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Balbirsingh V, Mohammed AS, Turner AM, Newnham M. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax 2022; 77:thoraxjnl-2021-218333. [PMID: 35772939 DOI: 10.1136/thoraxjnl-2021-218333] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD) and concomitant disease leads to reduced quality of life, increased hospitalisations and worse survival. Acute pulmonary exacerbations are an important contributor to COPD burden and are associated with increased cardiovascular (CV) events. Both COPD and CVD represent a significant global disease impact and understanding the relationship between the two could potentially reduce this burden. The association between CVD and COPD could be a consequence of (1) shared risk factors (environmental and/or genetic) (2) shared pathophysiological pathways (3) coassociation from a high prevalence of both diseases (4) adverse effects (including pulmonary exacerbations) of COPD contributing to CVD and (5) CVD medications potentially worsening COPD and vice versa. CV risk in COPD has traditionally been associated with increasing disease severity, but there are other relevant COPD subtype associations including radiological subtypes, those with frequent pulmonary exacerbations and novel disease clusters. While the prevalence of CVD is high in COPD populations, it may be underdiagnosed, and improved risk prediction, diagnosis and treatment optimisation could lead to improved outcomes. This state-of-the-art review will explore the incidence/prevalence, COPD subtype associations, shared pathophysiology and genetics, risk prediction, and treatment of CVD in COPD.
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Affiliation(s)
- Vishanna Balbirsingh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrea S Mohammed
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Michael Newnham
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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102
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Nomograms for Predicting Coexisting Cardiovascular Disease and Prognosis in Chronic Obstructive Pulmonary Disease: A Study Based on NHANES Data. Can Respir J 2022; 2022:5618376. [PMID: 35721788 PMCID: PMC9203208 DOI: 10.1155/2022/5618376] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/20/2022] [Indexed: 12/25/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common chronic disease. Progression is further exacerbated by the coexistence of cardiovascular disease (CVD). We aim to construct a diagnostic nomogram for predicting the risk of coexisting CVD and a prognostic nomogram for predicting long-term survival in COPD. Methods The 540 eligible participants selected from the NHANES 2005-2010 were included in this study. Logistic regression analysis was used to construct a diagnostic nomogram for the diagnosis of coexisting CVD in COPD. Cox regression analyses were used to construct a prognostic nomogram for COPD. A risk stratification system was developed based on the total score generated from the prognostic nomogram. We used C-index and ROC curves to evaluate the discriminant ability of the newly built nomograms. The models were also validated utilizing calibration curves. Survival curves were made using the Kaplan-Meier method and compared by the Log-rank test. Results Logistic regression analysis showed that gender, age, neutrophil, RDW, LDH, and HbA1c were independent predictors of coexisting CVD and were included in the diagnostic model. Cox regression analysis indicated that CVD, gender, age, BMI, RDW, albumin, LDH, creatinine, and NLR were independent predictors of COPD prognosis and were incorporated into the prognostic model. The C-index and ROC curves revealed the good discrimination abilities of the models. And the calibration curves implied that the predicted values by the nomograms were in good agreement with the actual observed values. In addition, we found that coexisting with CVD had a worse prognosis compared to those without CVD, and the prognosis of the low-risk group was better than that of the high-risk group in COPD. Conclusions The nomograms we developed can help clinicians and patients to identify COPD coexisting CVD early and predict the 5-year and 10-year survival rates of COPD patients, which has some clinical practical values.
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Csoma B, Vulpi MR, Dragonieri S, Bentley A, Felton T, Lázár Z, Bikov A. Hypercapnia in COPD: Causes, Consequences, and Therapy. J Clin Med 2022; 11:jcm11113180. [PMID: 35683563 PMCID: PMC9181664 DOI: 10.3390/jcm11113180] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/18/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that may lead to gas exchange abnormalities, including hypercapnia. Chronic hypercapnia is an independent risk factor of mortality in COPD, leading to epithelial dysfunction and impaired lung immunity. Moreover, chronic hypercapnia affects the cardiovascular physiology, increases the risk of cardiovascular morbidity and mortality, and promotes muscle wasting and musculoskeletal abnormalities. Noninvasive ventilation is a widely used technique to remove carbon dioxide, and several studies have investigated its role in COPD. In the present review, we aim to summarize the causes and effects of chronic hypercapnia in COPD. Furthermore, we discuss the use of domiciliary noninvasive ventilation as a treatment option for hypercapnia while highlighting the controversies within the evidence. Finally, we provide some insightful clinical recommendations and draw attention to possible future research areas.
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Affiliation(s)
- Balázs Csoma
- Department of Pulmonology, Semmelweis University, 25-29 Tömő Str., 1083 Budapest, Hungary; (B.C.); (Z.L.)
| | - Maria Rosaria Vulpi
- School of Medicine: Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, 11 Piazza G. Cesare-Bari, 70124 Bari, Italy; (M.R.V.); (S.D.)
| | - Silvano Dragonieri
- School of Medicine: Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, 11 Piazza G. Cesare-Bari, 70124 Bari, Italy; (M.R.V.); (S.D.)
| | - Andrew Bentley
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; (A.B.); (T.F.)
| | - Timothy Felton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; (A.B.); (T.F.)
| | - Zsófia Lázár
- Department of Pulmonology, Semmelweis University, 25-29 Tömő Str., 1083 Budapest, Hungary; (B.C.); (Z.L.)
| | - Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; (A.B.); (T.F.)
- Correspondence: ; Tel.: +36-203141599
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Baeradeh N, Ghoddusi Johari M, Moftakhar L, Rezaeianzadeh R, Hosseini SV, Rezaianzadeh A. The prevalence and predictors of cardiovascular diseases in Kherameh cohort study: a population-based study on 10,663 people in southern Iran. BMC Cardiovasc Disord 2022; 22:244. [PMID: 35643460 PMCID: PMC9148515 DOI: 10.1186/s12872-022-02683-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The prevalence of cardiovascular disease (CVD) is rapidly increasing in the world. The present study aimed to assess the prevalence and Predictors factors of CVD based on the data of Kherameh cohort study. METHODS The present cross-sectional, analytical study was done based on the data of Kherameh cohort study, as a branch of the Prospective Epidemiological Studies in Iran (PERSIAN). The participants consisted of 10,663 people aged 40-70 years. CVD was defined as suffering from ischemic heart diseases including heart failure, angina, and myocardial infarction. Logistic regression was used to model and predict the factors related to CVD. Additionally, the age-standardized prevalence rate (ASPR) of CVD was determined using the standard Asian population. RESULTS The ASPR of CVD was 10.39% in males (95% CI 10.2-10.6%) and 10.21% in females (95% CI 9.9-10.4%). The prevalence of CVD was higher among the individuals with high blood pressure (58.3%, p < 0.001) as well as among those who smoked (28.3%, p = 0.018), used opium (18.2%, p = 0.039), had high triglyceride levels (31.6%, p = 0.011), were overweight and obese (66.2%, p < 0.001), were unmarried (83.9%, p < 0.001), were illiterate (64.2%, p < 0.001), were unemployed (60.9%, p < 0.001), and suffered from diabetes mellitus (28.1%, p < 0.001). The results of multivariable logistic regression analysis showed that the odds of having CVD was 2.25 times higher among the individuals aged 50-60 years compared to those aged 40-50 years, 1.66 folds higher in opium users than in non-opium users, 1.37 times higher in smokers compared to non-smokers, 2.03 folds higher in regular users of sleeping pills than in non-consumers, and 4.02 times higher in hypertensive individuals than in normotensive ones. CONCLUSION The prevalence of CVD was found to be relatively higher in Kherameh (southern Iran) compared to other places. Moreover, old age, obesity, taking sleeping pills, hypertension, drug use, and chronic obstructive pulmonary disease had the highest odds ratios of CVD.
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Affiliation(s)
- Najibullah Baeradeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Leila Moftakhar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Rezaeianzadeh
- Experimental Medicine Program, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Abbas Rezaianzadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Florentin J, O'Neil SP, Ohayon LL, Uddin A, Vasamsetti SB, Arunkumar A, Ghosh S, Boatz JC, Sui J, Kliment CR, Chan SY, Dutta P. VEGF Receptor 1 Promotes Hypoxia-Induced Hematopoietic Progenitor Proliferation and Differentiation. Front Immunol 2022; 13:882484. [PMID: 35634304 PMCID: PMC9133347 DOI: 10.3389/fimmu.2022.882484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Although it is well known that hypoxia incites unleashed cellular inflammation, the mechanisms of exaggerated cellular inflammation in hypoxic conditions are not known. We observed augmented proliferation of hematopoietic stem and progenitor cells (HSPC), precursors of inflammatory leukocytes, in mice under hypoxia. Consistently, a transcriptomic analysis of human HSPC exposed to hypoxic conditions revealed elevated expression of genes involved in progenitor proliferation and differentiation. Additionally, bone marrow cells in mice expressed high amount of vascular endothelial growth factor (VEGF), and HSPC elevated VEGF receptor 1 (VEGFr1) and its target genes in hypoxic conditions. In line with this, VEGFr1 blockade in vivo and in vitro decreased HSPC proliferation and attenuated inflammation. In silico and ChIP experiments demonstrated that HIF-1α binds to the promoter region of VEGFR1. Correspondingly, HIF1a silencing decreased VEGFr1 expression in HSPC and diminished their proliferation. These results indicate that VEGF signaling in HSPC is an important mediator of their proliferation and differentiation in hypoxia-induced inflammation and represents a potential therapeutic target to prevent aberrant inflammation in hypoxia-associated diseases.
