Impact of changing GOLD guidelines (2007-2011-2017) on assignment of a COPD patient to disease severity category.

INTRODUCTION: The international standard for the recognition and treatment of chronic obstructive pulmonary disease (COPD) is guided by a regularly updated set of criteria developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). AIM: To investigate the impact of updated COPD management guidelines from 2007 to 2017 (GOLD 2007, GOLD 2011 and GOLD 2017) on the assignment of patients into individual therapeutic groups, examining both individual and population dimensions. MATERIAL AND METHODS: Each of 500 randomly chosen primary care physicians in Poland provided information on 10 individual COPD patients (disease history, clinical status, treatment and pharmacotherapy). This data was used to simulate the consequences of the implementation of the GOLD 2007, 2011 and 2017 guidelines. RESULTS: A group of 298 physicians of 500 approached provided information on 2597 patients (64.2% males) aged 29-96 (61.6 ±11.1 years). Based on GOLD 2007 guidelines, most patients (56.7%) presented a severe stage of COPD. GOLD 2011 updates would significantly increase the proportion of patients with the most severe stage of disease, and this group would be predominantly classified as moderate or severe in GOLD 2007. The implementation of GOLD 2017 guidelines would result in a significant migration of patients towards the lightest (category A) form of the disease. CONCLUSIONS: Updates to the GOLD 2007 COPD guidelines for GOLD 2011 and 2017 would have a significant impact on the classification of patients for particular therapeutic groups. As a result of the migration of patients to particular therapeutic groups, the pharmacological treatment would also change.

Consequences of Changing the GOLD Reports (2007-2011-2017) on the Treatment Regimen of Patients with COPD.

Detailed treatment regimens for patients with chronic obstructive pulmonary disease (COPD) were developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Every few years the method of classification of COPD severity and the treatment recommendations are significantly revised. The aim of this study was to determine the clinical implications of changing GOLD reports (2007-2011-2017) and the impact that these changes would have on pharmacological treatment regimens of patients with COPD. A group of 500 randomly chosen primary care physicians in Poland each provided information on 10 consecutive patients diagnosed with COPD. This data was used to simulate the therapeutic consequences of the update of the GOLD 2007 report to GOLD 2011 and GOLD 2017. Pharmacological treatment algorithms from the GOLD 2007 report prefer the use of inhaled corticosteroids (ICS) and short-acting bronchodilators (60.2% and 50%, respectively). Compared to the GOLD 2007 report, there would be an almost eightfold reduction in the frequency of short-acting bronchodilator using the GOLD 2011 report and over fourfold decrease using the GOLD 2017 report. With each subsequent update of the GOLD report, the frequency of use of ICS would be significantly (p < 0.001) reduced. Pharmacological treatment by the GOLD 2011 and 2017 reports would be dominated by the use of long-acting bronchodilators from the group ß2-agonists and muscarinic antagonist groups. Updates from the GOLD 2007 COPD report to GOLD 2011 and 2017 would have a significant impact on everyday clinical practice. Changes would result in a reduction of treatment intensity.

Chronic Obstructive Pulmonary Disease and Platelet Count.

Recently, it has been shown in the murine model that platelet maturation takes place, to some extent, in the lungs. The extrapolation of these findings to humans leads to the possibility that chronic lung diseases could affect platelet maturation and, consequently, the platelet count. The aim of this study was to investigate whether there are changes in the platelet count in patients with chronic obstructive disease (COPD). The study included 44 patients, aged 66.5 ± 5.5 years, in stage II-IV COPD. The control group consisted of 48 age- and gender-matched patients without any respiratory diseases. We failed to find a significant difference in the platelet count between the two groups: 231 ± 80 vs. 223 ± 63 x 103/µL, respectively (p = 0.61). However, the number of platelets in the COPD patients was inversely associated with hemoglobin content (r = -0.57; p < 0.001), hematocrit (r = -0.40; p = 0.006), and the red cell count (r = -0.51; p < 0.001); the blood morphology indices that are typically increased in severe COPD. Such associations were absent in the control non-COPD group. We conclude that COPD has no influence on the platelet count in humans.

Costs of pharmacotherapy of chronic obstructive pulmonary disease in relation to changing Global Initiative for Chronic Obstructive Lung Disease guidelines (2007, 2011, and 2017 updates).

