scholarly journals How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease?

2020 ◽  
Vol 4 (7) ◽  
pp. 418-424
Author(s):  
N.Yu. Grigorieva ◽  
◽  
M.O. Samolyuk ◽  
T.V. Sheshina ◽  
N.B. Koroleva ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lipid Peroxidation ◽  
Arterial Hypertension ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Group 2 ◽  
Azilsartan Medoxomil ◽  
Group 1

Aim: to conduct a comparative assessment of the hypotensive effect, as well as the effect on endothelial function, oxidative stress, and pulmonary artery pressure of chlorthalidone and hydrochlorothiazide as part of combined antihypertensive therapy in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).Patients and Methods: the prospective study included 66 patients divided into two groups. As the main antihypertensive therapy, group 1 was prescribed with a combination of azilsartan medoxomil 40 mg and chlortalidone 12.5 mg as a fixed combination of Edarbi® CLO. Group 2 received a free combination of azilsartan medoxomil 40 mg (Edarbi®) and hydrochlorothiazide 12.5 mg. All patients underwent 24-hour blood pressure monitoring: (ABPM), echodopplercardiography, endothelium-dependent vasodilation, lipid peroxidation (LPO), nitric oxide metabolites, and endothelin-1 levels at baseline and after 6 months of treatment. Results: target blood pressure values (<130/80 mm Hg) were achieved in 91% of patients in group 1, and 51.5% in group 2 after 1 month of the study. After 6 months of treatment, all patients in both groups reached the target BP values, but in group 2, the dose of hydrochlorothiazide had to be increased to 25 mg. According to the ABPM data, after 6 months of treatment, group 1 showed a decrease in the morning surge in SBP by 7.0±2.1% and DBP by 10±7.3%. There was also an increase in the number of patients with the daily profile of «dipper» type to 78.8%. In group 2, there was a decrease in the morning surge in SBP by 6.3±5.9% and DBP by 4.8±4.6% after 6 months of treatment. There was an increase in the number of patients with the daily profile of «dipper» type to 36.4%. After 6 months of treatment, there was more pronounced improvement in laboratory parameters of group 1 characterizing endothelial dysfunction and oxidative stress. Statistically significant results were obtained for conjugated trienes, NO2, S, Imax, and endothelin-1 when comparing groups 1 and 2.Conclusion: treatment of AH in patients with concomitant COPD in the form of a fixed combination of azilsartan medoxomil and chlorthalidone versus free combination of azilsartan medoxomil with hydrochlorothiazide has a more pronounced antihypertensive effect, positively affecting the daily BP profile, pulmonary artery pressure, endothelial function and lipid peroxidation processes after 6 months of treatment.KEYWORDS: arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, lipid peroxidation, azilsartan medoxomil, chlorthalidone.FOR CITATION: Grigorieva N.Yu., Samolyuk M.O., Sheshina T.V. et al. How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease? Russian Medical Inquiry. 2020;4(7):418–424. DOI: 10.32364/2587-6821-2020-4-7-418-424.

scholarly journals Is Chronic Obstructive Pulmonary Disease An Independent Risk Factor For Coronary and Peripheral Atherosclerosis In Heavy Smokers?

2020 ◽  
Author(s):  
Maria Angélica Pires Ferreira ◽  
Leila Beltrami Moreira ◽  
Felipe Soares Torres ◽  
Marli Maria Knorst
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Similar Distribution ◽  
Obstructive Pulmonary Disease ◽  
The Mean ◽  
Group 2 ◽  
Heavy Smokers ◽  
Group 1

Abstract BACKGROUNDThere is a high prevalence of cardiovascular disease (CVD) and atherosclerosis in people with chronic obstructive pulmonary disease (COPD); sharing of risk factors could not be the only cause of the association.OBJECTIVESTo verify whether coronary atherosclerosis and peripheral vascular disease are independently associated with COPD in heavy smokers. We also investigated whether inflammation and poor lung function were related with atherosclerosis findings.METHODSHeavy smokers (≥ 20 pack-years) with COPD (group 1) or normal spirometry (group 2) were recruited. Clinical, laboratory, and anthropometric data were obtained. Main interest variables were prevalence of CCS > 75th percentile (P75), and rates of ABI < 0,9 by Doppler ultrasound. CVD risk was calculated using the Framingham risk score. Serum C-reactive protein (CRP) was measured, and lung function was assessed by spirometry. Differences between groups were compared using parametric and nonparametric tests as adequate.RESULTSWere included 87 patients, 49 with COPD (group 1). The mean ± SD age was 57.2 ± 6.0 years (58.7 ± 5.1 in group 1, 55.2 ± 6.6 in group 2, p=0.006). The mean FEV 1 % was 45.8 ± 17.24 vs. 91.7 ± 15.9 in groups 1 and 2, respectively; p<0.05. The mean smoking index was 48.6 ± 25.4, higher in the COPD group (p=0.037). Stratification by Framingham score yielded a similar distribution in both groups. The frequency of patients with CCS > P75 was 55% vs. 66% in groups 1 and 2, respectively (p=0.823); ABI <9.0 ocurred in 6,3% vs 2,6%, respectivelly ( p=0.555) . CCS and ABI were not associated to FEV 1 %. CRP was inversely associated with VEF 1 ( r s= -0.419; p<0.001), but unrelated to CCS ( r s= 0.136; p=0.265) and ABI ( r s= -0.51; p=0.677).CONCLUSIONSThe studied coronary and peripheral atherosclerosis markers were similar between heavy smokers with COPD and those with normal spirometry. Nor serum CRP neither poor lung function related to CCS or ABI. Our results suggest absence of a independent association between COPD and atherosclerosis.

