Can GOLD Stage 0 Provide Information of Prognostic Value in Chronic Obstructive Pulmonary Disease?

BACKGROUND: An adequate evaluation of exacerbations is a primary objective in managing patients with chronic obstructive pulmonary disease (COPD).OBJECTIVES: To define the profile of health status recovery during severe exacerbations of COPD using the COPD Assessment Test (CAT) questionnaire and to evaluate its prognostic value.METHODS: Forty-five patients with previous COPD diagnoses who were hospitalized due to severe exacerbation(s) were included in the study. These patients were treated by their respective physicians following current recommendations; health status was assessed daily using the CAT questionnaire. The CAT score, spirometry and recurrent hospitalizations were recorded one and three months after hospital discharge.RESULTS: Global initiative for chronic Obstructive Lung Disease (GOLD) stage was an independent determinant for increased CAT score during the first days of exacerbation with respect to postexacerbation values. From hospitalization day 5, the CAT score was similar to that obtained in the stable phase. Body mass index, GOLD stage and education level were related to health status recovery pattern. CAT score increase and the area under the curve of CAT recovery were inversely related to the forced expiratory volume in 1 s achieved three months after discharge (r= −0.606; P<0.001 and r= −0.532; P<0.001, respectively). Patients with recurrent hospitalizations showed higher CAT score increases and slower recovery.CONCLUSIONS: The CAT detects early health status improvement during severe COPD exacerbations. Its initial worsening and recovery pattern are related to lung function and recurrent hospitalizations.

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Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00066-x ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Gamal Agmy ◽

Manal A. Mahmoud ◽

Azza Bahaa El-Din Ali ◽

Mohamed Adam

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Cutoff Point ◽

Whole Body ◽

Significant Response ◽

Chronic Obstructive ◽

Lung Volumes ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Clinically Significant

Abstract Background Reversibility measured by spirometry in chronic obstructive pulmonary disease (COPD) is defined as an increase in forced expiratory volume in first second (FEV1) that is both more than 12% and 200 mL above the pre-bronchodilator value in response to inhaled bronchodilators. FEV1 only may not fully reverberate the changes caused by reduction in air trapping or hyperinflation. To date, the studies that examined the effect of inhaled bronchodilators (BD) on residual volume (RV) and total lung capacity (TLC) are limited. This study was carried out to assess the differences between flow and volume responses after bronchodilator reversibility testing in patients with different COPD GOLD stages (GOLD stage I to stage IV). Spirometry and whole body plethysmography were done before and 15 min after inhalation of 400 μg salbutamol. Results Majority (53.3%) of cases were volume responders, 18.7% were flow responders, 20% were flow and volume responders, and 8% were non responders. Significant increase in Δ FEV1% was found in 15% of cases while 55% showed a significant increase in Δ FVC (P= < 0.001). Mean difference of Δ FVC (L) post BD was significantly increased with advancing GOLD stage (P= 0.03). A cutoff point > 20% for Δ RV% had 70% sensitivity and 60% specificity and > 12% for Δ TLC% showed 90% sensitivity and 45% specificity for prediction of clinically significant response to BD based on FEV1. A cutoff point > 18% for Δ RV% had 78% sensitivity and 29% specificity and > 14% for Δ TLC% had 50% sensitivity and 70% specificity for prediction of clinically significant response to BD based on FVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilators with advancing GOLD stage. Measurement of lung volumes in addition to the standard spirometric indices is recommended when determining bronchodilator response in COPD patients.

