scholarly journals A 5 years follow-up for ischemic cardiac outcomes in patients with carotid artery calcification on panoramic radiographs confirmed by doppler ultrasonography in Turkish population

2020 ◽  
Vol 49 (4) ◽  
pp. 20190440 ◽  
Author(s):  
Ozlem Akkemik ◽  
Hakkı Kazaz ◽  
Sadik Tamsel ◽  
Nesrin Dündar ◽  
Sahin Sahinalp ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Doppler Ultrasonography ◽  
Turkish Population ◽  
Control Group ◽  
Chronic Obstructive ◽  
Vascular Events ◽  
Carotid Artery Calcification ◽  
Ct Angiogram ◽  
Diastolic Hypertension

Objective: To evaluate the diagnostic accuracy of digital panoramic radiograph (DPR) for detection of carotid artery calcification (CAC) confirmed by Doppler Ultrasonography (DUSG) and to clarify the relationship between between CAC identified by DPR and cardiovascular events through a 5 year follow-up period. Methods: Of 3600 consecutive patients examined, 158 patients presented with CAC as detected by DPR. The final study group was composed of 96 patients who had CAC confirmed by DUSG or CT angiogram. The control group was composed of 62 patients who has normal DUSG. The end point of the study was the occurrence of any cardiovascular event. Results: 72 (75%) of the 96 patients with CAC confirmed by DUSG (16 patients had significant stenosis) had bilateral and 24 (25%) had unilateral CAS as detected by DUSG. There was a low agreement between the examination results with a κ value of 0.488 (p < 0.005) for calcification. Study data revealed that smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and diastolic hypertension were significantly more common in patients with CAC than the control group (p < 0.05). During the follow-up period, 13 subjects had myocardial infarction and 1 subject died; in the control group, 1 patient died after MI and 1 patient died of a non-cardiac event. Conclusion: Patients with CAC detectable by DPR concomitant with COPD, DM, smoking or diastolic hypertension are more likely to suffer from vascular events. Therefore, patients with detectable carotid plaque in DPR require referral to a cardiovascular surgery clinic for further investigations.

scholarly journals The Prevalence of Carotid Artery Calcification on the Panoramic Radiographs in Cappadocia Region Population

2007 ◽  
Vol 01 (03) ◽  
pp. 132-138 ◽  
Author(s):  
Yildiray Sisman ◽  
Elif Tarim Ertas ◽  
Cumali Gokce ◽  
Ahmed Menku ◽  
Mustafa Ulker ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Turkish Population ◽  
Smoking History ◽  
Panoramic Radiographs ◽  
Carotid Artery Calcification ◽  
Medical Evaluation ◽  
Life Saving ◽  
Males And Females ◽  
School Of Dentistry ◽  
And Gender

ABSTRACTObjectives: The aim of this study is to determine retrospectively the presence of carotid artery calcifications (CACs) detected on panoramic radiographs (PRs) in a group of Turkish population. Further, the relationships between CACs and gender, life style, and medical history were evaluated.Methods:During the years 2004 to 2006, a random sample of 1282 PRs was collected from patients older than 40 years who were being treated by the School of Dentistry, Erciyes University. Of these 1282 PRs, 750 PRs were included in this study. Medical data was collected from the archival records of the dental school.Results: About 38 (5.06%) CACs were found on the PRs of 12 (4.5%) males and 26 (5.4%) females. The CAC prevalence was not significantly different between the males and females (P=0.583). These calcifications were unilateral in 26 (68.4%) and bilateral in 12 (31.6%) subjects. Of those in the positive group, there were 12 subjects (31.58%) with hyperlipidemia, 12 subjects (31.58%) with hypertension, 7 subjects (18.4%) with diabetes mellitus, 6 subjects (15.8%) with cardiovascular disease, and 6 subjects (15.8%) with smoking history.Conclusions: This study has the highest CACs prevalence in comparison to the other studies. Therefore, dentists caring for subjects with dental problems should carefully evaluate their PRs for the evidence of CACs, and refer them for medical evaluation as indicated. So, incidental findings could provide life-saving information. (Eur J Dent 2007;1:132-138)

