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Heart rate slopes during 6-min walk test in pulmonary arterial hypertension, other lung diseases, and healthy controls.

6mwtSix-minute walk test (6MWT) continues to be a useful tool to determine the functional capacity in patients with vascular and other lung diseases; nevertheless, it has a limited ability to predict prognosis in this context.

We tested whether the heart rate (HR) acceleration and decay slopes during the 6-m walk test are different in patients with pulmonary arterial hypertension (PAH), other lung diseases, and healthy controls. In addition, we assessed whether the HR slopes are associated with clinical worsening. Using a portable, signal-morphology-based, impedance cardiograph (PhysioFlow Enduro, Paris, France) with real-time wireless monitoring via a Bluetooth USB adapter we determined beat-by-beat HR. We included 50 subjects in this pilot study, 20 with PAH (all on PAH-specific treatment), 17 with other lung diseases (obstructive [n = 12, 71%] or restrictive lung diseases [5, 29%]), and 13 healthy controls. The beat-by-beat HR curves were significantly different among all three groups of subjects either during the activity or recovery of the 6MWT. HR curves were less steep in PAH than the other two groups (P < 0.001). HR acceleration rates were slower in patients with PAH or other lung diseases with progression of their disease (P < 0.001).

In conclusion, the acceleration and decay slopes during 6MWT are different among patients with PAH, other lung diseases, and healthy controls. The HR slopes during 6MWT were steeper in patients without clinical worsening.

Prevalence of airflow limitation in outpatients with cardiovascular diseases in Japan.

BACKGROUND AND OBJECTIVES: Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) commonly coexist and share common risk factors. The prevalence of COPD in outpatients with a smoking history and CVD in Japan is unknown. The aim of this study was to determine the proportion of Japanese patients with a smoking history being treated for CVD who have concurrent airflow limitation compatible with COPD. A secondary objective was to test whether the usage of lung function tests performed in the clinic influenced the diagnosis rate of COPD in the patients identified with airflow limitation.

METHODS: In a multicenter observational prospective study conducted at 17 centers across Japan, the prevalence of airflow limitation compatible with COPD (defined as forced expiratory volume (FEV)1/FEV6 <0.73, by handheld spirometry) was investigated in cardiac outpatients ≥40 years old with a smoking history who routinely visited the clinic for their CVD. Each patient completed the COPD Assessment Test prior to spirometry testing.

RESULTS: Data were available for 995 patients with a mean age of 66.6±10.0 years, of whom 95.5% were male. The prevalence of airflow limitation compatible with COPD was 27.0% (n=269), and 87.7% of those patients (n=236) did not have a prior diagnosis of COPD. The prevalence of previously diagnosed airflow limitation was higher in sites with higher usage of lung function testing (14.0%, 15.2% respectively) compared against sites where it is performed seldom (11.1%), but was still low.

CONCLUSION: The prevalence of airflow limitation in this study indicates that a quarter of outpatients with CVD have COPD, almost all of whom are undiagnosed. This suggests that it is important to look routinely for COPD in CVD outpatients.

Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients.

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Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients.

Respirology. 2014 Jun 9;

Authors: Borel JC, Pepin JL, Pison C, Vesin A, Gonzalez-Bermejo J, Court-Fortune I, Timsit JF

Abstract
BACKGROUND AND OBJECTIVE: Long-term non-invasive ventilation (NIV) has become a widespread modality of treatment in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. However, benefits in terms of patient-related outcomes are still under debate. Both NIV adherence and heterogeneous responses in different COPD phenotypes may contribute to the difficulty of demonstrating NIV benefits. Our aim was to assess the impact of NIV adherence on the rate of hospitalization for acute exacerbation and death.
METHODS: This is a prospective multi-centre cohort study of COPD patients treated by long-term NIV. Comorbidities, anthropometrics, respiratory parameters were collected at inclusion in the study. Follow-up data included vital status, NIV adherence and hospitalizations. The influence of NIV adherence on prognosis was tested using an adjusted Cox model. Sensitivity analyses for obese and non-obese COPD subtypes were also conducted.
RESULTS: Two hundred thirteen patients (48% obese) were included with 45.5% died during 47.7 [interquartile range = 27.8; 73] months' follow-up. Survival was better in obese COPD than non-obese COPD. The use of NIV > 9 h/day was associated with an increased risk of death or hospitalization for acute exacerbation [HR = 1.6; 95CI: 1.1-2.4]. In obese COPD, this risk described a U-shaped curve from >1 to >9 h/day NIV usage with an improvement in prognosis when NIV adherence was > 5 h/day [HR = 0.5; 95CI: 0.2-0.9].
CONCLUSIONS: Adherence to NIV was associated with better prognosis only in obese COPD. NIV use > 9 h/day predicted poor outcomes.

