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Fogarty C, Hattersley H, Di Scala L, Drollmann A. Bronchodilatory effects of NVA237, a once daily long-acting muscarinic antagonist, in COPD patients. Respir Med 2011; 105:337-42. [DOI: 10.1016/j.rmed.2010.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/27/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Holownia A, Mroz RM, Skopinski T, Kielek A, Kolodziejczyk A, Chyczewska E, Braszko JJ. Tiotropium increases cytosolic muscarinic M3 receptors and acetylated H3 histone proteins in induced sputum cells of COPD patients. Eur J Med Res 2011; 15 Suppl 2:64-7. [PMID: 21147623 PMCID: PMC4360339 DOI: 10.1186/2047-783x-15-s2-64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is characterized by irreversible progressive airflow limitation related to tobacco smoking. This limitation is caused by chronic inflammation of the airways and lung parenchyma and is associated with increased activity of parasympathetic system. The most effective bronchodilators in COPD are muscarinic receptor antagonists (MRA), which reverse, at least in part, compromised respiratory function. MRA also contribute to control inflammatory processes via interactions with inflammatory signaling molecules. The use of the long-acting cholinolytic bronchodilatator - tiotropium, with high affinity to M3 receptors, is suggested as a first line maintenance treatment in COPD patients. Materials and methods In this study we assessed M3 receptor protein expression in induced sputum of 27 stable COPD patients before and after therapy consisting of 18 μg once daily tiotropium for 12 weeks. Lung function tests including spirometry, lung volumes, and DLCO were performed before and after therapy in all COPD patients. The patients were subjected to the sputum induction procedures before and after therapy. Sputum cells were isolated, sample-specific cell profiles were characterized, and the cells were processed to isolate pure cytosolic fractions. Cytosolic M3 protein and HDAC2 levels and nuclear acetylated histone H3 (AcH3) expression was quantified using specific antibodies against human proteins and Western blot with enhanced luminescence detection. Results Therapy significantly increased the mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) volume (P < 0.05). The mean expression of M3 protein was higher by 37% after therapy (P < 0.05), HDAC2 expression was not altered, while AcH3 level was increased by about 90% (P < 0.01), compared with the corresponding data before therapy. HDAC2 expression before therapy was positively correlated with AcH3 expression (r = 0.74), while after therapy no correlation was detected. FEV1, FCV, and cytosolic M3 protein expression did not correlate with other biochemical parameters tested. Conclusions Twelve weeks of tiotropium therapy in COPD patients improves clinical indices of lung function and involves alterations in sputum cell chromatin acetylation and also increased cholinergic M3 receptor internalization.
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Affiliation(s)
- Adam Holownia
- Department of Clinical Pharmacology, Medical University of Bialystok, Bialystok, Poland.
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203
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Subjects with Discordant Airways Obstruction: Lost between Spirometric Definitions of COPD. Pulm Med 2011; 2011:780215. [PMID: 21637369 PMCID: PMC3101606 DOI: 10.1155/2011/780215] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 01/08/2011] [Indexed: 11/17/2022] Open
Abstract
Background. Since the FEV1/FVC ratio declines with age, using the fixed ratio of 0.70 leads to overdiagnosis of COPD in older populations and underdiagnosis among young adults. Objective. To evaluate whether discordant obstructive cases (FEV1/FVC < 0.70 but ≥LLN) are a healthy population or have clinical features that would place them at increased risk. Methods. We used post-bronchodilator spirometry data from the population-based Austrian Burden of Obstructive Lung Disease (BOLD) study. Those with post-bronchodilator FEV1/FVC ratio <LLN and <0.70 were defined as concordant obstructive cases. Participants with post-bronchodilator FEV1/FVC ratio ≥LLN but <0.70 were defined as discordant obstructive cases. Results. Discordant obstructive cases were more likely to be older, male and never-smokers. Additionally they had less respiratory symptoms and less severe impairment of FEV1. However, discordant obstructive cases reported significantly more often a diagnosis of heart disease than subjects with normal lung function (27.2% vs 7.3%, P = .015). Conclusion. The clinical profile of discordant obstructive cases includes potentially important comorbid disease.
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Genetic influences on chronic obstructive pulmonary disease – A twin study. Respir Med 2010; 104:1890-5. [DOI: 10.1016/j.rmed.2010.05.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 05/01/2010] [Accepted: 05/10/2010] [Indexed: 11/23/2022]
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206
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Blasi F, Concia E, Mazzei T, Moretti AM, Nicoletti G, Novelli A, Tempera G. Description of the disease and diagnostic and epidemiologic aspects. J Chemother 2010; 22 Suppl 1:4-7. [PMID: 21097387 DOI: 10.1179/joc.2010.22.supplement-1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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207
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Bellos C, Papadopoulos A, Fotiadis DI, Rosso R. An intelligent system for classification of patients suffering from chronic diseases. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:2890-3. [PMID: 21095978 DOI: 10.1109/iembs.2010.5626314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The CHRONIOUS system addresses a smart wearable platform, based on multi-parametric sensor data processing, for monitoring people suffering from chronic diseases in long-stay setting. Several signals are being recorded through wearable sensors and are stored together with additional information, entered by the patient. An Intelligent System, placed at a Smart Assistant Device, analyzes incoming data and facilitates data mining techniques resulting upon the severity of a health episode. Part of the Intelligent System is the Mental Support Tool, which calculates a Stress Index and classifies the mental condition and stress levels of the patient. An additional component aiming at the personalization of the Intelligent System's Decision is the Profiler which defines several patients profiles and facilitates clustering techniques in order to associate each patient's description with one of the predefined profiles.
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Affiliation(s)
- Christos Bellos
- FORTH BRI Foundation for Research and Technology - Hellas, Biomedical Research, Ioannina Greece.
