Prognostic Factors in COPD Patients Receiving Long-term Oxygen Therapy

Oswald‐Mammosser, Monique; Weitzenblum, E; Quoix, Élisabeth; Moser, Gelson Aguiar da Silva; Chaouat, Ari; Charpentier, Catherine; Kessler, Romain

doi:10.1378/chest.107.5.1193

Cited by 467 publications

(340 citation statements)

References 19 publications

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“…Other resting indices have been found to predict the prognosis of these patients, the most important being BMI [175,176], IC/total lung capacity (TLC) ratio [177], arterial hypoxaemia during sleep [178], pulmonary artery pressure [179], mixed venous partial pressure of oxygen (PO 2 ) [180] and the degree of functional breathlessness [181].…”

Section: Utility Of Exercise Testing In Prognostic Evaluationmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Utility Of Exercise Testing In Prognostic Evaluationmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

View full text Add to dashboard Cite

show abstract

“…4,5 However, even in patients receiving long-term oxygen therapy, PH is the strongest prognostic factor, independent of the severity of airflow limitation or hypoxemia. 3,6 The pathogenesis of PH in patients with advanced COPD is still incompletely understood. Chronic hypoxemia is considered the major contributing factor, in association with morphological changes in lung parenchyma and inflammation.…”

mentioning

confidence: 99%

Polymorphism of the Serotonin Transporter Gene and Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

et al. 2003

Self Cite

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Background-The serotonin transporter (5-HTT) is involved in the pulmonary artery smooth muscle hyperplasia that leads to pulmonary hypertension (PH). Because hypoxia and 5-HTT gene polymorphism control 5-HTT expression, we examined 5-HTT gene polymorphism and PH in hypoxemic patients with advanced chronic obstructive pulmonary disease (COPD). Methods and Results-In 103 patients with COPD recruited in France (nϭ67) and the UK (nϭ36), we determined 5-HTT gene polymorphism and pulmonary artery pressure (PAP) measured during right heart catheterization (France) or Doppler echocardiography (UK). Ninety-eight subjects from the 2 countries served as control subjects. The distribution of 5-HTT gene polymorphism did not differ between patients and control subjects. In patients carrying the LL genotype, which is associated with higher levels of 5-HTT expression in pulmonary artery smooth muscle cells than the LS and SS genotypes, PH was more severe than in LS or SS patients. Mean PAP values in patients from France with the LL, LS, and SS genotypes were 34Ϯ3, 23Ϯ1, and 22Ϯ2 mm Hg (meanϮSEM), respectively (PϽ0.01). Corresponding systolic PAP values in the UK were 40Ϯ3, 28Ϯ3, and 24Ϯ3 mm Hg, respectively (PϽ0.01). Compared with control subjects, platelet 5-HTT protein was increased in COPD patients in proportion to the hypoxemia level, and strong 5-HTT immunostaining was observed in remodeled pulmonary arteries from COPD patients. Conclusions-5-HTT gene polymorphism appears to determine the severity of PH in hypoxemic patients with COPD.Because PH is an important prognostic factor in this disease, recognition of patients at risk for PH should be helpful in

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“…However, pulmonary hypertension is possibly an important comorbidity, which can result from LVSD32, 33, 34 or IPF 35, 36. Whether due to LVSD37, 38 or IPF,39, 40, 41 pulmonary hypertension is associated with significantly increased morbidity and mortality. In addition to the postulated role of pulmonary hypertension, there is evidence demonstrating extensive redistribution of pulmonary blood flow in individuals with hemodynamically significant LVSD, underscoring a complex heart–lung interaction 42.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Waheed

Chaves

Gardin

et al. 2015

JAHA

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BackgroundImpaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all‐cause mortality, and their impact on risk classification using a continuous net reclassification index.Methods and ResultsWe followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all‐cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5–3.0), 1.7 (1.4–2.1), and 3.2 (2.0–5.1) for HF; 1.8 (1.2–2.6), 1.4 (1.1–1.8), and 2.8 (1.7–4.7) for cardiovascular mortality; 1.3 (1.0–1.8), 1.7 (1.4–1.9), and 2.1 (1.5–3.0) for all‐cause mortality, and 1.6 (1.3–2.1), 1.7 (1.5–1.9), and 2.4 (1.7–3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF.ConclusionsWhile risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.

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Prognostic Factors in COPD Patients Receiving Long-term Oxygen Therapy

Cited by 467 publications

References 19 publications

Recommendations on the use of exercise testing in clinical practice

Recommendations on the use of exercise testing in clinical practice

Polymorphism of the Serotonin Transporter Gene and Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

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