851
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Lee HM, Lee J, Lee K, Luo Y, Sin DD, Wong ND. Relation between COPD severity and global cardiovascular risk in US adults. Chest 2013; 142:1118-1125. [PMID: 22518027 DOI: 10.1378/chest.11-2421] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD is associated with the risk of cardiovascular events (CVEs), but its impact on overall mortality has not been well quantified. We determined the impact of global CVE risk assessment on CVE and total mortality in subjects with COPD. METHODS We examined the severity of COPD in 6,266 US adult patients aged 40 years in relation to the estimated 10-year risk of CVEs. COPD was defi ned by spirometry, and severity was classified as mild (FEV1 ≥ 80%), moderate (50% ≤ FEV< 1 , 80%), or severe (FEV 1 , 50%). Cox proportional hazards regression was used to evaluate the relationship of global CVE risk combined with COPD status to CVE and all-cause mortality over a mean follow-up of 98.8 ± 51.3 months. RESULTS The proportion of individuals at high risk for CVEs ranged from 25% (without COPD)to . 50% (with moderate to severe COPD) ( P , .05). When global CVE risk scores were low, CVE mortality was also low ( , 10/1,000 person-years) regardless of COPD severity, and CVE mortality was high when CVE global risk was high ( . 40/1,000 person-years). Global CVE risk improved prediction for both CVEs and total mortality in patients with COPD ( P , .0001), with a net reclassification improvement of 17.1% ( P , .0001) and 13.0% ( P , .0001), respectively, beyond lung function measures. CONCLUSIONS The addition of global CVE risk scores to lung function data significantly improves risk stratification of patients with COPD for CVE and total mortality and, thus, adds to predicting long-term survival of these patients.
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Affiliation(s)
- Hwa Mu Lee
- Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, CA; Division of Cardiology, School of Medicine, and Division of Pulmonary Medicine, Department of Medicine, University of California, Irvine, CA.
| | - Janet Lee
- Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, CA
| | - Katherine Lee
- Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, CA
| | - Yanting Luo
- Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, CA
| | - Don D Sin
- The James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Vancouver, BC, Canada
| | - Nathan D Wong
- Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, CA
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852
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Freeman CM, Martinez FJ, Han MK, Washko GR, McCubbrey AL, Chensue SW, Arenberg DA, Meldrum CA, McCloskey L, Curtis JL. Lung CD8+ T cells in COPD have increased expression of bacterial TLRs. Respir Res 2013; 14:13. [PMID: 23374856 PMCID: PMC3583694 DOI: 10.1186/1465-9921-14-13] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/29/2013] [Indexed: 12/21/2022] Open
Abstract
Background Toll-like receptors (TLRs) on T cells can modulate their responses, however, the extent and significance of TLR expression by lung T cells, NK cells, or NKT cells in chronic obstructive pulmonary disease (COPD) is unknown. Methods Lung tissue collected from clinically-indicated resections (n = 34) was used either: (a) to compare the expression of TLR1, TLR2, TLR2/1, TLR3, TLR4, TLR5, TLR6 and TLR9 on lung CD8+ T cells, CD4+ T cells, NK cells and NKT cells from smokers with or without COPD; or (b) to isolate CD8+ T cells for culture with anti-CD3ε without or with various TLR ligands. We measured protein expression of IFN-γ, TNF-α, IL-13, perforin, granzyme A, granzyme B, soluble FasL, CCL2, CCL3, CCL4, CCL5, CCL11, and CXCL9 in supernatants. Results All the lung subsets analyzed demonstrated low levels of specific TLR expression, but the percentage of CD8+ T cells expressing TLR1, TLR2, TLR4, TLR6 and TLR2/1 was significantly increased in COPD subjects relative to those without COPD. In contrast, from the same subjects, only TLR2/1 and TLR2 on lung CD4+ T cells and CD8+ NKT cells, respectively, showed a significant increase in COPD and there was no difference in TLR expression on lung CD56+ NK cells. Production of the Tc1 cytokines IFN-γ and TNF-α by lung CD8+ T cells were significantly increased via co-stimulation by Pam3CSK4, a specific TLR2/1 ligand, but not by other agonists. Furthermore, this increase in cytokine production was specific to lung CD8+ T cells from patients with COPD as compared to lung CD8+ T cells from smokers without COPD. Conclusions These data suggest that as lung function worsens in COPD, the auto-aggressive behavior of lung CD8+ T cells could increase in response to microbial TLR ligands, specifically ligands against TLR2/1.
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Affiliation(s)
- Christine M Freeman
- Research Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI 48105, USA.
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853
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Romme EAPM, Rutten EPA, Smeenk FWJM, Spruit MA, Menheere PPCA, Wouters EFM. Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease. Ann Med 2013; 45:91-6. [PMID: 22462562 DOI: 10.3109/07853890.2012.671536] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with several extrapulmonary effects that contribute to the severity of the disease. Vitamin D is suggested to play a role in COPD and its related extrapulmonary effects. AIMS To determine the prevalence of vitamin D deficiency and its relation with bone density, muscle strength, and exercise capacity in patients with COPD. METHODS Our cross-sectional study included patients with moderate to very severe COPD. We collected data on lung function, body composition, bone density, quadriceps muscle strength, 6-minute walking distance, and plasma 25-hydroxyvitamin D (25(OH)D) concentration. Vitamin D deficiency was defined as plasma 25(OH)D concentration below 50 nmol/L. RESULTS In total, 151 COPD patients were included; 87 patients (58%) had vitamin D deficiency. Plasma 25(OH)D concentration was positively associated with bone density (P = 0.005) and 6-minute walking distance (P < 0.001) after adjustment for potential confounders. Plasma 25(OH)D concentration was not associated with quadriceps muscle strength. CONCLUSIONS The majority of COPD patients had vitamin D deficiency. Plasma 25(OH)D concentration was positively associated with bone density and exercise capacity. Intervention studies are necessary to determine whether vitamin D supplementation is of benefit in the prevention or treatment of osteoporosis and poor exercise capacity in patients with COPD.
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Affiliation(s)
- Elisabeth A P M Romme
- Department of Respiratory Medicine, Catharina Hospital, 5602 ZA Eindhoven, the Netherlands.
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854
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Bellamy D, Peake M, Williams A. The role of primary care as part of the multidisciplinary team (MDT) in the management of lung cancer: the "Dream MDT" report - new guidance from the UK Lung Cancer Coalition. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:3-4. [PMID: 23358648 PMCID: PMC6442775 DOI: 10.4104/pcrj.2013.00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David Bellamy
- Retired general practitioner; member of the UK Lung Cancer Coalition
- 8 Littledown Drive, Bournemouth, BH7 7AQ Tel: +44 (0)1202 394443 E-mail:
| | - Mick Peake
- Consultant and Senior Lecturer in Respiratory Medicine, University Hospitals of Leicester, Leicester, UK; Clinical Lead for the UK National Cancer Intelligence Network (NCIN) and the UK National Lung Cancer Audit Programme (NLCA); Chairman, clinical section of the UK Lung Cancer Coalition
| | - Andrea Williams
- General practitioner, King Street Surgery, Hereford, UK; GP adviser for Herefordshire Clinical Commissioning Group; GP spokesperson for the UK Lung Cancer Coalition
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855
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Burgel PR, Mannino D. Systemic inflammation in patients with chronic obstructive pulmonary disease: one size no longer fits all! Am J Respir Crit Care Med 2013; 186:936-7. [PMID: 23155208 DOI: 10.1164/rccm.201209-1634ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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856
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Soeda S, Ohyashiki JH, Ohtsuki K, Umezu T, Setoguchi Y, Ohyashiki K. Clinical relevance of plasma miR-106b levels in patients with chronic obstructive pulmonary disease. Int J Mol Med 2013; 31:533-9. [PMID: 23338559 DOI: 10.3892/ijmm.2013.1251] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/17/2012] [Indexed: 11/06/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by both chronic inflammation in the airway and systemic inflammation; however, the molecular mechanism of COPD has not been fully elucidated. By measuring microRNA (miRNA) expression in the plasma of COPD subjects, we aimed to identify the clinical relevance of plasma miRNA levels in these patients. Blood samples were obtained from COPD patients and age-matched normal controls. We initially produced plasma miRNA expression profiles using TaqMan low-density array screening. For further validation, individual qRT-PCRs were performed in 40 COPD patients and 20 healthy subjects. TaqMan low-density array screening showed that 9 miRNAs (miR-29b, miR-483-5p, miR-152, miR-629, miR-26b, miR-101, miR-106b, miR-532-5p and miR-133b) were significantly downregulated in the plasma from COPD patients when compared with normal smokers. Among these miRNAs, we focused on miR-106b. A reduction in the plasma miR-106b levels was evident in COPD ex-smokers and COPD current smokers compared with levels in smokers. There was a negative correlation between the plasma miR-106b level and the duration of disease since diagnosis in COPD ex-smokers and the duration of smoking in COPD current smokers. These findings support the concept that progressive reduction in the plasma miR-106b level may reflect persistent and systemic changes even after the discontinuation of smoking in COPD patients. miR-106b may therefore play an important role in the pathogenesis of COPD.
