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Marron RM, Zheng M, Fernandez Romero G, Zhao H, Patel R, Leopold I, Thomas A, Standiford T, Kumaran M, Patlakh N, Stewart J, Criner GJ. Impact of Chronic Obstructive Pulmonary Disease and Emphysema on Outcomes of Hospitalized Patients with Coronavirus Disease 2019 Pneumonia. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2021; 8:255-268. [PMID: 33780602 DOI: 10.15326/jcopdf.2020.0200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Comorbid disease is a risk factor for severe coronavirus disease 2019 (COVID-19) infection. However, initial rates of chronic obstructive pulmonary disease (COPD) in case series were low and severity of COVID-19 in COPD patients was variable. Methods We performed a retrospective study of patients admitted with COVID-19 and evaluated outcomes in those with and without COPD and/or emphysema. Patients were identified as having COPD if they had a diagnosis in the medical record and a history of airflow-obstruction on spirometry, or a history of tobacco use and prescribed long-acting bronchodilator(s). Computed tomography scans were evaluated by radiologists. Propensity matching was performed for age, body mass index (BMI), and serologic data correlated with severity of COVID-19 disease (D-dimer, C-reactive protein, ferritin, fibrinogen, absolute lymphocyte count, lymphocyte percentage, and lactate dehydrogenase). Results Of 577 patients admitted with COVID-19, 103 had a diagnosis of COPD and/or emphysema. The COPD/emphysema cohort was older (67 versus 58, p<0.0001) than the other cohort and had a lower BMI. Among unmatched cohorts those with COPD/emphysema had higher rates of intensive care unit (ICU) admission (35% versus 24.9%, p=0.036) and maximal respiratory support requirements, with more frequent invasive mechanical ventilation (21.4% versus 11.8%), but no significant difference in mortality. After propensity-matching there was no difference in ICU admission, maximal respiratory support requirements, or mortality. Univariate and multivariate regression analyses yielded similar results. Discussion Our propensity-matched retrospective cohort study suggests that patients hospitalized with COVID-19 who have COPD and/or emphysema may not have worse outcomes than those without these comorbid conditions.
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Affiliation(s)
- Robert M Marron
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Matthew Zheng
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Gustavo Fernandez Romero
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Raj Patel
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Ian Leopold
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Ashanth Thomas
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Taylor Standiford
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Maruti Kumaran
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Nicole Patlakh
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Jeffrey Stewart
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
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The determinants of dyspnoea evaluated by the mMRC scale: The French Palomb cohort. Respir Med Res 2020; 79:100803. [PMID: 33326922 DOI: 10.1016/j.resmer.2020.100803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE Dyspnoea is a major symptom in COPD patients, but the determinants that could be associated with a higher dyspnoea mMRC score in COPD patients remain unclear. Our research aimed to study the determinants of dyspnoea at the threshold of 1, 2, 3 and 4 mMRC. PATIENTS AND METHODS Diagnosis of COPD was made using spirometry with post-bronchodilator FEV1FVC<70%. An online questionnaire has been employed by pulmonologists to recruit COPD patients. The following variables were collected: age, gender, BMI, FEV1, RV, IC, TLC, FRC, mMRC, frequency of exacerbations and comorbidities. The LASSO was used to select the variables associated with the mMRC dyspnoea scale in a subgroup (who had no missing IC, RV and FRC values) of 421 COPD patients defined by the previously mentioned variables. RESULTS One thousand nine hundred and sevety-three patients (65.3% males, average age=66±10, 38% current smokers) were included. Dyspnoea was correlated with a low FEV1 and with the number of exacerbations in the past 12 months. Multivariate analysis showed that the determinants of dyspnoea(mMRC≥2) are: FEV1: OR=3.71[2.86-4.82]; anxiety: OR=2.52[1.82-3.47]; cough: OR=1.94[1.57-2.40]; bronchiectasis: OR=1.84[1.03-3.29]; age: OR=1.80[1.45-2.24]; hyperinflation (RV/TLC): OR=1.68[1.34-2.11]; ischemic cardiopathy: OR=1.63[1.22-2.18]; hypertension: OR=1.52[1.21-1.91]; exacerbations (≥2): OR=1.41[1.10-1.81]; women: OR=1.39[1.10-1.74] and overweight: OR=1.33[1.06-1.67]. The subgroup analysis showed that: FEV1: OR=3.47[1.96-6.12]; exacerbations (≥2) OR=2.31[1.33-4.17] and hyperinflation (IC/TLC) OR=0.57[0.35-0.85] were associated with higher dyspnoea (mMRC≥2). CONCLUSION Our results showed that dyspnoea is related to the severity of airflow limitation, gender, exacerbations, comorbidities and hyperinflation.
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Effect of BMI on health care expenditures stratified by COPD GOLD severity grades: Results from the LQ-DMP study. Respir Med 2020; 175:106194. [PMID: 33166903 DOI: 10.1016/j.rmed.2020.106194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation, which is progressive and not fully reversible. In patients with COPD, body mass index (BMI) is an important parameter associated with health outcomes, e.g. mortality and health-related quality of life. However, so far no study evaluated the association of BMI and health care expenditures across different COPD severity grades. We used claims data and documentation data of a Disease Management Program (DMP) from a statutory health insurance fund (AOK Bayern). Patients were excluded if they had less than 4 observations in the 8 years observational period. Generalized additive mixed models with smooth functions were used to evaluate the association between BMI and health care expenditures, stratified by severity of COPD, indicated by GOLD grades 1-4. We included 30,682 patients with overall 188,725 observations. In GOLD grades 1-3 we found an u-shaped relation of BMI and expenditures, where patients with a BMI of 30 or slightly above had the lowest and underweight and obese patients had the highest health care expenditures. Contrarily, in GOLD grade 4 we found an almost linear decline of health care expenditures with increasing BMI. In terms of expenditures, the often reported obesity paradox in patients with COPD was clearly reflected in GOLD grade 4, while in all other severity grades underweight as well as severely obese patients caused the highest health care expenditures. Reduction of obesity may thus reduce health care expenditures in GOLD grades 1-3.
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Min J, Feng R, Badesch D, Berman-Rosenzweig E, Burger C, Chakinala M, De Marco T, Feldman J, Hemnes A, Horn EM, Lammi MR, Mathai S, McConnell JW, Presberg K, Robinson J, Sager J, Shlobin OA, Simon M, Thenappan T, Ventetuolo C, Al-Naamani N. Obesity in Pulmonary Arterial Hypertension (PAH): The Pulmonary Hypertension Association Registry (PHAR). Ann Am Thorac Soc 2020; 18:229-237. [PMID: 33085915 PMCID: PMC7869778 DOI: 10.1513/annalsats.202006-612oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood. OBJECTIVES To assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH. METHODS We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status. RESULTS 767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively). CONCLUSIONS In a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients.
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Affiliation(s)
- Jeff Min
- University of Pennsylvania, 6572, Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Rui Feng
- University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - David Badesch
- University of Colorado, Medicine, Aurora, Colorado, United States
| | | | - Charles Burger
- Mayo Clinic, Pulmonary and Critical Care, Jacksonville, Florida, United States
| | - Murali Chakinala
- Washington University, Internal Medicine, Saint Louis, Missouri, United States
| | - Teresa De Marco
- University of California San Francisco, Medicine, San Francisco, California, United States
| | - Jeremy Feldman
- Arizona Pulmonary Specialists, Phoenix, Arizona, United States
| | - Anna Hemnes
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Evelyn M Horn
- Weill-Cornell Medical School, New York, New York, United States
| | - Matthew R Lammi
- Louisiana State University Health Sciences Center, Pulmonary/Critical Care and Allergy/Immunology, New Orleans, Louisiana, United States
| | - Stephen Mathai
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Medicine, Baltimore, United States
| | - John W McConnell
- Kentuckiana Pulmonary Associates, Louisville, Kentucky, United States
| | - Kenneth Presberg
- Froedtert and the Medical College of Wisconsin Froedtert Hospital, 20721, Milwaukee, Wisconsin, United States
| | | | - Jeffrey Sager
- Santa Barbara Pulmonary Associates, Santa Barbara, California, United States
| | - Oksana A Shlobin
- Inova Fairfax Hospital, Advanced Lung Disease and Transplant, Falls Church, Virginia, United States
| | - Marc Simon
- UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | | | - Corey Ventetuolo
- Brown University, Medicine , Providence, Rhode Island, United States
| | - Nadine Al-Naamani
- University of Pennsylvania, 6572, Philadelphia, Pennsylvania, United States;
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Zhu J, Zhao Z, Wu B, Shi Z, Nie Q, Fu Z, Zeng Z, Hu W, Dong M, Xiong M, Hu K. Effect of Body Mass Index on Lung Function in Chinese Patients with Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2020; 15:2477-2486. [PMID: 33116464 PMCID: PMC7568679 DOI: 10.2147/copd.s265676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/31/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study was to explain “obesity paradox” in chronic obstructive pulmonary disease (COPD) by evaluating the effect of body mass index (BMI) on lung function in Chinese patients with COPD. Methods A total of 1644 patients diagnosed with COPD were recruited from four Chinese tertiary hospitals and were divided into four groups including underweight, normal weight, overweight and obese according to BMI classification standard. The medical data of these patients were collected and used for the multiple linear regression analyses. Results After adjustment for age, sex, educational level, economic status, smoking status, alcohol consumption, duration of COPD history, events of acute exacerbation in previous year, hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular disease and osteoporosis, BMI had a curvilinear correlation with the forced expiratory volume in the first second (FEV1) in patients with Global Initiative for Obstructive Lung Disease (GOLD) 1–2 grade (first-order coefficient β, 0.09; 95% CI, 0.03–0.16; second-order coefficient β, −0.002; 95% CI, −0.003–-0.001; P<0.01). However, BMI had a positive correlation with FEV1 in patients with GOLD 3–4 grade (β, 0.01; 95% CI, 0.008–0.017; P<0.01) when BMI was used as a quantitative variable. When BMI was used as a qualitative variable, only FEV1 in overweight group with GOLD 1–2 grade was significantly higher than that of normal weight group (P<0.01). Interestingly, both overweight and obese groups had higher FEV1 in GOLD 3–4 grade compared with normal weight group (β, 0.06; 95% CI, 0.02–0.11; β, 0.11; 95% CI, 0.04–0.18; P<0.01). The effect of BMI on predicted percentage of FEV1 (FEV1%) was similar to that of FEV1 in different GOLD grades. Conclusion Obesity only had a protective effect on lung function in COPD patients with GOLD 3–4 grade rather than GOLD 1–2 grade. Trial Registry ClinicalTrials.gov, No.: NCT 03182309, URL: www.clinicaltrials.gov.
