Stable COPD Patients 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.

Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation

Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality.
 Material and Methods: The Descriptive cross-sectional study was conducted DHQ Hospital Rawalpindi from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (> 18 years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded. Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia. Data was analyzed by SPSS with significant p< 0.05.
 Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years). Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs. 55.30+7.47 in patients without hypomagnesaemia (p=0.228).
 Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations.

The Six-Minute Stepper Test Is Valid to Evaluate Functional Capacity in Hospitalized Patients With Exacerbated COPD.

Background: The six-minute stepper test (6MST) is a self-paced test considered a valid tool to assess functional capacity in stable COPD patients. However, a high floor effect, where a large proportion of participants reach the minimum score when using the measurement instrument, might compromise the test validity in the hospital setting. Therefore, this study aimed at verifying the concurrent validity of 6MST in hospitalized patients with acute exacerbation of COPD (AECOPD). Methods: A cross-sectional study was conducted in a tertiary hospital. Patients who were hospitalized due to AECOPD were considered for inclusion. On the first day, when patients reached minimum clinical criteria considered as the use of non-invasive ventilation less than 2 h for 6 h/period, dyspnea at rest less than 7 (very severe) on the modified Borg scale, a respiratory rate less than 25 breaths per minute, oxygen pulse saturation greater than 88% (considering use of supplemental oxygen) and absence of paradoxical breathing pattern, they underwent a lung function evaluation and answered three questionnaires: Chronic Respiratory Questionnaire (CRQ), Modified Medical Research Council Dyspnea Scale (MMRC), and COPD Assessment Test (CAT). Then, on two consecutive days, patients performed 6MST or six-minute walk test (6MWT), in random order. Each test was performed twice, and the best performance was recorded. Also, the patient’s severity was classified according to the BODE index. Inspiratory capacity measurements were performed before and after each test execution. Results: Sixteen patients (69.4 ± 11.4 years) with a mean FEV₁ of 49.4 ± 9.9% predicted were included (9 females). There was a strong correlation of the performance in 6MST (number of cycles) with 6MWT (distance walked in meters) in absolute values (r = 0.87, p < 0.001) as well as with the percentage of predicted normal 6MWT (r = 0.86, p < 0.001). There was a strong correlation between the performance in 6MST with the dynamic hyperinflation (r = 0.72, p = 0.002) and a moderate correlation between 6MST with the percentage of reduction of inspiratory capacity (r = 0.68, p = 0.004). We also identified that 6MST showed moderate negative correlations with CAT (r = −0.62, p = 0.01) and BODE index (r = −0.59, p = 0.01). Conclusion: It could be concluded that 6MST is valid for evaluating functional capacity in hospitalized patients with exacerbated COPD.

The Effect of Roflumilast on Absolute Neutrophil Count, MMP-9 Serum, % VEP1 Value, and CAT Scores in Stable COPD Patients

Background: Chronic obstructive pulmonary disease is the leading cause morbidity and mortality worldwide. Cigarette smoke and noxious agent causing oxidative stress activated nuclear factor-κB then increase inflammatory cell releases. Roflumilast have antiiinflammatory effect which can be use as addition therapy for stable COPD.Methods: The pretest and postest experimental clinical trial was carried out in 40 patients with stable COPD in the pulmonology outpatient clinics of Dr. Moewardi Surakarta and dr. Soehadi Prijonegoro Sragen hospital from 6 January to 6 March 2020. Forty subjects were grouped into treatment group (n=20) receiving standart therapy along with roflumilast 500 mg/day and placebo group (n=20) receiving standart therapy only for 28 days. Decreased inflammation measured by ANC and serum MMP-9, improvement of obstruction measured by % FEV1, and clinic improvement measured by CAT score.Results: Our finding revealed decreases of ANC and MMP-9 serum in the treatment group, although statistically insignificant (p=0,449), (p= 0,195) respectively. %VEP1 value increased insignificant in the treatment groups (p=0,189). Chronic obstructive pulmonary disease assessment test (CAT) score decreased significantly in the treatment group (p=0.000).Conclusion: Roflumilast administration reduce inflammation as it can lower not significant ANC, MMP-9 serum, higher not significant %VEP1, and improves the clinical condition of patients with stable COPD based on a decrease in CAT score.

