Co Morbidities in Chronic Obstructive Pulmonary Disease, Are We Aware

Introduction: COPD is a major cause of morbidity andmortality worldwide Besides lungs it has systemic effects,co morbidities. These co morbidities increase the risk ofexacerbation, reduce health status and increase risk ofmortality. The primary objective of this study was to assesthe various co morbidities in COPD patients, to study thedifference in proportion of co morbidities in smokers ascompared to the non-smokers and to study the proportion ofvarious co morbidities according to GOLD stageMaterial and methods: We studied 55 consecutive COPDpatients who presented to the department of pulmonarymedicine, Goa Medical College from August 2016 to July2017.Results: Out of the 55 patients included in the study 34(61.8%) were males and 21(31.8%) were females, age (meanand SD) 67.32±9.46, FEV1% (mean and SD) 47.45±12.78,FEV1/FVC% (mean and SD) 57.05±9.11, 36(65.4%) weresmokers with pack /year (mean and SD) 26.08±17.55, and19(34.5%) had biomass exposure with Biomass exposureindex (mean and SD)104.54±71.05 and Hb (mean and SD)was 12.83±2.19. The most frequent co morbidties werehypertension 54.5% (30 cases), followed by psychologicaldisturbance like depression 43.6% (24 cases). Percentage ofco morbidities were higher in the COPD patients exposed totobacco smoke as compared to biomass smoke. Percentage ofco morbidities were higher in the very severe stage of COPDas compared to the other stages of COPD.Conclusion: We recommend as a general practice to assesco morbidities in all COPD patients and vise versa as the comorbidities play a important role in exacerbation, reducinghealth status and increasing risk of mortality

Factors Associated with Airway Disease and Interstitial Lung Disease in Rheumatoid Arthritis

OBJECTIVE: This study examined lung involvement in patients with rheumatoid arthritis (RA) and identified factors associated with airway disease (AD) and interstitial lung disease (ILD). METHODS: A total of 507 RA patients were enrolled in a cross-sectional study. Lung involvement was assessed by high-resolution computed tomography scan. The patient groups were classified according to normal, AD, and ILD. Multinomial logistic regression analysis was performed to identify factors associated with AD and ILD. RESULTS: The most frequent lung involvement was AD (38.3%) followed by ILD (12.6%). Old age (adjust odds ratio [aOR] 2.58, 95% confidence interval [CI] 1.70 to 3.90 for AD; aOR 4.38, 95% CI 2.30 to 8.35 for ILD), male gender (aOR 2.57, 95% CI 1.22 to 5.42 for AD; aOR 5.48, 95% CI 2.20 to 13.65 for ILD) were factors associated with AD and ILD in RA patients. ILD was associated with short disease duration (aOR 0.30, 95% CI 0.14 to 0.62), AD was associated with high titers of anti-cyclic citrullinated peptides antibodies (anti-CCP; aOR 1.61, 95% CI 1.07 to 2.44). CONCLUSION: AD was the most frequent lung involvement in patients with RA. Old age and male gender were both associated with AD and ILD. Short disease duration was associated with ILD. High titers of anti-CCP was associated with AD.

Immunoglobulin G Subclass Deficiencies in Adult Patients with Chronic Airway Diseases

Immunoglobulin G subclass deficiency (IgGSCD) is a relatively common primary immunodeficiency disease (PI) in adults. The biological significance of IgGSCD in patients with chronic airway diseases is controversial. We conducted a retrospective study to characterize the clinical features of IgGSCD in this population. This study examined the medical charts from 59 adult patients with IgGSCD who had bronchial asthma or chronic obstructive pulmonary disease (COPD) from January 2007 to December 2012. Subjects were classified according to the 10 warning signs developed by the Jeffrey Modell Foundation (JMF) and divided into two patient groups: group I (n = 17) met ≥ two JMF criteria, whereas group II (n = 42) met none. IgG3 deficiency was the most common subclass deficiency (88.1%), followed by IgG4 (15.3%). The most common infectious complication was pneumonia, followed by recurrent bronchitis, and rhinosinusitis. The numbers of infections, hospitalizations, and exacerbations of asthma or COPD per year were significantly higher in group I than in group II (P < 0.001, P = 0.012, and P < 0.001, respectively). The follow-up mean forced expiratory volume (FEV1) level in group I was significantly lower than it was at baseline despite treatment of asthma or COPD (P = 0.036). In conclusion, IgGSCD is an important PI in the subset of patients with chronic airway diseases who had recurrent upper and lower respiratory infections as they presented with exacerbation-prone phenotypes, decline in lung function, and subsequently poor prognosis.