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Affiliation(s)
- Jing Zhu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Department of Respiratory and Critical Care Medicine, The People's Hospital of China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - Zhiling Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bin Wu
- Institute of Respiratory Diseases, Department of Respiratory, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Zhihong Shi
- Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xian, Shanxi, People's Republic of China
| | - Qingrong Nie
- Division of Respiratory Disease, Liangxiang Hospital of Yanjing Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhaofu Zeng
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Weihua Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Minglin Dong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
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Hanania NA, Mannino DM, Criner GJ, Dransfield MT, Han MK, Jones CE, Kilbride S, Lomas DA, Martin N, Martinez FJ, Singh D, Wise RA, Halpin DMG, Lima R, Lipson DA. Effect of Age on the Efficacy and Safety of Once-Daily Single-Inhaler Triple-Therapy Fluticasone Furoate/Umeclidinium/Vilanterol in Patients With COPD: A Post Hoc Analysis of the Informing the Pathway of COPD Treatment Trial. Chest 2020; 159:985-995. [PMID: 33031829 DOI: 10.1016/j.chest.2020.09.253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/21/2020] [Accepted: 09/11/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the Informing the Pathway of COPD Treatment (IMPACT) trial, single-inhaler triple-therapy fluticasone furoate (FF), umeclidinium (UMEC), and vilanterol (VI) reduced moderate/severe exacerbation rates vs FF/VI and UMEC/VI in patients with symptomatic COPD and a history of exacerbations, with a similar safety profile. RESEARCH QUESTION Are trial outcomes with single-inhaler triple-therapy FF/UMEC/VI vs FF/VI and UMEC/VI affected by age in patients with symptomatic COPD and a history of exacerbations? STUDY DESIGN AND METHODS IMPACT was a phase III, double-blind, 52-week trial. Patients ≥ 40 years of age with symptomatic COPD and ≥ 1 moderate/severe exacerbation in the previous year were randomly assigned 2:2:1 to FF/UMEC/VI 100/62.5/25 μg, FF/VI 100/25 μg, or UMEC/VI 62.5/25 μg. End points assessed by age included annual rate of moderate/severe exacerbations, change from baseline (CFB) in trough FEV1, proportion of St. George's Respiratory Questionnaire (SGRQ) responders (≥ 4 units decrease from baseline in SGRQ total score), and safety. RESULTS The intention-to-treat population comprised 10,355 patients; 4,724 (46%), 4,225 (41%), and 1,406 (14%) were ≤ 64, 65 to 74, and ≥ 75 years of age, respectively. FF/UMEC/VI reduced on-treatment moderate/severe exacerbation rates vs FF/VI (% reduction [95% CI]: ≤ 64 years, 8% [-1 to 16]; P = .070; 65-74 years, 22% [14-29]; P < .001; ≥ 75 years, 18% [3-31]; P = .021) and vs UMEC/VI (≤ 64 years, 16% [7-25]; P = .002; 65-74 years, 33% [25-41]; P < .001; ≥ 75 years, 24% [6-38]; P = .012), with greatest rate reduction seen in the 65 to 74 and ≥ 75 years subgroups. Post hoc analyses of CFB in trough FEV1 and proportion of SGRQ responders at week 52 were significantly greater with FF/UMEC/VI than with FF/VI or UMEC/VI in all subgroups. No new safety signals were identified. INTERPRETATION FF/UMEC/VI reduced the rate of moderate/severe exacerbations and improved lung function and health status vs FF/VI and UMEC/VI irrespective of age for most end points, with a similar safety profile. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02164513; URL: www.clinicaltrials.govCTT116855.
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Affiliation(s)
- Nicola A Hanania
- Airways Clinical Research Center, Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX.
| | - David M Mannino
- Department of Preventative Medicine and Environmental Health, University of Kentucky, College of Public Health, Lexington, KY; GSK, Research Triangle Park, NC
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL
| | - MeiLan K Han
- Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI
| | | | | | - David A Lomas
- UCL Respiratory, University College London, London, England
| | - Neil Martin
- GSK, Brentford, Middlesex, England; University of Leicester, Leicester, England
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, England
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, England
| | | | - David A Lipson
- GSK, Collegeville, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Liu D, Meister M, Zhang S, Vong CI, Wang S, Fang R, Li L, Wang PG, Massion P, Ji X. Identification of lipid biomarker from serum in patients with chronic obstructive pulmonary disease. Respir Res 2020; 21:242. [PMID: 32957957 PMCID: PMC7507726 DOI: 10.1186/s12931-020-01507-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States with no effective treatment. The current diagnostic method, spirometry, does not accurately reflect the severity of COPD disease status. Therefore, there is a pressing unmet medical need to develop noninvasive methods and reliable biomarkers to detect early stages of COPD. Lipids are the fundamental components of cell membranes, and dysregulation of lipids was proven to be associated with COPD. Lipidomics is a comprehensive approach to all the pathways and networks of cellular lipids in biological systems. It is widely used for disease diagnosis, biomarker identification, and pathology disorders detection relating to lipid metabolism. METHODS In the current study, a total of 25 serum samples were collected from 5 normal control subjects and 20 patients with different stages of COPD according to the global initiative for chronic obstructive lung disease (GOLD) (GOLD stages I ~ IV, 5 patients per group). After metabolite extraction, lipidomic analysis was performed using electrospray ionization mass spectrometry (ESI-MS) to detect the serum lipid species. Later, the comparisons of individual lipids were performed between controls and patients with COPD. Orthogonal projections to latent structures discriminant analysis (OPLS-DA) and receiver operating characteristic (ROC) analysis were utilized to test the potential biomarkers. Finally, correlations between the validated lipidomic biomarkers and disease stages, age, FEV1% pack years and BMI were evaluated. RESULTS Our results indicate that a panel of 50 lipid metabolites including phospholipids, sphingolipids, glycerolipids, and cholesterol esters can be used to differentiate the presence of COPD. Among them, 10 individual lipid species showed significance (p < 0.05) with a two-fold change. In addition, lipid ratios between every two lipid species were also evaluated as potential biomarkers. Further multivariate data analysis and receiver operating characteristic (ROC: 0.83 ~ 0.99) analysis suggest that four lipid species (AUC:0.86 ~ 0.95) and ten lipid ratios could be potential biomarkers for COPD (AUC:0.94 ~ 1) with higher sensitivity and specificity. Further correlation analyses indicate these potential biomarkers were not affected age, BMI, stages and FEV1%, but were associated with smoking pack years. CONCLUSION Using lipidomics and statistical methods, we identified unique lipid signatures as potential biomarkers for diagnosis of COPD. Further validation studies of these potential biomarkers with large population may elucidate their roles in the development of COPD.
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Affiliation(s)
- Ding Liu
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA
| | - Maureen Meister
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA
- Department of Nutrition, Georgia State University, Atlanta, 30302, USA
| | - Shiying Zhang
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA
| | - Chi-In Vong
- Department of Nutrition, Georgia State University, Atlanta, 30302, USA
| | - Shuaishuai Wang
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA
| | - Ruixie Fang
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, 30302, USA
| | - Lei Li
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA
| | - Peng George Wang
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA
| | - Pierre Massion
- Cancer Early Detection and Prevention Initiative, Vanderbilt Ingram Cancer Center; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Xiangming Ji
- Department of Chemistry, Georgia State University, Atlanta, GA, 30303, USA.
- Department of Nutrition, Georgia State University, Atlanta, 30302, USA.