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Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity

Journal of Applied Physiology ◽

10.1152/japplphysiol.00085.2009 ◽

2009 ◽

Vol 106 (6) ◽

pp. 1902-1908 ◽

Cited By ~ 102

Author(s):

Roberto Rodríguez-Roisin ◽

Mitra Drakulovic ◽

Diego A. Rodríguez ◽

Josep Roca ◽

Joan Albert Barberà ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Gas Exchange ◽

Pulmonary Disease ◽

Forced Expiratory Volume ◽

Pulmonary Gas Exchange ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Stage 1

Chronic obstructive pulmonary disease (COPD) is characterized by a decline in forced expiratory volume in 1 s (FEV1) and, in many advanced patients, by arterial hypoxemia with or without hypercapnia. Spirometric and gas exchange abnormalities have not been found to relate closely, but this may reflect a narrow range of severity in patients studied. Therefore, we assessed the relationship between pulmonary gas exchange and airflow limitation in patients with COPD across the severity spectrum. Ventilation-perfusion (V̇A/Q̇) mismatch was measured using the multiple inert gas elimination technique in 150 patients from previous studies. The distribution of patients according to the GOLD stage of COPD was: 15 with stage 1; 40 with stage 2; 32 with stage 3; and 63 with stage 4. In GOLD stage 1, AaPo2 and V̇A/Q̇ mismatch were clearly abnormal; thereafter, hypoxemia, AaPo2, and V̇A/Q̇ imbalance increased, but the changes from GOLD stages 1–4 were modest. Postbronchodilator FEV1 was related to PaO2 ( r = 0.62) and PaCO2 ( r = −0.59) and to overall V̇A/Q̇ heterogeneity ( r = −0.48) ( P < 0.001 each). Pulmonary gas exchange abnormalities in COPD are related to FEV1 across the spectrum of severity. V̇A/Q̇ imbalance, predominantly perfusion heterogeneity, is disproportionately greater than airflow limitation in GOLD stage 1, suggesting that COPD initially involves the smallest airways, parenchyma, and pulmonary vessels with minimal spirometric disturbances. That progression of V̇A/Q̇ inequality with spirometric severity is modest may reflect pathogenic processes that reduce both local ventilation and blood flow in the same regions through airway and alveolar disease and capillary involvement.

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ALVEOLAR MACROPHAGE ACTIVITY AND ITS CORRELATION WITH BURDEN OF REACTIVE OXYGEN SPECIES IN BRONCHOALVEOLAR FLUID AND IN THE SERUM OF PATIENTS AFFECTED BY CHRONIC OBSTRUCTIVE PULMONARY DISEASE III-IV GOLD STAGE

CHEST Journal ◽

10.1378/chest.136.4_meetingabstracts.87s-c ◽

2009 ◽

Vol 136 (4) ◽

pp. 87S

Author(s):

Pietro B. Bracciale ◽

Salvatore Bellanova ◽

Antonio Castagnaro ◽

Cristina Scoditti ◽

Giuseppe Valerio

Keyword(s):

Reactive Oxygen Species ◽

Chronic Obstructive Pulmonary Disease ◽

Alveolar Macrophage ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Oxygen Species ◽

Obstructive Pulmonary Disease ◽

Macrophage Activity ◽

Gold Stage ◽

Bronchoalveolar Fluid

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Association of Anthropometric Indexes With Disease Severity in Male Patients With Chronic Obstructive Pulmonary Disease in Qazvin, Iran

American Journal of Men s Health ◽

10.1177/1557988318760053 ◽

2018 ◽

Vol 12 (4) ◽

pp. 1023-1028 ◽

Cited By ~ 3

Author(s):

Ramin Sami ◽

Raheleh Sadegh ◽

Neda Esmailzadehha ◽

Sanaz Mortazian ◽

Masoomeh Nazem ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Disease Severity ◽

