699 Incidence of COPD in primary and secondary outcomes in patients undergoing a TAVI

Abstract Aims The association between severe chronic obstructive pulmonary disease (COPD) and in-hospital mortality (IHM) as well as incidence of post-procedural intubation and length of in-hospital stay (LOHS) in patients with severe aortic stenosis (AS) undergoing transfemoral (TF) transcatheter aortic valve implantation (TAVI) is still unclear. We evaluated the impact of severe COPD on IHM, post-procedural tracheal intubation and LOHS in patients with severe AS undergoing TF TAVI. Methods We retrospectively analysed a total of 550 consecutive patients who underwent transfemoral TAVI in our centre between 2011 and 2021. We divided the patients in Group 1 (affected by severe COPD) and Group 2 (without COPD). We further divided the patients affected by COPD into Subgroup A (on COPD medical treatment) and Subgroup B (without COPD medical treatment). Results A total of 550 patients who underwent TF TAVI were included in this analysis. 38.55% (n=212) had a diagnosis of COPD (Group 1) and 61.45% (n=338) were not affected by COPD (Group 2). In Group 1, 29.38% (n=62) of patients were receiving medical treatment for COPD (Subgroup A), while 70.6% (n=149) were not on COPD medications (Subgroup B). The mean age was 81.83±6.67 in Group 1 vs. 81.33±7.21 in Group 2 (P=0.45), and 82.12±7.6 in Subgroup A vs. 82.14±6.82 in Subgroup B (P=0.98). The gender distribution showed 127 (45%) men in Group 1 vs. 96 (50%) men in Group 2 (P=0. 33), and 21 (42%) men in Subgroup 1 vs. 75 (53%) men in Subgroup B (P=0.28). The mean EUROSCOREII was 8.26±7.03 in Group 1 vs. 6.81± 7.57 in Group 2, P= 0.11, and 7.24±5.49 in Subgroup A vs. 9.30±7.5 in Subgroup B, P=0.52. There was no difference observed for in-hospital mortality between Group 1 and Group 2 (0.04% vs. 0.05%; P=0.6) and between Subgroup A and Subgroup B (0.04% vs. 0.04%; P=0.7). Similarly, the incidence of post-procedural intubation was comparable between Group 1 and Group 2 (0.06% vs. 0.03%; P=0.18), and between Subgroup A and Subgroup B (0.08% vs. 0.05%; P=0.78). Finally, also the mean length of in-hospital stay was similar between Group 1 and Group 2 (10±4.46 days vs. 9.68± 5.02 days; P=0.47), and between Subgroup A and Subgroup B (10.36±4.24 days vs. 9.87±4.54 days; P=0.5). Conclusions In patients with severe aortic stenosis treated with transfemoral TAVI, the presence of severe COPD does not affect in-hospital mortality, incidence of post-procedural intubation and length of in-hospital stay. COPD medications do not impact any of the outcomes evaluated. Therefore, TF TAVI is a safe procedure also for patients affected by severe chronic obstructive pulmonary disease that are not on COPD medications.

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Is Chronic Obstructive Pulmonary Disease An Independent Risk Factor For Coronary and Peripheral Atherosclerosis In Heavy Smokers?

10.21203/rs.3.rs-91443/v1 ◽

2020 ◽

Author(s):

Maria Angélica Pires Ferreira ◽

Leila Beltrami Moreira ◽

Felipe Soares Torres ◽

Marli Maria Knorst

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Lung Function ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Similar Distribution ◽