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Affiliation(s)
- Jonathan Florentin
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Scott P O'Neil
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lee L Ohayon
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Afaz Uddin
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sathish Babu Vasamsetti
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Anagha Arunkumar
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Samit Ghosh
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer C Boatz
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Justin Sui
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Corrine R Kliment
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen Y Chan
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Partha Dutta
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Koteci A, Morgan AD, Portas L, Whittaker HR, Kallis C, George PM, Quint JK. Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study. BMC Pulm Med 2022; 22:190. [PMID: 35549901 PMCID: PMC9097426 DOI: 10.1186/s12890-022-01973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cardiovascular disease is prevalent in idiopathic pulmonary fibrosis (IPF), yet the extent of left-sided heart failure (HF) burden, whether this has changed with time and whether HF impacts mortality risk in these patients are unknown. The aims of this study were therefore to determine the temporal trends in incidence and prevalence of left-sided HF in patients with IPF in England and compare these to published estimates in the general population and those with comparable chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), as well as determine the risk of all-cause and cause-specific mortality in patients with comorbid left-sided HF and IPF at population-level using electronic healthcare data. Methods Clinical Practice Research Datalink (CPRD) Aurum primary-care data linked to mortality and secondary-care data was used to identify IPF patients in England. Left-sided HF prevalence and incidence rates were calculated for each calendar year between 2010 and 2019, stratified by age and sex. Risk of all-cause, cardiovascular and IPF-specific mortality was calculated using multivariate Cox regression. Results From 40,577patients with an IPF code in CPRD Aurum, 25, 341 IPF patients met inclusion criteria. Left-sided HF prevalence decreased from 33.4% (95% CI 32.2–34.6) in 2010 to 20.9% (20.0–21.7) in 2019. Left-sided HF incidence rate per 100 person-years (95% CI) remained stable between 2010 and 2017 but decreased from 4.3 (3.9–4.8) in 2017 to 3.4 (3.0–3.9) in 2019. Throughout follow-up, prevalence and incidence were higher in men and with increasing age. Comorbid HF was associated with poorer survival (adjusted HR (95%CI) 1.08 (1.03–1.14) for all-cause mortality; 1.32 (1.09–1.59) for cardiovascular mortality). Conclusion Left-sided HF burden in IPF patients in England remains high, with incidence almost 4 times higher than in COPD, a comparable lung disease with similar cardiovascular risk factors. Comorbid left-sided HF is also a poor prognostic marker. More substantial reduction in left-sided HF prevalence than incidence suggests persistently high IPF mortality. Given rising IPF incidence in the UK, this calls for better management of comorbidities such as left-sided HF to help optimise IPF survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01973-5.
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Affiliation(s)
- Ardita Koteci
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - Ann D Morgan
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - Laura Portas
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - Hannah R Whittaker
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - Constantinos Kallis
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK.,Royal Brompton Hospital, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR, UK. .,NIHR Imperial Biomedical Research Centre, London, UK. .,Royal Brompton Hospital, London, UK.
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107
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Litchfield I, Kingston B, Narga D, Turner A. The move towards integrated care: Lessons learnt from managing patients with multiple morbidities in the UK. Health Policy 2022; 126:777-785. [DOI: 10.1016/j.healthpol.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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108
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Fu Y, Chapman EJ, Boland AC, Bennett MI. Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review. Palliat Med 2022; 36:770-782. [PMID: 35311415 PMCID: PMC9087316 DOI: 10.1177/02692163221079697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) face limited treatment options and inadequate access to palliative care. AIM To provide a pragmatic overview of clinical guidelines and produce evidence-based recommendations for severe COPD. Interventions for which there is inconsistent evidence to support their use and areas requiring further research were identified. DESIGN Practice review of guidelines supported by scoping review methodology to examine the evidence reporting the use of guideline-recommended interventions. DATA SOURCES An electronic search was undertaken in MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Database of Systematic Reviews, complemented by web searching for guidelines and publications providing primary evidence (July 2021). Guidelines published within the last 5 years and evidence in the last 10 years were included. RESULTS Severe COPD should be managed using a multidisciplinary approach with a holistic assessment. For stable patients, long-acting beta-agonist/long-acting muscarinic antagonist and pulmonary rehabilitation are recommended. Low dose opioids, self-management, handheld fan and nutritional support may provide small benefits, whereas routine corticosteroids should be avoided. For COPD exacerbations, systematic corticosteroids, non-invasive ventilation and exacerbation action plans are recommended. Short-acting inhaled beta-agonists and antibiotics may be considered but pulmonary rehabilitation should be avoided during hospitalisation. Long term oxygen therapy is only recommended for patients with chronic severe hypoxaemia. Short-acting anticholinergic inhalers, nebulised opioids, oral theophylline or telehealth are not recommended. CONCLUSIONS Recommended interventions by guidelines are not always supported by high-quality evidence. Further research is required on efficacy and safety of inhaled corticosteroids, antidepressants, benzodiazepines, mucolytics, relaxation and breathing exercises.
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Affiliation(s)
- Yu Fu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison C Boland
- Department of Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Lee H, Sin DD. GETting to know the many causes and faces of COPD. THE LANCET RESPIRATORY MEDICINE 2022; 10:426-428. [DOI: 10.1016/s2213-2600(22)00049-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
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Svendsen CD, Kuiper KKJ, Ostridge K, Larsen TH, Nielsen R, Hodneland V, Nordeide E, Bakke PS, Eagan TM. Factors associated with coronary heart disease in COPD patients and controls. PLoS One 2022; 17:e0265682. [PMID: 35476713 PMCID: PMC9045629 DOI: 10.1371/journal.pone.0265682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background COPD and coronary heart disease (CHD) frequently co-occur, yet which COPD phenotypes are most prone to CHD is poorly understood. The aim of this study was to see whether COPD patients did have a true higher risk for CHD than subjects without COPD, and to examine a range of potential factors associated with CHD in COPD patients and controls. Methods 347 COPD patients and 428 non-COPD controls, were invited for coronary computed tomography angiography (CCTA) and pulmonary CT. Arterial blood gas, bioelectrical impedance and lung function was measured, and a detailed medical history taken. The CCTA was evaluated for significant coronary stenosis and calcium score (CaSc), and emphysema defined as >10% of total area <-950 Hounsfield units. Results 12.6% of the COPD patients and 5.7% of the controls had coronary stenosis (p<0.01), whereas 55.9% of the COPD patients had a CaSc>100 compared to 31.6% of the controls (p<0.01). In a multivariable model adjusting for sex, age, body composition, pack-years, CRP, cholesterol/blood pressure lowering medication use and diabetes mellitus, the OR (95% CI) for having significant stenosis was 1.80 (0.86–3.78) in COPD patients compared with controls. In a similar model, the OR (95% CI) for having CaSc>100 was 1.68 (1.12–2.53) in COPD patients compared with controls. Examining the risk of significant stenosis and CaSc>100 among COPD patients, no variable was associated with significant stenosis, whereas male sex [OR 2.85 (1.56–5.21)], age [OR 3.74 (2.42–5.77)], statin use [OR 2.23 (1.23–4.50)] were associated with CaSc>100, after adjusting for body composition, pack-years, C-reactive protein, use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diabetes, emphysema score, GOLD category, exacerbation frequency, eosinophilia, and hypoxemia. Conclusion COPD patients were more likely to have CHD, but neither emphysema score, lung function, exacerbation frequency, nor hypoxemia predicted presence of either coronary stenosis or CaSc>100.
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Affiliation(s)
- Christina D. Svendsen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Karel K. J. Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kristoffer Ostridge
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Vidar Hodneland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eli Nordeide
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Per S. Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tomas M. Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Xue Z, Guo S, Liu X, Ma J, Zhu W, Zhou Y, Liu F, Luo J. Impact of COPD or Asthma on the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:872446. [PMID: 35479273 PMCID: PMC9035743 DOI: 10.3389/fcvm.2022.872446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Respiratory diseases related to chronic pulmonary ventilation dysfunction are mainly composed of chronic obstructive pulmonary disease (COPD) and asthma. Our meta-analysis aimed to illustrate the association of COPD or asthma with risk of atrial fibrillation (AF). Methods We systematically searched the databases of the PubMed, Embase, and Cochrane library until December 2021 for studies focusing on the relationship between COPD or asthma and AF risk. Due to the potential heterogeneity across studies, the random-effects model was used to pool the studies. Results Our meta-analysis included 14 studies. Based on the random-effects model, the pooled analysis showed that COPD (risk ratio[RR] = 1.74, 95% confidence interval [CI]: 1.70–1.79) and asthma (RR = 1.08, 95% CI: 1.04–1.12) were significantly associated with an increased risk of AF. The results did not change after each study was excluded. Conclusion Our current data suggested that COPD or asthma with associated with an increased risk of AF.
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113
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The effectiveness of pulmonary rehabilitation on chronic obstructive pulmonary disease patients with concurrent presence of comorbid depression and anxiety. Respir Med 2022; 197:106850. [DOI: 10.1016/j.rmed.2022.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
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Wu X, Shi Y, Wang X, Yu X, Yang M. Diagnostic value of computed tomography-based pulmonary artery to aorta ratio measurement in chronic obstructive pulmonary disease with pulmonary hypertension: A systematic review and meta-analysis. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:276-283. [PMID: 35289083 PMCID: PMC9060111 DOI: 10.1111/crj.13485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/13/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We conducted a meta-analysis to systematic assess the diagnostic value of computed tomography (CT)-based pulmonary artery to aorta (PA:A) ratio measurement in COPD with pulmonary hypertension (COPD-PH). METHODS Published studies referring to diagnostic accuracy of PA:A ratio for COPD-PH were screened out from PubMed, Embase, Web of science, China National Knowledge databases (CNKI), Wan fang databases, and VIP databases. We used bivariate random-effects model to estimate pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), and diagnostic odds ratios (DOR). Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were also calculated to summarize the aggregate diagnostic performance. RESULTS Nine eligible studies were included and the pooled SEN was 69% (95% CI: 59 ~ 78), SPE was 85% (95% CI: 77 ~ 90), PLR was 4.5 (95% CI: 2.8 ~ 7.5), and NLR was 0.36 (95% CI: 0.26 ~ 0.51), respectively. DOR reached 13.00 (95% CI: 6.00 ~ 28.00), and value of AUC was 0.84 (95% CI: 0.81 ~ 0.87). Subgroup analysis indicated that when the value of PA:A ratio was equal or greater than one (PA/A ≥ 1), the combined SEN, SPE, AUC, and DOR was 69%, 89%, 0.90, and 19.65, respectively. CONCLUSIONS PA:A ratio is helpful for appraisal of COPD-PH, and PA/A ≥ 1 possessed prominent diagnostic accuracy.
