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1.
NPJ Prim Care Respir Med ; 32(1): 24, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794130

RESUMO

The Timed Up and Go (TUG) is a global measure of mobility and has the ability to detect frail individuals. Frail patients with chronic obstructive pulmonary disease (COPD) are usually undiagnosed. We hypothesised that the TUG would identify frail patients with COPD. Frailty was assessed in 520 patients diagnosed with COPD and 150 controls using a Comprehensive Geriatric Assessment questionnaire and frailty index (FI) was derived. The TUG was used to assess physical mobility. All participants were assessed for lung function and body composition. A ROC curve was used to identify how well TUG discriminates between frail and non-frail patients with COPD. The patients with COPD and controls were similar in age, sex and BMI but the patients with COPD were more frail, mean ± SD FI 0.16 ± 0.08 than controls 0.05 ± 0.03, P < 0.001. Frail patients with COPD had a greater TUG time (11.55 ± 4.03 s) compared to non-frail patients (9.2 ± 1.6 sec), after controlling for age and lung function (F = 15.94, P < 0.001), and both were greater than the controls (8.3 ± 1.2 sec), P < 0.001. The TUG discriminated between frail and non-frail patients with COPD with an area under the curve of 72 (95% CI: 67-76), and a diagnostic odds ratio of 2.67 (95% CI:1.5-4.6), P < 0.001. The TUG showed the ability to discriminate between frail and non-frail patients with COPD, independent of age and severity of the airflow obstruction. The TUG is a simple, easy and quick measure that could be easily applied in restricted settings to screen for frailty in COPD.


Assuntos
Fragilidade , Doença Pulmonar Obstrutiva Crônica , Idoso , Idoso Fragilizado , Fragilidade/diagnóstico , Humanos , Equilíbrio Postural , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estudos de Tempo e Movimento
2.
BMC Pulm Med ; 20(1): 60, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138714

RESUMO

BACKGROUND: Factors associated with reduced daily physical activity (DPA) in patients with COPD are still controversial. Physical inactivity in COPD increases risk of cardiovascular disease, frequent exacerbations, reduced health status, and increased symptoms. We hypothesised that reduced DPA in patients with COPD is independent of traditional risk factors including age and spirometry. METHODS: In this cross-sectional study, DPA (over 7 days) was assessed on 88 community stable patients with COPD and 40 controls free from cardiorespiratory disease. Spirometry, body composition, number of exacerbations, handgrip strength (HGS), modified Medical Research Council (mMRC), arterial stiffness, 6-min walking distance (6MWD) and BODE index were also determined. Frequent exacerbation was defined as ≥2 and non-frequent exacerbation < 2. RESULTS: Patients with COPD had reduced DPA and exercise capacity compared with controls similar in age, BMI and gender, p < 0.001. Frequent exacerbators had less DPA than infrequent exacerbators and both less than controls, p < 0.001. Patients with higher BODE index were less active than those with lower index. Time spent on moderate activity was related to cardiovascular risk factors including arterial stiffness. The DPA in patients was independent of age, gender, spirometry, body composition and HGS, p > 0.05. The level of breathlessness was superior to lung function in predicting the level of DPA. CONCLUSION: The level of DPA in COPD was independent of traditional risk factors. Breathlessness score is a better predictor of the DPA than lung function and handgrip strength.


Assuntos
Dispneia/fisiopatologia , Exercício Físico , Força da Mão , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Índice de Gravidade de Doença , Espirometria , Teste de Caminhada
3.
Medicina (Kaunas) ; 55(4)2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30987061

