Search

The aim of this study is to evaluate of microbiological and inflammatory characteristics of exacerbations in COPD patients with previously undiagnosed radiographic bronchiectasis and the impact of bronchiectasis on exacerbation course. We enrolled 160 patients with COPD exacerbation. High-resolution computed tomography (HRCT) of chest was performed, and the presence of bronchiectasis was evaluated. The patients were classified into two groups: COPD with bronchiectasis and COPD without bronchiectasis. Serum CRP, procalsitonin and IL-8 concentration were measured. Sputum microbiological anaysis were performed. Microbiological and inflammatory characteristics of both groups were compared. The mean age of the patients was 66.57 ± 8.6 years. Bronchiectasis was diagnosed in 43 (26.8%) patients by HRCT. Sputum and purulent sputum symptoms were common in exacerbations of COPD with bronchiectasis group to without bronchiectasis group (p=0.001). Compared with those without bronchiectasis, COPD patients with bronchiectasis had a higher proportion of sputum culture positivity (55.8% vs 24.7%, p In conclusion, COPD exacerbations in patents with comorbid bronchiectasis is associated with more bacteriological load, an increase in both local and systemic inflammation and worse exacerbation course.

The aim of this study is to investigate whether COPD exacerbations of infectious origin are different clinically and prognostically from non-infectious origin or not. We recruited 160 COPD patients between October 2015-June 2016. Patients were divided into 3 groups (group-1:patiens with pneumatic infiltration, group-2: patients don’t have pneumatic infiltration, group-3:noninfective COPD exacerbations). Obtained from the patients clinical, microbiological, radiological and functional parameters were compared. In addition, patients were prospectively monitored discharge after 3 month post discharge mortality, hospital mortality, hospitalization. The mean age:66.57±8.6 years. Sputum and purulent sputum symptoms were common in infectious exacerbations of COPD group to non-infectious exacerbation of COPD group (p=0.001).Sputum culture positivity, accompanied by pneumonia and infectious exacerbations of COPD in the group, a higher proportion of non-infectious exacerbation of COPD was seen by the group. Charlson comorbidity index, was significantly higher in the group 1 than the group 2(p=0.039).Total of 35% patients had recurrent exacerbations in 3-month follow-up period, after exacerbations treatment. However, there was no significant difference between the groups in terms of recurrence rate of patients with exacerbations. Both the mortality rate during hospitalization, as well as a total of 3 months accompanied by pneumonia and mortality rate was significantly higher than the non-infectious exacerbation of COPD group in both infectious exacerbation of COPD group. Our study showed that the patients clinical and prognostic show a different pattern according to the etiology of exacerbations of COPD

Objective: Although protein-calorie malnutrition and associated weight loss have been demonstrated in chronic obstructive pulmonary disease (COPD), the reasons for weight loss, as well as the relation of weight loss with hormonal and inflammatory markers is not clear. Therefore, the present study aimed to investigate the reasons for weight loss in COPD patients and the relation of weight loss with hormonal/inflammatory markers and hyperinflation. Methods: The present study included 60 patients with stable COPD who were admitted to the Chest Diseases Outpatient Clinic and 20 healthy controls. The patients were divided into three groups according to their body mass index (BMI); Group 1: BMI 25 kg/m2. The patients underwent pulmonary function testing and arterial blood gas analysis. Serum adiponectin, ghrelin, leptin, tumour necrosis factor (TNF) alpha, C-reactive protein (CRP), prealbumin and transferrin levels were measured. The results were evaluated by appropriate statistical methods. Results: Considering the patient groups together, leptin and ghrelin levels were found to be statistically significantly lower in the patient group (p=0.001 and p=0.003). Serum leptin level was found to be lower in Group 1 with a BMI 25 (p=0.031). No statistically significant difference was determined between the patients with and without hyperinflation in terms of serum ghrelin, leptin, adiponectin, TNF-α, prealbumin and transferrin levels. Conclusion: Decreased serum ghrelin and leptin levels were associated with weight loss. However, no relation could be identified between hyperinflation and hormonal markers. It was thought that further studies are needed in order to reach a definite conclusion.

