Correlation between cardiorespiratory coupling and six-minute walking tests in patients with chronic obstructive pulmonary disease

Abstract Background : Cardiovascular disease is a common comorbidity and cause of mortality among patients with chronic obstructive pulmonary disease (COPD). However, the interaction between the heart and lungs in COPD patients has yet to be fully elucidated.Aim : Our objective in this study was to characterize cardiorespiratory interactions in terms of cardiorespiratory coupling (CRC) using the synchrogram index of the heart rate and respiration flow signals.Methods : This prospective study examined 10 normal subjects and 55 COPD patients. Linear regression and forward stepwise regression were used to determine the correlation between the synchrogram index and the six-minute walking test.Results : K-means clustering analysis was used to separate the 55 COPD patients into a synchronized group (median 0.89 (0.64-0.97), n=43) and a desynchronized group (median 0.23 (0.02-0.51), n=12) based on the synchrogram index. In this study, the synchrogram index was significantly correlated with the six-minute walking distance (r 2 =0.3, sigma T=0.02) and the distance saturation product (r 2 =0.3, sigma T =0.03). Note that age was a significant confounding factor.Conclusion : The synchrogram index shows clinical potential for the stratification of COPD patients for treatment.

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Inspiratory muscle strength in chronic obstructive pulmonary disease depending on disease severity

Clinical Science ◽

10.1042/cs20060362 ◽

2007 ◽

Vol 113 (5) ◽

pp. 243-249 ◽

Cited By ~ 18

Author(s):

Hans-Joachim Kabitz ◽

Stephan Walterspacher ◽

David Walker ◽

Wolfram Windisch

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Muscle Strength ◽

Pulmonary Disease ◽

Disease Severity ◽

Inspiratory Muscle ◽

Walking Distance ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Inspiratory Muscle Strength

Staging criteria for COPD (chronic obstructive pulmonary disease) include symptoms and lung function parameters, but the role of reduced inspiratory muscle strength related to disease severity remains unclear. Therefore the present study tested whether inspiratory muscle strength is reduced in COPD and is related to disease severity according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria and assessed its clinical impact. PImax (maximal inspiratory mouth occlusion pressure), SnPna (sniff nasal pressure) and TwPmo (twitch mouth pressure) following bilateral anterior magnetic phrenic nerve stimulation were assessed in 33 COPD patients (8 GOLD0, 6 GOLDI, 6 GOLDII, 7 GOLDIII and 6 GOLDIV) and in 28 matched controls. Furthermore, all participants performed a standardized 6 min walking test. In comparison with controls, PImax (11.6±2.5 compared with 7.3±3.0 kPa; P<0.001), SnPna (9.7±2.5 compared with 6.9±3.3 kPa; P<0.001) and TwPmo (1.6±0.6 compared with 0.8±0.4 kPa; P<0.001) were markedly lower in COPD patients. TwPmo decreased with increasing COPD stage. TwPmo was correlated with walking distance (r=0.75; P<0.001), dyspnoea (r=−0.61; P<0.001) and blood gas values following exercise (r>0.57; P<0.001). Inspiratory muscle strength, as reliably assessed by TwPmo, decreased with increasing severity of COPD and should be considered as an important factor in rating disease severity and to reflect burden in COPD.

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Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease

Journal of Applied Physiology ◽

10.1152/jappl.1983.55.1.8 ◽

1983 ◽

Vol 55 (1) ◽

pp. 8-15 ◽

Cited By ~ 193

Author(s):

