COPD: Rethinking Patient Management - How to Approach a Challenging Patient Group Successfully

Relationship between serum Th1/Th2 imbalance and depression in elderly patients with COPD and its clinical implications

BACKGROUND

Chronic obstructive pulmonary disease (COPD) causes organic damage as well as anxiety, depression, fear, and other psychological disorders, which seriously affect the quality of life and prognosis of patients and cause a huge economic burden to the family and society.

OBJECTIVE

The aim of this study was to investigate the correlation between an imbalance of serum Th1/Th2 indicators and psychiatric depression in elderly patients with COPD and analyze its implications for clinical management.

METHODS

From January 2018 to May 2022, 120 elderly patients with COPD treated at our hospital were categorized into two groups based on the self-rating depression scale (SDS): COPD with depression (SDS score ⩾ 50) and COPD alone (SDS score < 50). Blood gas analysis, pulmonary function, and serum Th1/Th2 index were determined. Receiver operating characteristic (ROC) curves were analyzed to explore the diagnostic value of serum Th1/Th2 ratios for COPD complicated by depression.

RESULTS

Compared with the group without depression, the partial pressure of carbon dioxide and COPD assessment test scores were significantly higher, and the oxygenation index, forced expiratory volume in one second (FEV1), and percent predicted FEV1 were significantly lower in the COPD with depression group (P< 0.05). Interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were significantly higher in the COPD with depression group than in the group without depression (P< 0.05). Logistic regression analysis indicated that the imbalance of serum IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α was a risk factor for mental depression in elderly patients with COPD. When comparing prognostic indices, the interval before the first onset of clinically noticeable deterioration (CID-C) in the COPD with depression group was noticeably shorter than that in the COPD without depression group; the incidence of CID-C within 6 months was noticeably higher in the COPD with depression group than in the group without depression.

CONCLUSION

Elderly patients with COPD and depression had reduced pulmonary function and higher serum Th1/Th2 levels, and an imbalance in serum Th1/Th2 indicators was a potential risk factor for depression. Moreover, elderly patients with COPD and depression were at a higher risk of disease progression and had a worse prognosis. Thus, an imbalance in serum Th1/Th2 indicators is a potential prognostic factor for evaluating depression in patients with COPD.

Effectiveness of Energy Conservation Techniques in Patients with COPD

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) might suffer from severe dyspnea, which importantly impacts on the performance of activities of daily living (ADL). Patient training of energy conservation techniques (ECTs) might be useful to improve the tolerance and execution of these ADL, but objective studies evaluating the effect of teaching ECTs on the metabolic equivalent of task (MET) in patients with COPD are sparse.

OBJECTIVES

The aim of this study was to test the hypothesis that practicing ECTs after a 2-week ECT teaching period would reduce the energy expenditure (MET) in performing an activity in patients with severe COPD.

METHODS

Energy expenditure was assessed with a gas exchange system (OxyconTM Mobile) during one out of five standardized ADL before and after a 2-week intervention period in which ECTs were taught. These ECTs comprised a good breathing technique, an ergonomic way of performing the activity, and the use of assistive devices.

RESULTS

Thirty-two patients with COPD (mean FEV1: 39 ± 14%; female: n = 18; age: 68 ± 7 years) were included. A significantly lower MET (2.3 ± 0.6 to 2.1 ± 0.5; p < 0.05) and less desaturation (89.7 ± 5.2 vs. 91.1 ± 5.5% HbO2; p < 0.05) were seen while performing the same activity after the intervention. However, there was no significant difference in the time spent on the task performed (6.0 ± 3.9 vs. 6.7 ± 4.0 min; p > 0.05).

CONCLUSIONS

A 2-week educative program on ECTs successfully reduces the energy spent for performing ADL relevant to the patient without any significant increase in the time spent on the activity.