Relations between asthma and obesity: an analysis of multiple factors / Relações entre asma e obesidade: análise de múltiplos fatores

ABSTRACT Objective: Asthma and obesity are prevalent and interrelated diseases. In the pediatric population, the effect of systemic inflammation associated to obesity, leading to inflammation of the airways, is currently controversial. Our aim was to compare inflammatory, clinical and spirometric patterns between children with asthma and obesity and those within the normal weight status range. Methods: A total of 79 boys and girls from 6 to 10 years old were selected and divided into four groups: obese asthmatics, non-obese asthmatics, obese non-asthmatics, and non-obese non-asthmatics. In addition to collecting clinical and anthropometric data, all children underwent spirometry and skin prick tests for inhalant allergens. Blood samples for measurement of cytokines and adipokines were also collected. Results: Obese asthmatics had significantly worse control of asthma than non-obese asthmatics (OR 4.9; 95%CI 1.1‒22.1), regardless of sex, physical activity and atopy. No differences in spirometry, Th1 and Th2 cytokines and adipokines levels were observed among the four groups. The prick tests were positive in 81.8 and 80% of non-obese asthmatics and obese asthmatics, respectively. Conclusions: The degree of control of asthma was significantly lower in the obese group, regardless of the findings of no differences in spirometry. Extra-pulmonary factors could be responsible for this symptomatic profile. High positivity of skin test in both groups, which is considered a good marker of atopy, shows a preponderant atopic component in the genesis of asthma, both in children with obesity and in those within the normal weight status.

RESUMO Objetivo: A asma e a obesidade são doenças prevalentes e inter-relacionadas. Na população pediátrica, o efeito da inflamação sistêmica associada à obesidade, levando à inflamação das vias aéreas, é controverso. Nosso objetivo foi comparar padrões inflamatórios, clínicos e espirométricos entre crianças obesas e aquelas com peso normal. Métodos: Setenta e nove meninos e meninas de 6‒10 anos de idade foram selecionados e divididos em quatro grupos: asmáticos obesos, asmáticos não obesos, não asmáticos obesos e não asmáticos não obesos. Além de dados clínicos e antropométricos, todas as crianças foram submetidas a espirometria e testes cutâneos para alérgenos inalantes. Também foram coletadas amostras de sangue para dosagem de citocinas e adipocinas. Resultados: Obesos asmáticos tiveram um controle significativamente pior da asma do que os não obesos (RP 4,9; IC95% 1,1‒22,1), independentemente do sexo, atividade física e atopia. Não foram observadas diferenças nos níveis de espirometria, citocinas Th1 e Th2 e adipocinas entre os quatro grupos. Os testes cutâneos foram positivos em 81,8 e 80% dos não obesos asmáticos e obesos asmáticos, respectivamente. Conclusões: O grau de controle da asma foi significativamente menor no grupo obeso, apesar de não ter havido diferenças nos achados espirométricos. Esse resultado sugere que fatores extrapulmonares podem ser responsáveis por esse perfil sintomático. A alta positividade do teste cutâneo nos dois grupos, considerado um bom marcador de atopia, demonstrou o componente atópico como preponderante na gênese da asma, tanto em crianças com obesidade quanto naquelas com peso normal.

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study / Comparação entre os resultados de espirometria após tratamento para tuberculose pulmonar em pacientes com e sem doença pulmonar prévia: um estudo multicêntrico

ABSTRACT Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

RESUMO Objetivo: Comparar os resultados da espirometria de pacientes tratados e curados para tuberculose pulmonar (TBP) com e sem doença pulmonar prévia e analisar os fatores de risco relacionados à gravidade funcional. Métodos: Estudo transversal, multicêntrico, em quatro centros de referência no Brasil. Os pacientes foram classificados em dois grupos: grupo com doença pulmonar prévia ou história de tabagismo (grupo DPT+) e grupo sem doença pulmonar prévia e sem tabagismo (grupo DPT−). Os pacientes realizaram espirometria (pelo menos seis meses após a cura), e foram coletados dados sociodemográficos e clínicos. Resultados: Foram incluídos 378 pacientes: 174 (46,1%) no grupo DPT+ e 204 (53,9%) no grupo DPT−. Na amostra total, 238 pacientes (62,7%) apresentaram alguma alteração espirométrica. No grupo DPT+ houve predominância de distúrbio ventilatório obstrutivo (em 33,3%), e distúrbio ventilatório restritivo predominou no grupo DPT− (em 24,7%). Quando comparados com o grupo DPT+, os pacientes do grupo DPT− apresentaram menos frequentemente alteração radiológica (p < 0,01) e funcional (p < 0,05). Porém, dos 140 (79,1%) do grupo DPT− com radiografia de tórax normal ou minimamente alterada, 76 (54%) apresentaram alguma alteração funcional (p < 0,01). Os fatores de risco relacionados com a gravidade funcional no grupo DPT− foram grau de dispneia (p = 0,03) e alterações radiológicas moderadas ou acentuadas. Conclusões: O comprometimento da função pulmonar é frequente após o tratamento da TBP independentemente do histórico de tabagismo ou doença pulmonar prévia. A espirometria deve ser sugerida para esses pacientes que evoluem com grau moderado/grave de dispneia e/ou alteração radiológica relevante após o tratamento da TBP.