Obstructive Pulmonary Disease ◽

The Mean ◽

Group 2 ◽

Heavy Smokers ◽

Group 1

Abstract BACKGROUNDThere is a high prevalence of cardiovascular disease (CVD) and atherosclerosis in people with chronic obstructive pulmonary disease (COPD); sharing of risk factors could not be the only cause of the association.OBJECTIVESTo verify whether coronary atherosclerosis and peripheral vascular disease are independently associated with COPD in heavy smokers. We also investigated whether inflammation and poor lung function were related with atherosclerosis findings.METHODSHeavy smokers (≥ 20 pack-years) with COPD (group 1) or normal spirometry (group 2) were recruited. Clinical, laboratory, and anthropometric data were obtained. Main interest variables were prevalence of CCS > 75th percentile (P75), and rates of ABI < 0,9 by Doppler ultrasound. CVD risk was calculated using the Framingham risk score. Serum C-reactive protein (CRP) was measured, and lung function was assessed by spirometry. Differences between groups were compared using parametric and nonparametric tests as adequate.RESULTSWere included 87 patients, 49 with COPD (group 1). The mean ± SD age was 57.2 ± 6.0 years (58.7 ± 5.1 in group 1, 55.2 ± 6.6 in group 2, p=0.006). The mean FEV 1 % was 45.8 ± 17.24 vs. 91.7 ± 15.9 in groups 1 and 2, respectively; p<0.05. The mean smoking index was 48.6 ± 25.4, higher in the COPD group (p=0.037). Stratification by Framingham score yielded a similar distribution in both groups. The frequency of patients with CCS > P75 was 55% vs. 66% in groups 1 and 2, respectively (p=0.823); ABI <9.0 ocurred in 6,3% vs 2,6%, respectivelly ( p=0.555) . CCS and ABI were not associated to FEV 1 %. CRP was inversely associated with VEF 1 ( r s= -0.419; p<0.001), but unrelated to CCS ( r s= 0.136; p=0.265) and ABI ( r s= -0.51; p=0.677).CONCLUSIONSThe studied coronary and peripheral atherosclerosis markers were similar between heavy smokers with COPD and those with normal spirometry. Nor serum CRP neither poor lung function related to CCS or ABI. Our results suggest absence of a independent association between COPD and atherosclerosis.

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Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.165 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Rivadeneira Ruiz ◽

DF Arroyo Monino ◽

T Seoane Garcia ◽

MP Ruiz Garcia ◽

JC Garcia Rubira

Keyword(s):

Mechanical Ventilation ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Coronary Care Unit ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Funding Sources ◽

Copd Patients ◽

The Mean ◽

Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation. Methods We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay. Results We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%. Conclusions Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.

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THE EFFECT OF TRACHEAL DIVERTICULUM AND CHRONIC OSTRUCTIVE LUNG DISEASE ON CHEST ANTHROPOMETRY

10.22541/au.161248656.64273199/v1 ◽

2021 ◽

Author(s):

Mine ARGALI DENIZ ◽

Hilal ER ULUBABA ◽

M. Furkan ARPACI ◽

Fatih CAVUS ◽

Gokhan DEMIRTAS ◽

...

Keyword(s):

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Group 4 ◽

Tracheal Diverticulum ◽

Copd Patients ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: In this study, the effect of tracheal diverticula (TD) on chest anthropometry and its relation with chronic obstructive pulmonary disease (COPD) was evaluated. Method: Between January 2019 and March 2020, 995 patients who underwent chest CT were retrospectively analyzed and TD was detected in 31 cases. Group 1 is only TD, Group 2 is TD + COPD, Group 3 is only COPD, Group 4 is defined as control group. We measured the localization, size, the distance to carina and vocal cord of TDs. In all groups chest diameters at T4 and T9 levels were measured as transverse and vertical plans. Results: TDs detected mostly at the T2 and T3 levels. In Group 1 and Group 2, there was a statistically significant difference the distance to TD of vocal chords. A statistically significant difference was found between Group 1 and Group 3 only in the vertical diameter at the T4 and T9 levels. Conclusion: We observed that COPD effect TD location and also TD had opposite effect on anteroposteriorly increasing chest parameters in COPD. Precence of TD is essential on COPD patients about thorax anthropometry. Keywords: Tracheal diverticulum; antropometry; radiology; COPD; chest diameter

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One-step Laparoscopic and Endoscopic Treatment of Gallbladder and Common Bile Duct Stones: Our Experience of the Last 9 Years in a Retrospective Study

The American Surgeon ◽

10.1177/000313481307901213 ◽

2013 ◽

Vol 79 (12) ◽

pp. 1243-1247 ◽

Cited By ~ 1

Author(s):

Andrea Liverani ◽

Mirko Muroni ◽

Francesco Santi ◽

Tiziano Neri ◽

Gerardo Anastasio ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hospital Stay ◽

