[Chronic obstructive pulmonary disease concurrent with metabolic syndrome: Pathophysiological and clinical features]

Features of the cytogram and cytokine profile of bronchoalveolar lavage fluid in experimental metabolic syndrome

The aim of the study was to identify the features of the cellular composition and cytokine profile of bronchoalveolar lavage fluid in rats in a model of diet-induced metabolic syndrome.

Materials and methods. In an experiment on animals (rats), a model of metabolic syndrome (MS) induced by a high-fat and high-carbohydrate diet was reproduced. To assess the viability of the reproduced model, biochemical and morphometric methods were used, such as measurement of body weight, specific gravity of liver and visceral fat, and blood pressure, determination of glucose concentration in the blood (including a glucose tolerance test), as well as determination of blood lipid parameters. To assess the intensity of the inflammatory response in the blood, the concentration of total protein, the total number of leukocytes, and the levels of immunocytokines (interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)α, monocyte chemoattractant protein (MCP)-1) were determined. Open bronchoalveolar lavage was performed on the isolated heart – lung complex. The concentration of protein, immunocytokines (IL-6, IL-10, TNFα, MCP-1), the total number of leukocytes, and the ratio of their morphological types were determined in the bronchoalveolar lavage fluid (BALF).

Results. In animals with MS, an increase in the total number of leukocytes in the blood due to granulocytes and a rise in the concentration of protein, TNFα, and IL-10 were revealed compared with the parameters in the controls. BALF analysis revealed an increase in the concentration of protein, the total number of leukocytes, and the absolute number of alveolar macrophages, neutrophil granulocytes, and lymphocytes. The levels of IL-6 and MCP-1 were more than 1.5 times higher.

Conclusion. Changes in the qualitative and quantitative parameters of BALF are inflammatory in nature and are formed during a systemic inflammatory response accompanying metabolic disorders in modeling MS in rats in the experiment.

Kravchenko A, Budnevsky AV, Ovsyannikov ES. Functional Status And Cytokine Profile Assessment In Patients With Chronic Obstructive Pulmonary Disease And Chronic Heart Failure

Objective — to evaluate the effect of chronic obstructive pulmonary disease (COPD) on the level of cytokines and the functional status of patients with chronic heart failure (CHF) with different categories of left ventricular ejection fraction. Methods — The study included 240 patients 40–70 years of age with CHF. All patients were divided into four groups: 69 CHF patients with preserved ejection fraction (CHFpEF), 91 CHF patients with reduced ejection fraction (CHFrEF), 36 COPD patients with CHFpEF and 44 COPD patients with CHFrEF. All participants underwent echocardiography, six-minute walk test (6MWT), the results of which were compared with the predicted six-minute walk distance: 6МWD (i). Additionally, we assessed the levels of NT-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), IL-1β, IL-6, TNF-α, suppression of tumorigenicity 2 (ST2) in patient blood samples. Results — Patients with CHFpEF had higher levels of hs-CRP and proinflammatory cytokines as compared with patients with CHFrEF. The levels of NT-proBNP were higher in patients with COPD and CHF, compared with patients with CHF alone. A negative effect of COPD on the functional status of CHF patients with different EF values was established by the lower 6MWT values and 6MWD/6MWD ratio (i). An increase in the level of suppression of tumorigenicity 2 soluble forms (sST2) was noted in patients with COPD and CHF as compared with the isolated course of cardiac pathology patients. Conclusion — We established that unfavorable effect of COPD on patients with CHF was caused by disadvantageous values of NT-proBNP, ST2, 6MWT, and 6MWD/6MWD (i) ratio.

[Systemic inflammation in patients with chronic obstructive pulmonary disease and obesity]

Chronic obstructive pulmonary disease (COPD) is an important public health problem. According to various studies, the prevalence of obesity in patients with COPD is as high as 50%.

AIM

To evaluate pro- and anti-inflammatory cytokine profile, lung diseases biomarkers levels and adipokines levels in patients with COPD and obesity.

MATERIALS AND METHODS

The study included 88 patients with COPD (GOLD 24, group D). Patients were divided into two groups. The first group consisted of 44 patients with COPD and normal body weight: 35 men and 9 women. The second group 44 patients with obesity and COPD: 34 men and 10 women. The levels of pro- and anti-inflammatory cytokines were determined interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor  (TNF-), interleukin-4 (IL-4), interleukin-10 (IL-10), as well as the concentration of highly sensitive C-reactive protein (CRP), surfactant protein D, elastase, leptin, adiponectin, 1-antitrypsin, receptors of tumor necrosis factor 1 and 2 (TNF-R1, TNF-R2).

RESULTS

In patients with COPD and obesity, compared with patients with COPD and normal body weight, the levels of CRP, interferon-, TNF-, TNF-R1, TNF-R2 were significantly higher. At the same time, the levels of IL-4, IL-6, IL-8, IL-10 did not differ significantly. The level of leptin in patients with COPD and obesity was significantly higher than in patients with COPD and normal body weight.

CONCLUSION

In patients with COPD and obesity, in contrast to patients with COPD with normal body weight, the severity of systemic inflammation is significantly higher. However, further research is needed in this area.

Influence of Anxiety/Depression on the Subjective Evaluation of Cough in Patients with Chronic Obstructive Pulmonary Disease and Obesity

Background and objectives: Obesity and anxiety and/or depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD). For doctors treating COPD, cough has a certain importance as a symptom. The purpose of this study was to figure out how obesity and anxiety/depression may influence the subjective assessment of cough. Materials and Methods: 110 patients with COPD participated in the study. The patients were divided into two groups, one including obese patients, and the other including patients with normal body weight. All patients filled out the hospital anxiety and depression scale (HADS) questionnaire, evaluated the severity of their cough by using visual analogue scale (VAS) on the 1st and 10th day of treatment, and underwent a 12 h cough monitoring with a special cough monitoring device both on the 1st and the 10th day of treatment. Results: The severity of anxiety according to the HADS in patients with COPD and normal body weight was significantly higher than in patients with COPD and obesity, corresponding to 9.25 ± 1.37 and 8.20 ± 1.18 points, respectively (p = 0.0063). The patients with normal body weight and obesity, but without anxiety and depression, subjectively noted an improvement in their well-being on the 10th day of treatment (p = 0.0022, p = 0.0021, respectively). In subgroups with normal body weight and obesity with anxiety and/or depression, the mean values for VAS on day 10 did not change significantly (p = 0.1917, p = 0.1921, respectively). Also, patients from the subgroup with normal body weight and anxiety/depression had a significantly higher assessment of their cough on day 10 than obese patients with anxiety/depression (p = 0.0411). The VAS values correlated positively with the actual amount of cough (r = 0.42, p = 0.0122 and r = 0.44, p = 0.0054, respectively) in patients without anxiety and/or depression, while in patients with anxiety and/or depression, there was an inverse correlation between VAS values and cough (r = −0.38, p = 0.0034 and r = −0.40, p = 0.0231). Conclusions: It is important to diagnose and treat anxiety and depression in patients with COPD for a better prognosis and higher efficacy of medical treatments. While treating such patients, it is preferable to use a cough monitoring device for objective assessments, since the patients may exaggerate or underestimate their symptoms.