Dyselectrolytemia in Chronic Obstructive Pulmonary Diseases with acute exacerbation

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and morbidity world wide. Due to lack of awareness about the precipitating factors and predictors of prognosis, cases of acute exacerbation of COPD often suffer the fatal outcomes. In our study we assessed the levels of serum sodium and potassium in subjects with acute episodes of COPD and their healthy controls. We found a significantly low level of serum sodium (133± 6.86 meq/lit) and potassium (3.39 ± 0.96 meq/L)) in subjects with acute exacerbation of COPD than their healthy counterparts [sodium-142 ± 2.28 meq/L and potassium- 4.52 ± 0.02 meq/L (p <0.05)]. Therefore, our study findings suggest that, serum sodium and potassium levels may get deranged in subjects with acute exacerbations of COPD which should be routinely checked for to avoid fatal outcomes.     

Leukocyte Mitochondrial DNA Copy Number Is Associated with Chronic Obstructive Pulmonary Disease

Background

Oxidative stress is known to be involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Evidence suggests that leukocytes mitochondria DNA (mtDNA) is susceptible to undergo mutations, insertions, or depletion in response to reactive oxidative stress (ROS). We hypothesize that mtDNA copy number is associated with the development of COPD.

Methodology/Principal Findings

Relative mtDNA copy number was measured by a quantitative real-time PCR assay using DNA extracted from peripheral leukocytes. MtDNA copy number of peripheral leukocytes in the COPD group (n = 86) is significantly decreased compared with non-smoker group (n = 77) (250.3± 21.5 VS. 464.2± 49.9, P<0.001). MtDNA copy number in the COPD group was less than that in the healthy smoking group, but P value nearly achieved significance (250.3± 21.5 VS. 404.0± 76.7, P = 0.08) MtDNA copy number has no significance with age, gender, body mass index, current smoking, and pack-years in COPD group, healthy smoker group and no smoker group, respectively. Serum glutathione level in the COPD group is significantly decreased compared with healthy smoker and non-smoker groups (4.5± 1.3 VS. 6.2± 1.9 and 4.5± 1.3 VS. 7.1±1.1 mU/mL; P<0.001 respectively). Pearson correlation test shows a significant liner correlation between mtDNA copy number and serum glutathione level (R = 0.2, P = 0.009).

Conclusions/Significance

COPD is associated with decreased leukocyte mtDNA copy number and serum glutathione. COPD is a regulatory disorder of leukocytes mitochondria. However, further studies are needed to determine the real mechanisms about the gene and the function of mitochondria.     

Reproducibility and Respiratory Function Correlates of Exhaled Breath Fingerprint in Chronic Obstructive Pulmonary Disease

Background

The electronic nose (e nose) provides distinctive breath fingerprints for selected respiratory diseases. Both reproducibility and respiratory function correlates of breath fingerprint are poorly known.

Objectives

To measure reproducibility of breath fingerprints and to assess their correlates among respiratory function indexes in elderly healthy and COPD subjects.

Method

25 subjects (5 COPD patients for each GOLD stage and 5 healthy controls) over 65 years underwent e-nose study through a seven sensor system and respiratory function tests at times 0, 7, and 15 days. Reproducibility of the e nose pattern was computed. The correlation between volatile organic compound (VOC) pattern and respiratory function/clinical parameters was assessed by the Spearman''s rho.

Measurements and Main Results

VOC patterns were highly reproducible within healthy and GOLD 4 COPD subjects, less among GOLD 1–3 patients.VOC patterns significantly correlated with expiratory flows (Spearman''s rho ranging from 0.36 for MEF25% and sensor Co-Buti-TPP, to 0.81 for FEV1% and sensor Cu-Buti-TPP p<0.001)), but not with residual volume and total lung capacity.

Conclusions

VOC patterns strictly correlated with expiratory flows. Thus, e nose might conveniently be used to assess COPD severity and, likely, to study phenotypic variability. However, the suboptimal reproducibility within GOLD 1–3 patients should stimulate further research to identify more reproducible breath print patterns.     

