The View of the Turkish Thoracic Society on the Report of the GOLD 2017 Global Strategy for the Diagnosis, Management, and Prevention of COPD

Continuous low-dose cyclophosphamide plus prednisone in the treatment of relapsed and refractory multiple myeloma with severe complications

Background/objective

We retrospectively analyzed the effective and safety of continuous low-dose cyclophosphamide combined with prednisone (CP) in relapsed and refractory multiple myeloma (RRMM) patients with severe complications.

Methods

A total of 130 RRMM patients with severe complications were enrolled in this study, among which 41 patients were further given bortezomib, lenalidomide, thalidomide or ixazomib on the basis of CP regimen (CP+X group). The response to therapy, adverse events (AEs), overall survival (OS) and progression-free survival (PFS) were recorded.

Results

Among the 130 patients, 128 patients received therapeutic response assessment, with a complete remission rate (CRR) and objective response rate (ORR) of 4.7% and 58.6%, respectively. The median OS and PFS time were (38.0 ± 3.6) and (22.9±5.2) months, respectively. The most common AEs were hyperglycemia (7.7%), pneumonia (6.2%) and Cushing's syndrome (5.4%). In addition, we found the pro-BNP/BNP level was obviously decreased while the LVEF (left ventricular ejection fraction) was increased in RRMM patients following CP treatment as compared with those before treatment. Furthermore, CP+X regimen further improved the CRR compared with that before receiving the CP+X regimen (24.4% vs. 2.4%, P=0.007). Also, both the OS and PFS rates were significantly elevated in patients received CP+X regimen following CP regimen as compared with the patients received CP regimen only.

Conclusion

This study demonstrates the metronomic chemotherapy regimen of CP is effective to RRMM patients with severe complications.

Greek Guidelines for the Management of COPD, a Proposal of a Holistic Approach Based on the needs of the Greek Community

Despite that COPD remains one of the most common respiratory diseases worldwide, it can be managed effectively with certain treatments and, more importantly, be prevented by the early implementation of various measures. The pathology and pathophysiology of this disease continue to be studied, with new pharmacological and invasive therapies emerging. In this consensus paper, the Working Group of the Hellenic Thoracic Society aimed to consolidate the up-to-date information and new advances in the treatment of COPD. Local and international data on its prevalence are presented, with revised strategies on the diagnostic approach and the evaluation of risk assessment and disease severity classification. Emphasis is placed on the management and therapy of patients with COPD, covering both common principles, specialized modalities, and algorithms to distinguish between home care and the need for hospitalization. Although pharmacological treatment is commonly recognized in COPD, an integrative approach of pulmonary rehabilitation, physical activity, patient education, and self-assessment should be encountered for a comprehensive treatment, prevention of exacerbations, and increased quality of life in patients.

Application of MRT-qPCR for pathogen detection of lower respiratory tract infection

OBJECTIVE

To analyze and clarify the application value of multiplex quantitative real-time PCR (MRT-PCR) assay in detecting pathogens involved in lower respiratory tract infection (LRTI), so as to realize accurate and rapid detection of respiratory pathogens.

METHODS

Bronchial alveolar lavage fluid (BALF) specimens from 186 patients with LRTI collected in the Cangzhou Central Hospital from June 2020 to September 2021 were analyzed retrospectively. Pathogen detection was performed by both MRT-PCR and direct immunofluorescence assay (DFA), and the results of different inspection methods were compared.

RESULTS

Among the seven pathogens detected by MRT-PCR, 140 positive specimens were identified out of the 186 patients, with the top three pathogens with the highest positive rates being influenza A virus (Flu A; 36 [19.35%]), respiratory syncytial virus (RSV; 30 [16.13%]) and human adenovirus (HAdV; 23 [12.37%]), and the pathogen with the lowest positive rate being parainfluenza virus type 3 (PIV3; 9 [4.84%]). DFA showed 110 pathogen-positive specimens, and the top three pathogens with the highest positive rates were Flu A (30 [16.13%]), HAdV (21 [11.29%]) and RSV (19 [10.22%]). The total sensitivity and accuracy of MRT-PCR assay were 93.01% and 98.69% respectively, which were statistically higher than those of 48.45% and 91.24% of DFA (P<0.05). The two inspection methods showed no significant difference in specificity (99.4% for MRT-PCR assay and 97.28% for DFA) (P>0.05).

