Interventional Bronchoscopy in the Management of Chronic Obstructive Lung Disease

2019 ◽  
Vol 15 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Semra Bilaçeroğlu
Keyword(s):  
Management Strategies ◽  
Chronic Obstructive Lung Disease ◽  
Lifestyle Changes ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Interventional Bronchoscopy ◽  
Obstructive Pulmonary Disease ◽  
Mucosal Regeneration ◽  
Therapeutic Modalities ◽  
Collateral Ventilation

Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, hyperinflation and reduced gas exchange that lead to progressive dyspnea. Pulmonary rehabilitation, lifestyle changes, pharmacotherapy, long-term oxygen therapy, noninvasive ventilation and surgical therapeutic approaches are the basic management strategies. Purpose: In the last 15 years, various bronchoscopic therapeutic modalities have emerged for severe COPD. The aim of this review is to summarize the effects of these bronchoscopic treatments compared with lung rehabilitation and pharmacological therapies. Methods: A PubMed search for the eligible studies and reviews on interventional bronchoscopy and COPD has been conducted. Results: Bronchoscopic lung volume reduction (LVR) techniques are targeted to reduce hyperinflation. The efficacy of reversible valve implantation has been confirmed in several randomized controlled trials. It provides clinical benefit in the absence of interlobar collateral ventilation. Nonblocking bronchoscopic LVR with coils, thermal vapor or sealants is independent of collateral ventilation but has not been studied sufficiently. Partially irreversible coil implantation leads to parenchymal compression while irreversible LVR with thermal vapor or sealants induce an inflammatory reaction. Targeted lung denervation ablates parasympathetic pulmonary nerves in COPD for sustainable bronchodilation, and liquid nitrogen metered cryospray destroys hyperplastic goblet cells and excessive submucous glands in the central airways to induce mucosal regeneration in chronic bronchitis. Conclusion: The best-examined bronchoscopic LVR method is the valve therapy. The data from the other modalities are still limited. Further studies are required to select the patients that will optimally benefit from a particular treatment and to predict and treat the procedure-related complications.

scholarly journals Underuse of spirometry by general practitioners for the diagnosis of COPD in Italy

2005 ◽  
Vol 63 (1) ◽  
Author(s):  
G. Caramori ◽  
G. Bettoncelli ◽  
R. Tosatto ◽  
F. Arpinelli ◽  
G. Visonà ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
General Practitioners ◽  
Gold Standard ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Further Education ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Background. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) underlines that spirometry is the gold standard as the most reproducible, standardised, and objective way of measuring airflow limitation in the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD). However, studies undertaken in different countries have suggested a widespread underuse of spirometry by general practitioners to establish the diagnosis of COPD. Precise estimates of the prevalence of physician-diagnosed COPD in Italy are not currently available. In collaboration with the Italian Academy of General practitioners (SIMG) we have investigated the degree of use of spirometry to establish the diagnosis of COPD in Italy. Methods. A standardised questionnaire has been selfadministered to a sample of 2425 Italian general practitioners (representing 5% of all the Italian doctors involved in general practice). They have been chosen to cover each of the Italian counties. Results. The prevalence of physician-diagnosed COPD was found to be approximately 4%. However, 30% of general practitioners do not use spirometry to establish the diagnosis of COPD. The main reasons given for the failure to use spirometry are (i) that spirometry is not necessary for the diagnosis of COPD or (ii) there are logistical limitations to the access of the patients to lung function laboratories. Conclusions. This data suggests that contrary to GOLD Guidelines, in Italy, as with other countries, spirometry is not always used in the diagnosis of COPD. There is a clear necessity for further education initiatives targeted to this group of physicians.

scholarly journals Only severe COPD is associated with being underweight: results from a population survey

2016 ◽  
Vol 2 (3) ◽  
pp. 00051-2015 ◽  
Author(s):  
Berne Eriksson ◽  
Helena Backman ◽  
Apostolos Bossios ◽  
Anders Bjerg ◽  
Linnea Hedman ◽  
...  
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Structured Interview ◽  
Airflow Limitation ◽  
Sensitivity Analyses ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severity Grading ◽  
Severe Copd