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Affiliation(s)
- Seiko Soeda
- Division of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan.
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857
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Porszasz J, Rambod M, van der Vaart H, Rossiter HB, Ma S, Kiledjian R, Casaburi R. Sinusoidal high-intensity exercise does not elicit ventilatory limitation in chronic obstructive pulmonary disease. Exp Physiol 2013; 98:1102-14. [PMID: 23335005 DOI: 10.1113/expphysiol.2012.070375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
During exercise at critical power (CP) in chronic obstructive pulmonary disease (COPD) patients, ventilation approaches its maximum. As a result of the slow ventilatory dynamics in COPD, ventilatory limitation during supramaximal exercise might be escaped using rapid sinusoidal forcing. Nine COPD patients [age, 60.2 ± 6.9 years; forced expiratory volume in the first second (FEV(1)), 42 ± 17% of predicted; and FEV(1)/FVC, 39 ± 12%] underwent an incremental cycle ergometer test and then four constant work rate cycle ergometer tests; tolerable duration (t(lim)) was recorded. Critical power was determined from constant work rate testing by linear regression of work rate versus 1/t(lim). Patients then completed fast (FS; 60 s period) and slow (SS; 360 s period) sinusoidally fluctuating exercise tests with mean work rate at CP and peak at 120% of peak incremental test work rate, and one additional test at CP; each for a 20 min target. The value of t(lim) did not differ between CP (19.8 ± 0.6 min) and FS (19.0 ± 2.5 min), but was shorter in SS (13.2 ± 4.2 min; P < 0.05). The sinusoidal ventilatory amplitude was minimal (37.4 ± 34.9 ml min(-1) W(-1)) during FS but much larger during SS (189.6 ± 120.4 ml min(-1) W(-1)). The total ventilatory response in SS reached 110 ± 8.0% of the incremental test peak, suggesting ventilatory limitation. Slow components in ventilation during constant work rate and FS exercises were detected in most subjects and contributed appreciably to the total response asymptote. The SS exercise was associated with higher mid-exercise lactate concentrations (5.2 ± 1.7, 7.6 ± 1.7 and 4.5 ± 1.3 mmol l(-1) in FS, SS and CP). Large-amplitude, rapid sinusoidal fluctuation in work rate yields little fluctuation in ventilation despite reaching 120% of the incremental test peak work rate. This high-intensity exercise strategy might be suitable for programmes of rehabilitative exercise training in COPD.
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Affiliation(s)
- Janos Porszasz
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
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858
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García-Olmos L, Alberquilla A, Ayala V, García-Sagredo P, Morales L, Carmona M, de Tena-Dávila MJ, Pascual M, Muñoz A, Salvador CH, Monteagudo JL. Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study. BMC FAMILY PRACTICE 2013; 14:11. [PMID: 23324308 PMCID: PMC3556139 DOI: 10.1186/1471-2296-14-11] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is frequent and often coexists with other diseases. The aim of this study was to quantify the prevalence of COPD and related chronic comorbidity among patients aged over 40 years visiting family practices in an area of Madrid. METHODS An observational, descriptive, cross-sectional study was conducted in a health area of the Madrid Autonomous Region (Comunidad Autónoma de Madrid). The practice population totalled 198,670 persons attended by 129 Family Physicians (FPs), and the study population was made up of persons over the age of 40 years drawn from this practice population. Patients were deemed to have COPD if this diagnosis appeared on their clinical histories. Prevalence of COPD; prevalence of a further 25 chronic diseases in patients with COPD; and standardised prevalence ratios, were calculated. RESULTS Prevalence of COPD in family medicine was 3.2% (95% CI 3.0-3.3) overall, 5.3% among men and 1.4% among women; 90% of patients presented with comorbidity, with a mean of 4 ± 2.04 chronic diseases per patient, with the most prevalent related diseases being arterial hypertension (52%), disorders of lipid metabolism (34%), obesity (25%), diabetes (20%) and arrhythmia (15%). After controlling for age and sex, the observed prevalence of the following ten chronic diseases was higher than expected: heart failure; chronic liver disease; asthma; generalised artherosclerosis; osteoporosis; ischaemic heart disease; thyroid disease; anxiety/depression; arrhythmia; and obesity. CONCLUSIONS Patients with COPD, who are frequent in family practice, have a complex profile and pose a clinical and organisational challenge to FPs.
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Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Hacienda de Pavones, 271, Madrid, 28030, Spain.
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859
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Puente-Maestu L, Lázaro A, Humanes B. Metabolic derangements in COPD muscle dysfunction. J Appl Physiol (1985) 2013; 114:1282-90. [PMID: 23288549 DOI: 10.1152/japplphysiol.00815.2012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Mitochondrial muscle alterations are common in patients with chronic obstructive pulmonary disease (COPD) and manifest mainly as decreased oxidative capacity and excessive production of reactive oxygen species (ROS). The significant loss of oxidative capacity observed in the quadriceps of COPD patients is mainly due to reduced mitochondrial content in the fibers, a finding consistent with the characteristic loss of type I fibers observed in that muscle. Decreased oxidative capacity does not directly limit maximum performance; however, it is associated with increased lactate production at lower exercise intensity and reduced endurance. Since type I fiber atrophy does not occur in respiratory muscles, the loss of such fibers in the quadriceps could be to the result of disuse. In contrast, excessive production of ROS and oxidative stress are observed in both the respiratory muscles and the quadriceps of COPD patients. The causes of increased ROS production are not clear, and a number of different mechanisms can play a role. Several mitochondrial alterations in the quadriceps of COPD patients are similar to those observed in diabetic patients, thus suggesting a role for muscle alterations in this comorbidity. Amino acid metabolism is also altered. Expression of peroxisome proliferator-activated receptor-γ coactivator-1α mRNA is low in the quadriceps of COPD patients, which could also be a consequence of type I fiber loss; nevertheless, its response to exercise is not altered. Patterns of muscle cytochrome oxidase gene activation after training differ between COPD patients and healthy subjects, and the profile is consistent with hypoxic stress, even in nonhypoxic patients.
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Affiliation(s)
- Luis Puente-Maestu
- Servicio de Neumología, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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860
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Fisk M, Mohan D, Cheriyan J, Yang L, Fuld J, McEniery C, Tal-Singer R, Polkey M, Wilkinson I. Evaluation of losmapimod in patients with chronic obstructive pulmonary disease (COPD) with systemic inflammation stratified using fibrinogen (‘EVOLUTION’): Rationale and protocol. Artery Res 2013. [DOI: 10.1016/j.artres.2013.10.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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861
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Li J, Huang Y, Fei GH. The Evaluation of Cognitive Impairment and Relevant Factors in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2013. [DOI: 10.1159/000342970] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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862
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Lahousse L, van den Bouwhuijsen QJA, Loth DW, Joos GF, Hofman A, Witteman JCM, van der Lugt A, Brusselle GG, Stricker BH. Chronic Obstructive Pulmonary Disease and Lipid Core Carotid Artery Plaques in the Elderly. Am J Respir Crit Care Med 2013; 187:58-64. [DOI: 10.1164/rccm.201206-1046oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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863
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Senda K. [Depression in elder patients with chronic obstructive pulmonary disease]. Nihon Ronen Igakkai Zasshi 2013; 50:755-8. [PMID: 24622218 DOI: 10.3143/geriatrics.50.755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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864
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Kobayashi S, Hanagama M, Yamanda S, Satoh H, Tokuda S, Kobayashi M, Ueda S, Suzuki S, Yanai M. Impact of a large-scale natural disaster on patients with chronic obstructive pulmonary disease: the aftermath of the 2011 Great East Japan Earthquake. Respir Investig 2012; 51:17-23. [PMID: 23561254 DOI: 10.1016/j.resinv.2012.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/25/2012] [Accepted: 10/22/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND A large-scale natural disaster may exacerbate chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD). The aftermath of a natural disaster can include poor access to medication, medical equipment, and medical supplies. Little is known about the impact on patients with COPD. METHODS A retrospective cohort study was conducted at a regional medical center in Ishinomaki, the area affected most severely by the Great East Japan Earthquake in 2011. The study was performed 6 months after the disaster. The characteristics, clinical courses, and outcomes of COPD patients hospitalized after emergency visits during the study period were investigated and compared. RESULTS One hundred patients (112 episodes) were identified. Within a few days after the disaster, patients undergoing oxygen therapy at home came to the hospital to receive oxygen. In the subacute phase (from the third to the fifth week), the number of hospitalizations due to COPD exacerbations was significantly increased compared to the numbers observed before the earthquake (p<0.05). On admission, COPD patients reported significantly reduced participation in the activities of daily living (ADLs) after as compared to before the disaster. The incidence of cases of exacerbated COPD normalized 6 weeks after the earthquake. CONCLUSIONS The large-scale natural disaster that hit Japan in 2011 had a serious negative impact on the clinical outcomes of COPD patients in the disaster-affected area.
