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Intravenous diuretic and vasodilator therapy reduce plasma brain natriuretic peptide levels in acute exacerbation of chronic obstructive pulmonary disease.

Plasma brain natriuretic peptide levels decreased rapidly in patients with acute exacerbations of chronic obstructive pulmonary disease, after intravenous therapy with a diuretic and a vasodilator, and the treatment did not impair the health status of these patients.

Background and objective : Plasma concentrations of brain natriuretic peptide (BNP) are elevated in patients with chronic obstructive pulmonary disease (COPD) and high plasma BNP levels are associated with a poor prognosis. We aimed to evaluate the effects of a diuretic and a vasodilator on plasma BNP levels and health-related quality of life (HRQOL), in patients with acute exacerbations of COPD (AECOPD).

Methods : Forty patients with an AECOPD and high plasma BNP levels, but without any clinical evidence of cor pulmonale, were selected. The patients were randomly divided into two groups of 20 patients. In addition to standard treatment for AECOPD, the patients in group I were treated with a mild diuretic, and those in group II were treated with the diuretic and a vasodilator. Twenty patients with stable COPD were selected as a control group. Plasma BNP concentrations were measured on admission and on the third and sixth days. The patients' HRQOL was evaluated using the short-form 36-item (SF-36) questionnaire before and after treatment.

Results : Plasma BNP concentrations in patients with AECOPD were significantly decreased after treatment, and this decrease was more striking in group II than in group I. There were no significant differences in SF-36 domain scores between patients with stable COPD and those with acute exacerbations who were treated with a diuretic and a vasodilator.

Conclusions : Plasma BNP levels decreased rapidly in patients with an AECOPD, after therapy with a diuretic and a vasodilator, and the treatment did not impair their health status. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

Effects of resistance training on respiratory function in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Over the last decade, the potential use of resistance training (RT) for patients with chronic obstructive pulmonary disease (COPD) has gained increasing attention. Many COPD patients experience muscle dysfunction and reduced muscle mass, primarily as a result of chronic immobilization. These symptoms have been associated with reduced exercise tolerance and complaints of fatigue and dyspnea (even after minimal exertion).

This paper presents findings from a systematic review that sought to:

  • present a meta-analysis of randomized controlled trials (RCT) investigating the effects of RT on respiratory function measures in patients with COPD
  • and investigate the existence of a dose-response relationship between intensity, duration and frequency of RT and assessed outcomes.

METHODS: A systematic literature search of MEDLINE electronic database (January 1980 to December 2009) produced a body of research on the effects of RT with a control group in patients with COPD. Data analysis involved a random effects meta-analysis, in order to determine weighted mean differences with 95 confidence intervals (95% CI) for each endpoint. All data were analyzed with the software package Review Manager V 4.2.10 (of the Cochrane Collaboration); 14 RCTs were included in the meta-analysis.

RESULTS: Findings demonstrated that RT did not substantially increase forced expiratory volume in 1 s. In addition, the weighted mean difference was 2.71% of predicted (95% CI, -1.86 to 7.27; p = 0.25) or by absolute 0.08 L (95% CI, -0.03 to 0.19; p = 0.14). It appeared that maximum minute ventilation increased by 3.77 L/min (95% CI, -0.51 to 8.04; p = 0.08).

CONCLUSIONS: Based on findings from the meta-analysis, RT produces a clinically and statistically significant effect on respiratory function (such as forced vital capacity) and is therefore recommended in the management of COPD.

Total lung capacity by plethysmography and high-resolution computed tomography in COPD.

AIM: To characterize and compare total lung capacity (TLC) measured by plethysmography with high-resolution computed tomography (HRCT), and to identify variables that predict the difference between the two modalities.

METHODS: Fifty-nine consecutive patients referred for the evaluation of COPD were retrospectively reviewed. Patients underwent full pulmonary function testing and HRCT within 3 months. TLC was obtained by plethysmography as per American Thoracic Society/European Respiratory Society standards and by HRCT using custom software on 0.75 and 5 mm thick contiguous slices performed at full inspiration (TLC).

