scholarly journals Pendelluft in Chronic Obstructive Lung Disease Measured with Lung Sounds

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Andrey Vyshedskiy ◽  
Raymond Murphy
Keyword(s):  
Lead Time ◽  
Gas Flow ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Lung Sounds ◽  
Lung Sound ◽  
Gold Stage ◽  
Tracheal Sound ◽  
Copd Patients ◽  
Lag Times

Objective. The phenomenon of pendelluft was described over five decades ago. In patients with regional variations in resistance and elastance, gas moves at the beginning of inspiration out of some alveoli into others. Gas moves in the opposite direction at the end of inspiration. The objective of this study was to apply the method of lung sounds mapping, which is known to provide regional information about gas flow, to study pendelluft in COPD patients.Methods. A 16-channel lung sound analyzer was used to collect sounds from patients with COPD (n=90) and age-matched normals (n=90). Pendelluft at the beginning of inspiration is expected to result in vesicular sounds leading the tracheal sound by a few milliseconds. Pendelluft at the end of inspiration is expected to result in vesicular sounds lagging the tracheal sound. These lead and lag times were calculated for the 14 chest wall sites.Results. The lead time was significantly longer in COPD patients:123±107 ms versus48±59 ms in controls (P<0.0001). The lag time was also significantly longer in COPD patients:269±249 ms in COPD patients versus147±124 ms in controls (P<0.0001). When normalized by the duration of the inspiration at the trachea, the lead was14±13% for COPD versus4±5% for controls (P<0.0001). The lag was28±25% for COPD versus13±12% for controls (P<0.0001). Both lead and lag correlated moderately with the GOLD stage (correlation coefficient 0.43).Conclusion. Increased lead and lag times in COPD patients are consistent with the phenomenon of pendelluft as has been observed by other methods.

scholarly journals Sarcopenia in COPD: relationship with COPD severity and prognosis

2015 ◽  
Vol 41 (5) ◽  
pp. 415-421 ◽  
Author(s):  
Tatiana Munhoz da Rocha Lemos Costa ◽  
Fabio Marcelo Costa ◽  
Carolina Aguiar Moreira ◽  
Leda Maria Rabelo ◽  
César Luiz Boguszewski ◽  
...  
Keyword(s):  
Lean Mass ◽  
Smoking Status ◽  
Airflow Obstruction ◽  
Chronic Obstructive Lung Disease ◽  
The Body ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Skeletal Muscle Index ◽  
Gold Stage ◽  
Copd Patients

Objective: To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD. Methods: A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index. Results: We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage. Conclusions: In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.

Belastungstest bei chronisch-obstruktiver Lungenerkrankung: Wege zur optimalen Trainingssteuerung finden

2020 ◽  
Vol 8 (6) ◽  
pp. 330-331
Author(s):  
Daniela Leitl ◽  
A. Rembert Koczulla
Keyword(s):  
Minute Ventilation ◽  
Chronic Obstructive Lung Disease ◽  
Blood Gas Analysis ◽  
Cardiopulmonary Exercise Test ◽  
Gas Analysis ◽  
Stage I ◽  
Stage Iii ◽  
Chronic Obstructive ◽  
Gold Stage ◽  
Copd Patients

<b>Background:</b> In moderate-to-severe chronic obstructive pulmonary disease (COPD) patients the 6-min walk test (6MWT) is often exhaustive and correlates with the incremental cycle cardiopulmonary exercise test (CPET). <b>Objectives:</b> The aim of this study was to assess the agreement between oxygen uptake (VO<sub>2</sub>) measured during the 6MWT by portable equipment and incremental cycle exercise in COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) I–IV. <b>Methods:</b> A total of 30 patients with COPD GOLD I–IV (14 patients GOLD stage I and II and 16 patients GOLD stage III and IV) underwent a 6MWT and an incremental CPET. Breath-by-breath analysis for VO<sub>2</sub>, carbon dioxide output (VCO<sub>2</sub>), and minute ventilation (VE) were measured during each test. Blood gas analysis and lactate measurements were performed before, during, and after the test. <b>Results:</b> VO<sub>2</sub> in COPD patients GOLD stage I and II was 16.2 ± 4.2 mL/kg/min measured by 6MWT and 20.5 ± 7.0 mL/kg/min measured by CPET as compared to GOLD stage III and IV (11.2 ± 3.7 mL/kg/min measured by 6MWT and 15.5 ± 4.3 mL/kg/min measured by CPET). No significant correlation in VO<sub>2</sub> measurements could be found between both tests in COPD GOLD I and II (<i>r</i> = 0.17), whereas the VO<sub>2</sub> significantly correlated in patients with COPD stage III and IV (<i>r</i> = 0.7). <b>Conclusions:</b> A significant relationship between VO<sub>2</sub> measured by 6MWT and CPET could only be found in patients with more severe COPD but not in milder stages. 6MWT and CPET provide different VO<sub>2</sub> measurements in COPD patients. The two methods cannot be used interchangeably.