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Affiliation(s)
- Seiichi Kobayashi
- Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-8522, Japan.
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865
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Sinden NJ, Stockley RA. Chronic obstructive pulmonary disease: an update of treatment related to frequently associated comorbidities. Ther Adv Chronic Dis 2012; 1:43-57. [PMID: 23251728 DOI: 10.1177/2040622310370631] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with a pulmonary inflammatory response to inhaled substances, and individuals with COPD often have raised levels of several circulating inflammatory markers indicating the presence of systemic inflammation. Recently, there has been increasing interest in comorbidities associated with COPD such as skeletal muscle dysfunction, cardiovascular disease, osteoporosis, diabetes and lung cancer. These conditions are associated with a similar inflammation-based patho-physiology to COPD, and may represent a lung inflammatory 'overspill' to distant organs. Cardiovascular disease is a significant cause of mortality in COPD, and the concepts of an inflammatory link raise the possibility that treatment for one organ may show benefits to comorbidities in other organs. When considering treatment of COPD and its comorbidities, one approach is to target the pulmonary inflammation and hence reduce any 'overspill' effect of inflammatory mediators systemically as suggested by response to inhaled corticosteroids. Alternatively, treatment targeted towards comorbid organs may alter features of pulmonary disease as statins, angiotensin-converting enzyme (ACE) inhibitors and peroxisome proliferator-activated receptor (PPAR) agonists may have beneficial effects on COPD by reducing exacerbations and mortality. Newer anti-inflammatory treatments, such as phosphodiesterase 4 (PDE4), nuclear factor(NF)-kB, and p38 mitogen-activated protein kinase (MAPK) inhibitors, are given systemically and may confer benefits to both COPD and its comorbidities. With common inflammatory pathways it might be expected that successful anti-inflammatory therapy in one organ may also influence others. In this review we explore the concepts of systemic inflammation in COPD and current evidence for treatment of its related comorbidities.
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Affiliation(s)
- Nicola J Sinden
- Nicola J. Sinden, MBChB(Honours), MRCP (UK) University Hospital Birmingham NHS Foundation Trust - Respiratory Medicine, Birmingham, UK
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866
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de Pablo P, Cooper MS, Buckley CD. Association between bone mineral density and C-reactive protein in a large population-based sample. ACTA ACUST UNITED AC 2012; 64:2624-31. [PMID: 22487938 DOI: 10.1002/art.34474] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Several studies suggest that bone mineral density (BMD) is reduced in chronic inflammatory diseases. Higher serum levels of C-reactive protein (CRP) have been associated with lower BMD in women and older adults. However, it is not clear whether this association holds in a representative sample of the general population. The purpose of this study was to examine the relationship between BMD and CRP level in a large representative US population-based sample from the National Health and Nutrition Examination Survey (NHANES). METHODS We included participants age ≥20 years with BMD (total and subregions) measured by dual x-ray absorptiometry scans and complete information on covariates from NHANES. The association between CRP level and BMD was evaluated using multivariate linear regression models, adjusting for potential confounders and further adjusting for comorbid diseases, medications, and serum vitamin D levels. RESULTS The study sample included 10,475 participants (53% Caucasian, 22% Mexican American, 18% African American, and 7% other races). Men had higher BMD and lower CRP concentrations than women. BMD (total body BMD as well as subtotal BMD and BMD of the extremities, ribs, and trunk subregions) was inversely associated with quintiles of CRP concentration both in men and in women in a dose-dependent manner (for total BMD, P for trend < 0.0001 for men, P for trend = 0.0005 for women). The associations were independent of medications, comorbidities, and other potential confounders. The results remained largely unchanged with further adjustment for serum vitamin D levels. CONCLUSION Among men and women in a large representative population-based sample, the CRP level was inversely and independently associated with total BMD in a dose-dependent manner.
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Affiliation(s)
- Paola de Pablo
- University of Birmingham College of Medical and Dental Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, and Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham, UK.
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867
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Luppi F, Beghè B, Roversi P. BPCO e altre malattie polmonari croniche. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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868
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Epidemiology of comorbidities in chronic obstructive pulmonary disease: clusters, phenotypes and outcomes. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2012.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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869
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Kim YJ, Lee BK, Jung CY, Jeon YJ, Hyun DS, Kim KC, Yu SK, Choi HS, Shin WH, Lee KH. Patient's perception of symptoms related to morning activity in chronic obstructive pulmonary disease: the SYMBOL Study. Korean J Intern Med 2012; 27:426-35. [PMID: 23269884 PMCID: PMC3529242 DOI: 10.3904/kjim.2012.27.4.426] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 08/21/2012] [Accepted: 09/04/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Patients with chronic obstructive pulmonary disease (COPD) experience more problematic respiratory symptoms and have more trouble performing daily activities in the morning. The aim of this study was to assess the perception of COPD symptoms related to morning activities in patients with severe airflow limitation. METHODS Data of 133 patients with severe airflow limitation were analyzed in a prospective, non-interventional study. A clinical symptom questionnaire was completed by patients at baseline. In patients having morning symptoms, defined by at least one or more prominent or aggravating symptom during morning activities, a morning activity questionnaire was also completed at baseline and following 2 months of COPD treatment. RESULTS The most frequently reported COPD symptom was breathlessness (90.8%). Morning symptoms were reported in 76 (57%) patients; these had more frequent and severe clinical COPD symptoms. The most frequently reported morning activity was getting out of bed (82.9%). The long acting muscarinic antagonist (odds ratio [OR], 6.971; 95% confidence interval [CI], 1.317 to 11.905) and chest tightness (OR, 0.075; 95% CI, 0.011 to 0.518) were identified as significantly related to absence of morning symptoms. There was no significant correlation between the degree of forced expiratory volume in 1 second improvement and severity score differences of all items of morning activity after 2-month treatment. CONCLUSIONS Fifty-seven percent of COPD patients with severe airflow limitation have morning symptoms that limit their morning activities. These patients also have more prevalent and severe COPD symptoms. The results of this study therefore provide valuable information for the development of patient-reported outcomes in COPD.
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Affiliation(s)
- Yeon Jae Kim
- Division of Pulmonary and Critical Care Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Byung Ki Lee
- Division of Pulmonary and Critical Care Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Chi Young Jung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Young June Jeon
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Dae Sung Hyun
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung Ken Yu
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hye Sook Choi
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Won Hyuk Shin
- Department of Internal Medicine, Sunlin Hospital, Handong Global University, Pohang, Korea
| | - Kwan Ho Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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870
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Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease and associated with considerable individual and socioeconomic burden. Recent research started examining the role of psychosocial factors for course and management of the disease. PURPOSE This review provides an overview on recent findings on psychosocial factors and behavioral medicine approaches in COPD. RESULTS Research has identified several important psychosocial factors and effective behavioral medicine interventions in COPD. However, there is considerable need for future research in this field. CONCLUSIONS Although beneficial effects of some behavioral medicine interventions have been demonstrated in COPD, future research efforts are necessary to study the effects of distinct components of these interventions, to thoroughly examine promising but yet not sufficiently proven interventions, and to develop new creative interventions.