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208
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Vestbo J, Rennard S. Chronic obstructive pulmonary disease biomarker(s) for disease activity needed--urgently. Am J Respir Crit Care Med 2010; 182:863-4. [PMID: 20884938 DOI: 10.1164/rccm.201004-0602ed] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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209
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Önnervik PO, Lindahl M, Svitacheva N, Stämpfli M, Thim K, Smailagic A, Virtala R, Taylor JD. The role of the CCR1 receptor in the inflammatory response to tobacco smoke in a mouse model. Inflamm Res 2010; 59:817-25. [PMID: 20387089 PMCID: PMC2933852 DOI: 10.1007/s00011-010-0193-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 03/19/2010] [Accepted: 03/22/2010] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim was to create pathological changes in mice relevant to human smoke exposure that can be used to further understand the mechanisms and pathology of smoke-induced inflammatory disease. METHODS Mice were exposed to tobacco smoke or lipopolysaccharide (LPS) to generate an inflammatory infiltrate within the lungs. RESULTS Tobacco smoke exposure over a 4 day period led to neutrophilia in the lungs of BALB/c mice. Within the inflammatory exudates, significant changes were also seen in protein levels of IL-1B, IL-6, MIP-2, KC (IL-8) and TIMP-1 as measured by ELISA. Further protein changes, as measured via multiplex analysis revealed increased levels of MMP-9, MDC, LIF and MCP-1, amongst other mediators. Major changes in whole lung tissue gene expression patterns were observed. The neutrophilia seen after smoke exposure was steroid-insensitive, relative to doses of steroid needed to reduce LPS-driven neutrophilia in controls. This exposes pathological switches that are changed upon exposure to tobacco smoke, rendering steroids less effective under these conditions. Challenge of chemokine receptor type 1 (CCR1) KO mice in the tobacco smoke model showed that lack of this gene protected the mice from smoke-induced inflammation. CONCLUSIONS This suggests the CCR1 receptor has a key role in the pathogenesis of smoke-induced inflammation.
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Affiliation(s)
- Per-Ola Önnervik
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
| | - Maria Lindahl
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
| | - Naila Svitacheva
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
| | - Martin Stämpfli
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
- Department of Pathology and Molecular Medicine, Centre for Gene Therapeutics, McMaster University, Hamilton, ON L8N 3Z5 Canada
| | - Kerstin Thim
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
| | - Amir Smailagic
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
| | - Robert Virtala
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
| | - John D. Taylor
- Integrative Pharmacology, Department of Biosciences, AstraZeneca R&D Lund, Respiratory and Inflammation Research Area, 22187 Lund, Sweden
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Verkindre C, Fukuchi Y, Flémale A, Takeda A, Overend T, Prasad N, Dolker M. Sustained 24-h efficacy of NVA237, a once-daily long-acting muscarinic antagonist, in COPD patients. Respir Med 2010; 104:1482-9. [DOI: 10.1016/j.rmed.2010.04.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 04/08/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
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211
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La bronchopneumopathie chronique obstructive (BPCO) du sujet âgé en huit questions/réponses. Rev Mal Respir 2010; 27:855-73. [DOI: 10.1016/j.rmr.2010.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 02/25/2010] [Indexed: 01/02/2023]
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212
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Kneidinger N, Yildirim AÖ, Callegari J, Takenaka S, Stein MM, Dumitrascu R, Bohla A, Bracke KR, Morty RE, Brusselle GG, Schermuly RT, Eickelberg O, Königshoff M. Activation of the WNT/β-catenin pathway attenuates experimental emphysema. Am J Respir Crit Care Med 2010; 183:723-33. [PMID: 20889911 DOI: 10.1164/rccm.200910-1560oc] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is a devastating disease, for which no causal therapy is available. OBJECTIVES To characterize WNT/β-catenin signaling in COPD in humans and elucidate its potential role as a preventive and therapeutic target in experimental emphysema in mice. METHODS The expression, localization, and activity of WNT/β-catenin signaling was assessed in 12 COPD and 12 transplant donor samples using quantitative reverse transcriptase polymerase chain reaction, immunohistochemistry, and Western blotting. The role of WNT/β-catenin signaling was assessed in elastase- and cigarette smoke-induced emphysema and therapeutic modulation thereof in elastase-induced emphysema in TOPGAL reporter and wild-type mice in vivo. MEASUREMENTS AND MAIN RESULTS No differences in the mRNA expression profile of the main WNT/β-catenin signaling components were observed comparing COPD and donor lung homogenates. Immunohistochemical analysis revealed reduced numbers of nuclear β-catenin-positive alveolar epithelial cells in COPD. Similarly, WNT/β-catenin signaling was down-regulated in both experimental emphysema models. Preventive and therapeutic, WNT/β-catenin activation by lithium chloride attenuated experimental emphysema, as assessed by decreased airspace enlargement, improved lung function, reduced collagen content, and elevated expression of alveolar epithelial cell markers. CONCLUSIONS Decreased WNT/β-catenin signaling is involved in parenchymal tissue destruction and impaired repair capacity in emphysema. These data indicate a crucial role of WNT/β-catenin signaling in lung repair mechanisms in vivo, and highlight WNT/β-catenin activation as a future therapeutic approach for emphysema.
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Affiliation(s)
- Nikolaus Kneidinger
- Department of Medicine, University of Giessen Lung Center, University of Giessen, Giessen, Germany
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213
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D'Agostino B, Sullo N, Siniscalco D, De Angelis A, Rossi F. Mesenchymal stem cell therapy for the treatment of chronic obstructive pulmonary disease. Expert Opin Biol Ther 2010; 10:681-7. [PMID: 20384521 DOI: 10.1517/14712591003610614] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Recent studies have revealed that adult stem cells such as bone marrow-derived cells contribute to lung tissue regeneration and protection, and thus administration of exogenous stem/progenitor cells may be a potent next-generation therapy for COPD. Pathogenesis of COPD is characterized by an upregulation of inflammatory processes leading to irreversible events such as apoptosis of epithelial cells, proteolysis of the terminal air-space and lung extracellular matrix components. The available pharmacological treatments are essentially symptomatic, therefore, there is a need to develop more effective therapeutic strategies. It has been previously demonstrated that transplanted MSC home to the lung in response to lung injury and adopt phenotypes of alveolar epithelial cells, endothelial cells, fibroblasts and bronchial epithelial cells. However, engraftment and differentiation are now felt to be rare occurrences and other mechanisms might be involved and play a more important role. Importantly, MSCs protect lung tissue through suppression of proinflammatory cytokines, and through triggering production of reparative growth factors. Accordingly, it is not clear if and how these cells will be able to repair, to slow or to prevent the disease. This article reviews recent advances in regenerative medicine in COPD and highlights that their potential application although promising and very attractive, are still a far away opinion.