ΔSpO2/distance ratio from the six-minute walk test in evaluation of patients with chronic obstructive pulmonary disease.

The six-minute walk test (6MWT) contains two independent components: walk distance (6MWD) and oxygen saturation (SpO₂). 6MWD does not give detailed data on numerous COPD associated disorders. As oxygen desaturation plays a key role in exercise limita-tions, a few new parameters integrating oxygen desaturation during exercise along with walk distance are necessary. So, this study was conducted to assess the relationships between ΔSpO₂/distance ratio and pulmonary function test in addition to extent of pulmonary emphysema in COPD patients. 57 stable COPD patients who attended the outpatient clinic of chest medicine department. Mansoura university. were enrolled. Included patients were classified according to GOLD airflow limitation. Age, sex, and modified Medical Research Council dyspnea score (mMRC) were recorded. furthermore, every patient completed the 6MWT and underwent a pulmonary function test and a CT scan to evaluate the degree of pulmonary emphysema. ΔSpO₂/distance ratio was moderately correlated with DLCO%, FVC % and GOLD classification. However, strong correlation was found with FEV1% and RV%. mMRC was weakly correlated with ΔSpO₂/distance ratio. In addition, weak nonsignificant correlation was found between ΔSpO₂/distance ratio and extent of pulmonary emphysema as measured by HRCT volumetry. A significant moderate cor-relation was noticed between the ΔSpO₂/distance ratio and 6MWD (r = -0.5, P < 0.001). a significant strong cor-relation was observed between the ΔSpO₂/distance ratio and ΔSpO₂ (r = 0.87, P < 0.001). ΔSpO₂/distance ratio could be a simple and valuable index for the evaluation of exercise capacity in COPD individuals and might be utilized to predict severity of airway obstruction, pulmonary diffusing capacity disorder and severe hyperinflation.

The Microbiome in Bronchial Biopsies from Smokers and Ex-Smokers with Stable COPD - A Metatranscriptomic Approach

Current knowledge about the respiratory microbiome is mainly based on 16S ribosomal RNA gene sequencing. Newer sequencing approaches, such as metatranscriptomics, offer the technical ability to measure the viable microbiome response to environmental conditions such as smoking as well as to explore its functional role by investigating host-microbiome interactions. However, knowledge about its feasibility in respiratory microbiome research, especially in lung biopsies, is still very limited. RNA sequencing was performed in bronchial biopsies from clinically stable smokers (n = 5) and ex-smokers (n = 6) with COPD not using (inhaled) steroids. The Trinity assembler was used to assemble non-human reads in order to allow unbiased taxonomical and microbial transcriptional analyses. Subsequently, host-microbiome interactions were analyzed based on associations with host transcriptomic data. Ultra-low levels of microbial mass (0.009%) were identified in the RNA-seq data. Overall, no differences were identified in microbiome diversity or transcriptional profiles of microbial communities or individual microbes between COPD smokers and ex-smokers in the initial test dataset as well as a larger replication dataset. We identified an upregulated host gene set, related to the simultaneous presence of Bradyrhizobium, Roseomonas, Brevibacterium.spp., which were related to PERK-mediated unfolded protein response (UPR) and expression of the microRNA-155-5p. Our results show that metatranscriptomic profiling in bronchial biopsy samples from stable COPD patients yields ultra-low levels of microbial mass. Further, this study illustrates the potential of using transcriptional profiling of the host and microbiome to gain more insight into their interaction in the airways.

A Study of Various Predictors of COPD-Related Fatigue (COPD-RF) and its Correlation with other Established Outcome Parameters in COPD.