F. Bellemare ◽

A. Grassino

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Normal Subjects ◽

Chronic Obstructive ◽

Cycle Duration ◽

Inspiratory Time ◽

Obstructive Pulmonary Disease ◽

Transdiaphragmatic Pressure ◽

Copd Patients ◽

Gastric Pressure

The fatigue threshold of the human diaphragm in normal subjects corresponds to a transdiaphragmatic pressure (Pdi)-inspiratory time integral (TTdi) of about 15% of Pdimax. The TTdi of resting ventilation was measured in 20 patients with chronic obstructive pulmonary disease (COPD) and ranged between 1 and 12% of Pdimax (mean 5%). TTdi was significantly related to total airway resistance (Raw) (r = 0.57; P less than 0.05). Five of these patients were asked to voluntarily modify their TI/TT (ratio of inspiratory time to total cycle duration; from 0.33 to 0.49) so as to increase their TTdi from a control value of 8% to an imposed value of 17% of Pdimax. The imposed pattern induced a progressive decline in the high-frequency (150-350 Hz)/low-frequency (20-40 Hz) power ratio (H/L) of the diaphragm electromyogram (fatigue pattern), quantitatively similar to that seen in normal subjects breathing with similar TTdi levels. The decay in H/L was followed by a progressive fall in mean Pdi meanly due to decrease in gastric pressure swings. It is concluded that 1) the force reserve of the diaphragm in COPD patients is decreased because of a decrease in Pdimax; 2) the remaining force reserve of the diaphragm can be exhausted by even minor modifications in the breathing pattern; and 3) at a TI/TT of 0.40 our COPD patients can increase their mean Pdi 3-fold before reaching a fatiguing pattern of breathing compared with 8-fold in normal subjects.

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FKBP5 rs4713916: A Potential Genetic Predictor of Interindividual Different Response to Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease in a Real-Life Setting

International Journal of Molecular Sciences ◽

10.3390/ijms20082024 ◽

2019 ◽

Vol 20 (8) ◽

pp. 2024 ◽

Cited By ~ 4

Author(s):

Patrizia Russo ◽

Carlo Tomino ◽

Alessia Santoro ◽

Giulia Prinzi ◽

Stefania Proietti ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Real Life ◽

Walking Distance ◽

Chronic Obstructive ◽

Forced Expiration ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Glucocorticoid Receptor Gene

Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and manageable lung disease characterized by large heterogeneity in disease presentation and grades impairment. Inhaled corticosteroids (ICS) are commonly used to manage COPD/COPD-exacerbation. The patient’s response is characterized by interindividual variability without disease progression/survival modification. Objectives: We hypothesize that a therapeutic intervention may be more effective if single nucleotide polymorphisms (SNPs) are investigated. Methods: In 71 COPD patients under pulmonary rehabilitation, a small number of powerful SNPs, selected according to current literature, were analyzed; namely the glucocorticoid receptor gene NR3C1 (rs6190/rs6189/rs41423247), the glucocorticoid-induced transcript 1 gene (GLCCI1 rs37972), and the related co-chaperone FKBP5 gene (rs4713916). MDR1 rs2032582 was also evaluated. Lung function outcomes were assessed. Results: A significant association with functional outcomes, namely FEV1 (forced expiration volume/one second) and 6MWD (six-minutes walking distance), was found for rs4713916 and weakly for rs37972. The genotype rs4713916(GA) and, in a lesser extent, the genotype rs37972(TT), were more favorable than the wild-type. Conclusions: Our study supports a possible picture of pharmacogenomic control for COPD intervention. rs4713916 and, possibly, rs37972 may be useful predictors of clinical outcome. These results may help to tailor an optimal dose for individual COPD patients based on their genetic makeup.

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Cardiorespiratory Coupling is Associated With Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease

10.21203/rs.3.rs-99704/v1 ◽

2020 ◽

Author(s):

Yu-Chen Huang ◽

Ting-Yu Lin ◽

Hau-Tieng Wu ◽

Po-Jui Chang ◽

Chun-Yu Lo ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Regression Analysis ◽

Pulmonary Disease ◽

Exercise Capacity ◽

Clustering Analysis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Multivariable Regression ◽

