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Chronic Bronchitis and COPD.

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Chronic Bronchitis and COPD.

Am J Respir Crit Care Med. 2012 Nov 29;

Authors: Kim V, Criner GJ

Abstract
Chronic bronchitis is a common but variable phenomenon in COPD. It has numerous clinical consequences, including an accelerated decline in lung function, greater risk of the development of airflow obstruction in smokers, a predisposition to lower respiratory tract infection, higher exacerbation frequency, and worse overall mortality. Chronic bronchitis is caused by overproduction and hypersecretion of mucus by goblet cells, which leads to worsening airflow obstruction by lumenal obstruction of small airways, epithelial remodeling, and alteration of airway surface tension predisposing to collapse. Despite its clinical sequelae, little is known about the pathophysiology of chronic bronchitis and goblet cell hyperplasia in COPD, and treatment options are limited. In addition, it is becoming increasingly apparent that in the classic COPD spectrum, with emphysema on one end and chronic bronchitis on the other, most patients lie somewhere in the middle. It is known now that many patients with severe emphysema can develop chronic bronchitis, and small airway pathology has been linked to worse clinical outcomes, such as increased mortality and lesser improvement in lung function after lung volume reduction surgery. However, in recent years, a greater understanding of the importance of chronic bronchitis as a phenotype to identify patients with a beneficial response to therapy has been described. Herein we review the epidemiology of chronic bronchitis, the evidence behind its clinical consequences, the current understanding of the pathophysiology of goblet cell hyperplasia in COPD, and current therapies for chronic bronchitis.

PMID: 23204254 [PubMed - as supplied by publisher]

Comparison of the lung function change in patients with COPD and bronchial asthma before and after treatment with budesonide/formoterol.

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Comparison of the lung function change in patients with COPD and bronchial asthma before and after treatment with budesonide/formoterol.

J Thorac Dis. 2012 Dec;4(6):583-7

Authors: Gao SY, Huang JQ, Luo YF, Li ZP, Xie CM, Guo YB

Abstract
OBJECTIVE: This study investigated the rapid onset of bronchodilation effect and compared lung function changes following budesonide/formoterol (Symbicort Turbuhaler®) inhalation in Chinese patients with moderate-severe chronic obstructive pulmonary disease (COPD) and bronchial asthma.
METHODS: In this open-label, parallel-group clinical study, patients eligible for study were divided into COPD group (n=62, mean age 68.16±8.75 years) and asthma group (n=30, mean age 45.80±12.35 years). Lung function tests (include FEV1, FVC, FEV1/FVC, and IC) were performed at baseline (t=0 min time point, value before inhalation of budesonide/formoterol), and then eligible patients received two inhalations of budesonide/formoterol (160/4.5 μg). Lung function tests were reassessed at t=3, 10 and 30 min time point. The primary end-point was lung function change 3 min after drug inhalation, and the secondary end-points were comparison of the gas flow rate (ΔFEV1) and volume responses (ΔFVC, ΔIC) between COPD and asthma patients after inhalation of budesonide/formoterol.
RESULTS: Compared with the baseline, all patients significantly improved their lung function (included FEV1, FVC, FEV1/FVC, and IC) at 3 min (P<0.05). Greater bronchodilation efficacy was found in the asthma group compared with the COPD group (P<0.05). In the asthmatic patients, the curves of FEV1, FVC, FEV1/FVC, IC, showed improvement with an ascending trend at all time points from 3 to 30 min. Whereas in the COPD patients, only the curves of FEV1, FVC, IC showed similar pattern. We found that ΔFVC was significantly higher than ΔFEV1 in both groups (P<0.05), but no significant difference between ΔIC and ΔFEV1 (P>0.05). Compared with COPD group, asthma group had higher level of ΔFEV1 and ΔIC (P<0.05), but no significant difference for ΔFVC can be found.
CONCLUSIONS: Budesonide/formoterol has a fast onset of bronchodilation effect in patients with moderate-severe COPD and asthma. Greater efficacy was found in the asthma group compared with the COPD group. The gas flow rate and volume responses in patients with COPD differ from those with asthma after inhalation of Budesonide/formoterol.

PMID: 23205282 [PubMed - in process]

Severe pulmonary hypertension associated with emphysema: a new phenotype?

