Anthropometric and pulmonary function test profiles of outpatients with stable chronic obstructive pulmonary disease

Sahebjami, Hamid; Doers, Jesse T.; Render, Marta L.; Bond, Terry L.

doi:10.1016/0002-9343(93)90080-9

Cited by 89 publications

(46 citation statements)

References 18 publications

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“…Our finding of an association between low BMI or body weight with poor survival agrees with other studies [10,20,21]. A low BMI has been correlated in a study of 126 patients with stable COPD with a low FEV1 suggesting that they are not independent predictors of poor survival [22]. A high daytime Pa,CO 2 has been shown to be a predictor of poor survival either with [9,23] or without [12,13] oxygen therapy.…”

Section: Discussionsupporting

confidence: 91%

Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Sivasothy¹,

Smith²,

Shneerson³

1998

Eur Respir J

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The use of noninvasive ventilation in pulmonary disease has been shown to improve the blood gases of pati-ents both while awake [1][2][3] and asleep [1,4,5] but it has proved difficult to identify in which patients survival or quality of life can be improved [5][6][7]. Mask intermittent positive pressure ventilation (MIPPV) has been introduced in acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) as a short-term measure to reduce intubation rates and improve survival [8].Long-term oxygen therapy (LTOT) improves survival in chronically hypoxic COPD patients [9,10]; however, patients with a high arterial carbon dioxide tension (Pa,CO 2 ) had a poor prognosis both prior to oxygen therapy [11,12] and (at least in the first year) with oxygen therapy [13]. In some patients, hypercapnia deteriorates with oxygen therapy manifesting with headaches, confusion, drowsiness and difficulty concentrating such that LTOT is not tolerated. Long-term MIPPV could in principle prevent this complication and improve survival.We report our experience with nocturnal mask ventilation in patients with COPD with hypercapnic respiratory failure in whom oxygen therapy resulted in worsening daytime or nocturnal hypercapnia. Materials and methods Patient selectionThe inclusion criteria were: 1) arterial oxygen tension (Pa,O 2 ) <7.3 kPa and Pa,CO 2 >6.0 kPa while breathing room air; 2) stable clinical state, arterial blood gases and pulmonary function tests over the 3 weeks prior to the study (with a daytime arterial H + concentration between 35-48 nmol -1 ); and 3) supplementary oxygen therapy failed either to raise the daytime Pa,O 2 to >7.3 kPa without a rise in the awake Pa,CO 2 to >8 kPa or failed to raise nocturnal oxygen saturations to >90% without a rise in the transcutaneous carbon dioxide tension (Ptc,CO 2 ) to >9 kPa. Patients with co-existing pulmonary diseases, neuromuscular or chest wall disorders were excluded. Twenty six patients, 13 males and 13 females, fulfilling these criteria were studied retrospectively. Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease. P. Sivasothy, I.E. Smith, J.M. Shneerson. ERS Journals Ltd 1998.ABSTRACT: Noninvasive ventilation in chronic obstructive pulmonary disease (COPD) has been shown to improve arterial blood gases but its long-term role has not been established.We retrospectively studied 26 consecutive patients with hypercapnic ventilatory failure due to COPD in whom oxygen therapy caused worsening hypercapnia (defined as a rise in the daytime arterial carbon dioxide tension (Pa,CO 2 ) to >8.0 kPa or nocturnal transcutaneous carbon dioxide tension (Ptc,CO 2 ) to >9 kPa). All were treated with mask ventilation (15 with nasal and 11 face masks) at night and during daytime naps. Additional oxygen therapy was required in 15 patients.The mean annualized death rate was 10.8% with a 1 and 3 yr survival of 92 and 68%, respectively. After 1 yr the median daytime Pa,CO 2 had falle...