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Affiliation(s)
- Xing‐gui Wu
- Department of Respiratory and Critical Care MedicineThe Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical UniversityChangzhouChina
| | - Yu‐jia Shi
- Department of Respiratory and Critical Care MedicineThe Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical UniversityChangzhouChina
| | - Xiao‐hua Wang
- Department of Respiratory and Critical Care MedicineThe Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical UniversityChangzhouChina
| | - Xiao‐wei Yu
- Department of Respiratory and Critical Care MedicineThe Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical UniversityChangzhouChina
| | - Ming‐xia Yang
- Department of Respiratory and Critical Care MedicineThe Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical UniversityChangzhouChina
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115
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Lin J, Xue Y, Su W, Zhang Z, Wei Q, Huang T. Identification of Dysregulated Mechanisms and Candidate Gene Markers in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:475-487. [PMID: 35281477 PMCID: PMC8904782 DOI: 10.2147/copd.s349694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to identify candidate gene markers that may facilitate chronic obstructive pulmonary disease (COPD) diagnosis and treatment. Methods The GSE47460 and GSE151052 datasets were analyzed to identify differentially expressed mRNAs (DEmRs) between COPD patients and controls. DEmRs that were differentially expressed in the same direction in both datasets were analyzed for functional enrichment and for coexpression. Genes from the largest three modules were tested for their ability to diagnose COPD based on the area under the receiver operating characteristic curve (AUC). Genes with AUC > 0.7 in both datasets were used to perform regression based on the "least absolute shrinkage and selection operator" in order to identify feature genes. We also identified differentially expressed miRNAs (DEmiRs) between COPD patients and controls using the GSE38974 dataset, then constructed a regulatory network. We also examined associations between feature genes and immune cell infiltration in COPD, and we identified methylation markers of COPD using the GSE63704 dataset. Results A total of 1350 genes differentially regulated in the same direction in the GSE47460 and GSE151052 datasets were found. The genes were significantly enriched in immune-related biological functions. Of 186 modules identified using MEGENA, the largest were C1_ 6, C1_ 3, and C1_ 2. Of the 22 candidate genes screened based on AUC, 11 feature genes emerged from analysis of a subset of GSE47460 data, which we validated using another subset of GSE47460 data as well as the independent GSE151052 dataset. Feature genes correlated significantly with infiltration by immune cells. The feature genes GPC4 and RS1 were predicted to be regulated by miR-374a-3p. We identified 117 candidate methylation markers of COPD, including PRRG4. Conclusion The feature genes we identified may be potential diagnostic markers and therapeutic targets in COPD. These findings provide new leads for exploring disease mechanisms and targeted treatments.
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Affiliation(s)
- Jie Lin
- Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530022, People’s Republic of China,Department of Respiratory and Critical Care, The First People’s Hospital of Nanning, Nanning, Guangxi, 530022, People’s Republic of China
| | - Yanlong Xue
- Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530022, People’s Republic of China,Department of Respiratory and Critical Care, The First People’s Hospital of Nanning, Nanning, Guangxi, 530022, People’s Republic of China
| | - Wenyan Su
- Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530022, People’s Republic of China,Department of Respiratory and Critical Care, The First People’s Hospital of Nanning, Nanning, Guangxi, 530022, People’s Republic of China
| | - Zan Zhang
- Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530022, People’s Republic of China,Department of Respiratory and Critical Care, The First People’s Hospital of Nanning, Nanning, Guangxi, 530022, People’s Republic of China
| | - Qiu Wei
- Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530022, People’s Republic of China,Department of Respiratory and Critical Care, The First People’s Hospital of Nanning, Nanning, Guangxi, 530022, People’s Republic of China,Correspondence: Qiu Wei; Tianxia Huang, Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, 89 Qixing Road, Nanning, Guangxi, 530022, People’s Republic of China, Tel +86 7712636163, Fax +86 7712617892, Email ;
| | - Tianxia Huang
- Department of Respiratory and Critical Care, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530022, People’s Republic of China,Department of Respiratory and Critical Care, The First People’s Hospital of Nanning, Nanning, Guangxi, 530022, People’s Republic of China
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Coker RK, Armstrong A, Church AC, Holmes S, Naylor J, Pike K, Saunders P, Spurling KJ, Vaughn P. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax 2022; 77:329-350. [PMID: 35228307 PMCID: PMC8938676 DOI: 10.1136/thoraxjnl-2021-218110] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robina Kate Coker
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Armstrong
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Katharine Pike
- Department of Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, UK
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Cui Y, Zhan Z, Ma Y, Huang K, Liang C, Mao X, Zhang Y, Ren X, Lei J, Chen Y, Yang T, Wang C. Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study. Respir Res 2022; 23:28. [PMID: 35151338 PMCID: PMC8840293 DOI: 10.1186/s12931-022-01945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Coronary artery disease (CAD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). However, data related to the impact of CAD on outcomes of acute exacerbation of COPD (AECOPD) are limited and whether the relationship depends on sex remains unknown. Our aim was to determine the impact of comorbid CAD on clinical outcomes among men and women with AECOPD. Methods We used data from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study, which is a nationwide observational real-world study conducted between September 2017 and February 2020 at 163 centers in patients admitted with AECOPD as their primary diagnosis. Patients were stratified according to the presence or absence of CAD in men and women. The primary outcomes were the length of hospital stay and economic burden during hospitalization. Results Among 3906 patients included in our study, the prevalence of CAD was 17.0%, and it was higher in women than in men (19.5% vs. 16.3%; P = 0.034). Age and other cardiovascular diseases were common factors associated with comorbid CAD in men and women, while body-mass index, cerebrovascular disease, and diabetes were determinants in men and pre-admission use of long-acting beta-adrenoceptor agonist and home oxygen therapy were protective factors in women. Only in men, patients with CAD had a longer length of hospital stay (median 10.0 vs. 9.0 days, P < 0.001), higher total cost during hospitalization (median $1502.2 vs. $1373.4, P < 0.001), and more severe COPD symptoms at day 30 compared to those without CAD. No significant difference was found in women. Comorbid CAD showed no relationship with 30-day readmission or death regardless of sex. In our real-world study, mortality/readmission risk within 30 days increased in patients with previous frequent hospitalizations and poorer pulmonary function. Conclusions In hospitalized AECOPD patients, comorbid CAD was significantly associated with poorer short-term outcomes in men. Clinicians should have heightened attention for men with comorbid CAD to achieve an optimal management of AECOPD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01945-7.
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The Indices of Instantaneous Pulse Rate Variability Are Indicators for Daily Life Quality Assessment in Patients with COPD. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6103305. [PMID: 35186234 PMCID: PMC8853820 DOI: 10.1155/2022/6103305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory illness. Questionnaires such as modified Medical Research Council (mMRC) dyspnea scale and COPD assessment test (CAT) are useful for COPD condition and life quality assessment. These questionnaires reflect how respiratory disorder affects daily life. Breathing and autonomic nervous system (ANS) usually regulate each other. Few studies discussed the ANS activity and daily life quality in patients with COPD. Therefore, this study aimed to find the relationship between daily life quality assessed by mMRC or CAT and ANS assessed by a novel method, instantaneous pulse rate variability (iPRV), a method indicating not only the ANS activity but also the peripheral response. The result showed that the change in mMRC and the change in low frequency power to high frequency power ratio, which usually represents the sympathetic activity in conventional heart rate variability analysis, had significant correlation (r = 0.63;
). The change in CAT and the change in high frequency power (regulated by vagal nervous and respiratory system) or very high frequency power (new frequency band can be indicated in iPRV spectrum) had significant negative correlation (r = −0.64 and −0.55, respectively;
for both). This study showed the change in iPRV indices when the condition of COPD was improvement or exacerbation. This study presents a possible way to show how cardiovascular activity affects daily life quality in patients with COPD. Increase in LF or decrease in HF and VHF would cause poorer quality of daily life in patients with COPD. The result can also be a reference for patients with COPD to choose the breathing type to adjust rehabilitation and therapy program for ANS regulation to indicate or improve their daily life quality.
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119
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Zhao Z, Zhang X, Zhang H, Shan X, Bai M, Wang Z, Yang F, Zhang H, Kan Q, Sun B, Sun J, He Z, Luo C. Elaborately Engineering a Self-Indicating Dual-Drug Nanoassembly for Site-Specific Photothermal-Potentiated Thrombus Penetration and Thrombolysis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2104264. [PMID: 34802198 PMCID: PMC8811805 DOI: 10.1002/advs.202104264] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 05/19/2023]
Abstract
Thrombotic cardio-cerebrovascular diseases seriously threaten human health. Currently, conventional thrombolytic treatments are challenged by the low utilization, inferior thrombus penetration, and high off-target bleeding risks of most thrombolytic drugs, resulting in unsatisfactory treatment outcomes. Herein, it is proposed that these challenges can be overcome by precisely integrating the conventional thrombolytic strategy with photothermal therapy. After co-assembly engineering optimization, a fibrin-targeting peptide-decorated nanoassembly of DiR (a photothermal probe) and ticagrelor (TGL, an antiplatelet drug) is prepared for thrombus-homing delivery, abbreviated as FT-DT NPs. The elaborately engineered nanoassembly shows multiple advantages, including simple preparation with high drug co-loading capacity, synchronous delivery of two drugs with long systemic circulation, thrombus-targeted accumulation with self-indicating function, as well as photothermal-potentiated thrombus penetration and thrombolysis with high therapeutic efficacy. As expected, FT-DT NPs not only show bright fluorescence signals in the embolized vessels, but also perform photothermal/antiplatelet synergistic thrombolysis in vivo. This study offers a simple and versatile co-delivery nanoplatform for imaging-guided photothermal/antiplatelet dual-modality thrombolysis.
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Affiliation(s)
- Zhiqiang Zhao
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Xuanbo Zhang
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Hongyuan Zhang
- School of Life Science and BiopharmaceuticsShenyang Pharmaceutical UniversityShenyang110016P. R. China
| | - Xinzhu Shan
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Meiyu Bai
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Zhe Wang
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Fujun Yang
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Haotian Zhang
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Qiming Kan
- School of Life Science and BiopharmaceuticsShenyang Pharmaceutical UniversityShenyang110016P. R. China
| | - Bingjun Sun
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Jin Sun
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Zhonggui He
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
| | - Cong Luo
- Department of PharmaceuticsWuya College of InnovationShenyang Pharmaceutical UniversityShenyangLiaoning110016P. R. China
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Brana Q, Thibault F, Courtehoux M, Metrard G, Ribeiro MJ, Angoulvant D, Bailly M. Regadenoson versus dipyridamole: Evaluation of stress myocardial blood flow response on a CZT-SPECT camera. J Nucl Cardiol 2022; 29:113-122. [PMID: 32651801 DOI: 10.1007/s12350-020-02271-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Regadenoson is a selective adenosine receptor agonist. It is currently unclear if the level of hyperemia differs between stress agents. We compared Myocardial Blood Flow (MBF) and Myocardial Flow Reserve (MFR) response on CZT-SPECT Myocardial Perfusion Imaging (MPI) to evaluate if dipyridamole and regadenoson could induce the same level of hyperemia. METHODS 228 patients with dynamic CZT-SPECT MPI were retrospectively analyzed (66 patients stressed with regadenoson and 162 with dipyridamole) in terms of MBF and MFR. To rule out confounding factors, two groups of 41 patients were matched for clinical characteristics in a sub-analysis, excluding high cardiovascular risk patients. RESULTS Overall stress MBF was higher in regadenoson patients (1.71 ± 0.73 vs. 1.44 ± 0.55 mL·min-1·g-1 for regadenoson and dipyridamole, respectively, p < .05). However, when confounding factors were ruled out, stress MBF (1.57 ± 0.56 vs. 1.61 ± 0.62 mL·min-1·g-1 for dipyridamole and regadenoson, respectively, p = .88) and MFR (2.62 ± 0.77 vs. 2.46 ± 0.76 for dipyridamole and regadenoson, respectively, p = .40) were not different between regadenoson and dipyridamole. CONCLUSIONS Our results suggest that dipyridamole and regadenoson induce equivalent hyperemia in dynamic SPECT with similar stress MBF and MFR in comparable patients.