Low body mass index (BMI) and malnutrition in chronic obstructive pulmonary disease (COPD) are associated with a poor prognosis. The prevalence of underweight, as well as overweight, in severity grades of COPD is sparsely investigated in studies of the general population and the associated patterns of risk factors are not well established. The aim of the present study was to determine the association between severity grades of airflow limitation in COPD, and both underweight and obesity when corrected for possible confounding factors.The study is based on pooled data from the OLIN (Obstructive Lung Disease in Northern Sweden) studies. Complete records with lung function, BMI and structured interview data were available from 3942 subjects (50.7% women and 49.3% men). COPD and severity grading were defined using the Global Initiative for Chronic Obstructive Lung Disease criteria. In sensitivity analyses, the lower limit of normal was used.The prevalence of underweight was 7.3% in severe COPD (grades 3 and 4) versus 2.0% in those with normal spirometry. The prevalence of obesity increased from 9.7% in grade 1, to 16.3% in grade 2 and 20.0% in severe COPD, versus 17.7% in those with normal spirometry.In adjusted analysis, of the COPD severity grades, only severe COPD was associated with underweight (OR 3.24, 95% CI 1.0004–10.5), while the COPD severity grades tended to be inversely associated with overweight.

scholarly journals Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

2021 ◽  
Vol 8 (1) ◽  
pp. e001135
Author(s):  
Subash Heraganahally ◽  
Timothy P Howarth ◽  
Elisha White ◽  
Helmi Ben Saad
Keyword(s):  
Indigenous Population ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Indigenous Australians ◽  
Obstructive Pulmonary Disease ◽  
Reference Equations ◽  
Global Initiative ◽  
Lower Limit Of Normal

BackgroundAssessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) are observed to be 20%–30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts.MethodsAdult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV1/FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV1 values (mild, moderate, severe, very severe) as per the recommended classifications.ResultsFrom a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%–43%), GOLD (33%–65%), GLI-2012 (18%–75%)). The FVC and FEV1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X ‘moderate’ AFL almost matching ‘severe’ AFL categorisation by GOLD or GLI-2012.ConclusionsHealth professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients.

scholarly journals GOLD criteria overestimate airflow limitation in one-third of cases in the general Finnish population

2016 ◽  
Vol 2 (4) ◽  
pp. 00084-2015 ◽  
Author(s):  
Annette Kainu ◽  
Kirsi Timonen ◽  
Ari Lindqvist ◽  
Päivi Piirilä
Keyword(s):  
Reference Values ◽  
Population Sample ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
International Studies ◽  
Finnish Population ◽  
Obstructive Pulmonary Disease ◽  
Severity Grading

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria for chronic obstructive pulmonary disease (COPD) use a fixed threshold of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (<0.70) in post-bronchodilation spirometry to indicate disease, which has been shown to underestimate and overestimate disease prevalence in younger and older adults, respectively, whilst criteria based on reference values have better accuracy. Differences in reference values have limited their use in international studies. However, the new Global Lung Function Initiative reference values (GLI2012) showed FEV1/FVC to be the least dependent on ethnicity. The aim of this study was to assess the prevalence of airflow limitation with GLI2012 and the degree of underdetection or overestimation related to the use of GOLD in the general population.A Finnish population sample of 1323 subjects (45% male) with post-bronchodilation spirometry was studied.80 subjects (6.0%) and 55 subjects (4.2%) were identified with airflow limitation with GOLD and GLI2012 criteria, respectively. The proportion of overestimation with GOLD increased with age from 25% of cases in 50-year-olds to 54% in 70-year-olds. Using z-score-based grading resulted in more dispersion in severity grading.In conclusion, the GOLD criteria cause a marked overestimation already from 50-year-olds and should be replaced with the GLI2012 criteria to improve diagnostic accuracy.

