Responses to Incremental Exercise and the Impact of the Coexistence of HF and COPD on Exercise Capacity: A Follow-up Study

Abstract Aim: Our aim was to evaluate: 1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied population; 2) the impact of HF+COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and 3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; 4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years.Methods: The current study included 124 patients (HF:46, COPD: 53 and HF+COPD:25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. All patients were contacted by telephone every 6 months and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. Results: We found a 20% prevalence of HF + COPD overlap in the studied population. Patients with HF+COPD demonstrated a lower work rate (WR), peak oxygen uptake (V̇O2), rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak V̇O2 (r: 0.56 p< 0.001), the oxygen uptake efficiency slope (OUES) (r: 0.42 p<0.001), and O2 pulse (r: 0.58 p<0.001), lung diffusing factor for carbon monoxide (DLCO) and WR (r: 0.51 p< 0.001), DLCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV1) and peak V̇O2 (r: 0.52; p< 0.001), and FEV1 and WR (r: 0.62; p<0.001). There were no significant differences in the occurrence of events and deaths contrasting both groups.Conclusion: the coexistence of HF+COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the two diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied. CPET provides important information to guide effective strategies for these patients with the goal of improving exercise performance and functional capacity. Moreover, given our findings related to pulmonary function, body composition and exercise responses, evidenced that the lean mass, FEV1 and DLCO influence important responses to exercise.

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Inflammatory Pattern of Eosinophilic COPD Involving 12/15-LOX Lipid Signals Expressed by Eosinophils

10.21203/rs.3.rs-706875/v1 ◽

2021 ◽

Author(s):

Chuanxu Cai ◽

Shuyan Wang ◽

Huakui Yue ◽

Danting Zhan ◽

Yimin Zha ◽

...

Keyword(s):

Pulmonary Function ◽

Blood Count ◽

Complete Blood Count ◽

Pulmonary Function Tests ◽

Chronic Obstructive ◽

Blood Eosinophil ◽

Treatment Interventions ◽

Obstructive Pulmonary Disease ◽

Inflammatory Pattern

Abstract Background and objective:Eosinophilic chronic obstructive pulmonary disease (COPD) has been recognized as an inflammatory pattern which is importance for precise treatment interventions among COPD. However, the studies about eosinophilic COPD show conflicting results and the role of eosinophils in COPD remains unclear. In this study, LC-MS/MS-based mediator lipidomics was to determine the expression status of lipid signals in non-eosinophilic and eosinophilic COPD.Method:A totally 80 patients with COPD including 40 eosinophilic COPD and 40 non-eosinophilic COPD were enrolled over 12 months. Clinical characteristics information record, pulmonary function tests, complete blood count, serum metabolites analysis and other clinical tests were performed at baseline and follow-up. Results:There were no significant differences in pulmonary function or pulmonary function decline between eosinophilic COPD and non-eosinophilic COPD after follow-up. However, eosinophilic COPD have higher numbers of acute exacerbation patient in the last 1 year. Complete blood count (CBC) data demonstrated that Δblood eosinophil count (BEC) was significantly decreased and correlated with ΔFEV1 (% Predicted) (r = 0.314, P = 0.036) in eosinophilic COPD. Furthermore, compared to non-eosinophilic COPD, a series of 12/15-LOX-derived mediators were found increased in eosinophilic COPD. Among them, 17-HDoHE was found significantly decreased after follow-up and significantly correlated with ΔBEC (r= 0.336, P= 0.023).Conclusion:This study demonstrates that metabolic levels of non-eosinophilic COPD and eosinophilic COPD were different due to the huge difference in eosinophil level, which leads to different inflammatory patterns, and the 12/15-LOX metabolic pathway was one of them. The results might help to understand the inflammatory response and lipid metabolism of eosinophilic COPD.

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Treatment of acromegaly has substantial effects on body composition. A long-term follow-up study.

Acta Endocrinologica ◽

10.1530/eje-21-0900 ◽

2021 ◽

Author(s):

Peter Wolf ◽

Sylvie Salenave ◽

Emmanuel Durand ◽

Jacques Young ◽

Peter Kamenicky ◽

...