Microsatellite Instability in Arabidopsis Increases with Plant Development

Plant development consists of the initial phase of intensive cell division followed by continuous genome endoreduplication, cell growth, and elongation. The maintenance of genome stability under these conditions is the main task performed by DNA repair and genome surveillance mechanisms. Our previous work showed that the rate of homologous recombination repair in older plants decreases. We hypothesized that this age-dependent decrease in the recombination rate is paralleled with other changes in DNA repair capacity. Here, we analyzed microsatellite stability using transgenic Arabidopsis (Arabidopsis thaliana) plants that carry the nonfunctional β-glucuronidase gene disrupted by microsatellite repeats. We found that microsatellite instability increased dramatically with plant age. We analyzed the contribution of various mechanisms to microsatellite instability, including replication errors and mistakes of DNA repair mechanisms such as mismatch repair, excision repair, and strand break repair. Analysis of total DNA polymerase activity using partially purified protein extracts showed an age-dependent decrease in activity and an increase in fidelity. Analysis of the steady-state RNA level of DNA replicative polymerases α, δ, Pol I-like A, and Pol I-like B and the expression of mutS homolog 2 (Msh2) and Msh6 showed an age-dependent decrease. An in vitro repair assay showed lower efficiency of nonhomologous end joining in older plants, paralleled by an increase in Ku70 gene expression. Thus, we assume that the more frequent involvement of nonhomologous end joining in strand break repair and the less efficient end-joining repair together with lower levels of mismatch repair activities may be the main contributors to the observed age-dependent increase in microsatellite instability.The genome of Arabidopsis (Arabidopsis thaliana) is extensively repetitive, which leads many to believe that Arabidopsis is subject to ancient autoploid events with many subsequent rearrangements and alterations (Meinke et al., 1998; Arabidopsis Genome Initiative, 2000; Blanc et al., 2000). Despite the highly reduplicated genome with the potential for a high degree of genetic redundancy, maintaining a consistent level of genome stability is critical. This is especially important when considering that plants do not have a predetermined germ line and that gametes are produced from meristematic cells that are products of many somatic cell divisions (Hays, 2002). Furthermore, as plants are sessile organisms, they are continuously exposed to various genotoxic elements such as heavy metals, reactive oxygen species, and UV irradiation. This constant exposure to harsh environmental conditions imposes a need for precise and efficient genome maintenance pathways, as the persistence of DNA damage and mutagenesis can decrease the fitness of current and future generations (Britt, 1996).DNA mutagenesis cannot solely be attributed to environmentally induced genotoxic stress, as DNA is prone to spontaneous or replication-induced mutagenesis. For example, transitions of 5-methylcytosine to thymine are common spontaneous mutations (Britt, 1996), while DNA replication and repair infidelity can induce numerous errors (Sia et al., 1997; Tuteja et al., 2001). Hundreds of mutations are introduced upon each genome replication due to DNA polymerase infidelity. Repetitive elements are particularly prone to this type of mutation due to replication slippage, which refers to DNA polymerase dissociation during the replication of short repetitive sequences followed by the separation and subsequent reassociation of the daughter strand in a different but identical repeat (Viguera et al., 2001). Polymerase reloading and the resumption of DNA synthesis can result in addition or subtraction of the repeated sequence. Microsatellites, the simple tandem repeats of one to six nucleotides (Viguera et al., 2001), are highly susceptible to replication slippage.The frequency at which these and other polymerase-derived errors persist depends largely on the DNA polymerase proofreading activity and the precision and fidelity of core DNA repair enzymes. Since many repair pathways involve DNA polymerase activity, many of them can potentially contribute to an increase in microsatellite instability. Mismatch repair (MMR) is a repair mechanism involved in the correction of replication errors. It is essential for the maintenance of repeated sequences, as mutations in MMR genes are associated with a substantial destabilization of microsatellites (Karran, 1996), and in humans, microsatellite instability increases with aging (Ben Yehuda et al., 2000; Krichevsky et al., 2004; Neri et al., 2005).The fidelity of different repair pathways can vary largely in the same or similar types of lesions. For example, single- and double-strand breaks can be repaired via homologous recombination (HR) or nonhomologous end joining (NHEJ) pathways (Britt, 1996; Tuteja et al., 2001; Kovalchuk et al., 2004; Boyko et al., 2006a). Of these pathways, HR is believed to be precise and largely error free, while NHEJ can induce numerous mutations ranging from single- to thousand-nucleotide insertions or deletions (Pelczar et al., 2003; Boyko et al., 2006b). It is unclear how either of these pathways is chosen for repair, but recent evidence from our laboratory suggests that the HR pathway is developmentally regulated, whereby NHEJ is up-regulated and HR is down-regulated with plant development (Boyko et al., 2006b). Currently, there is no information on whether other DNA repair pathways in plants are developmentally regulated.Previous publications suggest that aging human cells have a higher frequency of mutations in microsatellites (Ben Yehuda et al., 2000; Krichevsky et al., 2004; Neri et al., 2005). No such data exist for plants. Here, we investigated microsatellite stability during the development of Arabidopsis using the uidA (GUS) reporter gene inactivated by an artificially incorporated microsatellite (Azaiez et al., 2006). We found a strong increase in instability with plant maturity. We tested the contributions of various repair pathways to age-dependent microsatellite instability and suggest that these changes are primarily due to more frequent involvement of the NHEJ pathway in DNA repair.     