RESUMO

Background and objectives: Cardiovascular (CV) disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Patients with COPD have increased arterial stiffness, which may predict future CV risk. However, the development of arterial stiffness in COPD has not yet been studied prospectively. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) is a longitudinal study of CV risk and other comorbidities in COPD. The aims of this analysis were to explore factors associated with aortic pulse wave velocity (aPWV) at baseline and to describe the progression of aPWV in patients with COPD and comparators over two years. Materials and methods: At baseline, 520 patients with COPD (confirmed by spirometry) and 150 comparators free from respiratory disease were assessed for body composition, blood pressure, aPWV, noninvasive measures of cardiac output, inflammatory biomarkers, and exercise capacity. This was repeated after two years, and mortality cases and causes were also recorded. Results: At baseline, aPWV was greater in COPD patients 9.8 (95% confidence interval (CI) 9.7-10.0) versus comparators 8.7 (8.5-9.1) m/s (p < 0.01) after adjustments for age, mean arterial pressure (MAP), and heart rate. Mean blood pressure was 98 ± 11 in COPD patients and 95 ± 10 mmHg in comparators at baseline (p = 0.004). After two years, 301 patients and 105 comparators were fully reassessed. The mean (95% CI) aPWV increased similarly in patients 0.44 (0.25-0.63) and comparators 0.46 (0.23-0.69) m/s, without a change in blood pressure. At the two-year follow-up, there were 29 (6%) deaths in COPD patients, with the majority due to respiratory causes, with an overall dropout of 43% of patients with COPD and 30% of comparators. Conclusions: This was the first large longitudinal study of CV risk in COPD patients, and we confirmed greater aPWV in COPD patients than comparators after adjustments for confounding factors. After two years, patients and comparators had a similar increase of almost 0.5 m/s aPWV.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Comorbidade/tendências , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Análise de Onda de Pulso , Idoso , Análise de Variância , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Progressão da Doença , Feminino , Seguimentos , Frequência Cardíaca , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Risco , Estatísticas não Paramétricas , Rigidez Vascular , País de Gales/epidemiologia
4.
Chron Respir Dis ; 15(4): 347-355, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29334783

RESUMO

Chronic obstructive pulmonary disease (COPD) is a multisystem disease that resembles the accumulation of multiple impairments seen in aging. A comprehensive geriatric assessment (CGA) captures multisystem deficits, from which a frailty index (FI) can be derived. We hypothesized that patients with COPD would be frailer than a comparator group free from respiratory disease. In this cross-sectional analysis, the CGA questionnaire was completed and used to derive an FI in 520 patients diagnosed with COPD and 150 comparators. All subjects were assessed for lung function, body composition, 6-minute walking distance (6MWD), and handgrip strength. Patients completed validated questionnaires on health-related quality of life and respiratory symptoms. Patients and comparators were similar in age, gender, and body mass index, but patients had a greater mean ± SD FI 0.16 ± 0.08 than comparators 0.05 ± 0.03. In patients, a stepwise linear regression 6MWD ( ß = -0.43), number of comorbidities ( ß = -0.38), handgrip ( ß = -0.11), and number of exacerbations ( ß = 0.11) were predictors of frailty (all p < 0.01). This large study suggests patients with COPD are frailer than comparators. The FI derived from the CGA captures the deterioration of multiple systems in COPD and provides an overview of impairments, which may identify individuals at increased risk of morbidity and mortality in COPD.


Assuntos
Fragilidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Composição Corporal , Comorbidade , Estudos Transversais , Progressão da Doença , Feminino , Volume Expiratório Forçado , Fragilidade/etiologia , Avaliação Geriátrica , Força da Mão , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida , Testes de Função Respiratória , Fatores de Risco , Inquéritos e Questionários , Teste de Caminhada
5.
Clin Immunol ; 183: 344-353, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28951328

RESUMO

Autoimmunity occurs in chronic obstructive pulmonary disease (COPD). We describe an antigen microarray for detecting serum autoantibodies (AAbs) to determine how IgM, as well as IgG, AAbs distinguish patients with COPD from controls with a history of smoking without COPD. All COPD patients' sera contained elevated levels of AAbs to some of 30 autoantigens. There were significant differences in the autoantigenic specificities of IgM AAbs compared to IgG AAbs in the COPD sera: for example, AAbs to histone and scl-70 were mainly IgG, whereas AAbs to CENP-B and La/ssB were mainly IgM; by contrast, IgM and IgG AAbs to collagen-V were equally prevalent. Thus, a combination of IgM and IgG AAbs specific for multiple autoantigens are detected in all cases of COPD at a level at which all non-COPD controls are negative for AAbs. This highlights the importance of different classes of AAbs to a range of autoantigens in COPD.


Assuntos
Autoanticorpos/imunologia , Autoantígenos/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Idoso , Antígenos de Bactérias , Antígenos de Fungos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Serial de Proteínas , Fumar
6.
Artigo em Inglês | MEDLINE | ID: mdl-27536090