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Dupuy-McCauley KL, Novotny PJ, Benzo RP. Treating Severe Obesity to Reduce Dyspnea in Patients With Chronic Lung Disease: A Pilot Mixed Methods Study. Chest 2020; 158:1128-1131. [PMID: 32145244 DOI: 10.1016/j.chest.2020.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Mouronte-Roibás C, Botana-Rial M, Ramos-Hernández C, Fernández-Villar A. Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd. PLoS One 2020; 15:e0229257. [PMID: 32106226 PMCID: PMC7046279 DOI: 10.1371/journal.pone.0229257] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/02/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. METHODS We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. RESULTS 253 patients were included, aged 68.9±9.8years, FEV1 = 42.1%±14.2%, and a Charlson's index = 1.8±0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission. CONCLUSIONS The patients' limitation to perform BADLs and their history of admissions for AECOPD were the best predictive variables for the likelihood of readmission when adjusted for many other social and clinical variables, regardless of the time period considered for such prediction.
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Affiliation(s)
- Sara Fernández-García
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Cristina Represas-Represas
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública), Madrid, Spain
| | - Cecilia Mouronte-Roibás
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Maribel Botana-Rial
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Cristina Ramos-Hernández
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
| | - Alberto Fernández-Villar
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I +i. Institute of Health Research Galicia Sur (IISGS, Instituto de Investigación Sanitaria Galicia Sur), Vigo, Pontevedra, Spain
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Djibo DA, Goldstein J, Ford JG. Prevalence of disability among adults with chronic obstructive pulmonary disease, Behavioral Risk Factor Surveillance System 2016-2017. PLoS One 2020; 15:e0229404. [PMID: 32106254 PMCID: PMC7046217 DOI: 10.1371/journal.pone.0229404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of disabilities is rising steadily, reflecting an aging population and an increasing burden of chronic conditions affecting quality of life. There are scant national data on the prevalence of disability among individuals with chronic obstructive pulmonary disease (COPD). The main objective was to estimate the prevalence of common disabilities among US-based individuals diagnosed with COPD. METHODS Data from the BRFSS, a national telephone survey examining health-related behaviors in 2016-2017 were analyzed. The study population consisted of individuals with self-reported COPD (N = 38352 in 2016 and N = 35423 in 2017). The prevalence of disabilities in hearing, vision, cognition, mobility, and independent living were obtained and adjusted with sampling weights. Healthcare access measures were described by type of disability. RESULTS Mobility disability had the highest prevalence of 45.9 (44.8-47.0) % in 2016 and 48.4 (47.3-49.5) % in 2017 among respondents with COPD. The prevalence of disabilities was highest among those 45-64 years old, except for hearing and cognition. Hearing disabilities were most prevalent among males with COPD while cognitive and mobility disabilities were most prevalent among females with COPD. While differences in the prevalence of disabilities were observed, access to health care was similar by disability type and age group among respondents. CONCLUSION Contrary to expectation, the highest prevalence of disabilities was found not to be among those 65 years old and above. Further research is needed to explain this age-specific shift in the burden of disability, as long-term care planning and prevention support systems should be informed by the demographical patterns of disabilities among individuals with COPD.
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Affiliation(s)
- Djeneba Audrey Djibo
- Division of Research, Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
- * E-mail:
| | - Jessica Goldstein
- Division of Research, Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
| | - Jean G. Ford
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
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Choate R, Mannino DM, Holm KE, Beiko T, Boyd B, Sandhaus RA. Home-Based Multicomponent Intervention Increases Exercise Activity and Improves Body Mass Index: Results of a 5-Year Randomized Trial Among Individuals with Alpha-1 Antitrypsin Deficiency-Associated Lung Disease. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2020; 8. [PMID: 33135406 DOI: 10.15326/jcopdf.8.1.2020.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Step Forward Study (SFS) was designed to increase exercise activity and improve body mass index (BMI) among individuals with alpha-1 antitrypsin deficiency (AATD)-associated lung disease. Methods The SFS is a randomized trial of an intensive distance intervention that was delivered via a series of mailings and teleconferences versus no additional intervention. All participants (n=500) were also enrolled in a disease management program designed for individuals with AATD-associated lung disease who have been prescribed augmentation therapy. The primary outcome was self-reported number of exercise minutes per week. The secondary outcome was BMI. Linear mixed model analyses were used to assess the difference in average weekly exercise minutes between the intervention arms over time. T-tests, signed rank and Wilcoxon rank-sum tests were used to evaluate changes in BMI between the intervention arms and within each BMI category. Results The study included 429 individuals with evaluable primary outcome data.There was a significant effect of intervention on exercise minutes over time (p=0.018). Participants in the intervention group reported an average of 167.14 minutes (standard deviation [SD]=10.68) of weekly exercise and those in the standard care group reported 148.31 minutes (SD=10.96). There was a significant difference in BMI change between the intervention (mean BMI decrease 0.74, SD=2.16) and the standard care group (mean BMI decrease 0.27, SD=1.63); p=0.0122. Conclusion Individuals who were randomly assigned to the intervention group reported more exercise activity and improvements in BMI over the course of this multicomponent intervention compared to individuals assigned to standard care.
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Affiliation(s)
- Radmila Choate
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States
| | - David M Mannino
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States.,College of Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, Colorado, United States.,AlphaNet, Inc., Coral Gables, Florida, United States
| | - Tatsiana Beiko
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Bonnie Boyd
- AlphaNet, Inc., Coral Gables, Florida, United States
| | - Robert A Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado, United States.,AlphaNet, Inc., Coral Gables, Florida, United States
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62
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Wu TD, Ejike CO, Wise RA, McCormack MC, Brigham EP. Investigation of the Obesity Paradox in Chronic Obstructive Pulmonary Disease, According to Smoking Status, in the United States. Am J Epidemiol 2019; 188:1977-1983. [PMID: 31504124 DOI: 10.1093/aje/kwz185] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/14/2022] Open
Abstract
An obesity paradox in chronic obstructive pulmonary disease (COPD), whereby overweight/obese individuals have improved survival, has been well-described. These studies have generally included smokers. It is unknown whether the paradox exists in individuals with COPD arising from factors other than smoking. Nonsmoking COPD is understudied yet represents some 25%-45% of the disease worldwide. To determine whether the obesity paradox differs between ever- and never-smokers with COPD, 1,723 adult participants with this condition were examined from 2 iterations of the National Health and Nutrition Examination Survey (1988-1994, 2007-2010), with mortality outcomes followed through December 2011. Using Cox proportional hazards models, adjusted for sociodemographic factors, lung function, and survey cycle, ever/never-smoking was found to modify the association between body mass index and hazard of death. Compared with normal-weight participants, overweight/obese participants had lower hazard of death among ever-smokers (for overweight, adjusted hazard ratio (aHR) = 0.56, 95% confidence interval (CI): 0.43, 0.74; for obesity, aHR = 0.66, 95% CI: 0.48, 0.92), but never-smokers did not (overweight, aHR = 1.41, 95% CI: 0.66, 3.03; obesity, aHR = 1.29, 95% CI: 0.48, 3.48). An obesity paradox appeared to be absent among never-smokers with COPD. This, to our knowledge, novel finding might be explained by pathophysiological differences between smoking-related and nonsmoking COPD or by smoking-associated methodological biases.
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63
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Gender Differences in the Pharmacological Actions of Pegylated Glucagon-Like Peptide-1 on Endothelial Progenitor Cells and Angiogenic Precursor Cells in a Combination of Metabolic Disorders and Lung Emphysema. Int J Mol Sci 2019; 20:ijms20215414. [PMID: 31671663 PMCID: PMC6862381 DOI: 10.3390/ijms20215414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/20/2019] [Accepted: 10/27/2019] [Indexed: 02/06/2023] Open
Abstract
In clinical practice, the metabolic syndrome (MetS) is often associated with chronic obstructive pulmonary disease (COPD). Although gender differences in MetS are well documented, little is known about sex-specific differences in the pathogenesis of COPD, especially when combined with MetS. Consequently, it is not clear whether the same treatment regime has comparable efficacy in men and women diagnosed with MetS and COPD. In the present study, using sodium glutamate, lipopolysaccharide, and cigarette smoke extract, we simulated lipid metabolism disorders, obesity, hyperglycemia, and pulmonary emphysema (comorbidity) in male and female C57BL/6 mice. We assessed the gender-specific impact of lipid metabolism disorders and pulmonary emphysema on angiogenic precursor cells (endothelial progenitor cells (EPC), pericytes, vascular smooth muscle cells, cells of the lumen of the nascent vessel), as well as the biological effects of pegylated glucagon-like peptide 1 (pegGLP-1) in this experimental paradigm. Simulation of MetS/COPD comorbidity caused an accumulation of EPC (CD45−CD31+CD34+), pericytes, and vascular smooth muscle cells in the lungs of female mice. In contrast, the number of cells involved in the angiogenesis decreased in the lungs of male animals. PegGLP-1 had a positive effect on lipids and area under the curve (AUC), obesity, and prevented the development of pulmonary emphysema. The severity of these effects was stronger in males than in females. Furthermore, PegGLP-1 stimulated regeneration of pulmonary endothelium. At the same time, PegGLP-1 administration caused a mobilization of EPC (CD45−CD31+CD34+) into the bloodstream in females and migration of precursors of angiogenesis and vascular smooth muscle cells to the lungs in male animals. Gender differences in stimulatory action of pegGLP-1 on CD31+ endothelial lung cells in vitro were not observed. Based on these findings, we postulated that the cellular mechanism of in vivo regeneration of lung epithelium was at least partly gender-specific. Thus, we concluded that a pegGLP-1-based treatment regime for metabolic disorder and COPD should be further developed primarily for male patients.
