[Comorbidities of COPD]

[Chronic obstructive pulmonary disease: somato-psychological dimensions]

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is a poorly understood lung disease. It is accompanied by significant psychological co-morbidities (anxiety, depression, identity and body image disorders) which are under-diagnosed and have an impact on quality of life and the frequency of  re-hospitalization. The management of COPD is multidisciplinary and its role is to prevent complications, relieve symptoms and slow the progression of the disease. Therapeutic education of the patient brings a real added value in this multidisciplinary management.

[COPD, anxiety-depression and cognitive disorders: Does inflammation play a major role?]

COPD is a chronic respiratory disease, often associated with extrapulmonary manifestations. Co-morbidities, including anxiety, depression and cognitive impairment, worsen its progression and quality of life. The prevalence of these disorders is high, yet they are often poorly understood and inadequately managed. In the development of psychological disorders, there is accumulated evidence highlighting the major role of systemic inflammation, as well as chronic disease, genetics, the consequences of smoking, hypoxaemia, oxidative stress, and the gut microbiome In addition to traditional treatments such as bronchodilatator medications, respiratory rehabilitation and smoking cessation, systemic inflammation is an interesting therapeutic target, with the use of anti-inflammatory drugs, anti-cytokines, and nutritional interventions.

[The GLORI-COPD score: detection of COPD patients at risk of complications]

DEVELOPMENT OF THE GLORI-COPD SCORE

GLObal RIsk of severe outcomes in COPD patients.

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a commonly under-diagnosed disease. This study aimed to develop a screening tool for COPD patients with a high risk of complications, taking into account COPD severity and associated co-morbidity.

METHODS

Two Delphi rounds were conducted to select the items for a preliminary score. Subsequently, this score was submitted to patients with a possible diagnosis of COPD attending for pulmonary function tests in hospital and primary care. Items associated with a diagnosis of COPD and its severity were examined with multivariate logistic regressions. Associated items in our analyses and in the literature were integrated into the score. The score was developed with a factorial analysis and optimized according to ROC curves.

RESULTS

Fifteen items were selected with the Delphi method, of which six were retained after logistic regression. They were submitted to 64 patients (mean age: 59+/-13.6 years). Factors associated with COPD were smoking ≥10 pack-years and a history of acute exacerbations. Low levels of activity and coughing up sputum were associated with COPD severity. Age ≥40 years and co-morbidities were added to the score. According to the factorial analysis, a two-stage score was developed assessing first the diagnosis of COPD and then the risk of severe outcomes. It showed a sensitivity of 71 %, a specificity of 77 %. The positive and negative predictive value were respectively 28 % and 96 %.

CONCLUSION

The score was an acceptable screening tool to identify COPD patients with high risk of complications. Nevertheless, validation needs be performed in a larger population to allow its use in primary care.

Importance of Social Relationships in Patients with Chronic Respiratory Diseases

The literature lacks reports on the role of the social relationships domain (SRD) of quality of life (QoL) in shaping care for patients with chronic respiratory diseases in primary care. In this study we examined a group of 582 patients with chronic respiratory diseases and chronic non-respiratory diseases recruited from 199 primary care centers. In the patients with chronic respiratory diseases, higher SRD correlated with more frequent patient visits due to medical issue, fewer district nurse interventions over the past 12 months, less frequent hospitalizations over the past 3 years, and fewer chronic diseases. In these patients, a high SRD was most effectively created by high QoL in the Psychological, Environmental, and Physical domains, and the satisfaction with QoL. Programs for preventing a decline in SRD should include patients with low scores in the Psychological, Environmental, and Physical domains, those who show no improvement in mental or somatic well-being in the past 12 months, those with a low level of positive mental attitudes, unhealthy eating habits, and with low levels of met needs. Such programs should include older widows and widowers without permanent relationships, with only primary education, living far from a primary care center, and those whose visits were not due to a medical issue.

Chronic obstructive pulmonary disease is independently associated with hypertension in men: A survey design analysis using nationwide survey data

Although studies have shown that chronic obstructive pulmonary disease (COPD) and hypertension are linked as comorbidities, it remains unclear whether COPD is independently associated with the risk of hypertension or is caused by common risk factors such as age and smoking. The objective of this study was to investigate the relationship between COPD and hypertension by using nationally representative data.This cross-sectional study analyzed data from the Korea National Health and Nutrition Examination Survey V conducted during 2010 to 2012. Hypertension was defined as a mean systolic blood pressure ≥ 140 mm Hg and/or a diastolic blood pressure ≥ 90 mm Hg, or current consumption of antihypertensive medications. A diagnosis of COPD was defined as a smoking history of at least 10 pack-years with airflow limitation on spirometry. Multivariate logistic regression was performed to investigate the independent association between COPD and hypertension after adjusting for covariates. Survey design analyses were conducted for all analyses.Among 4043 men (aged ≥ 40 years) who underwent spirometry, 2190 (54.2%) had hypertension. Even after adjusting for age, body mass index, smoking status, diabetes, metabolic syndrome, and stroke, COPD was independently associated with hypertension (adjusted odds ratio, 1.71; 95% confidence interval, 1.37-2.13; P < .001). Adjusted pulse pressure significantly increased as the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity and FEV1 decreased.COPD is independently associated with hypertension, and this could explain the link between the risk of cardiovascular diseases and COPD.