CONCLUSIONS

MRT-PCR is rapid, accurate and specific in detecting pathogens of LRTI, which significantly improves the detection rate, with reliable performance and it has high clinical application value.

The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990–2019

Background

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. The present study reported the burden of COPD, and its attributable risk factors, in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex and socio-demographic index (SDI).

Methods

Data from the Global Burden of Disease (GBD) 2019 study were used to report the burden of COPD in the MENA countries. The prevalence, deaths, and disability-adjusted life-years (DALYs) were presented as counts and age-standardised rates per 100,000 population, with their associated 95% uncertainty intervals (UIs).

Results

In 2019, the regional age-standardised point prevalence and rates of death due to COPD were 2333.9 (2230.1, 2443.6) and 26.1 (22.2, 29.5) per 100,000, which represent a 30.6% (28.2%, 33.0%) increase and an 18.0% (2.8%, 30.9%) decrease, respectively, since 1990. The regional age-standardised DALY rate in 2019 was 649.1 (574.6, 717.7) per 100,000, which had decreased by 11.8% (0.9%, 21.1%) since 1990. Turkey had the highest age-standardised point prevalence in 2019 [3287.1 (3187.4, 3380.3)], while Afghanistan had the highest age-standardised death [40.4 (24.2, 52.6)] and DALY [964.5 (681.8, 1203.2)] rates. The regional age-standardised point prevalence, death and DALY rates in 2019 increased with advancing age and were higher in males in almost all age groups. There was a U-shaped association between SDI and the burden of COPD over the period 1990 to 2019. Moreover, in 2019 smoking (43.7%), ambient particulate matter pollution (22.8%) and occupational particulate matter (11.4%) had the largest proportion of attributable DALYs for both sexes.

Conclusions

COPD is one of the leading causes of death and disability in the MENA region, although the age-standardised burden has decreased over the last 30 years. Nevertheless, COPD accounted for a substantial number of deaths and DALYs, especially among the elderly. Programs targeting risk factors, like smoking, should be taken into consideration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-02242-z.

2021 Guideline for the Management of COPD Exacerbations: Emergency Medicine Association of Turkey (EMAT) / Turkish Thoracic Society (TTS) Clinical Practice Guideline Task Force

Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.

The narrative review of chronic obstructive pulmonary disease management in Turkey: medical treatment, pulmonary rehabilitation and endobronchial volume reduction

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. In Turkey, the prevalence of COPD has been shown at rates of 9.1% to 19.1%, and COPD was found to be the third leading cause of mortality and eighth leading cause of disability. In several national multicentral studies, a high rate of non-adherence to pharmacologic treatment according to GOLD was found to be high, and the most commonly prescribed treatment was the triple regimen. The most important non-pharmacologic treatment of COPD is pulmonary rehabilitation (PR), which is also highly recommended in Turkey, but it is also underutilized, like in other countries. Awareness of healthcare professionals and patients should increase in Turkey. The recommendations in content and modality of programs are similar to international guidelines. Another non-pharmacologic treatment is endobronchial volume reduction (EBVR). Although there is limited number of studies about EBVR, in national reports, the importance of patient selection, method, close follow-up after intervention, and applications in experienced centers are emphasized to decrease the economic burden of this expensive treatment. There is still great need for further randomized studies about pharmacologic and non-pharmacologic treatment and additionally, a close collaboration between healthcare professionals, physicians, professional societies of pulmonology, planners of reimbursement system, patients, patient advocacy groups and the general public should be established.

Physician's attitude against COPD guidelines and the choice of first-line treatment for COPD

AIM

Our aim was to evaluate changes in attitudes of pulmonologists in Turkey towards COPD guidelines and their choice of first-line treatments for COPD patients.

MATERIAL-METHOD

333 physicians who completed the questionnaire were included in this cross-sectional questionnaire study. The questionnaire contained demographic data, professional information, extent of guideline use, rationales behind using or not using a guideline. The data was compared with the same survey conducted previously in 2011 and was analyzed by appropriate statistical methods.