Valeurs spirométries de référence dans la population bantoue de Kinshasa de 20 à 70 ans

Introduction: les valeurs spirométriques de référence ne sont pas extrapolables entre populations, étant tributaires de nombreuses variables humaines et environnementales, d'où l'intérêt des études locales dans ce domaine. L'objectif est de déterminer des valeurs de référence chez des adultes sains de Kinshasa. Méthodes: une étude transversale incluant 7443 sujets (3208 femmes, 43%). Le VEMS, la CVF et le DEP ont été corrélés aux données anthropométriques. Cinq groupes d'âge ont été constitués et les comparaisons effectuées en fonction du sexe, de l'âge, de l'IMC et de la pratique d'une activité sportive.Résultats: les différences sont évidentes entre sexes, pour le VEMS (3,00 vs 2,21 L), la CVF (3,19 vs 2,38 L), et le DEP (6,8 vs 5,70 L/s); de même que pour les tranches d'âge extrêmes. Elles sont comprises entre: 2,33 et 4,54 vs 1,93-3,3 L dans le groupe de 20-29 ans et 1,76-3,39 vs 1,60 vs 2,53 L chez les 60-70 ans; pour La CVF entre 2,44-4,89 vs 1,96-3,56 L et 1,79-3,78 vs 1,66-2,74 L; pour le DEP entre 4,34-12,2 vs 3,62-8,58 L/s et 2,99-6,76 vs 2,99-7,34L/s chez les 60-70 ans. Conclusion: les différences liées au genre, à l'âge, aux données anthropométriques ainsi qu'à la pratique d'une activité sportive sont évidentes. Ces résultats justifient des enquêtes plus étendues et montrent la pertinence des valeurs basées sur les percentiles dans la déterminantion d'un référentiel spirométrique dans une population donnée

Estudio Transversal: Prevalencia y Factores Asociados de Alteraciones Espirométricas en Personas de 40 a 59 años que Residen en la Ciudad de Cuenca, 2013 / Cross sectional research: Prevalence and associated factors of spirometric alterations in people of 40 to 59 years of residence in the city of cuenca, 2013

INTRODUCCIÓN: La exposición a contaminantes ambientales pueden llevar a efectos negativos en la población, el objetivo del presente estudio fue determinar la prevalencia y los factores asociados de alteraciones espirométricas en personas de 40 a 59 años que residen en la ciudad de Cuenca - Ecuador, 2013. MÉTODO: Se trató de un estudio transversal analítico con 500 personas entre 40 a 59 años, escogidas por aleatorización simple del centro de la ciudad y el parque industrial de Cuenca ­ Ecuador. Los datos se obtuvieron mediante espirometrías y encuestas analizadas por el programa SPSS 22, se calculó frecuencia y razón de prevalencia con intervalos de confianza del 95 % y el valor p. RESULTADOS: La prevalencia de alteraciones espirométricas es del 34 %, predominando el patrón restrictivo (56.4 %). Los participantes se distribuyeron en 53.4 % y 46.6 % para mujeres y hombres respectivamente. Existe asociación estadísticamente significativa en alteración espirométrica con los hombres, entre 50 a 59 años, tiempo de consumo de tabaco, comorbilidad no respiratoria, tránsito vehicular abundante y la vivienda cercana tanto a parqueaderos como a fábricas. Sin embargo, no se demostró asociación por ocupación, exposición al tabaco e índice de masa corporal. CONCLUSIONES: La prevalencia de alteraciones espirométricas es alta, la cual estuvo asociada al género masculino, edad mayor de 50 años, consumo de tabaco por un periodo de tiempo mayor a 5 años, vivir cerca de parqueaderos y fábricas.(au)