Keyword(s):

Body Composition ◽

Fat Mass ◽

Lean Mass ◽

Individual Therapy ◽

Sensitivity Index ◽

Igf I ◽

The Individual ◽

The Impact

Background: Acromegaly is associated with changes in body composition. Long-term changes following acromegaly treatment and the impact of different treatments have been less investigated. Methods: We performed a retrospective study in 201 patients with acromegaly. Body composition was assessed by dual-energy X-ray absorptiometry (DXA). To investigate specific effects of treatment vs ageing, changes in body composition were compared in a group of patients evaluated both at the time of active and controlled disease (A>C; n=31) and in another group of patients evaluated two times while the disease was controlled (C>C; n=32). Results: In the whole cohort, IGF-I correlated with fat (r=-0.369;p<0.001) and lean mass (r=0.383;p<0.001). Patients from A>C and C>C groups were comparable for age, sex, BMI and follow-up duration (p=n.s.). Reduction in IGF-I levels was associated with an increase in fat mass and a decrease in lean mass in the A>C group, which was four and eight times more pronounced compared to the C>C group (fat mass: +39±34 vs +10±15%, p<0.001; lean mass: -8±8 vs -0.2±6%, p<0.001, respectively). Changes in fat mass were negatively associated with IGF-I (r=-0.450; p=0.011) and independent of the individual therapy. The daily dose of pegvisomant correlated with fat mass (r=0.421;p=0.002) and insulin sensitivity index (r=-0.466;p<0.001). Conclusions: Treatment of acromegaly strongly impacts body composition until biochemical disease remission, characterized by an increase in fat mass and a decrease in lean mass. These changes are closely associated with the normalization of IGF-I. Thereafter, body composition changes are similar to what is observed with ageing.

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Impact of Low-Dose Irradiation of the Lung and Heart on Toxicity and Pulmonary Function Parameters after Thoracic Radiotherapy

Cancers ◽

10.3390/cancers13010022 ◽

2020 ◽

Vol 13 (1) ◽

pp. 22

Author(s):

Christina Schröder ◽

André Buchali ◽

Paul Windisch ◽

Erwin Vu ◽

Lucas Basler ◽

...

Keyword(s):

Pulmonary Function ◽

Low Dose ◽

Pulmonary Function Tests ◽

Thoracic Radiotherapy ◽

Dose Irradiation ◽

Dosimetric Data ◽

Diffusion Parameters ◽

Blood Gas Parameters ◽

The Impact

Objective: To assess the impact of (low) dose irradiation to the lungs and heart on the incidence of pneumonitis and pulmonary function changes after thoracic radiotherapy (RT). Methods/Material: Data of 62 patients treated with curative thoracic radiotherapy were analyzed. Toxicity data and pulmonary function tests (PFTs) were obtained before RT and at 6 weeks, at 12 weeks, and at 6 months after RT. PFTs included ventilation (e.g., vital capacity) and diffusion parameters (e.g., diffusion capacity for carbon monoxide (DLCO)). Dosimetric data of the lung and heart were extracted to assess the impact of dose on PFT changes and radiation pneumonitis (RP). Results: No statistically significant correlations between dose parameters and changes in ventilation parameters were found. There were statistically significant correlations between DLCO and low-dose parameters of the lungs (V5Gy–V30Gy (%)) and irradiation of the heart during the follow-up up to 6 months after RT, as well as a temporary correlation of the V60Gy (%) on the blood gas parameters at 12 weeks after RT. On multivariate analysis, both heart and lung parameters had a significant impact on DLCO. There was no statistically significant influence of any patient or treatment-related (including dose parameters) factors on the incidence of ≥G2 pneumonitis. Conclusion: There seems to be a lasting impact of low dose irradiation to the lung as well as irradiation to the heart on the DLCO after thoracic radiotherapy. No influence on RP was found in this analysis.

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A qualitative study of pulmonary function tests between smokers and non smokers in Telangana state

Indian Journal of Clinical Anatomy and Physiology ◽

10.18231/j.ijcap.2021.049 ◽

2021 ◽

Vol 8 (3) ◽

pp. 219-225

Author(s):

Farzana Mustafa ◽

Abdul Hai Mohammad

Keyword(s):

Qualitative Study ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Medical College ◽

Quit Smoking ◽

The Mean ◽

Telangana State ◽

Gandhi Medical College ◽

The Impact

In a few examinations, low spirometric levels have been displayed to expand the achievement paces of smoking discontinuance, while different investigations have demonstrated that aspiratory work affects stopping smoking. Given the way that there are conflicting outcomes regarding this matter, we expected to research the impact of distinguishing aviation route obstacle by means of spirometry and its clarification to subjects on the achievement pace of smoking discontinuance temporarily. The current study was led in Gandhi Medical College, Hyderabad, India, Subjects who were conceded to the smoking discontinuance out-patient facility, went through pneumonic capacity tests (PFTs) and finished somewhere around 90 days of the suspension program following their induction were remembered for the investigation. The mean age of the 563 subjects was 41.9 ± 12.1 y 340 subjects (60.4%) were male. An aggregate of 162 subjects (28.8%) went to the subsequent visits following the primary meeting. The accomplishment of smoking suspension for 90 days was 11.3% for all subjects and 39.5% for subjects who came to follow-up visits. Of the subjects with impediment on PFT; 22.8% quit smoking, while 8.4% of the subjects without block did as such (P < .001). The level of subjects with impediment on PFT was altogether higher (P < .001) and the FEV1 % (P = .005), FEV1/FVC (P < .001), and constrained expiratory stream 25–75% (P = .008) levels were fundamentally lower in the weaklings contrasted and the non-slackers. Strategic relapse investigation showed that age (P = .001) and the presence of impediment on pft (p = .029) were autonomous factors. Old age and the presence of impediment on PFT increment the accomplishment of smoking end. Aspiratory work tests ought to be performed on all patients who apply to smoking end out-patient facilities, and patients ought to be educated with regards to their condition.