Common Bile Duct Stones ◽

Optimal Timing ◽

Bile Duct Stones ◽

One Step ◽

The Mean ◽

Group 2 ◽

Group 1

The optimal timing and best method for removal of common bile duct stones (CBDS) associated with gallbladder stones (GBS) is still controversial. The aim of this study is to investigate the outcomes of a single-step procedure combining laparoscopic cholecystectomy (LC), intra-operative cholangiography (IOC), and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2003 and January 2012, 1972 patients underwent cholecystectomy at our hospital. Of those, 162 patients (8.2%; male/female 72/90) presented with GBS and suspected CBDS. We treated 54 cases (Group 1) with ERCP and LC within 48 to 72 hours. In 108 patients (Group 2) we performed LC with IOC and, if positive, was associated with IO-ERCP and sphincterotomy. In Group 1, a preoperative ERCP and LC were completed in 50 patients (30%). In four cases (2%), an ERCP and endobiliary stents were performed without cholecystectomy and then patients were discharged because of the severity of clinical conditions and advanced American Society of Anesthesiologists score (III to IV). Two months later a preoperative ERCP and removal of biliary stents were performed followed by LC 48 to 72 hours later. In Group 2, the IOC was performed in all cases and CBDS were extracted in 94 patients (87%). In two cases, the laparoscopic choledochotomy was necessary to remove large stones. In another two cases, an open choledochotomy was performed to remove safely the stones with T-tube drainage. In three cases, conversion was necessary to safely complete the procedure. The mean operative time was 95 minutes (range, 45 to 150 minutes) in Group 1 and 130 minutes (range, 50 to 300 minutes) in Group 2. The mean hospital stay was 6.5 days (range, 4 to 21 days) in Group 1 and 4.7 days (range, 3 to 14 days) in Group 2. Five cases (two in Group 2 and three in Group 1) presented with CBDS at 12 to 18 months after surgery. They were treated successfully with a second ERCP. There was no perioperative mortality. Our experience suggests that when clinically and technically feasible, a single-stage approach combining LC, IOC, and ERCP to the patients diagnosed with chole-choledocholithiasis is indicated. The IO-ERCP with CBDS extraction is a safe and effective method with low risk of postoperative pancreatitis. One-step treatment is more comfortable for the patient and also reduces the mean hospital stay.

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Blood Eosinophils and Clinical Outcome of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000510516 ◽

2020 ◽

pp. 1-10

Author(s):

Yajie You ◽

Guo chao Shi

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Clinical Outcome ◽

Hospital Mortality ◽

Hospital Stay ◽

Pulmonary Disease ◽

Lower Risk ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Background: Numerous studies have shown the association between eosinophilia and clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). But the evidences are lack of consensus. Objective: The aim of this meta-analysis was to conduct a pooled analysis of outcome comparing eosinophilic (EOS) AECOPD and non-EOS AECOPD patients. Methods: We included PubMed, EMBASE, Web of Science, and Cochrane databases up to 2020 to retrieve articles. Randomized controlled trials and quasi-experimental studies about patients with and without EOS AECOPD in terms of in-hospital mortality, length of hospital stay, comorbidities, forced expiratory volume in 1 s (FEV1), gender, and BMI were included preclinical studies, review articles, editorials, commentaries, conference abstracts, and book chapters were excluded. The methodologic assessment of studies was performed with the Newcastle-Ottawa Scale and Cochran scale. Comprehensive Rev Man 5 was used for the statistical analysis. Results: Twenty-one studies with 18,041 patients fulfilled the inclusion criteria and were used in this meta-analysis. Comparing to the non-EOS group, those with EOS AECOPD patients had a lower risk for in-hospital mortality (odds ratio (OR) = 0.59, 95% confidence interval [CI] 0.36–0.95, p = 0.03), shorter length of hospital stay (OR = −0.72, 95% CI −1.44 to −0.00, p = 0.05), better FEV1 (mean difference = 0.14, 95% CI 0.08–0.20, p < 0.00001), and a lower risk of arrhythmias (OR = 1.50, 95% CI 1.01–2.21, p = 0.04). In addition, the non-EOS group had a higher percentage of male (OR = 1.34, 95% CI 1.15–1.56, p = 0.0002) than EOS group. The rate of steroid use (OR = 0.82, 95% CI 0.47–1.42, p = 0.48) and BMI (mean difference = 0.43, 95% CI −0.18 to 1.05, p = 0.17] had no difference between 2 groups. Conclusion: The results of our meta-analysis suggest that EOS AECOPD patients have a better clinical outcome than non-EOS AECOPD patients in terms of length of hospital stay, in-hospital mortality, FEV1, and risk of arrhythmias. In addition, the non-EOS AECOPD patients have higher percentage of male than EOS AECOPD patients.

