Simulation of Airway Deposition of an Aerosol Drug in COPD Patients

Medical aerosols are key elements of current chronic obstructive pulmonary disease (COPD) therapy. Therapeutic effects are conditioned by the delivery of the right amount of medication to the right place within the airways, that is, to the drug receptors. Deposition of the inhaled drugs is sensitive to the breathing pattern of the patients which is also connected with the patient’s disease severity. The objective of this work was to measure the realistic inhalation profiles of mild, moderate, and severe COPD patients, simulate the deposition patterns of Symbicort® Turbuhaler® dry powder drug and compare them to similar patterns of healthy control subjects. For this purpose, a stochastic airway deposition model has been applied. Our results revealed that the amount of drug depositing within the lungs correlated with the degree of disease severity. While drug deposition fraction in the lungs of mild COPD patients compared with that of healthy subjects (28% versus 31%), lung deposition fraction characteristic of severe COPD patients was lower by a factor of almost two (about 17%). Deposition fraction of moderate COPD patients was in-between (23%). This implies that for the same inhaler dosage severe COPD patients receive a significantly lower lung dose, although, they would need more.

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The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01374-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tao Yang ◽

Chihua Chen ◽

Zhongyuanlong Chen

Keyword(s):

Acute Exacerbation ◽

Disease Severity ◽

Smoking History ◽

Chronic Obstructive ◽

Lung Field ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Pulmonary Vessels ◽

Copd Patients ◽

Severe Copd

Abstract Background It is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD. Methods COPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed. Results A total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively. Conclusions Patients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.

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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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Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00093-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Osama Ibrahim Mohammad ◽

Ahmed Gouda Elgazzar ◽

Shymaa Mohammad Mahfouz ◽

Marwa Elsayed Elnaggar

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obese Patients ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Obstructive Sleep ◽

Severe Copd

Abstract Background The conjunction of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is known as overlap syndrome (OS). The coexistence of these diseases has cardiovascular morbidity and mortality. The aim of this study is to assess the prevalence of OSA in COPD patients. One hundred COPD patients (obese and non-obese) performed sleep questionnaires and polysomnograms. Results OSA prevalence in COPD was 50% and it increases with increasing disease severity (P < 0.001). The highest prevalence of OSA was found in obese patients with severe COPD; 90.5% of these patients have OSA. In the OSA group, obese patients were found to have significantly higher STOP-Bang Questionnaire (SBQ), Epworth Sleep Scale (ESS), modified medical research council (mMRC) dyspnea scale, apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI). Both obese and non-obese COPD patients showed significant positive correlations between AHI and smoking index (SI), SBQ, ESS, mMRC, ODI, and neck circumference (NC). Conclusions From this study, it can be concluded that moderate and severe COPD patients had a higher diagnosis of sleep-disordered breathing. Also, obese-COPD patients are more susceptible to develop OSA. Trial registration Name of the registry: Benha University Protocol Record Benha U123, Obstructive Sleep Apnea Prevalence in Patients With Chronic Obstructive Pulmonary Diseases. Trial registration number: NCT04903639. Date of registry: 5/22/2021 (retrospective study).

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Decreased plasma epidermal growth factor (EGF) levels in patients with severe chronic obstructive pulmonary disease

Pneumologia ◽

10.2478/pneum-2019-0004 ◽

2019 ◽

Vol 68 (1) ◽

pp. 21-26

Author(s):

Retno AS Soemarwoto ◽

Andika Chandra Putra ◽

Syazili Mustofa ◽

◽

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Growth Factor ◽

Epidermal Growth Factor ◽

Pulmonary Disease ◽

Plasma Levels ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Epidermal Growth ◽

