scholarly journals Diagnostic Insights from Plethysmographic Alveolar Pressure Assessed during Spontaneous Breathing in COPD Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 918
Author(s):  
Camilla Zilianti ◽  
Pierachille Santus ◽  
Matteo Pecchiari ◽  
Edgardo D’Angelo ◽  
Dejan Radovanovic
Keyword(s):  
Spontaneous Breathing ◽  
Respiratory Diseases ◽  
Airway Resistance ◽  
Chronic Obstructive ◽  
Alveolar Pressure ◽  
Expiratory Flow Limitation ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Spontaneously Breathing

Since its introduction in the clinical practice, body plethysmography has assisted pneumologists in the diagnosis of respiratory diseases and patients’ follow-up, by providing easy assessment of absolute lung volumes and airway resistance. In the last decade, emerging evidence suggested that estimation of alveolar pressure by electronically-compensated plethysmographs may contain information concerning the mechanics of the respiratory system which goes beyond those provided by the simple value of airway resistance or conductance. Indeed, the systematic study of expiratory alveolar pressure-flow loops produced during spontaneous breathing at rest has shown that the marked expansion of expiratory loops in chronic obstructive pulmonary disease patients mainly reflects the presence of tidal expiratory flow-limitation. The presence of this phenomenon can be accurately predicted on the basis of loop-derived parameters. Finally, we present results suggesting that plethysmographic alveolar pressure may be used to estimate non-invasively intrinsic positive end-expiratory pressure (PEEPi) in spontaneously breathing patients, a task which previously could be only accomplished by introducing a balloon-tipped catheter in the esophagus.

scholarly journals Tidal expiratory flow limitation induces expiratory looping of the alveolar pressure-flow relation in COPD patients

2020 ◽  
Vol 129 (1) ◽  
pp. 75-83
Author(s):  
Matteo Pecchiari ◽  
Dejan Radovanovic ◽  
Camilla Zilianti ◽  
Laura Saderi ◽  
Giovanni Sotgiu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Alveolar Pressure ◽  
Expiratory Flow Limitation ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Expiratory Flow ◽  
Spontaneously Breathing

In stable chronic obstructive pulmonary disease (COPD) patients spontaneously breathing at rest, tidal expiratory flow limitation is the major determinant of the occurrence of expiratory looping in the plethysmographic flow-alveolar pressure diagram. In these patients the magnitude and the characteristics of the loop can be used as predictors of the presence of tidal expiratory flow limitation.

Detection of expiratory flow limitation during exercise in COPD patients

1997 ◽  
Vol 82 (3) ◽  
pp. 723-731 ◽  
Author(s):  
Nickolaos G. Koulouris ◽  
Ioanna Dimopoulou ◽  
Päivi Valta ◽  
Richard Finkelstein ◽  
Manuel G. Cosio ◽  
...  
Keyword(s):  
Normal Subjects ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Obstructive Pulmonary Disease ◽  
Normal Limits ◽  
Volume Curve ◽  
Copd Patients ◽  
Flow Volume Curve ◽  
Expiratory Flow

Koulouris, Nickolaos G., Ioanna Dimopoulou, Päivi Valta, Richard Finkelstein, Manuel G. Cosio, and J. Milic-Emili.Detection of expiratory flow limitation during exercise in COPD patients. J. Appl. Physiol. 82(3): 723–731, 1997.—The negative expiratory pressure (NEP) method was used to detect expiratory flow limitation at rest and at different exercise levels in 4 normal subjects and 14 patients with chronic obstructive pulmonary disease (COPD). This method does not require performance of forced expirations, nor does it require use of body plethysmography. It consists in applying negative pressure (−5 cmH2O) at the mouth during early expiration and comparing the flow-volume curve of the ensuing expiration with that of the preceding control breath. Subjects in whom application of NEP does not elicit an increase in flow during part or all of the tidal expiration are considered flow limited. The four normal subjects were not flow limited up to 90% of maximal exercise power output (W˙max). Five COPD patients were flow limited at rest, 9 were flow limited at one-third W˙max, and 12 were flow limited at two-thirdsW˙max. Whereas in all patients who were flow limited at rest the maximal O2 uptake was below the normal limits, this was not the case in most of the other patients. In conclusion, NEP provides a rapid and reliable method to detect expiratory flow limitation at rest and during exercise.

scholarly journals Tanimilast, A Novel Inhaled Pde4 Inhibitor for the Treatment of Asthma and Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Fabrizio Facchinetti ◽  
Maurizio Civelli ◽  
Dave Singh ◽  
Alberto Papi ◽  
Aida Emirova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Side Effects ◽  
Pulmonary Disease ◽  
Respiratory Diseases ◽  
Pde4 Inhibitor ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases ◽  
Copd Patients ◽  
Anti Inflammatory