BACKGROUND: Exposure to environmental pollutants can lead to negative effects on the population, the aim of scientific research and the associated factors of spirometric alterations in people aged 40 to 59 residing in the city of Cuenca - Ecuador, 2013. METHOD: This is an analytical cross - sectional study with 500 people between 40 and 59 years old, chosen by the simple center of Cuenca - Ecuador and the industrial park. Data were obtained by spirometry and surveys analyzed by the SPSS program 22, calculating frequency and prevalence ratio with 95 % confidence intervals and p-value. RESULTS: The prevalence of spirometric alterations was 34 %, with the restrictive pattern predominating (56.4 %). Participants were distributed in 53.4 % and 46.6 % for women and men respectively. There is a statistically significant association in spirometric alteration with men, between 50 and 59 years, time of smoking, non-respiratory comorbidity, abundant vehicular traffic and housing near a parking lot as a factories. However, the association by occupation, tobacco exposure and body mass index was not demonstrated. CONCLUSIONS: The prevalence of spirometric alterations is high, which was associated with males, older than 50 years, tobacco consumption for a period of more than 5 years, near the parking lots and factories.(au)

A eficácia do cicloergômetro no condicionamento cardiovascular em pacientes com lesão medular / Effectiveness of the cycle ergometer in cardiovascular conditioning of spinal cord injured patients

OBJETIVO: Avaliar a eficácia do cicloergômetro de membros superiores no condicionamento ardiorrespiratório em pacientes com lesão medular. MÉTODOS: Três pacientes participantes do programa de reabilitação do Hospital Estadual Mário Covas realizaram o programa de condicionamento físico durante 6 semanas (duas vezes/semana). Para avaliação inicial, foram utilizados: anamnese inicial, escala da American Spinal Injury Association, Functional Independence Measure, Medical Outcomes Study 36 - Item Short - Form Health Survey, exame espirométrico e mensuração da pressão inspiratória. As sessões de fisioterapia constaram de treino com cicloergômetro, sendo repetida a avaliação inicial ao término do estudo. RESULTADOS: Houve aumento de 40%, 53,4%, 20% na pressão inspiratória, respectivamente, para o paciente de nível cervical, torácico e lombar, com aumento na capacidade vital forçada e volume expiratório forçado no primeiro segundo (VEF1) nos pacientes tetraplégico e paraplégico nível torácico e redução na capacidade vital forçada e volume expiratório no primeiro segundo no paraplégico baixo. CONCLUSÃO: O cicloergômetro de membro superiores mostrou-se eficaz no programa de reabilitação em pacientes com diferentes níveis de lesão medular, apresentando melhora na pressão inspiratória e capacidades pulmonares não apresentando alteração quanto à escala de independência funcional e qualidade de vida.

OBJECTIVE: To evaluate the effectiveness of the upper limb cycle ergometer on cardiorespiratory fitness in spinal cord injured patients METHODS: Three patients participating in the rehabilitation program of Hospital Estadual Mário Covas participated in the fitness program for 6 weeks (2 times/week). For the initial evaluation, the following were used: initial anamnesis, American Spinal Injury Association scale, Functional Independence Measure, Medical Outcomes Study 36 - Item Short - Form Health Survey, spirometry and measurement of inspiratory pressure. The physiotherapy sessions consisted of training with a cycle ergometer, with the same initial assessment being repeated at the end of the study. RESULTS: There was an increase of 40%, 53.4%, 20% in the inspiratory pressure, for the patient with an injury at the cervical, thoracic, and lumbar levels, respectively, with an increase in forced vital capacity and forced expiratory volume in the first second (FEV1) in quadriplegic and paraplegic patients with thoracic level of injury, and reduction in forced vital capacity and forced expiratory volume in the first second in a paraplegic patients with a low injury. CONCLUSION: The upper limb cycle ergometer was effective in the rehabilitation program in patients with different levels of spinal cord injury, with an improvement in inspiratory pressure and lung capacity, showing no change as for functional independence scale and quality of life.