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Affiliation(s)
- Quentin Brana
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
- Nuclear Medicine Department, CHRU TOURS, Tours, France
| | - Frédérique Thibault
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
| | | | - Denis Angoulvant
- Cardiology Department, CHRU TOURS & EA4245 T2i, Tours University, Tours, France
| | - Matthieu Bailly
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France.
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Baniak LM, Scott PW, Chasens ER, Imes CC, Jeon B, Shi X, Strollo PJ, Luyster FS. Sleep problems and associations with cardiovascular disease and all-cause mortality in asthma-COPD overlap: analysis of the National Health and Nutrition Examination Survey (2007-2012). J Clin Sleep Med 2022; 18:1491-1501. [PMID: 35040430 DOI: 10.5664/jcsm.9890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The impact of sleep problems (i.e. sleep duration and presence of sleep disorders) on cardiovascular morbidity and all-cause mortality in adults with asthma-COPD overlap (ACO) is unknown. METHODS Using the National Health and Nutrition Examination Survey (NHANES) database (2007-2012 cycles) and National Death Index data, we identified 398 persons with ACO. Data on self-reported physician-diagnosed sleep disorder and cardiovascular disease were collected. Sleep duration in hours was categorized as short (≤5), normal (6-8), and long (≥9). Associations between sleep duration and presence of sleep disorders and cardiovascular disease and all-cause mortality were analyzed in regression models adjusted for age, sex, race, smoking status, and body mass index. RESULTS Presence of sleep disorders was more commonly reported in the ACO group (24.7%) compared to all other groups. The ACO group had a higher proportion of short sleepers (27.6%) compared to controls (11.7%) and COPD (19.2%) and a higher proportion of long sleepers (6.9%) compared to COPD (5.5%). Presence of sleep disorders was associated with increased risk for CVD (OR = 2.48, 95% CI, 1.65 - 3.73) and death (HR = 1.44, 95% CI, 1.03 - 2.02); risk did not vary between groups. A stronger association existed between sleep duration and increased risk for CVD and all-cause mortality in ACO as compared to COPD and controls. CONCLUSIONS These results suggest that persons with ACO may represent a high-risk group that should be targeted for more aggressive intervention of sleep problems, a modifiable risk factor.
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Affiliation(s)
- Lynn M Baniak
- Veteran Affairs Pittsburgh Healthcare System, Pittsburgh PA.,School of Nursing, University of Pittsburgh, Pittsburgh PA
| | - Paul W Scott
- School of Nursing, University of Pittsburgh, Pittsburgh PA
| | | | | | - Bomin Jeon
- School of Nursing, University of Pittsburgh, Pittsburgh PA
| | - Xiaojun Shi
- School of Nursing, University of Pittsburgh, Pittsburgh PA
| | - Patrick J Strollo
- Veteran Affairs Pittsburgh Healthcare System, Pittsburgh PA.,School of Medicine, University of Pittsburgh, Pittsburgh PA
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Jurevičienė E, Burneikaitė G, Dambrauskas L, Kasiulevičius V, Kazėnaitė E, Navickas R, Puronaitė R, Smailytė G, Visockienė Ž, Danila E. Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:970. [PMID: 35055792 PMCID: PMC8775709 DOI: 10.3390/ijerph19020970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/04/2023]
Abstract
Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40-79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD-five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.
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Affiliation(s)
- Elena Jurevičienė
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
| | - Greta Burneikaitė
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
| | - Laimis Dambrauskas
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
| | - Vytautas Kasiulevičius
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
| | - Edita Kazėnaitė
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
| | - Rokas Navickas
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
| | - Roma Puronaitė
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
- Faculty of Mathematics and Informatics, Institute of Data Science and Digital Technologies, Vilnius University, Naugarduko g. 24, LT-03225 Vilnius, Lithuania
| | - Giedrė Smailytė
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
| | - Žydrūnė Visockienė
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
| | - Edvardas Danila
- Faculty of Medicine, Vilnius University, Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania; (G.B.); (L.D.); (V.K.); (E.K.); (R.N.); (R.P.); (G.S.); (Ž.V.); (E.D.)
- Vilnius University Hospital, Santaros Klinikos, Santariškių Str. 2, LT-08661 Vilnius, Lithuania
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Control of Cardiovascular Risk Factors in Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2022; 19:1102-1111. [DOI: 10.1513/annalsats.202104-463oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Meszaros M, Latshang TD, Aeschbacher SS, Huber F, Flueck D, Lichtblau M, Ulrich S, Hasler ED, Scheiwiller PM, Reinhard L, Ulrich S, Bloch KE, Furian M, Schwarz EI. Effect of Nocturnal Oxygen on Blood Pressure Response to Altitude Exposure in COPD - Data from a Randomized Placebo-Controlled Cross-Over Trial. Int J Chron Obstruct Pulmon Dis 2022; 16:3503-3512. [PMID: 34992358 PMCID: PMC8713709 DOI: 10.2147/copd.s331658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to hypoxia-induced autonomic dysregulation. Hypoxemia is marked during sleep. In COPD, altitude exposure is associated with an increase in blood pressure (BP) and a decrease in baroreflex-sensitivity (BRS). Whether nocturnal oxygen therapy (NOT) may mitigate these cardiovascular autonomic changes in COPD at altitude is unknown. Materials and Methods In a randomized placebo-controlled cross-over trial, 32 patients with moderate-to-severe COPD living <800 m were subsequently allocated to NOT and placebo during acute exposure to altitude. Measurements were done at low altitude at 490 m and during two stays at 2048 m on NOT (3 L/min) and placebo (3 L/min, ambient air) via nasal cannula. Allocation and intervention sequences were randomized. Outcomes of interest were BP, BRS (from beat-to-beat BP measurement), BP variability (BPV), and heart rate. Results About 23/32 patients finished the trial per protocol (mean (SD) age 66 (5) y, FEV1 62 (14) % predicted) and 9/32 experienced altitude-related illnesses (8 vs 1, p < 0.05 placebo vs NOT). NOT significantly mitigated the altitude-induced increase in systolic BP compared to placebo (Δ median −5.8 [95% CI −22.2 to −1.4] mmHg, p = 0.05) but not diastolic BP (−3.5 [95% CI −12.6 to 3.0] mmHg; p = 0.21) or BPV. BRS at altitude was significantly higher in NOT than in placebo (1.7 [95% CI 0.3 to 3.4] ms/mmHg, p = 0.02). Conclusion NOT may protect from hypoxia-induced autonomic dysregulation upon altitude exposure in COPD and thus protect from a relevant increase in BP and decrease in BRS. NOT may provide cardiovascular benefits in COPD during conditions of increased hypoxemia and may be considered in COPD travelling to altitude.
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Affiliation(s)
- Martina Meszaros
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Tsogyal D Latshang
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Sayaka S Aeschbacher
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Huber
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Deborah Flueck
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Ulrich
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth D Hasler
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Philipp M Scheiwiller
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Reinhard
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland.,Centre of Competence Sleep & Health, University of Zurich, Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,Centre of Competence Sleep & Health, University of Zurich, Zurich, Switzerland
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125
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Gilbert RF, Cichowitz C, Bibangambah P, Kim JH, Hemphill LC, Yang IT, Sentongo RN, Kakuhikire B, Christiani DC, Tsai AC, Okello S, Siedner MJ, North CM. Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda. BMC Pulm Med 2022; 22:12. [PMID: 34983492 PMCID: PMC8728924 DOI: 10.1186/s12890-021-01792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure. METHODS We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status. RESULTS Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT. CONCLUSIONS Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.
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Affiliation(s)
- Rebecca F Gilbert
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | - Cody Cichowitz
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | | | - June-Ho Kim
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Linda C Hemphill
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Ruth N Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David C Christiani
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Crystal M North
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
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Müllerová H, Marshall J, de Nigris E, Varghese P, Pooley N, Embleton N, Nordon C, Marjenberg Z. Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221113647. [PMID: 35894441 PMCID: PMC9340406 DOI: 10.1177/17534666221113647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The majority of patients with chronic obstructive pulmonary disease (COPD)
suffer from comorbid cardiovascular (CV) disease. Accumulating evidence
suggests a temporal association between COPD exacerbations and acute CV
events, possibly due to lung hyperinflation, increased hypoxemia and
systemic inflammation. The aims of the study were to estimate the risk of
(1) acute CV events [acute myocardial infarction (AMI), CV-related death] or
stroke in the months following a COPD exacerbation and (2) COPD exacerbation
in the months following an acute CV event. Methods: A systematic literature review of observational studies published since 2000
was conducted by searching literature databases (Medline and Embase).
Studies were eligible if conducted in adults with COPD, exposed to either
COPD exacerbation or acute CV events, with outcomes of acute CV events or
COPD exacerbation reported. Studies were appraised for relevance, bias and
quality. Meta-analyses, using random-effect models, were performed for each
outcome of interest, thus providing a pooled relative risk (RR) and its 95%
confidence interval. Results: Eight studies were identified, of which seven were used for the meta-analyses
examining the risk of CV events 1–3 months after an exacerbation compared
with none. For stroke (six studies), RR was 1.68 (95% CI = 1.19–2.38). For
AMI (six studies), RR was 2.43 (95% CI = 1.40–4.20). No studies exploring
risk of exacerbation following an acute CV event were identified. Conclusion: This meta-analysis identified a markedly increased risk of stroke or AMI
within a relatively short period of time following a COPD exacerbation.
Although the underlying mechanisms are not fully elucidated, patients with
COPD should be monitored for risk of CV outcomes after exacerbations. In
addition, preventing exacerbations may decrease the risk of subsequent acute
CV events. Registration: The study protocol was published via PROSPERO: International Prospective
Register of Systematic Reviews (#CRD42020211055).