慢性阻塞性肺疾病合并肺曲菌病一例及文献复习

目的:提高对慢性阻塞性肺疾病合并侵袭性肺曲菌病(COPD合并IPA)临床特点、诊断及治疗的认识.方法:回顾性分析2011年4月收治的一例COPD合并IPA患者的临床资料及诊治经过,并复习相关文献.结果:男患,“咳嗽、咳痰30余年,气短3年,加重1月余”入院,肺部CT示双肺多发结节影、空洞影,经抗炎、抗念珠菌治疗无效,CT下肺结节病灶活检病理示肺曲菌.抗曲菌治疗后症状好转、肺部影像明显吸收.结论:COPD合并IPA正逐渐引起重视,临床特征无明显特异性,肺部影像以结节影、空洞影多见,早期常规治疗无效时应积极抗曲菌治疗,可明显改善症状,降低死亡率,病理活检是确诊的依据.     

TLR-4 在慢性阻塞性肺病患者肺组织表达的研究

目的:观察COPD患者肺组织中TLR-4,IL-8,MUC5AC的表达,并探讨其在气道炎症、气道高分泌中的作用。方法:非COPD、COPD组男性肺癌病人各20例,取其肺叶切除后的外周肺组织,对肺组织标本行HE及AB-PAS染色,用免疫组织化学方法检测肺组织中TLR-4,IL-8,MUC5AC的表达并分析其相关性。结果:①COPD患者肺组织中TLR-4,IL-8,MUC5AC表达较对照组增高(P<0.05)。TLR-4主要在气道上皮细胞、肺巨噬细胞及血管内皮细胞表达,IL-8在气道壁、肺泡间隔、血管壁及肺组织内浸润的单核细胞、巨噬细胞、多形核白细胞均有表达,MUC5AC主要在气道上皮杯状细胞中表达。②TLR-4、IL-8表达与气道炎细胞评分成正相关(P<0.05)。TLR-4与IL-8、MUC5AC表达成正相关(P<0.05)。结论:COPD患者肺组织中TLR-4高表达可能参与了COPD的气道炎症及气道高分泌,这可能是通过增加IL-8与MUC5AC的表达来实现的。     

Cognitive Impairment in Chronic Obstructive Pulmonary Disease

Background/Purpose

Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with multiple cognitive problems. Montreal Cognitive Assessment test (MoCA) is used to detect cognitive impairment evaluating several areas: visuospatial, memory, attention and fluency. Our study aim was to evaluate the impact of stable COPD and exacerbation (AECOPD) phases on cognitive status using MoCA questionnaire.