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64
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Sun Y, Milne S, Jaw JE, Yang CX, Xu F, Li X, Obeidat M, Sin DD. BMI is associated with FEV 1 decline in chronic obstructive pulmonary disease: a meta-analysis of clinical trials. Respir Res 2019; 20:236. [PMID: 31665000 PMCID: PMC6819522 DOI: 10.1186/s12931-019-1209-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
Background There is considerable heterogeneity in the rate of lung function decline in chronic obstructive pulmonary disease (COPD), the determinants of which are largely unknown. Observational studies in COPD indicate that low body mass index (BMI) is associated with worse outcomes, and overweight/obesity has a protective effect – the so-called “obesity paradox”. We aimed to determine the relationship between BMI and the rate of FEV1 decline in data from published clinical trials in COPD. Methods We performed a systematic review of the literature, and identified 5 randomized controlled trials reporting the association between BMI and FEV1 decline. Four of these were included in the meta-analyses. We analyzed BMI in 4 categories: BMI-I (< 18.5 or < 20 kg/m2), BMI-II (18.5 or 20 to < 25 kg/m2), BMI-III (25 to < 29 or < 30 kg/m2) and BMI-IV (≥29 or ≥ 30 kg/m2). We then performed a meta-regression of all the estimates against the BMI category. Results The estimated rate of FEV1 decline decreased with increasing BMI. Meta-regression of the estimates showed that BMI was significantly associated with the rate of FEV1 decline (linear trend p = 1.21 × 10− 5). Conclusions These novel findings support the obesity paradox in COPD: compared to normal BMI, low BMI is a risk factor for accelerated lung function decline, whilst high BMI has a protective effect. The relationship may be due to common but as-of-yet unknown causative factors; further investigation into which may reveal novel endotypes or targets for therapeutic intervention.
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Affiliation(s)
- Yilan Sun
- The Respiratory Department of the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.,Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Stephen Milne
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jen Erh Jaw
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Chen Xi Yang
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Feng Xu
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xuan Li
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ma'en Obeidat
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Does Associated Chronic Obstructive Pulmonary Disease Increase Morbidity and Mortality in Obstructive Sleep Apnea? Ann Am Thorac Soc 2019; 16:50-53. [PMID: 30592452 DOI: 10.1513/annalsats.201809-628ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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66
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McNicholas WT, Hansson D, Schiza S, Grote L. Sleep in chronic respiratory disease: COPD and hypoventilation disorders. Eur Respir Rev 2019; 28:28/153/190064. [DOI: 10.1183/16000617.0064-2019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
COPD and obstructive sleep apnoea (OSA) are highly prevalent and different clinical COPD phenotypes that influence the likelihood of comorbid OSA. The increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA whereas the peripheral oedema and higher BMI often associated with the predominant chronic bronchitis phenotype promote OSA. The diagnosis of OSA in COPD patients requires clinical awareness and screening questionnaires which may help identify patients for overnight study. Management of OSA-COPD overlap patients differs from COPD alone and the survival of overlap patients treated with nocturnal positive airway pressure is superior to those untreated. Sleep-related hypoventilation is common in neuromuscular disease and skeletal disorders because of the effects of normal sleep on ventilation and additional challenges imposed by the underlying disorders. Hypoventilation is first seen during rapid eye movement (REM) sleep before progressing to involve non-REM sleep and wakefulness. Clinical presentation is nonspecific and daytime respiratory function measures poorly predict nocturnal hypoventilation. Monitoring of respiration and carbon dioxide levels during sleep should be incorporated in the evaluation of high-risk patient populations and treatment with noninvasive ventilation improves outcomes.
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67
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Jaitovich A, Barreiro E. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients. Am J Respir Crit Care Med 2019; 198:175-186. [PMID: 29554438 DOI: 10.1164/rccm.201710-2140ci] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
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Affiliation(s)
- Ariel Jaitovich
- 1 Division of Pulmonary and Critical Care Medicine and.,2 Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Esther Barreiro
- 3 Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain; and.,4 Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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68
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Maselli DJ, Bhatt SP, Anzueto A, Bowler RP, DeMeo DL, Diaz AA, Dransfield MT, Fawzy A, Foreman MG, Hanania NA, Hersh CP, Kim V, Kinney GL, Putcha N, Wan ES, Wells JM, Westney GE, Young KA, Silverman EK, Han MK, Make BJ. Clinical Epidemiology of COPD: Insights From 10 Years of the COPDGene Study. Chest 2019; 156:228-238. [PMID: 31154041 PMCID: PMC7198872 DOI: 10.1016/j.chest.2019.04.135] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/08/2019] [Accepted: 04/28/2019] [Indexed: 12/16/2022] Open
Abstract
The Genetic Epidemiology of COPD (COPDGene) study is a noninterventional, multicenter, longitudinal analysis of > 10,000 subjects, including smokers with a ≥ 10 pack-year history with and without COPD and healthy never smokers. The goal was to characterize disease-related phenotypes and explore associations with susceptibility genes. The subjects were extensively phenotyped with the use of comprehensive symptom and comorbidity questionnaires, spirometry, CT scans of the chest, and genetic and biomarker profiling. The objective of this review was to summarize the major advances in the clinical epidemiology of COPD from the first 10 years of the COPDGene study. We highlight the influence of age, sex, and race on the natural history of COPD, and the impact of comorbid conditions, chronic bronchitis, exacerbations, and asthma/COPD overlap.
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Affiliation(s)
- Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, UT Health San Antonio, and South Texas Veterans Health System, San Antonio, TX
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Antonio Anzueto
- Division of Pulmonary Diseases and Critical Care, UT Health San Antonio, and South Texas Veterans Health System, San Antonio, TX
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily S Wan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; VA Boston Healthcare System, Jamaica Plain, MA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gloria E Westney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
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69
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Chen H, Li Z, Dong L, Wu Y, Shen H, Chen Z. Lipid metabolism in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:1009-1018. [PMID: 31190786 PMCID: PMC6524761 DOI: 10.2147/copd.s196210] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
Dysregulated lipid metabolism plays crucial roles in various diseases, including diabetes mellitus, cancer, and neurodegeneration. Recent studies suggest that alterations in major lipid metabolic pathways contribute to pathogenesis of lung diseases, including chronic obstructive pulmonary disease (COPD). These changes allow lung tissue to meet the energy needs and trigger anabolic pathways that initiate the synthesis of active molecules directly involved in the inflammation. In this review, we summarize the changes of catabolism and anabolism of lipids, lipid molecules including lipid mediators, lipid synthesis transcription factors, cholesterol, and phospholipids, and how those lipid molecules participate in the initiation and resolution of inflammation in COPD.
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Affiliation(s)
- Haipin Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Zhouyang Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Lingling Dong
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Yinfang Wu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China.,State Key Lab of Respiratory Disease, Guangzhou, Guangdong, People's Republic of China
| | - Zhihua Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
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Figueira Gonçalves JM, García Bello MÁ, Martín Martínez MD, Pérez Méndez LI, García-Talavera I, García Hernández S, Díaz Pérez D, Bethencourt Martín N. The COPD Comorbidome in the Light of the Degree of Dyspnea and Risk of Exacerbation. COPD 2019; 16:104-107. [PMID: 31032664 DOI: 10.1080/15412555.2019.1592144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The BODE group designed a bubble chart, analogous to the solar system, which depicts the prevalence of each disease and its association with mortality and called it a "comorbidome". Although this graph was used to represent mortality and, later, the risk of needing hospital admission, it was not applied to visualize the association between a set of comorbidities and the categories of the GOLD 2017 guidelines, neither according to the degree of dyspnea nor to the risk of exacerbation. For the purpose of knowing to which extent each comorbidity associates with each of the two conditions-most symptomatic group (groups B and D) and highest risk of exacerbation (groups C and D)-we performed a analysis based on the comorbidome. 439 patients were included. Cardiovascular comorbidity (especially cardiac and renal disease) is predominantly observed in patients with a higher degree of dyspnea, whereas bronchial asthma and stroke occur more frequently in subjects at higher risk of exacerbation. This is the first time that the comorbidome is presented based on the categories of the GOLD 2017 document, which we hope will serve as a stimulus for scientific debate.