Chronic respiratory diseases are the third leading cause of death, behind cardiovascular diseases and cancer, affecting approximately 550 million of people all over the world. Most of the chronic respiratory diseases are attributable to asthma and chronic obstructive pulmonary disease (COPD) with this latter being the major cause of deaths. Despite differences in etiology and symptoms, a common feature of asthma and COPD is an underlying degree of airways inflammation. The nature and severity of this inflammation might differ between and within different respiratory conditions and pharmacological anti-inflammatory treatments are unlikely to be effective in all patients. A precision medicine approach is needed to selectively target patients to increase the chance of therapeutic success. Inhibitors of the phosphodiesterase 4 (PDE4) enzyme like the oral PDE4 inhibitor roflumilast have shown a potential to reduce inflammatory-mediated processes and the frequency of exacerbations in certain groups of COPD patients with a chronic bronchitis phenotype. However, roflumilast use is dampened by class related side effects as nausea, diarrhea, weight loss and abdominal pain, resulting in both substantial treatment discontinuation in clinical practice and withdrawal from clinical trials. This has prompted the search for PDE4 inhibitors to be given by inhalation to reduce the systemic exposure (and thus optimize the systemic safety) and maximize the therapeutic effect in the lung. Tanimilast (international non-proprietary name of CHF6001) is a novel highly potent and selective inhaled PDE4 inhibitor with proven anti-inflammatory properties in various inflammatory cells, including leukocytes derived from asthma and COPD patients, as well as in experimental rodent models of pulmonary inflammation. Inhaled tanimilast has reached phase III clinical development by showing promising pharmacodynamic results associated with a good tolerability and safety profile, with no evidence of PDE4 inhibitors class-related side effects. In this review we will discuss the main outcomes of preclinical and clinical studies conducted during tanimilast development, with particular emphasis on the characterization of the pharmacodynamic profile that led to the identification of target populations with increased therapeutic potential in inflammatory respiratory diseases.

scholarly journals Chronic obstructive pulmonary disease patients electronic register analysis: the effectiveness of patient’s dynamic follow up and evaluation of treatment program

2019 ◽  
Vol 91 (1) ◽  
pp. 78-83
Author(s):  
V Ju Mishlanov ◽  
I V Shubin ◽  
K N Bekker ◽  
A V Katkova ◽  
E P Koshurnikova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pneumococcal Infection ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Register Analysis ◽  
Long Acting

In the last few years new informatics methods were implemented in medicine and allowed to create big data including individual clinical markers of every patient. It is suggested that clinical electronic patient’s register analysis will present accurate information about different treatment programs effectiveness, including those whose effectiveness is not still proved today. The aim of the study. To estimate the effectiveness of clinical patients register implementation as well as to analyze different treatment and prophylactic programs on chronic obstructive pulmonary disease (COPD) patients’ structure. Materials and methods. The COPD patient’s register consists of 4257 cases. Spirometrical data were evaluated. Dynamic follow was performed on 567 COPD patients. Bronchodilator’s therapy was estimated as well as combined inhaled corticosteroid/ long acting β2-agonist medications and vaccination against pneumococcal infection. Results. Computer program “Electronic polyclinic” proposed by the authors of this article is effective in precision of diagnostic decision making in cohort study, dynamic follow up after clinical symptoms, evaluation of instrumental and laboratory results, prophylactics and treatment effectiveness, “clinical patients registers” automatic formation using syndrome or nosological principle, checking the COPD patients in the group of those with bronchial obstruction. Conclusion. Positive effects of long-acting bronchodilator treatment on COPD exacerbation decreasing and more expressed effect of inhaled corticosteroid/ long acting β2-agonists were confirmed. More interesting result was influence of vaccination against pneumococcal infection PCV13 (polyvalent conjugated vaccine) on exacerbation frequency and dyspnea severity.

scholarly journals Aortic Pulse Wave Velocity as a Measure of Cardiovascular Risk in Chronic Obstructive Pulmonary Disease: Two-Year Follow-Up Data from the ARCADE Study