Methods

We enrolled 39 patients (pts), smokers with COPD group D (30 stable and 9 in AECOPD) and 13 healthy subjects (control group), having similar level of education and no significant differences regarding the anthropometric measurements. We analyzed the differences in MoCA score between these three groups and also the correlation between this score and inflammatory markers.

Results

Patients with AECOPD had a significant (p<0.001) decreased MoCA score (14.6±3.4) compared to stable COPD (20.2±2.4) and controls (24.2±5.8). The differences between groups were more accentuated for the language abstraction and attention (p<0.001) and delayed recall and orientation (p<0.001) sub-topics. No significant variance of score was observed between groups regarding visuospatial and naming score (p = 0.095). The MoCA score was significantly correlated with forced expiratory volume (r = 0.28) and reverse correlated with C-reactive protein (CRP) (r = −0.57), fibrinogen (r = −0.58), erythrocyte sedimentation rate (ESR) (r = −0.55) and with the partial pressure of CO₂ (r = −0.47).

Conclusions

According to this study, COPD significantly decreases the cognitive status in advanced and acute stages of the disease.     

Epicardial Adipose Tissue in Patients with Chronic Obstructive Pulmonary Disease

Rationale

Epicardial Adipose Tissue (EAT) volume as determined by chest computed tomography (CT) is an independent marker of cardiovascular events in the general population. COPD patients have an increased risk of cardiovascular disease, however nothing is known about the EAT volume in this population.

Objectives

To assess EAT volume in COPD and explore its association with clinical and physiological variables of disease severity.

Methods

We measured EAT using low-dose CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI. We determined blood pressure, cholesterol, glucose and HbA1c levels, microalbuminuria, lung function, BODE index, co-morbidity index and coronary artery calcium score (CAC). EAT volume were compared between groups. Uni and multivariate analyses explored the relationship between EAT volume and the COPD related variables.

Results

COPD patients had a higher EAT volume [143.7 (P_25–75, 108.3–196.6) vs 129.1 (P_25–75, 91.3–170.8) cm³, p = 0.02)] and the EAT volume was significantly associated with CAC (r = 0.38, p<0.001) and CRP (r = 0.32, p<0.001) but not with microalbuminuria (r = 0.12, p = 0.13). In COPD patients, EAT volume was associated with: age, pack-years, BMI, gender, FEV₁%, 6 MWD, MMRC and HTN. Multivariate analysis showed that only pack-years (B = 0.6, 95% CI: 0.5–1.3), BMI (B = 7.8, 95% CI: 5.7–9.9) and 6 MWD (B = −0.2, 95% CI: −0.3–−0.1), predicted EAT volume.

Conclusions

EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular events.     

Systemic and Pulmonary Vascular Remodelling in Chronic Obstructive Pulmonary Disease

BackgroundChronic Obstructive Pulmonary Disease (COPD) is associated with subclinical systemic atherosclerosis and pulmonary vascular remodelling characterized by intimal hyperplasia and luminal narrowing. We aimed to determine differences in the intimal thickening of systemic and pulmonary arteries in COPD subjects and smokers. Secondary aims include comparisons with a non-smokers group; determining the clinical variables associated with systemic and pulmonary intimal thickening, and the correlations between systemic and pulmonary remodelling changes.MethodsAll consecutive subjects undergoing lung resection were included and divided into 3 groups: 1) COPD, 2) smokers, and 3) non-smokers. Sections of the 5th intercostal artery and muscular pulmonary arteries were measured by histo-morphometry. Four parameters of intimal thickening were evaluated: 1) percentage of intimal area (%IA), 2) percentage of luminal narrowing, 3) intimal thickness index, and 4) intima-to-media ratio.ResultsIn the adjusted analysis, the systemic arteries of COPD subjects showed greater intimal thickening (%IA) than those of smokers (15.6±1.5% vs. 14.2±1.6%, p = 0.038). In the pulmonary arteries, significant differences were observed for %IA between the 2 groups (37.3±2.2% vs. 29.3±2.3%, p = 0.016). Among clinical factors, metabolic syndrome, gender and COPD status were associated with the systemic intimal thickening, while only COPD status was associated with pulmonary intimal thickening. A correlation between the %IA of the systemic and pulmonary arteries was observed (Spearman’s rho = 0.46, p = 0.008).ConclusionsGreater intimal thickening in systemic and pulmonary arteries is observed in COPD patients than in smokers. There is a correlation between systemic and pulmonary vascular remodelling in the overall population.     