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Section: Discussionsupporting

confidence: 91%

Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Sivasothy¹,

Smith²,

Shneerson³

1998

Eur Respir J

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“…In the same clinical sample, it was also shown that the DL,CO decreased after remarkable weight loss [12]. A significant correlation between BMI and DL,CO, and between BMI and KCO was found in a group of outpatients with stable COPD [10] and in a group of never smoker obese patients with moderate-to-severe obstructive sleep apnoea [11], respectively. Data from the different samples above consistently show a positive correlation between BMI and DL,CO, which is independent from concomitant comorbidity, respiratory disease and smoking habit.…”

Section: Discussionmentioning

confidence: 58%

“…By applying a statistical model analogous to that applied in the above mentioned paper, the present authors have previously found that weight at baseline and change in weight were significant predictors of DL,CO longitudinal increases over an 8-yr period, both in adult males and females from the Po river delta prospective epidemiological study in Italy [9]. With regard to clinical studies, large BMI values have been shown to be an independent determinant of increased diffusion indexes in groups of patients with chronic obstructive pulmonary disease (COPD) [10] and obstructive sleep-apnoea [11]. In a small study on massively obese but otherwise normal, nonsmoking, young adults, the single-breath DL,CO increased with the degree of obesity [12].…”

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confidence: 61%

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Longitudinal changes of body mass index, spirometry and diffusion in a general population

Bottai¹,

Pistelli²,

Pede³

et al. 2002

European Respiratory Journal

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The aim of this study was to evaluate the effects of body mass index (BMI) changes over an 8-yr follow-up, on longitudinal changes of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and carbon monoxide diffusing capacity of the lung (DL,CO) indices in a general population sample of North Italy.To avoid including weight changes possibly related to physical growth, only the 1,426 adults (w24 yrs, 46% males) with complete follow-up were selected. Median linear regression models were applied to estimate the medians of change (computed as followup minus baseline values) of VC, FVC, FEV1 and DL,CO indices, as functions of changes of BMI over the follow-up period, separately by sex, after considering several potential confounders and effect modifiers.The extent of lung function loss tended to be higher among those who, at baseline, reported greater BMI values. Males experienced larger losses than females (20 and 16 mL FEV1 median reduction for a BMI unit increase in males and females, respectively). Conversely, longitudinal changes of BMI caused a slight and nonsignificant increase in DL,CO values in both sexes.Over an 8-yr follow-up, the detrimental effect of gaining weight might be reversible for many adults as most of those who reduced their body mass index values also increased their lung function. Overweight patients with ventilatory impairment should be routinely encouraged to lose weight for improving their lung function. Eur Respir J 2002; 20: 665- (1999)(2000), and from GlaxoSmithKline, London, UK (2001).The body mass index (BMI), body weight (kg) to squared height (m) ratio, is a well known index that is receiving increasing attention to evaluate the effects of overall obesity on ventilatory function.Besides age and height, BMI has recently been considered as an additional independent variable in models for deriving spirometric prediction equations [1,2]. In particular, the present authors have previously observed that BMI improved the precision of predictions for both volumes and flows, regardless of sex [2].Furthermore, BMI or body weight gains have been shown to be related to longitudinal decline of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in adults, both in occupational cohorts [3,4] and in general population samples [5][6][7].This effect of BMI on lung function has been shown to be independent of age [4,5]. In studies with both males and females, significantly higher effects have been found in males [5][6][7].Little is known about the effect of longitudinal changes of BMI on variations of the carbon monoxide diffusing capacity of the lung (DL,CO) in large general population samples. Body weight, but not BMI, change was included among predictors of longitudinal change of DL,CO in adults from the Tucson Epidemiological Study of Obstructive Lung Disease, although its effect was not specifically addressed [8]. By applying a statistical model analogous to that applied in the above mentioned paper, the present auth...

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“…After the patient arrived at the laboratory at 8 am before breakfast, weight and height were measured using a mechanical scale (Welmy, São Paulo, SP, Brazil) and body mass index was calculated. Three consecutive measurements of triceps skinfold (TSF) thickness were used as an indirect estimate of body fat (17). Three measurements of midarm circumference (MAC) were performed in the nondominant arm, positioned parallel to the trunk.…”

Section: Experimental Designmentioning

confidence: 99%

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

Borghi‐Silva

Baldissera

Sampaio

et al. 2006

Braz J Med Biol Res

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The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH 2 O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

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Anthropometric and pulmonary function test profiles of outpatients with stable chronic obstructive pulmonary disease

Cited by 89 publications

References 18 publications

Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease

Longitudinal changes of body mass index, spirometry and diffusion in a general population

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

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