Análisis de la incidencia de patologías respiratorias por exposición al polvo de madera en los carpinteros del quindío(Colombia) / Analysis of the incidence of respirator y pathologies caused by exposure to wood dust in carpenters of quindío (Colombia)

Es bien conocido por la comunidad científica internacional que la exposición al polvo de madera, dependiendo del tipo de madera utilizada en la fabricación del mueble, acarrea diferentes problemas a la salud del carpintero. Las madera blandas (coníferas) son irritantes, alergénicas, y con el tiempo pueden llegar a generar asma ocupacional y EPOC (Enfermedad pulmonar obstructiva crónica). El polvo de madera dura (no-coníferas) ha sido asociado con varios tipos de cáncer, incluyendo el de la cavidad nasal, pulmón y tracto gastrointestinal, y la enfermedad de Hodgkin. Las fibras alargadas acompañadas de poros corresponden a las fibras de coníferas. La mayoría de las fibras de no-coníferas son de paredes gruesas y cortas. Se sospecha que las características morfológicas de las fibras de las coníferas hacen que éstas sean más agresivas en la deposición de los tejidos blandos de la nariz y los pulmones quelas fibras de no-coníferas, aunque los efectos de estas últimas sean más letales. Sin embargo, la aparición del cáncer nasal y pulmón es más tardía que los problemas respiratorios e irritaciones provocadas por las coníferas. Un estudio de morbi-mortalidad laboral de los carpinteros de10 empresas del Quindío (Colombia) concluyó que el riesgo relativo eradel 81 por ciento, lo que nos confirma que la exposición continua al polvo demadera incide en la aparición de problemas o enfermedades respiratoriasy por ende al absentismo laboral.

It is well known by the international scientific community that exposure to wood dust, depending on the type of wood used in furniture manufacturing, affects the carpenter’s health in different ways. Softwoods (coniferous) are irritant, allergenic, and can eventually result in occupational asthma and COPD (Chronic obstructive pulmonary disease). Hardwood dust (non-coniferous) has been associated with several types of cancer, including the nasal cavity, lung and gastrointestinal tract, and Hodgkin's disease. Long and porous fibers are typical from conifers. Most non-coniferous fibers are short and thick-walled. It is suspected that the morphological characteristics of the fibers of conifers make them more aggressive in the deposition in the soft tissues of nose and lungs than nonconiferous fibers, although the effects of the latter are more lethal.However, the onset of nasal and lung cancer takes longer than respiratory problems and irritation caused by conifers. A study of morbidity and mortality of the carpenters working in 10 companies at Quindío (Colombia) concluded that the relative risk was 81 percent, which confirms that continuous exposure to wood dust influences the onset of problems or respiratory diseases and hence absenteeism in the workplace.

Clinical significance of serum IL - 8, sICAM - 1 and sE - selectin in patients with chronic obstructive pulmonary disease / 中国医师进修杂志

Objective To explore the roles of IL-8, sICAM-1 and sE- selectin in the airway inflammation of chronic obstructive pulmonary disease (COPD). Methods The levels of IL - 8, sICAM -1 and sE-selectin in the serum were measured by double-sandwich ELISA in 40 COPD patients and 20 healthy persons. The COPD patients were divided into two groups: 20 cases in COPD a-cute exacerbation group and 20 cases in stable period group. Results The IL- 8, sICAM- 1 and sE - selectin level of serum in patients with COPD acute exacerbation group and stable period group were obviously higher than those in healthy group, and patients with COPD acute exacerbation group was obviously higher than those in stable period group (P

Uso da mistura de hélio e oxigênio no estudo da ventilação de crianças com doença pulmonar obstrutiva crônica / The use of helium-oxygen mixture in the ventilation study of children with chronic obstructive lung disease