Abstract 65: Effects of Immediate Blood Pressure Reduction on Two-Year Mortality and Major Disability in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jiang He ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Dali Wang ◽  
Chung-Shiuan Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Antihypertensive Treatment ◽  
Blood Pressure Reduction ◽  
Control Group ◽  
Antihypertensive Medications ◽  
Vascular Events

Although elevated blood pressure (BP) is very common in patients with acute ischemic stroke, the management of hypertension among them remains controversial. We tested the effect of immediate BP reduction on two-year mortality and major disability in acute ischemic stroke patients. The China Antihypertensive Trial in Acute Ischemic Stroke, a randomized, single-blind, blinded end-points trial, was conducted in 4,071 patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment (n=2,038) or to discontinue all antihypertensive medications (n=2,033) during hospitalization. Post-treatment follow-ups were conducted at 3, 12, and 24 months after hospital discharge. The primary outcome was a composite of death and major disability at the two-year follow-up visit. Mean SBP was reduced by 21.8 in the treatment group and 12.7 mm Hg in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mm Hg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At two-year follow-up, study outcomes were obtained in 1945 (95.4%) participants in the treatment group and 1925 (94.7%) in the control group. 78.8% of the patients in the treatment group and 72.6% in the control group reported the use of antihypertensive medications (p<0.001). SBP was 138.8 mmHg in the antihypertensive treatment group and 139.7 in the control group (p=0.02). Among patients in the antihypertensive treatment group, 24.5% (476/1945) died or had a major disability, compared with 22.1% (425/1925) in the control group (odds ratio 1.14 [95% CI 0.99 to 1.33], p=0.078). Hazard ratios for all-cause mortality (1.01 [0.81, 1.25], p=0.95), recurrent stroke (0.91 [0.73, 1.13], p=0.40), and vascular events (0.97 [0.79, 1.19], p=0.76) were not statistically significant comparing the antihypertensive treatment group to the control group. The effect of antihypertensive treatment did not differ by pre-defined subgroups. In conclusion, among patients with acute ischemic stroke, BP reduction with antihypertensive medications during hospitalization did not reduce or increase the composite outcome of death and major disability over two years.

Frequency and management of recurrent stenosis after carotid artery stent implantation

2005 ◽  
Vol 102 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Elad I. Levy ◽  
Ricardo A. Hanel ◽  
Tsz Lau ◽  
Christopher J. Koebbe ◽  
Naveh Levy ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Doppler Ultrasonography ◽  
Velocity Ratio ◽  
Content Type ◽  
Recurrent Stenosis ◽  
Diastolic Velocity ◽  
Lost To Follow Up ◽  
Fine Print

Object. To determine the rate of hemodynamically significant recurrent carotid artery (CA) stenosis after stent-assisted angioplasty for CA occlusive disease, the authors analyzed Doppler ultrasonography data that had been prospectively collected between October 1998 and September 2002 for CA stent trials. Methods. Patients included in the study participated in at least 6 months of follow-up review with serial Doppler studies or were found to have elevated in-stent velocities (> 300 cm/second) on postprocedure Doppler ultrasonograms. Hemodynamically significant (≥ 80%) recurrent stenosis was identified using the following Doppler criteria: peak in-stent systolic velocity at least 330 cm/second, peak in-stent diastolic velocity at least 130 cm/second, and peak internal carotid artery/common carotid artery velocity ratio at least 3.8. Follow-up studies were obtained at approximate fixed intervals of 1 day, 1 month, 6 months, and yearly. Angiography was performed in the event of recurrent symptoms, evidence of hemodynamically significant stenosis on Doppler ultrasonography, or both. Treatment was repeated because of symptoms, angiographic evidence of severe (≥ 80%) recurrent stenosis, or both of these. Stents were implanted in 142 vessels in 138 patients (all but five patients were considered high-risk surgical candidates and 25 patients were lost to follow-up review). For the remaining 112 patients (117 vessels), the mean duration of Doppler ultrasonography follow up was 16.42 ± 10.58 months (range 4–54 months). Using one or more Doppler criteria, severe (≥ 80%) in-stent stenosis was detected in six patients (5%). Eight patients underwent repeated angiography. Six patients (three with symptoms) required repeated intervention (in four patients angioplasty alone; in one patient conventional angioplasty plus Cutting Balloon angioplasty; and in one patient stent-assisted angioplasty). Conclusions. In a subset of primarily high-risk surgical candidates treated with stent-assisted angioplasty, the rates of hemodynamically significant restenosis were comparable to surgical restenosis rates cited in previously published works. Treatment for recurrent stenosis incurred no instance of periprocedure neurological morbidity.