Medicina ◽  
2019 ◽  
Vol 55 (4) ◽  
pp. 89
Author(s):  
Nichola Gale ◽  
Ali Albarrati ◽  
Margaret Munnery ◽  
Barry Mcdonnell ◽  
Victoria Benson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Longitudinal Study ◽  
Arterial Stiffness ◽  
Pulse Wave ◽  
Aortic Pulse Wave Velocity ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Background and objectives: Cardiovascular (CV) disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Patients with COPD have increased arterial stiffness, which may predict future CV risk. However, the development of arterial stiffness in COPD has not yet been studied prospectively. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) is a longitudinal study of CV risk and other comorbidities in COPD. The aims of this analysis were to explore factors associated with aortic pulse wave velocity (aPWV) at baseline and to describe the progression of aPWV in patients with COPD and comparators over two years. Materials and methods: At baseline, 520 patients with COPD (confirmed by spirometry) and 150 comparators free from respiratory disease were assessed for body composition, blood pressure, aPWV, noninvasive measures of cardiac output, inflammatory biomarkers, and exercise capacity. This was repeated after two years, and mortality cases and causes were also recorded. Results: At baseline, aPWV was greater in COPD patients 9.8 (95% confidence interval (CI) 9.7–10.0) versus comparators 8.7 (8.5–9.1) m/s (p < 0.01) after adjustments for age, mean arterial pressure (MAP), and heart rate. Mean blood pressure was 98 ± 11 in COPD patients and 95 ± 10 mmHg in comparators at baseline (p = 0.004). After two years, 301 patients and 105 comparators were fully reassessed. The mean (95% CI) aPWV increased similarly in patients 0.44 (0.25–0.63) and comparators 0.46 (0.23–0.69) m/s, without a change in blood pressure. At the two-year follow-up, there were 29 (6%) deaths in COPD patients, with the majority due to respiratory causes, with an overall dropout of 43% of patients with COPD and 30% of comparators. Conclusions: This was the first large longitudinal study of CV risk in COPD patients, and we confirmed greater aPWV in COPD patients than comparators after adjustments for confounding factors. After two years, patients and comparators had a similar increase of almost 0.5 m/s aPWV.

scholarly journals Differences in the Outcome of Patients with COPD according to Body Mass Index

2020 ◽  
Vol 9 (3) ◽  
pp. 710 ◽  
Author(s):  
Zichen Ji ◽  
Javier de Miguel-Díez ◽  
Christian Reynaldo Castro-Riera ◽  
José María Bellón-Cano ◽  
Virginia Gallo-González ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Hospital Admissions ◽  
Obesity Paradox ◽  
Chronic Obstructive ◽  
P Value ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Critical Unit

Background: In chronic obstructive pulmonary disease (COPD), the “obesity paradox” is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). Methods: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. Results: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24–27.69; 27.70–31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit. Survival was lower in the quartile 1 of BMI with respect to each of the 2–4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03–1.09), low pulmonary function (HR 0.93; 95% CI 0.86–0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01–3.06), high Charlson (HR 1.32, 95% CI 1.18–1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08–3.69) were identified as risk factors independently associated with mortality. Conclusions: In COPD, low BMI conditions a lower survival, although not for having more acute events.

Impact of Body Mass Index Change on the Prognosis of Chronic Obstructive Pulmonary Disease

Respiration ◽  
2020 ◽  
pp. 1-11
Author(s):  
Eun Kyung Kim ◽  
Dave Singh ◽  
Joo Hun Park ◽  
Yong Bum Park ◽  
Seung-Il Kim ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Body Mass Index ◽  
Pulmonary Disease ◽  
Body Mass ◽  
Longitudinal Change ◽  
Chronic Obstructive ◽  
Outpatient Basis ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

<b><i>Background:</i></b> Low body mass index (BMI) is an important prognostic factor in chronic obstructive pulmonary disease (COPD). However, the prognostic value of longitudinal BMI change in COPD has not been well studied. <b><i>Objective:</i></b> We aimed to evaluate the association between longitudinal change of BMI and prognosis of COPD in Korean COPD cohort. <b><i>Methods:</i></b> This study was conducted in a prospective Korean Obstructive Lung Disease (KOLD) cohort where COPD patients were recruited on an outpatient basis at 17 hospitals in South Korea. Annual BMI was measured over a period of 3 years or more. All patients were categorized into underweight (UW), normal weight (NW), and overweight (OW) groups by BMI. Clinical characteristics and outcomes including exacerbation and mortality were compared based on initial BMI grade and longitudinal change of BMI. <b><i>Results:</i></b> This analysis included 537 COPD patients (mean age = 67.4 ± 7.9 years, male = 97.0%, mean BMI = 23.0 ± 3.1) of KOLD cohort. The proportions of UW, NW, and OW groups were 6.9% (<i>n</i> = 37), 68.9% (<i>n</i> = 370), and 24.2% (<i>n</i> = 130) respectively. The UW group showed lower forced expiratory volume in 1 s (FEV<sub>1</sub>) (<i>p</i> &#x3c; 0.001), shorter 6-minute walk distance (<i>p</i> &#x3c; 0.001), higher modified Medical Research Council score (<i>p</i> = 0.002), higher St. George Respiratory Questionnaire score (<i>p</i> &#x3c; 0.001), higher emphysema index (<i>p</i> &#x3c; 0.001) and air-trapping index (<i>p</i> &#x3c; 0.001), and more frequent (<i>p</i> &#x3c; 0.001) and severe exacerbations (<i>p</i> = 0.003). Multivariable analyses demonstrated that decrease of BMI (hazard ratio [HR] = 0.786, <i>p</i> = 0.038) and the descent of BMI group (HR = 3.167, <i>p</i> = 0.016) at 3-year follow-up along with age, initial BMI, post-bronchodilator FEV<sub>1</sub>, and severe exacerbations were significantly associated with mortality. <b><i>Conclusions:</i></b> This study demonstrated that BMI decrease during follow-up was independently associated with exacerbation and higher mortality of COPD, suggesting BMI reduction in COPD should be carefully managed.