Stage Iv ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Increased Risk ◽

Anthropometric Indexes ◽

Male Patients

Malnutrition is one of the most important factors that lead to lower quality of life in patients suffering from chronic obstructive pulmonary disease (COPD). There are several methods for assessing malnutrition including anthropometric indexes. The aim of this study was to determine the association of anthropometric indexes with disease severity in male patients with COPD in Qazvin, Iran. This cross-sectional study was conducted on 72 male patients with COPD in Qazvin, Iran, from May to December 2014. Spirometry was performed for all participants. Disease severity was determined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. Body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TSF) were measured. MAMC and TSF were categorized into three subgroups as <25th P, between 25th P and 75th P, and >75th P (Where P is the abbreviation for percentile.). Data were analyzed using ANOVA and logistic regression analysis. Mean age was 60.23 ± 11.39 years. Mean BMI was 23.23 ± 4.42 Kg/m2, mean MAMC was 28.34 ± 3.72 cm2, and mean TSF was 10.15 ± 6.03 mm. Mean BMI and MAMC in the GOLD stage IV were significantly lower than other stages. Of 72, 18.1% were underweight while 6.9% were obese. The GOLD stage IV was associated with 16 times increased risk of underweight and nine times increased risk of MAMC < 25th P. Disease severity was associated with BMI and MAMC as indexes of malnutrition in patients with COPD in the present study. The GOLD stage IV was associated with increased risk of underweight and low MAMC.

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Long noncoding RNAs antisense noncoding RNA in the INK4 locus (ANRIL) correlates with lower acute exacerbation risk, decreased inflammatory cytokines, and mild GOLD stage in patients with chronic obstructive pulmonary disease

Journal of Clinical Laboratory Analysis ◽

10.1002/jcla.22678 ◽

2018 ◽

Vol 33 (2) ◽

pp. e22678 ◽

Cited By ~ 5

Author(s):

Jianli Ge ◽

Shasha Geng ◽

Hua Jiang

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Acute Exacerbation ◽

Inflammatory Cytokines ◽

Noncoding Rna ◽

Noncoding Rnas ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Exacerbation Risk

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Abstract 16961: Time-dependent Markers of Chronic Obstructive Pulmonary Disease Severity and Change are Associated With Increased Risk of Mortality in the General Heart Failure Population: A National Study of 50,114 Patients From the United Kingdom

Circulation ◽

10.1161/circ.132.suppl_3.16961 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Claire A Rushton ◽

Lucy Riley ◽

Duwarakan K Satchithananda ◽

Peter W Jones ◽

Umesh T Kadam

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Forced Expiration ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Risk Of Mortality ◽

Increased Risk

Purpose: Heart failure (HF) carries poor prognosis which changes over time. Chronic obstructive pulmonary disease (COPD) is common in HF and increases risk of mortality but how COPD severity and change influences HF prognosis is unknown. We hypothesised that in the HF general population, comorbidity stratification by increasing severity and longitudinal change would be associated with increased mortality. Methods: We used a case-control study nested within the UK Clinical Practice Research Datalink database (12-year time-period to 2014), of newly diagnosed HF patients aged over 40 years. Using risk set sampling, four controls were matched to cases on calendar and follow-up time. Routinely collected clinical measures of severity and change for COPD were (i) forced expiration volume in 1 second (FEV 1 ) stages, defined by Global Initiatives for Chronic Obstructive Lung Disease (GOLD) guidelines and (ii) prescribed medications in two time-windows covering 1-year prior to the match date. Conditional logistic regression was used to estimate risk ratios (RR) for all-cause mortality adjusted for known confounders. Results: Of the 50,114 HF sample, 5,848 (11.7%) had COPD and of these 62% died during follow-up compared to 52% of patients without COPD. COPD comorbidity risk associated with mortality stratified by GOLD stages was as follows: stage 1; adjusted RR 1.73 (95% CI 1.50-1.99) to stage 4; 3.14 (2.65, 3.73). Estimates for COPD FEV 1 change compared to no COPD were: GOLD stage same or better; 2.15 (1.97, 2.34) and GOLD stage worse; 2.70 (2.30, 3.17). The mortality estimates for medications severity were: inhalers only 1.13 (1.07,1.19), oral steroids; 1.83 (1.69,1.97) and oxygen; 2.94 (2.47, 3.51). The estimates for medications change were: no new steroids or oxygen; 1.22, (1.16, 1.28), new steroids but not oxygen; 1.84, (1.67,1.28) and new on oxygen; 3.41, (2.71,4.29). Conclusions: COPD is an important and common comorbidity in HF. Our results show that worse COPD severity and recent change based on routinely collected clinical data was associated with increased mortality and provides key prognostic information for clinical assessment in practice.

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