PMID: 24912564 [PubMed - as supplied by publisher]

Tiotropium might improve survival in subjects with COPD at high risk of mortality.

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Tiotropium might improve survival in subjects with COPD at high risk of mortality.

Respir Res. 2014 Jun 10;15(1):64

Authors: Burgel PR, Paillasseur JL, Dusser D, Roche N, Liu D, Liu Y, Furtwaengler A, Metzdorf N, Decramer M

Abstract
BACKGROUND: Inhaled therapies reduce risk of chronic obstructive pulmonary disease (COPD) exacerbations, but their effect on mortality is less well established. We hypothesized that heterogeneity in baseline mortality risk influenced the results of drug trials assessing mortality in COPD.
METHODS: The 5706 patients with COPD from the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT(R)) study that had complete clinical information for variables associated with mortality (age, forced expiratory volume in 1 s, St George's Respiratory Questionnaire, pack-years and body mass index) were classified by cluster analysis. Baseline risk of mortality between clusters, and impact of tiotropium were evaluated during the 4-yr follow up.
RESULTS: Four clusters were identified, including low-risk (low mortality rate) patients (n = 2339; 41%; cluster 2), and high-risk patients (n = 1022; 18%; cluster 3), who had a 2.6- and a six-fold increase in all-cause and respiratory mortality compared with cluster 2, respectively. Tiotropium reduced exacerbations in all clusters, and reduced hospitalizations in high-risk patients (p < 0.05). The beneficial effect of tiotropium on all-cause mortality in the overall population (hazard ratio, 0.87; 95% confidence interval, 0.75-1.00, p = 0.054) was explained by a 21% reduction in cluster 3 (p = 0.07), with no effect in other clusters.
CONCLUSIONS: Large variations in baseline risks of mortality existed among patients in the UPLIFT(R) study. Inclusion of numerous low-risk patients may have reduced the ability to show beneficial effect on mortality. Future clinical trials should consider selective inclusion of high-risk patients.

PMID: 24913266 [PubMed - as supplied by publisher]

Severe COPD Exacerbation: CT Features.

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Severe COPD Exacerbation: CT Features.

COPD. 2014 Jun 10;

Authors: Hackx M, Ghaye B, Coche E, Muylem AV, Gevenois PA

Abstract
Abstract Objective: To describe CT features associated with severe exacerbations of Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: In this prospective ethical-committee-approved study, 44 COPD patients (34 men, 10 women, age range 49-83 years) who provided written informed consent were included at the time of hospital admission for severe exacerbation. Pulmonary function tests (PFT) and chest CT scans were performed at admission and after resolution of the episode following a minimum of 4 weeks free of any acute symptom. For each CT scan, two radiologists independently scored 15 features in each lobe and side. CT features and PFT results were compared for exacerbation and control through Mac-Nemar tests and paired t-tests, respectively. Results: Forced expiratory volume in 1 second and vital capacity improved significantly after exacerbation (p = 0.023 and 0.012, respectively). Bronchial wall thickening and lymphadenopathy were graded significantly higher at exacerbation than at control by both readers (p ranging from < 0.001 to 0.028). Other CT features were not observed during exacerbation, or were so only by one reader (p ranging from < 0.001 to 0.928). Conclusion: Only lymphadenopathy and bronchial wall thickening are CT features associated with severe COPD exacerbation, respectively in 25% and 50% of patients. Our findings do not advocate a role for CT in the routine work-up of patients with severe COPD exacerbation.

PMID: 24914492 [PubMed - as supplied by publisher]

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