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871
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Thomsen M, Dahl M, Lange P, Vestbo J, Nordestgaard BG. Inflammatory Biomarkers and Comorbidities in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2012; 186:982-8. [DOI: 10.1164/rccm.201206-1113oc] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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872
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873
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Toraldo DM, Minelli M, De Nuccio F, Nicolardi G. Chronic obstructive pulmonary disease phenotype desaturator with hypoxic vascular remodelling and pulmonary hypertension obtained by cluster analysis. Multidiscip Respir Med 2012; 7:39. [PMID: 23127203 PMCID: PMC3500223 DOI: 10.1186/2049-6958-7-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 10/25/2012] [Indexed: 11/26/2022] Open
Abstract
Significant heterogeneity of clinical presentation and disease progression exists within chronic obstructive pulmonary disease (COPD). This article discusses and refines the concept of desaturator phenotypes in COPD with pulmonary hypertension (PH) obtained by cluster analysis and presents a pattern of phenotypic markers that could be used as a framework for future diagnosis and research. Nocturnal oxygen desaturation results in sleep disturbances which predispose to nocturnal cardiac dysrhythmias, PH and possibly nocturnal death, particularly during acute exacerbations. We assume that in patients with COPD at least two factors play a role in PH: the severity of pulmonary impairment, and the severity of systemic nocturnal hypoxaemia due to reduced pulmonary functions. Establishing a common language for future research will facilitate our understanding and management of such a disease. This knowledge could lead to different pharmacological treatments and other interventions directed at specific phenotypic groups.
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Affiliation(s)
- Domenico Maurizio Toraldo
- “A. Galateo” Lung Disease Hospital, Rehabilitation Division, Regional Service Puglia, via A. C. Casetti n. 2, San Cesario di Lecce, 73100, ASL, Lecce, Italy
| | - Mauro Minelli
- Director of the Operative Unit“IMID Centre” in Campi Salentina Hospital, ASL, Lecce, Italy
| | - Francesco De Nuccio
- Laboratory of Human Anatomy, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Giuseppe Nicolardi
- Laboratory of Human Anatomy, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
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874
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Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease. Int J Cardiol 2012; 161:156-9. [DOI: 10.1016/j.ijcard.2012.05.044] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
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875
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Romme EAPM, Murchison JT, Phang KF, Jansen FH, Rutten EPA, Wouters EFM, Smeenk FWJM, Van Beek EJR, Macnee W. Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res 2012; 27:2338-43. [PMID: 22692725 DOI: 10.1002/jbmr.1678] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic obstructive pulmonary disease (COPD), although primarily a disease of the lungs, is associated with extrapulmonary effects such as muscle weakness and osteoporosis. Fractures owing to osteoporosis cause significant morbidity and mortality, particularly in patients with COPD. To prevent osteoporotic fractures, it is important to diagnose osteoporosis in an early stage and to start anti-osteoporotic therapy in at-risk patients. Because routine chest computed tomography (CT) is increasingly used to assess the extent of emphysema and airways disease in patients with COPD, we investigated whether simple attenuation measurement of the thoracic spine on routine chest CT may provide useful information on bone health in patients with COPD. Fifty-eight patients with moderate to very severe COPD were included in our study. The average attenuation of thoracic vertebrae 4, 7, and 10 on chest CT was correlated with the lowest bone mineral density (BMD) of the hip and lumbar spine (L(1) to L(4)) on dual-energy X-ray absorptiometry (DXA) in patients with COPD. The inter- and intra-observer variabilities of the attenuation measurements were low as shown by Bland-Altman plots. Pearson's correlation coefficient between the average attenuation of the three thoracic vertebrae and the lowest BMD of the hip and lumbar spine was high (r = 0.827, p < 0.001). A receiver-operating characteristic (ROC) analysis of the area under the curve for osteoporosis was 0.969 (p < 0.001), corresponding to an attenuation threshold of 147 Hounsfield Units (HU). In conclusion, our data demonstrated that bone attenuation measured on routine chest CT correlated strongly with BMD assessed on DXA in patients with COPD. Routine chest CT may provide useful information on bone health in patients with COPD.
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Affiliation(s)
- Elisabeth A P M Romme
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
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876
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Steiropoulos P, Papanas N, Nena E, Xanthoudaki M, Goula T, Froudarakis M, Pita E, Maltezos E, Bouros D. Mean Platelet Volume and Platelet Distribution Width in Patients With Chronic Obstructive Pulmonary Disease. Angiology 2012; 64:535-9. [DOI: 10.1177/0003319712461436] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated mean platelet volume (MPV; an indicator of vascular risk) and platelet distribution width in patients with stable chronic obstructive pulmonary disease (COPD; n = 85). We also included a control group of 34 smokers without airflow limitation. Mean platelet volume was significantly higher in patients with COPD (10.69 ± 1.0 vs 9.96 ± 1.10 fL, P < .001) than in the smoker controls. White blood cell (WBC) count was also significantly higher in patients with COPD than in the smoker controls (10 642 ± 1247 vs 7136 ± 1887/μL, P < .001). There was a correlation between MPV and WBC in patients with COPD, especially in those at stage III ( r = .530, P = .004) and IV ( r = .389, P = .023). Mean platelet volume did not correlate with any indices of COPD severity. In patients with COPD, MPV and WBC levels are higher than those of smokers with normal pulmonary function and are significantly correlated. Whether these effects relate to vascular risk in patients with COPD remain to be established.
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Affiliation(s)
- P. Steiropoulos
- Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - N. Papanas
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - E. Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - M. Xanthoudaki
- Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - T. Goula
- Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - M. Froudarakis
- Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - E. Pita
- Haematology Laboratory, University General Hospital of Alexandroupolis, Greece
| | - E. Maltezos
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - D. Bouros
- Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
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877
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Chen LF, Wang CH, Chou PC, Ho SC, Joa WC, Sheng TF, Kuo HP. Association Between Emphysema Score, Six-Minute Walk and Cardiopulmonary Exercise Tests in COPD. Open Respir Med J 2012; 6:104-10. [PMID: 23115601 PMCID: PMC3480708 DOI: 10.2174/1874306401206010104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 09/15/2012] [Accepted: 09/16/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-resolution computed tomography (HRCT) has allowed in detection of airway wall abnormalities and emphysema, whose extent may correlate with the clinical severity of the disease in patients with chronic obstructive pulmonary disease (COPD). Six minute walk test (6MWT) and cardiopulmonary exercise test (CPET) can determine functional status. METHODS A study was undertaken to investigate whether the extent of emphysema in COPD patients quantitatively confirmed by HRCT scoring was associated with distance walked, inspiratory capacity (IC) changes after exercise, anaerobic threshold of cardiopulmonary exercise and the BODE index (body mass index, airflow obstruction, dyspnea, exercise performance). RESULTS Seventeen patients with COPD underwent HRCT scanning, 6MWT and CPET. The emphysema score was highly correlated to forced vital capacity (FVC) (r=-0.748, p<0.001), forced expiratory volume in 1 second (FEV1) (r=-0.615, p<0.01), IC post exercise (r=-0.663, p<0.01) and dyspnea score post exercise (r=0.609, p<0.01), but was not associated with the BODE index. The distance walked during 6MWT was inversely correlated to emphysema score (r=-0.557, p<0.05). IC before exercise was highly related to the 6MWT. The change in IC after exercise was associated with the percent decline of oxygen saturation after exercise (r=0.633, p<0.01). Severity of lung emphysema in COPD patients was inversely correlated to VO(2) max (r=-0.514, p<0.05) and anaerobic threshold (r=-0.595, p<0.01) of cardiopulmonary exercise. CONCLUSIONS These results suggest that COPD associated with emphysema on HRCT is characterized by more severe lung function impairment, greater exercise impairment and cardiopulmonary dysfunction.