Severe Copd

Abstract Background Chronic mucus hypersecretion is a common feature in chronic obstructive pulmonary disease (COPD) and is associated with epidermal growth factor (EGF) activity. Aberrant EGF and its receptor signalling can cause airway hyperproliferation, increase in mucous cell differentiation and mucus hyperproduction. Furthermore, it can also promote subepithelial fibrosis and excessive collagen deposition in COPD. The objective of this research was to investigate the plasma levels of EGF in smokers with COPD in comparison with clinically healthy smokers. In addition, the relationship between the plasma levels of EGF and clinical features was investigated. Methods A cross-sectional study included 82 clinically stable male patients with mild-to-very severe COPD (mean age: 64.5±8.6 years), and the control group consisted of 86 healthy male smokers (mean age: 61.6±9.5 years). To define COPD, we performed spirometry and classified COPD using Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. We analyzed the levels of EGF by enzyme-linked immunosorbent assay in plasma. Results The mean serum levels of EGF were significantly lower in smokers with COPD than those in controls (69.30 and 83.82 pg/mL, respectively, p = 0.046). The plasma levels of EGF were significantly different (p = 0.004) between mild COPD and moderate-to-very severe COPD. There were no significant differences between the levels of EGF in plasma of spontaneous sputum producers (COPD patients) vs. nonsputum producers (p = 0.101) and between nonexacerbated COPD and exacerbated COPD patients(p = 0.138). Conclusions There is a significant difference in the plasma levels of EGF in male smokers with COPD as compared with male healthy smokers. Our findings suggest that the plasma levels of EGF may contribute to the pathogenesis of COPD.

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Association of Plasma Heat Shock Protein 70 with Disease Severity, Smoking and Lung Function of Patients with Chronic Obstructive Pulmonary Disease

10.21203/rs.3.rs-41671/v1 ◽

2020 ◽

Author(s):

Iva Hlapčić ◽

Andrea Hulina-Tomašković ◽

Marija Grdić Rajković ◽

Sanja Popović-Grle ◽

Andrea Vukić Dugac ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Heat Shock ◽

Lung Function ◽

Heat Shock Protein ◽

Disease Severity ◽

Heat Shock Protein 70 ◽

Smoking Status ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients

Abstract Background: Extracellular heat shock protein 70 (eHsp70) acts like a damage-associated molecular pattern (DAMP) and it might modulate immune responses in patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to explore plasma eHsp70 concentration in patients with stable COPD, its association with disease severity and smoking status as well as its diagnostic performance in COPD assessment.Methods: Blood samples were collected from 137 COPD patients and 95 healthy individuals. COPD patients were subdivided into GOLD 2-4 stages based on airflow obstruction severity and GOLD A-D groups regarding symptoms and exacerbations. Concentration of eHsp70 was assessed in EDTA plasma by the commercially available ELISA kit. Statistic analysis was performed by MedCalc statistical software.Results: eHsp70 concentration was increased in COPD patients when compared to controls and was increasing with the severity of airflow limitation as well as symptoms burden and exacerbation history. There were no differences in eHsp70 concentrations among COPD patients based on smoking status, yet eHsp70 was increased in healthy smokers compared to healthy non-smokers. Interestingly, healthy smokers had similar eHsp70 level as COPD patients in GOLD 2 stage and those in GOLD A group. In addition, eHsp70 showed significant negative correlation with lung function parameters FEV1 and FEV1/FVC and positive correlation with COPD multicomponent indices BODCAT, BODEx, CODEx and DOSE. Finally, eHsp70 showed great predictive value (OR=7.63) and correctly classified 76% of cases.Conclusions: Plasma eHsp70 is associated with COPD prediction and disease severity and might have a potential of becoming an additional biomarker in COPD assessment.

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The Expression of NOX4 in Smooth Muscles of Small Airway Correlates with the Disease Severity of COPD

BioMed Research International ◽

10.1155/2016/2891810 ◽

2016 ◽

Vol 2016 ◽

pp. 1-17 ◽

Cited By ~ 2

Author(s):

Xianyan Liu ◽

Binwei Hao ◽

Ailing Ma ◽

Jinxi He ◽

Xiaoming Liu ◽

...