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Affiliation(s)
- Hana Müllerová
- AstraZeneca, Academy House, 136 Hills Rd., Cambridge CB2 8PA, UK
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127
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Chen H, Liu X, Gao X, Lv Y, Zhou L, Shi J, Wei W, Huang J, Deng L, Wang Z, Jin Y, Yu W. Epidemiological evidence relating risk factors to chronic obstructive pulmonary disease in China: A systematic review and meta-analysis. PLoS One 2021; 16:e0261692. [PMID: 34962941 PMCID: PMC8714110 DOI: 10.1371/journal.pone.0261692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD), the most common chronic respiratory disease worldwide, not only leads to the decline of pulmonary function and quality of life consecutively, but also has become a major economic burden on individuals, families, and society in China. The purpose of this meta-analysis was to explore the risk factors for developing COPD in the Chinese population that resides in China and to provide a theoretical basis for the early prevention of COPD. METHODS A total of 2457 cross-sectional, case-control, and cohort studies published related to risk factors for COPD in China were searched. Based on the inclusion and exclusion criteria, 20 articles were selected. Stata 11.0 was used for meta-analysis. After merging the data, the pooled effect and 95% confidence intervals (CIs) were calculated to assess the association between risk factors and COPD. Heterogeneity between studies was assessed using I2 and Cochran's Q tests. Begg's test was used to assess publication bias. RESULTS Exposure to particulate matter less than 2.5 μm in diameter (PM2.5) (pooled effect = 1.73; 95%CI: 1.16~2.58; P <0.01), smoking history (pooled effect = 2.58; 95%CI: 2.00~3.32; P <0.01), passive smoking history (pooled effect = 1.39; 95%CI: 1.03~1.87; P = 0.03), male sex(pooled effect = 1.70; 95%CI: 1.31~2.22; P <0.01), body mass index (BMI) <18.5 kg/m2 (pooled effect = 1.73; 95%CI: 1.32~2.25; P <0.01), exposure to biomass burning emissions (pooled effect = 1.65; 95%CI: 1.32~2.06; P <0.01), childhood respiratory infections (pooled effect = 3.44; 95%CI: 1.33~8.90; P = 0.01), residence (pooled effect = 1.24; 95%CI: 1.09~1.42; P <0.01), and a family history of respiratory diseases (pooled effect = 2.04; 95%CI: 1.53~2.71; P <0.01) were risk factors for COPD in the Chinese population. CONCLUSION Early prevention of COPD could be accomplished by quitting smoking, reducing exposure to air pollutants and biomass burning emissions, maintaining body mass index between 18.5 kg/m2 and 28 kg/m2, protecting children from respiratory infections, adopting active treatments to children with respiratory diseases, and conducting regular screening for those with family history of respiratory diseases.
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Affiliation(s)
- Hong Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Liu
- Department of Respiratory Disease, The 903 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Xiang Gao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yipeng Lv
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wei
- Department of general practice, Dapuqiao Community Health Service Center of Huangpu District, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijia Deng
- School of informatics, The University of Leicester, Leicester, United Kingdom
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Jin
- Department of general practice, Dapuqiao Community Health Service Center of Huangpu District, Shanghai, China
- * E-mail: (WY); (YJ)
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (WY); (YJ)
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Goedemans L, Abou R, Montero-Cabezas JM, Ajmone Marsan N, Delgado V, J Bax J. Chronic Obstructive Pulmonary Disease and Risk of Atrial Arrhythmias After ST-Segment Elevation Myocardial Infarction. J Atr Fibrillation 2021; 13:2360. [PMID: 34950317 DOI: 10.4022/jafib.2360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/12/2020] [Accepted: 06/20/2020] [Indexed: 11/10/2022]
Abstract
Background ST-segment elevation myocardial infarction (STEMI) and cardiac arrhythmias frequently occur in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the association of COPD with the occurrence of atrial arrhythmias after STEMI. Methods This retrospective analysis consisted of 320 patients with first STEMI without a history of atrial arrhythmias, with available 24-hour holter-ECG at 3- and/or 6 months follow-up. In total, 80 COPD patients were compared with 240 non-COPD patients, matched by age and gender (mean age 67±10 years, 74% male). Atrial arrhythmias were defined as: atrial fibrillation/flutter, atrial tachycardia (≥3 consecutive premature atrial contractions (PAC's)) and excessive supraventricular ectopy activity (ESVEA, ≥30 PAC's/hour or runs of ≥20 PAC's). Results Baseline characteristics were similar among COPD and non-COPD patients regarding infarct location, β-blocker use and cardiovascular risk profile except for smoking (69% vs. 49%, respectively, p=0.002). Additionally, atrial volumes, LVEF and TAPSE were comparable. During 1 year follow-up, a significantly higher prevalence of atrial tachycardia and ESVEA was observed in patients with COPD as compared to non-COPD patients (70% vs. 46%; p<0.001 and 21% vs. 11%; p=0.024, respectively). In multivariate analysis, COPD was independently associated with the occurrence of atrial arrhythmias (combined) during 1 year of follow-up (HR 3.59, 95% CI 1.78-7.22; p<0.001). Conclusion COPD patients after STEMI have a significantly higher prevalence of atrial tachycardia and ESVEA within 1 year follow-up as compared to age- and gender matched patients without COPD. Moreover, COPD is independently associated with an increased prevalence of atrial arrhythmias after STEMI.
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Affiliation(s)
- Laurien Goedemans
- Department of Cardiology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - José M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
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Pereira-Neto EA, Johnston KN, Lewthwaite H, Boyle T, Fon A, Williams MT. Title: Blood flow restricted exercise training: Perspectives of people with chronic obstructive pulmonary disease and health professionals. Chron Respir Dis 2021; 18:14799731211056092. [PMID: 34823382 PMCID: PMC8743940 DOI: 10.1177/14799731211056092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This descriptive qualitative study explored perspectives of people with chronic obstructive pulmonary disease (COPD) and health professionals concerning blood flow restricted exercise (BFRE) training. Methods People living with COPD and health professionals (exercise physiologists, physiotherapists, and hospital-based respiratory nurses and doctors) participated in interviews or focus groups, which included information about BFRE training and a facilitated discussion of positive aspects, barriers and concerns about BFRE training as a possible exercise-based intervention. Sessions were audio-recorded, and transcript data analysed using inductive content analysis. Results Thirty-one people participated (people with COPD n = 6; health professionals n = 25). All participant groups expressed positive perceptions of BFRE as a potential alternative low-intensity exercise mode where health benefits might be achieved. Areas of overlap in perceived barriers and concerns included the need to address the risk of potential adverse events, suitability of training sites and identifying processes to appropriately screen potential candidates. Discussion While potential benefits were identified, concerns about determining who is safe and suitable to participate, delivery processes, health professional training and effects on a variety of health-related outcomes need to be addressed before implementation of BFRE training for people with COPD.
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Affiliation(s)
- Elisio A Pereira-Neto
- Allied Health and Human Performance, 1067University of South Australia, Adelaide, SA, Australia
| | - Kylie N Johnston
- Allied Health and Human Performance, 1067University of South Australia, Adelaide, SA, Australia
| | - Hayley Lewthwaite
- Allied Health and Human Performance, 1067University of South Australia, Adelaide, SA, Australia.,School of Environmental & Life Sciences, College of Engineering, Science and Environment, 180773University of Newcastle, Ourimbah, NSW, Australia
| | - Terry Boyle
- Allied Health and Human Performance, 1067University of South Australia, Adelaide, SA, Australia.,Australian Centre for Precision Health, Allied Health and Human Performance, 1067University of South Australia, Adelaide, SA, Australia
| | - Andrew Fon
- Department of Sleep and Respiratory Medicine, 8703The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Marie T Williams
- Allied Health and Human Performance, 1067University of South Australia, Adelaide, SA, Australia
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130
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Kyriakopoulos C, Chronis C, Papapetrou E, Tatsioni A, Gartzonika K, Tsaousi C, Gogali A, Katsanos C, Vaggeli A, Tselepi C, Daskalopoulos G, Konstantopoulos S, Kostikas K, Konstantinidis A. Prothrombotic state in patients with stable COPD: an observational study. ERJ Open Res 2021; 7:00297-2021. [PMID: 34729369 PMCID: PMC8558471 DOI: 10.1183/23120541.00297-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background COPD patients have an increased risk of cardiovascular disease and venous thromboembolism. Methods This study aimed to investigate whether patients with stable COPD have a prothrombotic state compared to COPD-free smokers. We conducted an observational study comparing levels of: D-dimers, INR, aPTT, coagulation factors; fibrinogen, FII, FV, FVII, FVIII, FIX, FX and coagulation inhibitors; protein S, proteins C and antithrombin between stable COPD patients and control subjects. Results A total of 103 COPD patients and 42 controls with similar age, sex, current smoking status, comorbidity burden and cardiovascular risk met the inclusion criteria. Compared to controls, COPD patients had higher levels of D-dimers (median (interquartile range): 360 (230–600) ng·mL−1versus 240 (180–400) ng·mL−1, p=0.001), fibrinogen (mean±sd: 399±82 mg·dL−1versus 346±65 mg·dL−1, p<0.001), FII (122±22% versus 109±19%, p=0.004), FV (131±25% versus 121±19%, p=0.015), FVIII (143±32% versus 122±20%, p<0.001) and FX (111 (94–134)% versus 98 (88–107)%, p=0.002), and lower levels of protein S (95 (85–105)% versus 116 (98–121)%, p<0.001) and antithrombin (94.4±11.5% versus 102.3±13.2%, p=0.001). In the COPD group, patients with more severe airflow limitation and frequent exacerbations had significantly higher levels of FII, FV and FX, whereas patients with higher COPD assessment test score had significantly higher levels of FX and lower levels of protein S. Conclusion Patients with stable COPD exhibited increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers. Among COPD patients, increased levels of FII, FV and FX and decreased levels of protein S were found in patients with more severe disease. Patients with stable COPD exhibit increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers, indicating a prothrombotic state in stable COPDhttps://bit.ly/2VmR1PP
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Affiliation(s)
| | - Christos Chronis
- Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece
| | | | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, University of Ioannina, Ioannina, Greece
| | | | - Christina Tsaousi
- University Hospital of Ioannina, Hematology Laboratory, Ioannina, Greece
| | - Athena Gogali
- Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece
| | - Christos Katsanos
- Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece
| | - Aikaterini Vaggeli
- Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece
| | - Charikleia Tselepi
- Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece
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131
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Parkin L, Williams S, Sharples K, Barson D, Horsburgh S, Jackson R, Wu B, Dummer J. Dual versus single long-acting bronchodilator use could raise acute coronary syndrome risk by over 50%: A population-based nested case-control study. J Intern Med 2021; 290:1028-1038. [PMID: 34289189 PMCID: PMC8596666 DOI: 10.1111/joim.13348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coronary heart disease occurs more frequently among patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. While some research suggests that long-acting bronchodilators might confer an additional risk of acute coronary syndrome (ACS), information from real-world clinical practice about the cardiovascular impact of using two versus one long-acting bronchodilator for COPD is limited. We undertook a population-based nested case-control study to estimate the risk of ACS in users of both a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist (LABA) relative to users of a LAMA. METHODS The study was based on the primary care PREDICT Cardiovascular Disease Cohort and linked data from regional laboratories and the New Zealand Ministry of Health's national data collections. The underlying cohort (n = 29,993) comprised patients aged 45-84 years, who initiated treatment with a LAMA and/or LABA for COPD between 1 February 2006 and 11 October 2016. 1490 ACS cases were matched to 13,550 controls by date of birth, sex, date of cohort entry (first long-acting bronchodilator dispensing), and COPD severity. RESULTS Relative to current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a significantly higher risk of ACS (adjusted OR = 1.72; [95% CI: 1.28-2.31]). CONCLUSION Dual long-acting bronchodilator therapy, rather than LAMA mono-therapy, could increase the risk of ACS by more than 50%. This has important implications for decisions about the potential benefit/harm ratio of COPD treatment intensification, given the modest benefits of dual therapy.