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Affiliation(s)
- Juan Marco Figueira Gonçalves
- a Pneumology and Thoracic Surgery Service , University Hospital Nuestra Señora de la Candelaria (HUNSC) , Santa Cruz de Tenerife , Spain
| | - Miguel Ángel García Bello
- b Division of Clinical Epidemiology and Biostatistics, Research Unit , University Hospital Nuestra Señora de la Candelaria (HUNSC) and Primary Care Management , Santa Cruz de Tenerife , Spain
| | - María Dolores Martín Martínez
- c Clinical Analysis Service , University Hospital Nuestra Señora de la Candelaria (HUNSC) , Santa Cruz de Tenerife , España
| | - Lina Inmaculada Pérez Méndez
- b Division of Clinical Epidemiology and Biostatistics, Research Unit , University Hospital Nuestra Señora de la Candelaria (HUNSC) and Primary Care Management , Santa Cruz de Tenerife , Spain.,d Networked Biomedical Research Centre (CIBER) of Respiratory Diseases , Carlos III Health Institute , Madrid , Spai'n
| | - Ignacio García-Talavera
- a Pneumology and Thoracic Surgery Service , University Hospital Nuestra Señora de la Candelaria (HUNSC) , Santa Cruz de Tenerife , Spain
| | - Sara García Hernández
- a Pneumology and Thoracic Surgery Service , University Hospital Nuestra Señora de la Candelaria (HUNSC) , Santa Cruz de Tenerife , Spain
| | - David Díaz Pérez
- a Pneumology and Thoracic Surgery Service , University Hospital Nuestra Señora de la Candelaria (HUNSC) , Santa Cruz de Tenerife , Spain
| | - Natalia Bethencourt Martín
- a Pneumology and Thoracic Surgery Service , University Hospital Nuestra Señora de la Candelaria (HUNSC) , Santa Cruz de Tenerife , Spain
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Abstract
RATIONALE Obesity is relatively common among individuals with chronic obstructive pulmonary disease (COPD). However, little is known about the association of obesity with severity of acute exacerbation of COPD and in-hospital mortality. OBJECTIVES To examine the association of obesity with markers of severity of acute exacerbation of COPD and in-hospital mortality. METHODS This is a population-based, retrospective cohort study using the 2012-2013 State Inpatient Databases of seven U.S. states (Arkansas, Florida, Iowa, Nebraska, New York, Utah, and Washington). We included adults (aged ≥40 yr) hospitalized for acute exacerbation of COPD. Obesity, use of noninvasive positive pressure ventilation (NIPPV), and use of invasive mechanical ventilation were determined by International Classification of Diseases, Ninth Revision codes. To examine associations between obesity and each outcome (NIPPV, invasive mechanical ventilation, hospital length of stay (LOS), and in-hospital mortality), we fit unadjusted and adjusted logistic regression models using generalized estimating equations to account for patient clustering within hospitals. We adjusted for age, sex, race/ethnicity, primary payer, median household income, patient residence, hospitalization year, chronic comorbidities, and hospital state. In the sensitivity analysis, we used stabilized inverse probability weighting to estimate the causal relation of obesity with outcomes in this observational study. RESULTS Of 187,647 patients hospitalized for an acute exacerbation of COPD, 17% were obese. Obesity was associated with increased use of both NIPPV (12.0% vs. 6.5%; adjusted odds ratio [OR] = 1.86; 95% confidence interval [CI] = 1.77-1.95; P < 0.001) and invasive mechanical ventilation (3.5% vs. 2.8%; adjusted OR = 1.13; 95% CI = 1.04-1.22; P = 0.003). Similarly, obese patients were more likely to have a hospital LOS of 4 days or longer (57.9% vs. 50.3%; adjusted OR = 1.37; 95% CI = 1.33-1.41; P < 0.001). In contrast, obesity was associated with a lower in-hospital mortality (0.9% vs. 1.4%; unadjusted OR = 0.63; 95% CI = 0.56-0.72; P < 0.001). After adjusting for potential confounders, this association was no longer statistically significant (adjusted OR = 0.86; 95% CI = 0.75-1.00; P = 0.06). Results were similar in sensitivity analyses using stabilized inverse probability weighting. CONCLUSIONS In this population-based study of adults hospitalized with an acute exacerbation of COPD, obesity was associated with increased use of noninvasive and invasive ventilation, increased hospital LOS, but was not associated with increased in-hospital mortality.
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72
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Palo SK, Swain S, Priyadarshini S, Behera B, Pati S. Epidemiology of obesity and its related morbidities among rural population attending a primary health centre of Odisha, India. J Family Med Prim Care 2019; 8:203-208. [PMID: 30911507 PMCID: PMC6396592 DOI: 10.4103/jfmpc.jfmpc_255_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Context: Overweight and obesity has become a major contributor to global burden of chronic diseases and disability. Obesity among rural India is emerging as a major health problem because of change in lifestyle and food habits, thereby increases the risk of multiple morbid conditions among rural population. Aims: This study aims to find out the association of overweight/obesity with different socio-demographic factors and explore the co-morbidities among overweight and obese in a rural setting. Settings and Design: A cross-sectional study was done in a randomly selected primary health centre of Khurda district, Odisha for 4 months. Materials and Methods: This study was done among 183 patients aged >20 years with BMI >25 kg/m2 after taking their consent. Anthropometric measurements were done and data were collected using a semi-structured questionnaire. Statistical Analysis Used: Descriptive statistics such as proportion, mean and standard deviation were calculated and inferential statistics such as Chi-square test, univariate and multivariate regression was done using the SPSS version 20.0. Results: Mean age of participants was 45.7 (±13.8) years. About 93.4% were Grade II obese while 51.9% were at risk according to their waist–hip ratio. Around 53.6% of participants had multi-morbidity. Age, occupation and number of children were significantly associated with obesity. Morbidity was significantly associated with age, occupation, marital status and number of children. Increased grade in obesity the more is the probability of having morbidity. Conclusions: There is an urgent need to screen for obesity at rural health facility and early management for prevention from co-morbidities.
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Affiliation(s)
| | - Swagatika Swain
- Technical Assistant Nursing, ICMR-RMRC, Bhubaneswar, Odisha, India
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73
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Participation of NADPH Oxidase-Related Reactive Oxygen Species in Leptin-Promoted Pulmonary Inflammation: Regulation of cPLA2α and COX-2 Expression. Int J Mol Sci 2019; 20:ijms20051078. [PMID: 30832310 PMCID: PMC6429300 DOI: 10.3390/ijms20051078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 12/13/2022] Open
Abstract
Obesity is a worldwide epidemic problem and correlates to varieties of acute or chronic lung diseases such as acute respiratory distress syndrome, chronic obstructive pulmonary disease, and pulmonary fibrosis. An increase of leptin, a kind of adipokine, in lean mice plasma has been found to impair immune responses and facilitate the infection of Klebsiella pneumoniae, resulting in increased pneumonia severity. Also, a higher leptin level is found in exhaled breath condensates of obese or asthmatic subjects, compared to healthy ones, suggesting that leptin is involved in the occurrence or exacerbation of lung injury. In previous studies, we showed that leptin stimulated cytosolic phospholipase A2-α (cPLA2α) gene expression in lung alveolar type II cells via mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-κB)-activated coactivator p300. Herein, we show that the in vivo application of leptin in the respiratory system upregulated the expression of inflammatory proteins cPLA2α and cyclooxygenase-2 (COX-2) together with leukocyte infiltration. Treatment with an ROS scavenger (N-acetylcysteine, NAC), an NADPH oxidase inhibitor (apocynin), or an activating protein (AP)-1 inhibitor (tanshinone IIA) attenuated leptin-mediated cPLA2α/COX-2 expression and leukocyte recruitment in the lung. Leptin increased intracellular oxidative stress in a leptin receptor (OB-R) and NADPH oxidase-dependent manner, leading to the phosphorylation of the AP-1 subunit c-Jun. In summation, leptin increased lung cPLA2α/COX-2 expression and leukocyte recruitment via the NADPH oxidase/ROS/AP-1 pathway. Understanding the inflammatory effects of leptin on the pulmonary system provides opportunities to develop strategies against lung injury related to metabolic syndrome or obesity.
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74
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Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies. Pharmacol Ther 2019; 198:160-188. [PMID: 30822464 PMCID: PMC7112632 DOI: 10.1016/j.pharmthera.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and is currently the 4th largest cause of death in the world. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction) and infective viral and bacterial acute exacerbations (AECOPD). Current pharmacological treatments for COPD are relatively ineffective and the development of effective therapies has been severely hampered by the lack of understanding of the mechanisms and mediators underlying COPD. Since comorbidities have a tremendous impact on the prognosis and severity of COPD, the 2015 American Thoracic Society/European Respiratory Society (ATS/ERS) Research Statement on COPD urgently called for studies to elucidate the pathobiological mechanisms linking COPD to its comorbidities. It is now emerging that up to 50% of COPD patients have metabolic syndrome (MetS) as a comorbidity. It is currently not clear whether metabolic syndrome is an independent co-existing condition or a direct consequence of the progressive lung pathology in COPD patients. As MetS has important clinical implications on COPD outcomes, identification of disease mechanisms linking COPD to MetS is the key to effective therapy. In this comprehensive review, we discuss the potential mechanisms linking MetS to COPD and hence plausible therapeutic strategies to treat this debilitating comorbidity of COPD.
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75
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Snow SJ, Phillips PM, Ledbetter A, Johnstone AF, Schladweiler MC, Gordon CJ, Kodavanti UP. The influence of maternal and perinatal high-fat diet on ozone-induced pulmonary responses in offspring. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:86-98. [PMID: 30755101 PMCID: PMC10926063 DOI: 10.1080/15287394.2018.1564101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is growing interest in understanding how maternal diet might affect the sensitivity of offspring to environmental exposures. Previous studies demonstrated that adult rat offspring (approximately 6-months-old) from dams given a high-fat diet (HFD) prior to, during, and after pregnancy displayed elevated pulmonary responses to an acute ozone (O3) exposure. The aim of this study was to examine the influence of maternal and perinatal HFD on pulmonary and metabolic responses to O3 in male and female young-adult offspring (approximately 3-month old). One-month-old F0 female Long-Evans rats commenced HFD (60% kcal from fat) or control diet (CD; 10.5% kcal from fat) and were bred on PND 72. Offspring were maintained on respective HFD or CD until PND 29 when all groups were switched to CD. The 3-months-old female and male offspring (n = 10/group) were exposed to air or 0.8 ppm O3 for 5hr/day for 2 consecutive days. Maternal and perinatal HFD significantly increased body weight and body fat % in offspring regardless of gender. Ozone exposure, but not maternal and perinatal diet, induced hyperglycemia and glucose intolerance in the offspring. Ozone-induced alterations in pulmonary function were exacerbated by maternal and perinatal HFD in both offspring genders. Pulmonary injury/inflammation markers in response to O3 exposure such as bronchoalveolar lavage fluid total protein, lactate dehydrogenase, total cells, and neutrophils were further augmented in offspring (males>females) from dams fed the HFD. Data suggest that maternal and perinatal HFD may enhance the susceptibility of offspring to O3-induced pulmonary injury and that these effects may be sex-specific.
