Value of integrated pulmonary index to predict exacerbation of chronic obstructive pulmonary Disease's severity.

PURPOSE: In this study, we aimed to examine the correlation between current prognostic scores and the integrated pulmonary index (IPI) in patients admitted to the emergency department (ED) with exacerbation of chronic obstructive pulmonary disease (COPD), and the diagnostic value of using the IPI in combination with other scores in determining patients who can be discharged safely. METHODS: This study was conducted as a multicenter and prospective observational study between August 2021 and June 2022. Patients diagnosed with COPD exacerbation (eCOPD) at the ED were included in the study and they were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age older than 65 years), BAP-65 (Blood urea nitrogen, Altered mental status, Pulse rate, and age older than 65 years), and DECAF (Dyspnea, Eosinopenia, Consolidation, Academia, and atrial Fibrillation) scores and IPI values of the patients were recorded. The correlation between the IPI and the other scores and its diagnostic value in detecting mild eCOPD were examined. The diagnostic value of CURB-IPI, a new score created by the combination of CURB-65 and IPI, in mild eCOPD was examined. RESULTS: The study was carried out with 110 patients (49 female and 61 male), mean age of 67 (min/max: 40/97). The IPI and CURB-65 had better predictive value in detecting mild exacerbations than DECAF and BAP-65 scores [Area under curves (AUC) were 0.893, 0.795, 0.735, 0.541 respectively]. The CURB-IPI score, on the other hand, had the best predictive value for detecting mild exacerbations (AUC 0.909). CONCLUSION: We found that the IPI has good predictive value in the detection of mild COPD exacerbations, and its predictive value increases when used in combination with CURB-65. We think that the CURB-IPI score can be a guide when deciding whether patients with exacerbation of COPD can be discharged.

Effects of 20-degree spinal immobilization on respiratory functions in otherwise healthy volunteers with android-type obesity.

AIM: The aim of the study was to assess whether spinal immobilization with long back board (LBB) and semi-rigid cervical collar (CC) at 20° instead of 0° conserves pulmonary functions in obese volunteers, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. METHODS: The study included adult volunteer subjects with android-type obesity who were otherwise healthy. First, pulmonary functions were tested in a seated position to obtain baseline levels, than volunteers were immobilized with LBB and CC at 0-degree and measurements repeated at 0th and 30th minute of immobilization. Next day, same procedures were repeated with the trauma board at 20-degree. Changes over time in FEV1, FVC values and FEV1/FVC ratios during spinal immobilization at 0° and 20° were compared to baseline levels. RESULTS: Study included 30 volunteers. Results showed a significant decline in all values for both situations following spinal immobilization (p < .001). We also compared the decrease over time in those values (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio) during spinal immobilization at 0° and 20°. The decrease in pulmonary functions was similar in both groups (p > .05). CONCLUSION: The present findings confirm that spinal immobilization reduces pulmonary functions in obese volunteers, and that 20-degree immobilization has no conservative effect on these values when compared to the traditional 0-degree immobilization. It may be that 20° is insufficient to decrease the negative effect of abdominal obesity on pulmonary functions.