慢性阻塞性肺病动物模型的研究进展

慢性阻塞性肺病(COPD)是一种严重的呼吸系统疾病,该病主要包括慢性肺气肿及慢性支气管炎,其发病率、死亡率高,医疗负担重。由于其发病机制、临床发展过程较为复杂,对COPD诊断、治疗的研究工作进展仍然相当缓慢。目前,国内外研究人员通过建立COPD动物模型对该病进行了大量研究工作。旨在对COPD动物模型的建立及评价方法进行总结,并对模型动物选择,评价方法的选择提出一点新的思路。     

聚焦慢性阻塞性肺病治疗药物

慢性阻塞性肺病(COPD) 是肺部进行性疾病,需长期治疗。预计到2020 年,每年COPD 将会导致全球600 多万人死亡。尽管对新型药物开发投资不断增加,但该领域的治疗仍以缓解症状的支气管扩张吸入剂为主,而不是治愈性疗法,故应对COPD 的创新药的研发仍困难重重。与乳腺癌等疾病领域相比,呼吸系统药物的研发成功率不到50%,但每种获批药物的研发成本却翻倍。因此,制药公司致力于药品生命周期的管理,在当前治疗的基础上进一步改进。其策略包括不同种类药物联用、开发新配方和各种剂量剂型,改善疗效,方便给药。其中以长效β 受体激动剂 (LABA)/ 长效毒蕈碱拮抗剂(LAMA) 的定量复方药的需求增长最多。领导市场的GSK 公司的LABA 沙美特罗和吸入型皮质类固醇 (ICS) 氟替卡松的复方药Advair,就是应用以上方法的典型。虽已出现潜在新型靶标,但这些药物还处于早期开发阶段。吸入型LABA/ICS 定量复方药短期内仍是 COPD 治疗领域的主力军。     

Refining Susceptibility Loci of Chronic Obstructive Pulmonary Disease with Lung eqtls

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality worldwide. Recent genome-wide association studies (GWAS) have identified robust susceptibility loci associated with COPD. However, the mechanisms mediating the risk conferred by these loci remain to be found. The goal of this study was to identify causal genes/variants within susceptibility loci associated with COPD. In the discovery cohort, genome-wide gene expression profiles of 500 non-tumor lung specimens were obtained from patients undergoing lung surgery. Blood-DNA from the same patients were genotyped for 1,2 million SNPs. Following genotyping and gene expression quality control filters, 409 samples were analyzed. Lung expression quantitative trait loci (eQTLs) were identified and overlaid onto three COPD susceptibility loci derived from GWAS; 4q31 (HHIP), 4q22 (FAM13A), and 19q13 (RAB4B, EGLN2, MIA, CYP2A6). Significant eQTLs were replicated in two independent datasets (n = 363 and 339). SNPs previously associated with COPD and lung function on 4q31 (rs1828591, rs13118928) were associated with the mRNA expression of HHIP. An association between mRNA expression level of FAM13A and SNP rs2045517 was detected at 4q22, but did not reach statistical significance. At 19q13, significant eQTLs were detected with EGLN2. In summary, this study supports HHIP, FAM13A, and EGLN2 as the most likely causal COPD genes on 4q31, 4q22, and 19q13, respectively. Strong lung eQTL SNPs identified in this study will need to be tested for association with COPD in case-control studies. Further functional studies will also be needed to understand the role of genes regulated by disease-related variants in COPD.     

