Effect of Pursed-Lip Breathing in Patients With COPD: Linear and Nonlinear Analysis of Cardiac Autonomic Modulation

Objective: The aim of the present study was to evaluate the effect of pursed-lip breathing (PLB) on cardiac autonomic modulation in individuals with chronic obstructive pulmonary disease (COPD) while at rest. Methods: Thirty-two individuals were allocated to one of two groups: COPD (n = 17; 67.29 +/- 6.87 years of age) and control (n = 15; 63.2 +/- 7.96 years of age). The groups were submitted to a two-stage experimental protocol. The first stage consisted of the characterization of the sample and spirometry. The second stage comprised the analysis of cardiac autonomic modulation through the recording of R-R intervals. This analysis was performed using both nonlinear and linear heart rate variability (HRV). In the statistical analysis, the level of significance was set to 5% (p = 0.05). Results: PLB promoted significant increases in the SD1, SD2, RMSSD and LF (ms(2)) indices as well as an increase in alpha(1) and a reduction in alpha(2) in the COPD group. A greater dispersion of points on the Poincare plots was also observed. The magnitude of the changes produced by PLB differed between groups. Conclusion: PLB led to a loss of fractal correlation properties of heart rate in the direction of linearity in patients with COPD as well as an increase in vagal activity and impact on the spectral analysis. The difference in the magnitude of the changes produced by PLB between groups may be related to the presence of the disease and alterations in the respiration rate.

Nasal mucociliary clearance in subjects with COPD after smoking cessation

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Correlation between heart rate variability indexes and aerobic physiological variables in patients with COPD

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Physical Activity In Daily Life In Brazilian COPD Patients During and After Exacerbation

Background: Although hospitalization is recognized as an important cause of reduction in physical activity in daily life (PADL) in COPD, there is only one study evaluating this effect, and it was performed in European COPD patients who have a lower PADL than that of South American COPD patients. Objectives: To investigate the effect of hospitalization due to acute exacerbation of PADL in Brazilian COPD patients and to evaluate the factors that determines the physical activity levels during hospitalization and after discharge. Methods: PADL was quantified using a 3-axis accelerometer on the 3rd day of hospitalization and 1 month after discharge in Brazilian COPD patients who were hospitalized due to disease exacerbation. Six-minute walking distance (6MWD), lower limb strength and pulmonary function were also evaluated. Results: A total of 20 patients completed the study. During hospitalization, patients spent most of the time (87%) lying down or sitting; however, 1 month after they were walking >40 min/day. In addition, patients with prior hospitalization had a lower level of physical activity compared to those without a previous history of hospitalization. The time spent walking during hospitalization was significantly explained by the quadriceps strength (r(2) = 0.29; p < 0.05), while 1 month after, the time spent walking was only significantly explained by the 6MWD (r(2) = 0.51; p = 0.02). Conclusions: Brazilian COPD patients are inactive during hospitalization but become active 1 month after discharge. Previously hospitalized are more inactive both during and after exacerbation. The quadriceps strength and 6MWD explain the physical activity levels during hospitalization and at home, respectively.

Extracellular matrix composition in COPD

Extracellular matrix (ECM) composition has an important role in determining airway structure. We postulated that ECM lung composition of chronic obstructive pulmonary disease (COPD) patients differs from that observed in smoking and nonsmoking subjects without airflow obstruction. We determined the fractional areas of elastic fibres, type-I, -III and -IV collagen, versican, decorin, biglycan, lumican, fibronectin and tenascin in different compartments of the large and small airways and lung parenchyma in 26 COPD patients, 26 smokers without COPD and 16 nonsmoking control subjects. The fractional area of elastic fibres was higher in non-obstructed smokers than in COPD and nonsmoking controls, in all lung compartments. Type-I collagen fractional area was lower in the large and small airways of COPD patients and in the small airways of non-obstructed smokers than in nonsmokers. Compared with nonsmokers, COPD patients had lower versican fractional area in the parenchyma, higher fibronectin fractional area in small airways and higher tenascin fractional area in large and small airways compartments. In COPD patients, significant correlations were found between elastic fibres and fibronectin and lung function parameters. Alterations of the major ECM components are widespread in all lung compartments of patients with COPD and may contribute to persistent airflow obstruction.

Smoking cessation and bronchial epithelial remodelling in COPD: a cross-sectional study

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is associated with bronchial epithelial changes, including squamous cell metaplasia and goblet cell hyperplasia. These features are partially attributed to activation of the epidermal growth factor receptor (EGFR). Whereas smoking cessation reduces respiratory symptoms and lung function decline in COPD, inflammation persists. We determined epithelial proliferation and composition in bronchial biopsies from current and ex-smokers with COPD, and its relation to duration of smoking cessation. Methods 114 COPD patients were studied cross-sectionally: 99 males/15 females, age 62 ± 8 years, median 42 pack-years, no corticosteroids, current (n = 72) or ex-smokers (n = 42, median cessation duration 3.5 years), postbronchodilator FEV1 63 ± 9% predicted. Squamous cell metaplasia (%), goblet cell (PAS/Alcian Blue+) area (%), proliferating (Ki-67+) cell numbers (/mm basement membrane), and EGFR expression (%) were measured in intact epithelium of bronchial biopsies. Results Ex-smokers with COPD had significantly less epithelial squamous cell metaplasia, proliferating cell numbers, and a trend towards reduced goblet cell area than current smokers with COPD (p = 0.025, p = 0.001, p = 0.081, respectively), but no significant difference in EGFR expression. Epithelial features were not different between short-term quitters (<3.5 years) and current smokers. Long-term quitters (≥3.5 years) had less goblet cell area than both current smokers and short-term quitters (medians: 7.9% vs. 14.4%, p = 0.005; 7.9% vs. 13.5%, p = 0.008; respectively), and less proliferating cell numbers than current smokers (2.8% vs. 18.6%, p < 0.001). Conclusion Ex-smokers with COPD had less bronchial epithelial remodelling than current smokers, which was only observed after long-term smoking cessation (>3.5 years). Trial registration NCT00158847