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The usefulness of Shock Index and Modified Shock Index in predicting outcome of COVID-19 patients

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.187 ◽

2021 ◽

pp. 1-16

Author(s):

Erdem KURT ◽

Suphi BAHADIRLI

Keyword(s):

Hospital Mortality ◽

Operating Characteristic ◽

Area Under The Curve ◽

Male Gender ◽

Chronic Obstructive ◽

Shock Index ◽

Obstructive Pulmonary Disease ◽

Predicting Outcome ◽

The Mean ◽

Artery Disease

Abstract Objective: The aim of this study is to investigate the accuracy of shock index (SI) and modified shock index (mSI) in predicting intensive care unit (ICU) requirement and in-hospital mortality among COVID-19 patients who admitted to the emergency department (ED). Likewise, the effects of patients’ conditions such as age, gender and comorbidity on prognosis will be analyzed. Methods: The files were retrospectively scanned for all COVID-19 patients over the age of 18 who were admitted to the ED and hospitalized between January 1, 2021 and March 15, 2021. The area under the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to assess each scoring system discriminatory for predicting in-hospital mortality and ICU admission. Results: There were 464 patients included in this study. The mean age of the patients was 62.4±16.7, of which 245 were men and 219 were women. The most common comorbidity in patients was hypertension 200 (43.1%), followed by chronic obstructive pulmonary disease 174 (37.5%) and coronary artery disease 154 (33.2%). In terms of in-hospital mortality, the AUC of SI, and mSI were 0.719, and 0.739, respectively. In terms of ICU requirement, the AUC of SI, and mSI were 0.704, and 0.729, respectively. Conclusions: In this study, it was concluded that SI and mSI are useful in predicting in-hospital mortality and ICU requirement in COVID-19 patients. In addition, it is another important result of the study that advanced age, male gender and hypertension may be associated with poor prognosis.

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Features of the Functional Status and Cytokine Profile of Patients with Chronic Heart Failure in Combination with Chronic Obstructive Pulmonary Disease

International Journal of Biomedicine ◽

10.21103/article11(1)_oa1 ◽

2021 ◽

Vol 11 (1) ◽

pp. 9-13

Author(s):

Roman Tokmachev ◽

Andrey Kravchenko ◽

Andrey Budnevsky ◽

Evgeniy Ovsyannikov ◽

Evgeniy Tokmachev ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Functional Status ◽

Serum Levels ◽

Cytokine Profile ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Group 2 ◽

Hs Crp ◽

Group 1

The purpose of this research was to study the effect of COPD on the functional status and cytokine profile of patients with chronic heart failure (CHF) with different ejection fraction (EF). Methods and Results: The study involved 240 patients diagnosed with CHF (mean age of 72.4±8.7 years). Among them, 80 patients were diagnosed with CHF and COPD. Depending on the presence of COPD, the patients were divided into two groups: Group 1 included 160 patients with CHF without COPD; Group 2 included CHF 80 patients with COPD. According to the value of LVEF, each of the two groups was divided into two more subgroups: In Group 1, CHFpEF (EF≥50%) was recorded in 69 patients (Subgroup 1) and CHFrFV (EF<50%) in 91 patients (Subgroup 2). In Group 2, CHFpEF was observed in 36 patients (Subgroup 3) and CHFrEF in 44 patients (Subgroup 4). The 6-minute walk distance (6MWD) was measured in meters and compared with the proper 6MWD(i). All patients included in the study underwent the Borg test to assess dyspnea after 6MWT. The serum levels of NT-proBNP, hs-CRP, IL-1β, IL-6, and TNF-α were determined using an automatic analyzer IMMULITE 2000 (Siemens Diagnostics, USA) and quantitative ELISA kits. The patients with CHFpEF had higher levels of hs-CRP, pro-inflammatory cytokines than patients with CHFrEF. The combination of COPD and CHF amplifies systemic inflammation (hs-CRP, proinflammatory cytokines) and myocardial remodeling processes (NT-proBNP) in comparison with the isolated course of CHF. COPD negatively affects the functional status of patients with CHF with different EF by lower values of 6MWD, 6MWD/6MWD(i) ratio, and higher results on the Borg dyspnea test.

