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Determinants of Noninvasive Ventilation Outcomes during an Episode of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease: The Effects of Comorbidities and Causes of Respiratory Failure.

Biomed Res Int. 2014;2014:976783

Authors: Pacilli AM, Valentini I, Carbonara P, Marchetti A, Nava S

Abstract
Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status.

PMID: 24563868 [PubMed - in process]

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Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron.

BMC Pulm Med. 2014 Feb 24;14(1):24

Authors: Silverberg DS, Mor R, Tia Weu M, Schwartz D, Schwartz IF, Chernin G

Abstract
BACKGROUND: Little is known about iron deficiency (ID) and anemia in Chronic Obstructive Pulmonary Disease (COPD). The purposes of this study were: (i) To study the prevalence and treatment of anemia and ID in patients hospitalized with an exacerbation of COPD. (ii) to study the hematological responses and degree of dyspnea before and after correction of anemia with subcutaneous Erythropoiesis Stimulating Agents (ESAs) and intravenous (IV) iron therapy, in ambulatory anemic patients with both COPD and chronic kidney disease.
METHODS: (i) We examined the hospital records of all patients with an acute exacerbation of COPD (AECOPD) to assess the investigation, prevalence, and treatment of anemia and ID. (ii) We treated 12 anemic COPD outpatients with the combination of ESAs and IV-iron, given once weekly for 5 weeks. One week later we measured the hematological response and the severity of dyspnea by Visual Analogue Scale (VAS).
RESULTS: (i) Anemia and iron deficiency in hospitalized COPD patients: Of 107 consecutive patients hospitalized with an AECOPD, 47 (43.9%) were found to be anemic on admission. Two (3.3%) of the 60 non-anemic patients and 18 (38.3%) of the 47 anemic patients had serum iron, percent transferrin saturation (%Tsat) and serum ferritin measured. All 18 (100%) anemic patients had ID, yet none had oral or IV iron subscribed before or during hospitalization, or at discharge. (ii) Intervention outpatient study: ID was found in 11 (91.7%) of the 12 anemic ambulatory patients. Hemoglobin (Hb), Hematocrit (Hct) and the VAS scale scores increased significantly with the ESAs and IV-iron treatment. There was a highly significant correlation between the [increment]Hb and [increment]VAS; rs = 0.71 p = 0.009 and between the [increment]Hct and [increment]VAS; rs = 0.8 p = 0.0014.
CONCLUSIONS: ID is common in COPD patients but is rarely looked for or treated. Yet correction of the ID in COPD patients with ESAs and IV iron can improve the anemia, the ID, and may improve the dyspnea.

PMID: 24564844 [PubMed - as supplied by publisher]

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Determinants of exercise capacity in obese and non-obese COPD patients.

Respir Med. 2014 Feb 12;

Authors: Rodríguez DA, Garcia-Aymerich J, Valera JL, Sauleda J, Togores B, Galdiz JB, Gea J, Orozco-Levi M, Ferrer A, Gomez FP, Barberà JA, Serra I, Antó JM, Roca J, PAC-COPD Study Group

Abstract
BACKGROUND: The effects of obesity in combination with chronic obstructive pulmonary disease (COPD) on exercise capacity are receiving increased attention. But, a comprehensive analysis of factors associated with aerobic capacity in obese COPD patients has not been performed.
METHODS: Six-min walking test (6MWT) was performed in 251 COPD patients, and 159 of those also carried out an incremental cardiopulmonary exercise test (CPET) to evaluate exercise capacity. In all patients, anthropometrics, dyspnea and anxiety-depression scores, lung function, daily physical activity, co-morbidities and circulating inflammatory biomarkers were also assessed. Six-min walking distance (6MWD) and peak oxygen uptake (VO2 peak) during CPET were two primary outcome variables.
RESULTS: 57% of the patients showed body mass index (BMI) < 30 kg/m(2) (COPDN) and the remaining 43% were obese with a BMI ≥ 30 kg/m(2) (COPDO). In patients with COPDN, 6MWD showed independent negative associations with age, dyspnea score, sedentarism, depression scores and a positive relationship with arterial oxygenation; whereas in COPDO, 6MWD showed an inverse relationship with BMI. In COPDN, VO2 peak showed a negative association with age and positive relationships with both FEV1 and DLCO. However, in COPDO the dyspnea score was the strongest determinant of VO2 peak.
CONCLUSIONS: Obese and non-obese COPD patients show different determinants of aerobic capacity, including pulmonary and non-pulmonary factors that are also dependent on the type of exercise protocol. These results could be considered in the evaluation of obese patients with COPD.

PMID: 24565602 [PubMed - as supplied by publisher]

Chronic obstructive pulmonary disease: clinical review and update on consensus guidelines.

Hosp Pract (1995). 2014 Feb;42(1):79-91

Authors: Bozarth AL, Covey A, Gohar A, Salzman G

Abstract
In the last 2 decades, chronic obstructive pulmonary disease (COPD) has been increasingly recognized as a major public health problem. Since the introduction of the Global Initiative for Chronic Obstructive Lung Disease in 1998, growing interest in the pathogenesis and management of patients with COPD has led to notable improvements in patient care and quality of life. Despite greater awareness of this common preventable disease and major therapeutic advances during this period, the global impact of COPD remains strikingly large. We provide an evidence-based clinical review on COPD, with a focus on internists as the target audience.

PMID: 24566600 [PubMed - in process]