scholarly journals The biochemical markers associated with TCD to evaluate the curative effect after Carotid Artery Stenting

2020 ◽  
Author(s):  
Xiaofan Yuan ◽  
Jianhong Wang ◽  
Lei Guo ◽  
Duozi Wang ◽  
Shu Yang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Biochemical Markers ◽  
Control Group ◽  
Serum Concentrations ◽  
Curative Effect ◽  
Severe Stenosis ◽  
Blood Samples ◽  
Surrogate Outcome ◽  
Post Operation

Abstract Introduction：This study associated the expression of GFAP and S100B in serum with the imaging tools (TCD and DWI) to confirm these cerebral biochemical markers as surrogate outcome methods for evaluating the curative effect after CAS.Methods and materials：72 patients with unilateral carotid stenosis who underwent CAS were enrolled in the operation group. The blood samples of the operation patients were collected on four different time points: T1: the day before operation; T2: 1 day (24 hours) after operation; T3: 3 days (72 hours) after operation; T4: 30 days after operation. The operation patients were performed on the MRI after CAS to evaluate the post-operative lesion and received the TCD to monitor the changes of hemodynamics. 47 patients who were excluded for carotid artery stenosis by DSA were selected as the control group. The blood samples of patients in control group were collected at D1 (before DSA) and D2 (24 hours after DSA). The concentrations of GFAP and S100B in serum were measured with ELISA.Results：(1) The MFV (pre-operation, post-operation, 30 days follow-up: 47.65±17.24, 62.37±18.25, 70.29±16.89; P<0.05) and PI (pre-operation, post-operation, 30 days follow-up: 0.78±0.21, 0.98±0.19, 1.02±0.20; P<0.05) increased significantly in the ipsilateral MCA after CAS. And at 30 days follow-up, the CVR improved significantly (post-operation, 30 days follow-up: 27.47±12.13, 31.92±10.94; P<0.05). Patients with different degrees of stenosis, the more severe stenosis in carotid artery, the more obvious improvement of CVR at the 30 days follow-up. (2) After CAS, the serum concentrations of GFAP and S100B increased to the peak at 24 hour after operation (T2), and then decrease gradually (T2>T3>T4; P < 0.05). Furthermore, the serum concentrations of GFAP (r=0.71, P<0.05) and S100B (r=0.78, P<0.05) correlated positively with CVR at 30 days after CAS. (3) 29/72 patients (40.28%) were shown the emerging hyperintense in DWI after CAS.Conclusion：Our finding proven that the trend of GFAP and S100B in serum after CAS had a positive correlation to the improved hemodynamics which was verified by TCD. We recommend the biochemical markers (GFAP and S100B) associated with TCD to evaluate the curative effect after CAS.

scholarly journals COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up

2020 ◽  
Vol 11 ◽  
pp. 204062232096161 ◽  
Author(s):  
Ricardo Polosa ◽  
Jaymin B Morjaria ◽  
Umberto Prosperini ◽  
Barbara Busà ◽  
Alfio Pennisi ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Reference Group ◽  
Electronic Cigarettes ◽  
Control Group ◽  
Chronic Obstructive ◽  
User Group ◽  
Exacerbation Rate ◽  
Copd Patients