Comparison of Lung Flute and threshold positive expiratory pressure devices for airway clearance in patients with chronic obstructive pulmonary disease: a randomised clinical trial

2021 ◽  
Vol 28 (11) ◽  
pp. 1-7
Author(s):  
Orein Fernandes ◽  
Cherishma D'Silva ◽  
Don Gregory Mascarenhas ◽  
Sydney Roshan Rebello
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Pulmonary Functions ◽  
Airway Clearance ◽  
Group 2 ◽  
Group 1 ◽  
Positive Expiratory Pressure

Background/Aims Mucus hypersecretion and altered lung functions leads to adverse clinical outcomes in chronic obstructive pulmonary disease. The aim of this study was to compare the effects of the Lung Flute and threshold positive expiratory pressure devices on sputum quantity and pulmonary functions in chronic obstructive pulmonary disease patients. Methods A total of 50 patients with chronic obstructive pulmonary disease were randomly divided into two groups. Group 1 used the Lung Flute device and group 2 used a threshold positive expiratory pressure device. Sputum quantity was measured post-intervention on a daily basis. Forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow rate were evaluated on day 1 and day 6. Results The mean sputum quantity in group 1 was 11.40 ml and it was 11.04 ml in group 2. Between-group comparison demonstrated a significant improvement in forced expiratory volume in the first second for group 1 compared to group 2 (P<0.005). Conclusions The Lung Flute was found to be slightly more effective than the threshold positive expiratory pressure device for airway clearance and also had a positive effect on pulmonary functions in patients with chronic obstructive pulmonary disease.

scholarly journals APPLICATION OF EXERCISE COMBINED WITH LUNG REHABILITATION IN RESPIRATORY DISEASE

2022 ◽  
Vol 28 (1) ◽  
pp. 17-19
Author(s):  
Guangheng Wang ◽  
Yuqi Cai
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Educational Interventions ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Breathing Training ◽  
Group 2 ◽  
Experimental Group ◽  
Group 1

ABSTRACT Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by incomplete reversibility of airflow obstruction and persistent respiratory symptoms. Objective: To explore the therapeutic effect of physical exercise on patients with chronic obstructive pulmonary disease in pulmonary rehabilitation. Methods: Forty-eight experimental subjects were divided into control group, experimental group 1, and experimental group 2 for research. The control group received normal medical-related treatment without any other means of intervention. In addition to normal medical-related treatment, experimental group 1 received breathing training and educational interventions and experimental group 2 received exercise, breathing training and educational interventions. Results: The vital capacity of female subjects before and during the experiment ranged from 2.23±0.01 to 2.26±0.04, the FVC ranged from 2.00±0.02 to 2.01±0.03, the FEV1 ranged from 1.03±0.01 to 1.03±0.01,the FEV1% ranged from 55.50±1.29 to 55.25±1.71,the FEV1/FVC ranged from 51.44±0.24 to 50.84±1.00, andthe heart rate ranges from 65.00±0.82 to 65.50±1.29. Conclusions: Exercise training can increase the exercise tolerance of patients with COPD, relieve dyspnea, and improve the quality of life. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals Comorbidity and polymorbidity of the patient with chronic obstructive pulmonary disease and cardiovascular diseases

2019 ◽  
Vol 91 (1) ◽  
pp. 43-47 ◽  
Author(s):  
N Yu Grigoryeva ◽  
M V Maiorova ◽  
M E Korolyova ◽  
M O Samolyuk
Keyword(s):  
Myocardial Infarction ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Course ◽  
Chronic Obstructive ◽  
Case Histories ◽  
Obstructive Pulmonary Disease ◽  
Cardiology Department ◽  
Group 2 ◽  
Group 1