RESULTS

80 physicians were resident pulmonologists (24%), 250 physicians were specialists (75.1%). 298 (89.5%) physicians reported that they follow at least one guideline for selection of the appropriate treatment in COPD. The current application of guidelines when compared with the first survey in 2011, was found to be decreased, 91.2% and 89.5%, respectively (p = 0.07). 46.8% (n = 156) of participants thought that guidelines provided the physicians more legal protection (p < 0.001). The number of physicians who didn't follow the guidelines due to workload increased over this period of time (36.8% in 2011, 85.3% in 2018, p < 0.001). The number of physicians using inhaler steroid combinations as their first choice of treatment was found to be similar with the previous survey (p = 0.909).

CONCLUSION

According to the results of previous questionnaire, the application of COPD guidelines has decreased. The number of pulmonologists who declared they have no time for following or applying guidelines has profoundly increased since 2011. Despite the warnings of these guidelines, the use of inhaler steroid combination as a first treatment option in COPD is still common.

Variations in fecal microbial profiles of acute exacerbations and stable chronic obstructive pulmonary disease

AIM

Alterations in the respiratory and digestive tract microbiomes influence the occurrence and progression of chronic obstructive pulmonary disease (COPD). Here, we aimed to identify fecal microbiome profiles during COPD development.

METHODS

Fecal samples were collected from 29 COPD patients with acute exacerbation (AECOPD), 29 stable COPD patients, and 22 normal subjects (NS). The fecal microbial profiles were obtained using 16S rRNA gene sequencing.

KEY FINDINGS

The diversity and richness were lower and fewer variations in the taxonomic composition of fecal microbiota were observed in AECOPD patients than in stable COPD and NS. The relative abundances of Firmicutes and Actinobacteria were decreased, while those of Bacteroidetes and Proteobacteria were increased in AECOPD compared to COPD and NS. Among the top ten genera, the proportions of Lachnoclostridium and Parabacteroides significantly increased in AECOPD, whereas those of other genera decreased. Discriminative bacteria, such as p_Bacteroidetes, c_Bacteroidia, o_Bacteroidales, Lactobacillales, and Proteobacteria, were identified in AECOPD compared to stable COPD and NS. The weighted gene co-expression networks showed that Firmicutes and Actinobacteria were the main hub bacterial taxa related with lung function (FEV1% and FEV1/FVC%) and inflammatory indices (TNF-α, IL-6, IL-8, PCT, and CRP).

SIGNIFICANCE

These findings emphasized the changes in the abundance and composition of the fecal microbiome in stable COPD and AECOPD. Variations in fecal microbiota may be associated with COPD progression.

Mechanisms by Which the MBD2/miR-301a-5p/CXCL12/CXCR4 Pathway Regulates Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is characterized by irreversible expiratory airflow obstruction, and its chronic course is worsened by recurrent acute exacerbations. Our previous microarray assay identified microRNA (miR)-301a-5p as being associated with progression of acute exacerbation of COPD (AE-COPD); however, the mechanism underlying COPD pathogenesis remains unknown.

Methods

Samples of serum and peripheral blood mononuclear cells (PBMCs) were isolated from healthy control subjects and patients with stable COPD (R-COPD) or with an acute exacerbation of COPD (AE-COPD). Human HULEC-5a and human bronchial epithelial (HBE) cells were transfected with methyl-CpG-binding domain protein 2 (MBD2), sh-MBD2, miR-301a-5p mimics or an inhibitor, and then stimulated with cigarette smoke extract (CSE). Conditioned medium co-culture assays were performed by adding the supernatant of medium derived from HULEC-5a cells transfected with miR-301a-5p mimics or inhibitor into wells containing si-c-x-c motif chemokine receptor 4 (CXCR4)-transfected-lung fibroblasts or human leukemic THP-1 cell line macrophages. Transwell assays were performed to analyze cell migration.

Results

Our analysis of clinical samples showed that decreased miR-301a-5p levels in patients with AE-COPD were positively correlated with levels of MBD2 expression, but negatively correlated with levels of chemokine ligand C-X-C motif chemokine ligand 12 (CXCL12) expression. MBD2 overexpression significantly promoted miR-301a-5p production, but suppressed CXCL12 production in HULEC-5a and HBE cells. CXCL12 was confirmed to be a direct target of miR-301a-5p. CXCR4 knockdown significantly enhanced the suppressive effect of miR-301a-5p mimics and attenuated the promotional effects of the miR-301a-5p inhibitor on the migration of circulating fibroblasts and macrophages, as well as the expression levels of phospho-mitogen-activated protein kinase (p-MEK) and phospho-protein kinase B (p-AKT).