INTRODUCTION Chronic obstructive pulmonary disease (COPD) is one of the most common chronic noninfectious diseases. The clinical management is determined by patient assignment to the severity stage of the disease in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. OBJECTIVES Our aim was to determine the economic implications of changing GOLD guidelines (2007, 2011, and 2017 updates) and their impact on the direct costs of pharmacological treatment of patients diagnosed with COPD. PATIENTS AND METHODS This analysis was based on data provided by a group of 298 out of 500 randomly selected primary care physicians in Poland (response rate, 59.6%). Each primary care physician provided information on 10 consecutive patients with COPD. These data were used to simulate the economic consequences of the 2007, 2011, and 2017 GOLD guideline updates. RESULTS Regardless of the GOLD guidelines used, pharmacotherapy of patients with a very severe form of COPD was most expensive. Pharmacotherapy costs would be reduced with each subsequent guideline. In the same group of 2597 COPD patients, the average monthly cost of the first­line pharmacotherapy as well as the overall costs of pharmacotherapy (first- and second­line) per patient would be the lowest when applying the therapeutic regimen in accordance with the 2017 GOLD guidelines. CONCLUSIONS Implementation of 2011 and 2017 GOLD guidelines, as compared with the 2007 update, would result in a reduction of direct costs of COPD treatment.

End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists.

INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end­of­life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient's caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.

Novel method of noninvasive ventilation supported therapeutic lavage in pulmonary alveolar proteinosis proves to relieve dyspnea, normalize pulmonary function test results and recover exercise capacity: a short communication.

Whole lung lavage (WLL) under general anesthesia with a double-lumen endobronchial intubation has remained standard treatment option for pulmonary alveolar proteinosis (PAP) for over fifty years now. To the best of our knowledge, this is the first description of noninvasive ventilation (NIV) as an innovative alternative, which enables safe and effective treatment. NIV support enabled cost-effective lavage of the most affected segments and resulted in restoration and long-term maintenance of exercise capacity and diffusion, without WLL related hypoxaemia, volume overload, intubation, or mechanical ventilation related complications. The study presents all details of performed procedure, including anesthesia, NIV technique and bronchoscopy, therefore this may be easily implemented into clinical practice at other centers conducting PAP treatment. We assume that presented technique of therapeutic lung lavage (TLL) with NIV support may be considered a novel PAP treatment method, however, target population who will benefit the most from such therapy modification must be assessed in large scale prospective trials.

Influence of noninvasive ventilation on clinical status, dyspnea sensation and subsequent copd diagnosis.

Chronic obstructive lung disease (COPD) is a common life-threatening disease characterized by exposure to tobacco smoke, dyspnea and persistent lower airway obstruction coexistence of COPD and chronic heart failure (HF) may present a considerable challenge during both diagnostic and therapeutic processes. Herein, we report an elderly, obese male, an ex-smoker, suffering from both COPD and HF, and treated according to the applied guidelines for 15 years. On admission to hospital, the patient was diagnosed and treated for severe type 2 respiratory failure. The patient's COPD diagnosis was questioned at first, but then reconsidered after treatment described below. Noninvasive ventilation (NIV) improved the patient's clinical condition and reduced his dyspnea sensation. As a consequence, during check-ups, spirometry maneuvers could have been performed properly, revealing the underlying bronchial obstruction, which had been beforehand concealed by debilitation of respiratory muscles and decreased lung tissue compliance in a patient with chronic HF. Conclusion: NIV application in a patient with type 2 respiratory failure may significantly improve one's clinical condition, reduce dyspnea sensation and help establish an accurate diagnosis.

Bronchial hyperreactivity in perimenstrual asthma is associated with increased Th-2 response in lower airways.

BACKGROUND: Perimenstrual asthma (PMA) is a commonly observed, usually difficult-to-treat asthma phenotype. The mechanisms underlying this phenomenon remain unexplained. The aim of the study was to assess the degree of airway hyperresponsiveness and its relationship to proinflammatory cytokines concentration in lower airways of PMA compared to non-PMA patients. METHODS: Premenopausal women with regular menstrual cycles diagnosed as: PMA (n=12), non-PMA asthmatics (n=9), and healthy controls (n=10) were prospectively followed for 10 weeks over two consecutive menstrual cycles. The bronchial responsiveness (BR) test to methacholine was performed in each subject prior to the study. The serum for total immunoglobulin E (IgE) concentrations was taken and sputum was induced in the 26th day of each of the two cycles. Sputum concentration of eotaxin, IL-4 and IL-10 were measured by ELISA. RESULTS: Levels of BR to metacholine as well, as total blood IgE concentrations in PMA subjects were significantly higher than in non-PMA asthmatics and healthy controls (P=0.001, P=0.022 respectively) and correlated with each other (P=0.030; r =-0.65). Sputum eotaxin and IL-4 concentrations in luteal phase were increased in PMA patients when compared with non-PMA asthmatics (P=0.016; P=0.041, respectively) and healthy subjects (P<0.001 both cytokines). No differences for the sputum levels of IL-10 among studied groups were seen. CONCLUSIONS: BR level in perimenstrual asthma is higher than in non-PMA asthmatics and correlates with increased total IgE serum concentration. The increased level of BR in PMA patients is associated with a shift in the type-1/type-2 cytokine balance toward a type-2 response.