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Pulmonary function testing in COPD: looking beyond the curtain of FEV1

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-021-00236-w ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Sotirios Kakavas ◽

Ourania S. Kotsiou ◽

Fotis Perlikos ◽

Maria Mermiri ◽

Georgios Mavrovounis ◽

...

Keyword(s):

Pulmonary Function ◽

Clinical Symptoms ◽

Pulmonary Function Tests ◽

Cardiopulmonary Exercise Testing ◽

Forced Expiratory Volume ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Forced Oscillation Technique ◽

Comprehensive Overview ◽

Obstructive Pulmonary Disease

AbstractChronic obstructive pulmonary disease (COPD) management remains challenging due to the high heterogeneity of clinical symptoms and the complex pathophysiological basis of the disease. Airflow limitation, diagnosed by spirometry, remains the cornerstone of the diagnosis. However, the calculation of the forced expiratory volume in the first second (FEV1) alone, has limitations in uncovering the underlying complexity of the disease. Incorporating additional pulmonary function tests (PFTs) in the everyday clinical evaluation of COPD patients, like resting volume, capacity and airway resistance measurements, diffusion capacity measurements, forced oscillation technique, field and cardiopulmonary exercise testing and muscle strength evaluation, may prove essential in tailoring medical management to meet the needs of such a heterogeneous patient population. We aimed to provide a comprehensive overview of the available PFTs, which can be incorporated into the primary care physician’s practice to enhance the efficiency of COPD management.

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Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000840 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000840

Author(s):

Lianne Parkin ◽

Sheila Williams ◽

David Barson ◽

Katrina Sharples ◽

Simon Horsburgh ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Practice ◽

Real World ◽

Chronic Obstructive ◽

Treatment Intensification ◽

Cardiovascular Comorbidity ◽

Coronary Syndrome ◽

Long Acting ◽

The Impact

BackgroundCardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case–control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.MethodsWe used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.ResultsFrom the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).ConclusionIn real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.

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Serum IGFBP-2 in systemic sclerosis as a prognostic factor of lung dysfunction

Scientific Reports ◽

10.1038/s41598-021-90333-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Julien Guiot ◽

Makon-Sébastien Njock ◽

Béatrice André ◽

Fanny Gester ◽

Monique Henket ◽

...

Keyword(s):

Systemic Sclerosis ◽

Prognostic Factor ◽

Pulmonary Function ◽

Lung Disease ◽

Pulmonary Function Tests ◽

Serum Levels ◽

Roc Curve Analysis ◽

Significant Deterioration ◽

Lung Dysfunction

AbstractSystemic sclerosis (SSc) is a rare connective tissue disease associated with rapid evolving interstitial lung disease (ILD), driving its mortality. Specific biomarkers associated with the progression of this lung disease are highly needed. We aimed to identify specific biomarkers of SSc-ILD to predict the evolution of the disease. For this, we compared prospectively serum levels of several biomarkers associated with lung fibrosis in SSc patients (n = 102), among which SSc-no ILD (n = 63) and SSc-ILD (n = 39), compared to healthy subjects (HS) (n = 39). We also performed a longitudinal study in a subgroup of 28 patients analyzing biomarkers variations and pulmonary function tests over a period of 2 years. Serum level of IGFBP-2 was significantly increased in SSc patients compared to HS, and negatively correlated with pulmonary function (assessed by carbon monoxide transfer coefficient (KCO)) (r = − 0.29, p < 0.01). Two-year longitudinal analysis in a subgroup of 28 SSc patients determined that IGFBP-2 variation was positively correlated with KCO at 2-year follow-up (r = 0.6, p < 0.001). SSc patients with a lower variation of IGFBP-2 (less than 22%) presented significant deterioration of pulmonary function at 2-year follow-up (p < 0.01). ROC curve analysis enabled us to identify that baseline IGFBP-2 > 105 ng/ml was associated with a poor outcome (KCO < 70% predicted) at 2-year follow-up (AUC = 0.75, p < 0.05). We showed for the first time that serum levels of IGFBP-2 might be a prognostic factor of the development of SSc-ILD.

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