Keyword(s):

Disease Severity ◽

Transforming Growth Factor ◽

Smooth Muscles ◽

Nicotinamide Adenine Dinucleotide Phosphate ◽

Small Airway ◽

Chronic Obstructive ◽

Small Airways ◽

Obstructive Pulmonary Disease ◽

Pulmonary Functions ◽

Copd Patients

Airway smooth muscle (ASM) remodeling is a hallmark in chronic obstructive pulmonary disease (COPD), and nicotinamide-adenine dinucleotide phosphate (NADPH) oxidases (NOXs) produced reactive oxygen species (ROS) play a crucial role in COPD pathogenesis. In the present study, the expression of NOX4 and its correlation with the ASM hypertrophy/hyperplasia, clinical pulmonary functions, and the expression of transforming growth factorβ(TGF-β) in the ASM of COPD small airways were investigated by semiquantitative morphological and/or immunohistochemistry staining methods. The results showed that an elevated expression of NOX4 and TGF-β, along with an increased volume of ASM mass, was found in the ASM of small airways in COPD patients. The abundance of NOX4 protein in the ASM was increased with disease severity and inversely correlated with the pulmonary functions in COPD patients. In addition, the expression of NOX4 and ASM markerα-SMA was colocalized, and the increased NOX4 expression was found to accompany an upregulated expression of TGF-βin the ASM of small airways of COPD lung. These results indicate that NOX4 may be a key regulator in ASM remodeling of small airway, in part through a mechanism interacting with TGF-βsignaling in the pathogenesis of COPD, which warrants further investigation.

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Relationship of the Content of Systemic and Endobronchial Soluble Molecules of CD25, CD38, CD8, and HLA-I-CD8 and Lung Function Parameters in COPD Patients

Disease Markers ◽

10.1155/2017/8216723 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Nailya Kubysheva ◽

Larisa Postnikova ◽

Svetlana Soodaeva ◽

Viкtor Novikov ◽

Tatyana Eliseeva ◽

...

Keyword(s):

Lung Function ◽

Blood Serum ◽

Exhaled Breath Condensate ◽

Diagnostic Methods ◽

Stable Phase ◽

Chronic Obstructive ◽

Exhaled Breath ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Severe Copd

The definition of new markers of local and systemic inflammation of chronic obstructive pulmonary disease (COPD) is one of the priority directions in the study of pathogenesis and diagnostic methods improvement for this disease. We investigated 91 patients with COPD and 21 healthy nonsmokers. The levels of soluble CD25, CD38, CD8, and HLA-I-CD8 molecules in the blood serum and exhaled breath condensate (EBC) in moderate-to-severe COPD patients during exacerbation and stable phase were studied. An unidirectional change in the content of sCD25, sCD38, and sCD8 molecules with increasing severity of COPD was detected. The correlations between the parameters of lung function and sCD8, sCD25, and sHLA-I-CD8 levels in the blood serum and EBC were discovered in patients with severe COPD. The findings suggest a pathogenetic role of the investigated soluble molecules of the COPD development and allow considering the content of sCD8, sCD25, and sHLA-I-CD8 molecules as additional novel systemic and endobronchial markers of the progression of chronic inflammation of this disease.

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Echocardiographic right heart study in patients with chronic obstructive pulmonary disease

Nepalese Heart Journal ◽

10.3126/njh.v14i2.18496 ◽

2017 ◽

Vol 14 (2) ◽

pp. 9-12

Author(s):

Anish Hirachan ◽

Arun Maskey ◽

Ram Kishore Shah ◽

Bishal KC ◽

Miqdhaadh Shareef ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Heart Function ◽

Chronic Obstructive ◽

Rapid Progression ◽

Right Heart ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

The Right

Background and Aims: Chronic obstructive pulmonary disease (COPD) is highly prevalent in the Nepalese population. It is associated with significant extrapulmonary effects among which cardiovascular complications are most common. Echocardiography evaluation mainly focused on effects on the right heart function is a salient tool to evaluate the presence of degree of pulmonary hypertension and also identify those group of patients who need more early aggressive therapy for the underling lung disease . We aimed to prospectively study the patients with diagnosed COPD with echocardiogram for evaluating the right heart.Methods: An observational, cross sectional study was done on 50 patients with COPD who were admitted at Bir Hospital and underwent echocardiographic evaluation from Dec 2015 –Dec 2016. All echocardiogaphic parameters focused on right heart and its function were assessed .Results: Out of total 50 COPD patients studied, majority of them were female (32 patients. 64%). The mean age group of the studied patients was 60.9 ±11.4 years. Pulmonary hypertension defined as sPAP>30 mmHg was evident in all of the patients ; with 30 patients (60% ), 14 (28 %) and 6(12 %) patients having severe, moderate and mild pulmonary hypertension respectively. RV dysfunction was evident with reduced average TAPSE values (1.59± 0.38 cm) and elevated RIMP values (0.58±0.16).Conclusion: Majority of COPD patients had evidence of pulmonary hypertension. Echocardiogram can be a helpful tool to assess early changes on the right heart size and function in patients with COPD and also monitor these patients for rapid progression of the illness.Nepalese Heart Journal 2017; Vol 14(2), 9-12