Over the years approach to COPD has changed. The focus of evaluation is shifting from physiological outcome parameters to patient centered outcomes. COPD-RF is one such patient related outcome that is of considerable importance to the patients as fatigue is the second common distressing symptom in COPD & is a major concern for the patients. COPD-RF is not only a reflection of airflow limitation severity but also a result of psychological, behavioral, and physical factors. Therefore, identification of markers which determine COPD RF is essential to improve patient management. This study aims to identify the predictors of COPD Related fatigue (COPD-RF) and its correlation with other outcome tools like FEV1, 6-minute walk distance (6MWD), MMRC grade, BODE index & inflammatory markers. 50 stable COPD patients were taken in the study. MMRC grade, FEV1, 6MWD, BODE index, CRP level and sputum neutrophil % obtained. COPD-RF was assessed using 13 item (FACIT-fatigue) questionnaire. The correlation analysis was done by spearman rank correlation and ANOVA. Predictors of COPD-RF were identified by multiple linear regression. Mean age of the population was 56.53 ± 9.29. All GOLD category of severity was equally represented in the study group. The fatigue score showed significant correlation with inflammatory markers (CRP-r=-0.675; neutrophil%- r=-0.485) & 6MWD (r=-.428). Categorical variables (MMRC, FEV1 GOLD stages & BODE quartiles) also showed significant difference of fatigue among categories. BODE index & serum CRP were identified as the statistically significant predictors of fatigue, suggesting COPD-RF could reflect severity of underlying pathophysiologic process i.e. systemic inflammation. BODE index and CRP levels are the two important surrogate markers that predicts COPR-RF implying a role of systemic inflammation in the pathogenesis of fatigue. Also, COPD-RF could be an indicator of long-term prognosis of the disease & should be routinely evaluated during COPD assessment.

The Relationship between Serum Uric Acid Levels and Early Mortality in Chronic Obstructive Pulmonary Disease Cases during Exacerbation.

In this study, it was aimed to compare the levels of serum uric acid and uric acid/creatinine ratios in patients with COPD during an attack or in stable COPD, and to show whether serum uric acid and uric acid/creatinine ratios are associated with early mortality in COPD patients during an acute attack. In this study, COPD acute attack (n=155) and stable COPD (n=30) patients were evaluated. The data of these patients were obtained from patient files and computer records. COPD diagnosis and severity assessment were made according to the GOLD 2006 guideline. Participants' age, gender, body mass index, pulmonary function test, arterial blood gas, uric acid, creatinine values and comorbidity information were recorded in the previously prepared Case Data Form. In 2012, when we conducted this study, gold 2006 was taken as the guideline for spirometry measurement, but spirometric measurements determined with reference values determined according to age, height and gender, and FEV1/FVC measurement <70% as diagnostic criteria in acute attack after bronchodilator were the guidelines used later, gold 2017. It is also compatible with gold2020 and gold2021 spirometry criteria. It was determined that the uric acid (p<0.001) and uric acid/creatinine (p<0.001) levels of the patients in the acute attack group were significantly higher than the levels of the patients in the stable group. The attack group was divided into two subgroups according to certain cut-off points for uric acid (>6 mg/dl for women and >7 mg/dl for men) and uric acid/creatinine ratio (median value 7.10). Since the upper limit of the uric acid value measured in the blood is 6 mg/dl in women and 7-8 mg/dl in men, the cut-off points for uric acid (>6 mg/dl for women and >7 mg/dl for men) were determined in our study. According to this categorization, it was determined that there was no statistically significant relationship between uric acid level (odds ratio 2.985 [95% confidence interval 0.61814,151]) and early mortality risk. The results of this study showed that the uric acid and uric acid/creatinine levels in the attack group were higher than the levels in the stable group, but these parameters were not associated with early mortality.

P7‐52: The effectiveness of home‐based upper arm endurance and strength exercises with eggwhite supplementation on functional capacity and quality of life in stable COPD patients

P7‐52: The effectiveness of home‐based upper arm endurance and strength exercises with eggwhite supplementation on functional capacity and quality of life in stable COPD patients

P7‐57: The effectiveness of home‐based upper‐body strength and endurance training pulmonary rehabilitation program on the muscle mass of stable COPD patients

P7‐57: The effectiveness of home‐based upper‐body strength and endurance training pulmonary rehabilitation program on the muscle mass of stable COPD patients

Association Between Vitamin D Levels and FEV1, Number of Exacerbations, and CAT Score in Stable COPD Patients in Indonesia.