细辛脑联合多索茶碱治疗慢性阻塞性肺病疗效观察

目的:观察细辛脑联合多索茶碱治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床疗效。方法:将164例AECOPD患者随机分为观察组（82例）和对照组（82例）,对照组予低流量吸氧、抗炎、抗感染、纠正水电解质紊乱等综合治疗,观察组在此基础上加用注射用细辛脑、多索茶碱静脉治疗。观察两组治疗前后症状、体征改善情况及血气分析变化。结果:观察组与对照组临床总有效率分别为93.9%、81.7%（P<0.05）,观察组在发热、咳嗽咳痰、喘息症状消失时间,以及肺部罗音减少50%以上时间均显著短于对照组（P<0.01）,在FEV1、FEV1/FVC、PEF、PaO₂、PaCO₂等指标也显著优于对照组（P<0.01）。结论:在常规治疗基础上加用细辛脑、多索茶碱可以有效提高AECOPD患者的临床疗效。     

The Lung Microbiome in Moderate and Severe Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder characterized by incompletely reversible airflow obstruction. Bacterial infection of the lower respiratory tract contributes to approximately 50% of COPD exacerbations. Even during periods of stable lung function, the lung harbors a community of bacteria, termed the microbiome. The role of the lung microbiome in the pathogenesis of COPD remains unknown. The COPD lung microbiome, like the healthy lung microbiome, appears to reflect microaspiration of oral microflora. Here we describe the COPD lung microbiome of 22 patients with Moderate or Severe COPD compared to 10 healthy control patients. The composition of the lung microbiomes was determined using 454 pyrosequencing of 16S rDNA found in bronchoalveolar lavage fluid. Sequences were analyzed using mothur, Ribosomal Database Project, Fast UniFrac, and Metastats. Our results showed a significant increase in microbial diversity with the development of COPD. The main phyla in all samples were Actinobacteria, Firmicutes, and Proteobacteria. Principal coordinate analyses demonstrated separation of control and COPD samples, but samples did not cluster based on disease severity. However, samples did cluster based on the use of inhaled corticosteroids and inhaled bronchodilators. Metastats analyses demonstrated an increased abundance of several oral bacteria in COPD samples.     

细辛脑联合多索茶碱治疗慢性阻塞性肺病疗效观察

目的：观察细辛脑联合多索茶碱治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床疗效。方法：将164例AECOPD患者随机分为观察组（82例）和对照组（82例）,对照组予低流量吸氧、抗炎、抗感染、纠正水电解质紊乱等综合治疗,观察组在此基础上加用注射用细辛脑、多索茶碱静脉治疗。观察两组治疗前后症状、体征改善情况及血气分析变化。结果：观察组与对照组临床总有效率分别为93．9％、81．7％（P〈0．05）,观察组在发热、咳嗽咳痰、喘息症状消失时间,以及肺部罗音减少50％以上时间均显著短于对照组（P〈0．01）,在FEV1、FEV1／FVC、PEF、PaO2、PaCO2等指标也显著优于对照组（P〈0．01）。结论：在常规治疗基础上加用细辛脑、多索茶碱可以有效提高AECOPD患者的临床疗效。     

Cluster Analysis in Patients with GOLD 1 Chronic Obstructive Pulmonary Disease

Background

We hypothesized that heterogeneity exists within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 spirometric category and that different subgroups could be identified within this GOLD category.

Methods

Pre-randomization study participants from two clinical trials were symptomatic/asymptomatic GOLD 1 chronic obstructive pulmonary disease (COPD) patients and healthy controls. A hierarchical cluster analysis used pre-randomization demographics, symptom scores, lung function, peak exercise response and daily physical activity levels to derive population subgroups.