Cardiorespiratory Coupling

Abstract Background: Although comorbidites of cardiovascular disease is common in patients with chronic obstructive pulmonary disease (COPD), the interaction between the heart and lungs in COPD patients has yet to be further elucidated. Synchrogram index is a new parameter that can quantify this interaction and has the potential to apply in COPD patients. Aim: Our objective in this study was to characterize cardiorespiratory interactions in terms of cardiorespiratory coupling (CRC) using the synchrogram index of the heart rate and respiratory flow signals in patients with chronic obstructive pulmonary disease. Methods: This is a cross-sectional and a preliminary data from a prospective study, examining 55 COPD patients. K-means clustering analysis was applied to cluster COPD patients based on synchrogram index. Linear regression and multivariable regression analysis were used to determine the correlation between the synchrogram index and the exercise capacity assessed by six-minute walking test (6MWT).Results: The 55 COPD patients were separated into a synchronized group (median 0.89 (0.64-0.97), n=43) and a desynchronized group (median 0.23 (0.02-0.51), n=12) based on K-means clustering analysis. Synchrogram index was correlated significantly with six minutes walking distance (r=0.42, p=0.001) and distance saturation product (r= 0.41, p=0.001) assessed by 6MWT, and still was an independent variable by multivariable regression analysis.Conclusion: This is the first result studying the heart-lung interaction in terms of cardiorespiratory coupling in COPD patients by the synchrogram index, and COPD patients are clustered into synchronized and desynchronized groups. Cardiorespiratory coupling is associated with exercise capacity in patients with COPD.

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Cardiorespiratory coupling is associated with exercise capacity in patients with chronic obstructive pulmonary disease

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01400-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yu-Chen Huang ◽

Ting-Yu Lin ◽

Hau-Tieng Wu ◽

Po-Jui Chang ◽

Chun-Yu Lo ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Regression Analysis ◽

Pulmonary Disease ◽

Exercise Capacity ◽

Clustering Analysis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Multivariable Regression ◽

Cardiorespiratory Coupling

Abstract Background The interaction between the pulmonary function and cardiovascular mechanics is a crucial issue, particularly when treating patients with chronic obstructive pulmonary disease (COPD). Synchrogram index is a new parameter that can quantify this interaction and has the potential to apply in COPD patients. Our objective in this study was to characterize cardiorespiratory interactions in terms of cardiorespiratory coupling (CRC) using the synchrogram index of the heart rate and respiratory flow signals in patients with chronic obstructive pulmonary disease. Methods This is a cross-sectional and preliminary data from a prospective study, which examines 55 COPD patients. K-means clustering analysis was applied to cluster COPD patients based on the synchrogram index. Linear regression and multivariable regression analysis were used to determine the correlation between the synchrogram index and the exercise capacity assessed by a six-minute walking test (6MWT). Results The 55 COPD patients were separated into a synchronized group (median 0.89 (0.64–0.97), n = 43) and a desynchronized group (median 0.23 (0.02–0.51), n = 12) based on K-means clustering analysis. Synchrogram index was correlated significantly with six minutes walking distance (r = 0.42, p = 0.001) and distance saturation product (r = 0.41, p = 0.001) assessed by 6MWT, and still was an independent variable by multivariable regression analysis. Conclusion This is the first result studying the heart–lung interaction in terms of cardiorespiratory coupling in COPD patients by the synchrogram index, and COPD patients are clustered into synchronized and desynchronized groups. Cardiorespiratory coupling is associated with exercise capacity in patients with COPD.

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Integrated community-based interventions for chronic obstructive pulmonary disease (COPD)：A systematic review and meta-analysis (Preprint)

10.2196/preprints.32402 ◽

2021 ◽

Author(s):

