COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation

Şahin, Hülya; Naz, İlknur; Varol, Yelda; Tuksavul, Fevziye; Özsöz, Ayşe

doi:10.1016/j.rppnen.2016.03.003

Cited by 10 publications

(16 citation statements)

References 27 publications

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“…It is shown that COPD patients with severe diffusing defect improved in Dl CO ( P = .04) value and FEV 1 % ( P = .01) value after PR. COPD patients with low diffusing capacity significantly higher changes in FEV1 and TLCO levels compared to those having moderate diffusing capacity . In our study the increase in FEV1% observed in both groups were statistically significant.…”

Section: Discussionsupporting

confidence: 53%

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Effectiveness of pulmonary rehabilitation in COPD patients receiving long‐term oxygen therapy

Şahin¹,

Varol

Naz

et al. 2017

Clinical Respiratory J

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Section: Discussionsupporting

confidence: 53%

“…The patients with COPD had benefited from PR regardless of disease severity . Sometimes severe‐very severe COPD patients may benefit from PR more than mild‐moderate COPD patients . Our objective was COPD patients with LTOT benefit from PR as well as severe COPD patients without respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of pulmonary rehabilitation in COPD patients receiving long‐term oxygen therapy

Şahin¹,

Varol

Naz

et al. 2017

Clinical Respiratory J

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“…No changes in D LCO have been shown by Mota et al [12], but apart from expiratory muscle training, no other rehabilitative respiratory intervention was administered to the patients enrolled in the study. However, the possibility of an increase in D LCO has been described in a recent paper by Sahin et al [13], which found that patients with a severe reduction in D LCO had better improvements in dyspnea compared to patients with a mild-moderate D LCO impairment due to blood flow redistribution to lung capillaries. We think that the latter hypothesis might be unlikely to occur because the redistribution of blood during exercise is temporary in nature, and, taking into account the need for an intact pulmonary peripheral vascular bed and the regional inhomogeneity of the D LCO raise during exercise in patients with COPD, unless the lung function test has been performed during or right after the exercise training, the explanation must be different.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a recent report described a significant increase in D LCO in severe patients with COPD after an 8-week outpatient PR program. Also in this case, the primary outcome was not D LCO , no subcomponents were measured, and the patients enrolled were 36 [13]. As opposed to heart failure [14], in COPD the KCO is related to the integrity of the alveolar-capillary membrane, and therefore to the extent of emphysema [15], which should constitute an irreversible phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Improvements in Lung Diffusion Capacity following Pulmonary Rehabilitation in COPD with and without Ventilation Inhomogeneity

et al. 2016

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Background: Lung diffusing capacity (DLCO) and lung volume distribution predict exercise performance and are altered in COPD patients. If pulmonary rehabilitation (PR) can modify DLCO parameters is unknown. Objectives: To investigate changes in DLCO and ventilation inhomogeneity following a PR program and their relation with functional outcomes in patients with COPD. Methods: This was a prospective, observational, multicentric study. Patients were evaluated before and after a standardized 3-week PR program. Functional assessment included body plethysmography, DLCO, transfer factor (KCO) and alveolar volume (VA), gas exchange, the 6-min walking test (6MWT) and exercise-related dyspnea. Patients were categorized according to the severity of airflow limitation and presence of ventilation inhomogeneity, identified by a VA/TLC <0.8. Results: Two hundred and fifty patients completed the study. Baseline forced expiratory volume in 1 s (FEV₁) % predicted (mean ± SD) was 50.5 ± 20.1 (76% males); 137 patients had a severe disease. General study population showed improvements in 6MWT (38 ± 55 m; p < 0.01), DLCO (0.12 ± 0.63 mmol × min^-1 kPa^-1; p < 0.01), lung function and dyspnea. Comparable improvements in DLCO were observed regardless of the severity of disease and the presence of ventilation inhomogeneity. While patients with VA/TLC <0.8 improved the DLCO increasing their VA (177 ± 69 ml; p < 0.01), patients with VA/TLC >0.8 improved their KCO (8.1 ± 2.8%; p = 0.019). The latter had also better baseline lung function and higher improvements in 6MWT (14.6 ± 6.7 vs. 9.0 ± 1.8%; p = 0.015). Lower DLCO at baseline was associated with lower improvements in 6MWT, the greatest difference being between subjects with very severe and mild DLCO impairment (2.7 ± 7.4 vs. 14 ± 2%; p = 0.049). Conclusions: In COPD patients undergoing a PR program, different pathophysiological mechanisms may drive improvements in DLCO, while ventilation inhomogeneity may limit improvements in exercise tolerance.