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Affiliation(s)
- Bruno D'Agostino
- Department of Experimental Medicine, Second University of Naples, Section of Pharmacology L Donatelli, via S Maria di Costantinopoli, 16-80138 Napoli, Italy.
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214
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Löfdahl CG. COPD and co-morbidities, with special emphasis on cardiovascular conditions. CLINICAL RESPIRATORY JOURNAL 2010; 2 Suppl 1:59-63. [PMID: 20298351 DOI: 10.1111/j.1752-699x.2008.00085.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The concept of COPD as a systemic disease has been widely accepted in the past several years. In parallel, it has been emphasised that COPD morbidity and mortality is strongly related to co-morbid conditions. This review summarises some recent studies showing that in patients with COPD, the prevalence of cardiac failure is manifested in 10%-46% of the patients, and that up to 40% of patients with cardiac failure show evidence of COPD, about half of them not earlier diagnosed. Recent data also show an increased risk for arteriosclerotic manifestations in COPD patients, and cardiac complications are common causes of death in COPD patients. Other manifestations of the metabolic syndrome, as diabetes, are also over-represented in patients. It is also a well-established fact that a low FEV(1) is a risk factor for cardiovascular diseases and events. Mechanistically, a systemic inflammation in COPD could be a link to cardiovascular events. COPD raises inflammatory parameters and local anti-inflammatory treatment seems to have a potential to decrease the systemic inflammation and also to decrease cardiovascular events.
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Affiliation(s)
- Claes-Göran Löfdahl
- Department of Respiratory Medicine and Allergology, Lund University Hospital, Lund, Sweden.
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215
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Taylor JD. COPD and the response of the lung to tobacco smoke exposure. Pulm Pharmacol Ther 2010; 23:376-83. [PMID: 20382250 DOI: 10.1016/j.pupt.2010.04.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 03/18/2010] [Accepted: 04/03/2010] [Indexed: 11/28/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a major cause of death in the western world and increasing in prevalence in developing countries. COPD is characterised by irreversible airflow obstruction, loss of lung tissue, reduced quality of life and high rates of mortality. The major cause of COPD is tobacco smoke. The changes in the innate immune system directed by tobacco smoke exposure lead to a pronounced and chronic inflammation in the lung. This in turn leads to other pathological changes including remodelling and destruction of lung tissue. Tobacco smoke exposure also leads to infection of the lung by bacteria and viruses. These, bacteria, viruses and co-infection are key triggers of acute worsening's of COPD termed exacerbations. COPD exacerbations are an additional major factor in the morbidity and mortality within COPD and are also the major healthcare costs associated with the disease. Within this review we discuss the response of the immune system to cigarette smoke exposure and inappropriate harmful responses. Successful treatment strategies will need to balance the positive effects of reducing inflammatory aspects of the disease whilst retaining some of the needed immune responses triggered by tobacco smoke exposure.
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Affiliation(s)
- John D Taylor
- Integrative Pharmacology, Biosciences R&D Lung, Respiratory & Inflammation Research Area, AstraZeneca, Lund, Sweden.
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216
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Balance is impaired in people with chronic obstructive pulmonary disease. Gait Posture 2010; 31:456-60. [PMID: 20206529 DOI: 10.1016/j.gaitpost.2010.01.022] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/28/2010] [Accepted: 01/29/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND It has recently been suggested that people with chronic obstructive pulmonary disease have an increased risk of falls. Although falls risk is multifactorial, impaired balance may contribute. The primary aim of this study was to compare balance between people with and without chronic obstructive pulmonary disease and the secondary aim was to determine if balance deteriorates when respiratory demand is increased by upper limb exercise. METHODS Twelve people with chronic obstructive pulmonary disease and 12 healthy control subjects participated in this study. Participants stood on a force plate to record centre of pressure displacement during a range of conditions that challenge balance. Lumbar spine and hip motion were measured with inclinometers. Balance trials were performed before and after participation in upper limb exercise that increased respiratory demand in those with chronic obstructive pulmonary disease. FINDINGS People with chronic obstructive pulmonary disease had increased mediolateral centre of pressure displacement and increased angular motion of the hip compared to healthy controls. Mediolateral centre of pressure displacement was further increased in people with chronic obstructive pulmonary disease following exercise, but unchanged in controls. Anteroposterior centre of pressure displacement did not differ between groups. INTERPRETATION People with chronic obstructive pulmonary disease have reduced control of balance in the mediolateral direction. This may contribute to an increased risk of falls in this population.
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217
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Eriksen N, Vestbo J. Management and survival of patients admitted with an exacerbation of COPD: Comparison of two Danish patient cohorts. CLINICAL RESPIRATORY JOURNAL 2009; 4:208-14. [DOI: 10.1111/j.1752-699x.2009.00177.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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218
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Stewart CE, Hall IP, Parker SG, Moffat MF, Wardlaw AJ, Connolly MJ, Ruse C, Sayers I. PLAUR polymorphisms and lung function in UK smokers. BMC MEDICAL GENETICS 2009; 10:112. [PMID: 19878584 PMCID: PMC2784766 DOI: 10.1186/1471-2350-10-112] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/31/2009] [Indexed: 12/15/2022]
Abstract
Background We have previously identified Urokinase Plasminogen Activator Receptor (PLAUR) as an asthma susceptibility gene. In the current study we tested the hypothesis that PLAUR single nucleotide polymorphisms (SNPs) determine baseline lung function and contribute to the development of Chronic Obstructive Pulmonary Disease (COPD) in smokers. Methods 25 PLAUR SNPs were genotyped in COPD subjects and individuals with smoking history (n = 992). Linear regression was used to determine the effects of polymorphism on baseline lung function (FEV1, FEV1/FVC) in all smokers. Genotype frequencies were compared in spirometry defined smoking controls (n = 176) versus COPD cases (n = 599) and COPD severity (GOLD stratification) using logistic regression. Results Five SNPs showed a significant association (p < 0.01) with baseline lung function; rs2302524(Lys220Arg) and rs2283628(intron 3) were associated with lower and higher FEV1 respectively. rs740587(-22346), rs11668247(-20040) and rs344779(-3666) in the 5'region were associated with increased FEV1/FVC ratio. rs740587 was also protective for COPD susceptibility and rs11668247 was protective for COPD severity although no allele dose relationship was apparent. Interestingly, several of these associations were driven by male smokers not females. Conclusion This study provides tentative evidence that the asthma associated gene PLAUR also influences baseline lung function in smokers. However the case-control analyses do not support the conclusion that PLAUR is a major COPD susceptibility gene in smokers. PLAUR is a key serine protease receptor involved in the generation of plasmin and has been implicated in airway remodelling.