Background and Aims: The long-term health effects of the use of electronic cigarettes (ECs) in patients with chronic obstructive pulmonary disease (COPD) are largely unexplored. We present findings from a 5-year prospective assessment of respiratory parameters in a cohort of COPD patients who substantially reduced conventional smoking or achieved abstinence by switching to ECs. Methods: Patients were evaluated prospectively for their measurements of respiratory exacerbations, spirometric indices, quality of life using the COPD assessment tool (CAT), 6-min walk distance (6MWD), as well as conventional cigarette consumption. Baseline measurements prior to switching to EC use were compared with follow-up visits at 12-, 24-, 48- and 60-months. Age- and sex-matched COPD patients reporting to be regular smokers (not using ECs) were the reference group for the analysis. Results: Complete data were available from 39 patients. Those in the EC user group achieved a marked decline in cigarette smoking or abstinence. COPD EC users had a significant diminution in COPD exacerbations; with the mean (±SD) exacerbation rate falling from 2.3 (±0.9) at baseline to 1.1 (±1.0) at 5 years ( p < 0.001), whereas no significant changes were observed in the control group. Significant and constant improvements in lung function, CAT scores and 6MWD were reported in the EC user group over the 5-year observation period compared with the reference group ( p < 0.05). Conclusion: The present study suggests that EC use may ameliorate objective and subjective COPD outcomes, and that the benefits gained appear to persist long term. EC use for abstinence and smoking reduction may ameliorate some of the harm resulting from tobacco smoking in COPD patients.

Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients

2012 ◽  
Vol 18 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Birthe Dinesen ◽  
Lisa KE Haesum ◽  
Natascha Soerensen ◽  
Carl Nielsen ◽  
Ove Grann ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Admission ◽  
Intervention Group ◽  
Home Monitoring ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Mean ◽  
Lost To Follow Up

We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health centre, general practitioner (GP) or the pulmonary hospital ward. They were randomized to usual care or tele-rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to follow-up. In the control group 51 patients were allocated to usual care and three patients were lost to follow-up. In the tele-rehabilitation group, the mean hospital admission rate was 0.49 per patient per 10 months compared to the control group rate of 1.17; this difference was significant ( P = 0.041). The mean cost of admissions was €3461 per patient in the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls, but the difference was not significant. Future work requires large-scale studies of prolonged home monitoring with more extended follow-up.

scholarly journals OP0219 THE ASSOCIATION OF PSORIATIC ARTHRITIS WITH ALL-CAUSE MORTALITY AND LEADING CAUSES OF DEATH IN PSORIATIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 131.1-131
Author(s):  
A. Haddad ◽  
W. Saliba ◽  
I. Lavi ◽  
A. Batheesh ◽  
S. Kasem ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Causes Of Death ◽  
Ischemic Heart ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
All Cause Mortality ◽  
History Of