scholarly journals Experiences of Patients With Chronic Obstructive Pulmonary Disease receiving Integrated Telehealth Nursing Services During COVID-19 Lockdown

2021 ◽  
Author(s):  
Antonia Arnaert ◽  
Hamza Ahmad ◽  
Shameera N. Mohamed ◽  
Emilie Hudson ◽  
Stephanie Craciunas ◽  
...  
Keyword(s):  
Chronic Obstructive ◽  
Daily Lives ◽  
Obstructive Pulmonary Disease ◽  
Levels Of Care ◽  
Nursing Services ◽  
Copd Patients ◽  
Medical Consultations ◽  
Potential Benefits ◽  
The Times

Abstract Objective: Even though telemonitoring existed prior to COVID-19, the need was accelerated for patients with COPD due to the limited medical consultations and the anxiety for being infected. To our knowledge, no qualitative study has explored the experiences of COPD patients and the potential benefits of receiving integrated telehealth nursing services during the lockdown. Methods: Ten participants were interviewed after receiving telehealth nursing services for 3 months; data was analyzed thematically. Results: Irrespective of COPD severity, all participants expressed that the existing fragmented follow-up care was intensified during COVID. The telenursing services provided them with the comfort and reassurance that a clinician is available for support, advice, and care during the times of isolation. Despite diverse opinions regarding the respiratory-related questions for follow-up, all were enthusiastic about the use of the oximeter in their daily lives. None perceived sharing data as an issue, instead they encouraged the exchange across levels of care. Conclusion: Despite an appreciation for the service, it is imperative for sustainability reasons that standardized protocols are developed to balance patient preferences in terms of response frequency and the clinical data needed for a telenurse to provide appropriate interventions.

A model of the spontaneously breathing patient: applications to intrinsic PEEP and work of breathing

1997 ◽  
Vol 82 (5) ◽  
pp. 1694-1703 ◽  
Author(s):  
Thomas F. Schuessler ◽  
Stewart B. Gottfried ◽  
Jason H. T. Bates
Keyword(s):  
Work Of Breathing ◽  
Measurement Techniques ◽  
Esophageal Pressure ◽  
Accurate Estimation ◽  
Intrinsic Peep ◽  
Chronic Obstructive ◽  
Random Errors ◽  
Expiratory Flow Limitation ◽  
Obstructive Pulmonary Disease ◽  
Spontaneously Breathing

Schuessler, Thomas F., Stewart B. Gottfried, and Jason H. T. Bates. A model of the spontaneously breathing patient: applications to intrinsic PEEP and work of breathing. J. Appl. Physiol. 82(5): 1694–1703, 1997.—Intrinsic positive end-expiratory pressure (PEEPi) and inspiratory work of breathing (Wi) are important factors in the management of severe obstructive respiratory disease. We used a computer model of spontaneously breathing patients with chronic obstructive pulmonary disease to assess the sensitivity of measurement techniques for dynamic PEEPi(PEEPi dyn) and Wi to expiratory muscle activity (EMA) and cardiogenic oscillations (CGO) on esophageal pressure. Without EMA and CGO, both PEEPi dynand Wi were accurately estimated ( r = 0.999 and 0.95, respectively). Addition of moderate EMA caused PEEPi dynand Wi to be systematically overestimated by 141 and 52%, respectively. Furthermore, CGO introduced large random errors, obliterating the correlation between the true and estimated values for both PEEPi dyn( r = 0.29) and Wi( r = 0.38). Thus the accurate estimation of PEEPi dynand Wi requires steps to be taken to ameliorate the adverse effects of both EMA and CGO. Taking advantage of our simulations, we also investigated the relationship between PEEPi dynand static PEEPi(PEEPi stat). The PEEPi dyn/PEEPi statratio decreased as stress adaptation in the lung was increased, suggesting that heterogeneity of expiratory flow limitation is responsible for the discrepancies between PEEPi dynand PEEPi statthat have been reported in patients with severe airway obstruction.

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