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Affiliation(s)
- Ceri E Stewart
- Division of Therapeutics & Molecular Medicine, Nottingham Respiratory Biomedical Research Unit, University Hospital of Nottingham, Nottingham, UK.
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219
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Omachi TA, Katz PP, Yelin EH, Iribarren C, Knight SJ, Blanc PD, Eisner MD. The COPD Helplessness Index: a new tool to measure factors affecting patient self-management. Chest 2009; 137:823-30. [PMID: 19837823 DOI: 10.1378/chest.09-0764] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Psychologic factors affect how patients with COPD respond to attempts to improve their self-management skills. Learned helplessness may be one such factor, but there is no validated measure of helplessness in COPD. METHODS We administered a new COPD Helplessness Index (CHI) to 1,202 patients with COPD. Concurrent validity was assessed through association of the CHI with established psychosocial measures and COPD severity. The association of helplessness with incident COPD exacerbations was then examined by following subjects over a median 2.1 years, defining COPD exacerbations as COPD-related hospitalizations or ED visits. RESULTS The CHI demonstrated internal consistency (Cronbach alpha = 0.75); factor analysis was consistent with the CHI representing a single construct. Greater CHI-measured helplessness correlated with greater COPD severity assessed by the BODE (Body-mass, Obstruction, Dyspnea, Exercise) Index (r = 0.34; P < .001). Higher CHI scores were associated with worse generic (Short Form-12, Physical Component Summary Score) and respiratory-specific (Airways Questionnaire 20) health-related quality of life, greater depressive symptoms, and higher anxiety (all P < .001). Controlling for sociodemographics and smoking status, helplessness was prospectively associated with incident COPD exacerbations (hazard ratio = 1.31; P < .001). After also controlling for the BODE Index, helplessness remained predictive of COPD exacerbations among subjects with BODE Index </= median (hazard ratio = 1.35; P = .01), but not among subjects with higher BODE Index values (hazard ratio = 0.93; P = .34). CONCLUSIONS The CHI is an internally consistent and valid measure, concurrently associated with health status and predictively associated with COPD exacerbations. The CHI may prove a useful tool in analyzing differential clinical responses mediated by patient-centered attributes.
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Affiliation(s)
- Theodore A Omachi
- University of California, San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143-0111, USA.
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220
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Impact of chronic obstructive pulmonary disease (COPD) on attention functions. Respir Med 2009; 104:52-60. [PMID: 19748260 DOI: 10.1016/j.rmed.2009.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 08/11/2009] [Accepted: 08/14/2009] [Indexed: 11/21/2022]
Abstract
The present study investigates the influence of COPD on attention functions, learning, and logical thinking. Therefore, 60 COPD patients and 60 healthy controls were recruited into a cross-sectional study and underwent extensive neuropsychological testing. The Attention Network Test was used for assessment of tonic and phasic alertness, orienting, and executive attention. Logical thinking and learning were determined with the Standard Progressive Matrices and the Verbal and Nonverbal Learning Test, respectively. Significant group differences were found in phasic alertness (p=0.001) and orienting (p=0.01) but not in executive attention. In addition overall reaction time was significantly slower in the COPD group (p=0.001). Further group differences were found in verbal (p<0.001) and visual learning (p<0.001) and logical thinking (p<0.001). Regression analysis revealed significant correlations for age (p=0.024) and blood carbon dioxide levels (p=0.043) in reaction time, a correlation for age and orienting (p=0.019) and finally for age (p=0.011) as well as for blood carbon dioxide values (p=0.048) and performance in logical thinking. Results are indicating a global impairment in cognitive functions of COPD patients which is negatively influenced by accelerated aging and increasing with disease severity.
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221
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Higashimoto Y, Iwata T, Okada M, Satoh H, Fukuda K, Tohda Y. Serum biomarkers as predictors of lung function decline in chronic obstructive pulmonary disease. Respir Med 2009; 103:1231-8. [DOI: 10.1016/j.rmed.2009.01.021] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/15/2008] [Accepted: 01/25/2009] [Indexed: 11/28/2022]
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Poole JA, Thiele GM, Alexis NE, Burrell AM, Parks C, Romberger DJ. Organic dust exposure alters monocyte-derived dendritic cell differentiation and maturation. Am J Physiol Lung Cell Mol Physiol 2009; 297:L767-76. [PMID: 19648285 DOI: 10.1152/ajplung.00107.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Organic dust exposure in agricultural animal environments results in airway diseases. Dendritic cells (DCs) orchestrate inflammatory immune response in the airways, but little is known about how organic dust affects differentiation and maturation of monocyte-derived immature and mature DCs (iDCs, mDCs). Peripheral blood monocytes were differentiated in vitro into iDCs with granulocyte-macrophage colony stimulating factor + IL-4 (6 days) with and without swine facility organic dust extract (ODE, 0.1%). Unlike control iDCs, ODE-conditioned iDCs maintained key monocyte properties (increased mCD14, increased phagocytic ability) while expressing DC features [increased mCD83, HLA-DR, CD80, CD86, diminished cytokine (TNF-alpha, IL-6) responsiveness]. At day 6, iDCs were cultured for an additional 48 h (days 7 and 8) with lipopolysaccharide (LPS) to induce mDCs. ODE-conditioned mDCs maintained high expression of mCD14(+) and elevated phagocytosis while their DC features weakened as evidenced by decreased CD11c, CD83, HLA-DR, CD86, and CCR7 expression and reduced lymphocyte-stimulating capacity. Similar results were observed when monocytes were exposed to ODE for only the first 48 h and with ODE depleted of endotoxin. Control iDCs exposed to ODE during the final 2 days of iDC maturation (days 7 and 8) did not differ from control (no ODE) iDCs in surface marker expression and phagocytic ability, but exhibited enhanced lymphocyte-stimulating capacity. Dust exposure alters monocyte differentiation to iDCs and prevents maturation of iDC to mDCs. The first 48 h of monocyte differentiation appears to be the susceptible period to exposure. Environmental exposures present during early monocyte differentiation may impact the critical balance of DCs in the lung.