Manejo ambulatorio de la enfermedad pulmonar obstructiva crónica / Outpatient Management of Chronic Obstructive Pulmonary Disease

La Organización Mundial para la Salud (OMS) estima que actualmente en el mundo existen 210 millones de personas que padecen EPOC; asimismo estima que en el año 2030 esta enfermedad será la tercera causa de muerte a nivel mundial. El 90% de las muertes se producen en países de ingresos medios a bajos. De las dos presentaciones de EPOC la más frecuente es a nivel mundial bronquitis crónica...(AU)

Prevalence of Spirometrically-defined Restrictive Ventilatory Defect in Korea: The Fourth-2, 3, and Fifth Korean National Health and Nutrition Examination Survey, 2008-2012

The aim of the study was to evaluate the prevalence of restrictive ventilatory defect and to determine the risk factors in subjects with spirometrically-defined restrictive ventilatory defect. We used the population-based, fourth-2, 3 (2008, 2009) and fifth (2010-2012) Korea National Health and Nutrition Examination Survey (KNHANES) to analyze 15,073 subjects, aged > or =40 yr who underwent spirometry. Chest radiographs were also analyzed to identify restrictive lung disease. Spirometrically-defined restrictive ventilatory defect (FEV1/FVC> or =70% and FVC or =40 yr. The prevalence increased to 12.3% on using the lower limit of normal (LLN) criteria. Approximately 99.4% of subjects were classified as mild restrictive. Among these, 11.3% had inactive tuberculosis (TB) lesion, 2.2% cardiac disease, 2.0% previous operation scar or radiation injury and/or mediastinal disease, and 7.4% other pulmonary disease suggestive of restrictive lung diseases on chest radiograph. Evidence of previous TB history was independently associated with restrictive ventilatory defect (odds ratios [OR], 1.78; 95% confidence interval, 1.45-2.18) after adjustment for gender, age, smoking, area for residence and body mass index. The prevalence of restrictive ventilatory defect among the nationwide population in Korea was 11.3% with fixed ratio criterion and 12.3% with LLN criterion. Most cases were of the mild restrictive category and previous TB history is the independent risk factor for restrictive ventilatory defect.

Value of proton magnetic resonance spectroscopy of brain to study the cerebral metabolic abnormalities in COPD: Initial experience

Chronic obstructive pulmonary disease [COPD] patients were found to have cerebral metabolic abnormalities. Proton magnetic resonance spectroscopy [1H MRS] is a sensitive technique that detects metabolic changes of the brain. To study the cerebral metabolic changes in COPD patients using 1H MRS. This study was carried-out on twenty symptomatic COPD patients [16 male and 4 female] and age matched group of 20 healthy controls [11 male and 19 female]. Pulmonary function tests, respiratory muscle strength, resting arterial blood gases, and 1H MRS of the brain were carried out on all subjects. The parieto-temporal and occipital regions were localized for 1H MRS. The metabolic ratios of 7V-acetyl aspartate to creatine [NAA/Cr] and choline to creatine [Cho/Cr] were calculated by the single voxel technique. In comparison with healthy control subjects, the mean values of Cho/Cr in COPD patients were lower in parietotemporal and occipital areas [0.99 +/- 0.21 vs. 1.10 +/- 0.31; P = 0.22] [0.81 +/- 0.26 vs. 0.88 +/- 0.21; P = 0.37], respectively while, the mean values of NAA/ Cr in COPD patients were higher in both parieto-temporal and occipital areas of the brain [1.82 +/- 0.35 vs. 1.68 +/- 0.22; P = 0.14] [1.59 +/- 0.31 vs. 1.39 +/- 0.39; P = 0.08], respectively. In COPD patients, significant positive correlations were observed between maximal expiratory pressure [MEP] and NAA/Cr in parieto-temporal area of the brain. The cerebral metabolites, arterial blood gases, respiratory muscle strength, and pulmonary function tests are altered in symptomatic COPD patients. 1H MRS is a non invasive technique that detects cerebral metabolic changes in COPD patients

impact and effect of liver insufficiency of HCV infection on patients with chronic obstructive pulmonary diseases

Hepatitis C virus [HCV] infection is associated with a wide series of extra- hepatic manifestations. Pulmonary involvement is one of the extrahepatic manifestations of chronic hepatitis C virus [HCV] infection. The objective of this study was to determine the impact of HCV; infection and the degree of liver dysfunction in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted on COPD patients. They were selected from outpatient chest clinic in the Menoufia University Hospital. They were classified into 2 groups the first group COPD patients [n = 40] without hepatitis C and the second group COPD patients with chronic hepatitis C. Second group [COPD with HCV] classified into 3 subgroups according Child-Pugh classification to determine the degree of liver insufficiency. Group IIA: patients Child-Pugh [A], group IIB: patients Child-Pugh [B] and group IIC: patients Child-Pugh [C]. The following pulmonary function parameters were recorded: Forced Expiratory Volume in the first second [FEV1], Forced Expiratory Volume percent [FEV1/FVC%], Forced Expiratory Flow 25-75% [FEF 25-75%] and Maximal Voluntary Ventilation [MVV]. The study included 80 patients with COPD, 40 patients without chronic HCV infection [group I], and 40 patients with chronic HBV infection [group II].COPD patients with HCV infection have increased deterioration in pulmonary function [FEV1, FEV1/FVC, FEF 25-75% and MVV] than COPD patients without HCV infection. Also there were significant decreases in pulmonary function tests [FEV1, FEV1/FVC, FEF 25-75% and MVV] in group II subgroups IIA, IIB and IIC according to the degree of decompensation. Patients with COPD with HCV infection, have increased deterioration in pulmonary function than patients with COPD without HCV infection and the deterioration increases with hepatitis decompensation