Background:Data on the association between PsA and mortality remains conflicting as it has been hampered by small sample size with few events and the potential for confounders of selection and severity biases from clinic-based studies.Objectives:To examine the association between PsA and all-cause mortality in a cohort of PsA patients and matched controls, using data from a population-based large medical record database.Methods:Patients with newly diagnosis of PsA between January 1st, 2003 and December 31st, 2018 from the Clalit Health database were identified. 4 controls without PsA were selected and matched to cases of PsA by age (within 1 year), sex, ethnicity (Jewish vs. non-Jewish), and index date. The two groups were followed from the index date until the first occurrence of death from any cause or end of follow-up (June 30, 2019). Data on mortality and on the immediate cause of death was based on the Notification of Death form legally required by the Israeli Ministry of the Interior for every deceased person in the country. Demographic data including age, sex, ethnicity (Jewish or Arab), and socioeconomic status (SES) at inception were retrieved from the CHS database. Data regarding tobacco use (ever), obesity, body mass index, diabetes mellitus, hyperlipidemia, hypertension, ischemic heart disease, prior cerebrovascular accident, congestive heart failure, chronic renal failure, chronic obstructive pulmonary disease, cirrhosis, prior malignancy, psoriasis, and the concomitant use of glucocorticosteroids, conventional and biologic disease-modifying anti-rheumatic drugs (cDMARDs and bDMARDs, respectively) were extracted from the database.We estimated the attributable fraction of the various causes of death in PsA patients and compared it to the proportionate mortality rate (PMR) of the leading causes of death in Israel during 2014-2016 based on a recently published report by the Central Bureau of Statistics. Cox proportional hazard regression models were used to estimate the crude and the multivariate adjusted hazard ratio (HR) for the association between PsA and all-cause mortality, as well as for factors associated with mortality within the PsA group.Results:A total of 5275 PsA patients were identified between 2003 and 2018 and where matched to 21,011 controls based on age, sex, and ethnicity. The mean age was 51.7 ± 15.4 years of whom 53% were females. More individuals in the PsA group were smokers, obese, with diabetes, hypertension, and dyslipidemia, as well as with a history of ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure and cirrhosis than patients in the control group, and 38.2% of PsA patients were on b-DMARDS. Overall 471 (8.9%) patients died in the PsA group compared to 1,668 (7.9%) in the control group during a mean follow-up of 7.2 ± 4.4 years. The crude HR for the association of PsA and all-cause mortality was 1.16 (95% CI, 1.042-1.29). However, the association was not significant on multivariate analysis with HR of 1.096 (95% CI, 0.977-1.229).In PsA patients, malignancy was the leading cause of death, constituting 26% of all deaths, followed by ischemic heart disease 15.8%, diabetes 6.2%, cerebrovascular diseases 5.5% and septicemia 5.5%, in keeping with the order of the leading causes of death in the general population of Israel during 2014-2016 as recently reported by the Central Bureau of Statistics.On multivariate model Cox regression analysis, male sex, increased body mass index, increased Charlson comorbidity index scores and history of hospitalization in a year prior to death were associated with higher mortality, whereas treatment bDMARDs and cDMARDs were associated with a lower relative risk of death.Conclusion:No clinically relevant increase in mortality rate was observed in PsA patients from the period 2003-2018. The most common causes of specific proportionate mortality rates in our cohort were similar to those in the general population.Disclosure of Interests:None declared

scholarly journals CAROTID ARTERY STENOSIS

2017 ◽  
Vol 24 (08) ◽  
pp. 1126-1131
Author(s):  
Muhammad Ishaq Khattak ◽  
Faramoz Khan ◽  
Zahid Fida ◽  
Adnan Zar
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Doppler Ultrasound ◽  
Doppler Ultrasonography ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Cross Sectional Study ◽  
Vascular Events ◽  
Cross Sectional ◽  
Carotid Artery Atherosclerosis

Objectives: The objective of this study is to determine the frequency of carotidartery atherosclerosis using color Doppler ultrasound in ischemic stroke patients. StudyDesign: Cross-sectional study. Period: July 2015 to June 2016. Setting: Khyber TeachingHospital, Peshawar. Method: Doppler ultrasonography was done to assess carotid artery statusin patients diagnosed with cerebral infarction. Results: Data comprised of 174 ischemic strokepatients between ages 37-95 years. 111 were males whereas 63 were males. Mean age wasfound to be 64.03±11.71 years. Doppler ultrasound revealed carotid artery atherosclerosis in52.3% (n=91) patients with 57% males and 34% females. Right carotid artery involvement wasfound in 28 patients and left carotid artery involvment in 38 patients. Both carotid arteries wereinvolved in 25 patients. Conclusion: We have concluded that carotid artery atherosclerosis is anindependent predictor for future vascular events. Our study reports carotif artery atherosclerosisin 52.3% patients with ischemic stroke.