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Affiliation(s)
| | - Chun-Hua Wang
- Address correspondence to this author at the 199 Tun-Hwa North Road, Taipei, Taiwan. Pulmonary Medicine Research Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taiwan; Tel: 886 3 3281200, Ext. 8470; Fax: 886 3 3272474; E-mail:
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878
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Chang SS, Chen S, McAvay GJ, Tinetti ME. Effect of coexisting chronic obstructive pulmonary disease and cognitive impairment on health outcomes in older adults. J Am Geriatr Soc 2012; 60:1839-46. [PMID: 23035917 PMCID: PMC3470752 DOI: 10.1111/j.1532-5415.2012.04171.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine the extent to which the co-occurrence of chronic obstructive pulmonary disease (COPD) and cognitive impairment affect adverse health outcomes in older adults. DESIGN Multicenter longitudinal cohort study. SETTING California, Pennsylvania, Maryland, and North Carolina. PARTICIPANTS Three thousand ninety-three community-dwelling adults aged 65 and older from the Cardiovascular Health Study. Four hundred thirty-one had chronic obstructive pulmonary disease (COPD) at study baseline. MEASUREMENTS Follow-up began at the second CHS visit and continued for 3 years. Spirometric criteria for airflow limitation served to establish COPD using the Lambda-Mu-Sigma method, which accounts for age-related changes in lung function. Cognitive impairment was evaluated using the modified Mini-Mental State Examination and claims data. Outcomes were respiratory-related and all-cause hospitalizations and death. RESULTS Participants with coexisting COPD and cognitive impairment had the highest rates of respiratory-related (adjusted hazard ratio (aHR) = 4.10, 95% confidence interval (CI) = 1.86-9.05) and all-cause hospitalizations (aHR = 1.34, 95% CI = 1.00-1.80) and death (aHR = 2.29, 95% CI = 1.18-4.45). In particular, individuals with both conditions had a 48% higher rate of all-cause hospitalizations (adjusted synergy index (aSI) = 1.48, 95% CI = 0.19-11.31) and a rate of death nearly three times as high (aSI = 2.74, 95% CI = 0.43-17.32) as the sum of risks for each respective outcome associated with having COPD or cognitive impairment alone. Nevertheless, tests for interaction were not statistically significant for the presence of synergism between the two conditions contributing to each of the outcomes. Therefore, it cannot be concluded that the combined effect of COPD and cognitive impairment is greater than additive. CONCLUSION Coexisting COPD and cognitive impairment have an additive effect on respiratory-related and all-cause hospitalizations and death. Optimizing outcomes in older adults with COPD and cognitive impairment will require that how to improve concurrent management of both conditions be determined.
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Affiliation(s)
- Sandy S. Chang
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Shu Chen
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Gail J. McAvay
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Mary E. Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
- Division of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
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879
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Serrano-Mollar A. [Alveolar epithelial cell injury as an etiopathogenic factor in pulmonary fibrosis]. Arch Bronconeumol 2012; 48 Suppl 2:2-6. [PMID: 23116901 PMCID: PMC7131261 DOI: 10.1016/s0300-2896(12)70044-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive accumulation of extracellular matrix and an imbalance between profibrotic and antifibrotic mediators. In the last few years, understanding of the mechanisms of the biology of IPF has increased. One of the most significant discoveries is the finding that alveolar epithelial cell injury plays an important role in the pathogenesis of this disease. In this review, we describe some of the mechanisms involved in alveolar cell injury and their contribution to the development of IPF.
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Affiliation(s)
- Anna Serrano-Mollar
- Departamento de Patología Experimental, Institut d'Investigacions Biomèdiques de Barcelona, España.
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880
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de Matos Cavalcante AG, de Bruin PFC, de Bruin VMS, Nunes DM, Pereira EDB, Cavalcante MM, Andrade GM. Melatonin reduces lung oxidative stress in patients with chronic obstructive pulmonary disease: a randomized, double-blind, placebo-controlled study. J Pineal Res 2012; 53:238-44. [PMID: 22507631 DOI: 10.1111/j.1600-079x.2012.00992.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), a major cause of death and disability, is attributed to an abnormal inflammatory response by the lungs to noxious substances, primarily from cigarette smoke. Although oxidative stress is regarded as central to the pathogenesis of COPD, very few studies have examined the effects of antioxidants in this condition. This was a randomized, double-blind, placebo-controlled study on the effects of melatonin in COPD. Thirty-six consecutive patients with clinically stable moderate to very severe COPD (30 men; mean±S.D.=66.6±7.8yr) were randomized to receive 3mg melatonin (N=18) or placebo for 3 months. Oxidative stress was evaluated by 8-isoprostane levels in exhaled breath condensate at baseline (T0) and after one (T1), two (T2), and three months (T3) of treatment. Additionally, exhaled breath condensate levels of IL-8, dyspnea severity (Medical Research Council scale), lung function (spirometry), and functional exercise capacity (six min walk test) were compared at baseline and after treatment. Patients receiving melatonin showed a decrease in 8-isoprostane (T0: mean±S.E.M.=20.41±2.92pg/mL; T1: 18.56±2.68pg/mL; T2: 12.68±2.04pg/mL; T3: 12.70±2.18pg/mL; P=0.04; repeated measures ANOVA) with significant differences from baseline after 2 (P=0.03) and 3months (P=0.01). Dyspnea was improved by melatonin (P=0.01), despite no significant changes in lung function or exercise capacity. Placebo-treated patients, but not those who were given melatonin, showed an increase in IL-8 (P=0.03). In summary, melatonin administration reduced oxidative stress and improved dyspnea in COPD. Further studies are necessary to determine the potential role for melatonin in the long-term management of these patients.
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881
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Hornikx M, Van Remoortel H, Lehouck A, Mathieu C, Maes K, Gayan-Ramirez G, Decramer M, Troosters T, Janssens W. Vitamin D supplementation during rehabilitation in COPD: a secondary analysis of a randomized trial. Respir Res 2012; 13:84. [PMID: 23006613 PMCID: PMC3493348 DOI: 10.1186/1465-9921-13-84] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/18/2012] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Pulmonary rehabilitation is an important treatment for patients with Chronic Obstructive Pulmonary Disease, who are often vitamin D deficient. As vitamin D status is linked to skeletal muscle function, we aimed to explore if high dose vitamin D supplementation can improve the outcomes of rehabilitation in Chronic Obstructive Pulmonary Disease. MATERIAL AND METHODS This study is a post-hoc subgroup analysis of a larger randomized trial comparing a monthly dose of 100.000 IU of vitamin D with placebo to reduce exacerbations. 50 Subjects who followed a rehabilitation program during the trial are included in this analysis. We report changes from baseline in muscle strength and exercise performance between both study arms after 3 months of rehabilitation. RESULTS Vitamin D intervention resulted in significantly higher median vitamin D levels compared to placebo (51 [44-62] ng/ml vs 15 [13-30] ng/ml; p < 0.001). Patients receiving vitamin D had significantly larger improvements in inspiratory muscle strength (-11±12 cmH2O vs 0±14 cmH2O; p = 0.004) and maximal oxygen uptake (110±211 ml/min vs -20±187 ml/min; p = 0.029). Improvements in quadriceps strength (15±16 Nm) or six minutes walking distance (40±55 meter) were not significantly different from the effects in the placebo group (7±19 Nm and 11±74 meter; p>0.050). CONCLUSION High dose vitamin D supplementation during rehabilitation may have mild additional benefits to training.
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Affiliation(s)
- Miek Hornikx
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KULeuven, Leuven, Belgium
| | - Hans Van Remoortel
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KULeuven, Leuven, Belgium
| | - An Lehouck
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
| | - Chantal Mathieu
- Division of Endocrinology, University Hospital, KULeuven, Leuven, Belgium
| | - Karen Maes
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
| | - Ghislaine Gayan-Ramirez
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
| | - Marc Decramer
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
| | - Thierry Troosters
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KULeuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division and Rehabilitation, Laboratory of Pneumology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, Leuven, 3000, Belgium
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882
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Renin-angiotensin system blockade: a novel therapeutic approach in chronic obstructive pulmonary disease. Clin Sci (Lond) 2012; 123:487-98. [PMID: 22757959 DOI: 10.1042/cs20120081] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) are already widely used for the treatment and prevention of cardiovascular disease and their potential role in other disease states has become increasingly recognized. COPD (chronic obstructive pulmonary disease) is characterized by pathological inflammatory processes involving the lung parenchyma, airways and vascular bed. The aim of the present review is to outline the role of the RAS (renin-angiotensin system) in the pathogenesis of COPD, including reference to results from fibrotic lung conditions and pulmonary hypertension. The review will, in particular, address the emerging evidence that ACE inhibition could have a beneficial effect on skeletal muscle function and cardiovascular co-morbidity in COPD patients. The evidence to support the effect of RAS blockade as a novel therapeutic approach in COPD will be discussed.
