[The continuum of COPD and cardiovascular risk: A global scenario of disease]

A scoring system to detect fixed airflow limitation in smokers from simple easy-to-use parameters

No validated screening method currently exists for Chronic Obstructive Pulmonary Disease (COPD) in smokers. Therefore, we constructed a predictive model with simple parameters that can be applied for COPD screening to detect fixed airflow limitation. This observational cross-sectional study included a random sample of 222 smokers with no previous diagnosis of COPD undertaken in a Spanish region in 2014-2016. The main variable was fixed airflow limitation by spirometry. The secondary variables (COPD factors) were: age, gender, smoking (pack-years and Fagerström test), body mass index, educational level, respiratory symptoms and exacerbations. A points system was developed to predict fixed airflow limitation based on secondary variables. The model was validated internally through bootstrapping, determining discrimination and calibration. The system was then integrated into a mobile application for Android. Fifty-seven patients (25.7%) presented fixed airflow limitation. The points system included as predictors: age, pack-years, Fagerström test and presence of respiratory symptoms. Internal validation of the system was very satisfactory, both in discrimination and calibration. In conclusion, a points system has been constructed to predict fixed airflow limitation in smokers with no previous COPD. This system can be integrated as a screening tool, though it should be externally validated in other geographical regions.

Risk Factors for Depression in Patients with Chronic Obstructive Pulmonary Disease

Background

Depression is a major comorbidity in patients with chronic obstructive pulmonary disease (COPD). The aim of this prospective study was to investigate socio-demographic and clinical factors and serum markers of inflammation, including cytokines that, may be a cause or an association with COPD-related depression.

Material/Methods

This study enrolled 53 patients who were hospitalized in the Department of Respiratory Medicine of Hefei First People’s Hospital, China between October 2015 and October 2016. Patients were consecutively recruited who were diagnosed with COPD and without lower respiratory tract disease, psychiatric disorders, or a family history of cognitive disorders. All patients were investigated for symptoms of depression. Lung function testing included forced expiratory volume in 1 second (FEV₁). Serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were measured.

Results

Of the 53 patients with COPD, 40 (75.47%) patients had symptoms of depression. Univariate analysis showed that gender, smoking, a high level of education, duration of a cough, FEV₁, and serum CRP level were associated with depression. A multivariate logistic regression model identified two risk factors for depression in patients with COPD: serum CRP level and FEV₁.

Conclusions

The findings of this study showed that the risk factors for COPD-related depression included male gender, heavy smoking, higher academic qualifications, and duration of cough, but the two strongest risk factors were a high serum CRP level and low FEV₁.

Prevalence of different comorbidities in COPD patients by gender and GOLD stage

BACKGROUND

Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution.

METHODS

The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012-2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient.

RESULTS

At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females.

CONCLUSIONS

All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.