Avaliação da distância percorrida e velocidade média durante o TC6 em pacientes com diferentes doenças pulmonares / Six-minute walk distance and average speed evaluation in patients with differents lung diseases

Objetivo - Avaliar e comparar a distância percorrida pelos diferentes distúrbios pulmonares com a predita por Enright-Sherrill, assim como a velocidade média durante o teste de caminhada de seis minutos (TC6). Além de verificar se a idade, o índice de massa corporal (IMC), os índices espirométricos e a velocidade média poderiam influenciar na resposta do TC6. Métodos - Participaram 124 indivíduos com diagnóstico de doenças pulmonares, que foram divididos a partir da espirometria em três grupos: obstrutivo, restritivo e misto. Foram avaliados os dados antropométricos e pessoais destes, e depois encaminhados para realizar o TC6 segundo a ATS. Resultados - Observou-se diferença estatística (p<0,001) entre a distância percorrida pelos três grupos durante o TC6 com a predita por Enright-Sherrill. No entanto, quando avaliada a distância entre os grupos não foi observada diferença estatística (p>0,05). Em relação à velocidade média não houve diferença entre os grupos (p=0,666). Contudo, observou-se que esta variável é influenciada pelo tempo (p<0,001). Também se observou correlação entre a idade (r=-0,29) e a velocidade média (r=0,93) com a distância percorrida. Já a distância predita, apresentou correlação com o IMC (r=-0,84), idade (r=-0,36) e velocidade média (r=0,37). Conclusões - Quanto ao distúbioo pulmonar, não houve interferência deste sobre a distância percorrida e predita no TC6, e sobre a velocidade média. No entanto, observou-se que a idade, o IMC e a velocidade média são os responsáveis pela resposta do TC6.

Objective -To evaluate and compare the six-minute walking distance (6MWD) in different lung disorders with the predicted by Enright-Sherrill; as well as the average speed during the six-minute walk test (6MWT). Beyond this, check if age, body-mass index, lung function and average speed can influence the response of 6MWT. Methods - This study included 124 subjects with lung diseases, which have been divided from the lung functions results in three groups: obstructive, restrictive and mixed. The anthropometrics and personal data was evaluated, and then, they were sent to perform the 6MWT, according to ATS. Results - We observed statistical difference (p<0.001) between the 6MWD obtained by the groups and the predicted by Enright-Sherrill. However, we didn't observed statistical difference among the groups, when we evaluate the 6MWD. In relation to average speed, we didn't find difference among groups (p=0.666). However, we observed that the time influenced this variable (p<0.001). Also, we observed correlation between the age (r=-0.29) and average speed (r=0.93) with the 6MWD. Already, the predicted 6MWD had correlation with body-mass index (r=-0.84), age (r=-0.36) and average speed (r=0.37). Conclusions - As to lung disorders, there was no interference about six-minute walk distance and predicted 6MWD, as well as about average speed. However, has been observed that age, body-mass index and average speed are the responsible for the response of 6MWT.

Asthma is inversely associated with Helicobacter pylori status

The increase in asthma rates has been linked epidemiologically to the rapid disappearance of Helicobacter pylori, a bacterial pathogen that persistently colonizes the human stomach. Recent evidence indicates that, H. pylori may have protective effects on allergic diseases. The aim of this study was to explore the relationship between asthma and H. pylori infection in a population with high prevalence of H. pyloriinfection. One hundred and seventeen asthma cases were eligible for the study in addition to 86 non asthma cases as control. Pre and post - bronchodilator spirometry, assay of Total serum immunoglobulin E [IgE] by enzyme immunoassay technique [ELISA] and [14]C Urea Breath Test [UBT] were done. Out of 41 asthmatic cases with positive H. pylori were 22 patients had mild asthma, 14 had moderate asthma, and 5 only had severe asthma with statistically significant difference between them. The mean serum level of Total IgE was significantly higher [190.04 +/- 111.9] in patients group than control group [94.13 +/- 46.49] with p-value 0.000, while the mean UBT was significantly lower [325.85 +/- 261.35] in patients group than control group [1068.67 +/- 680.7] with p-value 0.000. AS regard pulmonary function tests [FEV1 and FVC], there was statistically significant difference between positive H. pylori asthmatic and negative H. pylori asthmatic. We demonstrate an inverse association between H. pylori and asthma in a population with a high prevalence of H. pylori