RESUMO

Impaired physical performance is common in chronic obstructive pulmonary disease (COPD), but its assessment can be difficult in routine clinical practice. We compared the timed up and go (TUG) test and other easily applied assessments of physical performance with the 6-minute walk distance (6MWD). In a longitudinal study of comorbidities in COPD, submaximal physical performance was determined in 520 patients and 150 controls using the TUG test and 6MWD. Spirometry, body composition, handgrip strength, the COPD assessment test, St George's Respiratory Questionnaire (SGRQ), and the modified Medical Research Council dyspnoea scale were also determined. Patients and controls were similar in age, body mass index, and sex proportions. The TUG in the patients was greater than that in the control group, P=0.001, and was inversely related to 6MWD (r=-0.71, P<0.001) and forced expiratory volume in one second predicted (r=-0.19, P<0.01) and was directly related to the SGRQ activity (r=0.39, P<0.001), SGRQ total (r=0.37, P<0.001), and total COPD assessment test scores (r=0.37, P<0.001). The TUG identified the difference in physical performance between patients and controls. The TUG test and validated questionnaires provide a measure of physical performance, which is rapid and could be used in clinical practice.


Assuntos
Tolerância ao Exercício , Avaliação Geriátrica/métodos , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Teste de Caminhada , Fatores Etários , Idoso , Área Sob a Curva , Composição Corporal , Estudos de Casos e Controles , Estudos Transversais , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Força da Mão , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Curva ROC , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Espirometria , Inquéritos e Questionários , Fatores de Tempo
7.
Chron Respir Dis ; 11(4): 199-207, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25159833

RESUMO

Chronic obstructive pulmonary disease (COPD) is a multisystem disease. Established comorbidities include cardiovascular disease, osteoporosis, loss of muscle mass and function, depression, and impaired quality of life. The natural history is not well understood. The Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE) is a longitudinal study of comorbidities in COPD. The primary aims are to delineate the progression and interrelationships of cardiovascular disease and associated comorbidities. Each year ARCADE aims to recruit 250 patients diagnosed with COPD and 50 comparators (free from respiratory disease). Assessments include spirometry, body composition, blood pressure, aortic stiffness (pulse wave velocity (PWV)), noninvasive measures of cardiac output, systemic inflammatory mediators, blood and urine biochemistry, and physical and health outcomes. These will be repeated at 2 and 5 years. In the first year of recruitment, 350 patients and 100 comparators were recruited. The reproducibility of aortic PWV, cardiac output, stroke volume, and cardiac index was evaluated and accepted in 30 patients free from overt cardiovascular disease. The preliminary data from ARCADE have demonstrated acceptable reproducibility of hemodynamic outcome measures. Further longitudinal data collection will increase knowledge of the progression and interactions between cardiovascular risk factors and other comorbidities in COPD.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Projetos de Pesquisa , Idoso , Pressão Sanguínea , Composição Corporal , Comorbidade , Progressão da Doença , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Inflamação/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Análise de Onda de Pulso , Reprodutibilidade dos Testes , Medição de Risco , Volume Sistólico , Inquéritos e Questionários , Rigidez Vascular , Capacidade Vital
9.
COPD ; 11(5): 552-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24832197

RESUMO

Extrapulmonary manifestations are recognized to be of increasing clinical importance in Chronic Obstructive Pulmonary disease. To investigate cardiovascular and skeletal muscle manifestations of COPD, we developed a unique UK consortium funded by the Technology Strategy Board and Medical Research Council comprising industry in partnership with 5 academic centres. ERICA (Evaluating the Role of Inflammation in Chronic Airways disease) is a prospective, longitudinal, observational study investigating the prevalence and significance of cardiovascular and skeletal muscle manifestations of COPD in 800 subjects. Six monthly follow up will assess the predictive value of plasma fibrinogen, cardiovascular abnormalities and skeletal muscle weakness for death or hospitalization. As ERICA is a multicentre study, to ensure data quality we sought to minimise systematic observer error due to variations in investigator skill, or adherence to operating procedures, by staff training followed by assessment of inter- and intra-observer reliability of the four key measurements used in the study: pulse wave velocity (PWV), carotid intima media thickness (CIMT), quadriceps maximal voluntary contraction force (QMVC) and 6-minute walk distance (6MWT). This report describes the objectives and methods of the ERICA trial, as well as the inter- and intra-observer reliability of these measurements.


