Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

Martínez, Fernando J.; Foster, Gregory; Curtis, Jeffrey L.; Criner, Gerard J.; Weinmann, Gail G.; Fishman, Alfred P.; DeCamp, Malcolm M.; Benditt, Joshua O.; Sciurba, Frank C.; Make, Barry J.; Mohsenifar, Zab; Diaz, Philip T.; Hoffman, Eric A.; Wise, Robert A.

doi:10.1164/rccm.200510-1677oc

Cited by 392 publications

(321 citation statements)

References 45 publications

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“…1,2 Many studies [3][4][5] have shown that the causes of death in patients with mild COPD are predominantly cancer and cardiovas-cular disease, but as COPD severity increases, deaths due to non-malignant respiratory disease are increasingly common. In practice, the mortality of patients with COPD has been found to be predicted by air-flow limitation, 6 hypercapnia, 7 hypoxemia, 8 low exercise capacity, 9 smoking habits, 8,10 dyspnea, 11 low body mass index, 12 a high BODE (body mass index, obstruction, dyspnea, exercise capacity) index, 13,14 and exposure to biomass smoke. 15 Two of the most common comorbidities of patients with COPD are depression and anxiety, 16 which increase mortality.…”

Section: Introductionmentioning

confidence: 99%

Effects of Smoking, Depression, and Anxiety on Mortality in COPD Patients: A Prospective Study

et al. 2013

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BACKGROUND: Smoking, depression, and anxiety increase the risk of death in patients with COPD, but the combined effect of these factors is unknown. We assessed the interactive effects of smoking, depression, and anxiety on mortality in patients with COPD. METHODS: We collected and analyzed data from 7,787 subjects with COPD, in 14 rural communities, from May 2008 to May 2012, and used logistic regression to evaluate the interactions and relative excess risk due to interaction (RERI). We applied the attributable proportion of interaction and the synergy index to evaluate the additive interactions of the factors. RESULTS: In our COPD subjects the interaction of current smoking and depression symptoms increased the death risk by 3.8-fold (

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Section: Introductionmentioning

confidence: 99%

Effects of Smoking, Depression, and Anxiety on Mortality in COPD Patients: A Prospective Study

et al. 2013

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“…27 In multivariate analysis of these 609 patients, more severe hyperinflation measured by RV was associated with higher mortality (Table 5). In a seeming paradox, among these patients with severe emphysema, more severe hyperinflation measured by TLC was associated with a lower mortality (see Table 5).…”

Section: Is D Lco Helpful In Predicting Exercisementioning

confidence: 98%

Which Pulmonary Function Tests Best Differentiate Between COPD Phenotypes?

Salzman

2012

Respir Care

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We are still at the early phase of finding useful phenotypes in COPD that can guide therapy. However, in a simple sense, "sick patients die." Many phenotypic measurements of severity correlate with mortality in COPD: FEV 1 , the ratio of inspiratory capacity to total lung capacity (IC/TLC), diffusing capacity of the lung for carbon monoxide (D LCO ), 6-min walk distance, and maximum oxygen (O 2 ) consumption or maximum watts on exercise testing. However, composite parameters, such as the BODE index (body mass index, air flow obstruction, dyspnea, exercise capacity), perform better, likely because they capture different aspects of severity that affect functional impairment and risk of death. Bronchodilator responsiveness is just a relative feature that aids in distinction of asthma and COPD but is not diagnostic in this use. A normal D LCO helps to rule out exercise-induced O 2 desaturation, but those with a low D LCO and COPD need exercise measurements to confirm desaturation. Currently, pulmonary function tests (PFTs) alone do not define subsets who respond to particular therapies. The presence of air flow obstruction and its severity increase the risk of lung cancer in COPD patients. Inflammatory biomarkers (exhaled nitric oxide and eosinophilia in sputum or bronchoalveolar lavage fluid) help distinguish asthma from COPD. Genetics is a promising area to elucidate pathophysiology and treatment for asthma and COPD, but currently alpha-1 antitrypsin deficiency is the only genetically-determined phenotype that has relevance for COPD management. The best promise for the future seems to be in composite phenotypes or scores, both for distinguishing asthma from COPD, and for guiding therapeutic options. It may be better to throw out the old, limiting diagnostic concepts. If, instead, we start from outcomes of interest, perhaps we can work back to predictors of these outcomes, and organize new diagnostic entities that have predictive relevance for treatment choices, functional outcomes, and mortality.

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“…Interestingly, the group of researchers in the National Emphysema Treatment Trial (NEET) found that oxygen use was an independent risk factor for death compared to those who did not use oxygen (hazard ratio, 1.36, 95% confidence interval, 1.02-2.10) in those who were randomized to NETT's medical arm [84]. To what extent oxygen contributed to early mortality or was simply an epimarker of a sicker group of patients is difficult to discern from the data.…”

Section: Future Researchmentioning

confidence: 99%

Domiciliary Oxygen: Facts and fallacies

Alvarado¹

2017

Clin Res Trial

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Molecular oxygen is vital for energy which is essential for life. The fact that we all need oxygen to live might make us think that the use of supplemental oxygen in every hypoxemic patient seems obvious. This is a fallacy. The survival of all metazoan organisms is dependent on the regulation of the delivery and use of oxygen to maintain a balance between the generation of energy and the production of oxygen radicals, potentially toxic. HIF (hypoxia inducible factor) is a transcription factor or nuclear messenger that should be conceptualized as a master regulator of oxygen homeostasis. Therefore, it is proceeded to discuss how its action in hypoxia conditions the activation of diverse genes that codify the synthesis of proteins that explain some of the clinical manifestations and the events of hypoxia. We also discuss how inflammatory diseases of the respiratory system can perpetuate, in the presence of oxygen at inappropriately high doses, the oxidative stress that in turn amplifies the inflammatory phenomenon. Subsequently, the doses of ambulatory oxygen are defined in conventional indications and in some unconventional indications such as air travel and high altitude. Finally, some research avenues are mentioned in this topic.

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Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

Abstract: Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.

Cited by 392 publications

References 45 publications

Effects of Smoking, Depression, and Anxiety on Mortality in COPD Patients: A Prospective Study

Effects of Smoking, Depression, and Anxiety on Mortality in COPD Patients: A Prospective Study

Which Pulmonary Function Tests Best Differentiate Between COPD Phenotypes?

Domiciliary Oxygen: Facts and fallacies

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