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Affiliation(s)
- Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.,Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Sheila Williams
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand.,Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.,Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - David Barson
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.,Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand.,Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
| | - Rod Jackson
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Billy Wu
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jack Dummer
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand.,Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
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132
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Liu X, Chen Z, Li S, Xu S. Association of Chronic Obstructive Pulmonary Disease With Arrhythmia Risks: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:732349. [PMID: 34660734 PMCID: PMC8514787 DOI: 10.3389/fcvm.2021.732349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background: A large number of studies have shown that the arrhythmia risks may be the potential causes of death among chronic obstructive pulmonary disease (COPD) patients. However, the association of COPD with risks of arrhythmias has never been systematically reviewed. Therefore, we performed a meta-analysis to assess the relationship between COPD and arrhythmia risks. Methods: An updated systematic retrieval was carried out within the databases of Embase and PubMed until June 27, 2021.The random-effects model was used to pool studies due to the potential heterogeneity across the included studies. The risk ratios (RRs) with 95% confidence intervals (CIs) were regarded as effect estimates. Results: A total of 21 studies were included in our meta-analysis. In the pooled analysis by the random-effects model, the results showed that COPD was significantly related to the risk of atrial fibrillation (AF) (RR = 1.99, 95% CI: 1.46–2.70), ventricular arrhythmias (VA) (RR = 2.01, 95% CI: 1.42–2.85), and sudden cardiac death (SCD) (RR = 1.68, 95% CI: 1.28–2.21). The corresponding results were not changed after exclusion one study at a time. The pooled results were also stable when we re-performed the analysis using the fixed-effects model. Conclusions: Our current data suggested that COPD was associated with increased risks of AF, VA, and SCD.
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Affiliation(s)
- Xin Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zhuohui Chen
- Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Siyuan Li
- Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Shuo Xu
- Department of Pulmonary and Critical Care Medicine, The Ganzhou People's Hospital, Ganzhou, China
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133
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Verdecchia P, Cavallini C, Coiro S, Riccini C, Angeli F. Certainties fading away: β-blockers do not worsen chronic obstructive pulmonary disease. Eur Heart J Suppl 2021; 23:E172-E176. [PMID: 34650380 PMCID: PMC8503302 DOI: 10.1093/eurheartj/suab116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
For many years, β-blockers have been considered contraindicated in patients with heart failure (HF) and in those with bronchial asthma or even chronic obstructive pulmonary disease (COPD) although without clear evidence of asthma. Today, despite overwhelming evidence of the usefulness of β-blockers, especially in HF with reduced left ventricular ejection fraction (HFrEF), and in ischaemic heart disease, some reluctance persists in using these drugs when COPD coexists. Such resistance is due to the fear that a possible worsening of bronchospasm induced by β-blockers could induce negative effects greater than the benefits. The Guidelines of the European Society of Cardiology clearly suggest that: (i) implantation of a cardiac defibrillator (ICD) are not contraindicated in COPD without clear evidence of bronchial asthma; (ii) β-blockers are only ‘relatively’ contraindicated when there is certainty of bronchial asthma with a documented bronchodilator response to the β2 stimulant. Therefore, bronchial asthma is not an absolute contraindication to β-blockers. The cardiologist should not limit the diagnosis of COPD to clinical suspicion, but should rely on a spirometry examination associated with any bronchodilation tests. In any case, selective β1 blockers are preferred, starting at a basic dose, which ensure a better dilator response to bronchodilators and in any case cause less bronchospasm than non-selective β-blockers. Unfortunately, there is still some reluctance to the use of β-blockers in patients with COPD associated with HF, which should be eliminated.
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Affiliation(s)
- Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy.,Struttura Complessa di Cardiologia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Claudio Cavallini
- Struttura Complessa di Cardiologia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Stefano Coiro
- Struttura Complessa di Cardiologia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Clara Riccini
- Struttura Complessa di Cardiologia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Dipartimento di Medicina e Riabilitazione Cardiopolmonare, Maugeri Care and Research Institutes, IRCCS, Tradate, Varese, Italy
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134
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Tabyshova A, Estebesova B, Beishenbekova A, Sooronbaev T, Brakema EA, Chavannes NH, Postma MJ, van Boven JFM. Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2833-2843. [PMID: 34703219 PMCID: PMC8523360 DOI: 10.2147/copd.s322778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings. AIM We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan. METHODS A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses. RESULTS A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost. CONCLUSION The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.
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Affiliation(s)
- Aizhamal Tabyshova
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bermet Estebesova
- Kyrgyz-Russian Slavic University (KRSU), Bishkek, Kyrgyzstan
- Primary Care Center of the Ministry of Internal Affairs, Bishkek, Kyrgyzstan
| | | | - Talant Sooronbaev
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
- Department of Pharmacology & Therapy, Airlangga University, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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135
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Rahaghi FN, Pistenmaa CL. Hypercoagulation in COPD: the clot thickens. ERJ Open Res 2021; 7:00534-2021. [PMID: 34729371 PMCID: PMC8558549 DOI: 10.1183/23120541.00534-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/18/2021] [Indexed: 11/12/2022] Open
Abstract
There is a growing body of evidence that hypercoagulability is present in stable COPD, involves changes in multiple coagulation factors, and is not simply associated with major causes of inflammation and thrombosis https://bit.ly/3F5NnfN.
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Affiliation(s)
- Farbod N. Rahaghi
- Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie L. Pistenmaa
- Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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136
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Doğan NÖ, Varol Y, Köktürk N, Aksay E, Alpaydın AÖ, Çorbacıoğlu ŞK, Aksel G, Baha A, Akoğlu H, Karahan S, Şen E, Ergan B, Bayram B, Yılmaz S, Gürgün A, Polatlı M. 2021 Guideline for the Management of COPD Exacerbations: Emergency Medicine Association of Turkey (EMAT) / Turkish Thoracic Society (TTS) Clinical Practice Guideline Task Force. Turk J Emerg Med 2021; 21:137-176. [PMID: 34849428 PMCID: PMC8593424 DOI: 10.4103/2452-2473.329630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 01/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.
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Affiliation(s)
- Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yelda Varol
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Nurdan Köktürk
- Department of Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ersin Aksay
- Department of Emergency Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Pulmonology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Şeref Kerem Çorbacıoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gökhan Aksel
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Ayşe Baha
- Department of Pulmonology, Near East University, Nicosia, TRNC
| | - Haldun Akoğlu
- Department of Emergency Medicine, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elif Şen
- Department of Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Begüm Ergan
- Department of Pulmonology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Başak Bayram
- Department of Emergency Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Alev Gürgün
- Department of Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mehmet Polatlı
- Department of Pulmonology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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137
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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138
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Woodhouse DC, Frolkis AD, Murray BJ, Solbak NM, Samardzic N, Burak KW. The Impact of Comorbidities on Calgary Hospital Utilization in Patients With Chronic Obstructive Pulmonary Disease and Heart Failure. Cureus 2021; 13:e17303. [PMID: 34552837 PMCID: PMC8449541 DOI: 10.7759/cureus.17303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/06/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are chronic conditions with high acute care utilization. Disease-specific order sets were developed for patients with COPD or HF in Calgary to reduce total days in hospital for this population of patients. However, many patients have comorbidities which may contribute to hospital utilization; thus, disease-specific order sets may not be an optimal solution to reduce overall acute care utilization. Methods Inpatient data on Calgary hospitalizations for COPD or HF between April 1, 2017 - March 31, 2019 and associated diagnoses were identified. Outcomes included total days in hospital and length of stay for COPD and HF patients stratified by number of comorbidities. Results Total days in hospital increased with the number of comorbidities for both conditions. During the study period, 131 patients with COPD and no comorbidities had a median length of stay of three days (IQR: 3) compared to 3,911 COPD patients with one to five comorbidities with a median length of stay of seven days (IQR: 9). There were 47 patients with HF and no comorbidities with a median length of stay of four days (IQR: 5) compared to 6,273 HF patients with one to five comorbidities with a median length of stay of nine days (IQR: 12). Common comorbidities included hypertension, type 2 diabetes, and acute renal failure. COPD and HF are frequently comorbid. Conclusions Total days in hospital for patients with COPD or HF is positively correlated with the number of comorbidities. COPD or HF patients with between one to five comorbidities (compared to those with no comorbidities, and those with more than five comorbidities) represent the majority of total days in hospital, and the majority of patients. This highlights the importance of focusing on patients with comorbidities in efforts to reduce hospital utilization, and suggests that concurrent management of commonly occurring comorbidities for HF and COPD patients may be necessary to achieve this goal.
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Affiliation(s)
| | | | | | | | | | - Kelly W Burak
- Internal Medicine, University of Calgary, Calgary, CAN
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139
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Collaro AJ, Chang AB, Marchant JM, Chatfield MD, Dent A, Blake T, Mawn P, Fong K, McElrea MS. Associations between lung function and future cardiovascular morbidity and overall mortality in a predominantly First Nations population: a cohort study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 13:100188. [PMID: 34527981 PMCID: PMC8403916 DOI: 10.1016/j.lanwpc.2021.100188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
Background Spirometric lung function impairment is an independent predictor of respiratory and cardiovascular disease, and mortality across a broad range of socioeconomic backgrounds and environmental settings. No contemporary studies have explored these relationships in a predominantly regional/remote First Nations population, whose health outcomes are worse than for non-First Nations populations, and First Nations people living in urban centres. Methods This was a retrospective cohort study of 1,734 adults (1,113 First Nations) referred to specialist respiratory outreach clinics in the state of Queensland, Australia from February 2012 to March 2020. Regression modelling was used to test associations between lung function and mortality and cardiovascular disease. Findings At the time of analysis (August 2020), 189 patients had died: 88 (47%) from respiratory causes and 38 (20%) from cardiovascular causes. When compared to patients with forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) Z-scores of >0 to -1, patients with Z-scores <-1 were at elevated mortality risk (HR=3•2, 95%CI 1•4-7•4; HR=2•6, 95%CI 1•3-5•1), and elevated cardiovascular disease risk (OR=1•5, 95%CI 1•1-2•2; OR=1•6, 95%CI 1•2-2•3). FEV1/FVC% Z-scores <-1 were associated with increased overall mortality (HR=1•6, 95%CI 1•1-2•3), but not cardiovascular disease (OR=1•1, 95%CI 0•8-1•4). These associations were not affected by First Nations status. Interpretation Reduced lung function even within the clinically normal range is associated with increased mortality, and cardiovascular disease in First Nations Australians. These findings highlight the importance of lung function optimisation and inform the need for future investment to improve outcomes in First Nations populations. Funding None.