scholarly journals Prevalence and impact of diabetes, hypertension, and cardiovascular diseases in chronic obstructive pulmonary diseases: A hospital-based cross-section study

2015 ◽  
Vol 3 (4) ◽  
pp. 155-160 ◽  
Author(s):  
Vinay Mahishale ◽  
Naveen Angadi ◽  
Vijayanand Metgudmath ◽  
Ajith Eti ◽  
Mitchelle Lolly ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Limited Data ◽  
Obstructive Pulmonary Disease ◽  
Chronic Obstructive Pulmonary Diseases ◽  
Common Risk Factors ◽  
Global Initiative ◽  
The Relationship

Abstract Background: Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including diabetes, hypertension and cardiovascular diseases. As very limited data is available in India, the aim of the present study was to determine the relationship between COPD and the common, chronic comorbid conditions of diabetes mellitus (DM), hypertension (HTN), and cardiovascular diseases (CVD) and also to determine how these affect the clinical course of COPD. Methods: All the COPD cohorts diagnosed as per Global Initiative for Chronic Obstructive Lung Disease-2013 (GOLD-2013) criteria were screened for DM, HTN, and CVD as per stipulated national and WHO guidelines. Results: The prevalence of DM, HTN, and CVD in the 2432 COPD subjects was 25.94%, 37.25%, and 13.93%, respectively. In multivariate analyses, very severe COPD was associated with a higher risk of DM (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2), HTN (OR 1.6, 95% CI 1.4–1.9), and CVD (OR 2.5, 95% CI 1.9–3.0). Conclusion: A significant relationship was found between COPD and the presence of comorbid DM, HTN, and CVD. It was also found that subjects with advanced COPD were more likely to have at least two of these conditions and hugely affect the outcome of the disease. These findings suggest that the presence of COPD could provide a rationale to look for other comorbid disease and, conversely, that the presence of DM, HTN, or CVD might be the basis for the assessment of patients for airflow limitation and COPD as the tobacco smoking and advancing age were common risk factors.

scholarly journals Gait patterns in COPD: the Rotterdam Study

2015 ◽  
Vol 46 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Lies Lahousse ◽  
Vincentius J.A. Verlinden ◽  
Jos N. van der Geest ◽  
Guy F. Joos ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Chronic Obstructive Lung Disease ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Gait Velocity ◽  
Normal Lung ◽  
Chronic Obstructive ◽  
Rotterdam Study ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Gait disturbances in patients with chronic obstructive pulmonary disease (COPD) may lead to disability and falls. As studies assessing gait kinematics in COPD are sparse, we investigated associations of COPD with various gait domains and explored a potential link with falling.Gait was measured within the prospective, population-based Rotterdam Study (age ≥55 years) using an electronic walkway and summarised into seven gait domains: Rhythm, Variability, Phases, Pace, Tandem, Turning and Base of Support. Rhythm is a temporal gait aspect that includes cadence and reflects how quickly steps are taken.Persons with COPD (n=196) exhibited worse Rhythm (−0.21 sd, 95% CI −0.36– −0.06 sd) compared with persons with normal lung function (n=898), independent of age, sex, height, education, smoking or analgesic use, especially when dyspnoea and severe airflow limitation or frequent exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D: −0.83 sd, 95% CI −1.25– −0.41 sd) were present. A lower forced expiratory volume in 1 s was associated with worse Rhythm and Pace, including lower cadence and gait velocity, respectively. Importantly, fallers with COPD had significantly worse Rhythm than nonfallers with COPD.This study demonstrates that persons with COPD exhibit worse Rhythm, especially fallers with COPD. The degree of Rhythm deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations.