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Affiliation(s)
- Samantha J. Snow
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Pamela M. Phillips
- Toxicity Assessment Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Allen Ledbetter
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Andrew F.M. Johnstone
- Toxicity Assessment Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Mette C. Schladweiler
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Christopher J. Gordon
- Toxicity Assessment Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Urmila P. Kodavanti
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
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76
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McNicholas WT. Comorbid obstructive sleep apnoea and chronic obstructive pulmonary disease and the risk of cardiovascular disease. J Thorac Dis 2018; 10:S4253-S4261. [PMID: 30687541 DOI: 10.21037/jtd.2018.10.117] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) syndrome are both highly prevalent, affecting at least 10% of the general adult population, and each has been independently associated with an increased risk of cardiovascular disease. The presence of both disorders together, commonly referred to as the overlap syndrome, is also highly prevalent, although various clinical and pathophysiological factors associated with COPD may increase or decrease the likelihood of OSA. Lung hyperinflation reduces the likelihood of obstructive apnoea, whereas right heart failure increases the likelihood as a result of rostral fluid shift causing upper airway narrowing in the supine position while asleep. Furthermore, upper airway inflammation associated with OSA may aggravate lower airway inflammation in COPD. The proposed mechanisms of cardiovascular disease in each disorder are similar and include systemic inflammation, oxidative stress, and sympathetic excitation. Thus, one could expect that the prevalence of co-morbid cardiovascular disease would be higher in the overlap syndrome but, with the exception of pulmonary hypertension, there are few published reports that have explored this aspect in depth. Hypoxia is more pronounced in patients with the overlap syndrome, especially during sleep, which is likely to be the principal factor accounting for the recognised higher prevalence of pulmonary hypertension in these patients. Cardiac sympathetic activity is increased in patients with the overlap syndrome when compared to each disorder alone, but echocardiographic evidence of left ventricular strain is no greater in overlap patients when compared to COPD alone. While survival might be expected to be worse in overlap patients, recent evidence surprisingly indicates that the incremental contribution of lung function to mortality diminishes with increasing severity of OSA. Identification of co-morbid OSA in patients with COPD has practical clinical significance as appropriate positive airway pressure therapy in COPD patients with co-existing OSA is associated with improved morbidity and mortality.
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Affiliation(s)
- Walter T McNicholas
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China.,School of Medicine, University College Dublin, Dublin, Ireland
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77
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Figueira Gonçalves JM, Martín Martínez MD, Pérez Méndez LI, García Bello MÁ, Garcia-Talavera I, Hernández SG, Díaz Pérez D, Bethencourt Martín N. Health Status in Patients with COPD According to GOLD 2017 Classification: Use of the COMCOLD Score in Routine Clinical Practice. COPD 2018; 15:326-333. [DOI: 10.1080/15412555.2018.1531388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | - Sara García Hernández
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - David Díaz Pérez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
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78
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Luthe SK, Hirayama A, Goto T, Faridi MK, Camargo CA, Hasegawa K. Association Between Obesity and Acute Severity Among Patients Hospitalized for Asthma Exacerbation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1936-1941.e4. [PMID: 29452277 PMCID: PMC7723818 DOI: 10.1016/j.jaip.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although studies have demonstrated relations between obesity and incident asthma, little is known about the association of obesity with acute severity in adults hospitalized for asthma exacerbation. OBJECTIVES To investigate the association of obesity with acute severity of asthma exacerbation. METHODS This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) hospitalized for asthma exacerbation. The outcome measures were markers of acute severity-use of mechanical ventilation (defined by noninvasive positive pressure ventilation and/or invasive mechanical ventilation) and hospital length of stay. To determine the association of obesity with each outcome, we fit multivariable models adjusting for patient-level confounders (eg, age, sex, race/ethnicity, primary insurance, quartiles for household income, residential status, and comorbidities) and potential patient clustering within hospitals. RESULTS Among the 72,086 patients hospitalized for asthma exacerbation, 24% were obese. Obesity was associated with a significantly higher risk of any mechanical ventilation use (8.3% vs 5.0%; adjusted odds ratio [OR], 1.77; 95% CI, 1.63-1.92; P < .001) driven by the higher risk of noninvasive positive pressure ventilation use (7.2% vs 3.4%; adjusted OR, 2.14; 95% CI, 1.96-2.35; P < .001). Likewise, obese patients were more likely to have a hospital length of stay of 3 or more days compared with nonobese patients (59.4% vs 46.5%; adjusted OR, 1.37; 95% CI, 1.32-1.43; P < .001). These findings were consistent with stratifications by age, sex, and race/ethnicity. CONCLUSIONS In this population-based study of adults hospitalized for asthma exacerbation, obesity was associated with higher acute severity.
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Affiliation(s)
- Sarah Kyuragi Luthe
- Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
| | - Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Carlos A Camargo
- Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Kohei Hasegawa
- Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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79
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Wu Z, Yang D, Ge Z, Yan M, Wu N, Liu Y. Body mass index of patients with chronic obstructive pulmonary disease is associated with pulmonary function and exacerbations: a retrospective real world research. J Thorac Dis 2018; 10:5086-5099. [PMID: 30233884 DOI: 10.21037/jtd.2018.08.67] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is prevalent in China. The role of body mass index (BMI) in COPD progression and prognosis is unclear. We analyzed the association between BMI and pulmonary function, inflammation levels and exacerbation in Chinese COPD patients. Methods Our retrospective real world research included 744 patients with COPD diagnosed by spirometry and hospitalized from January 1st, 2014 to December 31st, 2016. The indicators were gathered from hospital records database and frequency of exacerbation in the three years were followed up. All 744 patients were divided into four groups by BMI grades. We analyzed the association between BMI and pulmonary function, inflammation levels and exacerbation by Spearman bivariate correlations, Kruskal-Wallis test, Mann-Whitney U test and logistic regression. Results The singly proportion (median of BMI) of these patients in underweight, normal weight, overweight and obesity was 7.80% (17.54), 45.97% (22.12), 27.96% (27.00) and 18.28% (31.25) respectively. With increasing of BMI grades, the values of forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), forced expiratory flow (FEF25/50/75) and diffusing capacity of carbon monoxide (DLCO) were correspondingly increasing; the percentage of neutrophils and C-reactive protein (CRP) presented significant declining trend while the trend of the percentage of eosinophils was negative; the dose of systemic corticosteroid and length of stay present decreasing tendency; the frequency of exacerbation and hospitalization were decreasing. These were similar results in gender, smoking status COPD subgroups. Conclusions In our study, BMI was moderately correlated with pulmonary function positively and exacerbations negatively. To some extent, BMI might be a useful indicator to predict the prognosis of COPD patients and for long-term management.
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Affiliation(s)
- Zhenchao Wu
- Department of Respiratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250022, China
| | - Dong Yang
- Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | | | | | - Nan Wu
- Shandong University, Jinan 250100, China
| | - Yi Liu
- Department of Respiratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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80
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Jo YS, Kim YH, Lee JY, Kim K, Jung KS, Yoo KH, Rhee CK. Impact of BMI on exacerbation and medical care expenses in subjects with mild to moderate airflow obstruction. Int J Chron Obstruct Pulmon Dis 2018; 13:2261-2269. [PMID: 30100716 PMCID: PMC6067770 DOI: 10.2147/copd.s163000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and objective The rate of obesity is increasing in Asia, but the clinical impact of body mass index (BMI) on the outcome of chronic obstructive pulmonary disease (COPD) remains unknown. We aimed to assess this impact while focusing on the risk of exacerbation, health-care utilization, and medical costs. Methods We examined 43,864 subjects registered in the Korean National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2012, and linked the data of COPD patients who had mild to moderate airflow obstruction (n = 1,320) to National Health Insurance (NHI) data. COPD was confirmed by spirometry. BMI was used to stratify patients into four categories: underweight (BMI <18.5 kg/m2), normal range (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (≥25 kg/m2). Results Of the 1,320 patients with COPD with mild to moderate airflow obstruction, 27.8% had a BMI ≥25 kg/m2. Compared with normal-weight patients, obese patients tended to experience fewer exacerbations (incidence rate ratio [IRR] 0.88; 95% CI 0.77–0.99; P = 0.04), although this association was not significant in a multivariable analysis. COPD-related health-care utilization and medical expenses were higher among underweight patients than the other groups. After adjustment, the risk of COPD-related hospitalization was highest among underweight and higher among overweight patients vs normal-weight patients (adjusted IRRs: 7.12, 1.00, 1.26, and 1.02 for underweight, normal, overweight, and obese groups, respectively; P = 0.01). Conclusion Decreased weight tends to negatively influence prognosis of COPD with mild to moderate airflow obstruction, whereas higher BMI was not significantly related to worse outcomes.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yee Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Kyungjoo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea,
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81
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Levy JI, Quirós-Alcalá L, Fabian MP, Basra K, Hansel NN. Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease. CURR EPIDEMIOL REP 2018; 5:114-124. [PMID: 30319934 PMCID: PMC6178976 DOI: 10.1007/s40471-018-0149-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Multiple respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), display significant socioeconomic and racial/ethnic disparities. The objective of this review is to evaluate the evidence supporting a link between disproportionate environmental exposures and these health disparities. RECENT FINDINGS Studies suggest that various co-occurring factors related to the home environment, neighborhood environment, non-modifiable individual factors, and individual behaviors and attributes can increase or modify the risk of adverse respiratory outcomes among socioeconomically-disadvantaged and racially/ethnically diverse populations. Pollutants in the home environment, including particulate matter, nitrogen dioxide, and pesticides, are elevated among lower socioeconomic status populations and have been implicated in the development or exacerbation of respiratory-related conditions. Neighborhood crime and green space are socioeconomically patterned and linked with asthma outcomes through psychosocial pathways. Non-modifiable individual factors such as genetic predisposition cannot explain environmental health disparities but can increase susceptibility to air pollution and other stressors. Individual behaviors and attributes, including obesity and physical activity, contribute to worse outcomes among those with asthma or COPD. SUMMARY The root causes of these multifactorial exposures are complex, but many likely stem from economic forces and racial/ethnic and economic segregation that influence the home environment, neighborhood environment, and access to healthy foods and consumer products. Critical research needs include investigations that characterize exposure to and health implications of numerous stressors simultaneously, both to guard against potential confounding in epidemiological investigations and to consider the cumulative impact of multiple elevated environmental exposures and sociodemographic stressors on health disparities.