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Affiliation(s)
- Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Indigenous Respiratory Outreach Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Annette Dent
- Indigenous Respiratory Outreach Care, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tamara Blake
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Patsi Mawn
- Indigenous Respiratory Outreach Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kwun Fong
- Indigenous Respiratory Outreach Care, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
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140
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2289] [Impact Index Per Article: 763.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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141
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Vaes AW, Spruit MA, Goswami N, Theunis J, Franssen FME, De Boever P. Analysis of retinal blood vessel diameters in patients with COPD undergoing a pulmonary rehabilitation program. Microvasc Res 2021; 139:104238. [PMID: 34492257 DOI: 10.1016/j.mvr.2021.104238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/05/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Regular exercise positively affects cardiovascular physiology, translating into the adequate capacity of microvascular blood vessels to dilate in response to acute bouts of exercise. However, this remains unstudied in patients with chronic obstructive pulmonary disease (COPD), who often suffer from cardiovascular comorbidity. Therefore, we studied acute changes in retinal blood vessel diameters in response to high-intensity exercise in patients with COPD. The effect of an exercise-based 8-week pulmonary rehabilitation (PR) program was evaluated. We consider changes in these retinal metrics as an indicator of microvascular reactivity. METHODS Demographics and clinical characteristics of 41 patients were collected at the start and end of the PR program. Patients performed a high-intensity exercise test on a cycle ergometer at the start and end of the PR program, during which we collected retinal images. Fundus images were taken immediately before and 0, 5, 10, 15, and 30 min after the ergometer test. Widths of retinal blood vessels, represented as Central Retinal Arteriolar and Venular Equivalents (CRAE and CRVE), were calculated. RESULTS Thirty patients with COPD completed the study protocol (57% males; mean age: 64 ± 7 years; mean FEV1: 45 ± 17%pred). We did not observe a change in retinal vessel widths following the ergometer test at the start of the PR program. This null result remained at the end of the 8-week PR program. Our observations did not alter when considering responders and non-responders to PR. CONCLUSION Retinal blood vessel diameters of patients with COPD did not change following an exercise test on an ergometer. The exercise-based PR program of eight weeks did not counteract the blunted retinal microvascular response.
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Affiliation(s)
- Anouk W Vaes
- Department of Research and Development, Ciro, Horn, the Netherlands.
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Nandu Goswami
- Division of Physiology, Medical University of Graz, Graz, Austria
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Frits M E Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium; Department of Biology, University of Antwerp, Wilrijk, Belgium; Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
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142
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Stafford G, Villén N, Roso-Llorach A, Troncoso-Mariño A, Monteagudo M, Violán C. Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179216. [PMID: 34501805 PMCID: PMC8430667 DOI: 10.3390/ijerph18179216] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/30/2023]
Abstract
(1) Background: The acquisition of multiple chronic diseases, known as multimorbidity, is common in the elderly population, and it is often treated with the simultaneous consumption of several prescription drugs, known as polypharmacy. These two concepts are inherently related and cause an undue burden on the individual. The aim of this study was to identify combined multimorbidity and polypharmacy patterns for the elderly population in Catalonia. (2) Methods: A cross-sectional study using electronic health records from 2012 was conducted. A mapping process was performed linking chronic disease categories to the drug categories indicated for their treatment. A soft clustering technique was then carried out on the final mapped categories. (3) Results: 916,619 individuals were included, with 93.1% meeting the authors’ criteria for multimorbidity and 49.9% for polypharmacy. A seven-cluster solution was identified: one non-specific (Cluster 1) and six specific, corresponding to diabetes (Cluster 2), neurological and musculoskeletal, female dominant (Clusters 3 and 4) and cardiovascular, cerebrovascular and renal diseases (Clusters 5 and 6), and multi-system diseases (Cluster 7). (4) Conclusions: This study utilized a mapping process combined with a soft clustering technique to determine combined patterns of multimorbidity and polypharmacy in the elderly population, identifying overrepresentation in six of the seven clusters with chronic disease and chronic disease-drug categories. These results could be applied to clinical practice guidelines in order to better attend to patient needs. This study can serve as the foundation for future longitudinal regarding relationships between multimorbidity and polypharmacy.
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Affiliation(s)
- Grant Stafford
- Programa de Máster en Salud Pública, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Unitat Transversal de Recerca (UTR), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (M.M.)
| | - Noemí Villén
- Àrea del Medicament i Servei de Farmàcia, Atenció Primària Barcelona Ciutat, Institut Català de la Salut (ICS), 08015 Barcelona, Spain; (N.V.); (A.T.-M.)
- Programa de Doctorat en Metodologia de la Recerca Biomèdica i Salut Pública, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Albert Roso-Llorach
- Unitat Transversal de Recerca (UTR), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (M.M.)
- Programa de Doctorat en Metodologia de la Recerca Biomèdica i Salut Pública, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Amelia Troncoso-Mariño
- Àrea del Medicament i Servei de Farmàcia, Atenció Primària Barcelona Ciutat, Institut Català de la Salut (ICS), 08015 Barcelona, Spain; (N.V.); (A.T.-M.)
- Department of Clinical Sciences, University of Barcelona and IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Mònica Monteagudo
- Unitat Transversal de Recerca (UTR), Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (M.M.)
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Concepción Violán
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitaria per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain
- Correspondence:
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143
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Shnoda M, Gajjar K, Ivanova V. COPD and Cardiovascular Disease: A Review of Association, Interrelationship, and Basic Principles for Integrated Management. Crit Care Nurs Q 2021; 44:91-102. [PMID: 33234862 DOI: 10.1097/cnq.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of comorbid cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD) can result in unfavorable outcomes, ranging from deterioration in quality of life to increases in all-cause and cardiovascular mortality. Moreover, cardiovascular events are major cause of hospitalization in patients with COPD and contributing significantly to the economic burden of the disease. Despite the acknowledgment of the prognostic significance of CVD comorbidity in COPD patients, CVD remains underrecognized and undertreated in this patient population. In this article, we address the current knowledge about the estimated prevalence, pathophysiologic association, as well as important considerations in the diagnosis and management of CVD in COPD patients.
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Affiliation(s)
- Mina Shnoda
- Divisions of Internal Medicine (Dr Shnoda) and Cardiovascular Institute (Drs Gajjar and Ivanova), Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
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144
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Søyseth V, Kononova N, Neukamm A, Holmedahl NH, Hagve TA, Omland T, Einvik G. Systemic inflammation induced by exacerbation of COPD or pneumonia in patients with COPD induces cardiac troponin elevation. BMJ Open Respir Res 2021; 8:8/1/e000997. [PMID: 34452935 PMCID: PMC8404456 DOI: 10.1136/bmjresp-2021-000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Troponin is a biomarker of myocardial injury. In chronic obstructive pulmonary disease (COPD), troponin is an important determinant of mortality after acute exacerbation. Whether acute exacerbation of COPD (AECOPD) causes troponin elevation is not known. Here, we investigated whether troponin is increased in AECOPD compared to stable COPD. Methods We included 320 patients with COPD in the stable state and 63 random individuals from Akershus University hospital’s catchment area. All participants were ≥40 years old (mean 65·1 years, SD 7·6) and 176 (46%) were females. The geometric mean of high-sensitivity cardiac troponin T (hs-cTnT) was 6·9 ng/L (geometric-SD 2·6). They were followed regarding hospital admission for the subsequent 5 years. Results During the 5-year follow-up, we noted 474 hospitalisations: Totally, 150 and 80 admissions were due to AECOPD or pneumonia, respectively. The geometric mean ratio with geometric SE (GSE) between cTnT at admission and stable state in AECOPD and pneumonia was 1·27 (GSE=1.11, p=0·023) and 1·28 (GSE=1.14, p=0·054), respectively. After inclusion of blood leucocyte count and C reactive protein at hospitalisation, these ratios attenuated to zero. However, we estimated an indirect of AECOPD and pneumonia on the ratio between hs-cTnT at admission and the stable state to 1·16 (p=0·022) and 1·22 (p=0·008), representing 91% (95% CI 82% to 100%) and 95% (95% CI 83% to 100%) of the total effects, respectively. Conclusion AECOPD and pneumonia in patients with COPD is associated with higher cTnT levels. This association appears to be mediated by systemic inflammation.
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Affiliation(s)
- Vidar Søyseth
- Medical Division, Akershus University Hospital, Lorenskog, Norway .,Campus Ahus, University of Oslo Faculty of Medicine, Lorenskog, Norway
| | - Natalia Kononova
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akerhus University Hospital, Lørenskog, Norway
| | - Anke Neukamm
- Department of Cardiology, Akerhus University Hospital, Lørenskog, Norway
| | | | - Tor-Arne Hagve
- Medical Division, Akershus University Hospital, Lorenskog, Norway
| | - Torbjorn Omland
- Campus Ahus, University of Oslo Faculty of Medicine, Lorenskog, Norway.,Lorenskog, Norway
| | - Gunnar Einvik
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akerhus University Hospital, Lørenskog, Norway
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145
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Martin A, Hancox RJ, Chang CL, Beasley R, Wrobel J, McDonald V, Dobler CC, Yang IA, Farah CS, Cochrane B, Hillis GS, Scowcroft CP, Aggarwal A, Di Tanna GL, Balicki G, Galgey S, Jenkins C. Preventing adverse cardiac events (PACE) in chronic obstructive pulmonary disease (COPD): study protocol for a double-blind, placebo controlled, randomised controlled trial of bisoprolol in COPD. BMJ Open 2021; 11:e053446. [PMID: 34452971 PMCID: PMC8404458 DOI: 10.1136/bmjopen-2021-053446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Heart disease in chronic obstructive pulmonary disease (COPD) is a common but neglected comorbidity. Patients with COPD are frequently excluded from clinical trials of treatments aimed at reducing cardiac morbidity and mortality, which has led to undertreatment of cardiovascular disease in patients with COPD. A particular concern in COPD is the underuse of beta (β)-blockers. There is observational evidence that cardioselective β-blockers are safe and may even reduce mortality risk in COPD, although some evidence is conflicting. There is an urgent need to answer the research question: Are cardioselective β-blockers safe and of benefit in people with moderately severe COPD? The proposed study will investigate whether cardioselective β-blocker treatment in patients with COPD reduces mortality and cardiac and respiratory morbidity. METHODS AND ANALYSES This is a double-blind, randomised controlled trial to be conducted in approximately 26 sites in Australia, New Zealand, India, Sri Lanka and other countries as required. Participants with COPD will be randomised to either bisoprolol once daily (range 1.25-5 mg, dependent on tolerated dose) or matched placebo, in addition to receiving usual care for their COPD over the study duration of 24 months.The study will enrol 1164 participants with moderate to severe COPD, aged 40-85 years. Participants will be symptomatic from their COPD and have a postbronchodilator forced expiratory volume in 1 s (FEV1) ≥30% and ≤70% predicted and a history of at least one exacerbation requiring systemic corticosteroids, antibiotics or both in the prior 24 months. ETHICS AND DISSEMINATION The study protocol has been approved by the Sydney Local Health District Human Research Ethics Committee at The Concord Repatriation General Hospital. TRIAL REGISTRATION NUMBERS NCT03917914; CTRI/2020/08/027322.
