The recent advances of phenotypes in acute exacerbations of COPD

Zhou, Aiyuan; Zhou, Zijing; Zhao, Yiyang; Chen, Ping

doi:10.2147/copd.s128604

Cited by 41 publications

(43 citation statements)

References 87 publications

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“…Previous studies have tried to identify different phenotypes of COPD patients: frequent exacerbators 31 – 36 , eosinophilic patients and those with asthma-COPD overlap syndrome 37 , 38 , and patients with severe airflow limitation or patients with milder airflow limitation but with obesity and CV comorbidities 39 . The identification of such phenotypes may have an impact both on long term integrated care and exacerbations 40 , 41 . The identification of comorbidities is a key step in characterizing these phenotypes 1 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease

Viglino¹,

Plazanet²,

Bailly³

et al. 2018

Sci Rep

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Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) both independently increase cardiovascular risk. We hypothesized that NAFLD might increase the incidence of cardiovascular disease and death in COPD patients. The relationship between NAFLD, incident cardiovascular events, and death was assessed in a prospective cohort of COPD patients with 5-year follow-up. Noninvasive algorithms combining biological parameters (FibroMax®) were used to evaluate steatosis, non-alcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate Cox regression models were used to assess the hazard for composite outcome at the endpoint (death or cardiovascular event) for each liver pathology. In 111 COPD patients, 75% exhibited liver damage with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During 5-year follow-up, 31 experienced at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis had more cardiovascular events and higher mortality (Hazard ratio [95% CI]: 2.75 [1.26; 6.03]) than those with no fibrosis; this remained significant in multivariate analysis (Hazard ratio [95% CI]: 2.94 [1.18; 7.33]). We also found that steatosis and NASH were not associated with increased cardiovascular events or mortality. To conclude, early assessment of liver damage might participate to improve cardiovascular outcomes in COPD patients.

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Section: Discussionmentioning

confidence: 99%

Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease

Viglino¹,

Plazanet²,

Bailly³

et al. 2018

Sci Rep

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“…The relationship between various subclasses of IgG and risk of exacerbations, however, remains unknown, as only a few articles with a number of limitations have described the frequency of IgG subclass deficiencies in COPD[ 15 – 17 ] and no prior studies have evaluated their impact on hospitalizations. Considering that COPD is a heterogeneous disease with several clinical phenotypes [ 18 ], we analyzed samples from patients who were at increased risk for exacerbations, and a second independent COPD cohort was also used to replicate our findings.…”

Section: Introductionmentioning

confidence: 99%

Serum IgG subclass levels and risk of exacerbations and hospitalizations in patients with COPD

et al. 2018

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BackgroundThe literature is scarce regarding the prevalence and clinical impact of IgG subclass deficiency in COPD. We investigated the prevalence of IgG subclass deficiencies and their association with exacerbations and hospitalizations using subjects from two COPD cohorts.MethodsWe measured IgG subclass levels using immunonephelometry in serum samples from participants enrolled in two previous COPD trials: Macrolide Azithromycin for Prevention of Exacerbations of COPD (MACRO; n = 976) and Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD (STATCOPE; n = 653). All samples were collected from clinically stable participants upon entry into both studies. IgG subclass deficiency was diagnosed when IgG subclass levels were below their respective lower limit of normal: IgG1 < 2.8 g/L; IgG2 < 1.15 g/L; IgG3 < 0.24 g/L; and IgG4 < 0.052 g/L. To investigate the impact of IgG subclass levels on time to first exacerbation or hospitalization, we log-transformed IgG levels and performed Cox regression models, with adjustments for confounders.ResultsOne or more IgG subclass deficiencies were found in 173 (17.7%) and 133 (20.4%) participants in MACRO and STATCOPE, respectively. Lower IgG1 or IgG2 levels resulted in increased risk of exacerbations with adjusted hazard ratios (HR) of 1.30 (95% CI, 1.10–1.54, p < 0.01) and 1.19 (95% CI, 1.05–1.35, p < 0.01), respectively in the MACRO study, with STATCOPE yielding similar results. Reduced IgG1 or IgG2 levels were also associated with increased risk of hospitalizations: the adjusted HR for IgG1 and IgG2 was 1.52 (95% CI: 1.15–2.02, p < 0.01) and 1.33 (95% CI, 1.08–1.64, p < 0.01), respectively for the MACRO study; in STATCOPE, only IgG2 was an independent predictor of hospitalization. In our multivariate Cox models, IgG3 and IgG4 levels did not result in significant associations for both outcomes in either MACRO or STATCOPE cohorts.ConclusionsApproximately 1 in 5 COPD patients had one or more IgG subclass deficiencies. Reduced IgG subclass levels were independent risk factors for both COPD exacerbations (IgG1 and IgG2) and hospitalizations (IgG2) in two COPD cohorts.Trial registrationThis study used serum samples from participants of the MACRO (NCT00325897) and STATCOPE (NCT01061671) trials.Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0733-z) contains supplementary material, which is available to authorized users.

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“…It is well known that AECOPD may be triggered by infection with bacteria or viruses or by noninfectious environmental or internal factors. Patients with AECOPD also display heterogeneous inflammation, and inflammatory markers such as CRP [44] as a kind of quantitative indicator are widely used in judging AE and for assessing prognoses [45]. Serum CRP may provide prognostic information about morbidity and mortality in COPD patients because of relationships among CRP, interleukin (IL)-6, exercise tolerance, and the health status [46,47].…”

Section: Discussionmentioning

confidence: 99%

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

et al. 2020

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Background: Chronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD. Methods: We enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software.Result: We recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group.Conclusions: HFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.

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The recent advances of phenotypes in acute exacerbations of COPD

Cited by 41 publications

References 87 publications

Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease

Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease

Serum IgG subclass levels and risk of exacerbations and hospitalizations in patients with COPD

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

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