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883
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Chronic obstructive pulmonary disease and lung cancer: common pathogenesis, shared clinical challenges. Ann Am Thorac Soc 2012; 9:74-9. [PMID: 22550249 DOI: 10.1513/pats.201107-039ms] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Environmental inhaled noxious particles have been known to play a role in several lung diseases, including chronic obstructive pulmonary disease (COPD) and lung cancer, the deadliest malignancy in the world in both sexes. Of the known noxious agents, tobacco smoking is the leading preventable cause of death worldwide and is a recognized risk for the development of both diseases. The association between COPD and lung cancer has been demonstrated in population-based studies, lung cancer screening programs, epidemiological surveys, and case control and biological mechanistic studies. There is evidence that cumulative smoking history is associated with the risk of developing lung cancer and COPD; however, the majority of smokers do not develop clinical COPD or lung cancer. This suggests the presence of one or several factors that modulate the responses to the offending agents and define the final risk for disease development. The 54th Aspen Lung Conference was convened to provide a forum for a systematic dissection of the potential mechanisms by which persons exposed to the causative agents are able to handle and control the process or, in the case of dysfunctional response, the mechanisms that take off in different directions and result in injury and disease. This summary reviews the themes presented and attempts to integrate them for those clinicians and researchers interested in these topics. The challenges and future directions emanating from the discussions may help frame future conferences and hopefully inspire the interest of young researchers.
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884
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Arimura K, Aoshiba K, Tsuji T, Tamaoki J. Chronic low-grade systemic inflammation causes DNA damage in the lungs of mice. Lung 2012; 190:613-20. [PMID: 22965854 DOI: 10.1007/s00408-012-9414-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/26/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Whether systemic inflammation compromises the pulmonary system is largely unknown. We tested the hypothesis that chronic low-grade systemic inflammation damages alveolar wall cells. METHODS A chronic low-grade systemic inflammatory state was induced in 8-week-old male C57/BL6J mice by administration of lipopolysaccharide (LPS, 44.4 μg/day) for a 90-day period by subcutaneous implantation of a delayed-release pellet system. Acute systemic inflammation was induced in another group of mice by a single intraperitoneal injection of LPS (125 μg/body). The lungs of mice were examined for histologic changes and genetic damage to alveolar wall cells. RESULTS Chronic LPS exposure for a 30-day period or a 90-day period did not cause any obvious architectural changes in the lungs except for a mild level of alveolar macrophage infiltration. Despite the lack of architectural changes in the lung, immunofluorescence staining for γH2AX and phosphorylated 53BP1 showed that chronic LPS exposure resulted in an almost doubling of the number of DNA double-strand breaks (DSBs) in type 1 and type 2 alveolar epithelial cells and in alveolar endothelial cells. Acute LPS exposure also resulted in a doubling of the number of DSBs in type 1 and type 2 alveolar epithelial cells and in alveolar endothelial cells at 24 h, but the increased number of DSBs returned to the baseline level by 48 h. CONCLUSIONS These results suggest that chronic systemic low-grade inflammation induces persistent DNA damage in alveolar epithelial and endothelial cells before architectural changes in the lung become evident.
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Affiliation(s)
- Ken Arimura
- Pulmonary Division, Graduate School of Medical Science, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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885
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Systemic inflammation and comorbidities in chronic obstructive pulmonary disease. Ann Am Thorac Soc 2012; 9:43-6. [PMID: 22550240 DOI: 10.1513/pats.201108-050ms] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The relationship between systemic inflammation and comorbidities in patients with chronic obstructive pulmonary disease (COPD) is unclear. This article discusses (1) the prevalence and clinical impact of comorbidities in COPD; (2) the current knowledge on definition, prevalence, consequences, and treatment of systemic inflammation in COPD; and (3) the relationship of systemic inflammation and lung cancer in COPD.
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886
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Liang B, Feng Y. The association of low bone mineral density with systemic inflammation in clinically stable COPD. Endocrine 2012; 42:190-5. [PMID: 22198912 DOI: 10.1007/s12020-011-9583-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 12/07/2011] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is known to be a systemic inflammatory disease which affects the function of many organs, and the low bone mineral density (BMD) may be the result of systemic inflammation. The aim of the present study was to explore the association of BMD with systemic inflammation in patients with clinically stable COPD. BMD and inflammatory markers, including C-reactive protein, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6), were determined in all the recruited patients with clinically stable COPD. The patients were classified according to T scores, and the relationship between BMD with markers of systemic inflammation and that with other osteoporosis risk factors was assessed. There were no differences in age, female sex, body composition, tobacco exposure, and the use of respiratory medications among these groups. As the abnormality of BMD went severer, COPD patients with osteoporosis had significantly higher levels of systemic inflammation than those with either normal BMD or osteopenia. The presence of systemic inflammation was associated with a greater likelihood of low BMD, and multivariate logistic regression analysis showed that TNF-α and IL-6 were independent predictors of low BMD. It can be concluded that systemic inflammation is a significantly independent predictor of low BMD in patients with clinically stable COPD.
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Affiliation(s)
- Binmiao Liang
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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887
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Tseng CC, Huang KT, Chen YC, Wang CC, Liu SF, Tu ML, Chung YH, Fang WF, Lin MC. Factors predicting ventilator dependence in patients with ventilator-associated pneumonia. ScientificWorldJournal 2012; 2012:547241. [PMID: 22919335 PMCID: PMC3417186 DOI: 10.1100/2012/547241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/27/2012] [Indexed: 01/08/2023] Open
Abstract
Objectives. To determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP). Study Design. A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008. Methods. This study evaluated 163 adult patients (aged ≥18 years). Eligibility was evaluated according to the criterion for VAP, Sequential Organ Failure Assessment (SOFA) score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) score. Oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis. Results. Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40%) had been weaned off ventilators at the time of discharge. Multivariate logistic regression analysis was used to identify underlying factors such as congestive cardiac failure (P = 0.009), initial high oxygenation index value (P = 0.04), increased SOFA scores (P = 0.01), and increased APACHE II scores (P = 0.02) as independent predictors of ventilator dependence. Results from the Kaplan-Meier method indicate that initial therapy with antibiotics could increase the ventilator weaning rate (log Rank test, P < 0.001). Conclusions. Preexisting cardiopulmonary function, high APACHE II and SOFA scores, and high oxygenation index were the strongest predictors of ventilator dependence. Initial empiric antibiotic treatment can improve ventilator weaning rates at the time of discharge.
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Affiliation(s)
- Chia-Cheng Tseng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
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888
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Lepeule J, Baccarelli A, Motta V, Cantone L, Litonjua AA, Sparrow D, Vokonas PS, Schwartz J. Gene promoter methylation is associated with lung function in the elderly: the Normative Aging Study. Epigenetics 2012; 7:261-9. [PMID: 22430802 DOI: 10.4161/epi.7.3.19216] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung function is a strong predictor of mortality. While inflammatory markers have been associated with lung function decrease, pathways are still poorly understood and epigenetic changes may participate in lung function decline mechanisms. We studied the cross-sectional association between DNA methylation in nine inflammatory genes and lung function in a cohort of 756 elderly men living in the metropolitan area of Boston. Participants donated a blood sample for DNA methylation analysis and underwent spirometry at each visit every 3 to 5 y from 1999-2006. We used separate multivariate mixed effects regression models to study the association between each lung function measurement and DNA methylation within each gene. Decreased CRAT, F3 and TLR2 methylation was significantly associated with lower lung function. One interquartile range (IQR) decrease in DNA methylation was associated with lower forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1), respectively by 2.94% (p < 10 (-4)) and 2.47% (p < 10 (-3)) for F3, and by 2.10% (p < 10 (-2)) and 2.42% (p < 10 (-3)) for TLR2. Decreased IFNγ and IL6 methylation was significantly associated with better lung function. One IQR decrease in DNA methylation was associated with higher FEV 1 by 1.75% (p = 0.02) and 1.67% (p = 0.05) for IFNγ and IL6, respectively. These data demonstrate that DNA methylation may be part of the biological processes underlying the lung function decline and that IFNγ and IL6 may have ambivalent roles through activation of negative feedback.