Zihui Wang ◽

Guannan Cai ◽

Zhiqing Zhan ◽

Yutong Chen ◽

Qing Zhang ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Outcomes ◽

Pulmonary Disease ◽

Meta Analysis ◽

Walking Distance ◽

Chronic Obstructive ◽

Community Based Interventions ◽

Community Based ◽

Obstructive Pulmonary Disease ◽

Copd Patients

BACKGROUND Limited evidence supports integrated community-based interventions for chronic obstructive pulmonary disease (COPD) patients. We aimed to assess whether integrated community-based interventions could result in better health outcomes. OBJECTIVE We aimed to assess whether integrated community-based interventions could result in better health outcomes. METHODS Relevant articles published from January 1, 2005, to October 15, 2020 were obtained. A total of 28 reports with randomized controlled trials (RCTs) were finally included in this meta-analysis. RESULTS Integrated community-based interventions could reduce all-cause hospitalization days per patient [weighted mean difference (95% confidence interval) -1.50 (-2.39, -0.61)], improve 6-minutes walking distance [WMD (95% CI) 10.75 (10.64, 10.86)], and reduce St.George's Respiratory Questionnaire total score per year [WMD (95% CI) -3.36 (-5.30, -1.42)], while could not reduce yearly decline in the lung function, all-cause mortality and all-cause hospital admissions in COPD patients. The efficiency of integrated community-based interventions might attribute to the implements of physical activity, medication management, self-management and long-term intervention (i.e., >12 months). CONCLUSIONS Integrated community-based interventions may have a potential to improve health-related outcomes for COPD.

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A Different Aproach of Chronic Obstructive Pulmonary Disease Severity and Plastic Medical Devices Used for Oxygenotherapy

Materiale Plastice ◽

10.37358/mp.19.2.5174 ◽

2019 ◽

Vol 56 (2) ◽

pp. 295-300 ◽

Cited By ~ 4

Author(s):

Doina Ecaterina Tofolean ◽

Gilda Popescu ◽

Ioan Anton Arghir ◽

Mirela Frandes ◽

Ariadna Petronela Fildan

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Depression Scale ◽

Walking Distance ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Scale Scores ◽

At Home

A very common questionnaire, used to evaluate the health status of Chronic Obstructive Pulmonary Disease (COPD) patients, COPD assessment test (CAT), was applied to finding correlations between the items of CAT and other tests used in the same category of COPD patients. A sample of 56 male COPD patients, aged between 51 and 74 years, mean 63.86 (�5.55), half of them receiving long-term oxygen therapy, using transparent, hypoallergenic plastic masks or nasal cannulas, answered to CAT mostly choosing single items, statistically significant correlated with the Hospital Anxiety and Depression Scale scores (HADs), like walking up hills and stairs (r = 0.412, p[ 0.01), doing activities at home (r = 0.329, p[ 0.01), confidence leaving my home (r = 0.409, p[ 0.001), sleep (r = 0.277, p[ 0.01), and energy (r = 0.387, p[ 0.01), but CAT item walking up hills and stairs correlated better to 6 min walking distance (6MWD) (r = -0.581, p[ 0.01). The most significant correlations were found between 3 items of CAT as walking up hills and stairs, limitations doing activities at home and confidence leaving home in a most powerful and depression scores and 6MWD.

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Validation of peripheral arterial tonometry as tool for sleep assessment in chronic obstructive pulmonary disease

Scientific Reports ◽

10.1038/s41598-019-55958-2 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Nils Henrik Holmedahl ◽

Odd-Magne Fjeldstad ◽

Harald Engan ◽

Ingvild West Saxvig ◽

Janne Grønli

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Normal Subjects ◽

Sleep Stages ◽

Apnea Hypopnea Index ◽

Chronic Obstructive ◽

Peripheral Arterial Tonometry ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Obstructive Sleep