Study the relationship of erythropoietin and chronic obstructive pulomonary disease

It has long been known that COPD causes polycythemia secondary to erythrocytosis caused by hypoxia present in advanced cases of COPD. However, it was shown in several studies that some COPD patients had anemia rather than erythrocytosis. Revealing the changes which occur in erythropoiesis in response to COPD was the aim of the current study. 41 COPD patients of different groups according to the inclusion and exclusion criteria and ten healthy control subjects age and sex matched were enrolled in the study. For all, history taking and full Clinical exam were performed, also ABGs, PFT [spirometry], routine labs [CBC, liver and renal function] and determination of EPO should be performed on human serum by ELISA. Showed that the erythropoietin level was 15.24 +/- 2.6 in stage 1, 22.61 +/- 5.68 in stage 2, 33.59 +/- 4, in stage 3, then 17.9 +/- 3.3 in stage 4. Also the total percentage of anemia in COPD patients was 46.3% [19/41], in comparison to 51.3% [21/41] non anemic and 2.4% [1/41] polycythemic. And that the percentage of anemia was 27.3% in stage 1, followed by 38.0% in stage 2, 100% in stage 3 then dropped to 58.33% in stage 4 with emergence of polycythemia in 8.33% of cases. Although COPD was thought to cause polycythemia, the current study showed that almost half of patients have anemia, and polycythemia occurred only in the advanced stages. It also appeared that response to erythropoietin in COPD is probably blunted especially with increased severity of the condition. This might be considered as a contributing factor in the development of anemia in COPD which is considered as anemia of chronic disease

Hormonal dysfunction in patients with chronic obstructive pulmonary disease

Systemic response to chronic disease in COPD patients might cause hormonal imbalance which in turn affects the severity of the disease. The severity of hypoxia in COPD patients causes alterations in thyroid function tests and IGF-1 levels. This work was carried on 50 COPD patients diagnosed and classified according to GOLD criteria and 20 healthy controlled subjects. All subjected to full clinical history, examination, chest X-ray and spirometry. Levels of TT3, TT4, FT3, FT4, IGF-1 and insulin were measured. TT4, FT3, FT4, TSH, and insulin levels were normal in all COPD. Despite the TT3 hormone level were normal in all stages of COPD, there is reduction in hormone levels in stage III and stage IV than control subjects. There is also reduction in TT3/TT4 ratio in severe COPD and there is correlation between TT3/TT4 ratio and PaO2 in stage III and stage IV but no correlation between TT3/TT4 ratio and PaO2 in stage I and stage II. IGF-1 hormone levels were variable among different stages of COPD. There is was no significant difference between some hormonal levels in COPD and in controls, accordingly hormonal replacement therapy in these patients is doubtful