Background: Recent studies investigated how health is affected by socio-economic status (SES) in COPD showed that low SES is a risk factor for adverse COPD health outcomes. Accordingly, we conducted this study with a hypothesis of “SES Shaping GOLD A-D Classification in Patients with COPD”. Methods: This is a cross-sectional study including 167 COPD patients. Patients were classified according to the GOLD 2014 Document. Comprehensive socio-demographic and clinical data were collected through the use of a predefined questionnaire. Education, household monthly income, marital status, insurance coverage and place of residence were used as the socio-economic status indicators. Results: Patients had a mean age of 63.1±8.3, FEV1% of 47.2±19, CAT score of 17.6±7.5. 16 (9.6%) of patients were classified as GOLD A, 44 (26.3 %) as GOLD B, 19 (11.4%) as GOLD C, and 88 (52.7%) as GOLD D groups. Significant differences among GOLD A-D groups, in terms of SES, were detected. The rate of patients with lower SES were significantly higher in the patients who have risk of exacerbation (GOLD C and D) compared without exacerbation risk (GOLD A and B) (χ2=9, p=0.029). The number of patients with frequent exacerbation was significantly higher in patients from rural areas and household monthly income. Household monthly income is a strong predictor of risk of exacerbation (p=0.04). Conclusions: This study indicate that low SES is associated with the risk of exacerbation and that it was a important determinant in evaluating patients with COPD according to GOLD A-D classification. Besides clinical factors, SES should be considered as a key patient-level marker in the management of the disease.

Dynamic hyperinflation (DH) and exercise limitation develop in patients with COPD; however, there is lack of knowledge about their long-term clinical consequences. We aimed to assess the impact of DH and exercise capacity in predicting mortality and also morbidity, as evaluated by emergency visits and hospital admissions in COPD patients during a 4-year period.We recruited 73 stable COPD patients. The relationships of different respiratory parameters (FEV(1)%, body mass index, 6 min walk test distance [6MWD], static hyperinflation as measured by the ratio of inspiratory capacity to total lung capacity (IC/TLC) at rest, DH as measured by the change between the post- and pre-exercise values of IC/TLC [ΔIC/TLC], P(aO(2)), and P(aCO(2))) with emergency visits and hospital admissions because of exacerbations and also with respiratory and all-cause mortality were assessed.The median follow-up period was 47 months (IQR 45-48 months, n = 73). During the follow-up there were 8 (11%) deaths. The ΔIC/TLC value was 3.9 ± 4.6%. The Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in the patients with ΔIC/TLC4 and with 6MWD ≤ 439.56 m, using these values as thresholds. (The rates for sensitivity were 100% and 87.5%, and for specificity were 56.92% and 87.69%, respectively). The Cox proportional hazards model showed that DH (hazard ratio = 1.4, 95% CI = 1.09-1.84, P = .009) and 6MWD (hazard ratio = 0.98, 95% CI = 0.97-0.99, P = .006) were independent predictors of all-cause and respiratory mortality. 6MWD, FEV(1)%, IC/TLC, and ΔIC/TLC were found to be significantly related to emergency visits (r = -0.28, r = -0.41, r = -0.24, and r = 0.38, respectively) and hospital admissions (r = -0.41, r = -0.45, r = -0.36, and r = 0.28, respectively).DH and exercise capacity are reliable and independent predictors for mortality and morbidity in COPD patients. We propose that DH and exercise capacity be considered in the assessment of long-term clinical consequences of COPD patients.