PurposeThis study aimed to assess the association between vitamin D levels and forced expiratory volume in one second (FEV1), number of exacerbations, and symptoms based on COPD assessment test (CAT) scores in stable COPD patients in Indonesia.Patients and MethodsAn observational cross-sectional study was conducted. Subjects were stable COPD patients who were treated at a pulmonary clinic in a tertiary referral hospital in West Java from March to June 2018.ResultsThirty subjects were recruited this study with an average age 62±8 years. The mean vitamin D level was 20.17±8.91 ng/mL. Half of the patients had low vitamin D level (<20ng/mL) (50%). The mean FEV1 (%) predicted value was 37.2±14. The median exacerbation per year was 1 (0–5) and symptoms based on CAT score was 14 (3–34). No correlation was found between vitamin D levels and FEV1 (%) predicted value (r=0.126, p=0.253). Vitamin D level was inversely correlated with number of exacerbations (r=−0.639, p<0.001) and CAT (r= −0.802, p<0.001).ConclusionLow level of vitamin D was associated with more frequent exacerbation and higher CAT scores but was not associated with FEV1 (%) predicted.

Frailty Impact during and after Pulmonary Rehabilitation

Frailty is a condition of reduced physiologic reserve common in COPD candidates to pulmonary rehabilitation, however no study has investigated whether frailty impacts the decline that a great part of COPD patients face after the completion of the rehabilitation program. Study objectives are to verify frailty impact on pulmonary rehabilitation outcomes during and after the program. This is a secondary analysis of a longitudinal study. Stable COPD patients GOLD I-III were randomized to a three-month endurance versus endurance and resistance training. Participants performed a multidimensional assessment at baseline, at the end of the rehabilitation program and after six months. Frailty was defined using a two-step approach including PRISMA-7 and Timed “Up and Go” test. Frailty interaction with time was evaluated using generalized least-squared regression models for repeated measures, correcting for potential confounders. Of the 53 participants with a mean age of 73 (SD:8) years 38 (72%) were frail. The mean 6MWD and V’O2peak increased in frail and no frail patients during pulmonary rehabilitation and declined after its completion, while CAT score showed a steep decline during the training, and a mild decline later. Frailty showed a significant interaction with time in terms of 6MWD variation during (β adj:43.6 meters, p-value:0.01) and after (β adj:-47 meters, p-value:0.02) pulmonary rehabilitation; no significant interaction was found in terms of V’O2peak and CAT score variation. In conclusion, frail COPD patients have a higher potential to benefit from pulmonary rehabilitation, but a higher risk to have a steeper decline later. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1967915 .

Prothrombotic state in patients with stable COPD: an observational study.

BackgroundCOPD patients have an increased risk of cardiovascular disease and venous thromboembolism.MethodsThis study aimed to investigate whether patients with stable COPD have a prothrombotic state compared to COPD-free smokers. We conducted an observational study comparing levels of: D-dimers, INR, aPTT, coagulation factors; fibrinogen, FII, FV, FVII, FVIII, FIX, FX and coagulation inhibitors; protein S, proteins C and antithrombin between stable COPD patients and control subjects.ResultsA total of 103 COPD patients and 42 controls with similar age, sex, current smoking status, comorbidity burden and cardiovascular risk met the inclusion criteria. Compared to controls, COPD patients had higher levels of D-dimers (median (interquartile range): 360 (230–600) ng·mL−1 versus 240 (180–400) ng·mL−1, p=0.001), fibrinogen (mean±sd: 399±82 mg·dL−1 versus 346±65 mg·dL−1, p<0.001), FII (122±22% versus 109±19%, p=0.004), FV (131±25% versus 121±19%, p=0.015), FVIII (143±32% versus 122±20%, p<0.001) and FX (111 (94–134)% versus 98 (88–107)%, p=0.002), and lower levels of protein S (95 (85–105)% versus 116 (98–121)%, p<0.001) and antithrombin (94.4±11.5% versus 102.3±13.2%, p=0.001). In the COPD group, patients with more severe airflow limitation and frequent exacerbations had significantly higher levels of FII, FV and FX, whereas patients with higher COPD assessment test score had significantly higher levels of FX and lower levels of protein S.ConclusionPatients with stable COPD exhibited increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers. Among COPD patients, increased levels of FII, FV and FX and decreased levels of protein S were found in patients with more severe disease.