Airway disease: similarities and differences between asthma, COPD and bronchiectasis

Airway diseases are highly prevalent worldwide; however, the prevalence of these diseases is underestimated. Although these diseases present several common characteristics, they have different clinical outcomes. The differentiation between asthma, chronic obstructive pulmonary disease and bronchiectasis in the early stage of disease is extremely important for the adoption of appropriate therapeutic measures. However, because of the high prevalence of these diseases and the common pathophysiological pathways, some patients with different diseases may present with similar symptoms. The objective of this review is to highlight the similarities and differences between these diseases in terms of the risk factors, pathophysiology, symptoms, diagnosis and treatment.

Akute Exazerbation der chronisch obstruktiven Atemwegserkrankung (COPD)

Grundsätzlich bestätigt sich in der vorliegenden Untersuchung die wichtige Bedeutung der bakteriellen Ätiologie der akuten Exazerbation der COPD. Bei 62,4 % aller Patienten wurde der Nachweis von Pathogenen in der Bakterienkultur geführt.Auch die Art der gefundenen Spezies deckt sich in Abhängigkeit vom Patientenkollektiv in etwa mit etablierten Erkenntnissen. Dabei ist das relativ häufige Vorkommen von gramnegativen Enterobakterien und Pseudomonas spp. in einem Setting mit schwerer Exazerbation bei hospitalisierten Patienten und fortgeschrittener Grunderkrankung hervorzuheben.Die hohe Prävalenz von Haemophilus parainfluenzae gibt Anlaß, über die ungeklärte Rolle dieses Bakteriums als pathogener Verursacher einer AECOPD weitere Forschungen anzustellen, wie in jüngster Zeit mit überraschenden Ergebnissen geschehen. Immunologische Studien zur Antikörperbildung bei Infektion mit diesem Bakterium sowie neueste Erkenntnisse über seine virulenten Eigenschaften auf Bronchusebene lassen die Vermutung zu, dass Haemophilus parainfluenzae zu den auslösenden Agenzien bei AECOPD zählen darf, was die Resultate dieser Arbeit bekräftigen würde.Für alle isolierten Spezies gilt dennoch, dass der positive Nachweis per se aufgrund der limitierten Aussagekraft der verwendeten Untersuchungsmethoden nicht als beweisend für eine pathogenetische Bedeutung gewertet werden darf.Künftige Studien sollten sich daher mit der Epidemiologie der Kolonisation respektive Infektion befassen und die Prozesse beleuchten, die einerseits eine neutrophile Inflammation auf zellulärer Ebene bewirken und andererseits dazu führen, dass die lokale Wirtsabwehr durch Bakterien unterlaufen wird.Die Patientenpopulationen mit bakterieller und nicht bakterieller Genese der akuten Exazerbation unterschieden sich hinsichtlich der Verteilung auf die Schweregrade der zugrundeliegenden COPD. Entsprechend zeigten die Patienten mit pathogenem Kulturbefund eine deutlichere Einbuße an Lungenfunktion, mehr Exazerbationen, häufiger eine Ventilationsinsuffizienz und eine längere Liegedauer.Patientencharakteristika, aus denen möglicherweise Kriterien zur Differenzierung zwischen einer bakteriellen Infektion und anderen Ursachen abgeleitet werden könnten, betrafen einen reduzierten Body-Mass-Index, eine höhere Komorbiditätstrate und eine größere Anzahl an Packyears.Keine relevanten Unterschiede waren bei der geschlechtsspezifischen Verteilung, der Erkrankungsdauer und dem aktuellen Rauchverhalten auszumachen.Eine erhöhte Serumkonzentration des C-reaktiven Proteins war mit einer Infektexazerbation assoziiert und ist mit Einschränkung als orientierendes Kriterium zur Differenzierung von Patienten geeignet, welche von einer antibiotischen Therapie profitieren könnten. Dabei konnte für einen CRP-Schwellenwert von 0,5 mg/dl eine hohe Sensitivität von 93 % und ein positiver Vorhersagewert von 65 % bei allerdings sehr geringer Spezifität von 15 % ermittelt werden. Bei willkürlicher Anhebung der Schwelle (CRP > 5 mg/dl) eignete sich die Messung der CRP-Konzentration unter Berücksichtigung der genannten Limitationen als richtungsweisender Marker für eine Infektexazerbation (Sensitivität 63 %, Spezifität 59 %, positiver Vorhersagewert 72 %, negativer Vorhersagewert 49 %). Darüber hinaus präsentierte sich das CRP als bewährter Verlaufsparameter unter Therapie.Von zentraler Bedeutung ist eine effektive Kategorisierung der Patienten anhand der COPD-Stadieneinteilung, da sowohl bakteriologische Ergebnisse wie auch patientenbezogene oder funktionelle Daten häufig einen Zusammenhang mit der Erkrankungsschwere aufwiesen.Eine diesbezügliche Evaluierung der jüngsten Klassifikation nach WHO/GOLD fiel positiv aus.