Prostate-specific antigen (PSA) is the most important biochemical marker in the diagnosis and follow-up of patients with prostate cancer. In recent years, a relationship between PSA levels and hypoxic conditions has been described. However, no study has investigated the PSA levels in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the impact of hypoxemia on serum total (tPSA) and free PSA (fPSA) levels in patients with COPD. Between January 2010 and January 2014, 95 male patients who hospitalized for acute exacerbations of COPD and 80 control subjects were enrolled in the study. Serum tPSA and fPSA levels and f/tPSA ratios were determined in all patients on the first day of hospitalization (exacerbation) and 7 days after the treatment (stable state). Statistical analysis included paired t test and Mann-Whitney U test. No statistically significant differences were found between COPD and control groups with regard to the baseline characteristics, except for smoking status. The levels of serum tPSA and fPSA during exacerbation of COPD were significantly higher than the levels of the stable period (p0.01), whereas f/tPSA ratio did not change (p0.05). Hypoxemia during acute exacerbation of COPD can cause a rise in serum tPSA and fPSA levels, but f/tPSA ratio is not affected. Acute exacerbation of COPD may be added to list of the events in which PSA measurements must be interpreted with caution.

The frequency and characteristics of headache in patients with chronic obstructive pulmonary disease (COPD) are not clear and there are only a few studies that have assessed the relationship between chronic hypoxaemia and headache. We performed this study in order to evaluate the frequency and characteristics of headache in COPD patients. A total of 119 patients, with a mean age of 63.4 +/- 8.2 years, diagnosed with moderate or severe stable COPD were included in the study. Overall 31.9% of the patients complained of headache and 45.4% were reported to have sleep disorders. There were significant effects of family history of COPD, having other systemic disorders or sleep disorders (snoring, bruxism, restless leg syndrome, etc.) and laboratory data of chronic hypoxaemia and airway obstruction on headache co-morbidity. In conclusion, possibly being a specific subtype of elderly headache, headache in patients with moderate or severe COPD is a common problem and future studies are needed to obtain more knowledge about its pathophysiological and clinical basis.

Summary Rationale To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). Methods Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF- α ) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (⩾3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). Results BAL revealed the microorganisms with potential pathogenicity above the established threshold (⩾10 3 cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls ( P = 0.05 ). BAL MPO, IL-8 and TNF- α levels were found to be significantly higher in COPD as compared to controls ( P = 0.001 ). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent ( P = 0.001 ). Airway bacterial load correlated with levels of airway inflammation markers in COPD ( P 0.05 ). Conclusion The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

The objective of this study was to examine the association among the duration of COPD, degree of hypoxemia, and neurological abnormalities including cognitive functioning. Fifty-four patients with severe COPD and 24 age- and sex-matched controls, were included in the study. All patients and controls were administered pulmonary function tests, standardized Mini-mental State Examination (MMSE), Blessed Dementia Scale (BDS), Physical Self-maintenance Scale (PSMS), Modified Activities of Daily Living scale (MADL), Instrumental Activities of Daily Living scale (IADL), Cornell Scale for Depression in Dementia (CSDD), Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR). In addition, detailed physical and neurological examinations were performed. Sixty-four percent of patients with COPD showed abnormalities in MMSE, predominantly in recent memory, construction, attention, language, and orientation domains. Functional abnormalities were correlated with cognitive abnormalities. Although COPD patients did not show significant depression compared to controls, 77.7%. of the patients showed subjective and objective cognitive disturbance and 72.2% of the patients were classified as questionable or mild dementia. In conclusion, patients with COPD show significant cognitive and functional impairments that cannot be explained just by coincidence or by depression.

Objective: The relationship between neuropathy and increased morbidity in patients with COPD is clear, but few studies have assessed cranial neuropathies, especially optic nerve involvement, in COPD patients. We evaluated peripheral involvement of the optic nerve and determined factors influencing this condition in patients with severe COPD. Methodology: Twenty-eight patients, mean age 59.4 ± 9.4 years, diagnosed with severe stable COPD according to the GOLD criteria, and 20 age- and gender-matched healthy individuals, mean age 55.6 ± 8.5 years, were included in the study. All subjects underwent visual evoked potential (VEP) assessment together with detailed clinical and laboratory examination to exclude concurrent risk factors for neuropathy. Results: VEP assessment showed significant abnormalities in COPD patients (82.1%) (commonly amplitude abnormalities) when compared with healthy controls. Conclusions: The optic nerve is often involved in patients with severe COPD, possibly as part of a polyneuropathy, and this is related to acidosis, hypercarbia and airway obstruction, independent of disease duration, smoking and age. These results should be taken into consideration when determining management strategies for these patients.