Exhaled breath condesate nitric oxide end products and pH in controlled asthma

Asthma imposes a growing burden on the society in terms of morbidity, quality of life, and healthcare costs. It has the highest morbidity amongst inflammatory lung diseases and its prevalence continues to increase over the world. Inquiry into recent day or nighttime symptoms alone underestimates the burden of asthma and may lead to inadequate treatment of asthma. The aim of the present work is to evaluate the role of nitric oxide [NO] and hydrogen ion concentration [pH] levels in exhaled breath condensate [EBC] in cases of controlled bronchial asthma. The present study was conducted on 49 controlled asthmatic patients and 12 control subjects. All patients were subjected to thorough history taking, complete clinical examination and plain postero-anterior chest X-ray. All asthmatics and control subjects were subjected to routine laboratory investigations, spirometric study, EBC collection, processing and analysis for its content of both nitric oxide end products: nitrite and nitrate [NOx] and pH. All asthmatics represented Group IT which was further divided into Group Ia: 34 patients on regular inhaled corticosteroid [ICS] therapy and Group Ib: 15 patients on no regular therapy. The control subjects represented Group II. The forced vital capacity [FVC], forced expiratory volume in the first second [FEV1], FEV1/FVC, peak expiratory flow rate [PEFR] and forced expiratory flow during the middle portion of a forced expiration [FEF 25-75%] were significantly lower in asthmatics than control subjects. The EBC-NOx mean +/- SD in micro mol/L in Group IT [5.99 +/- 1.63], in Group Ia [5.27 +/- 1.26] and in Group Ib [7.63 +/- 1.15] were significantly higher than in Group II [3.66 +/- 0.67] with, respectively [p = 0.000], [p = 0.000] and [p = 0.000]; and was significantly higher in Group Ib than Group Ia [p = 0.000]. The EBC-pH mean +/- SD in Group IT [7.32 +/- 0.27], in Group Ia [7.35 +/- 0.25] and in Group Ib [7.27 +/- 0.3] were significantly lower than in Group II [7.82 +/- 0.09] with, respectively [p = 0.000], [p = 0.000] and [p = 0.000]; with no significant difference between Group Ia and Group Ib. The EBC-NOx was significantly directly correlated to eosinophils count [p = 0.017] and neutrophils count [p = 0.002]; and inversely correlated to FEV1 [p = 0.016], FEV1/FVC [p = 0.001], PEFR [p = 0.030] and EBC-pH [p = 0.003]. The EBC-pH was significantly inversely correlated to eosinophils count [p = 0.017] and neutrophils count [p = 0.036]; and directly correlated to FVC [p = 0.004], FEV1 [p = 0.004] and PEFR [p = 0.000]. EBC-NOx is significantly higher and EBC-pH is significantly lower in asthmatic patients than in control subjects. Asthmatics receiving ICS have a lower EBC-NOx level than those not. EBC-NOx and EBC-pH were significantly correlated and both of them showed significant correlations with spirometric parameters of airway obstruction

Quality of life in COPD patients

Quality of life [QOL] can be severely impaired in patients with COPD. They usually show an accelerated decline in lung function and progressive impairment of physical performance. To study quality of life in patients with COPD and to examine its relationship with the severity of the disease. Quality of life was determined in 40 COPD patients using the St. George's Respiratory Questionnaire for COPD patients [SGRQ-C]. Mild COPD patients differed significantly from other grades of COPD in their total SGRQ-C score, symptoms score, activity score and impact score [p

Brain-stem auditory evoked responses in COPD patients

COPD is a multi-system disorder. It appears to be associated with the presence of systemic inflammatory markers as C reactive protein. The present study aimed to evaluate the brain-stem auditory evoked potentials [BAEP] abnormalities in stable COPD patient and its correlation with high sensitivity C reactive protein [hs-CRP] as a part of multi-system disorder. This case control study was carried out at Mansoura University Hospital Egypt from October 2009 to February 2010. The study comprised 40 stable COPD patients and 15 healthy controls with no risk that may lead to neuropathy. All the patients and controls were subjected to the following: I-Thorough history taking and clinical examination. II-Pulmonary function tests including: 1-Spirometry 2-Body plethsymography 3-Arterial blood gases analysis. III- Record of brain-stem auditory evoked potentials [BAEP] including: latencies of waves I, II, III, IV and V together with interpeak latencies [IPLs] of I-III, I-V and III-V and amplitudes of waves I-Ia and V-Va. IV - Measurement of serum high sensitivity C reactive protein [hs-CRP] by ELISA technique. V - Statistical analysis. The level of hs-CRP reactive protein in COPD was significantly elevated and correlated with spirometric, blood gases parameters and GOLD stage. The BAEP latencies of waves I, II, III, IV and V, together with interpeak latencies and amplitudes of waves I-Ia and V-Va measured on both ears were significantly different in COPD patients than controls. The prevalence of brain-stem auditory evoked potentials abnormalities was higher among very severe group of COPD. Most of BAEP wave latencies together with interpeak latencies and wave amplitudes on both ears were significantly correlated with the spirometric and blood gases parameters. The level of hs-CRP was correlated significantly with abnormalities of BAEP variables. This study showed significant subclinical BAEP abnormalities in studied stable COPD male patients. This indicates conductive defect of auditory nerve, cochlea and even hearing pathway in the brain as a part of systemic inflammation. Theses BAEP abnormalities were significantly correlated with GOLD classification, hs-CRP and PaO[2]

role of impulse oscillometry in assessment of airway obstruction in smokers and ex-smokers

