scholarly journals Lysophosphatidic acid species are associated with exacerbation in chronic obstructive pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qingling Li ◽  
Weng Wong ◽  
Andrew Birnberg ◽  
Arindam Chakrabarti ◽  
Xiaoying Yang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Lysophosphatidic Acid ◽  
Controlled Trial ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Exacerbation Rate ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Exacerbation Risk

Abstract Background Chronic obstructive pulmonary disease (COPD) exacerbations are heterogenous and profoundly impact the disease trajectory. Bioactive lipid lysophosphatidic acid (LPA) has been implicated in airway inflammation but the significance of LPA in COPD exacerbation is not known. The aim of the study was to investigate the utility of serum LPA species (LPA16:0, 18:0, 18:1, 18:2, 20:4) as biomarkers of COPD exacerbation. Patients and methods LPA species were measured in the baseline placebo sera of a COPD randomized controlled trial. Tertile levels of each LPA were used to assign patients into biomarker high, medium, and low subgroups. Exacerbation rate and risk were compared among the LPA subgroups. Results The levels of LPA species were intercorrelated (rho 0.29–0.91). Patients with low and medium levels of LPA (LPA16:0, 20:4) had significantly higher exacerbation rate compared to the respective LPA-high patients [estimated rate per patient per year (95% CI)]: LPA16:0-low = 1.2 (0.8–1.9) (p = 0.019), LPA16:0-medium = 1.3 (0.8–2.0) (p = 0.013), LPA16:0-high = 0.5 (0.2–0.9); LPA20:4-low = 1.4 (0.9–2.1) (p = 0.0033), LPA20:4-medium = 1.2 (0.8–1.8) (p = 0.0089), LPA20:4-high = 0.4 (0.2–0.8). These patients also had earlier time to first exacerbation (hazard ratio (95% CI): LPA16:0-low = 2.6 (1.1–6.0) (p = 0.028), LPA16:0-medium = 2.7 (1.2–6.3) (p = 0.020); LPA20.4-low = 2.8 (1.2–6.6) (p = 0.017), LPA20:4-medium = 2.7 (1.2–6.4) (p = 0.021). Accordingly, these patients had a significant increased exacerbation risk compared to the respective LPA-high subgroups [odd ratio (95% CI)]: LPA16:0-low = 3.1 (1.1–8.8) (p = 0.030), LPA16:0-medium = 3.0 (1.1–8.3) (p = 0.031); LPA20:4-low = 3.8 (1.3–10.9) (p = 0.012), LPA20:4-medium = 3.3 (1.2–9.5) (p = 0.025). For the other LPA species (LPA18:0, 18:1, 18:2), the results were mixed; patients with low and medium levels of LPA18:0 and 18:2 had increased exacerbation rate, but only LPA18:0-low patients had significant increase in exacerbation risk and earlier time to first exacerbation compared to the LPA18:0-high subgroup. Conclusions The study provided evidence of association between systemic LPA levels and exacerbation in COPD. Patients with low and medium levels of specific LPA species (LPA16:0, 20:4) had increased exacerbation rate, risk, and earlier time to first exacerbation. These non-invasive biomarkers may aid in identifying high risk patients with dysregulated LPA pathway to inform risk management and drug development.

Control of chronic obstructive pulmonary disease exacerbations frequency in association with ENT organs abnormalities

2020 ◽  
Vol 29 (6) ◽  
pp. 716-724
Author(s):  
D. G. Pavlush ◽  
V. A. Nevzorova ◽  
E. A. Gilifanov ◽  
V. B. Shumatov ◽  
I. M. Martynenko
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
High Risk ◽  
Pulmonary Disease ◽  
Treatment Plan ◽  
Control Group ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Exacerbation Rate ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations

Chronic obstructive pulmonary disease (COPD) is a disease holding a stable position in morbidity and mortality structure in patients aged over 40 years.The aim of the study was to evaluate the condition of otorhinolaryngological (ENT) organs in patients with the COPD at different disease periods with subsequent analysis of COPD exacerbation rate based on the results of therapy regimen change according to the established comorbidity.Materials and Methods. Examination of ENT organs was performed in patients with COPD (n = 99) Patients from group 1 (n = 50) were treated at Pulmonary Department of the Regional State Budgetary Health Institution "Vladivostok Clinical Hospital No.1" for disease exacerbation; outpatients from group 2 (n = 49) had stable COPD course. Control group (n = 50) included patients without history of smoking and without respiratory and hearing disorders. All patients were matched by age and sex. Repeated examination was conducted in patients (n = 72) with stable COPD after 6 months.Results. It was observed that patients from groups 1 and 2 had different severity of disease symptoms, but equally high (> 2) risk of COPD exacerbation within 1 year. 50.0 and 42.9% of patients actively complained about the ENT organ-related conditions during the periods of COPD exacerbation and stable course, respectively. Among ENT organ diseases the most frequent were laryngeal diseases reported in 84.0 and 73.5% of patients with COPD exacerbation and stable course, respectively. The chronic catarrhal rhinitis and pharyngitis were revealed in 26 and 30% of patients with COPD exacerbation (p < 0.01). According to the data of 6-month study, the number of COPD exacerbations in high-risk patients with COPD using personal treatment plan for ENT-organ diseases was reduced by half, which had a positive effect on the condition of ENT-organs.Conclusion. The study showed that patients with COPD often ENT-organ-related complaints – in the exacerbation period about 50% of patients, and at stable course – 43%. Patients most often complain on glottic incompetence with the most pronounced symptoms at COPD exacerbation. Decreased number of COPD exacerbations by 2 times in patients with high risk of their occurrence and improvement of ENT organ condition were noted if ENT diseases were timely treated. ENT specialist consultation should be provided at dispensary observation organization for patients with COPD in order to personalize the treatment plan depending on the clinical situation.

β-Blockers and the Rate of Chronic Obstructive Pulmonary Disease Exacerbations

2019 ◽  
Vol 53 (12) ◽  
pp. 1249-1258
Author(s):  
Tracey L. Mersfelder ◽  
Dane L. Shiltz
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Controlled Trial ◽  
Initial Assessment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Search Terms ◽  
Β Blocker ◽  
Β Blockers

Objective: To review the rate of exacerbations relative to β-blocker use in patients with chronic obstructive pulmonary disease (COPD). Data Sources: A MEDLINE search (1953 to May 2019) was performed using the search terms beta-blockers, chronic obstructive pulmonary disease, and exacerbations. An EMBASE search was also performed using the search terms chronic obstructive lung disease and beta adrenergic receptor blocking agents (1970 to May 2019). References from the review of literature citations were also identified. Study Selection and Data Extraction: English-language studies assessing COPD exacerbations in patients prescribed a β-blocker were included. Any article not addressing exacerbations was excluded. Data Synthesis: A total of 15 articles were included; 7 articles showed no change, 1 provided mixed results, and 7 indicated a significant decrease in COPD exacerbations in a variety of exacerbation severities. Two of the studies differentiated between cardioselective and noncardioselective β-blockers. Relevance to Patient Care and Clinical Practice: This work represents an initial assessment of the use of β-blockers to reduce COPD exacerbations. The findings raise the question if β-blockers should be used more frequently in patients with COPD. Conclusions: Based on the limited number of studies that address β-blocker use in COPD, it appears that exacerbations are not increased and may be decreased. A randomized, placebo-controlled trial is in progress to possibly provide more definitive answers to this question. Until the trial is complete, β-blockers should not be withheld in COPD patients who have concurrent cardiovascular conditions, especially where there is a mortality benefit.

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