Conclusion

In summary, the MBD2/miR-301a-5p/CXCL12/CXCR4 pathway was shown to affect the migration of lung fibroblasts and monocyte-derived macrophages, which may play an important role during COPD exacerbations.

Expression of Matrix Metalloproteinase-2, Matrix Metalloproteinase-9, Tissue Inhibitor of Metalloproteinase-1, and Changes in Alveolar Septa in Patients with Chronic Obstructive Pulmonary Disease

Background

This study investigated the relationship between the pathological alteration of alveolar septa and (1) pulmonary function and (2) matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor matrix metalloproteinase 1 (TIMP-1) expression in chronic obstructive pulmonary disease (COPD).

Material/Methods

Sixty patients with pulmonary disease were divided into control (n=20) and COPD (n=40) groups. Postoperative lung tissue specimens were examined. Hematoxylin and eosin and elastin van Gieson staining detected pathological alterations of pulmonary alveolar septa. Septa thickness was measured. MMP-2, MMP-9, and TIMP-1 expression levels were detected by immunohistochemical staining. Correlations were determined by Pearson analysis.

Results

Forced expiratory volume in 1 s (FEV₁), forced vital capacity, FEV₁ percent predicted (FEV₁%pre), and diffusion capacity of carbon monoxide percent predicted (DLCO%pre) in COPD patients were significantly lower than in those of the control group (P<0.05). MMP-2, MMP-9, and TIMP-1 expression levels were significantly higher in the COPD group than in control, especially the severe group (P<0.05). Septa thickness was negatively correlated with FEV₁%pre (r=−0.335; P<0.05) and positively correlated with MMP-2 and TIMP-1 expression (P<0.05). Proportion of collagenous fiber was negatively correlated with FEV₁%pre and DLCO%pre (P<0.01), and positively correlated with MMP-2, MMP-9, and TIMP-1 expression (P<0.01). Proportion of elastic fibers was negatively correlated with collagenous fiber.

Conclusions

The pathological alteration of alveolar septa was correlated with pulmonary function and expression levels of MMP-2, MMP-9, and TIMP-1, which can play vital roles in COPD progression.

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study

OBJECTIVE

To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity.

METHODS

This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS- group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected.

RESULTS

A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS- group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS- group (in 24.7%). Radiological changes were less common in the LDS- group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS- group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS- group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01).

CONCLUSIONS

Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

Factors associated with appendicular skeletal muscle mass among male Chinese patients with stable chronic obstructive pulmonary disease: A hospital-based cross-sectional study

Limbs muscle wasting is a common disorder in patients with chronic obstructive pulmonary disease (COPD) that limits daily activities and exercise intolerance, especially in males. The present study aimed to estimate the prevalence of appendicular skeletal muscle mass (ASM) in male patients with stable COPD. In addition, factors associated with parameters of ASM were also investigated.We recruited 116 male patients with stable COPD from the outpatient clinic between September 2016 and December 2017. For each patient, we obtained demographic characteristics and measured post-bronchodilator forced expiratory volume in 1 second, symptoms, exacerbations history, and ASM. ASM was defined as the sum of the muscle masses of the 4 limbs.Appendicular skeletal muscle mass index (ASMI) in male patients with stable COPD was 8.2 ± 0.9 kg/m, and the prevalence of low skeletal muscle mass was 7.8% (9 of 116 patients). Multiple linear-regression analysis showed that body mass index, occupation, fat-free mass index, and the modified medical research council scale were significantly correlated with ASMI. Compared with nonexercise group, lower limb muscle mass and ASM were significantly improved in physical exercise group.Underweight, retirement, fat-free mass depletion, and severe dyspnea are all risk factors for ASM in male patients with stable COPD. Our findings also justify the importance of exercise training in improving ASM.

Eicosanoids metabolized through LOX distinguish asthma-COPD overlap from COPD by metabolomics study

Background and objective

The prevalence of asthma is greater than 20% in patients previously diagnosed with COPD. Patients with asthma–COPD overlap (ACO) are at risk of rapid progression of disease and severe exacerbations. However, in some patients with ACO, a clear distinction from COPD is very difficult by using physiological testing techniques. This study aimed to apply a novel metabolomic approach to identify the metabolites in sera in order to distinguish ACO from COPD.

