Comparison of clinical characteristics between chronic bronchitis and non-chronic bronchitis in patients with chronic obstructive pulmonary disease

Association of heart rate variability index with depressive symptoms and lung function in chronic obstructive pulmonary disease

BACKGROUND

Depression is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). Research indicates that COPD affects cardiac autonomic control, and heart rate variability (HRV) serves as a simple, non-invasive measure of autonomic nerve activity. However, the relationship between HRV and lung function, as well as the impact of depressive symptoms, remains unclear.

AIM

To investigate the correlation between HRV indicators and depressive symptoms and lung function in patients with COPD.

METHODS

A retrospective cross-sectional study involving 120 COPD patients hospitalized from January 2018 to January 2024 at our institution was conducted. Demographic and clinical characteristics were collected, and depressive symptoms were assessed using the Beck Depression Inventory (BDI). Patients were categorized into a depressed group (BDI ≥ 16) and a non-depressed group (BDI < 16). A control group consisting of 60 healthy volunteers who underwent check-ups at the same institution was also included. Statistical analyses were performed using SPSS 26.0 software. Pearson correlation coefficients were calculated to determine and compare the relationships between HRV parameters, lung function measures, and depressive symptoms across the groups.

RESULTS

Of the 120 patients with COPD, 35.8% (43/120) were diagnosed with depression, compared to 5.0% (3/60) in the control group. The HRV index in COPD patients was significantly lower than that in the control group (P < 0.05), and the value in the depressed group was significantly lower than that in the non-depressed group (P < 0.05). Similarly, the COPD group had a significantly lower pulmonary forced vital capacity (FVC), first-second expiratory volume (FEV1) and FEV1/FVC ratios than the control group (P < 0.05), and the depressed group was significantly lower than that in the non-depressed group (P < 0.05). Pearson correlation analysis revealed that the standard deviation of normal R-R intervals, standard deviation of the mean of 5-minute normal R-R intervals, root mean square of successive differences of normal R-R intervals, percentage of normal R-R intervals greater than 50 ms, high-frequency, and low-frequency indices showed positive correlations with lung function parameters (P < 0.05) and negative correlations with BDI scores (P < 0.05).

CONCLUSION

Compared to patients without COPD, the incidence of depressive symptoms is higher among patients with COPD and is negatively correlated with the patients’ HRV indices. In contrast, HRV indices are positively correlated with the patients’ pulmonary function parameters. Patients and healthcare professionals should enhance their awareness of depression, actively conduct depression assessment screenings, and incorporate HRV indices into disease management. This approach aims to improve the psychological health of patients and ultimately enhance their prognosis and quality of life.

Kernel Conversion Improves the Correlation between the Extent of Emphysema and Clinical Parameters in Chronic Obstructive Pulmonary Disease: A Multicenter Cohort Study

BACKGROUND

Computed tomography (CT) scans are utilized to assess emphysema, a prominent phenotype of chronic obstructive pulmonary disease (COPD). Variability in CT protocols and equipment across hospitals can impact accuracy. This study aims to implement kernel conversion across different CT settings and evaluate changes in the correlation between the emphysema index pre- and post-kernel conversion, along with clinical measures in COPD patients.

METHODS

Data were extracted from the Korea COPD Subgroup Study database, which included CT scan images from 484 COPD patients. These images underwent kernel conversion. Emphysema extent was quantified using the percentage of low-attenuation areas (%LAA-950) determined by a deep learning-based program. The correlation between %LAA-950 and clinical parameters, including lung function tests, the modified Medical Research Council (mMRC), 6-minute walking distance (6MWD), COPD assessment test (CAT), and the St. George's Respiratory Questionnaire for COPD (SGRQ-c), was analyzed. Subsequently, these values were compared across various CT settings.