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A scintigraphy study of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler in patients with moderate-to-very severe chronic obstructive pulmonary disease

Respiratory Research ◽

10.1186/s12931-021-01813-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Omar Usmani ◽

Nicolas Roche ◽

Ezanul Wahab ◽

Samuel Israel ◽

Martin Jenkins ◽

...

Keyword(s):

Dose Inhaler ◽

Chronic Obstructive ◽

Metered Dose Inhaler ◽

Obstructive Pulmonary Disease ◽

Deposition Patterns ◽

Metered Dose ◽

The Mean ◽

Long Acting ◽

Severe Copd ◽

Formoterol Fumarate

Abstract Background Triple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β2-agonists (ICS/LAMA/LABA) is recommended for patients with chronic obstructive pulmonary disease (COPD) with continued symptoms or exacerbations, despite treatment with LAMA/LABA or ICS/LABA. The pulmonary, extrathoracic, and regional lung deposition patterns of a radiolabeled ICS/LAMA/LABA triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate (BGF 320/18/9.6 μg), delivered via a single Aerosphere metered dose inhaler (MDI) were previously assessed in healthy volunteers and showed good deposition to the central and peripheral airways (whole lung deposition: 37.7%). Here, we report the findings assessing BGF in patients with moderate-to-very severe COPD. Methods This phase I, single-dose, open-label gamma scintigraphy imaging study (NCT03906045) was conducted in patients with moderate-to-very severe COPD. Patients received two actuations of BGF MDI (160/9/4.8 μg per actuation) radiolabeled with technetium‑99‑pertechnetate, not exceeding 5 MBq per actuation. Immediately following each inhalation, patients performed a breath-hold of up to 10 s, then exhaled into an exhalation filter. Gamma scintigraphy imaging of the anterior and posterior views of the lungs and stomach, and a lateral head and neck view, were performed immediately after exhalation. The primary objective of the study was to assess the pulmonary deposition of BGF. Secondary objectives assessed the deposited dose of radiolabeled BGF in the oropharyngeal and stomach regions, on the actuator, and on the exhalation filter in addition to regional airway deposition patterns in the lungs. Results The mean BGF emitted dose deposited in the lungs was 32.1% (standard deviation [SD] 15.6) in patients with moderate-to-very severe COPD, 35.2% (SD 12.8) in patients with moderate COPD, and 28.7% (SD 18.4) in patients with severe/very severe COPD. Overall, the mean normalized outer/inner ratio was 0.55 (SD 0.19), while the standardized central/peripheral ratio was 2.21 (SD 1.64). Conclusions Radiolabeled BGF 320/18/9.6 μg was efficiently delivered and deposited throughout the entire lung, including large and small airways, in patients with moderate-to-very severe COPD, with similar deposition in patients with moderate COPD and patients with severe/very severe COPD. Trial registration: ClinicalTrials.gov, NCT03906045. Registered 8 April 2019, https://clinicaltrials.gov/ct2/show/NCT03906045

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How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease?

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-7-418-424 ◽

2020 ◽

Vol 4 (7) ◽

pp. 418-424

Author(s):

N.Yu. Grigorieva ◽

◽

M.O. Samolyuk ◽

T.V. Sheshina ◽

N.B. Koroleva ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Lipid Peroxidation ◽

Arterial Hypertension ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Number Of Patients ◽