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Affiliation(s)
- Johanna Lepeule
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
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889
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Ansari K, Keaney N, Price M, Munby J, Kay A, Taylor I, King K. Precision in Diagnosing and Classifying COPD: Comparison of Historical Height with Current Height and Arm Span to Predict FEV(1). Open Respir Med J 2012; 6:54-8. [PMID: 22896775 PMCID: PMC3415627 DOI: 10.2174/1874306401206010054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Measured reductions in lung function, as a result of COPD, use a measured current value and make comparisons to a determined 'normal' value arrived at using a regression equation based upon a patients height. Osteoporosis is a recognised co-morbidity in patients with chronic obstructive pulmonary disease (COPD) and may cause excessive height loss resulting in the 'normal' values and disease progression being under-estimated. PURPOSE The aim of the study was to examine the height variation in a cohort of COPD patients and controls over a 7-8 years period and evaluate its impact on estimates of lung function and hence COPD progression. METHODS In 1999-2002 we studied a cohort of primary care patients in Sunderland, UK with and without COPD and reexamined 104 (56 male) during 2007-2009. We calculated FEV(1)% predicted for actual and estimated height (armspan/1.03 and armspan/1.01 in males and females respectively). RESULTS In 1999-2002 the subjects were aged 62.6 ± 9.4 years, BMI was 26.4± 4.7 kg/m2, predicted FEV(1) was 59.0 ±16.0, and mean actual height was 167.3±8.9cm. The actual height changed significantly (p<0.001) by 2cms over time in both genders. Whilst the overall classifications of the cohort did not change significantly when armspan was used to determine height and hence normal lung volume, individual cases did move to a classification of higher severity. CONCLUSIONS The study suggests that current measured height may underestimate the degree of impairment of FEV(1) and hence progression of COPD. The use of height, derived from armspan, may give a more accurate measure of 'normal' lung volumes and hence the degree of impairment.
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Affiliation(s)
- Khalid Ansari
- Faculty of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, England, UK
| | - Niall Keaney
- Sunderland Royal Hospital, Sunderland, NE, England, UK
| | - Monica Price
- Faculty of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, England, UK
| | - Joan Munby
- Faculty of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, England, UK
| | - Andrea Kay
- Sunderland Royal Hospital, Sunderland, NE, England, UK
| | - Ian Taylor
- Sunderland Royal Hospital, Sunderland, NE, England, UK
| | - Kathryn King
- Faculty of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, England, UK
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890
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Corlateanu A, Siafakas N, Botnaru V. Defining COPD: from simplistic approach to multilateral assessment of COPD. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0023-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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891
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Boutou AK, Karrar S, Hopkinson NS, Polkey MI. Anemia and survival in chronic obstructive pulmonary disease: a dichotomous rather than a continuous predictor. ACTA ACUST UNITED AC 2012; 85:126-31. [PMID: 22759351 DOI: 10.1159/000338792] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/10/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a disorder characterized by high mortality. Hemoglobin (Hb) concentration has a prognostic impact on COPD patients receiving long-term oxygen treatment, but its value as an independent predictor of survival among stable COPD outpatients has not been fully clarified by previous studies. OBJECTIVES To investigate the potential association between anemia and survival in a cohort of stable COPD outpatients. METHODS A cohort of stable COPD patients, who had had their first spirometry, blood count and serum chemistry profile done between October 1999 and November 2010 were retrospectively analyzed. Patients with heart failure, renal impairment, malignancy, recent hemorrhage and other causes of anemia were excluded. Variables that were found to be univariately associated with survival entered a multivariate stepwise Cox regression analysis model, to allow independent predictors of survival to be identified. RESULTS Of 294 patients (67.9 ± 9.8 years old, 64.6% male) 15.6% were anemic (Hb <13 g/dl). The median survival differed significantly between anemic [68.7 (18.1-91.5) months] and nonanemic [79.8 (57.5-98.4) months, p = 0.035] individuals. Independent predictors of mortality in the total population were anemia [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.06-3.29], age (HR 1.08, 95% CI 1.04-1.12) and forced expiratory volume in 1 s (FEV(1)) % predicted (HR 0.94, 95% CI 0.92-0.97); the Hb concentration was neither univariately nor multivariately associated with mortality. CONCLUSION This is the first study to indicate that anemia (but not the Hb value) is independently associated with survival in stable COPD outpatients. It would be better to treat this as a categorical variable in future scoring systems.
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Affiliation(s)
- Afroditi K Boutou
- NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.
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892
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Boutou AK, Pitsiou GG, Stanopoulos I, Kontakiotis T, Kyriazis G, Argyropoulou P. Levels of inflammatory mediators in chronic obstructive pulmonary disease patients with anemia of chronic disease: a case-control study. QJM 2012; 105:657-63. [PMID: 22355163 DOI: 10.1093/qjmed/hcs024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although a subset of patients with chronic obstructive pulmonary disease (COPD) display anemia, the role of elevated pro-inflammatory cytokines in COPD-related anemia of chronic disease (ACD) has not been fully investigated. AIM To examine the levels of interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor-alpha (TNFα), interferon-gamma (IFNγ), C-reactive protein (CRP) and erythropoietin in stable COPD outpatients with and without ACD. DESIGN A case-control design was followed. METHODS Fifty-four patients with stable COPD were studied. Among them, 27 had ACD according to strict clinical and laboratory criteria (group of cases), while another 27 nonanemic COPD patients, carefully matched to cases for age, gender, height, lung function and smoking status represented the controls. Serum levels of IL-1β, IL-6, IL-10, TNFα, IFNγ, CRP and erythropoietin were measured in both groups. RESULTS Patients with ACD had significantly higher levels of IL-10 [25.6 (1.9-95.2) vs. 4.1 (1.9-31.9) pg/ml, P = 0.049] and IFNγ [15.2 (2.2-106.9) vs. 2 (1.2-18.3) pg/ml, P = 0.026] and had more frequently elevated CRP than controls. Levels of IL-1β [26.2 (9.8-96.4) vs. 7.9 (2.1-28.4) pg/ml, P = 0.073], IL-6 [20.3 (2.1-125.4) vs. 6.2 (1.2-33.8) pg/ml, P = 0.688] and TNFα [30.1 (3.2-107.5) vs. 10.1 (3.2-50.4) pg/ml, P = 0.131] were also higher in cases, but the differences did not reach statistical significance. Patients with ACD also displayed significantly higher erythropoietin levels than controls [(21.9 (8.4-101.7) vs. 9.7 (6.3-21.7) mIU/ml, P = 0.010], indicating erythropoietin resistance. CONCLUSION This study shows that in stable COPD outpatients with strictly defined ACD, levels of inflammatory mediators and erythropoietin are elevated compared to nonanemic controls.
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Affiliation(s)
- A K Boutou
- Respiratory Failure Unit, G. Papanikolaou Hospital, 57010, Exohi, Thessaloniki, Greece.
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893
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Giavedoni S, Deans A, McCaughey P, Drost E, MacNee W, Rabinovich RA. Neuromuscular electrical stimulation prevents muscle function deterioration in exacerbated COPD: a pilot study. Respir Med 2012; 106:1429-34. [PMID: 22726566 DOI: 10.1016/j.rmed.2012.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/16/2012] [Accepted: 05/19/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE COPD is a condition with systemic effects of which peripheral muscle dysfunction is a prominent contributor to exercise limitation, health related quality of life (HRQoL) impairment, and is an independent predictor of morbidity and mortality. Pulmonary rehabilitation (PR) is a successful strategy to improve exercise tolerance and HRQoL through the improvement of muscle function in patients with stable COPD or early after severe exacerbations of COPD (SECOPD). However, muscle function further deteriorates during SECOPD before early PR programmes commence. We aimed to investigate the feasibility and efficacy of quadriceps neuromuscular electrical stimulation (NMES) applied during a SECOPD to prevent muscle function deterioration. METHODS We have conducted a pilot study in eleven COPD patients (FEV(1) 41.3 ± 5.6 % pred) admitted to hospital with a SECOPD. We randomly allocated one leg to receive NMES (once a day for 14 days) with the other leg as a control (non-stimulated leg). We measured the change in quadriceps maximal voluntary contraction (ΔQMVC) as the main outcome. RESULTS Mean quadriceps muscle strength decreased in control legs (ΔQMVC -2.9 ± 5.3 N, p = ns) but increased in the stimulated legs (ΔQMVC 19.2 ± 6.1 N, p < 0.01). The difference in ΔQMVC between groups was statistically significant (p < 0.05). The effect of NMES was directly related to the stimulation intensity (∑mA) applied throughout the 14 sessions (r = 0.76, p < 0.01). All patients tolerated NMES without any side effects. CONCLUSIONS NMES is a feasible and effective treatment to prevent quadriceps muscle strength derangement during severe exacerbations of COPD and may be used to compliment early post-exacerbation pulmonary rehabilitation.
