Phrenic nerve conduction abnormality is an appreciated finding in COPD. Nerve stretching associated with diaphragmatic descent can be a suggested mechanism for nerve lesion. The presence of phrenic neuropathy may be an additional contributing factor to diaphragmatic dysfunction in COPD patients.

AddressesBackground The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. Osteopontin (OPN) is a pleiotropic integrin-binding protein with many functions. We assessed pleural effusion and serum concentrations of OPN and C-reactive protein (CRP) in patients with different types of pleural effusions.

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BackgroundBronchial vascular remodeling is an underresearched component of airway remodeling in COPD. Image-enhanced bronchoscopy may offer a less invasive method for studying bronchial microvasculature in COPD.ObjectivesTo evaluate endobronchial mucosal vasculature and changes in COPD by image-enhanced i-scan3 bronchoscopy and correlate them pathologically by analyzing bronchial mucosal biopsies.MethodsThis case–control study analyzed 29 COPD patients (41.4% Global initiative for chronic Obstructive Lung Disease B [GOLD B] and 58.6% GOLD D) and ten healthy controls admitted at Alexandria Main University Hospital, Egypt. Combined high-definition white light bronchoscopy (HD WLB) with i-scan3 was used to evaluate endobronchial mucosal microvasculature. The vascularity was graded according to the level of mucosal red discoloration (ie, endobronchial erythema) from decreased discoloration to normal, mild, moderate, and severe increased red discoloration (G−1, G0, G+1, G+2, and G+3, respectively) and scored by three bronchoscopists independently. Bronchial mucosal biopsies were taken for microvascular density counting using anti-CD34 antibody as angiogenesis marker.ResultsDifferent grades of endobronchial erythema were observed across/within COPD patients using combined HD WLB + i-scan3, with significant agreement among scorers (P=0.031; median score of G+1 [G−1–G+2]) being higher in GOLD D (P=0.001). Endobronchial erythema significantly correlated with COPD duration, exacerbation frequency, and body mass index (P<0.05). Angiogenesis was significantly decreased among COPD patients versus controls (10.6 [8–13.3] vs 14 [11–17.1]; P=0.02). Mucosal surface changes (including edema, atrophy, and nodules) were better visualized by the combined HD WLB + i-scan3 rather than HD WLB alone.ConclusionCombined HD WLB + i-scan3 seems to be valuable in evaluating mucosal microvasculature and surface changes in COPD, which may represent vasodilatation rather than angiogenesis.

Objectives: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) describes the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. The aim of this work is to study the value of copeptin and C-reactive protein in AECOPD.Patients and methods: The study enrolled 31 patients with AECOPD and 10 control subjects. All patients were subjected to history taking, clinical examination, arterial blood gases analysis and sputum culture for bacteriological examination. Serum samples were obtained from the patients on admission, 3 days and 14 days after and from control subjects. The samples were analyzed for copeptin and CRP levels.Results: The copeptin level on admission was significantly higher in AECOPD patients than the control subjects. The copeptin and CRP showed a statistically significant decline over the study duration but did not correlate with each other. ROC analysis curve showed that a copeptin level >14 pg/dl on admission had a sensitivity of 70% and specificity of 90% in predicting AECOPD and a level of >15 pg/dl on the fourteenth day had a sensitivity of 100% and specificity of 90% in predicting in-hospital mortality. Copeptin correlated significantly directly with the presence of bacterial infection and inversely with both PaO 2 and PaCO 2 . Neither the copeptin nor CRP correlated with the COPD severity as expressed by the FEV 1 %, BODE index and previous history of exacerbations.Conclusion: Copeptin has a good sensitivity and excellent specificity in predicting AECOPD. Additionally, it has good predilection for short term outcome and in-hospital mortality.