RESULTS: TLC measured by plethysmography correlated with TLC measured by inspiratory HRCT (r = 0.92, P < 0.01). TLC measured by plethysmography was larger than that determined by inspiratory HRCT in most patients (mean of 6.46 ± 1.28 L and 5.34 ± 1.20 L respectively, P < 0.05). TLC measured by both plethysmography and HRCT correlated significantly with indices of airflow obstruction (forced expiratory volume in 1 second/forced vital capacity [FVC] and FVC%), static lung volumes (residual volume, percent predicted [RV%], total lung capacity, percent predicted [TLC%], functional residual capacity, percent predicted [FRC%], and inspiratory capacity, percent predicted), and percent emphysema. TLC by plethysmography and HRCT both demonstrated significant inverse correlations with diffusion impairment. The absolute difference between TLC measured by plethysmography and HRCT increased as RV%, TLC%, and FRC% increased. Gas trapping (RV% and FRC%) independently predicted the difference in TLC between plethysmography and HRCT.

CONCLUSION: In COPD, TLC by plethysmography can be up to 2 L greater than inspiratory HRCT. Gas trapping independently predicts patients for whom TLC by plethysmography differs significantly from HRCT.

Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note.

Serum procalcitonin levels have been used as a biomarker of invasive bacterial infection and recently have been advocated to guide antibiotic therapy in patients with chronic obstructive pulmonary disease (COPD). However, rigorous studies correlating procalcitonin levels with microbiologic data are lacking. Acute exacerbations of COPD (AECOPD) have been linked to viral and bacterial infection as well as noninfectious causes. Therefore, we evaluated procalcitonin as a predictor of viral versus bacterial infection in patients hospitalized with AECOPD with and without evidence of pneumonia.

METHODS: Adults hospitalized during the winter with symptoms consistent with AECOPD underwent extensive testing for viral, bacterial, and atypical pathogens. Serum procalcitonin levels were measured on day 1 (admission), day 2, and at one month. Clinical and laboratory features of subjects with viral and bacterial diagnoses were compared.

RESULTS: In total, 224 subjects with COPD were admitted for 240 respiratory illnesses. Of these, 56 had pneumonia and 184 had AECOPD alone. A microbiologic diagnosis was made in 76 (56%) of 134 illnesses with reliable bacteriology (26 viral infection, 29 bacterial infection, and 21 mixed viral bacterial infection). Mean procalcitonin levels were significantly higher in patients with pneumonia compared with AECOPD. However, discrimination between viral and bacterial infection using a 0.25 ng/mL threshold for bacterial infection in patients with AECOPD was poor.

CONCLUSION: Procalcitonin is useful in COPD patients for alerting clinicians to invasive bacterial infections such as pneumonia but it does not distinguish bacterial from viral and noninfectious causes of AECOPD.

Effect of an integrated care programme on re-hospitalization of patients with chronic obstructive pulmonary disease.

A one-year integrated care (IC) programme with two components (patient-centred education + case management) was evaluated for its effectiveness in preventing COPD-related hospitalizations, and whether this was comparable for men and women. This study is the first to demonstrate that women benefited more from such an IC intervention.

Background and objective : Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a one-year integrated care (IC) programme comprising two components (patient-centred education+case management) would be effective in preventing COPD-related hospitalizations.

Methods : his was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty-nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components :

  1. Patient-centred education - involving three group sessions of self-management education that included one motivational interview and instruction in the use of a written action plan;
  2. and Case management - involving scheduled follow-up visits with access to a call centre.

The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD-related re-hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes.

Results:  Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re-hospitalization over the follow-up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23 to 0.85). Subgroup analyses revealed that the IC programme prevented more COPD-related hospitalizations in women compared with men. There were no significant between-group differences in length of hospital stay or number of ED visits.

Conclusions : An IC programme combining self-management education and case-management can decrease rates of COPD-related hospitalizations, particularly among women. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

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