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Affiliation(s)
- Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health
| | - Lesliam Quirós-Alcalá
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health
| | - Komal Basra
- Department of Environmental Health, Boston University School of Public Health
| | - Nadia N. Hansel
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins University
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82
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Gea J, Sancho-Muñoz A, Chalela R. Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations. J Thorac Dis 2018; 10:S1332-S1354. [PMID: 29928517 PMCID: PMC5989104 DOI: 10.21037/jtd.2018.02.66] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022]
Abstract
Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.
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Affiliation(s)
- Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Antoni Sancho-Muñoz
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
| | - Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar (IMIM), DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
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83
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James BD, Jones AV, Trethewey RE, Evans RA. Obesity and metabolic syndrome in COPD: Is exercise the answer? Chron Respir Dis 2018; 15:173-181. [PMID: 29117797 PMCID: PMC5958471 DOI: 10.1177/1479972317736294] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/11/2017] [Indexed: 01/22/2023] Open
Abstract
Approximately half of all patients with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation (PR) programmes are overweight or obese which negatively impacts upon dyspnoea and exercise tolerance particularly when walking. Within the obese population (without COPD), the observed heterogeneity in prognosis is in part explained by the variability in the risk of developing cardiovascular disease or diabetes (cardiometabolic risk) leading to the description of metabolic syndrome. In obesity alone, high-intensity aerobic training can support healthy weight loss and improve the constituent components of metabolic syndrome. Those with COPD, obesity and/or metabolic syndrome undergoing PR appear to do as well in traditional outcomes as their normal-weight metabolically healthy peers in terms of improvement of symptoms, health-related quality of life and exercise performance, and should therefore not be excluded. To broaden the benefit of PR, for this complex population, we should learn from the extensive literature examining the effects of exercise in obesity and metabolic syndrome discussed in this review and optimize the exercise strategy to improve these co-morbid conditions. Standard PR outcomes could be expanded to include cardiometabolic risk reduction to lower future morbidity and mortality; to this end exercise may well be the answer.
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Affiliation(s)
- Benjamin D James
- Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Amy V Jones
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Ruth E Trethewey
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rachael A Evans
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- Health Sciences, University of Leicester, Leicester, UK
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84
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85
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Reduced Risk of Acute Exacerbation of COPD After Bariatric Surgery. Chest 2018; 153:611-617. [DOI: 10.1016/j.chest.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022] Open
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86
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Alsaraireh FA, Aloush SA. Does pulmonary rehabilitation alleviate depression in older patients with chronic obstructive pulmonary disease. Saudi Med J 2018; 38:491-496. [PMID: 28439598 PMCID: PMC5447209 DOI: 10.15537/smj.2017.5.17965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: To identify if pulmonary rehabilitation can achieve a clinically significant alleviation in the level of depression among chronic obstructive pulmonary disease (COPD) patients older than 70 years. Methods: We conducted a retrospective secondary analysis of the patients’ electronic records from a major pulmonary rehabilitation center in Cleveland, OH, United States between 2010 and 2014. Profiles of 105 participants who had completed more than 6 pulmonary rehabilitation sessions and were older than 70 years at the time of enrollment in the program were included. The Beck Depression Inventory scores at the baseline and the end of the pulmonary rehabilitation sessions were compared. Results: There was a statistically and clinically significant reduction in mean scores of depression from the baseline to the end of pulmonary rehabilitation: mean± SD: 104±5.6; p=0.00. The mean±SD depression score at the end was 9±4.3 compared with the baseline 17±7.8. Seventy-seven (73%) participants showed clinically significant improvement in depression; however, 20 participants (27%) had no clinically significant improvement, and 8 (8%) had worse depression at the end of pulmonary rehabilitation. Participants with higher depression scores at the baseline were 1.3 times more likely to achieve clinically significant alleviation in depression at the end of rehabilitation (odds ratio = 1.3, p=0.00). Conclusion: Pulmonary rehabilitation induced clinically significant alleviation in depression among participants with COPD aged over 70 years.
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Affiliation(s)
- Faris A Alsaraireh
- Psychiatric/Mental Health and Community Health Nursing Department, Faculty of Nursing, Mutah University, Mutah, Jordan. E-mail.
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87
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Iyer AS, Dransfield MT. The "Obesity Paradox" in Chronic Obstructive Pulmonary Disease: Can It Be Resolved? Ann Am Thorac Soc 2018; 15:158-159. [PMID: 29388820 PMCID: PMC5822407 DOI: 10.1513/annalsats.201711-901ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anand S. Iyer
- Division of Pulmonary Allergy, and Critical Care Medicine
- Health Services, Outcomes, and Effectiveness Research Training Program, and
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Mark T. Dransfield
- Division of Pulmonary Allergy, and Critical Care Medicine
- Health Services, Outcomes, and Effectiveness Research Training Program, and
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama; and
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
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88
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Zewari S, Vos P, van den Elshout F, Dekhuijzen R, Heijdra Y. Obesity in COPD: Revealed and Unrevealed Issues. COPD 2017; 14:663-673. [DOI: 10.1080/15412555.2017.1383978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- S. Zewari
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - P. Vos
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - F. van den Elshout
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - R. Dekhuijzen
- Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Y. Heijdra
- Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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89
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Verberne LDM, Leemrijse CJ, Swinkels ICS, van Dijk CE, de Bakker DH, Nielen MMJ. Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice. NPJ Prim Care Respir Med 2017; 27:63. [PMID: 29167434 PMCID: PMC5700136 DOI: 10.1038/s41533-017-0065-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022] Open
Abstract
Guidelines for management of chronic obstructive pulmonary disease (COPD) primarily focus on the prevention of weight loss, while overweight and obesity are highly prevalent in patients with milder stages of COPD. This cross-sectional study examines the association of overweight and obesity with the prevalence of comorbid disorders and prescribed medication for obstructive airway disease, in patients with mild to moderate COPD. Data were used from electronic health records of 380 Dutch general practices in 2014. In total, we identified 4938 patients with mild or moderate COPD based on spirometry data, and a recorded body mass index (BMI) of ≥21 kg/m2. Outcomes in overweight (BMI ≥ 25 and <30 kg/m2) and obese (BMI ≥30 kg/m2) patients with COPD were compared to those with a normal weight (BMI ≥ 21 and <25 kg/m2), by logistic multilevel analyses. Compared to COPD patients with a normal weight, positive associations were found for diabetes, osteoarthritis, and hypertension, for both overweight (OR: 1.4-1.7) and obese (OR: 2.4-3.8) patients, and for heart failure in obese patients (OR: 2.3). Osteoporosis was less prevalent in overweight (OR: 0.7) and obese (OR: 0.5) patients, and anxiety disorders in obese patients (OR: 0.5). No associations were found for coronary heart disease, stroke, sleep disturbance, depression, and pneumonia. Furthermore, obese patients were in general more often prescribed medication for obstructive airway disease compared to patients with a normal weight. The findings of this study underline the need to increase awareness in general practitioners for excess weight in patients with mild to moderate COPD.