Effect of Dynamic Hyperinflation on Cardiac Response to Exercise of Patients With Chronic Obstructive Pulmonary Disease

IntroductionAlthough the major limitation to exercise performance in patients with COPD is dynamic hyperinflation (DH), little is known about its relation with cardiac response to exercise. Our objectives were to compare the exercise response of stroke volume (SV) and cardiac output (CO) between COPD patients with or without DH and control subjects, and to assess the main determinants. MethodsFifty-seven stable COPD patients without cardiac comorbidity and 25 healthy subjects were recruited. Clinical evaluation, baseline function tests, computed tomography and echocardiography were conducted in all subjects. Patients performed consecutive incremental exercise tests with measurement of operating lung volumes and non-invasive measurement of SV, CO and oxygen uptake (VO2) by an inert gas rebreathing method. Biomarkers of systemic inflammation and oxidative stress, tissue damage/repair, cardiac involvement and airway inflammation were measured. ResultsCOPD patients showed a lower SV/VO2 slope than control subjects, while CO response was compensated by a higher heart rate increase. COPD patients with DH experienced a reduction of SV/VO2 and CO/VO2 compared to those without DH. In COPD patients, the end-expiratory lung volume (EELV) increase was related to SV/VO2 and CO/VO2 slopes, and it was the only independent predictor of cardiac response to exercise. However, in the regression models without EELV, plasma IL-1β and high-sensitivity cardiac troponin T were also retained as independent predictors of SV/VO2 slope. ConclusionDynamic hyperinflation decreases the cardiac response to exercise of COPD patients. This effect is related to systemic inflammation and myocardial stress but not with left ventricle diastolic dysfunction.

Defective monocyte-derived macrophage phagocytosis is associated with exacerbation frequency in COPD

BackgroundLower airway bacterial colonisation (LABC) in COPD patients is associated with increased exacerbation frequency and faster lung function decline. Defective macrophage phagocytosis in COPD drives inflammation, but how defective macrophage function contributes to exacerbations is not clear. This study investigated the association between macrophage phagocytosis and exacerbation frequency, LABC and clinical parameters.MethodsMonocyte-derived macrophages (MDM) were generated from 92 stable COPD patients, and at the onset of exacerbation in 39 patients. Macrophages were exposed to fluorescently labelled Haemophilus influenzae or Streptococcus pneumoniae for 4 h, then phagocytosis measured by fluorimetry and cytokine release by ELISA. Sputum bacterial colonisation was measured by PCR.ResultsPhagocytosis of H. influenzae was negatively correlated with exacerbation frequency (r = 0.440, p < 0.01), and was significantly reduced in frequent vs. infrequent exacerbators (1.9 × 103 RFU vs. 2.5 × 103 RFU, p < 0.01). There was no correlation for S. pneumoniae. There was no association between phagocytosis of either bacteria with age, lung function, smoking history or treatment with inhaled corticosteroids, or long-acting bronchodilators. Phagocytosis was not altered during an exacerbation, or in the 2 weeks post-exacerbation. In response to phagocytosis, MDM from exacerbating patients showed increased release of CXCL-8 (p < 0.001) and TNFα (p < 0.01) compared to stable state.ConclusionImpaired COPD macrophage phagocytosis of H. influenzae, but not S. pneumoniae is associated with exacerbation frequency, resulting in pro-inflammatory macrophages that may contribute to disease progression. Targeting these frequent exacerbators with drugs that improve macrophage phagocytosis may prove beneficial.

Influence of Cell Quality on Inflammatory Biomarkers in COPD Sputum Supernatant.