RESULTS

A total of 484 participants were included. Kernel conversion significantly reduced the variance in %LAA-950 values (before vs. after: 12.6±11.0 vs. 8.8±11.9). Post-kernel conversion, %LAA-950 demonstrated moderate correlations with forced expiratory volume in 1 second (r=-0.41), residual volume/total lung capacity (r=0.42), mMRC (r=0.25), CAT score (r=0.12), SGRQ-c (r=0.21), and 6MWD (r=0.15), all of which were improved compared to the unconverted dataset (all p<0.01).

CONCLUSION

CT images processed through kernel conversion enhance the correlation between the extent of emphysema and clinical parameters in COPD.

Characterising airway inflammation in Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander adults with asthma and COPD

OBJECTIVE

To examine airway inflammatory cell profiles in Indigenous Australian adults with asthma and chronic obstructive pulmonary disease (COPD).

DESIGN/SETTING

A retrospective, cross-sectional study on data from a tertiary referral respiratory outpatient clinic.

PARTICIPANTS

Indigenous (n=23) and non-Indigenous (n=71) adults were matched according to diagnosis, gender and age to the ratio of 1:3.

MAIN OUTCOME MEASURES

Participants were defined by self-determined identification as Indigenous (Aboriginal) or non-Indigenous. A relevant history was taken, and lung function was measured by spirometry. In those with a diagnosis of asthma, symptom control was assessed by the Asthma Control Questionnaire, six items (ACQ6). In those with a diagnosis of COPD, symptoms were assessed by the COPD assessment test (CAT). Airway cell counts were obtained in all groups from bronchial lavage (BL) cell count.

RESULTS

Lung function and inhaled corticosteroid dose were similar between groups. Current smoking was three times more common in Indigenous people (35%) compared with non-Indigenous people (12%, p=0.009). In participants with asthma, ACQ6 scores were similar between Indigenous and non-Indigenous participants with asthma. In those with COPD, Indigenous participants had significantly higher total CAT scores as well as scores for cough and sputum with a score indicating a high impact on quality of life (CAT score ≥14, 85%-25%, p=0.017). There was no difference in BL cell differential counts.

CONCLUSIONS

Indigenous people with COPD had higher smoking rates, worsened CAT scores and more symptoms of cough and sputum production. There were no differences between the groups in airway inflammation, but neutrophilic inflammation was associated with poorly-controlled asthma.

The effect of nebulized N-acetylcysteine on the phlegm of chronic obstructive pulmonary disease: the NEWEST study

BACKGROUND

Phlegm is prevalent symptom in patients with chronic obstructive pulmonary disease (COPD). Few studies have investigated the effectiveness of N-acetylcysteine (NAC) nebulizer therapy in COPD patients. We evaluated the effect of nebulized NAC on the improvement of phlegm symptom in COPD patients.

METHODS

This was a 12-week, prospective, single-arm, open-label, phase IV multi-center trial (NCT05102305, Registration Date: 20-October-2021). We enrolled patients aged ≥ 40 years with post bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) < 0.7 and COPD assessment test (CAT) phlegm score ≥ 2; the patients were current or ex-smoker with smoking pack-years ≥ 10. The primary endpoint was to determine the change in CAT phlegm score at 12 weeks compared to the baseline. Patients were assessed at baseline, 4, 8, and 12 weeks of treatment using the CAT score.

RESULTS

In total, 100 COPD patients were enrolled from 10 hospitals. The mean age of the patients was 71.42 ± 8.20 years, with 19.78% being current-smokers and 80.22% being ex-smokers. The mean smoking pack-years was 40.32 ± 35.18. The mean FVC, FEV1, and FEV1/FVC were 3.94 L (75.44%), 2.22 L (58.50%), and 0.53, respectively. The CAT phlegm score at baseline was 3.47 ± 1.06, whereas after 12 weeks of nebulized NAC it significantly decreased to 2.62 ± 1.30 (p < 0.01). More than half (53.5%) of the patients expressed satisfaction with the effects of nebulized NAC therapy. Adverse events occurred in 8 (8.0%) patients. Notably, no serious adverse drug reactions were reported.