[Profile of adults suffering from COPD in Poland].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in adults. It is estimated, that in Poland around two million people suffer from COPD. THE AIM: The aim of this study, was to characterize population of patients with COPD in Poland. MATERIAL AND METHODS: The study, established and coordinated by the Polish Respiratory Society, included a representative sample of 500 GPs where were asked to fill questionnaires on diagnosis and treatment of their COPD patients. The questions dealt with disease history and clinical presentation, COPD severity stage, diagnostic and therapeutic procedures. RESULTS: Altogether 298 physicians (59.6% of invited) provided information about 2756 COPD patients aged 61.6 ± 11.1 years (36.3% were women). According to GOLD recommendations 16.6% of patients had mild, 57.0% moderate, 18.6% severe and 2.1% very severe COPD. Smoking history was declared by 97.8% of respondents. 51.4% of COPD patients had continued smoking. Over the last year Ambulance Service intervened in 19.7% of patients and 29.1% of respondents required hospital treatment of COPD. Among more than 80% of patients, doctor diagnosed limitation in exercise tolerance, and shortness of breath at rest, and in approximately 60% of the respondents were presented productive cough, weakened vesicular murmur and prolonged phase of exhalation. CONCLUSIONS: Despite the diagnosis, more than half of men and women had continued smoking. The number of hospitalizations and emergency intervention positively correlated with the severity of the disease. The survey results emphasize the urgent need for health education in patients with COPD.

[Exacerbations in perimenstrual asthma. Clinical significance of peripheral blood eosinophilia and BMI]. / Zaostrzenia w astmie okolomiesiaczkowej. Znaczenie kliniczne eozynofilii w krwi obwodowej i BMI.

INTRODUCTION: Asthma is a heterogeneous disease characterized by lower airways' obstruction, caused by various factors. There are many asthma phenotypes. Lately, perimenstrual asthma (PMA) with a pattern of exacerbations before and during menstruation as well as obesity associated asthma have been a subject of particular scientific and clinical interest. MATERIAL AND METHODS: 30 women were qualified for this three-arm case-control study(women with a pattern of asthma exacerbations in the perimenstrual period, women with asthma but no perimenstrual exacerbations, healthy control group). All patients performed spirometry and assessed disease control using specific questionnaires. Peripheral blood counts with smear were also performed. RESULTS: PMA patients differ in a statistically significant way in respect of anthropometric measurements such as BMI: in PMA group 25.8±1.8; in non-PMA asthmatics 23.9 ±2.2; healthy control 23.1±1.5; p=0.018) and spirometry results (FEV1 [%]: 85.1 (36.3-113.0); in PMA asthmatics, 93.1 (81,6-109,7), in nonPMA group, p<0.05; 105.4 (108,3-119,0) in healthy control and Tiffeneau index [%]: 70.1 (41.2-98.1); in PMA vs 83.5 (59.6-94.4); in non-PMA asthmatics 93.1(81,8-97,5) in healthy control p<0.05; ). PMA asthmatics also complain of poorer disease control than non-PMA asthmatics. There were no differences in peripheral blood eosinophilia or CRP between studied groups, p>0.05). CONCLUSIONS: Asthma exacerbations are not associated with the effect of peripheral blood eosinophilia. Women with greater BMI are more predisposed to perimenstrual asthma.

Lung-heart clinical crosstalk in the course of COPD exacerbation.