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“…It measures the capacity of pulmonary alveolar and capillary surfaces for gas exchange (2). DL CO has been used in diagnosing and determining the severity of multiple lung diseases (1), as well as in determining their prognosis (3) and predicting their response to treatment (4,5). DL CO is frequently abnormal in chronic obstructive pulmonary disease (COPD) and is associated with emphysema measured from computed tomography (6) as well as with pulmonary vascular disease.…”

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confidence: 99%

Genome-Wide Association Analysis of Single-Breath Dl_CO

Sakornsakolpat¹,

McCormack²,

Bakke

et al. 2019

Am J Respir Cell Mol Biol

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DL CO is a widely used pulmonary function test in clinical practice and a particularly useful measure for assessing patients with chronic obstructive pulmonary disease (COPD). We hypothesized that elucidating genetic determinants of DL CO could lead to better understanding of the genetic architecture of COPD. We estimated the heritability of DL CO using common genetic variants and performed genome-wide association analyses in four cohorts enriched for subjects with COPD (COPDGene [Genetic Epidemiology of COPD], NETT [National Emphysema Treatment Trial], GenKOLS [Genetics of Chronic Obstructive Lung Disease study], and TESRA [Treatment of Emphysema With a Gamma-Selective Retinoid Agonist study]) using a combined European ancestry white dataset and a COPDGene African American dataset. We assessed our genome-wide significant and suggestive associations for DL CO in previously reported genomewide association studies of COPD and related traits. We also characterized associations of known COPD-associated variants and DL CO . We estimated the SNP-based heritability of DL CO in the European ancestry white population to be 22% (P = 0.0004). We identified three genome-wide significant associations with DL CO : variants near TGFB2, CHRNA3, and PDE11A loci (P , 5 3 10 28 ). In addition, 12 loci were suggestively associated with DL CO in European ancestry white (P , 1 3 10 25 in the combined analysis and P , 0.05 in both COPDGene and GenKOLS), including variants near NEGR1, CADM2, PCDH7, RETREG1, DACT2, NRG1, ANKRD18A, KRT86, NTN4, ARHGAP28, INSR, and PCBP3. Some DL CO -associated variants were also associated with COPD, emphysema, and/or spirometric values. Among 25 previously reported COPD loci, TGFB2, CHRNA3/CHRNA5, FAM13A, DSP, and CYP2A6 were associated with DL CO (P , 0.001). We identified several genetic loci that were significantly associated with DL CO and characterized effects of known COPD-associated loci on DL CO . These results could lead to better understanding of the heterogeneous nature of COPD.

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COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation

Cited by 10 publications

References 27 publications

Effectiveness of pulmonary rehabilitation in COPD patients receiving long‐term oxygen therapy

Effectiveness of pulmonary rehabilitation in COPD patients receiving long‐term oxygen therapy

Improvements in Lung Diffusion Capacity following Pulmonary Rehabilitation in COPD with and without Ventilation Inhomogeneity

Genome-Wide Association Analysis of Single-Breath Dl_CO

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COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation

Cited by 10 publications

References 27 publications

Effectiveness of pulmonary rehabilitation in COPD patients receiving long‐term oxygen therapy

Effectiveness of pulmonary rehabilitation in COPD patients receiving long‐term oxygen therapy

Improvements in Lung Diffusion Capacity following Pulmonary Rehabilitation in COPD with and without Ventilation Inhomogeneity

Genome-Wide Association Analysis of Single-Breath DlCO

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Genome-Wide Association Analysis of Single-Breath Dl_CO