Aim: the study of comorbid status and characteristics of clinical course of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. We conducted a retrospective analysis of case histories of 958 IHD patients aged 32 to 93 years (mean age of 60.8±10.2 years), including men - 525 (54.8%), women - 433 (45.2%) who were treated in the cardiology Department of city clinical hospital №5 of Nizhny Novgorod. Related COPD was diagnosed in 251 patients (26.3%). We compared two groups patients: with IHD and COPD, and the second - persons suffering from only IHD (without COPD). Results. Myocardial infarction was transferred by 62.2% of patients in Group 1, which is 16.3% more than in Group 2 (p

scholarly journals Serum biomarkers in patients with stable and acute exacerbation of chronic obstructive pulmonary disease: A comparative study

2019 ◽  
Vol 38 (4) ◽  
pp. 503-511 ◽  
Author(s):  
Füsun Şahin ◽  
Ayşe Filiz Koşar ◽  
Ayşe Feyza Aslan ◽  
Burcu Yiğitbaş ◽  
Berat Uslu
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Summary Background Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have all been investigated as novel inflammatory markers of cardiac and oncological diseases, while there is only a limited number of studies investigating these markers in chronic obstructive pulmonary disease (COPD). In the present study we examine NLR, PLR; and other markers, such as eosinophil, MPV, plateletcrit (PCT), platelet distribution width (PDW), red cell distribution width (RDW), and C-reactive protein (CRP) in patients with stable and acute exacerbation of COPD. Methods Stable COPD (Group 1, n=140), COPD with acute exacerbation (Group 2, n=110), and healthy controls (Group 3, n=50) were included in the study. Leukocyte, CRP, hemoglobin (HB), RDW, platelet, MPV, PCT, PDW, neutrophil, lymphocyte, eosinophil, NLR, and PLR were analyzed in all groups. Results HB, leukocyte, platelet, neutrophil, eosinophil, MPV, PCT, CRP, NLR, and PLR were significantly higher, while the lymphocyte was lower in Group 1 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while lymphocyte was lower in Group 2 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while HB, platelet, MPV, PCT, and lymphocyte were significantly lower in Group 2 than in Group 1. NLR and PLR increased significantly in patients with bronchiectasis when compared to those without in Group 1. Conclusions Our study results suggest that NLR, PLR and RDW can be used as simple and cost-effective markers for the evaluation of severity of exacerbation and for predicting hospitalization and further exacerbations in patients with COPD.

scholarly journals PREDICTING THE EFFECTIVENESS OF TREATMENT WITH ROFLUMILAST IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2019 ◽  
Vol 1 (71) ◽  
pp. 51-56
Author(s):  
Екатерина Кулик ◽  
Ekaterina Kulik ◽  
Валентина Павленко ◽  
Valentina Pavlenko ◽  
Светлана Нарышкина ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
High Risk ◽  
Effective Treatment ◽  
Pulmonary Disease ◽  
Risk Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Tnf Α ◽  
Group 2 ◽  
Group 1

There were studied the possibilities of predicting the effectiveness of treatment with roflumilast in the complex therapy of patients with chronic obstructive pulmonary disease (COPD) with low and high risk by assessing the clinical and functional parameters (lung function, severity of respiratory complaints, frequency of exacerbations in the previous year) and serum indicators of systemic inflammation (C-reactive protein, TNF-α, IL-6, IL-8, fibrinogen). One-year study included 60 patients with COPD, among whom there were 22 patients with low risk (group 1) and 38 patients with high risk (group 2), according to the multi-faceted classification of disease. Each group was divided into 2 subgroups depending on the response to treatment: subgroup A included the patients whose therapy was effective and subgroup B consisted of the patients whose therapy was not effective. The criteria for the effectiveness of the treatment were: group 1 – the absence of exacerbations during a year or 1 episode that did not require hospitalization, the initial test CAT (COPD Assessment Test) – 10 points and lower, dyspnea on the mMRC scale no more than 2 points, an increase in FEV1 by 11% or more; in patients of group 2 the number of exacerbations was 0 or no more than 2 and they did not require hospitalization, dyspnea on the mMRC scale was no more than 2 points, there was no decrease in FEV1. The effectiveness of treatment was evaluated in points (4 points meant effective treatment, below 4 points – not effective treatment). It was found out that in group 1 in subgroup A after treatment the results of CAT (p<0.001), IL-8 (p<0.001), TNF-α (p<0.001) were significantly lower than in group B (p<0.001). In group 2 after treatment in subgroup A test CAT (p<0.001), CRP (p<0.001) and IL-6 (p<0.01) were significantly lower than in subgroup B. The revealed regularities formed the basis for the creation of mathematical model for predicting the effective application of roflumilast by discriminant analysis for different phenotypes of the disease which allow clinicians to solve the problem of a personalized approach to the selection of patients with COPD with low and high risk.