INTRODUCTION: COPD exacerbation is a life-threatening condition with acute dyspnoea caused by respiratory or circulatory distress. The significance and co-presence of lung hyperinflation, bronchial obstruction, and changes in haemodynamics in the course of COPD exacerbation treatment have not been well described yet in course of a single study. Our aim was to evaluate the influence of COPD exacerbation treatment on bronchial obstruction, pulmonary hyperinflation, and possible changes of right and left ventricle haemodynamics in relation to the patient's clinical status. MATERIAL AND METHODS: A total of 40 patients (90% males), 67 ± 8 years old, with COPD were assessed pre- and post-exacerbation treatment by the following: respiratory function tests, transthoracic echocardiography, 6MWT, endothelin-1 (ET-1) and NT-proBNP serum concentrations, and MRC scale. RESULTS: A significant decrease in RV%TLC (%) and mean pulmonary artery pressure (PAPmean) [mm Hg] was observed: pre -RV%TLC: 64.3 ± 9.0; post-RV%TLC 60.6 ± 11.1; p = 0.03; pre-PAPmean: 41.2 ± 11.2; post-PAPmean: 39.1 ± 12.1; p = 0.029, coupled with a significant increase of FEV1 [L]-preFEV1: 1.0 ± 0.4, post-FEV1: 1.2 ± 0.5; p < 0.001. A trend for reduced right ventricle systolic pressure (RVSP) [mm Hg]: pre-treatment: 44.5 ± 12.9; post-treatment: 36.3 ± 14.3; p = 0.068 and ET-1 [fmol/ml]: pre-treatment: 1.7 ± 2.8; post-treatment: 1.3 ± 1.9; p = 0.076, but not for NT-proBNP was noticed. Improvement of both, 6MWT [m]: pre-treatment: 294 ± 132; post-treatment: 415 ± 102; p < 0.001 and MRC [pts.]: pre-treatment: 3.3 ± 0.8; post-treatment: 1.8 ± 0.9; p < 0.001, were noticed. 6MWT correlated with RV%TLC (p < 0.05; r = -0.46; r = -0.53; respectively) and FEV1 (p < 0.05; r = 0.55; r = 0.60, respectively) on admission as well as on discharge. There was no such correlation with RVSP or PAPmean. CONCLUSIONS: Pulmonary hyperinflation and bronchial obstruction may be reduced by effective COPD exacerbation treatment and are accompanied by clinical improvement. The mPAP reduction observed in the course of treatment was not correlated with the results of 6MWT and MRC score.

Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study.

Psychiatric symptoms of anxiety, depression and cognitive dysfunction often occur in patients suffering from somatic conditions such as asthma and chronic obstructive pulmonary disease (COPD) which constitute a major and growing public health problem. In the present study we therefore aimed at analyzing depressive symptoms as well as symptoms of anxiety and cognitive problems in patients with mild to moderate asthma and COPD. 59 participants-17 with asthma, 24 with COPD and 18 healthy controls were enrolled. Depressiveness was assessed with the beck depression inventory (BDI); anxiety symptoms were measured with the State-Trait Anxiety Inventory Part 1 and 2, and cognitive function levels were estimated with the Trail Making Test Part A and B. A score above the threshold indicative for depression was found by 33 % (n = 8) of COPD patients, 29 % (n = 5) of asthma patients compared to 0.05 % (n = 1) of the control group. Clinically relevant anxiety levels were found in 42 % (n = 10) of the COPD group, 41 % (n = 7) of the asthma patients and 17 % (n = 3) of the controls. Patients with COPD performed significantly worse on the TMT than other groups. Psychoemotional state and cognitive functions were found to be correlated with exposure to tobacco smoke (measured in pack-years) and airway obstruction (measured with FEV1). In conclusion, patients with mild to moderate asthma and COPD exhibit significantly higher levels of depressive and anxiety symptoms as well as cognitive dysfunctions than controls. The prevalence of these symptoms is related to the amount of exposure to tobacco smoke and the severity of airflow obstruction.

Decreased percentage of CD4(+)Foxp3(+)TGF-ß(+) and increased percentage of CD4(+)IL-17(+) cells in bronchoalveolar lavage of asthmatics.