AbstractObstructive sleep apnea (OSA) worsens outcomes in Chronic Obstructive Pulmonary Disease (COPD), and reduced sleep quality is common in these patients. Thus, objective sleep monitoring is needed, but polysomnography (PSG) is cumbersome and costly. The WatchPAT determines sleep by a pre-programmed algorithm and has demonstrated moderate agreement with PSG in detecting sleep stages in normal subjects and in OSA patients. Here, we validated WatchPAT against PSG in COPD patients, hypothesizing agreement in line with previous OSA studies. 16 COPD patients (7 men, mean age 61 years), underwent simultaneous overnight recordings with PSG and WatchPAT. Accuracy in wake and sleep staging, and concordance regarding total sleep time (TST), sleep efficiency (SE), and apnea hypopnea index (AHI) was calculated. Compared to the best fit PSG score, WatchPAT obtained 93% sensitivity (WatchPAT = sleep when PSG = sleep), 52% specificity (WatchPAT = wake when PSG = wake), 86% positive and 71% negative predictive value, Cohen’s Kappa (κ) = 0.496. Overall agreement between WatchPat and PSG in detecting all sleep stages was 63%, κ = 0.418. The mean(standard deviation) differences in TST, SE and AHI was 25(61) minutes (p = 0.119), 5(15) % (p = 0.166), and 1(5) (p = 0.536), respectively. We conclude that in COPD-patients, WatchPAT detects sleep stages in moderate to fair agreement with PSG, and AHI correlates well.

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Motion of the Diaphragm in Patients with Chronic Obstructive Pulmonary Disease while Spontaneously Breathing versus during Positive Pressure Breathing after Anesthesia and Meeting Abstracts

Anesthesiology ◽

10.1097/00000542-200208000-00003 ◽

2002 ◽

Vol 97 (2) ◽

pp. 298-305 ◽

Cited By ~ 39

Author(s):

Bruce S. Kleinman ◽

Kerry Frey ◽

Mark VanDrunen ◽

Taqdees Sheikh ◽

Donald DiPinto ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Function ◽

Pulmonary Disease ◽

Normal Subjects ◽

Positive Pressure ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Control Subjects ◽

Copd Patients ◽

Significant Difference

Background Diaphragmatic excursion during spontaneous ventilation (SV) in normal supine volunteers is greatest in the dependent regions (bottom). During positive pressure ventilation (PPV) after anesthesia and neuromuscular blockade and depending on tidal volume, the nondependent region (top) undergoes the greatest excursion, or the diaphragm moves uniformly. The purpose of this study was to compare diaphragmatic excursion (during SV and PPV) in patients with chronic obstructive pulmonary disease (COPD) with patients having normal pulmonary function. Methods Twelve COPD patients and 12 normal control subjects were compared. Cross-table diaphragmatic fluoroscopy was performed while patients breathed spontaneously. After anesthetic induction and pharmacologic paralysis and during PPV, diaphragmatic fluoroscopy was repeated. For analytic purposes, the diaphragm was divided into three segments: top, middle, and bottom. Percentage of excursion of each segment during SV and PPV in normal subjects was compared with the percentage of excursion of each segment in patients with COPD. Results There was no significant difference in the pattern of regional diaphragmatic excursion (as a percentage of total excursion)-top, middle, bottom-when comparing COPD patients with control subjects during SV and PPV. In the control subjects, regional diaphragmatic excursion was 16 +/- (5), 33 +/- (5), 51 +/- (4) during SV and 49 +/- (13), 32 +/- (6), 19 +/- (9) during PPV. In COPD patients, regional diaphragmatic excursion was 18 +/- (7), 34 +/- (5), 49 +/- (7) during SV and 47 +/- (10), 32 +/- (6), 21 +/- (9) during PPV. Conclusion Regional diaphragmatic excursion in patients with COPD during SV and PPV is similar to that in persons with normal pulmonary function.

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Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00095 ◽

2020 ◽

Vol 29 (2) ◽

pp. 864-872

Author(s):

Fernanda Borowsky da Rosa ◽

Adriane Schmidt Pasqualoto ◽

Catriona M. Steele ◽

Renata Mancopes

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Oral Cavity ◽

Pulmonary Disease ◽

Thermal Sensation ◽

Sensory Function ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Age Related ◽

Copd Patients

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years ( SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years ( SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups (“≤ 65 years” and “> 65 years”) within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications ( p < .001) and xerostomia ( p = .003) in the COPD cohort. Oral cavity thermal sensation ( p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group ( p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.

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