scholarly journals Increased adherence to the treatment of comorbid patients with arterial hypertension and chronic obstructive pulmonary disease on the background of complex therapy

2021 ◽  
pp. 18-25
Author(s):  
I. G. Menshikova ◽  
E. V. Magalyas ◽  
I. V. Sklyar ◽  
N. V. Loskutova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Antihypertensive Drugs ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Complex Therapy ◽  
Group 2 ◽  
Group 1

Aim. To determine the adherence to treatment of patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) against the background of complex therapy.Materials and methods. We examined 56 patients with stage II hypertension in combination with COPD. Men accounted for 70%, women – 30%. The average age of patients is 52.9±0.46 years. The patients were prescribed a fixed combination of antihypertensive drugs – telmisartan 40 mg with amlodipine 5 mg and COPD therapy according to GOLD. Patients of group 1 (n=30) studied at a health school against the background of drug treatment, patients in group 2 (n=26) did not attend a health school.Results. After 6 months of treatment, the number of patients in group 1 increased (p=0.001) regularly taking antihypertensive drugs, 96.7% of patients began to independently control blood pressure and keep a diary of a patient with hypertension. Patients of group 2 showed a statistically significant increase in the level of awareness of the presence of the disease and the awareness of patients about the risk factors for the development of the disease (p=0.01), although the number of patients controlling blood pressure remained low (p=0.1). In group 1, there was a positive trend in terms of the main risk factors, in group 2 the frequency of the prevalence of risk factors practically did not change. By the 6th month of therapy, all patients in group 1 achieved the target blood pressure, in group 2 – in 73.1% of patients. By the end of the observation, in patients of group 1, against the background of the chosen treatment tactics, there was a significantly more significant decrease in left ventricular mass index (LVMI) with its normalization in 33.3% of patients, indicating regression of LV hypertrophy (p=0.01), as well as a significant increase in the ratio of peak velocities on the mitral valve (E/A), (p=0.01), indicating an improvement in LV diastolic function. In group 2, antihypertensive therapy showed a moderate decrease in LVMI (p=0.1) with normalization of this indicator in only 2 (7.7%) of patients. By the 6th month of treatment, an improvement in the parameters of bronchial patency was revealed, however, in the 2nd group of patients, the changes in these parameters were statistically insignificant.Conclusion. The effectiveness of the treatment of hypertension and COPD depends not only on the choice of the optimal treatment tactics, but also on the patient's compliance with the prescribed therapy regimen. The results obtained indicate a positive effect of the chosen complex treatment regimen on the functional parameters of the left ventricle and bronchial patency. 

scholarly journals ATRIAL FIBRILLATION IN COMORBID PATIENTS DEPENDING ON THE TREATMENT REGIMEN

2019 ◽  
Vol 8 (2) ◽  
pp. 21-29 ◽  
Author(s):  
L. D. Khidirova ◽  
D. A. Yakhontov ◽  
S. A. Zenin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Arterial Hypertension ◽  
Pulmonary Disease ◽  
Abdominal Obesity ◽  
Blood Pressure Monitoring ◽  
Clinical Status ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Aim. To study the clinical course of atrial fibrillation in patients with arterial hypertension and extracardiac comorbid pathology depending on the administered therapy.Methods. 207 men aged 45–65 years with atrial fibrillation (paroxysmal and persistent) and arterial hypertension in combination with diabetes mellitus (n = 40), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47) were recruited to a observational cohort study. 56 patients with atrial fibrillation and arterial hypertension but without any extracardiac diseases were included in the comparison group. Clinical and anthropometric parameters were assessed in all patients. Adherence to therapy was estimated with the Morisky-Green test. All patients underwent ECG; electrocardiographic holter monitoring, 24-hour blood pressure monitoring with the Daily Monitoring Systems SCHILLER (Schiller, Switzerland), 2D and M-mode echocardiography using a Vivid 7 device (General Electric, USA). The statistical analysis was performed in the Rstudio software (version 0.99.879, RStudio, Inc., MA, USA).Results. 66% of patients with atrial fibrillation and arterial hypertension had concomitant extracardiac comorbid pathology, of them 20% of had diabetes mellitus, 22% with chronic obstructive pulmonary disease, and 24% with abdominal obesity. The clinical groups were comparable in electro impulse and drug therapy. Patients who received medical treatment were frequently admitted to hospitals for atrial fibrillation recurrence (p<0.001), compared with those who underwent electro impulse therapy. Adherence to antiarrhythmic therapy was low in the entire cohort of patients. There were no significant differences found between the clinical groups.Conclusion. Early diagnosis of the factors contributing to the progression of AF, the prescription of additional therapy for the secondary prevention of arrhythmia and the choice of its optimal treatment strategy may slow the progression of arrhythmia and the development of CHF, which will improve not only the clinical status of patients, but also their prognosis.

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