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview

2019 ◽  
Author(s):  
Niki Katsiki ◽  
Paschalis Steiropoulos ◽  
Nikolaos Papanas ◽  
Dimitri P. Mikhailidis
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Low Socioeconomic Status ◽  
Daily Practice ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Common Disease ◽  
Obstructive Pulmonary Disease ◽  
Therapeutic Modalities

AbstractChronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular risk. The present narrative review considers the potential links between COPD and DM, such as systemic inflammation, oxidative stress, hypoxaemia and hyperglycaemia. The effects of antidiabetic drugs on lung function and COPD outcomes, as well as the possibility of common therapeutic modalities are also briefly considered. Further research is needed in this field to elucidate these relationships as well as their potential clinical implications in daily practice.

scholarly journals Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity

2015 ◽  
Vol 46 (6) ◽  
pp. 1589-1597 ◽  
Author(s):  
Ben-Gary Harvey ◽  
Yael Strulovici-Barel ◽  
Robert J. Kaner ◽  
Abraham Sanders ◽  
Thomas L. Vincent ◽  
...  
Keyword(s):  
New York ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Chronic Obstructive Lung Disease ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these “normal spirometry/low DLCO” smokers is unknown.From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers.In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD.Despite appearing “normal” according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

A CORRELATIVE STUDY OF ELECTROCARDIOGRAPHY, ECHOCRDIOGRAPHY AND HEMATOLOGICAL FINDINGS IN CHRONIC OBSTRUCTIVE LUNG DISEASE

2021 ◽  
pp. 3-3
Author(s):  
B.Pani Kumar ◽  
Arshida Arshida ◽  
Sravan kumar
Keyword(s):  
Cause Of Death ◽  
Obstructive Lung Disease ◽  
Respiratory Symptoms ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Mortality And Morbidity ◽  
The Third ◽  
History Of

INTRODUCTION Chronic obstructive pulmonary disease is one of the commonest cause of mortality and morbidity in our country. It is dened as “a common preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.” COPD is currently fourth leading cause of death in the world1 but is projected to be the third leading cause of death by 2020. Advances in understanding the pathogenesis of COPD have the potential for identifying new therapeutic targets that could alter the natural history of this devastating disorder.

scholarly journals Participation of the miR-22-HDAC4-DLCO Axis in Patients with COPD by Tobacco and Biomass

Biomolecules ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. 837 ◽  
Author(s):  
Yadira Velasco-Torres ◽  
Víctor Ruiz ◽  
Martha Montaño ◽  
Rogelio Pérez-Padilla ◽  
Ramcés Falfán-Valencia ◽  
...  
Keyword(s):  
Posttranscriptional Regulation ◽  
Chronic Obstructive Lung Disease ◽  
Serum Levels ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Single Breath ◽  
Global Initiative ◽  
Genetic And Environmental Factors ◽  
And Gender

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and systemic inflammation. The main causes of COPD include interaction between genetic and environmental factors associated with tobacco smoking (COPD-TS) and/or exposure to biomass smoke (COPD-BS). Several microRNAs (miRNAs) control posttranscriptional regulation of COPD-TS associated gene expression. The miR-22-HDAC4-IL-17 axis was recently characterized. It is still unknown, however, whether this axis, participates in COPD-BS. To investigate, 50 patients diagnosed with severe-to-very severe COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages III/IV, were recruited, 25 women had COPD-BS (never smokers, exposed heavily to BS) and 25 had COPD-TS. Serum levels of miRNA-22-3p were measured by RT (Reverse Transcription)-qPCR, while the concentration of HDAC4 (Histone deacetylase 4) was detected by ELISA. Additionally, we looked for association between serum HDAC4 and DLCOsb (Single-breath diffusing capacity of the lung for carbon monoxide), as % of predicted by age, height, and gender, one of the main differences described between COPD-BS and COPD-TS. Women with COPD-BS were older and shorter and had a higher DLCOsb %P (percent predicted) compared to COPD-TS. Serum miR-22-3p was downregulated in COPD-BS relative to COPD-TS. In contrast, the concentration of HDAC4 was higher in COPD-BS compared to COPD-TS. Furthermore, a positive correlation between serum HDAC4 levels and DLCOsb %P was observed. We concluded that the miR-22-HDAC4-DLCO axis behaves differently in patients with COPD-BS and COPD-TS.

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