CONCLUSION

In this study, we have established the effectiveness and safety of nebulized NAC over 12 weeks.

It is high time to discard a cut-off of 0.70 in the diagnosis of COPD

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) has traditionally been diagnosed based on the criterion of an FEV1/FVC <0.70. However, this definition has limitations as it may only detect patients with later-stage disease, when pathologic changes have become irreversible. Consequently, it potentially omits individuals with early-stage disease, in whom the pathologic changes could be delayed or reversed.

AREAS COVERED

This narrative review summarizes recent evidence regarding early-stage COPD, which may not fulfill the spirometric criteria but nonetheless exhibits features of COPD or is at risk of future COPD progression.

EXPERT OPINION

A comprehensive approach, including symptoms assessment, various physiologic tests, and radiologic features, is required to diagnose COPD. This approach is necessary to identify currently underdiagnosed patients and to halt disease progression in at- risk patients.

Obstructive Sleep Apnea and Medical Comorbidities in the Asian Population: Evidence From a Nationwide Healthcare System Data in South Korea

OBJECTIVE

Obstructive sleep apnea (OSA) is a breathing disorder characterized by recurrent airway obstruction during sleep. Previous western studies have investigated the link between medical disorders and the pathophysiology of OSA. The prevalence and comorbidity rates of OSA; however, vary across different countries and racial groups. This study aimed to delve into medical comorbidities in patients with OSA using a large nationwide healthcare database in Korea.

METHODS

This nationwide study used the Korean National Health Insurance claims database (2010-2019). The effect of OSA on the incidence of medical disorders was estimated using the Cox proportional hazard ratio (HR) model. The results were reported as crude and adjusted HRs with 95% confidence intervals (CI). Subgroup analysis was conducted by sex and age.

RESULTS

In total, 103,785 patients with OSA and 207,570 patients without OSA were included. OSA group had significantly higher HRs for ischemic heart disease and stroke even after adjusting for hypertension, dyslipidemia, and diabetes. The OSA group also showed an increased risk of metabolic syndrome-related diseases, chronic kidney disease, and gastroesophageal reflux disease. Female patients with OSA exhibited notably higher rates of comorbid liver cirrhosis, chronic obstructive pulmonary disease, and asthma. The cardiovascular burden of patients increased in accordance with the patients' age.

CONCLUSION

Korean patients with OSA have a significantly increased risk of cardio-cerebrovascular diseases, which aligns with the previous studies conducted in the western countries. This result holds particular significance as it represents the first nationwide, population-based study conducted in Asia.

The clinical characteristics and outcomes of different inhaled therapies in chronic obstructive pulmonary disease patients with frequent cough

BACKGROUND

Cough is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Patients with cough may exhibit various clinical characteristics and experience varying outcomes based on inhaled therapies they receive.

OBJECTIVES

This study aimed to explore the clinical characteristics and outcomes of various inhaled therapies in COPD patients with frequent cough.

METHODS

This was a multicenter, prospective cohort study. Of these patients, the median cough score in COPD assessment test (CAT) was two. Patients were classified into frequent cough group if they scored two or over in the first item of CAT and infrequent cough group otherwise. Patients with frequent cough were then divided into long-acting antimuscarinic (LAMA), long-acting beta2-agonist (LABA)/LAMA, inhaled corticosteroids (ICS)/LABA and ICS/LABA/LAMA groups. Minimum clinically important difference (MCID) (CAT scores decreased ≥2 from baseline) and the improvement of cough (cough score decreased ≥1 from baseline) were collected in the six-month follow-up. Frequent exacerbations (experiencing at least two exacerbations) were collected in the one-year follow-up.

