNG - SỨC KHỎE CỦA BỆNH NHÂN PHỔI TẮC NGHẼN MẠN TÍNH (COPD) TẠI BỆNH VIỆN HỮU NGHỊ ĐA KHOA NGHỆ AN NĂM 2023

Improving quality of life (QoL) is an important goal in COPD disease management. There are many tools to assess the QoL of COPD patients, but the CAT questionnaire is considered valuable and reliable in practice. The study was conducted to determine the reliability and validity of the CAT questionnaire on COPD patients at Nghe An General Friendship Hospital. 150 stable COPD patients at a respiratory clinic were studied using cross - sectional description. The results showed that the average score of 8 research areas in stable COPD patients was 21.15. Clinical impact of COPD according to CAT score at moderate and high levels. COPD is common in men over 48 years old. Smoking, disease stage, difficulty breathing and FEV1 are all related to QoL. A strong, positive correlation between MRC and CAT has been found. The more severe the difficulty breathing, the worse the QoL - health. On the contrary, between FEV1 and CAT there is a negative, moderate correlation. The lower the FEV1 value compared to predicted value, the higher the patient’s QoL - health. There is a positive correlation between CAT and SGRQ. The total CAT score is high, the SGRQ score is also high. Therefore, CAT questionnaire can be widely applied in clinical practice to assess QoL - health in COPD patients.

Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients

ObjectiveTo assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients. MethodsA cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation. Results58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5–14.8 vs. 7.2; 95% CI, 7.1–7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010–8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385–11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087–2.581). ConclusionIn stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.

The role of neutrophil to lymphocyte ratio in patients with COPD-OSA overlap syndrome.

The aim of this study is to investigate the role of the neutrophil to lymphocyte ratio (NLR) in patients diagnosed with the chronic obstructive pulmonary disease-obstructive sleep apnea (COPD-OSA) overlap syndrome and comorbid pulmonary hypertension (PH). We enrolled a consecutive of stable COPD patients and conducted spirometry measurements, nocturnal polysomnography (PSG), and echocardiography for all participants. Clinical laboratory data were collected. A total of 178 patients with stable COPD were enrolled among whom 33.14% (59/178) were diagnosed with OSA. Of the patients with overlap syndrome, 35.59% (21/59) showed comorbid PH, compared to 34.45% (41/119) in COPD patients without OSA. There was no significant difference in the occurrence of PH between COPD with and without OSA. NLR was significantly higher in patients with overlap syndrome compared to those with either disease alone. The difference in NLR between COPD-OSA patients with and without PH was not significant. Correlation analysis revealed that NLR was associated with age, total sleep time spent with oxygen saturation below 90% (T90), CRP, pulmonary artery systolic pressure (PASP), and minimum peripheral capillary oxygen saturation (SpO2min) in all COPD patients. NLR was identified as an independent factor contributing to OSA in COPD. The median cut-off value for detecting OSA in stable COPD was 2.49. However, NLR was not found to be a predictor for PH in COPD-OSA overlap syndrome. NLR can serve as a predictive marker for comorbid OSA in patients with COPD. NLR is expected to increase its clinical application as a convenient and cost-effective biomarker for COPD-OSA overlap syndrome.

COPD: systemic proteomic profiles in frequent and infrequent exacerbators.

Some patients with COPD suffer frequent exacerbations (FE). We hypothesised that their systemic proteomic profile would be different from that of non-frequent exacerbators (NFE). The objective of the present study was to contrast the systemic proteomic profile in FE versus NFE. As a reference, we also determined the systemic proteomic profile of healthy controls (HC) and COPD patients during an actual episode of exacerbation (AE). In the analysis we included 40 clinically stable COPD patients (20 FE and 20 NFE), and 20 HC and 10 AE patients. Their plasma samples were analysed by combining two complementary proteomic approaches: label-free liquid chromatography-tandem mass spectrometry and multiplex immunoassays. Gene Ontology annotation, pathway enrichment and network analyses were used to investigate molecular pathways associated with differentially abundant proteins/peptides (DAPs). Compared with HC, we identified 40 DAPs in FE, 10 in NFE and 63 in AE. Also compared to HC, pathway functional and protein-protein network analyses revealed dysregulation of inflammatory responses involving innate and antibody-mediated immunity in COPD, particularly in the FE group, as well as during an AE episode. Besides, we only identified alterations in the complement and coagulation cascades in AE. There are specific plasma proteome profiles associated with FE, which are partially shared with findings observed during AE, albeit others are uniquely present during the actual episode of AE.

Upper-limb interval versus constant-load exercise in patients with COPD: a physiological crossover study.