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Affiliation(s)
- Santiago Giavedoni
- ELEGI Colt Laboratory, Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, UK
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894
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Eagan TML, Gabazza EC, D'Alessandro-Gabazza C, Gil-Bernabe P, Aoki S, Hardie JA, Bakke PS, Wagner PD. TNF-α is associated with loss of lean body mass only in already cachectic COPD patients. Respir Res 2012; 13:48. [PMID: 22708547 PMCID: PMC3487870 DOI: 10.1186/1465-9921-13-48] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/08/2012] [Indexed: 12/31/2022] Open
Abstract
Background Systemic inflammation may contribute to cachexia in patients with chronic obstructive pulmonary disease (COPD). In this longitudinal study we assessed the association between circulating C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, and IL-6 levels and subsequent loss of fat free mass and fat mass in more than 400 COPD patients over three years. Methods The patients, aged 40–76, GOLD stage II-IV, were enrolled in 2006/07, and followed annually. Fat free mass and fat mass indexes (FFMI & FMI) were calculated using bioelectrical impedance, and CRP, TNF-α, IL-1ß, and IL-6 were measured using enzyme immunoassays. Associations with mean change in FFMI and FMI of the four inflammatory plasma markers, sex, age, smoking, FEV1, inhaled steroids, arterial hypoxemia, and Charlson comorbidity score were analyzed with linear mixed models. Results At baseline, only CRP was significantly (but weakly) associated with FFMI (r = 0.18, p < 0.01) and FMI (r = 0.27, p < 0.01). Univariately, higher age, lower FEV1, and use of beta2-agonists were the only significant predictors of decline in FFMI, whereas smoking, hypoxemia, Charlson score, and use of inhaled steroids predicted increased loss in FMI. Multivariately, high levels of TNF-α (but not CRP, IL-1ß or IL-6) significantly predicted loss of FFMI, however only in patients with established cachexia at entry. Conclusion This study does not support the hypothesis that systemic inflammation is the cause of accelerated loss of fat free mass in COPD patients, but suggests a role for TNF-α in already cachectic COPD patients.
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Affiliation(s)
- Tomas M L Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, N-5021, Bergen, Norway.
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895
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Emerging PPARγ-Independent Role of PPARγ Ligands in Lung Diseases. PPAR Res 2012; 2012:705352. [PMID: 22778711 PMCID: PMC3385049 DOI: 10.1155/2012/705352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/28/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
Peroxisome proliferator activated receptor (PPAR)-γ is a nuclear hormone receptor that is activated by multiple agonists including thiazolidinediones, prostaglandins, and synthetic oleanolic acids. Many PPARγ ligands are under investigation as potential therapies for human diseases. These ligands modulate multiple cellular pathways via both PPARγ-dependent and PPARγ-independent mechanisms. Here, we review the role of PPARγ and PPARγ ligands in lung disease, with emphasis on PPARγ-independent effects. PPARγ ligands show great promise in moderating lung inflammation, as antiproliferative agents in combination to enhance standard chemotherapy in lung cancer and as treatments for pulmonary fibrosis, a progressive fatal disease with no effective therapy. Some of these effects occur when PPARγ is pharmaceutically antagonized or genetically PPARγ and are thus independent of classical PPARγ-dependent transcriptional control. Many PPARγ ligands demonstrate direct binding to transcription factors and other proteins, altering their function and contributing to PPARγ-independent inhibition of disease phenotypes. These PPARγ-independent mechanisms are of significant interest because they suggest new therapeutic uses for currently approved drugs and because they can be used as probes to identify novel proteins and pathways involved in the pathogenesis or treatment of disease, which can then be targeted for further investigation and drug development.
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896
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Ege M, Guray U, Guray Y, Yilmaz M, Yucel O, Zorlu A, Tandogan I. Acute heart failure with accompanying chronic obstructive pulmonary disease. Herz 2012; 37:796-800. [DOI: 10.1007/s00059-012-3641-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 05/03/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
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897
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The Excessive Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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898
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Lahaije AJ, Heijdra YF, Willems LM, van Helvoort HA, Dekhuijzen PR. COPD Anno 2011: Emphasis on Bronch(iol)odilation. J Aerosol Med Pulm Drug Deliv 2012; 25:148-53. [DOI: 10.1089/jamp.2011.0922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anke J.M.C. Lahaije
- Radboud University Nijmegen Medical Centre, Department of Pulmonary Diseases, 454, Geert Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands
| | - Yvonne F. Heijdra
- Radboud University Nijmegen Medical Centre, Department of Pulmonary Diseases, 454, Geert Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands
| | - Laura M. Willems
- Radboud University Nijmegen Medical Centre, Department of Pulmonary Diseases, 454, Geert Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands
| | - Hanneke A.C. van Helvoort
- Radboud University Nijmegen Medical Centre, Department of Pulmonary Diseases, 454, Geert Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands
| | - P.N. Richard Dekhuijzen
- Radboud University Nijmegen Medical Centre, Department of Pulmonary Diseases, 454, Geert Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands
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899
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Koczulla AR, Jonigk D, Wolf T, Herr C, Noeske S, Klepetko W, Vogelmeier C, von Neuhoff N, Rische J, Wrenger S, Golpon H, Voswinckel R, Luisetti M, Ferrarotti I, Welte T, Janciauskiene S. Krüppel-like zinc finger proteins in end-stage COPD lungs with and without severe alpha1-antitrypsin deficiency. Orphanet J Rare Dis 2012; 7:29. [PMID: 22621770 PMCID: PMC3517304 DOI: 10.1186/1750-1172-7-29] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 05/08/2012] [Indexed: 11/24/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is influenced by environmental and genetic factors. An important fraction of COPD cases harbor a major genetic determinant, inherited ZZ (Glu342Lys) α1-antitrypsin deficiency (AATD). A study was undertaken to investigate gene expression patterns in end-stage COPD lungs from patients with and without AATD. Methods Explanted lungs of end-stage ZZ AATD-related (treated and non-treated with AAT augmentation therapy) and “normal” MM COPD, and liver biopsies from patients suffering from liver cirrhosis with and without ZZ AATD were used for gene expression analysis by Affymetrix microarrays or RT-PCR. Results A total of 162 genes were found to be differentially expressed (p-value ≤ 0.05 and |FC| ≥ 2) between MM and ZZ COPD patients. Of those, 134 gene sets were up-regulated and 28 were down-regulated in ZZ relative to MM lung tissue. A subgroup of genes, zinc finger protein 165, snail homolog 1 (Drosophila) (SNAI1), and Krüppel-like transcription factors (KLFs) 4 (gut), 9 and 10, perfectly segregated ZZ and MM COPD patients. The higher expression of KLF 9 and KLF10 has been verified in the replication cohort with AATD-related end-stage lung emphysema and liver cirrhosis. Furthermore, higher expression of KLF9, SNAI1 and DEFA1 was found in ZZ COPD lungs without augmentation therapy relative to MM COPD or ZZ COPD with augmentation therapy. Conclusions These results reveal the involvement of transcriptional regulators of the zinc-finger family in COPD pathogenesis and provide deeper insight into the pathophysiological mechanisms of COPD with and without AATD.
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900
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Shivshankar P. Modulation of bacterial pathogenesis by oppressive aging factors: insights into host-pneumococcal interaction strategies. ISRN INFLAMMATION 2012; 2012:267101. [PMID: 24049644 PMCID: PMC3765745 DOI: 10.5402/2012/267101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/20/2012] [Indexed: 01/20/2023]
Abstract
Streptococcus pneumonia, (Spn, the pneumococcus), is the leading cause of community-acquired pneumonia (CAP) and is responsible for 15–40% deaths in the elderly worldwide. A primed inflammatory status is a significant risk factor for the increased severity of infectious diseases among the elderly (≥65 years of age). Studies have shown that expression of host receptors that the pneumococci bind to invade the tissues are increased thereby increasing the susceptibility to pneumococcal challenge in aged mice. Cellular senescence, an age-related phenomenon that leads to cell cycle arrest may also contribute to increased inflammation in aged mice. Evidence of cellular senescence in aged lungs of humans and mice adds credits to the concept of inflammaging and enhanced bacterial ligands expression during aging. Furthermore, cell senescence has been shown to occur in age-associated lung pathologies such as idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) that may predispose the elderly to pathogenic assaults, including S. pneumoniae. This review highlights the aspects of: chronic inflammation in the aged population; contribution of cellular senescence to age-associated inflammation and their impact on host receptor expression; and, increased susceptibility of fibrosis and emphysematous lesions-bearing lungs to microbial infections.
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Affiliation(s)
- Pooja Shivshankar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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