Methods

In the study, blood samples were collected from patients with COPD, ACO, and healthy controls. Cholamine derivatization-ultrahigh performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) was used to investigate serum metabolites of eicosanoids.

Results

A clear intergroup separation existed between the patients with ACO and those with COPD, while ACO tends to have higher serum metabolic levels of eicosanoids. A robust Orthogonal Projections to Latent Structures-Discriminant Analysis (OPLS-DA) model was found for discriminating between ACO and COPD (R2Y =0.81, Q2=0.79). In addition, there is a significant correlation between some metabolites and clinical indicators, such as hydroxyeicosatetraenoic acids (HETEs), hydroperoxyeicosatetraenoic acids (HPETEs) and FEV1/FVC. The higher values of area under the receiver operating characteristic curves (ROC) of HETEs, which were metabolized from HPETEs through lipoxygenase (LOX), indicated that they should be the potential biomarkers to distinguish ACO from COPD.

Conclusion

Eicosanoids can clearly discriminate different biochemical metabolic profiles between ACO and COPD. The results possibly provide a new perspective to identify potential biomarkers of ACO and may be helpful for personalized treatment.

Controversies in Allergy: Is Asthma Chronic Obstructive Pulmonary Disease Overlap a Distinct Syndrome That Changes Treatment and Patient Outcomes?

While asthma/COPD overlap (ACO), like both asthma and COPD alone, is not a distinct syndrome, nonetheless it does have features that distinguish it from asthma and COPD only. Similar to the latter obstructive pulmonary disorders, it most likely represents a complex spectrum of diseases comprising several different phenotypes and underlying pathophysiologies. It also not yet clear how ACO is best defined, i.e., by clinical features (age, physiology, bronchodilator responsiveness, symptom variability, history of asthma), biomarkers or a combination of these features. The lack of generally agreed-on diagnostic criteria probably accounts for the marked heterogeneity of the results of published surveys of its prevalence. Until a true consensus is achieved regarding the definition of ACO, it will not be possible to determine with confidence not only its prevalence, but also its natural history (outcomes), its underlying biology or its optimal treatment based on findings from randomized controlled clinical trials focused specifically on patients with well-defined ACO.

Randomized Controlled Trial of Health Coaching for Vulnerable Patients with Chronic Obstructive Pulmonary Disease

RATIONALE

Socioeconomically disadvantaged patients with chronic obstructive pulmonary disease (COPD) often face barriers to evidence-based care that are difficult to address in public care settings with limited resources.

OBJECTIVES

To determine the benefit of health coaching for patients with moderate to severe COPD relative to usual care.

METHODS

We conducted a randomized controlled trial of 9 months of health coaching versus usual care for English- or Spanish-speaking patients at least 40 years of age with moderate to severe COPD. Primary outcomes were COPD-related quality of life and the dyspnea subscale of the Chronic Respiratory Disease Questionnaire. Secondary outcomes were self-efficacy for managing COPD, exercise capacity (6-min walk test), and number of COPD exacerbations. Additional outcomes were COPD symptoms, lung function (forced expiratory volume in 1 s percent predicted), smoking status, bed days owing to COPD, quality of care (Patient Assessment of Chronic Illness Care), COPD knowledge, and symptoms of depression (Patient Health Questionnaire). Outpatient visits, emergency department visits, and hospitalizations were assessed by review of medical records. Generalized linear modeling was used to adjust for baseline values and account for clustering by clinic.

RESULTS

Of 192 patients enrolled, 158 (82%) completed 9 months of follow-up. There were no significant differences between study arms for the primary or secondary outcomes. At 9 months, patients in the coached group reported better quality of care (mean Patient Assessment of Chronic Illness Care score, 3.30 vs. 3.18; adjusted P = 0.02) and were less likely to report symptoms of moderate to severe depression (Patient Health Questionnaire score, ≥15) than those in the usual care arm (6% vs. 20%; adjusted P = 0.01). During the study, patients in the coaching arm had 48% fewer hospitalizations related to COPD (0.27/patient/yr vs. 0.52/patient/yr), but this difference was not significant in the adjusted analysis.

CONCLUSIONS

These results help inform expectations regarding the limitations and benefits of health coaching for patients with COPD. They may be useful to health policy experts in assessing the potential value of reimbursement and incentives for health coaching-type activities for patients with chronic disease. Clinical trial registered with www.clinicaltrials.gov (NCT02234284).

Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes

Background

Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes.

Method

This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate <2%), and further subdivided according to place of admission (outpatient clinic, ward, or intensive care unit [ICU]) as an indicator of disease severity. Complete blood count, biochemistry, C-reactive protein (CRP), NLR, PLR, and platelet to mean platelet volume values were recorded from an electronic hospital database system and compared among all groups.

Results

Of the 10,592 patients included in the study, 7,864 were admitted as outpatients, 2,233 to the wards, and 495 to ICU. Neutrophilic COPD patients (n=6,536, 62%) had increased inflammatory markers compared with eosinophilic COPD patients (n=4,056, 38%); median NLR was 5.11 vs 2.62 (P<0.001), PLR was 175.66 vs 130.00 (P<0.001), and CRP was 11.6 vs 7.7 (P<0.001). All values increased relative to admission to the outpatient clinic, ward, or ICU: median NLR was 3.20, 6.33, and 5.94, respectively, median PLR was 140.43, 208.46, and 207.39, respectively, and median CRP was 6.4, 15.0, and 22.8, respectively. The median NLR values of patients in outpatients/ward/ICU increased in neutrophilic and eosinophilic endotypes: 4.21/7.57/8.60 (P<0.001) and 2.50/3.43/3.42 (P=0.81), respectively. CRP showed a similar increased pattern according to severity of AECOPD endotypes.

Conclusion

In COPD exacerbation, the inflammatory markers show different increases in each COPD endotypes. These findings may be crucial for defining exacerbation endotypes, the severity of exacerbation, and treatment response during follow-up in COPD patients.

Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that often goes undiagnosed, particularly in its early stages.

OBJECTIVE

To examine sociodemographic, general health, and COPD specific factors, including severity of lung obstruction, that are associated with healthcare provider-diagnosed COPD among U.S. adults.

METHODS

NHANES cross-sectional data collected from 2007-2012 on adults aged 40-79 years (n=10,219) were analyzed. The primary outcome was self-reported COPD diagnosis with predictive factors analyzed via chi-square and logistic regression analyses.

RESULTS

During 2007-2012, 5.2% of US adults aged 40-79 reported being diagnosed with COPD. Among those diagnosed, 50.8% reported fair or poor health, 47.1% were currently smoking cigarettes, 49.1% were taking prescription respiratory medication, 36.4% had moderate or worse lung obstruction, and nearly 90% had one or more respiratory symptoms. Logistic regression revealed positive associations between receiving a COPD diagnosis and the following: being white (AOR: 3.08, 95% CI: 1.82-5.20); being aged 60-79 years (AOR: 1.65, 95% CI: 1.07-2.53); reporting fair/poor health (AOR: 2.91, CI: 1.55-5.46); having 4-9 (AOR: 3.5, CI: 1.3-9.4) or 10 or more healthcare visits in prior year (AOR: 5.06, CI: 1.62-15.77); being a former (AOR: 1.75, CI: 1.2-2.5) or current smoker (AOR: 1.70, CI: 1.17-2.48); having more severe lung obstruction (AOR: 4.90, CI: 3.28-7.32); having 3 or more respiratory symptoms (AOR: 22.07, CI: 12.03-40.49).

CONCLUSIONS

Multiple factors are associated with self-reported COPD diagnosis with number of reported respiratory symptoms having the strongest association. After controlling for other factors, having mild lung obstruction was not associated with being diagnosed.

Lung volume reduction surgery or bronchoscopic lung volume reduction: is there an algorithm for allocation?

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world with the annual number of deaths increasing every year. Alterations in chest wall mechanics, respiratory muscle mechanics, and impaired cardiac function that result from increased air-trapping are well known sequelae of COPD and contribute to increased morbidity and mortality. A reduction in hyperinflation can improve cardiopulmonary function. In selected patients with COPD and an emphysema phenotype, lung volume reduction surgery (LVRS) has demonstrated improvements in symptom burden and mortality. Minimally invasive bronchoscopic techniques that reduce end-expiratory lung volume have shown improvements in lung function, dyspnea and quality of life. In this review, we review selection criteria, risks, and benefits of surgical and bronchoscopic lung volume reduction (BLVR). Recommendations are provided to guide treatment decisions based on the current literature.