Sniff nasal inspiratory pressure versus IC/TLC ratio as predictors of mortality in COPD

Moore, Alastair; Suades, Rosa; Cetti, Edward J.; Sathyapala, S. Amanda; Hopkinson, Nicholas S; Roughton, Michael; Moxham, John; Polkey, Michael I.

doi:10.1016/j.rmed.2010.03.001

Cited by 41 publications

(42 citation statements)

References 30 publications

(26 reference statements)

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“…The lack of difference in BMI between survivors and nonsurvivors in the nonatelectasis group suggests that it was not a significant factor determining survival, and it is unlikely to be the explanation for the marked difference in outcome we observed. Moreover, in a study from our group based on a similar hospital-based COPD cohort, following 110 patients with a mean FEV1 of 36.6% pred for f5 yrs, BMI did not differ between those who had died (n537) and survivors (n573) (25¡6.4 versus 25.1¡6.4 kg?m -2 , respectively) [24].…”

Section: Significance Of Findingsmentioning

confidence: 74%

“…Successful BLVR, where atelectasis occurred, is likely to have mimicked the effects of LVRS by reducing operating lung volumes. Measures of gas trapping inspiratory capacity/total lung capacity ratio [27] and sniff nasal pressure [24] have been shown to be associated with mortality in COPD, and both lung volumes and diaphragm function improved most in the atelectasis patients [14]. Dynamic hyperinflation also improved most in patients with atelectasis.…”

Section: Significance Of Findingsmentioning

confidence: 99%

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Atelectasis and survival after bronchoscopic lung volume reduction for COPD

Hopkinson¹,

Kemp²,

Tp³

et al. 2010

European Respiratory Journal

127

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Bronchoscopic therapies to reduce lung volumes in chronic obstructive pulmonary disease are intended to avoid the risks associated with lung volume reduction surgery (LVRS) or to be used in patient groups in whom LVRS is not appropriate. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves to target unilateral lobar occlusion can improve lung function and exercise capacity in patients with emphysema.

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Section: Significance Of Findingsmentioning

confidence: 74%

Section: Significance Of Findingsmentioning

confidence: 99%

Atelectasis and survival after bronchoscopic lung volume reduction for COPD

Hopkinson¹,

Kemp²,

Tp³

et al. 2010

European Respiratory Journal

127

View full text Add to dashboard Cite

show abstract

“…are evaluated including FEV 1 (33), carbon monoxide transfer (34), hyperinflation (35), and 6MW distance (36) no differences were observed between patients with and without PFO. These data are consistent with the observation that oxygen, except in high doses, does not extend exercise performance in COPD (37,38).…”

Section: Original Articlementioning

confidence: 99%

Patent Foramen Ovale Is Not Associated with Hypoxemia in Severe Chronic Obstructive Pulmonary Disease and Does Not Impair Exercise Performance

Shaikh¹,

Kelly²,

Shrikrishna³

et al. 2014

Am J Respir Crit Care Med

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Rationale: Patent foramen ovale (PFO) may be disadvantageous in chronic obstructive pulmonary disease (COPD). It is unknown whether right-to-left shunting through PFO increases during exercise impairing exercise performance.Objectives: To determine whether (1) PFO prevalence is greater in hypoxemic versus less hypoxemic patients with COPD, (2) PFO is associated with clinically relevant impairment, and (3) right-to-left shunting increases during exercise and impairs exercise performance.Methods: Patients with COPD and age-matched control subjects underwent contrast transthoracic echocardiography and transcranial Doppler to identify PFO. Patients with COPD with no shunt and patients with large PFO underwent cardiopulmonary exercise tests with contrast transcranial Doppler, esophageal, and gastric balloon catheters.Measurements and Main Results: PFO prevalence was similar in 50 patients with COPD and 50 healthy control subjects (46% vs. 30%; P = 0.15). Large shunts were more common in patients with COPD (26% vs. 6%; P = 0.01). In an expanded COPD cohort, PFO prevalence was similar in 31 hypoxemic (Pa O 2 < 7.3 kPa) and 63 less hypoxemic (Pa O 2 . 8.0 kPa) patients with COPD (39% vs. 52%; P = 0.27). Patients with intrapulmonary shunting had lower Pa O 2 than both patients with PFO and those with no right-to-left shunt (7.7 vs. 8.6 vs. 9.3 kPa, respectively; P = 0.002). Shunting significantly increased during exercise in patients with COPD with PFO. Endurance time at 60% VO 2max was 574 (178) seconds for patients with PFO and 534 (279) seconds for those without (P = ns).Conclusions: Hypoxemic patients with COPD do not have a higher prevalence of PFO. Patients with COPD with PFO do not perform less well either on a 6-minute walk or submaximal exercise testing despite increased right-to-left shunting during exercise.Keywords: patent foramen ovale; chronic obstructive pulmonary disease; right-to-left shunt; hypoxemia; exercise Among the complications most feared by patients with chronic obstructive pulmonary disease (COPD) is the need to use domiciliary oxygen (1, 2), yet there are clear data to show that when Pa O 2 is less than 7.3 kPa, supplemental oxygen extends life (3-5).

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“…They also state that inspiratory muscle weakness contributes to a range of poor outcomes in COPD, whereas in our view associations between reduced inspiratory pressures due to hyperinflation and poor outcomes may simply be epiphenomena. Thus, for example, in a recent survival analysis [10] we found that both inspiratory muscle strength and hyperinflation predicted death in a substantially similar way, probably because they measured different properties of the same thing. In fact, inspiratory muscle strength proved statistically, but not clinically, superior with an area under the curve on a receiver operating characteristic plot of 0.68 versus 0.62 compared with inspiratory capacity/total lung capacity ratio, but the possible technical factors, notably transmission of pressure within the emphysematous lung, underlying this are beyond the scope of this editorial.…”

mentioning

confidence: 68%