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Affiliation(s)
- Jill A Poole
- Omaha Veterans Administration Medical Center, Omaha, Nebraska, USA.
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223
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Zhong L, Fu WP, Sun C, Dai LM, Zhang YP. Absence of association between SERPINE2 genetic polymorphisms and chronic obstructive pulmonary disease in Han Chinese: a case-control cohort study. BMC MEDICAL GENETICS 2009; 10:66. [PMID: 19604412 PMCID: PMC2719615 DOI: 10.1186/1471-2350-10-66] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 07/16/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent studies have proposed that the serine protease inhibitor E2 (SERPINE2) was a novel susceptibility gene for chronic obstructive pulmonary disease (COPD) in Caucasians. However, this issue still remained controversial. Additional evidences from populations with different environments and/or genetic backgrounds, such as East Asian, would be helpful to elucidate the issue. METHODS In this study, five proposed causal SNPs in SERPINE2 were genotyped in 327 COPD patients and 349 controls, all of which belonged to the Han population sampled from Southwest China. The frequency of each SNP was compared both individually and in combination between patients and controls. The potential relationship between these SNPs and severity of COPD was also investigated. RESULTS Three SNPs (rs3795877, rs6747096, and rs3795879) showed complete linkage disequilibrium (r2 = 1), and the minor allele frequencies were 13.0% and 12.9% in case and control cohorts, respectively, with no significant difference observed (P = 0.96). We also failed to observe any significant correlation between these SNPs and COPD severity (P = 0.67). The other two SNPs (rs7579646 and rs840088) also presented a similar pattern. Moreover, four major haplotypes were observed in our sample but none showed a significant difference between case and control groups (P > 0.1). CONCLUSION Our results failed to obtain the evidence that these SNPs in SERPINE2 contributed to the COPD susceptibility in the Han Chinese population.
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Affiliation(s)
- Li Zhong
- Laboratory for Conservation and Utilization of Bio-resource, Yunnan University, Kunming 650091, PR China.
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224
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Martins P, Rosado-Pinto J, do Céu Teixeira M, Neuparth N, Silva O, Tavares H, Spencer JL, Mascarenhas D, Papoila AL, Khaltaev N, Annesi-Maesano I. Under-report and underdiagnosis of chronic respiratory diseases in an African country. Allergy 2009; 64:1061-7. [PMID: 19210360 DOI: 10.1111/j.1398-9995.2009.01956.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic respiratory diseases (CRD) are greatly underestimated. The aim of this study was to assess the burden associated with reported CRD and chronic obstructive pulmonary disease, as defined on the basis of various standardized criteria, by estimating their point prevalence in a sample of individuals attending the Primary Health Care (PHC) level and Emergency Room (ER) Departments in Cape Verde (CV) archipelago. The second aim of the study was to identify factors related to airways obstruction and reported CRD in this population. METHODS A cross-sectional study was carried out in CV during 2 weeks. Outpatients aged more than 20 years seeking care at PHC level and ER answered a standardized questionnaire and were subjected to spirometry, independently of their complaint. Two criteria for airways obstruction were taken into account: forced expiratory volume (FEV(1)) <80% of the predicted value and FEV(1)/forced vital capacity (FVC) ratio <0.70. RESULTS A total of 274 individuals with a satisfactory spirometry were included. 22% of the individuals had a FEV(1) < 80%. Individuals older than 46 years had a higher risk of having airways obstruction. Asthma diagnosis (11%) had a clear association with airways obstruction. Smoking was a risk factor for a lower FEV(1). Working in a dust place and cooking using an open fire were both related to chronic bronchitis and asthma diagnosis. CONCLUSION Under-report and underdiagnosis of chronic respiratory conditions seem to be a reality in CV just as in other parts of the world. To improve diagnosis, our results reinforce the need of performing a spirometry.
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Affiliation(s)
- P Martins
- Immunoallergy Department, Dona Estefânia Hospital, Rua Jacinta Marto, Lisbon, Portugal
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225
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Blake DJ, Singh A, Kombairaju P, Malhotra D, Mariani TJ, Tuder RM, Gabrielson E, Biswal S. Deletion of Keap1 in the lung attenuates acute cigarette smoke-induced oxidative stress and inflammation. Am J Respir Cell Mol Biol 2009; 42:524-36. [PMID: 19520915 DOI: 10.1165/rcmb.2009-0054oc] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Exposure to cigarette smoke (CS) is the primary factor associated with the development of chronic obstructive pulmonary disease (COPD). CS increases the level of oxidants in the lungs, resulting in a depletion of antioxidants, which promotes oxidative stress and the destruction of alveolar tissue. In response to CS, pulmonary epithelial cells counteract increased levels of oxidants by activating Nrf2-dependent pathways to augment the expression of detoxification and antioxidant enzymes, thereby protecting the lung from injury. We hypothesize that increasing the pathways activated by Nrf2 will afford protection against CS-induced lung damage. To this end we have developed a novel mouse model in which the cytosolic inhibitor of Nrf2, Keap1, is genetically deleted in Clara cells, which predominate in the upper airways in mice. Deletion of Keap1 in Clara cells resulted in increased expression of Nrf2-dependent genes, such as Nqo1 and Gclm, as determined by microarray analysis and quantitative PCR. Deletion of Keap1 in airway epithelium decreased Keap1 protein levels and significantly increased the total level of glutathione in the lungs. Increased Nrf2 activation protected Clara cells against oxidative stress ex vivo and attenuated oxidative stress and CS-induced inflammation in vivo. Expression of KEAP1 was also decreased in human epithelial cells through siRNA transfection, which increased the expression of Nrf2-dependent genes and attenuated oxidative stress. In conclusion, activating Nrf2 pathways in tissue-specific Keap1 knockout mice represents an important genetic approach against oxidant-induced lung damage.