scholarly journals Retrospective study on early outcomes of carotid stenting

2021 ◽  
pp. 94-97
Author(s):  
Saurabh Sharma ◽  
Prashant Raj Singh ◽  
Ram Kumar Goyal ◽  
Raghavendra Kumar Sharma ◽  
Yashuhiro Yamada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Doppler Ultrasonography ◽  
Carotid Stenting ◽  
Artery Stenosis ◽  
Minor Stroke ◽  
Safe Alternative ◽  
Asymptomatic Patients

Objective: This study is conducted to evaluate the early events after Carotid artery stenting (CAS) among our patients in a single institute. Methods: This study was conducted on 40 patients. These patients underwent stenting of extracranial carotid arteries. Stenting was performed on symptomatic patients with carotid artery stenosis of more than 50 per cent of asymptomatic patients with more than 70 per cent carotid artery stenosis on Doppler ultrasonography. Follow up period for this study was of one month.  Results: 40 patients who underwent CAS between August 2018 and June 2019 were included in the study. Self-expandable hybrid stents were implanted in all patients and pre or poststent-dilatation was performed if required after implantation. None of the patients suffered from a stroke, myocardial infarction or death due to CAS during their hospital stay. Only one patient had a minor stroke during follow up, which was managed conservatively. No transient ischemic attack (TIA), myocardial infarction or death during the follow-up period. Re-stenosis was not observed in the follow-up carotid Doppler ultrasonography; flow rates were within normal limits. Conclusions: Carotid stenting is a safe alternative to CEA (carotid endarterectomy) in the treatment of carotid stenosis regardless of age. CAS with cerebral protection can be performed safely in patients who are at high surgical risk, with low perioperative morbidity and mortality. The durability of the procedure must be determined with a longer follow-up. Further high-quality RCTs are required to address other shortcomings and controversies.

scholarly journals The effects of positioning and pursed-lip breathing exercise on dyspnea and anxiety status in patients with chronic obstructive pulmonary disease

2019 ◽  
Vol 9 (6) ◽  
pp. 41
Author(s):  
Salwa A. Mohamed
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Assessment Scale ◽  
University Hospital ◽  
Control Group ◽  
Chronic Obstructive ◽  
Breathing Exercise ◽  
Obstructive Pulmonary Disease ◽  
And Control

Background and objective: Chronic obstructive pulmonary disease (COPD) remains a significant burden for health. It is one of the most common respiratory disease and leads to limitation of airflow as well as deteriorating health status. The aim of the study was to determine the effects of positioning and pursed lip breathing exercise on dyspnea and anxiety status in patients with chronic obstructive pulmonary disease.Methods: The study was carried in the outpatient clinics in Mansoura University Hospital & Chest Hospital at Mansoura region, utilizing a quasi-experimental study design on sixty patients diagnosed COPD. Participation was randomized into both groups (study group and control group). Pretest, posttest and follow-up evaluation was done using Dyspnea Assessment Scale, Anxiety Assessment Scale and Demographic and Medical History Questionnaires (MHQ). The researcher established exercise program aimed at effecting dyspnea and anxiety in chronic obstructive pulmonary disease patients to help improve breathing and control anxiety. The research was accomplished over four steps namely assessment, planning, implementation and evaluation. Each patient was evaluated at baseline, immediately and three months after implementation of program.Results: There were statistically significant improvements after intervention of program on dyspnea symptoms and anxiety status at post and follow-up test (p < .05). There was a statistically significant improvement in temperature (T), heart rate (HR), blood pressure (BP) and respiratory rate (RR) throughout study (p < .05) after intervention. Also there are positive relation between anxiety and dyspnea after intervention.Conclusions: Developing breathing technique and forward leaning position in COPD patients help to improve physiological outcomes, dyspnea symptoms and anxiety status after implementing of program. It is recommended to implement exercise training program as a part of treatment by health professionals in the clinical setting.

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