scholarly journals Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nikolaos Tzanakis ◽  
Nikolaos Koulouris ◽  
Katerina Dimakou ◽  
Konstantinos Gourgoulianis ◽  
Epameinondas Kosmas ◽  
...  
Keyword(s):  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Medical Practitioners ◽  
Recommended Treatment ◽  
Copd Patients ◽  
Assessment Approach ◽  
Impaired Lung Function ◽  
Group B

Abstract Background Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece. Methods This was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece). Results The mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A. Conclusion Our data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.

scholarly journals Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study

2020 ◽  
Vol 30 (4) ◽  
pp. 822-827
Author(s):  
Maria T Castañ-Abad ◽  
Josep Montserrat-Capdevila ◽  
Pere Godoy ◽  
Josep R Marsal ◽  
Marta Ortega ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Lung Disease ◽  
Prospective Cohort ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Copd Patients ◽  
Global Initiative

Abstract Background Type 2 diabetes comorbidity is common in patients with COPD. One of the most frequent causes of hospital admission in patients with COPD are exacerbations. Methods Prospective cohort study, which included 512 patients with COPD recruited in a primary care centre in Mollerussa (Lleida, Spain). Inclusion criteria were: patients &gt;40 years of age with COPD according to the Global Initiative for Chronic Obstructive Lung Disease. Variables collected were as follows: age, gender, civil status, education level, smoking habit, severity (Global Initiative for Chronic Obstructive Lung Disease), comorbidities (Charlson), history of severe exacerbations, dyspnoea (mMRC), BODEx, EuroQol 5 D and depression (HAD). Logistic regression was used to determine the association of diabetes with risk of hospital admission and death. Results Prevalence of diabetes was 25.8%. During the second year of follow up, 18.2% of patients with COPD and diabetes were admitted for exacerbation, in comparison with 8.9% non-diabetic COPD patients. The variables associated with hospital admission were diabetes (ORa=1.54); gender (men, ORa=1.93); age (ORa=1.02); number of hospital admissions during the previous year: 1 (ORa=2.83) or more than one admission (ORa=4.08); EuroQol 5 D (ORa=0.76) and BODEx (ORa=1.24). With the exclusion of BODEx, all these variables were associated with a higher risk of death. Conclusion Prevalence of diabetes is high in patients suffering from COPD. COPD patients with diabetes are at higher risk of severe exacerbation and death. The suggested predictive model could identify patients at higher risk so that adequate preventive and therapeutic measures can be implemented.

scholarly journals Impaired Hemorheology in Exacerbations of COPD

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Erhan Ugurlu ◽  
Emine Kilic-Toprak ◽  
Ilknur Can ◽  
Ozgen Kilic-Erkek ◽  
Goksel Altinisik ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Erythrocyte Aggregation ◽  
Treatment Modalities ◽  
Patient Treatment ◽  
Rheological Parameters ◽  
Chronic Obstructive ◽  
Copd Patients ◽  
Rbc Deformability

Background. Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation. Cardiovascular-related comorbidities are established to contribute to morbidity and mortality especially during exacerbations. The aim of the current study was to determine alterations in hemorheology (erythrocyte aggregation, deformability) in newly diagnosed COPD patients and their response to medical treatment and to compare with values of COPD patients with exacerbations.Materials and Methods. The study comprised 13 COPD patients, 12 controls, and 16 COPD patients with exacerbations. The severity of COPD was determined according toGlobal Initiative for Chronic Obstructive Lung Diseaseguidelines. Red blood cell (RBC) deformability and aggregation were measured by an ektacytometer.Results. RBC deformability of COPD patients with exacerbations was decreased compared to the other groups. Erythrocyte aggregation and plasma fibrinogen of COPD patients determined during exacerbations were higher than control.Conclusion. Decreased RBC deformability and increased aggregation associated with exacerbations of COPD may serve as unfavorable mechanisms to worsen oxygenation and thus clinical symptoms of the patient. Treatment modalities that modify rheological parameters might be beneficial.

scholarly journals The patients with severe Chronic Obstructive Pulmonary Disease and chronic respiratory insufficiency

2016 ◽  
Vol 67 (3) ◽  
Author(s):  
N. Ambrosino ◽  
M. Di Giorgio ◽  
A. Di Paco
Keyword(s):  
Exercise Capacity ◽  
Chronic Obstructive Lung Disease ◽  
Supplemental Oxygen ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Chronic Respiratory Insufficiency ◽  
Global Initiative ◽  
End Stage