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Severe pulmonary hypertension associated with emphysema: a new phenotype?

Chest. 2012 Dec 1;142(6):1654-8

Authors: Adir Y, Shachner R, Amir O, Humbert M

Abstract
Mild to moderate precapillary pulmonary hypertension (PH) is a common complication of COPD and has typically been related to severe airflow limitation associated with chronic hypoxemia. Previous studies focusing specifically on patients with emphysema found that worsening PH was associated with progression of airflow obstruction. In the present report, we describe a new phenotype of COPD with severe precapillary PH in patients presenting with progressive dyspnea, normal spirometry, severely reduced diffusion capacity of the lung for carbon monoxide, and high-resolution CT scans of the chest showing diffuse centrilobular emphysema.

PMID: 23208339 [PubMed - in process]

Gender differences in symptoms and care delivery for chronic obstructive pulmonary disease.

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Gender differences in symptoms and care delivery for chronic obstructive pulmonary disease.

J Womens Health (Larchmt). 2012 Dec;21(12):1267-74

Authors: Martinez CH, Raparla S, Plauschinat CA, Giardino ND, Rogers B, Beresford J, Bentkover JD, Schachtner-Appel A, Curtis JL, Martinez FJ, Han MK

Abstract
Abstract Background: Morbidity and mortality for women with chronic obstructive pulmonary disease (COPD) are increasing, and little is known about gender differences in perception of COPD care. Methods: Surveys were administered to a convenience sample of COPD patients to evaluate perceptions about symptoms, barriers to care, and sources of information about COPD. Results: Data on 295 female and 273 male participants were analyzed. With similar frequencies, women and men reported dyspnea and rated their health as poor/very poor. Although more women than men reported annual household income <$30,000, no significant gender differences in frequency of health insurance, physician visits, or ever having had spirometry were detected. In adjusted models (1) women were more likely to report COPD diagnostic delay (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.13-2.45, p=0.01), although anxiety (OR 1.83, 95% CI 1.10-3.06, p=0.02) and history of exacerbations (OR 1.60, 95% CI 1.08-2.37, p=0.01) were also significant predictors, (2) female gender was associated with difficulty reaching one's physician (OR 2.54, 95% CI 1.33-4.86, p=0.004), as was prior history of exacerbations (OR 2.25, 95% CI 1.21-4.20, p=0.01), and (3) female gender (OR 2.15, 95% CI 1.10-4.21, p=0.02) was the only significant predictor for finding time spent with their physician as insufficient. Conclusions: Significant gender-related differences in the perception of COPD healthcare delivery exist, revealing an opportunity to better understand what influences these attitudes and to improve care for both men and women.

PMID: 23210491 [PubMed - in process]

Successful Smoking Cessation in COPD: Association with Comorbidities and Mortality.

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Successful Smoking Cessation in COPD: Association with Comorbidities and Mortality.

Pulm Med. 2012;2012:725024

Authors: Kupiainen H, Kinnula VL, Lindqvist A, Postma DS, Boezen HM, Laitinen T, Kilpeläinen M

Abstract
Smoking cessation is the cornerstone of COPD management, but difficult to achieve in clinical practice. The effect of comorbidities on smoking cessation and risk factors for mortality were studied in a cohort of 739 COPD patients recruited in two Finnish University Hospitals. The diagnosis of COPD was done for the first time on average 5.5 years prior to the enrollment. Data from the medical records and followup questionnaires (years 0, 1, 2, and 4) have been analyzed. The patients' lung function varied greatly; mean FEV(1) 58% of predicted. A total of 60.2% of men and 55.6% of women had been able to quit smoking. Alcohol abuse (OR 2.1, 95% CI 1.4-3.3) and psychiatric conditions (OR 1.8, 95% CI 1.2-2.7) were strongly related to low success rates of quitting. Among current smokers high nicotine dependency was again explained by alcohol abuse and psychiatric conditions. Non-quitters were younger than quitters, but their mortality rates remained significantly higher even when the model was adjusted for impairment of lung functions and comorbidities. In conclusion, co-existing addiction and psychiatric diseases significantly decreased the success rates in smoking cessation and increased mortality among the patients.

PMID: 23213517 [PubMed - in process]

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