Group 2 ◽

Azilsartan Medoxomil ◽

Group 1

Aim: to conduct a comparative assessment of the hypotensive effect, as well as the effect on endothelial function, oxidative stress, and pulmonary artery pressure of chlorthalidone and hydrochlorothiazide as part of combined antihypertensive therapy in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).Patients and Methods: the prospective study included 66 patients divided into two groups. As the main antihypertensive therapy, group 1 was prescribed with a combination of azilsartan medoxomil 40 mg and chlortalidone 12.5 mg as a fixed combination of Edarbi® CLO. Group 2 received a free combination of azilsartan medoxomil 40 mg (Edarbi®) and hydrochlorothiazide 12.5 mg. All patients underwent 24-hour blood pressure monitoring: (ABPM), echodopplercardiography, endothelium-dependent vasodilation, lipid peroxidation (LPO), nitric oxide metabolites, and endothelin-1 levels at baseline and after 6 months of treatment. Results: target blood pressure values (<130/80 mm Hg) were achieved in 91% of patients in group 1, and 51.5% in group 2 after 1 month of the study. After 6 months of treatment, all patients in both groups reached the target BP values, but in group 2, the dose of hydrochlorothiazide had to be increased to 25 mg. According to the ABPM data, after 6 months of treatment, group 1 showed a decrease in the morning surge in SBP by 7.0±2.1% and DBP by 10±7.3%. There was also an increase in the number of patients with the daily profile of «dipper» type to 78.8%. In group 2, there was a decrease in the morning surge in SBP by 6.3±5.9% and DBP by 4.8±4.6% after 6 months of treatment. There was an increase in the number of patients with the daily profile of «dipper» type to 36.4%. After 6 months of treatment, there was more pronounced improvement in laboratory parameters of group 1 characterizing endothelial dysfunction and oxidative stress. Statistically significant results were obtained for conjugated trienes, NO2, S, Imax, and endothelin-1 when comparing groups 1 and 2.Conclusion: treatment of AH in patients with concomitant COPD in the form of a fixed combination of azilsartan medoxomil and chlorthalidone versus free combination of azilsartan medoxomil with hydrochlorothiazide has a more pronounced antihypertensive effect, positively affecting the daily BP profile, pulmonary artery pressure, endothelial function and lipid peroxidation processes after 6 months of treatment.KEYWORDS: arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, lipid peroxidation, azilsartan medoxomil, chlorthalidone.FOR CITATION: Grigorieva N.Yu., Samolyuk M.O., Sheshina T.V. et al. How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease? Russian Medical Inquiry. 2020;4(7):418–424. DOI: 10.32364/2587-6821-2020-4-7-418-424.

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Twice versus three-times weekly pulmonary rehabilitation in a real-life clinical setting

F1000Research ◽

10.12688/f1000research.3778.1 ◽

2014 ◽

Vol 3 ◽

pp. 89

Author(s):

Keir Lewis ◽

Lucy Thatcher ◽

Carol-Anne Davies ◽

Patricia Hodgson ◽

Carol Llewellyn-Jones ◽

...

Keyword(s):

Clinical Setting ◽

Pulmonary Rehabilitation ◽

Real Life ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

St George's Respiratory Questionnaire ◽

Observational Cohort ◽

Group 2 ◽

Hospital Days ◽

Group 1

Aim: Our aim was to compare a less intensive but longer pulmonary rehabilitation programme (PRP) against a more intensive but shorter PRP.Methods: We carried out an observational, cohort study in a real-life clinical setting in patients primarily with chronic obstructive pulmonary disease (COPD). We compared standard outcomes in patients who were receiving 18 sessions of PRP delivered twice weekly over 9 weeks (Group 1) against similar patients receiving an identical PRP delivered three times weekly over 6 weeks (Group 2). Outcome measures were the St. George’s Respiratory Questionnaire (SGRQ), the Incremental Shuttle Walk Test (ISWT) and the number of hospital bed-days pre- and post-PRP.Results: Both groups showed statistically significant and clinically important improvements post-PRP. The largest effects were seen immediately post-PRP and waned over the following 12 months. Group 1 showed a larger improvement in ISWT immediately post-PRP (Group 1, +92 m versus Group 2 +64 m (p=0.001), but there were no differences between groups at 6 (p=0.67) or 12 months (p=0.96). There were no differences in SGRQ between groups immediately post-PRP (p=0.09) or at 12 months (p=0.78). There were no differences between groups in the number of hospital days 12 months prior to PRP versus 12 months post-PRP (p=0.18).Conclusion: Twice weekly outpatient, multidisciplinary PRP over 9 weeks is as effective as three times weekly PRP over 6 weeks.

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