Related Articles

Do frequent moderate exacerbations contribute to progression of chronic obstructive pulmonary disease in patients who are ex-smokers?

Int J Chron Obstruct Pulmon Dis. 2015;10:525-33

Authors: Dreyse J, Díaz O, Repetto PB, Morales A, Saldías F, Lisboa C

Abstract
BACKGROUND: In addition to smoking, acute exacerbations are considered to be a contributing factor to progression of chronic obstructive pulmonary disease (COPD). However, these findings come from studies including active smokers, while results in ex-smokers are scarce and contradictory. The purpose of this study was to evaluate if frequent acute moderate exacerbations are associated with an accelerated decline in forced expiratory volume in one second (FEV1) and impairment of functional and clinical outcomes in ex-smoking COPD patients.
METHODS: A cohort of 100 ex-smoking patients recruited for a 2-year follow-up study was evaluated at inclusion and at 6-monthly scheduled visits while in a stable condition. Evaluation included anthropometry, spirometry, inspiratory capacity, peripheral capillary oxygen saturation, severity of dyspnea, a 6-minute walking test, BODE (Body mass index, airflow Obstruction, Dyspnea, Exercise performance) index, and quality of life (St George's Respiratory Questionnaire and Chronic Respiratory Disease Questionnaire). Severity of exacerbation was graded as moderate or severe according to health care utilization. Patients were classified as infrequent exacerbators if they had no or one acute exacerbation/year and frequent exacerbators if they had two or more acute exacerbations/year. Random effects modeling, within hierarchical linear modeling, was used for analysis.
RESULTS: During follow-up, 419 (96% moderate) acute exacerbations were registered. At baseline, frequent exacerbators had more severe disease than infrequent exacerbators according to their FEV1 and BODE index, and also showed greater impairment in inspiratory capacity, forced vital capacity, peripheral capillary oxygen saturation, 6-minute walking test, and quality of life. However, no significant difference in FEV1 decline over time was found between the two groups (54.7±13 mL/year versus 85.4±15.9 mL/year in frequent exacerbators and infrequent exacerbators, respectively). This was also the case for all other measurements.
CONCLUSION: Our results suggest that frequent moderate exacerbations do not contribute to accelerated clinical and functional decline in COPD patients who are ex-smokers.

PMID: 25792820 [PubMed - in process]

Related Articles

Misidentification of airflow obstruction: prevalence and clinical significance in an epidemiological study.

Int J Chron Obstruct Pulmon Dis. 2015;10:535-40

Authors: Pothirat C, Chaiwong W, Phetsuk N, Liwsrisakun C

Abstract
BACKGROUND: The fixed threshold criterion for the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) <0.7 is widely applied for diagnosis of airflow obstruction (AO). However, this fixed threshold criterion may misidentify AO, because thresholds below the fifth percentile of normal FEV1/FVC (lower limit of normal; LLN) vary with age. This study aims to identify the prevalence of AO misidentification and its clinical significance.
MATERIALS AND METHODS: A cross-sectional population-based study was conducted to identify the prevalence of chronic respiratory diseases in adults older than 40 years of age who live in municipal areas of Chiang Mai province, Thailand. All randomly selected subjects underwent face-to-face interviews and examinations by pulmonologists, and received chest radiographs and post-bronchodilator spirometry. AO misidentification was classified into under- or overestimated AO subgroups. Underestimated AO was defined as ratio of FEV1/FVC greater than the fixed threshold, but below the LLN criteria. Overestimated AO was defined as the ratio of FEV1/FVC below the fixed threshold but greater than the LLN criteria. The clinical significance of each misidentified subject was then explored.
RESULTS: There were 554 subjects with a mean age of 52.9±10.1 years and a percent predicted FEV1 of 85.5%±15.4%. The prevalence of AO misidentification was 5.6% (31/554), and all subjects belonged to the underestimated subgroup. Clinical significance of underestimated subjects included clinical AO disease of 22.6% (7/31) (three subjects with chronic obstructive pulmonary disease [COPD] and four subjects with asthma); chronic respiratory symptoms of 54.8% (17/31) (mostly associated with chronic rhinitis, 70.6% [12/17]); and only 12.9% (4/31) were identified as non-ill subjects.
CONCLUSION: The prevalence of AO misidentification in this population was significant, and all were underestimated subjects. Most underestimated subjects had clinical significance as related to obstructive airway diseases and chronic respiratory symptoms, mostly associated with rhinitis.

PMID: 25792821 [PubMed - in process]

Association of Helicobacter pylori infection with chronic obstructive pulmonary disease and chronic bronchitis: a meta-analysis of 16 studies.

Infect Dis (Lond). 2015 Mar 21;:1-7

Authors: Wang F, Liu J, Zhang Y, Lei P

Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB) are common respiratory diseases globally. The aim of this meta-analysis was to quantify the risk of these two diseases being associated with Helicobacter pylori infection.
METHODS: A literature search was performed to identify studies published before 5 June 2014 for relevant risk estimates. Fixed and random effect meta-analytical techniques were conducted for COPD and CB.
RESULTS: Sixteen observational studies involving 1390 patients with COPD, 734 with CB and more than 13 000 controls were included. Helicobacter pylori infection was associated with an increased risk of COPD and CB [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.81-2.36, p for heterogeneity = 0.05; and OR 1.57, 95% CI 1.33-1.86, p for heterogeneity = 0.08]. We discovered a significant association between CagA-positive strains and risk for COPD (OR 3.46, 95% CI 2.29-5.25, p for heterogeneity = 0.20).
CONCLUSIONS: Our meta-analysis suggested a potential relationship between H. pylori infection and the development of COPD and CB.

PMID: 25797276 [PubMed - as supplied by publisher]

Evaluation of Markers of Inflammation and Oxidative Stress in COPD Patients with or without Cardiovascular Comorbidities.

Heart Lung Circ. 2015 Feb 20;

Authors: Kaźmierczak M, Ciebiada M, Pękala-Wojciechowska A, Pawłowski M, Nielepkowicz-Goździńska A, Antczak A

Abstract
BACKGROUND: Although both chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) are characterised by chronic, systemic inflammation, their reciprocal interactions are poorly understood. The purpose of this study was to determine the concentrations of both inflammatory and oxidative stress biomarkers in the serum and exhaled breath condensate (EBC) of COPD patients, either with coexisting CVD or without cardio-vascular comorbidities.
METHODS: Twenty-four COPD patients with CVD were allocated to group A, 20 COPD patients without CVD were assigned to group B and 16 healthy patients were included as a control. A medical history and physical examination were performed, and the following were measured: serum CRP concentration, glucose level, uraemic acid level and lipid profile. In addition 8-isoprostane, LTB4 and IL-8 concentrations were measured both in serum and EBC. Spirometry, six-minute walk test and echocardiography were performed in all subjects.
RESULTS: EBC concentrations of 8-isoprostane and LTB4, and serum levels of CRP, 8-soprostane, LTB4, IL-8 were significantly higher in COPD patients than in healthy controls. COPD patients with CVD were not found to have higher concentrations of the assessed markers than those without CVD, neither in the serum nor EBC. CRP, 8-isoprostane and LTB4 levels in serum, and IL-8 concentration in EBC correlated negatively with the value of forced expiratory volume in one second.
CONCLUSIONS: Although systemic inflammation coexists with COPD, it is not elevated in COPD patients with CVD. Since this phenomenon may result from treatment with statins, future studies should state whether COPD patients could benefit from the additional statin therapy.

PMID: 25797323 [PubMed - as supplied by publisher]