Results

Considerable heterogeneity existed for clinical variables among patients with GOLD 1 COPD. All parameters, except forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC), had considerable overlap between GOLD 1 COPD and controls. Three-clusters were identified: cluster I (18 [15%] COPD patients; 105 [85%] controls); cluster II (45 [80%] COPD patients; 11 [20%] controls); and cluster III (22 [92%] COPD patients; 2 [8%] controls). Apart from reduced diffusion capacity and lower baseline dyspnea index versus controls, cluster I COPD patients had otherwise preserved lung volumes, exercise capacity and physical activity levels. Cluster II COPD patients had a higher smoking history and greater hyperinflation versus cluster I COPD patients. Cluster III COPD patients had reduced physical activity versus controls and clusters I and II COPD patients, and lower FEV₁/FVC versus clusters I and II COPD patients.

Conclusions

The results emphasize heterogeneity within GOLD 1 COPD, supporting an individualized therapeutic approach to patients.

Trial registration

www.clinicaltrials.gov. NCT01360788 and NCT01072396.     

Predicting Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

Background

Objectively measuring daily physical activity (PA) using an accelerometer is a relatively expensive and time-consuming undertaking. In routine clinical practice it would be useful to estimate PA in patients with chronic obstructive pulmonary disease (COPD) with more simple methods.

Objectives

To evaluate whether PA can be estimated by simple tests commonly used in clinical practice in patients with COPD.

Methods

The average number of steps per day was measured for 7 days with a SenseWear Pro™ accelerometer and used as gold standard for PA. A physical activity level (PAL) of <1.4 was considered very inactive. Univariate and multivariate analyses were used to examine the relationship between the 6-minute walking distance (6MWD), the number of stands in the Sit-to-Stand Test (STST), hand-grip strength and the total energy expenditure as assessed by the Zutphen Physical Activity Questionnaire (TEE_ZPAQ). ROC curve analysis was used to identify patients with an extremely inactive lifestyle (PAL<1.4).

Results

In 70 patients with COPD (21 females) with a mean [SD] FEV₁ of 43.0 [22.0] %predicted, PA was found to be significantly and independently associated with the 6MWD (r = 0.69, 95% CI 0.54 to 0.80, p<0.001), STST (r = 0.51, 95% CI 0.31 to 0.66, p = 0.001) and TEEZPAQ (r = 0.50, 95% CI 0.30 to 0.66, p<0.001) but not with hand-grip strength. However, ROC curve analysis demonstrated that these tests cannot be used to reliably identify patients with an extremely inactive lifestyle.

Conclusions

In patients with COPD simple tests such as the 6-Minute Walk Test, the Sit-to-Stand Test and the Zutphen Physical Activity Questionnaire cannot be used to reliably predict physical inactivity.     

Multidrug-Resistant Tuberculosis in Patients with Chronic Obstructive Pulmonary Disease in China

Background

Relatively little is known about the specific relationship and impact from chronic obstructive pulmonary disease (COPD) on multidrug-resistant tuberculsosis (MDR-TB).

Methods

We conducted a retrospective study included patients aged ≥40 years with a confirmed pulmonary TB at three tertiary hospitals (Shandong, China) between January 2011 and October 2014. Univariable and multivariable analyses were performed to identify the relationship of MDR-TB and COPD.

Results

A total of 2164 patients aged ≥ 40 years with available results of drug susceptibility test (DST) and medical records were screened for this study: 268 patients with discharge diagnosis of COPD and 1896 patients without COPD. Overall, 14.2% of patients with COPD and 8.5% patients without COPD were MDR-TB. The rate of MDR-TB were significantly higher in patients with COPD (P<0.05). Migrant (odds ratios (OR) 1.32, 95% confidence interval (CI) 1.02–1.72), previous anti-TB treatment (OR 4.58, 95% CI 1.69–12.42), cavity (OR 2.33, 95% CI 1.14–4.75), and GOLD stage (OR 1.86, 95% CI 1.01–2.93) were the independent predictors for MDR-TB among patients with COPD.

Conclusions

MDR-TB occurs more frequently in patients with underlying COPD, especially those with being migrant, previous anti-TB therapy, cavity and severe airway obstruction.