Impulse oscillometry provides useful clinical information that prominently includes functional assessment of small, peripheral airway behavior beyond that available from commonly used pulmonary function tests [PFT]. The aim of this study was to assess the role of impulse oscillometry in assessment of airway obstruction in smokers and ex-smokers. Sixty subjects divided into three groups [asymptomatic smokers, ex-smokers and non smoker healthy subjects as a controls] all were assessed by spirometry and IOS. Based on the IOS results in smokers, there was 17 negative cases and only 3 diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was only 33% as it was able to detect one diseased case from a total of three cases .In ex-smokers, there was 13 negative cases and only 7 diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was only 42.8% as it was able to detect 3 diseased case from a total of 7 cases. In controls, there was 18 negative cases and two diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was 50% as it was able to detect 1 diseased case from a total of 2 cases. IOS is an effective, easy to perform, and a non invasive method for the assessment of airway obstruction in obstructive pulmonary disorders. Although, there is no significant difference between impulse oscillometry and spirometry parameters in early detection of airway obstruction in smokers and ex-smokers groups

prevalence of gastro esophageal reflux disease [GERD] in copd patients and its effect on the number of exacerbations in dnmi

This study included 25 COPD inpatients in chest, ICU and internal medicine departments in Damanhur National medical Institute., 10 of them with moderate COPD and 15 of them with severe COPD [by gold 2007][1]. 21 were males and 4 were females [active or passive smokers]. The aim of the work was to study the prevalence of GERD in COPD patients and its effect on the number of exacerbations of COPD. Both groups were subjected to history taking, full clinical examination, full laboratory investigations, Chest radiography, spirometry, arterial blood gases and upper GIT endoscopy and biopsy. Results revealed that the prevalence of GERD in COPD patients by endoscopy was 36% in the moderate group, 64% in the severe group. By biopsy being more prevalent in the severe group of COPD 86.6% compared to70% in moderate COPD. GERD severity increases as the degree of COPD increases. GERD increases with increase in the smoking [pack/year] both in moderate, in the severe group. Moreover, there was increase in the frequency of exacerbations of COPD in GERD patients both in moderate and severe groups. This study revealed that the frequency of exacerbation was higher among GERD cases with statistically significant difference in between both group From this study we conclude that GERD is common in COPD patients being more among severe COPD. Also GERD increase the number of exacerbations of COPD

Sensitivity and specificity of self-reported symptoms for exercise-induced bronchospasm diagnosis in children

Exercise-induced bronchospasm [EIB] is a common condition in elite athletes. The purpose of this study was to evaluate the diagnostic value of self-reported EIB symptoms in children. In a cross sectional study in 2005, all soccer player boys of 3 football schools of Shahr Rey a town in the south of Tehran, enrolled in this study. All subjects were asked for the presence of four cardinal symptoms of EIB [cough, wheeze, shortness of breath, chest pain/discomfort] during and after exercise. Self reported symptom-based EIB was defined as having at least two out of four symptoms. Findings were compared to spirometric criteria as a gold standard test. A total of 371 boys were enrolled in this study. The mean age of children was 11.67 +/- 1.53 years [range 7-16 years]. According to spirometric findings, 74 [19.9%] subjects had EIB. The sensitivity and specificity of self-reported symptoms for EIB diagnosis were 13.0% and 89.9%, respectively. Self-reported symptoms of EIB in children can be useful for epidemiological study. Our results in Iran are comparable with studies in other countries and point to a relatively high prevalence of EIB among athlete children

Chronic obstructive pulmonary disease in patients with catheter diagnosed coronary artery disease: prevalence and risk factors

Chronic obstructive pulmonary disease [COPD] and coronary artery disease [CAD] co-morbidity exists at different rates. This co-morbidity affects quality of life and increases mortality. In the developing world the prevalence of CAD is increasing but the prevalence of COPD is unknown. This study was designed to estimate the proportion of patients with CAD who have concomitant COPD and identify factors that may increase the likelihood of COPD in CAD patients. A cross sectional study that included consecutive adults with catheter diagnosed CAD recruited from two cardiac centers. Patients completed a COPD diagnosis validated questionnaire and performed spirometry using an electronic spirometer. COPD was diagnosed if patient score placed him/her in the high likelihood zone of having COPD, or if the FEV1 was less than 80% predicted. Results were compared using chi-square test. Fifty nine patients with CAD were studied. The mean age [SD] was 59 [9.7] years. Of these 59 patients; 27 [44%] had COPD diagnosed by either questionnaire or spirometry. COPD was significantly more among patients with single vessel disease compared with multiple vessel disease [p = 0.01]. There was no difference in the number of smokers among patients with CAD and COPD, and CAD alone [p = 0.29]. The prevalence of COPD increased with increasing age [p=0.003]. In this group of patients with CAD more than two in five have concomitant COPD. The prevalence of COPD increases with age and is more in patients with single vessel disease compared with patients who have multiple vessel disease