Impaired Spontaneous Baroreceptor Reflex Sensitivity in Patients With COPD Compared to Healthy Controls: The Role of Lung Hyperinflation

Background and Objectives: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for cardiovascular disease. This study aimed to investigate the relationship between pulmonary hyperinflation and baroreceptor reflex sensitivity (BRS), a surrogate for cardiovascular risk.Methods: 33 patients with COPD, free from clinical cardiovascular disease, and 12 healthy controls were studied. Participants underwent pulmonary function and non-invasive hemodynamic measurements. BRS was evaluated using the sequence method during resting conditions and mental arithmetic stress testing.Results: Patients with COPD had evidence of airflow obstruction [forced expiratory volume in 1 s predicted (FEV1%) 26.5 (23.3–29.1) vs. 91.5 (82.8–100.8); P < 0.001; geometric means (GM) with 95% confidence interval (CI)] and lung hyperinflation [residual volume/total lung capacity (RV/TLC) 67.7 (64.3–71.3) vs. 41.0 (38.8–44.3); P < 0.001; GM with 95% CI] compared to controls. Spontaneous mean BRS (BRSmean) was significantly lower in COPD, both during rest [5.6 (4.2–6.9) vs. 12.0 (9.1–17.6); P = 0.003; GM with 95% CI] and stress testing [4.4 (3.7–5.3) vs. 9.6 (7.7–12.2); P < 0.001; GM with 95% CI]. Stroke volume (SV) was significantly lower in the patient group [−21.0 ml (−29.4 to −12.6); P < 0.001; difference of the means with 95% CI]. RV/TLC was found to be a predictor of BRS and SV (P < 0.05 for both), independent of resting heart rate.Conclusion: We herewith provide evidence of impaired BRS in patients with COPD. Hyperinflation may influence BRS through alteration of mechanosensitive vagal nerve activity.

Proportion of Lung Hyperinflation In Patients With Persistent Asthma In Persahabatan Hospital Jakarta Using Multiple Breath N2-Washout

Background: In asthma, small airway dysfunction and inflammation may induce significant lung hyperinflation. The aim of the study is to discover the proportion of lung hyperinflation in patient with persistent asthma in Persahabatan Hospital Jakarta. Method: A cross sectional study with descriptive analysis was done in Asthma clinic Persahabatan Hospital from September-November 2016. Forty-five subjects were recruited consecutively. Interview, physical examination, chest x-ray (CXR), spirometry and multiple breath N2-washout (MBW) were performed. Lung hyperinflation was defined as a residual volume /total lung capacity (RV/TLC%) above the upper limit of normal. Results: The proportion of lung hyperinflation in patients with persistent asthma was 17,8% (8 of 45 subjects). Median RV in milliliter was 1230 (570-2860). Median functional residual capacity (FRC) in milliliter was 1730 (970-3990). Median TLC in milliliter was 3310 (2490-6350). Mean RV/TLC ratio was 36,39% (SD±8,86). Mean FRC/TLC ratio was 52,86% (SD ±6,85). There was a significant correlation between forced expiratory volume in 1 second (FEV1%) value with lung hyperinflation with the decline of FEV1 <60% increased the risk of lung hyperinflation by 8,46 (95%CI=1,155-61,98; p=0,036). There were no significant correlation between age, gender, smoking habit, body mass index (BMI), ACT score, the severity of persistent asthma, duration of asthma, duration of steroid inhalation use, exacerbation history in the last 12-months and emphysematous in CXR with lung hyperinflation (p>0,05). Conclusions: The proportion of lung hyperinflation in patient with persistent asthma in Persahabatan Hospital Jakarta is 17,8%. Lung hyperinflation in persistent asthma is associated with the degree of airway obstruction.

Telomere length dynamics over 10-years and related outcomes in patients with COPD

Background Chronic obstructive pulmonary disease (COPD) has been proposed as a disease of accelerated aging. Several cross-sectional studies have related a shorter telomere length (TL), a marker of biological aging, with COPD outcomes. Whether accelerated telomere shortening over time relates to worse outcomes in COPD patients, is not known. Methods Relative telomere length (T/S) was determined by qPCR in DNA samples from peripheral blood in 263 patients at baseline and up to 10 years post enrolment. Yearly clinical and lung function data of 134 patients with at least two-time measures of T/S over this time were included in the analysis. Results At baseline, T/S inversely correlated with age (r = − 0.236; p < 0.001), but there was no relationship between T/S and clinical and lung function variables (p > 0.05). Over 10 years of observation, there was a median shortening of TL of 183 bp/year for COPD patients. After adjusting for age, gender, active smoking and mean T/S, patients that shortened their telomeres the most over time, had worse gas exchange, more lung hyperinflation and extrapulmonary affection during the follow-up, (PaO2 p < 0.0001; KCO p = 0.042; IC/TLC p < 0.0001; 6MWD p = 0.004 and BODE index p = 0.009). Patients in the lowest tertile of T/S through the follow-up period had an increased risk of death [HR = 5.48, (1.23–24.42) p = 0.026]. Conclusions This prospective study shows an association between accelerated telomere shortening and progressive worsening of pulmonary gas exchange, lung hyperinflation and extrapulmonary affection in COPD patients. Moreover, persistently shorter telomeres over this observation time increase the risk for all-cause mortality.