BACKGROUND: Asthma is a chronic inflammatory disorder of the airways with the proven role of Th2 cells in its pathogenesis. The role and characteristic of different subsets of CD4(+) cells is much less known. AIM: The aim of the study was to analyze the incidence of different subsets of CD4(+) T cells, in particular different subsets of CD4(+) cells with the co-expression of different cytokines. METHODS: Twenty five stable asthmatic and twelve age-matched control subjects were recruited to the study. Bronchoscopy and bronchoalveolar lavage (BAL) were performed in all study subjects. CD4(+) T cells were isolated from BAL fluid by positive magnetic selection. After stimulation simultaneous expression of TGF-ß, FoxP3, CD25, IFN-γ, IL-4, TNF-α (set 1); IL-10, FoxP3, CD25, IFN-γ, IL-4, MIP-1ß (set 2); IL-17A, IL-8, IFN-γ, IL-4, MIP-1ß (set 3) were measured by flow cytometry. RESULTS: The percentage of CD4(+) cells co-expressing Foxp3 and TGF-ß (CD4(+)Foxp3(+)TGF-ß(+) cells) was significantly lower (P = 0.03), whereas the percentage of CD4(+)IL-17(+) cells (P = 0.008), CD4(+)IL-17(+) IFN-γ(+) cells (P = 0.047) and CD4(+)IL-4(+) cells (P = 0.01) were significantly increased in asthmatics compared with that seen in healthy subjects. A significantly higher percentage of CD4(+)Foxp3(+) cells from asthma patients expressed IFN-γ (P = 0.01), IL-4 (P = 0.004) and CD25 (P = 0.04), whereas the percentage of CD4(+)IL-10(+) cells expressing Foxp3 was significantly decreased in asthmatics (P = 0.03). FEV1% predicted correlated negatively with the percentage of CD4(+)IL-17(+) cells (r = -0.33; P = 0.046) and positively with CD4(+)Foxp3(+)TGF-ß(+) cells (r = 0.43; P = 0.01). CONCLUSIONS: Our results suggest that in the airways of chronic asthma patients there is an imbalance between increased numbers of CD4(+)IL-17(+) cells and Th2 cells and decreased number of CD4(+)Foxp3(+)TGF-ß(+).

Perimenstrual asthma as a gynecological and pulmonological clinical problem.

Asthma is one of the most common chronic diseases of the respiratory system. It is estimated that up to 40% of asthmatic women of childbearing age may experience a cyclical exacerbation of asthmatic symptoms during the perimenstrual period, which is called perimenstrual asthma (PMA). The precise prevalence of this particular phenotype of asthma is difficult to determine due to a lack of explicit diagnostic criteria and appropriate epidemiological surveys. According to one of the best documented hypotheses regarding perimenstrual exacerbations of asthma, the impact of female steroid sex hormones on the function of the respiratory system and inflammations in the bronchi may play a central role in this phenomenon. Although the basic medical approach to PMA is similar to that used in other asthma phenotypes, unconventional methods of "experimental" treatment have also been tried. Unfortunately, current knowledge about the pathogenic mechanisms of this phenotype of asthma is incomplete and inconsistent, which justifies the need for further interdisciplinary studies with the participation of specialists in both gynecology and lung diseases. The knowledge thus acquired will help to individualize and focus future therapy on specific cellular and/or hormonal mechanisms to optimize asthma control in patients with PMA.

Extrafine beclomethasone/formoterol compared to fluticasone/salmeterol combination therapy in COPD.

BACKGROUND: The study evaluated the efficacy of beclomethasone dipropionate/formoterol fumarate (BDP/FF) extrafine combination versus fluticasone propionate/salmeterol (FP/S) combination in COPD patients. METHODS: The trial was a 12-week multicentre, randomised, double-blind, double dummy study; 419 patients with moderate/severe COPD were randomised to BDP/FF 200/12 µg or FP/S 500/50 µg twice daily. The primary objective was to demonstrate the equivalence between treatments in terms of Transition Dyspnoea Index (TDI) score and the superiority of BDP/FF in terms of change from pre-dose in the first 30 minutes in forced expiratory volume in the first second (FEV1). Secondary endpoints included lung function, symptom scores, symptom-free days and use of rescue medication, St. George's Respiratory Questionnaire, six minute walking test and COPD exacerbations. RESULTS: BDP/FF was equivalent to FP/S in terms of TDI score and superior in terms of FEV1 change from pre-dose (p < 0.001). There were no significant differences between treatments in secondary outcome measures, confirming overall comparability in terms of efficacy and tolerability. Moreover, a clinically relevant improvement (>4 units) in SGRQ was detected in the BDP/FF group only. CONCLUSION: BDP/FF extrafine combination provides COPD patients with an equivalent improvement of dyspnoea and a faster bronchodilation in comparison to FP/S. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01245569.

Pulmonary function tests in the preoperative evaluation of lung cancer surgery candidates. A review of guidelines.