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Affiliation(s)
- Lisa D M Verberne
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Chantal J Leemrijse
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ilse C S Swinkels
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Christel E van Dijk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Dinny H de Bakker
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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90
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Boriek AM, Lopez MA, Velasco C, Bakir AA, Frolov A, Wynd S, Babb TG, Hanania NA, Hoffman EA, Sharafkhaneh A. Obesity modulates diaphragm curvature in subjects with and without COPD. Am J Physiol Regul Integr Comp Physiol 2017; 313:R620-R629. [PMID: 28903915 DOI: 10.1152/ajpregu.00173.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/08/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
Obesity is a common comorbidity of chronic obstructive pulmonary disease (COPD) and has been associated with worse outcomes. However, it is unknown whether the interaction between obesity and COPD modulates diaphragm shape and consequently its function. The body mass index (BMI) has been used as a correlate of obesity. We tested the hypothesis that the shape of the diaphragm muscle and size of the ring of its insertion in non-COPD and COPD subjects are modulated by BMI. We recruited 48 COPD patients with postbronchiodilator forced expiratory volume in 1 s (FEV1)-to-forced vital capacity (FVC) < 0.7 and 29 age-matched smoker/exsmoker control (non-COPD) subjects, who underwent chest computed tomography (CT) at lung volumes ranging from functional residual capacity (FRC) to total lung capacity (TLC). We then computed maximum principal diaphragm curvature in the midcostal region of the left hemidiaphragm at the end of inspiration during quiet breathing (EI) and at TLC. The radius of maximum curvature of diaphragm muscle increased with BMI in both COPD and non-COPD subjects. The size of diaphragm ring of insertion on the chest wall also increased significantly with increasing BMI. Surprisingly, COPD severity did not appear to cause significant alteration in diaphragm shape except in normal-weight subjects at TLC. Our data uncovered important factors such as BMI, the size of the diaphragm ring of insertion, and disease severity that modulate the structure of the ventilatory pump in non-COPD and COPD subjects.
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Affiliation(s)
| | | | | | | | | | - Shari Wynd
- Texas Chiropractic College, Houston, Texas
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas; and
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91
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Wei YF, Tsai YH, Wang CC, Kuo PH. Impact of overweight and obesity on acute exacerbations of COPD - subgroup analysis of the Taiwan Obstructive Lung Disease cohort. Int J Chron Obstruct Pulmon Dis 2017; 12:2723-2729. [PMID: 28979114 PMCID: PMC5602448 DOI: 10.2147/copd.s138571] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose A low body mass index (BMI) is a poor prognostic marker of acute exacerbations and mortality in patients with COPD. However, the impact of overweight and obesity on COPD-related outcomes is uncertain. The aim of this study was to examine whether a high BMI is associated with the frequent exacerbator phenotype (≥2/year) in Taiwanese patients with COPD. Patients and methods Data were obtained from the Taiwan Obstructive Lung Disease study, a retrospective, observational nationwide survey of COPD patients conducted at 12 hospitals in Taiwan. Multivariate logistic regression models were used to explore the association between BMI and other factors with the frequency of COPD exacerbations in these patients. Results Among the whole study cohort (n=1,096), 735 (67.1%) had no exacerbations and 148 (13.5%) were frequent exacerbators in the previous year. The BMI values of the patients with 0, 1, and ≥2 exacerbations were 23.6, 23.5, and 22.6 kg/m2, respectively. In all, 256 (23.4%) and 196 (17.9%) patients were overweight (27 kg/m2 > BMI ≥24 kg/m2) and obese (BMI ≥27 kg/m2), respectively. Even after adjusting for multiple factors, overweight and obesity were associated with the frequency of exacerbations (odds ratio [95% confidence interval] 0.49 [0.28–0.87, P=0.015] and 0.49 [0.26–0.94, P=0.033], respectively). Conclusion Our results suggest that overweight and obesity are associated with a lower frequency of COPD exacerbations in Taiwan.
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Affiliation(s)
- Yu-Feng Wei
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung.,Institute of Biotechnolog and Chemical Engineering, I-Shou University, Kaohsiung
| | - Ying-Huang Tsai
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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92
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Papp C, Pak K, Erdei T, Juhasz B, Seres I, Szentpéteri A, Kardos L, Szilasi M, Gesztelyi R, Zsuga J. Alteration of the irisin-brain-derived neurotrophic factor axis contributes to disturbance of mood in COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:2023-2033. [PMID: 28744117 PMCID: PMC5511021 DOI: 10.2147/copd.s135701] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
COPD is accompanied by limited physical activity, worse quality of life, and increased prevalence of depression. A possible link between COPD and depression may be irisin, a myokine, expression of which in the skeletal muscle and brain positively correlates with physical activity. Irisin enhances the synthesis of brain-derived neurotrophic factor (BDNF), a neurotrophin involved in reward-related processes. Thus, we hypothesized that mood disturbances accompanying COPD are reflected by the changes in the irisin–BDNF axis. Case history, routine laboratory parameters, serum irisin and BDNF levels, pulmonary function, and disease-specific quality of life, measured by St George’s Respiratory Questionnaire (SGRQ), were determined in a cohort of COPD patients (n=74). Simple and then multiple linear regression were used to evaluate the data. We found that mood disturbances are associated with lower serum irisin levels (SGRQ’s Impacts score and reciprocal of irisin showed a strong positive association; β: 419.97; 95% confidence interval [CI]: 204.31, 635.63; P<0.001). This association was even stronger among patients in the lower 50% of BDNF levels (β: 434.11; 95% CI: 166.17, 702.05; P=0.002), while it became weaker for patients in the higher 50% of BDNF concentrations (β: 373.49; 95% CI: −74.91, 821.88; P=0.1). These results suggest that irisin exerts beneficial effect on mood in COPD patients, possibly by inducing the expression of BDNF in brain areas associated with reward-related processes involved in by depression. Future interventional studies targeting the irisin–BDNF axis (eg, endurance training) are needed to further support this notion.
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Affiliation(s)
- Csaba Papp
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health
| | - Krisztian Pak
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine
| | - Tamas Erdei
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine
| | - Bela Juhasz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine
| | - Ildiko Seres
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen
| | - Anita Szentpéteri
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen
| | - Laszlo Kardos
- Department of Clinical Pharmacology, Infectious Diseases and Allergology, Kenezy Gyula Teaching County Hospital and Outpatient Clinic
| | - Maria Szilasi
- Department of Pulmonology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health
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93
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Lamonaca P, Prinzi G, Kisialiou A, Cardaci V, Fini M, Russo P. Metabolic Disorder in Chronic Obstructive Pulmonary Disease (COPD) Patients: Towards a Personalized Approach Using Marine Drug Derivatives. Mar Drugs 2017; 15:E81. [PMID: 28335527 PMCID: PMC5367038 DOI: 10.3390/md15030081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/23/2017] [Accepted: 03/15/2017] [Indexed: 12/18/2022] Open
Abstract
Metabolic disorder has been frequently observed in chronic obstructive pulmonary disease (COPD) patients. However, the exact correlation between obesity, which is a complex metabolic disorder, and COPD remains controversial. The current study summarizes a variety of drugs from marine sources that have anti-obesity effects and proposed potential mechanisms by which lung function can be modulated with the anti-obesity activity. Considering the similar mechanism, such as inflammation, shared between obesity and COPD, the study suggests that marine derivatives that act on the adipose tissues to reduce inflammation may provide beneficial therapeutic effects in COPD subjects with high body mass index (BMI).
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Affiliation(s)
- Palma Lamonaca
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Giulia Prinzi
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Aliaksei Kisialiou
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Vittorio Cardaci
- Department of Pulmonary Rehabilitation, IRCCS San Raffaele Pisana, Via della Pisana 235, I-00163 Rome, Italy.
| | - Massimo Fini
- Scientific Direction, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Patrizia Russo
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
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94
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Park JH, Lee JK, Heo EY, Kim DK, Chung HS. The effect of obesity on patients with mild chronic obstructive pulmonary disease: results from KNHANES 2010 to 2012. Int J Chron Obstruct Pulmon Dis 2017; 12:757-763. [PMID: 28280320 PMCID: PMC5338838 DOI: 10.2147/copd.s126192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A low body mass index has been associated with high mortalities in patients with chronic obstructive pulmonary disease (COPD), and studies reveal that obesity aggravates the clinical effects of COPD. We investigated the impact of obesity on patients newly identified with COPD. PATIENTS AND METHODS This population-based, cross-sectional study, used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2010 to 2012. Through analyses of data from this survey, we compared concurrent comorbid diseases, symptoms, and lung functions between an obese and nonobese group of patients with COPD. RESULTS In total, 618 participants were diagnosed with COPD and the average forced expired volume in 1 s (FEV1) was 79.47%±0.69%. Of the total, 30.5% of the subjects were categorized into an obese group. Subjects in the obese group were likely to have metabolic syndrome (P<0.001), hypertension (P=0.02), and a higher number of comorbidities compared to the nonobese group (2.3±0.1 vs 2.0±0.1, P=0.02). In addition, subjects in the obese group showed a lower forced vital capacity (FVC) than subjects in the nonobese group, even after adjusting for covariates (average FVC%, 89.32±1.26 vs 92.52%±0.72%, P=0.037). There were no significant differences in the adjusted FEV1% and adjusted FEV1/FVC between the groups. CONCLUSIONS Among subjects newly identified with mild COPD, participants in the obese group had more comorbid conditions and showed a lower FVC compared with subjects in the nonobese group, even after adjustment of covariates. These findings show that a combination of obesity and COPD may be a severe phenotype; therefore, early attention should be paid to obesity for the management of COPD patients.
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Affiliation(s)
- Ju-Hee Park
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hee Soon Chung
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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