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Affiliation(s)
- David J Blake
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA
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226
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Vaz Fragoso CA, Concato J, McAvay G, Van Ness PH, Rochester CL, Yaggi HK, Gill TM. Defining chronic obstructive pulmonary disease in older persons. Respir Med 2009; 103:1468-76. [PMID: 19464159 DOI: 10.1016/j.rmed.2009.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 04/17/2009] [Accepted: 04/23/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a more age-appropriate spirometric definition of chronic obstructive pulmonary disease (COPD) among older persons. METHODS Using data from the Third National Health and Nutrition Examination Survey (NHANES III), we developed a two-part spirometric definition of COPD in older persons, aged 65-80 years, that 1) determines a cut-point for the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) based on mortality risk; and 2) among persons below this critical FEV1/FVC threshold, determines cut-points for the FEV1, expressed as a standardized residual percentile (SR-tile) and based on the prevalence of respiratory symptoms and mortality risk. Measurements included spirometry, health questionnaires, and mortality (National Death Index). RESULTS There were 2480 older participants with a mean age of 71.7 years; 1372 (55.4%) had a smoking history, 1097 (44.2%) had respiratory symptoms and, over the course of 12-years, 868 (35.0%) had died. Among participants with an FEV1/FVC<.70 and FEV1<5th SR-tile, representing 7.7% of the cohort, the risk of death was doubled (adjusted hazard ratio, 2.01; 95% confidence interval [CI], 1.60-2.54). Among participants with an FEV1/FVC<.70 and FEV1<10th SR-tile, representing 13.4% of the cohort, the prevalence of respiratory symptoms was elevated (adjusted odds ratio, 2.44; CI, 1.79-3.33). CONCLUSION In a large, nationally representative sample of community-living older persons, defining COPD based on an FEV1/FVC<.70, with FEV1 cut-points at the 10th and 5th SR-tiles, identifies individuals with an increased prevalence of respiratory symptoms and an increased risk of death, respectively.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, CT, USA.
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227
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Roig M, Eng JJ, Road JD, Reid WD. Falls in patients with chronic obstructive pulmonary disease: a call for further research. Respir Med 2009; 103:1257-69. [PMID: 19419852 DOI: 10.1016/j.rmed.2009.03.022] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 03/31/2009] [Indexed: 12/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress. The effects of COPD, however, are not exclusively limited to respiratory function and people with COPD face many non-respiratory manifestations that affect both function and mobility. Deficits in function and mobility have been associated with an increased risk for falling in older adults. The purpose of this study was to provide a theoretical framework to identify risks factors for falls in people with COPD. We have analyzed the literature to identify possible relationships between pathophysiological changes observed in COPD and common risk factors for falls. Well-established fall risk factors in people with COPD include lower limb muscle weakness and impaired activities of daily living. Other intrinsic risk factors such as gait and balance deficits, nutritional depletion, malnutrition, depression, cognitive impairments and medications are possible risk factors that need to be confirmed with more studies. There is no evidence that visual deficits are common in COPD. The role that precipitating factors such as syncope and postural hypotension may have on fall risk is unclear. Exacerbations and dyspnea do not have a precipitating effect on fall risk but they contribute to the progressive physical deterioration that may theoretically increase the risk for falls. While these results suggest that people with COPD might have an increased susceptibility to fall compared to their healthy peers, further research is needed to determine the prevalence of falls and specific risk factors for falls in people living with COPD.
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Affiliation(s)
- Marc Roig
- Department of Physical Therapy, University of British Columbia, 828 West 10th Avenue, Vancouver, Canada.
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228
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Rodríguez-González Moro JM, Izquierdo JL, Antón E, de Lucas P, Martín A. Health-related quality of life in outpatient women with COPD in daily practice: the MUVICE Spanish study. Respir Med 2009; 103:1303-12. [PMID: 19406631 DOI: 10.1016/j.rmed.2009.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/24/2009] [Accepted: 04/01/2009] [Indexed: 01/01/2023]
Abstract
AIMS A cross-sectional multicenter study was designed to assess health-related quality of life (HRQL) in women with chronic obstructive pulmonary disease (COPD) who were attended in the outpatient setting in actual conditions of the daily practice. METHODS A total of 1786 women with COPD (mean age of 66.5 years) and 1661 pairs of men and women matched by age and COPD severity participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). RESULTS The mean PCS-12 and MCS-12 scores were 36.5+/-10.3 and 44.1+/-11.8, respectively. General health and physical functioning domains were those with the lowest scores, whereas role emotional and social functioning were those with the highest scores. The percentage of women with low HRQL increased according to age, whereas the percentage of women with high or normal HRQL decreased significantly. In relation to COPD severity, more women rated HRQL as low in the physical component than in the mental component. HRQL correlated significantly with FEV(1) in both PCS-12 and MCS-12 scales. As expected, an inverse significant correlation between HRQL and degree of dyspnea in the PCS-12 and the MCS-12 scales was observed. Women had also a significantly worse HRQL than men in all physical and mental domains. CONCLUSIONS In outpatient women with COPD, HRQL was impaired especially the physical component of the SF-12. For the same age and severity of COPD, women showed significantly lower scores in all physical and mental domains of the SF-12 than men.
