Disruptions in oral and nasal microbiota in biomass and tobacco smoke associated chronic obstructive pulmonary disease.

Chronic exposures to tobacco and biomass smoke are the most prevalent risk factors for COPD development. Although microbial diversity in tobacco smoke-associated COPD (TSCOPD) has been investigated, microbiota in biomass smoke-associated COPD (BMSCOPD) is still unexplored. We aimed to compare the nasal and oral microbiota between healthy, TSCOPD, and BMSCOPD subjects from a rural population in India. Nasal swabs and oral washings were collected from healthy (n = 10), TSCOPD (n = 11), and BMSCOPD (n = 10) subjects. The downstream analysis was performed using QIIME pipeline (v1.9). In nasal and oral microbiota no overall differences were noted, but there were key taxa that had differential abundance in either Healthy vs COPD and/or TSCOPD vs. BMSCOPD. Genera such as Actinomyces, Actinobacillus, Megasphaera, Selenomonas, and Corynebacterium were significantly higher in COPD subjects. This study suggests that microbial community undergoes dysbiosis which may further contribute to the progression of disease. Thus, it is important to identify etiological agents for such a polymicrobial alterations which contribute highly to the disease manifestation.

Phenotypic comparison between smoking and non-smoking chronic obstructive pulmonary disease.

BACKGROUND: Although COPD among non-smokers (NS-COPD) is common, little is known about this phenotype. We compared NS-COPD subjects with smoking COPD (S-COPD) patients in a rural Indian population using a variety of clinical, physiological, radiological, sputum cellular and blood biomarkers. METHODS: Two hundred ninety subjects (118 healthy, 79 S-COPD, 93 NS-COPD) performed pre- and post-bronchodilator spirometry and were followed for 2 years to study the annual rate of decline in lung function. Body plethysmography, impulse oscillometry, inspiratory-expiratory HRCT, induced sputum cellular profile and blood biomarkers were compared between 49 healthy, 45 S-COPD and 55 NS-COPD subjects using standardized methods. Spirometric response to oral corticosteroids was measured in 30 female NS-COPD patients. RESULTS: Compared to all male S-COPD subjects, 47% of NS-COPD subjects were female, were younger by 3.2 years, had greater body mass index, a slower rate of decline in lung function (80 vs 130 mL/year), more small airways obstruction measured by impulse oscillometry (p < 0.001), significantly less emphysema (29% vs 11%) on CT scans, lower values in lung diffusion parameters, significantly less neutrophils in induced sputum (p < 0.05) and tended to have more sputum eosinophils. Hemoglobin and red cell volume were higher and serum insulin lower in S-COPD compared to NS-COPD. Spirometric indices, symptoms and quality of life were similar between S-COPD and NS-COPD. There was no improvement in spirometry in NS-COPD patients after 2 weeks of an oral corticosteroid. CONCLUSIONS: Compared to S-COPD, NS-COPD is seen in younger subjects with equal male-female predominance, is predominantly a small-airway disease phenotype with less emphysema, preserved lung diffusion and a slower rate of decline in lung function.

Occupational cadmium exposure-associated oxidative stress and erythrocyte fragility among jewelry workers in India.

BACKGROUND: Cadmium-induced pulmonary and renal target organ effects are well-established although its association with oxidative stress and associated hematological effects for human toxicity remain understudied. METHODS: In a population of cadmium-exposed male jewelry manufacturing workers (n = 32) and referents without direct exposure (n = 21), all with urinary cadmium quantification, we measured plasma antioxidant enzymes (catalase, superoxide dismutase), lipid peroxidation (malondialdehyde), erythrocyte fragility, and surface irregularity of the erythrocyte membrane. RESULTS: Compared to referents, exposed workers manifested significantly lower plasma antioxidant enzymes, and increased malondialdehyde and erythrocyte fragility (for all, P < 0.01). Consistent with the exposure subcategories, activities of superoxide dismutase and catalase were reduced and lipid peroxidation and erythrocyte fragility were enhanced (P < 0.01 for all) in terms of Cd-effect indicating a strong impact on hematological system and oxidative stress. CONCLUSION: Cd exposure contributes to oxidative stress and related erythrocyte effects thus making the hematological system another end-organ target for chronic Cd toxicity.

Association between the Serum Metabolic Profile and Lung Function in Chronic Obstructive Pulmonary Disease.

OBJECTIVES: Although dietary patterns are known to modulate disease severity in patients with chronic obstructive pulmonary disease (COPD), the relationship between the circulating lipid profile and lung function in COPD has not been studied extensively. MATERIAL AND METHODS: There were 43 COPD patients with a history of smoking and 39 patients with a history of biomass fuel exposure recruited in this study, along with 43 age-matched healthy controls. All participants underwent complete lung function profiling, and their glucose and lipid profiles were measured. The association between the metabolic profile and lung function was assessed using the Spearman's rank-order correlation coefficient. RESULTS: 52.4% of the COPD patients were smokers compared to the healthy group (46.5%). We found an inverse correlation between triglyceride and functional residual capacity (p=-0.21, p=0.05) and a positive association between serum cholesterol and overall airway resistance (R5) (p=0.24, p=0.04) and central airway resistance (R20) (p=0.32, p=0.004). Low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) ratio and LDL/HDL ratio were also found to correlate with R5 (p=0.25, 0.23, and 0.22, respectively) and R20 (p=0.31, 0.24, and 0.24, respectively). No significant association was observed between other metabolites and either spirometric or plethysmographic lung function indices. CONCLUSION: High serum triglyceride and cholesterol may increase the resistance in the airways, which may lead to increased airway obstruction. Therefore, monitoring of lipid profile should be considered in the diagnosis and management of COPD.

Aclidinium bromide/formoterol fixed-dose combination therapy for COPD: the evidence to date.

The quest for the right combination of bronchodilators with different mechanisms of action such as long-acting muscarinic antagonists and long-acting ß-agonists in the management of stable moderate-to-severe chronic obstructive pulmonary disease (COPD) is a topic of intense research activity currently, given the rising morbidity and mortality due to this disease. The fixed-dose combination of aclidinium bromide and formoterol fumarate in a single inhaler seems to offer superior advantages over either drugs given alone or as separate inhalers concurrently. Since the fixed-dose combination needs to be given twice daily, it is likely to achieve control of symptoms most crucial to the quality of life in COPD, namely, the morning hours. This is reflected in significant trough FEV1 (forced expiratory volume in 1 second) improvements after the dose. This paper reviews the various studies related to this combination put in the perspective of its safety and efficacy and potential benefits over other therapeutic options. However, there is a dearth of data on the long-term safety and efficacy in terms of improvement in lung function. This combination could emerge as an excellent option in the management of stable COPD if data on exacerbation rates and patient-reported outcomes become available from longer-term studies. Moreover, we need some more studies to define the ideal phenotype of COPD best suited for the use of this combination.