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Study of Factors Associated with Sarcopenia in COPD Patients

Medicine Today ◽

10.3329/medtoday.v33i01.52160 ◽

2021 ◽

Vol 33 (1) ◽

pp. 50-53

Author(s):

Saleh Ahmed

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Bioelectrical Impedance ◽

Chronic Obstructive ◽

College Hospital ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Factors Associated ◽

Copd Patients ◽

Severe Copd

Introduction: Sarcopenia is frequently associated with chronic diseases such as chronic obstructive pulmonary disease (COPD). Sarcopenia can be classified as physical frailty where frailty is associated with adverse health outcomes. Sarcopenia was found to be associated with worsening lung function in male COPD patient. Objective was to find out the factors associated with sarcopenia in COPD patients. Materials & Methods: This was cross-sectional observational study was carried out Different Privet Medical in Chandpur and Chandpur Medical College Hospital, Chandpur. Patients diagnosed with COPD according to Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines were included in this study. Exclusion criteria were unstable cardiac disease, an exacerbation within the preceding 4 weeks, predominant neurological limitation to walking (eg, significant hemiplegia) or contraindication to bioelectrical impedance analysis (BIA) including an implanted pacemaker or defibrillator. All participants gave written informed consent. EWGSOP criteria were applied to outpatients with stable COPD. Results: In uniavariate analysis, age, moderate COPD, severe COPD, obesity, non-elective admission over the past 12 months, MMRC scale and MAP were significantly associated with sarcopenia. In multivariate analysis, age, moderate COPD, severe COPD, obesity and MMRC scale were significantly associated with sarcopenia. Conclusion: Prevalence of sarcopenia was 26%. Independent factors associated with sarcopenia Age (>70 years) years (adjusted odds ratio (AOR) 4.387. Sarcopenia affects about one-quarter of COPD patients. Age, severity of COPD, MMRC scale, and BMI status were the factors associated with sarcopenia. Medicine Today 2021 Vol.33(1): 50-53

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Extracellular adenosine triphosphate is associated with airflow limitation severity and symptoms burden in patients with chronic obstructive pulmonary disease

Scientific Reports ◽

10.1038/s41598-019-51855-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Iva Hlapčić ◽

Andrea Hulina-Tomašković ◽

Anita Somborac-Bačura ◽

Marija Grdić Rajković ◽

Andrea Vukić Dugac ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Disease Severity ◽

Adenosine Triphosphate ◽

Quantitative Polymerase Chain Reaction ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Extracellular Adenosine ◽

Copd Patients

Abstract Extracellular adenosine triphosphate (eATP)-driven inflammation was observed in chronic obstructive pulmonary disease (COPD) but was not investigated in patients’ blood. Therefore, this study aimed to investigate eATP concentration in plasma of COPD patients and its association with disease severity and smoking. Study included 137 patients with stable COPD and 95 control subjects. eATP concentration was determined in EDTA plasma by luminometric method, and mRNA expression of eATP receptors P2X7R and P2Y2R was analysed by quantitative polymerase chain reaction (qPCR). eATP concentration was increased in COPD patients compared to controls (P < 0.001). Moreover, it was increasing with disease severity (GOLD 2–4) as well as symptoms burden and exacerbations history (GOLD A–D) (P < 0.05). eATP in healthy smokers differed from healthy non-smokers (P < 0.05) but was similar to GOLD 2 and GOLD A patients. eATP showed great diagnostic performances (OR = 12.98, P < 0.001) and correctly classified 79% of study participants. It demonstrated association with FEV1 and multicomponent indices (ADO, BODEx, BODCAT, CODEx, DOSE). Regarding gene expression, P2Y2R was increased in the blood of COPD patients. Plasma eATP could become a diagnostic and/or prognostic biomarker in COPD, as it seems to be associated with patients’ condition, quality of life and disease progression.

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