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229
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Menadue C, Piper AJ, van't Hul AJ, Wong KK. Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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230
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:177-84. [DOI: 10.1097/aci.0b013e328329f9ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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231
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Michelozzi P, Accetta G, De Sario M, D'Ippoliti D, Marino C, Baccini M, Biggeri A, Anderson HR, Katsouyanni K, Ballester F, Bisanti L, Cadum E, Forsberg B, Forastiere F, Goodman PG, Hojs A, Kirchmayer U, Medina S, Paldy A, Schindler C, Sunyer J, Perucci CA. High Temperature and Hospitalizations for Cardiovascular and Respiratory Causes in 12 European Cities. Am J Respir Crit Care Med 2009; 179:383-9. [DOI: 10.1164/rccm.200802-217oc] [Citation(s) in RCA: 364] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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232
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Golemati S, Moupagiatzis I, Athanasopoulos D, Vasilopoulou M, Roussos C, Vogiatzis I. Comparative analysis of phase difference estimation methods quantifying asynchronies between compartmental chest wall volume signals. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:2871-2874. [PMID: 19963785 DOI: 10.1109/iembs.2009.5333106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Asynchronous breathing movements may be observed in the presence of pulmonary disease, such as chronic obstructive pulmonary disease (COPD). This study was undertaken in an attempt to propose a reliable methodology to quantify this asynchrony. Five methods for estimating phase differences between two signals, based on the phase angle of the Fourier Transform (PhD(FT)), paradoxical motion (PhD(PM)), the Lissajous figure (PhD(LF)), maximal linear correlation (PhD(P)) and least-squares filtering (PhD(LS)), were compared. Frequency-modulated signals, simulating compartmental chest wall volumes, were used to evaluate the methods. Breathing asynchrony was quantified in two ways; by estimating (a) a single PhD value for the entire recording and (b) time-varying PhDs, representing non-stationarities of human breathing. PhD(PM) and PhD(LF) had the lowest average errors (4%), and PhD(LS) had a slightly higher error. PhD(FT) had zero error when estimating a single PhD value but a considerable error when estimating time-varying PhDs. PhD(P) presented the highest errors in all cases. An application of this methodology is proposed in real compartmental chest wall volume signals of normal and COPD subjects. Preliminary results indicate that the methodology is promising in quantifying differences in asynchronous breathing between thoracic volumes of COPD patients and healthy controls.
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Abstract
BACKGROUND Patients with end-stage chronic obstructive pulmonary disease (COPD) experience poor quality of life and considerable problems in daily life. However, as they often do not actively express a wish for help, they do not get the help they need. AIM To gain insight into why patients with end-stage COPD tend not to express a wish for help. DESIGN OF STUDY Prospective qualitative study with semi-structured interviews. SETTING Outpatient clinics of four hospitals and one centre specialising in asthma and COPD in the Netherlands. METHOD Sixteen semi-structured interviews were conducted with 11 patients with end-stage COPD. RESULTS To express a wish for help, patients should regard their limitations as abnormal and should realise that there are possibilities to improve their situation. However, this was not the case with the patients interviewed. They appeared to consider themselves ill at a time of acute exacerbation of their illness, but regarded their everyday life as normal. In addition, patients lived with the assumption that, as their lungs were damaged beyond repair, they could not get help. CONCLUSION Patients with end-stage COPD do not actively express a wish for help because they do not consider their limitations to be abnormal and because they do not realise that there are possibilities to improve their situation. These results suggest that care in this stage of the disease should focus on improving daily life instead of just aiming to improve the functioning of the lungs. Professionals in health care should actively explore what kind of practical help these patients might welcome in keeping up their daily activities. Future research should focus on studying whether such an approach applies to the needs of patients with end-stage COPD.
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234
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Schweitzer C, Marchal F. Dyspnoea in children. Does development alter the perception of breathlessness? Respir Physiol Neurobiol 2008; 167:144-53. [PMID: 19114130 DOI: 10.1016/j.resp.2008.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 12/03/2008] [Accepted: 12/03/2008] [Indexed: 01/08/2023]
Abstract
Dyspnoea, the perception of an unpleasant and/or uncomfortable sensation of breathlessness, offers several physiological, anatomical and teleological analogies with pain. Pain perception has been shown to exist in the newborn, suggesting that dyspnoea may also occur from birth onwards. The perception of breathlessness will be subservient to developmental changes in the behaviour of sensors and lung and muscular receptors implicated in dyspnoea, some of which are known to be active at time of birth. For example, perinatal resetting of the arterial chemoreceptor could lead to transient depression of the dyspnoeic response to hypoxia. However, though early evoked ventilatory responses and peripheral receptor maturation do exist, dyspnoea will only occur if the corresponding central neural circuitry undergoes parallel maturation. Our knowledge of dyspnoea in later childhood is based on a small number of clinical or psychophysical studies, predominantly dealing with asthma and exercise. There is a thus a clear need for systematic assessment of the existence and severity of dyspnoea sensing in younger children that takes into account its role as an alarm mechanism for triggering adaptive and/or protective responses.
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235
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Laurent O, Pedrono G, Filleul L, Segala C, Lefranc A, Schillinger C, Rivière E, Bard D. Influence of socioeconomic deprivation on the relation between air pollution and beta-agonist sales for asthma. Chest 2008; 135:717-723. [PMID: 19017882 DOI: 10.1378/chest.08-1604] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations. METHODS The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis. RESULTS Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations. CONCLUSION The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.
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Affiliation(s)
| | | | | | | | - Agnès Lefranc
- Département Santé Environnement, Institut de Veille Sanitaire, Saint Maurice
| | - Charles Schillinger
- Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace, Schiltigheim
| | - Emmanuel Rivière
- Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace, Schiltigheim
| | - Denis Bard
- LERES, Ecole des Hautes Etudes en Santé Publique, Rennes.