Caring for patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure is difficult independent of whether the target is survival or quality of life (QOL). The role of inhaled drug therapy in this specific set of very severe COPD patients has not previously been assessed. The only drug able to prolong survival in these patients is long term oxygen therapy, whereas there is little evidence to indicate long term domiciliary mechanical ventilation in the routine management of stable hypercapnic patients. Supplemental oxygen during exercise reduces exercise breathlessness and improves exercise capacity of the hypoxaemic patient. Pulmonary rehabilitation including nutritional supplementation is a significant component of therapy, even in these severe patients. Relief of dyspnoea with drugs such as morphine should not be denied to severely disabled patients who share poor QOL with cancer patients. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Lung Volume Reduction Surgery may improve mortality, exercise capacity, and QOL in selected patients, but is associated with significant morbidity and an early mortality rate in the most severe patients. Lung transplantation is a final step in end-stage patients, but short- and long-term outcomes remain significantly inferior in relation to other “solid” organs recipients.

scholarly journals Perceptions of COPD patients of the proposed withdrawal of inhaled corticosteroids prescribed outside guidelines: A qualitative study

2019 ◽  
Vol 16 ◽  
pp. 147997311985588 ◽  
Author(s):  
Gill Gilworth ◽  
Timothy Harries ◽  
Chris Corrigan ◽  
Mike Thomas ◽  
Patrick White
Keyword(s):  
Side Effects ◽  
Inhaled Corticosteroids ◽  
Qualitative Interviews ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Individual Risk ◽  
Chronic Obstructive ◽  
Copd Patients ◽  
Global Initiative ◽  
Long Acting

Global Initiative for Chronic Obstructive Lung Disease guidelines support the prescription of fixed combination inhaled corticosteroids (ICS) and long-acting β-agonists in symptomatic COPD patients with frequent or severe exacerbations, with the aim of preventing them. ICS are frequently also prescribed to COPD patients with mild or moderate airflow limitation, outside guidelines, with the risk of unwanted effects. No investigation to date has addressed the views of these milder COPD patients on ICS withdrawal. The objective is to assess the views of COPD patients with mild or moderate airflow limitation on the staged withdrawal of ICS prescribed outside guidelines. One-to-one semi-structured qualitative interviews exploring COPD patients’ views about ICS use and their attitudes to proposed de-prescription were conducted. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was completed. Seventeen eligible COPD patients were interviewed. Many participants were not aware they were using an ICS. None was aware that prevention of exacerbations was the indication for ICS therapy or the risk of associated side effects. Some were unconcerned by what they perceived as low individual risk. Others expressed fears of worsening symptoms on withdrawal. Most with mild or moderate airflow limitation would have been willing to attempt withdrawal or titration to a lower dosage of ICS if advised by their clinician, particularly if a reasoned explanation were offered. Attitudes in this study to discontinuing ICS use varied. Knowledge of the drug itself, the indications for its prescription in COPD and potential for side effects, was scant. The proposed withdrawal of ICS is likely to be challenging and requires detailed conversations between patients and respiratory healthcare professionals.

scholarly journals Prediction of 30-Day Readmission for COPD Patients Using Accelerometer-Based Activity Monitoring

Sensors ◽  
2019 ◽  
Vol 20 (1) ◽  
pp. 217 ◽  
Author(s):  
Wen-Yen Lin ◽  
Vijay Kumar Verma ◽  
Ming-Yih Lee ◽  
Horng-Chyuan Lin ◽  
Chao-Sung Lai
Keyword(s):  
Activity Index ◽  
Airflow Obstruction ◽  
Chronic Obstructive Lung Disease ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Bode Index ◽  
Copd Patients ◽  
Proposed Model ◽  
Readmission Risk

Chronic obstructive pulmonary disease (COPD) claimed 3.0 million lives in 2016 and ranked 3rd among the top 10 global causes of death. Moreover, once diagnosed and discharged from the hospital, the 30-day readmission risk in COPD patients is found to be the highest among all chronic diseases. The existing diagnosis methods, such as Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019, Body-mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index, modified Medical Research Council (mMRC), COPD assessment test (CAT), 6-minute walking distance, which are adopted currently by physicians cannot predict the potential readmission of COPD patients, especially within the 30 days after discharge from the hospital. In this paper, a statistical model was proposed to predict the readmission risk of COPD patients within 30-days by monitoring their physical activity (PA) in daily living with accelerometer-based wrist-worn wearable devices. This proposed model was based on our previously reported PA models for activity index (AI) and regularity index (RI) and it introduced a new parameter, quality of activity (QoA), which incorporates previously proposed parameters, such as AI and RI, with other activity-based indices to predict the readmission risk. Data were collected from continuous PA monitoring of 16 COPD patients after hospital discharge as test subjects and readmission prediction criteria were proposed, with a 63% sensitivity and a 37.78% positive prediction rate. Compared to other clinical assessment, diagnosis, and prevention methods, the proposed model showed significant improvement in predicting the 30-day readmission risk.

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