Hypogammaglobulinemia and Risk of Exacerbation and Mortality in Patients with COPD.

Introduction: Chronic obstructive pulmonary disease (COPD) may, in some patients, be characterized by recurring acute exacerbations. Often these exacerbations are associated with airway infections. As immunoglobulins (Ig) are important parts of the immune defence against airway infections, the aim of this study was to relate the levels of circulating immunoglobulins to clinical features in unselected patients with COPD included in a Norwegian multicenter study. Methods: Clinical and biological data, including circulating levels of immunoglobulins, were assessed in 262 prospectively included patients with COPD GOLD stage II-IV at five hospitals in south-eastern Norway. A revisit was done after one year, and survival was assessed after five years. Clinical features and survival of those with immunoglobulin levels below reference values were compared to those with normal levels. Results: In total, 11.5% of all COPD patients and 18.5% of those with GOLD stage IV had IgG concentrations below reference values. These patients were more likely to use inhaled or oral steroids, had lower BMI, and lower FEV1%. Moreover, they had significantly more COPD-related hospital admissions (2.8 vs 0.6), number of prednisolone courses (3.9 vs 1.2), and antibiotic treatments (3.7 vs 1.5) in the preceding year. Importantly, hypogammaglobulinemia was significantly associated with reduced survival in a log-rank analysis. In multivariate regression analysis, we found that the higher risk for acute exacerbations in these patients was independent of other risk factors and was associated with impaired survival. Conclusion: In conclusion, our study suggests that hypogammaglobulinemia may be involved in poor outcome in COPD and may thus be a feasible therapeutic target for interventional studies in COPD.

Validation of the Norwegian Pain Sensitivity Questionnaire.

BACKGROUND AND PURPOSE: There is a large variation in people's reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ. METHODS: Construct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach's alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable. RESULTS: The factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach's alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women. CONCLUSION: This study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain.

Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease.

Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). Pain was measured using the Brief Pain Inventory. Of these 258 COPD patients, 157 (61%) reported pain. Multiple linear regression analyses were performed to determine which demographic, clinical, and symptom characteristics were associated with average pain severity, worst pain severity, and mean pain interference. Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients.

Differences in Symptom Burden Among Patients With Moderate, Severe, or Very Severe Chronic Obstructive Pulmonary Disease.

CONTEXT: The symptom experience of patients with chronic obstructive pulmonary disease (COPD) is extremely complex. It is characterized by multiple co-occurring symptoms. However, very few studies have described this experience in COPD patients. OBJECTIVES: The aims of this study were to evaluate for differences in symptom occurrence rates, as well as ratings of symptom severity, frequency, and distress among patients (n = 267) with moderate, severe, and very severe COPD. METHODS: The Memorial Symptom Assessment Scale was used to evaluate the multiple dimensions of the patient's symptom experience. Binary and ordinal logistic regression analyses with stage of disease as an ordinal predictor variable were used to evaluate for differences in symptom occurrence rates and ratings of symptom severity, frequency, and distress. RESULTS: Regardless of the severity of their disease, patients reported an average of 12 co-occurring symptoms. Shortness of breath and lack of energy were the only two symptoms that differed significantly among the three disease severity groups in terms of occurrence, severity, frequency, and distress. Patients with very severe COPD reported the highest ratings for shortness of breath and lack of energy across all four symptom dimensions. CONCLUSION: Regardless of stage of disease, the high symptom burden identified in this study underscores the need for COPD patients to be screened for multiple co-occurring symptoms.