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Conte ME, Pedone C, Forastiere F, Bellia V, Antonelli-Incalzi R. Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients. BMC Pulm Med 2008; 8:14. [PMID: 18700955 PMCID: PMC2525624 DOI: 10.1186/1471-2466-8-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 08/13/2008] [Indexed: 11/25/2022] Open
Abstract
Background The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether disease-specific health status measures and multidimensional assessment (MDA) have comparable prognostic value. Methods We analyzed data coming from the Salute Respiratoria nell'Anziano (Respiratory Health in the Elderly – SaRA) study, enrolling elderly people attending outpatient clinics for respiratory and non-respiratory problems. From this population we selected 449 patients with bronchial obstruction (77.3% men, mean age 73.1). We classified patients' health status using tertiles of the Saint George Respiratory Questionnaire (SGRQ) and a MDA including functional (the 6' walking test, WT), cognitive (Mini-Mental State Examination, MMSE) and affective status (Geriatric Depression Scale, GDS). The agreement of the classification methods was calculated using the kappa statistic, and survival associated with group membership was evaluated using survival analysis. Results Pulmonary function, expressed by the FEV1, worsened with increasing SGRQ or MDA scores. Cognitive function was not associated with the SGRQ, while physical performance and mood status were impaired only in the highest tertile of SGRQ. A poor agreement was found between the two classification systems tested (k = 0.194). Compared to people in the first tertile of SGRQ score, those in the second tertile had a sex-adjusted HR of 1.22 (0.75 – 1.98) and those in the third tertile of 2.90 (1.92 – 4.40). The corresponding figures of the MDA were 1.49 (95% CI 1.02 – 2.18) and 2.01 (95% CI: 1.31 – 3.08). After adjustment for severity of obstruction, only a SGRQ in the upper tertile was associated with mortality (HR: 1.86; 95% CI: 1.14 – 3.02). Conclusion In elderly outpatients with mild-moderate COPD, a disease-specific health status index seems to be a better predictor of death compared to a MDA.
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Affiliation(s)
- Maria E Conte
- Area di Geriatria, Università Campus Biomedico, Roma,
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237
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Gregersen NT, Chaput JP, Astrup A, Tremblay A. Energy expenditure and respiratory diseases: is there a link? Expert Rev Respir Med 2008; 2:495-503. [PMID: 20477213 DOI: 10.1586/17476348.2.4.495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies have suggested that respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS), influence energy expenditure (EE). This influence on energy balance may be responsible for the weight changes that are often seen in individuals suffering from OSAS and COPD. However, even though EE has been assessed in several studies, be it in OSAS or COPD, there are still controversies regarding these potential relationships. Thus, the objective of this review is to describe some of the potential mechanisms that may affect EE in respiratory diseases and, thereby discuss whether there seems to be an explanation for the aforementioned relationship. The primary focus is on the oxygen transport system, which may be an important determinant for the relationship between both of these respiratory diseases and EE.
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Affiliation(s)
- Nikolaj Ture Gregersen
- Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark.
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238
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Aniwidyaningsih W, Varraso R, Cano N, Pison C. Impact of nutritional status on body functioning in chronic obstructive pulmonary disease and how to intervene. Curr Opin Clin Nutr Metab Care 2008; 11:435-42. [PMID: 18542004 PMCID: PMC2736295 DOI: 10.1097/mco.0b013e3283023d37] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease is the fifth leading cause of mortality in the world. This study reviews diet as a risk or protective factor for chronic obstructive pulmonary disease, mechanisms of malnutrition, undernutrition consequences on body functioning and how to modulate nutritional status of patients with chronic obstructive pulmonary disease. RECENT FINDINGS Different dietary factors (dietary pattern, foods, nutrients) have been associated with chronic obstructive pulmonary disease and the course of the disease. Mechanical disadvantage, energy imbalance, disuse muscle atrophy, hypoxemia, systemic inflammation and oxidative stress have been reported to cause systemic consequences such as cachexia and compromise whole body functioning. Nutritional intervention makes it possible to modify the natural course of the disease provided that it is included in respiratory rehabilitation combining bronchodilators optimization, infection control, exercise and, in some patients, correction of hypogonadism. SUMMARY Diet, as a modifiable risk factor, appears more as an option to prevent and modify the course of chronic obstructive pulmonary disease. Reduction of mechanical disadvantage, physical training and anabolic agents should be used conjointly with oral nutrition supplements to overcome undernutrition and might change the prognosis of the disease in some cases. Major research challenges address the role of systemic inflammation and the best interventions for controlling it besides smoking cessation.
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Affiliation(s)
- Wahju Aniwidyaningsih
- Clinique de pneumologie
CHU GrenoblePôle de Médecine Aiguë et Communautaire BP 217 38043 Grenoble cedex 09,FR
- Bioenergétique fondamentale et appliquée
INSERM : U884Université Joseph Fourier - Grenoble IUniversité Joseph Fourier 2280, rue de la piscine 38400 ST MARTIN D HERES,FR
- Department of Pulmonology and Respiratory Medicine
Faculty of Medicine University of Indonesia Persahabatan Hospital Jakarta Indonesia,ID
| | - Raphaëlle Varraso
- Recherche en épidémiologie et biostatistique
INSERM : U780INSERM : IFR69Université Paris Sud - Paris XI16, Avenue Paul Vaillant-Couturier 94807 VILLEJUIF CEDEX,FR
- Department of Emergency Medicine
Massachusetts General HospitalBoston, MA,US
| | - Noel Cano
- CRNH, Centre de recherche en Nutrition Humaine
CHU Clermont-FerrandHôpital G. Montpied F-63003 Clermont-Ferrand,FR
- UMPE, Métabolisme protéino-énergétique
INRA : UR1019Université d'Auvergne - Clermont-Ferrand IFR
| | - Christophe Pison
- Clinique de pneumologie
CHU GrenoblePôle de Médecine Aiguë et Communautaire BP 217 38043 Grenoble cedex 09,FR
- Bioenergétique fondamentale et appliquée
INSERM : U884Université Joseph Fourier - Grenoble IUniversité Joseph Fourier 2280, rue de la piscine 38400 ST MARTIN D HERES,FR
- Recherche en épidémiologie et biostatistique
INSERM : U780INSERM : IFR69Université Paris Sud - Paris XI16, Avenue Paul Vaillant-Couturier 94807 VILLEJUIF CEDEX,FR
- * Correspondence should be adressed to: Christophe Pison
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