Assuntos
Doenças Cardiovasculares/imunologia , Fibrinogênio/metabolismo , Inflamação/imunologia , Doenças Musculares/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Teste de Esforço , Feminino , Humanos , Inflamação/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Força Muscular , Doenças Musculares/epidemiologia , Doenças Musculares/fisiopatologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/metabolismo , Análise de Onda de Pulso , Músculo Quadríceps/fisiopatologia , Músculos Respiratórios/fisiopatologia , Fumar/epidemiologia , Fumar/imunologia
10.
Chron Respir Dis ; 9(4): 231-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23129800

RESUMO

Bronchiectasis is a chronic inflammatory lung disease, which has similarities to chronic obstructive pulmonary disease (COPD). Comorbidities of COPD include increased risk of cardiovascular (CV) disease, loss of bone mineral density (BMD) and loss of skeletal muscle mass and function, all linked to systemic inflammation. The potential for such comorbidities has not been explored in bronchiectasis. We hypothesised that patients with bronchiectasis would have similar increased comorbidities. A total of 20 patients with noncystic fibrosis bronchiectasis were compared to 20 controls similar in age, gender and smoking exposure. Assessments included aortic pulse wave velocity (PWV; (a measure of arterial stiffness and an independent predictor of CV risk), blood pressure (BP) as well as levels of interleukin-6 (IL-6), albumin, fasting glucose and lipids. Body composition (fat free mass index (FFMI)), BMD, the 6-min walk distance (6MWD) and self-reported physical activity were also determined. Patients with bronchiectasis had increased aortic PWV, 10.5 (3.0) m/second, when compared with controls, 8.8 (1.6) m/second (p < 0.05), despite similar central and peripheral BP and lipid profile. Patients also had increased IL-6 and reduced albumin and glucose. Although mean body mass index, FFMI and BMD were similar in patients and controls, only 20% of patients had a healthy BMD compared with 50% of controls. Patients had reduced 6MWD and reported less physical activity (p < 0.05). Patients with bronchiectasis had increased arterial stiffness (an indicator of increased CV risk), increased inflammation, reduced exercise capacity and bone thinning. These additional comorbidities require further evaluation for their management in these patients.


Assuntos
Bronquiectasia/complicações , Idoso , Aorta/fisiopatologia , Pressão Sanguínea , Índice de Massa Corporal , Densidade Óssea , Bronquiectasia/fisiopatologia , Feminino , Fibrose , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Atividade Motora , Análise de Onda de Pulso , Caminhada
11.
BMC Pulm Med ; 11: 20, 2011 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-21510856

RESUMO

BACKGROUND: Patients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. We hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors. METHODS: Thirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation. RESULTS: On commencement of rehabilitation aortic PWV was increased in patients compared with controls (p<0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p<0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p<0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p<0.01). Total cholesterol and ISWT also improved (p<0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP. CONCLUSION: Cardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD.


Assuntos
Doenças Cardiovasculares/epidemiologia , Dietoterapia , Terapia por Exercício , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Idoso , Idoso de 80 Anos ou mais , Aorta/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Estudos de Casos e Controles , Estudos de Coortes , Tolerância ao Exercício , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/sangue , Qualidade de Vida , Fatores de Risco
12.
Respir Res ; 11: 173, 2010 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-21138571

RESUMO

BACKGROUND: Determining the presence and extent of co-morbidities is fundamental in assessing patients with chronic respiratory disease, where increased cardiovascular risk, presence of osteoporosis and low muscle mass have been recognised in several disease states. We hypothesised that the systemic consequences are evident in a further group of subjects with COPD due to Alpha-1 Antitrypsin Deficiency (A1ATD), yet are currently under-recognised. METHODS: We studied 19 patients with PiZZ A1ATD COPD and 20 age, sex and smoking matched controls, all subjects free from known cardiovascular disease. They underwent spirometry, haemodynamic measurements including aortic pulse wave velocity (aPWV), an independent predictor or cardiovascular risk, dual energy X-ray absorptiometry to determine body composition and bone mineral density. RESULTS: The aPWV was greater in patients: 9.9(2.1) m/s than controls: 8.5(1.6) m/s, p = 0.03, despite similar mean arterial pressure (MAP). The strongest predictors of aPWV were age, FEV1% predicted and MAP (all p < 0.01). Osteoporosis was present in 8/19 patients (2/20 controls) and was previously unsuspected in 7 patients. The fat free mass and bone mineral density were lower in patients than controls (p < 0.001). CONCLUSIONS: Patients with A1ATD related COPD have increased aortic stiffness suggesting increased risk of cardiovascular disease and evidence of occult musculoskeletal changes, all likely to contribute hugely to overall morbidity and mortality.


Assuntos
Doenças Cardiovasculares/mortalidade , Artropatias/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Deficiência de alfa 1-Antitripsina/mortalidade , Distribuição por Idade , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Análise de Sobrevida , Taxa de Sobrevida , Reino Unido/epidemiologia
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