Early COPD patients with lung hyperinflation associated with poorer lung function but better bronchodilator responsiveness

Chen, Chunlan; Jian, Wenhua; Gao, Yi; Xie, Yanqing; Song, Yan; Zheng, Jinping

doi:10.2147/copd.s110021

Cited by 20 publications

(19 citation statements)

References 23 publications

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“…(World Health Organization, 2011) Physical inactivity, a common finding in smokers, has also been mechanistically linked to a plethora of nontransmissible diseases (World Health Organization, 2010; Lee et al, 2012). There is, therefore, increasing awareness of the link between exercise intolerance and smoking (Clini et al, 2016); moreover, the last decades witnessed a growing debate on the consequences of preclinical chronic obstructive pulmonary disease (COPD) – the prototype of a smoking-related disease – on clinical outcomes, including exercise intolerance (Caram et al, 2016; Chen et al, 2016; Rhee et al, 2017; Soriano et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease

et al. 2019

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Smoking and physical inactivity are important preventable causes of disability and early death worldwide. Reduced exercise tolerance has been described in smokers, even in those who do not fulfill the extant physiological criteria for chronic obstructive pulmonary disease (COPD) and are not particularly sedentary. In this context, it is widely accepted that exercise capacity depends on complex cardio-pulmonary interactions which support oxygen (O 2 ) delivery to muscle mitochondria. Although peripheral muscular factors, O 2 transport disturbances (including the effects of increased carboxyhemoglobin) and autonomic nervous system unbalance have been emphasized, other derangements have been more recently described, including early microscopic emphysema, pulmonary microvascular disease, ventilatory and gas exchange inefficiency, and left ventricular diastolic dysfunction. Using an integrative physiological approach, the present review summarizes the recent advances in knowledge on the effects of smoking on the lung-heart-muscle axis under the stress of exercise. Special attention is given to the mechanisms connecting physiological abnormalities such as early cardio-pulmonary derangements, inadequate oxygen delivery and utilization, and generalized bioenergetic disturbances at the muscular level with the negative sensations (sense of heightened muscle effort and breathlessness) that may decrease the tolerance of smokers to physical exercise. A deeper understanding of the systemic effects of smoking in subjects who did not (yet) show evidences of COPD and ischemic heart disease – two devastating smoking related diseases – might prove instrumental to fight their ever-growing burden.

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Section: Introductionmentioning

confidence: 99%

Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease

et al. 2019

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“… 32 – 34 Budesonide and terbutaline can alleviate airway spasm, eliminate odema, improve tolerance to tracheal intubation, inhibit the release of inflammatory factors, and reduce respiratory secretions, these drugs are widely used to treat COPD, asthma, and many other respiratory diseases. 35 – 37 Aerosolized drugs play a role in moistening the bronchial mucosa, relieving bronchospasm, reducing the viscosity of the sputum, and easily expelling the sputum. 38 We hypothesized that inhaled budesonide and terbutaline might mitigate the inflammatory response and improve pulmonary protective effects in patients undergoing thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