RESULTS

Of 906 patients, 581 (64.1%) patients reported frequent cough at the initial visit. Frequent cough was associated with the current smokers and CAT scores (p < 0.05). The MCID showed no significant difference between frequent cough and infrequent cough groups in the follow-up. More patients with frequent cough experienced future frequent exacerbations compared to those with infrequent cough. After receiving inhaled therapies, 62% of patients with frequent cough got the cough improved. More patients with frequent cough treated with LABA/LAMA or ICS/LABA/LAMA attained MCID and fewer experienced exacerbations than those treated with LAMA or ICS/LABA (p < 0.05). The change in cough score showed no difference among various inhaled therapies in patients with frequent cough.

CONCLUSION

COPD patients with frequent cough were related to current smokers and higher CAT scores. These patients had a higher incidence of frequent exacerbations than those with infrequent cough. Patients with frequent cough who were treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID and at a lower risk of exacerbation than those treated with LAMA or ICS/LABA.

Prevalence and risk factors of patients with chronic bronchitis among Iraqi adults

This study aimed to identify the risk factors associated with chronic bronchitis among patients seeking medical attention for respiratory conditions in Al-Najaf Al-Ashraf city, Iraq. The study employed a case-control design and recruited 134 participants using convenient sampling. Data was collected using a questionnaire consisting of four parts which included demographic characteristics, individual factors, family history, and seasonal, environmental, and nutritional factors. The majority of participants were males aged between 21 and 35 years, with 71.8% of the study group residing in rural areas and 66.3% of the control group living in urban areas. We found that asthma was the most prevalent associated disease among chronic bronchitis patients, with 64.1% reporting it. The risk factors associated with chronic bronchitis were residency, smoking, exposure to secondhand smoke, respiratory sensitivity, dust sensitivity, spring sensitivity, hay fever, asthma, pulmonary obstruction, pneumonia, pertussis, and family history. The study highlights the need for smoking cessation, physical fitness, and healthy eating habits to prevent chronic bronchitis. The findings of this study are important for healthcare professionals in Iraq to design and implement effective prevention and management strategies for chronic bronchitis.

Associations between depression and anxiety index and frequency of acute exacerbation in chronic obstructive pulmonary disease

BACKGROUND

Comorbidities of chronic obstructive pulmonary disease (COPD) influence clinical characteristics and prognosis.

OBJECTIVES

This study compared the clinical characteristics and exacerbation rate of COPD according to the presence of depression or anxiety.

DESIGN

This study used data from The Korea COPD Subgroup Study (KOCOSS) cohort, a nationwide prospective cohort from 54 medical centers, between April 2012 and 2019.

METHODS

Depression and anxiety were diagnosed with the Beck Depression Inventory and Beck Anxiety Inventory. Negative binomial regression analysis was performed to analyze the frequency of exacerbations in depressed patients and anxiety. Differences in lung function trajectory according to presence of depression/anxiety were analyzed using a linear mixed model.

RESULTS

In all, 2147 patients were enrolled. Depressed patients or anxiety had lower lung function, higher modified Medical Research Council (mMRC) grade, St. George Respiratory Questionnaire (SGRQ) score, and COPD assessment test score, and higher rates of exacerbation in the past year than those without depression/anxiety. Depressed patients had a higher frequency of moderate to severe exacerbations [Incidence Rate Ratio (IRR): 1.57, CI: 1.17-2.11, p = 0.002] and those with anxiety had higher frequencies of moderate to severe (IRR: 1.52, CI: 1.03-2.27, p = 0.038) and severe exacerbations (IRR: 2.13, CI: 1.09-4.15, p = 0.025) during 1-year follow-up compared to those without these comorbidities. The differences in the change in annual forced expiratory volume in 1 seconds (FEV1) over 3 years according to the presence of depression or anxiety were not statistically significant.

CONCLUSION

Depressed and anxious patients showed increased respiratory symptoms and exacerbation rate as well as reduced health-related quality of life, whereas there were no significant differences in changes in lung function between groups with and without depression/anxiety.