PurposeWe recently introduced a sputum cell quality score to rate how cell morphology, cellular debris and squamous cell contamination influence inflammatory cell identification during microscopic evaluation. However, sputum cell quality is generally not considered for the interpretation of sputum fluid phase biomarkers. Therefore, we compared the soluble protein concentrations between sputum samples with different cell quality. The impact of cell quality was compared to other factors potentially affecting soluble biomarker concentrations.MethodsA comprehensive sputum dataset from 154 clinically stable COPD patients was used to analyse the differences and the variability of sputum supernatant concentrations for 23 proteins between low, medium, and high sputum cell quality samples. A model was developed and tested to compare the impact of different factors on sputum supernatant protein levels.ResultsMean percentages of sputum macrophages, neutrophils, eosinophils, monocytes and lymphocytes showed no significant differences between low, medium and high cell quality levels. The mean percentage of squamous cells were lower, while total cell count/mL sputum and cell viability were significantly higher in sputum samples with higher cell quality. The concentrations of Interleukin-6, Interleukin-8 and Tumor Necrosis Factor Receptor 2 were significantly increased in sputum samples of higher cell quality. The variability of most protein concentrations declined with increasing cell quality levels. Sixteen proteins showed significantly negative correlations with the percentage of squamous cells. For 14 proteins we observed a positive correlation with cell number/mL sputum. Multiple regression analysis shows that generally less than 30% of the protein variability can be explained by the included factors.ConclusionSputum cell quality has a significant impact on some soluble biomarker concentrations in sputum supernatant. Sputum samples with low sputum cell quality show a higher variability of fluid phase proteins in comparison to medium and high sputum cell quality levels.

Epidemiology and issues of NIV-treated AECOPD patients with hypercapnic respiratory failure in Shanghai: A multicentre retrospective survey.

To investigate the epidemiology, clinical features, treatment and outcome of Noninvasive ventilation (NIV)-treated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in secondary hospitals of Shanghai. Relying on Shanghai alliances for respiratory diseases, a retrospective observational study was performed in 34 secondary hospitals of Shanghai. The AECOPD patients treated with NIV and admitted to the respiratory department or respiratory intensive care unit were recruited between December 1, 2016, and November 30, 2017. There were 555 patients finally recruited in this study. The age was 75.8±9.6years old and 380 patients (68.5%) were male. 70.5% of all patients had respiratory acidosis (pH<7.35). 55.3% of all patients received nebulised bronchodilator and 77.7% were treated with systemic or inhaled corticosteroids during hospitalisation. 525 patients (94.6%) recovered successfully and the mortality was 3.2%. The hospitalisation was 15.3±6.7 days and hospital expenses were 22911±13595 RMB. Inadequate and nonstandard drug treatments were the most important problems during management. The NIV can be successfully used for AECOP patients in local hospitals of Shanghai, but accompanied by high costs and long hospital stays. However, the treatments for exacerbation and stable COPD patients are still insufficient.

Long-Term Auscultation in Chronic Obstructive Pulmonary Disease: Renaissance of an Ideograph of Medical Care

Background: Electronic auscultation technology has advanced dramatically in the last few years. Therefore, long-term pulmonary auscultation could provide additional information about respiratory system by monitoring acute chronic obstructive pulmonary disease (AECOPD) exacerbations or by identifying wheezing phenotypes amongst stable COPD patients. Objectives: Comparison of respiratory sounds in stable versus AECOPD patients recorded with a portable respiratory sound monitor over a period of 24 h. Methods: This prospective trial evaluated cough and wheezing events using an auscultation monitor specially developed for this purpose with 4 integrated highly sensitive microphones, in stable and severely AECOPD patients for a period of 24 h in an inpatient setting. Results: Twenty stable COPD patients (12 male, 60%) and 20 severely exacerbated COPD patients (14 male, 70%) were analyzed. In AECOPD patients, long-term auscultation revealed a significantly higher number of wheezing epochs than stable COPD patients (591 [IQR: 145–1,645] vs. 152 [IQR: 90–400]; p = 0.021). Conversely, cough epochs did not differ between AECOPD and stable COPD patients (213 [IQR: 140–327] vs. 162 [IQR: 123–243]; p = 0.256). The Borg-dyspnea scale, CAT score, and total CCQ score each showed no correlation with wheezing frequency, while CAT and CCQ scores did correlate with coughing frequency. Conclusion: Wheezing, but not coughing, occurs more frequently in AECOPD patients than in stable COPD patients, indicating that severe wheezing is an important clinical sign of exacerbation, while coughing is not. Therefore, the patterns of wheezing and coughing, as assessed by long-term auscultation, differ in stable versus exacerbated COPD patients.

