Causes and effects of chronic obstructive pulmonary disease

Blood cadmium concentration and pulmonary function injury: potential mediating role of oxidative stress in chronic obstructive pulmonary disease patients

BACKGROUND

Exposure to cadmium (Cd) is associated with a reduction in lung function among patients with chronic obstructive pulmonary disease (COPD). The longitudinal relationship and mechanism underlying the link between Cd exposure and lung function changes among COPD patients are yet unknown.

METHODS

The cohort study included 259 eligible patients who underwent regular professional follow-ups. Blood Cd levels and serum 8-iso-prostaglandin F2 alpha (8-iso-PGF2α) levels were assessed. Lung function was determined at baseline and follow-up research. The associations between changes in lung function and blood Cd concentration were analysed using multivariate linear and logistic regression models.

RESULTS

Each 1-ppb elevation in blood Cd content resulted in a 0.420 L decrease in forced vital capacity (FVC), a 0.424 L decrease in forced expiratory volume in 1 s (FEV1), a 4.341% decrease in FEV1/FVC%, and a 8.418% decrease in FEV1% predicted in patients with COPD. Blood Cd concentration showed a positive correlation with serum 8-iso-PGF2α levels in a specific range. The relative contribution of increased serum levels of 8-iso-PGF2α to Cd-induced declines in FEV1, predicted FEV1%, and FEV1/FVC% were 2.08%, 8.08%, and 13.19%, respectively.

CONCLUSION

Blood Cd levels are associated with lung function changes in COPD patients. Oxidative stress is thought to be an important mediator in Cd-induced reduction of pulmonary function.

Smoking and atherosclerotic cardiovascular disease: Part I: atherosclerotic disease process

The normal endothelium inhibits platelet and leukocyte adhesion to the vascular surface maintaining a balance of profibrinolytic and prothrombotic activity. Endothelial function is assessed largely as endothelium-dependent vasomotion, partly based on the assumption that impaired endothelium-dependent vasodilation reflects the alteration of important endothelial functions. Atherosclerotic risk factors, such as hypercholesterolemia, hypertension, diabetes and smoking, are associated with endothelial dysfunction. In the diseased endothelium, the balance between pro- and antithrombotic, pro- and anti-inflammatory, pro- and antiadhesive or pro- and antioxidant effects shifts towards a proinflammatory, prothrombotic, pro-oxidative and proadhesive phenotype of the endothelium. A common mechanism underlying endothelial dysfunction is related to the increased vascular production of reactive oxygen species. Recent studies suggest that inflammation per se, and C-reactive protein in particular, may contribute directly to endothelial dysfunction. The loss of endothelial integrity is a hallmark of atherosclerosis and the causal possible link between each individual risk factor, the development of atherosclerosis and the subsequent clinical events, such as myocardial infarction or stroke.

[Stress in elderly hospitalized patients with chronic respiratory disease: assessment in a public geriatric hospital]

INTRODUCTION

Studies of stress during hospitalization have mainly focused on patients admitted for acute problems. However, stress and its relationship with health-related quality of life (HRQOL) has yet to be described in chronic and elderly patients. The objective of this paper is to study the presence of stress and coping strategies in patients with chronic obstructive pulmonary disease (COPD) in a public geriatric hospital and its relationship with HRQL prior to admission, COPD severity, and dyspnea stage.

MATERIAL AND METHODS

Fifty-one patients with a diagnosis of COPD were evaluated in the Joan March Hospital (Balearic Islands, Spain) by means of the Hospital Stress Rating Scale, the Dyspnea Scale, the Nottingham Health Profile, and a list of coping strategies.

RESULTS

Low stress levels were found in elderly hospitalized COPD patients. Stress levels were independent of the COPD severity stage. Patients with mild dyspnea had higher stress levels than those with the most severe dyspnea (p<0.05). Patients with poor HRQOL before admission had higher stress levels during hospitalization (p<0.05). The most prevalent coping strategies in these hospitalized patients were related to avoidance.

CONCLUSIONS

The stress generated during hospitalization in elderly COPD patients was related to prior psychosocial conditions (HRQOL) and had a greater effect on patients with greater functional independence.

Does screening for loss of lung function help smokers give up?

One-fifth of smokers show accelerated decline in lung function. These are the patients that go on to develop chronic obstructive pulmonary disease (COPD), an illness characterized by cough, production of sputum, shortness of breath and premature death (Sethi and Rochester, 2000). If this group of smokers stopped smoking, their decline would slow and they might avoid developing COPD. This pilot study aimed to discover whether those with accelerated decline in lung function would quit if presented with the facts about their situation. Known smokers in their 50s were screened for signs of accelerated respiratory decline. Those with an accelerated decline in lung function were identified and given tailored smoking cessation advice. Of 141 eligible patients, 22 responded and six gave up smoking and remained non-smokers 1 year later. The results of this pilot suggest that screening smokers for accelerated respiratory decline by practice nurses is feasible and acceptable to those patients that respond. Further research is needed to discover whether such an intervention would be cost-effective.