<p>Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study</p>

Zhou

Lai

Wang

et al. 2020

CMAR

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Background: To investigate the effectiveness and cost minimization of comprehensive pulmonary rehabilitation (CPR) in lung cancer patients who underwent surgery. Patients and Methods: A retrospective observational study based on medical records was conducted, with 2410 lung cancer patients who underwent an operation with/without CPR during the peri-operative period. Variables including clinical characteristics, length of stay (LOS), postoperative pulmonary complications (PPCs), and hospitalization expenses were compared between the intervention group (IG) and control group (CG). The CPR regimen consists of inspiratory muscle training (IMT), aerobic endurance training, and pharmacotherapy. Results: Propensity score matching analysis was performed between two groups, and the ratio of matched patients was 1:4. Finally, 205 cases of IG and 820 cases of CG in the matched cohort of our study were identified. The length of postoperative hospital stay [median: 5 interquartile (4-7) vs 7 (4-8) days, P < 0.001] and drug expenses [7146 (5411-8987) vs 8253 (6048-11,483) ¥, P < 0.001] in the IG were lower compared with the CG. Additionally, the overall incidence of PPCs in the IG was reduced compared with the CG (26.8% vs 36.7%, P = 0.008), including pneumonia (10.7% vs 16.8%, P = 0.035) and atelectasis (8.8% vs 14.0%, P = 0.046). Multivariable analysis showed that CPR intervention (OR = 0.655, 95% CI: 0.430-0.865, P = 0.006), age ≥70 yr (OR = 1.919, 95% CI: 1.342-2.744, P < 0.001), smoking (OR = 2.048, 95% CI: 1.552-2.704, P < 0.001) and COPD (OR = 1.158, 95% CI: 1.160-2.152, P = 0.004) were related to PPCs. Conclusion: The retrospective cohort study revealed a lower PPC rate and the shorter postoperative length of stay in the patients receiving CPR, demonstrating the clinical value of CRP as an effective strategy for surgical lung cancer patients with risk factors.

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“…Unexpectedly, stratifying the LCI and RV/TLC did not reveal different bronchodilator responses. Recent literature suggested that RV more sensitively reflected airway reversibility than spirometric parameters (including FEV 1 ) in obstructive lung disease [ 25 ], and that hyperinflation was associated with greater bronchodilator responses in patients with chronic obstructive pulmonary disease who had poorer lung function [ 26 ]. These collectively indicated the potential significance of hyperinflation indices (including RV/TLC) as markers of bronchodilator responses.…”

Section: Discussionmentioning

confidence: 99%

Residual volume/total lung capacity ratio confers limited additive significance to lung clearance index for assessment of adults with bronchiectasis

et al. 2017

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BackgroundMosaicism and hyperinflation are common pathophysiologic features of bronchiectasis. The magnitude of ventilation heterogeneity might have been affected by the degree of hyperinflation. Some studies have evaluated the discriminative performance of lung clearance index (LCI) in bronchiectasis patients, but the additive diagnostic value of hyperinflation metrics to LCI is unknown.ObjectiveTo compare LCI and the ratio of residual volume to total lung capacity (RV/TLC), along with the LCI normalized with RV/TLC, in terms of discriminative performance, correlation and concordance with clinical variables in adults with bronchiectasis.MethodsMeasurement items included chest high-resolution computed tomography, multiple-breath nitrogen washout test, spirometry, and sputum culture. We analyzed bronchodilator responses by stratifying LCI and RV/TLC according to their median levels (LCIHigh/RV/TLCHigh, LCILow/RV/TLCHigh, LCIHigh/RV/TLCLow, and LCILow/RV/TLCLow).ResultsData from 127 adults with clinically stable bronchiectasis were analyzed. LCI had greater diagnostic value than RV/TLC in discriminating moderate-to-severe from mild bronchiectasis, had greater concordance in reflecting clinical characteristics (including the number of bronchiectatic lobes, radiological severity score, and the presence of cystic bronchiectasis). Normalization of LCI with RV/TLC did not contribute to greater discriminative performance or concordance with clinical variables. The LCI, before and after normalization with RV/TLC, correlated statistically with age, sex, HRCT score, Pseudomonas aeruginosa colonization, cystic bronchiectasis, and ventilation heterogeneity (all P<0.05). Different bronchodilator responses were not significant among the four subgroups of bronchiectasis patients, including those with discordant LCI and RV/TLC levels.ConclusionLCI is superior to RV/TLC for bronchiectasis assessment. Normalization with RV/TLC is not required. Stratification of LCI and RV/TLC is not associated with significantly different bronchodilator responses.

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Early COPD patients with lung hyperinflation associated with poorer lung function but better bronchodilator responsiveness

Cited by 20 publications

References 23 publications

Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease

Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease

<p>Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study</p>

Residual volume/total lung capacity ratio confers limited additive significance to lung clearance index for assessment of adults with bronchiectasis

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