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Affiliation(s)
- Allison Martin
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Jeremy Wrobel
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Vanessa McDonald
- University of Newcastle, Callaghan, New South Wales, Australia
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Claudia C Dobler
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ian A Yang
- The Prince Charles Hospital, Chermside, Queensland, Australia
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Claude S Farah
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Belinda Cochrane
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
- Western Sydney University, Penrith, NSW, Australia
| | - Graham S Hillis
- Royal Perth Hospital, Perth, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | | | - Ashutosh Aggarwal
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Balicki
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Shane Galgey
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Christine Jenkins
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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146
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Damkjær M, Suppli Ulrik C, Godtfredsen N, Håkansson KEJ. Beta-Blockers in High-Risk Outpatients with Chronic Obstructive Pulmonary Disease are Associated with All-Cause Mortality - The STATUETTE Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2397-2406. [PMID: 34465987 PMCID: PMC8402979 DOI: 10.2147/copd.s315151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Beta-blockers have been proposed to improve COPD-related outcomes, yet studies report conflicting results. We aimed to investigate the effect of beta blockers on time-to-first exacerbation and all-cause mortality in high-risk COPD outpatients. Methods All COPD outpatients managed at the Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Denmark in 2016 were followed for 3.5 years in this retrospective, registry-based cohort study. Outcomes were time-to-first acute exacerbation of COPD (AECOPD) or death. The association was estimated using time-varying crude and multivariable Cox proportional hazard regression adjusted for age, sex, BMI, use of COPD medication, smoking status, cardiovascular disease and COPD severity. Results The cohort comprised 950 COPD outpatients, mean age 71 (SD 11) years, and FEV1 44% predicted (IQR 33%; 57%). The annual exacerbation rate was 0.88 (SD 1.68) and 211 patients (22%) had a history of hospitalization requiring AECOPD within 12 months. Of the enrolled patients, 247 (26%) were prescribed beta blockers. Beta-blocker use was associated, although with borderline significance, with increased all-cause mortality (HR 1.37 (95% CI, 0.99 to 1.89, p = 0.059)). On the other hand, beta blocker use did not reduce the risk of AECOPD (HR = 0.89 (95% CI 0.71 to 1.10; p = 0.270)), which remained non-significant after stratifying for severity of exacerbations. Conclusion We found an association between beta blocker use and all-cause mortality in high-risk COPD outpatients. No association was found between beta blocker use and risk of AECOPD.
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Affiliation(s)
- Mathias Damkjær
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjell E J Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
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147
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Pullen R, Miravitlles M, Sharma A, Singh D, Martinez F, Hurst JR, Alves L, Dransfield M, Chen R, Muro S, Winders T, Blango C, Muellerova H, Trudo F, Dorinsky P, Alacqua M, Morris T, Carter V, Couper A, Jones R, Kostikas K, Murray R, Price DB. CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care. Int J Chron Obstruct Pulmon Dis 2021; 16:2301-2322. [PMID: 34413639 PMCID: PMC8370848 DOI: 10.2147/copd.s313498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) are managed predominantly in primary care. However, key opportunities to optimize treatment are often not realized due to unrecognized disease and delayed implementation of appropriate interventions for both diagnosed and undiagnosed individuals. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) is the first-of-its-kind, collaborative, interventional COPD registry. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. The first step in CONQUEST was the development of quality standards (QS). The QS will be imbedded in routine primary and secondary care, and are designed to drive patient-centered, targeted, risk-based assessment and management optimization. Our aim is to provide an overview of the CONQUEST QS, including how they were developed, as well as the rationale for, and evidence to support, their inclusion in healthcare systems. Methods The QS were developed (between November 2019 and December 2020) by the CONQUEST Global Steering Committee, including 11 internationally recognized experts with a specialty and research focus in COPD. The process included an extensive literature review, generation of QS draft wording, three iterative rounds of review, and consensus. Results Four QS were developed: 1) identification of COPD target population, 2) assessment of disease and quantification of future risk, 3) non-pharmacological and pharmacological intervention, and 4) appropriate follow-up. Each QS is followed by a rationale statement and a summary of current guidelines and research evidence relating to the standard and its components. Conclusion The CONQUEST QS represent an important step in our aim to improve care for patients with COPD in primary and secondary care. They will help to transform the patient journey, by encouraging early intervention to identify, assess, optimally manage and followup COPD patients with modifiable high risk of future exacerbations.
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Affiliation(s)
- Rachel Pullen
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Anita Sharma
- Platinum Medical Centre, Chermside, QLD, Australia
| | - Dave Singh
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fernando Martinez
- New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Luis Alves
- EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rongchang Chen
- Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, People's Republic of China
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Tonya Winders
- USA & Global Allergy & Airways Patient Platform, Vienna, Austria
| | - Christopher Blango
- Janssen Pharmaceutical Companies of Johnson & Johnson, Philadelphia, PA, USA
| | | | | | | | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Amy Couper
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Rupert Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK
| | - Konstantinos Kostikas
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ruth Murray
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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148
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Hypercoagulable State in COPD-A Comprehensive Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11081447. [PMID: 34441381 PMCID: PMC8394684 DOI: 10.3390/diagnostics11081447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/01/2021] [Accepted: 08/07/2021] [Indexed: 01/18/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease with multisystemic manifestations. Studies either held on stable disease patients or during exacerbations have demonstrated that COPD is strongly related to venous thromboembolism and cardiovascular events. The aim of the present review of the literature was to provide an in-depth overview regarding the alterations of coagulation factors and prothrombotic changes generated in patients with stable COPD and during COPD exacerbations.
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149
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Chen Z, Xu Y, Chen M, Cui R, Wang YH, Dai SM, Wei JCC. Gout Augments the Risk of Cardiovascular Disease in Patients With Psoriasis: A Population-Based Cohort Study. Front Immunol 2021; 12:703119. [PMID: 34335617 PMCID: PMC8320695 DOI: 10.3389/fimmu.2021.703119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 12/05/2022] Open
Abstract
Objective Patients with psoriasis (PsO) have a high frequency of concomitant gout and increased risk of cardiovascular diseases (CVD). We aimed to estimate the synergistic impact of gout on the risk of CVD in patients with PsO. Methods A population-based cohort of patients registered in the National Health Insurance Research Database of Taiwan between 2000 and 2013 was stratified according to the presence of PsO and gout. Propensity score analysis was used to match age and gender at a ratio of 1:4. Cox proportional hazard models and subgroup analyses were used to estimate the hazard ratios (HRs) for CVD adjusted for traditional risk factors. The Kaplan–Meier method was used to plot the cumulative incidence curves. Results Patients with combined PsO and gout (n = 97), PsO alone (n = 388), gout alone (matched, n = 388) and matched controls (n = 388) were identified. Compared with the patients with PsO alone, the patients with combined PsO and gout had a significantly higher risk of CVD (relative risk 2.39, 95% CI 1.56 to 3.65). After adjustment for traditional risk factors, the risk of CVD was higher in patients with gout alone (HR 2.16, 95% CI 1.54 to 3.04) and in patients with combined PsO and gout (HR 2.72, 95% CI 1.73 to 4.28). Conclusions Gout augments the risk of CVD independently of traditional risk factors in patients with PsO.
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Affiliation(s)
- Zhiyong Chen
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yiwen Xu
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Miao Chen
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ran Cui
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sheng-Ming Dai
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - James Cheng-Chung Wei
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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150
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Pereira-Neto EA, Lewthwaite H, Boyle T, Johnston K, Bennett H, Williams MT. Effects of exercise training with blood flow restriction on vascular function in adults: a systematic review and meta-analysis. PeerJ 2021; 9:e11554. [PMID: 34277146 PMCID: PMC8272459 DOI: 10.7717/peerj.11554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background Blood flow restricted exercise (BFRE) improves physical fitness, with theorized positive effects on vascular function. This systematic review and meta-analysis aimed to report (1) the effects of BFRE on vascular function in adults with or without chronic health conditions, and (2) adverse events and adherence reported for BFRE. Methodology Five electronic databases were searched by two researchers independently to identify studies reporting vascular outcomes following BFRE in adults with and without chronic conditions. When sufficient data were provided, meta-analysis and exploratory meta-regression were performed. Results Twenty-six studies were included in the review (total participants n = 472; n = 41 older adults with chronic conditions). Meta-analysis (k = 9 studies) indicated that compared to exercise without blood flow restriction, resistance training with blood flow restriction resulted in significantly greater effects on endothelial function (SMD 0.76; 95% CI [0.36–1.14]). No significant differences were estimated for changes in vascular structure (SMD −0.24; 95% CI [−1.08 to 0.59]). In exploratory meta-regression analyses, several experimental protocol factors (design, exercise modality, exercised limbs, intervention length and number of sets per exercise) were significantly associated with the effect size for endothelial function outcomes. Adverse events in BFRE studies were rarely reported. Conclusion There is limited evidence, predominantly available in healthy young adults, on the effect of BFRE on vascular function. Signals pointing to effect of specific dynamic resistance exercise protocols with blood flow restriction (≥4 weeks with exercises for the upper and lower limbs) on endothelial function warrant further investigation.
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Affiliation(s)
- Elisio A Pereira-Neto
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hayley Lewthwaite
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Terry Boyle
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Kylie Johnston
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Marie T Williams
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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