Objetivo: Estudar a distribuição do radioaerossol 99mTc-DTPA utilizando heliox ou oxigênio como veículos de nebulização na cintilografia pulmonar ventilatória de crianças e adolescentes com doença pulmonar obstrutiva crônica (DPOC). Material e métodos: Ensaio clínico randomizado e controlado. Incluídos pacientes (5 a 18 anos) com DPOC que, entre março de 1996 e setembro de 1998, necessitaram realizar cintilografia pulmonar ventilatória. A obstrução ao fluxo aéreo foi quantificada pela espirometria. Aleatoriamente foram distribuídos em dois grupos, conforme o gás utilizado na nebulização durante a cintilografia: heliox (hélio 80% e oxigênio 20%), ou oxigênio. Os resultados foram expressos através do slope (inclinação da curva de aquisição cumulativa de radioatividade pulmonar) e pela concentração cumulativa máxima de radioatividade obtida nos campos pulmonares. Determinou-se, ainda, o tamanho médio das partículas de 99mTc-DTPA geradas pelos dois gases. Resultados: Foram alocados dez pacientes em cada grupo, sem diferenças (p>0,05) quanto ao gênero, diagnóstico etiológico, presença de desnutrição, médias de peso, estatura, superfície corpórea, ou nos resultados da espirometria. A média dos slopes do grupo heliox (5.039 + 1.652) foi maior (p=0,018) que no grupo oxigênio (3.410 + 1.100). Pacientes do grupo heliox com acentuada redução do fluxo aéreo apresentaram um slope médio maior (p=0,017) do que o dos pacientes do grupo oxigênio com diminuição do fluxo aéreo. Os pacientes dos grupos do heliox e do oxigênio, sem evidências de obstrução ao fluxo aéreo na espirometria, não apresentaram diferenças nas médias dos slopes (p=0,507). O diâmetro médio das partículas do 99mTc-DTPA geradas pelo heliox foi de 2,13 (+0,62mm), que é maior (p=0,004) que o daquelas geradas pelo oxigênio (0,88 +0,99 mm). Conclusões: O heliox como veículo de nebulização na cintilografia pulmonar de crianças e adolescentes com DPOC promove uma melhor dispersão e distribuição do radioaerossol, do que a obtida pelo oxigênio. Esses benefícios do heliox, em relação aos do oxigênio, tornam-se mais evidentes em presença de obstrução das vias aéreas inferiores, enquanto que na sua ausência, não se observa diferença na dispersão e na distribuição de radioaerossol. As partículas geradas pelo heliox e pelo oxigênio, apesar de apresentarem diferenças significativas em seus diâmetros médios, encontram-se dentro da amplitude recomendada (1 a 5mm). Portanto, essa possível diferença não justifica os efeitos demonstrados pelo heliox neste estudo.

Objective: To study the distribution of the radioaerosol of 99mTc- DTPA when the heliox gas is used as an inhalation vehicle during the pulmonary ventilatory scintigraphy in children and adolescents with chronic obstructive lung disease (COPD). Material and methods: Clinical randomized and controlled trial. Patients (from 5 to 18 years old) with COPD needing pulmonary scintigraphic study, between March 1996 and September 1998, were included. The obstruction of the lower airway was measured by pulmonary function study. The patients were randomized in two groups: heliox (helium 80% and oxygen 20%) or oxygen, according to the gas used as a vehicle to nebulize the particles during the scintigraphic study. The results of the scintigraphic study were expressed by the slope of the curve (the inclination of the curve of cumulative pulmonary radioactivity) and by the maximal cumulative radioactivity achieved in the lungs areas. The mean diameter of the 99mTc-DTPA particles generated by heliox and oxygen were measured by laser diffraction. Results: Ten patients were allocated in each group, without any statistical difference (p>0.05) in respect to gender, main diagnosis, signs of undernutrition, the mean values of weight, height, body area and the results of the pulmonary function study. The mean slope in the heliox group (5.039 +1.652) showed a significant difference (p=0.018) when compared to the mean slope of the oxygen group (3,410 +1,100). The patients with reduction of the airway flow in the heliox group obtained a mean slope with significant difference (p=0.017) when compared to the mean slope of the patients in the oxygen group with the same reduction in airway flow. The patients of the heliox group and oxygen group without airway obstruction flow did not show any statistical difference when they were compared on the basis of either the means of the slopes (p= 0.507) or the means of the cumulative radiation in the lung fields (p=0.795). The mean diameter of the particles of 99mTc- DTPA generated by heliox was 2.13 (+0.62mm), with a statistical difference (p=0.004) when compared with the mean diameter of the particles generated when oxygen was used as a vehicle (0,88 +0,99 mm). Conclusions: When heliox was used as a vehicle in the scintigraphic study of children and adolescents with DPOC, it showed a better distribution and dispersion of the 99mTc-DTPA into the lungs than that obtained when oxygen was used. The benefits of heliox over oxygen are more evident in the presence of lower airway obstruction flow. Without airway obstruction flow we could not demonstrate any difference in the distribution and in the radiation activity into the lungs. The mean diameters of the particles of 99mTc-DTPA generated by heliox and oxygen showed a significant difference. In spite of this, the mean diameters observed in both groups were included in the recommended range (between 1 and 5 mm). Therefore, the observed differences between the particles generated by both gases could not justify the effects of heliox demonstrated in this study.