Before planned surgical treatment of lung cancer, the patient's respiratory system function should be evaluated. According to the current guidelines, the assessment should start with measurements of FEV1 (forced expiratory volume in 1 second) and DLco (carbon monoxide lung diffusion capacity). Pneumonectomy is possible when FEV1 and DLco are > 80% of the predicted value (p.v.). If either of these parameters is < 80%, an exercise test with VO2 max (oxygen consumption during maximal exercise) measurement should be performed. When VO2 max is < 35 % p.v. or < 10 ml/kg/min, resection is associated with high risk. If VO2 max is in the range of 35-75% p.v. or 10-20 ml/kg/min, the postoperative values of FEV1 and DLco (ppoFEV1, ppoDLco) should be determined. The exercise test with VO2 max measurement may be replaced with other tests such as the shuttle walk test and the stair climbing test. The distance covered during the shuttle walk test should be > 400 m. Patients considered for lobectomy should be able to climb 3 flights of stairs (12 m) and for pneumonectomy 5 flights of stairs (22 m).

May smoking be considered as the most important factor that determines premature death after hospitalization due to COPD exacerbation? Preliminary data.

INTRODUCTION: COPD, cardiovascular diseases and cancer are smoking-related diseases that have been accepted as the leading causes of premature mortality worldwide. Nevertheless, smoking is still considered to be a risk rather than a prognostic factor for mortality. The aim of the study was to determine the most important factors in predicting the risk of premature death after effective hospital treatment of COPD exacerbation. MATERIAL AND METHODS: 34 consecutive patients hospitalized with COPD exacerbation were followed up and their post-hospitalization survival time was analyzed. Basic clinical data (BORG, MRC, BMI, pack-years and age) was collected. The following tests that were performed prior to discharge were assessed: 6MWT, spirometry, body plethysmography, diffusion capacity, transthoracic echocardiography (TEE) and whole night polysomnography. Routine laboratory and immunoenzymatic tests (hs-CRP, endothelin 1 (ET-1), NT-proBNP, IL-6, TNF-alfa) were analyzed. RESULTS: The average follow-up period was 15.1 ± 8.2 month. The mortality rate was 3/34 = 8.8%. Univariable analysis revealed significant differences that indicated a greater number of deaths at higher values of: pack-years (p = 0.02), BODE (p = 0.03), heart rate (HR) after 6MWT (p = 0.003), ET-1 (p = 0.04), but at lower values of TLCO/VA (p = 0.03) and 6MWT-distance (p = 0.006). Multivariable analysis revealed that only pack-years (p = 0.005) were predictive for mortality. CONCLUSIONS: Smoking history seems to have the strongest impact on short-term mortality after recovery from COPD exacerbation.

Evaluation of COPD progression based on spirometry and exercise capacity.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is characterized by an airflow limitation that is usually progressive. The progression of COPD expressed as the rate of an annual decline in FEV 1 is very heterogeneous. Exercise capacity in COPD patients is often diminished and becomes worsened over the time. The purpose of the study was to examine how the change in FEV 1 and exercise capacity would deteriorate over long-term observation. MATERIAL AND METHODS: A total of 22 men with COPD were examined. At the beginning the average age was 59 ± 8.1 years and the mean post-bronchodilator FEV 1 was 52 ± 14.9% predicted. Pulmonary function testing was performed at entry and then each year for 10 years, and exercise testing on a cycle ergometer was performed at entry and after 10 years. RESULTS: FEV 1 and maximum oxygen uptake (VO2max), maximum mechanical work (W max ), maximum minute ventilation (V Emax ) and maximum tidal volume (V Tmax ) declined significantly over the observation time. The mean annual decline in FEV 1 was 42 ± 37 mL, and the mean decline for VO 2max was 30 ± 15 mL/min/yr and 0.44 ± 0.25 mL/min/kg/yr. Regression analysis revealed that the changes in FEV 1 do not predict changes in VO2max. We observed a correlation between the annual change in V Emax and annual change in VO2max (r = 0.51 p < 0.05). The baseline FEV 1 (expressed as a percentage of predicted and in absolute values) is the predictor of FEV 1 annual decline (r = 0.74 and 0.82; p < 0.05). CONCLUSIONS: We observed over time deterioration in exercise capacity in COPD patients which is independent of decline in airflow limitation. The long term follow-up of exercise capacity is important in monitoring of COPD patients in addition to pulmonary function.