Native lung hyperinflation after single lung transplantation – case report and literature review

Introduction: Single lung transplantation (SLuTx) is a challenging operation for patients with end-stage chronic pulmonary diseases. After surgery, native lung hyperinflation (NLH) and a mediastinal shift may develop, which changes the anatomical position of the lungs and heart and may lead to graft compression. Aim: We present a case report of a patient who developed NLH after SLuTx. We discuss the treatment methods and compare the outcomes with other case reports and analysis from world literature. Case study: A 56-year-old female patient was diagnosed with end-stage chronic obstructive pulmonary disease (FEV1 < 30%) and qualified for right SLuTx. After the procedure, spirometry revealed gradual loss in FEV1. Radiological images confirmed NLH and compression of the graft. Therefore, a native lung pneumonectomy was performed with positive outcomes. Results and discussion: NLH is a known complication of SLuTx. Typically, lung volume reduction surgery is performed to reduce the compression and a pneumonectomy is a rare treatment, even in centres with extensive experience with SLuTx. Conclusions: Despite SLuTx being a common approach in many pulmonary diseases, NLH should be always taken into consideration. Hyperinflation could cause a dangerous loss of respiratory efficiency and require invasive surgeries for lung transplant recipients.

The effect of tiotropium/olodaterol versus fluticasone propionate/salmeterol on left ventricular filling and lung hyperinflation in patients with COPD

This exploratory, randomised, double-blind, double-dummy, multicentre, cross-over study explored the effect of 6 weeks of treatment with tiotropium/olodaterol (T/O) versus fluticasone propionate/salmeterol (F/S) on left ventricular filling in patients with chronic obstructive pulmonary disease with functional residual capacity (FRC) >120% predicted and postbronchodilator improvement of FRC ≥7.5%. Overall, 76 patients were randomised across nine sites. Treatment with T/O or F/S increased left ventricular end-diastolic volume index from baseline (adjusted mean change: T/O: 2.317 mL/m2, F/S: 2.855 mL/m2), with no statistically significant difference between treatments. However, T/O resulted in a significantly greater reduction in lung hyperinflation versus F/S (FRC plethysmography absolute change from baseline: F/S: –0.329 L, T/O: –0.581 L).

Influence of lung Hyperinflation on Respiratory Muscles Pressures During a Submaximal test in Patients with COPD: a Clinical Perspective

Background and objective:: Reduction of exercise tolerance is associated with expiratory flow-limitation (EFL) and lung hyperinflation; those are only partially reversible to bronchodilator. Lung hyperinflation lowers the diaphragm muscle provoking a mechanical disadvantage that, eventually, reduces maximal inspiratory (MIP) and expiratory (MEP) pressures. We aimed to assess the influence of the dynamic lung hyperinflation on respiratory pressures changes at rest and after a submaximal exercise test in COPD patients with and without bronchodilator. Methods:: We prospectively analyzed 16 COPD patients (FEV1 36.4±10% pred.; age 61.0±8 years, height 165±12 cm and BMI 25.9±6 kg/m2). MIP and MEP were measured before and after performing the six minutes walking test (6MWT) with and without bronchodilator (400 mcg of albuterol). Results:: Nine of 16 patients increased IC more than 150 ml after bronchodilator use. Right after the 6MWT accomplished without bronchodilator IC decreased 7.05% compared to the 6MWT baseline value (p<0.01). Nine patients decreased IC more than 150ml. After bronchodilator use patients performed the 6MWT without any IC significant reduction (p>0.05). Twelve patients increased the MIP (ranging from 70±11cmH2O to 77±10cmH2O, p = 0.0043) using 400mcg of albuterol. Thirteen patients reduced MIP after the 6MWT without bronchodilator use (p <0.007). There was no significant reduction (p> 0.05) in MIP when patients performed the 6MWT after bronchodilator use. We also found a significant correlation between MIP and inspiratory capacity (IC) and MEP and the IC before and after the 6MWT (r=0.61, p=0.0054; r=0.60, p=0.0031, respectively). Conclusions:: Dynamic pulmonary hyperinflation directly interferes with the ability of respiratory muscles to generate inspiratory and expiratory pressures. The previous use of bronchodilator in patients with COPD reduced dynamic hyperinflation when accomplishing a sub-maximal exercise.