Upper-limb exercise is recommended for patients with COPD, albeit there are limited data concerning the optimal modality to implement. We compared interval (INT-EX) to continuous (CONT-EX) upper-limb exercise in terms of exercise tolerance, ventilatory and metabolic responses when both conditions were sustained at an equivalent work rate. 26 stable COPD patients undertook three upper-limb exercise sessions to initially establish peak work rate (PWR) via an incremental exercise test and subsequently two equivalent work rate tests to the limit tolerance in balanced order: 1) INT-EX consisting of 30-s work at 100% PWR interspersed with 30-s work at 40% of PWR; and 2) CONT-EX at 70% PWR. 20 patients (76.9%) had longer tolerance during INT-EX, while six out of 26 (23.1%) exhibited longer tolerance during CONT-EX. The average endurance time was 434.1±184.7 and 315.7±128.7 s for INT-EX and CONT-EX, respectively. During INT-EX at isotime (i.e. when work completed was the same between INT-EX and CONT-EX), the majority of patients manifested lower oxygen uptake, minute ventilation, pulmonary hyperinflation, heart rate, symptoms and higher CO2 blood concentration. Patients with longer INT-EX had a lower comorbidity score (Cumulative Illness Rating Scale: 1.58±0.30 versus 1.88±0.29, p=0.0395) and better-preserved lung function (forced vital capacity 84.7±15.31% versus 67.67±20.56%, p=0.0367; forced expiratory volume in 1 s 57.15±14.59 versus 44.67±12.99% predicted, p=0.0725) compared to patients with longer CONT-EX. INT-EX is more sustainable than CONT-EX for the majority of COPD patients with moderate obstruction, leading to lower dynamic hyperinflation and symptoms at isotime. Further studies need to define the benefits of its application during pulmonary rehabilitation.

Microbiome-host interactions in the pathogenesis of acute exacerbation of chronic obstructive pulmonary disease.

To explore the underlying mechanisms the airway microbiome contributes to Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD). We enrolled 31 AECOPD patients and 26 stable COPD patients, their sputum samples were collected for metagenomic and RNA sequencing, and then subjected to bioinformatic analyses. The expression of host genes was validated by Quantitative Real-time PCR(qPCR) using the same batch of specimens. Our results indicated a higher expression of Rothia mucilaginosa(p=0.015) in the AECOPD group and Haemophilus influenzae(p=0.005) in the COPD group. The Different expressed genes(DEGs) detected were significantly enriched in "type I interferon signaling pathway"(p<0.001, q=0.001) in gene function annotation, and "Cytosolic DNA-sensing pathway"(p=0.002, q=0.024), "Toll-like receptor signaling pathway"(p=0.006, q=0.045), and "TNF signaling pathway"(p=0.006, q=0.045) in KEGG enrichment analysis. qPCR amplification experiment verified that the expression of OASL and IL6 increased significantly in the AECOPD group. Pulmonary bacteria dysbiosis may regulate the pathogenesis of AECOPD through innate immune system pathways like type I interferon signaling pathway and Toll-like receptor signaling pathway.

A Cross-sectional Study of Correlation of Neutrophil-to-lymphocyte Ratio in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in significant morbidity and mortality. As COPD progresses, patients develop more frequent and severe exacerbations. Several scores have been tested in AECOPD, but none of them is yet widely accepted or recommended to be used in practice due to a lack of data and evidence. Aim and Objectives: (1) To compare neutrophil-to-lymphocyte ratio (NLR) between stable COPD patients and patients with acute exacerbation of COPD and (2) correlation of NLR with severity of acute exacerbation of disease as per clinical, spirometric, and arterial blood gas criteria. Materials and Methods: A total of 100 patients, 50 with acute exacerbation of COPD and 50 stable patients attending the casualty and Outpatient Department of Government Medical College and Associated Group of Hospitals, Kota, were included in the study. Results: The level of NLR was raised in patients with acute exacerbation of COPD (35.28 ± 34.66) as compared to stable COPD patients (2.23 ± 0.63) (P = 0.0001). Levels of this inflammatory marker (NLR) were also positively correlated with the duration of hospitalization (8.14 ± 5.99 days) (P = 0.0010). High NLR was found to be significantly associated with the need for mechanical ventilation (nine patients) and mortality (nine patients), and significantly associated with low forced expiratory volume 1/forced-vital capacity (0.49 ± 0.07) in cases with acute exacerbation of COPD. Conclusion: NLR can be used as a marker of acute exacerbation of COPD, as it was found to be significantly elevated in acute exacerbation patients and found within normal limits in stable patients.