Application Value of Broadband 3-Dimensional Impulse Oscillometry in COPD.

ObjectiveTo explore the correlation of respiratory resistance in stable COPD patients measured by broadband 3-dimensional impulse oscillometry (3D-IOS) and traditional pulmonary function test (PFT). To access the diagnostic value of 3D-IOS in COPD.MethodsA total of 107 COPD patients and 61 healthy subjects as controls were chosen to collect and statistically analyze the data of R5, R5–R20, R20, X5 and Fres measured by broadband 3D-IOS and FEV1%pred, FVC%pred and FEV1/FVC by PFTs. The diagnostic value of broadband 3D-IOS parameters in COPD was evaluated by receiver operating characteristic curve (ROC). 3D-colored images used to show dynamic changes of respiratory resistance in COPD.ResultsThe COPD group showed significant increases in R5, R20, R5–R20 and Fres, and a decrease in X5 (P<0.05). With the increase of GOLD grade, R5, R5–R20 and Fres increased whereas X5 decreased (P<0.05). Compared with FEV1%pred, FVC%pred and FEV1/FVC in the COPD group, R5, R5–R20 and Fres were negatively collated (P<0.05), whereas X5 was positively collated (P<0.01). R20 was uncorrelated with the traditional lung function parameters (P>0.05). Fres and FEV1/FVC (r=−0.467), and X5 and FEV1%pred (r=0.412) showed the strongest correlation. The AUC of R5, R5–R20, X5 and Fres was 0.7808, 0.7659, 0.8947 and 0.9095, respectively. Typical 3D-colored images of COPD displayed a green pattern in the inhalation phase and yellow–red–blue graduation in the expiration phase.ConclusionR5, R5-R20, X5 and Fres measured by broadband 3D-IOS can reflect the change of respiratory resistance in COPD. And they have good correlation with the traditional lung function parameters (FEV1%pred, FVC%pred, FEV1/FVC). Fres has the highest diagnostic accuracy. Comprehensive analysis of R5, R5–R20, Fres and X5 helps to determine the degree of respiratory obstruction in COPD. X5 and Fres can reflect changes in lung tissue compliance. 3D-colored images can visually show the change of respiratory resistance and reactance in COPD.

Correlations of Silent Information Regulator of Transcription 1 (SIRT1) Expression, Inflammatory Factors, and Oxidative Stress with Pulmonary Function in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD).

BackgroundThe aim of this study was to investigate the correlations of silent information regulator of transcription 1 (SIRT1) expression, inflammatory factors, and oxidative stress with pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Material/MethodsBronchoalveolar lavage fluid (BALF) was collected from 188 patients with COPD (83 in stable phase and 105 in acute exacerbation phase) and 56 healthy controls. Subsequently, the SIRT1 expression levels, the IL-6 and IL-8 levels (the representatives of inflammatory factors), and the MDA and SOD levels (indicative of oxidative stress) were detected via enzyme-linked immunosorbent assay. Correlations of SIRT1 expression, inflammatory factors, and oxidative stress with pulmonary function parameters [forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and FEV1] were measured via Spearman’s correlation analysis.ResultsThe levels of inflammatory factors and oxidative stress were elevated and SIRT1 expression remarkably declined in patients with AECOPD compared with those in healthy controls and stable COPD patients (P<0.05). Spearman’s correlation analysis revealed that SIRT1 expression, interleukin (IL)-6, and IL-8 were strongly associated with pulmonary function parameters (FEV1/FVC and FEV1) in patients with AECOPD (P<0.001), while no such obvious correlation was observed in stable COPD patients.ConclusionsOxidative stress and expression levels of inflammatory factors are evidently elevated and SIRT1 expression declines in patients with AECOPD. Moreover, SIRT1 expression is positively associated with pulmonary function parameters, while IL-6 and IL-8 exhibit negative correlations with pulmonary function parameters.