Influence of Diabetes Mellitus and Nutritional Parameters on Clinical and Functional Aspects and Quality of Life in Patients Hospitalized Due to Exacerbation of Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations. During severe exacerbations, nutritional and endocrinological comorbidities can play an important role in the clinical and functional aspects of these patients. The aim of this study was to analyse the influence of the presence of diabetes mellitus (DM) and nutritional parameters on the deterioration of symptoms and quality of life during a severe exacerbation in patients with COPD. An observational study was conducted on COPD patients admitted due to an exacerbation. The COPD Assessment Test (CAT) questionnaire was administered, and clinical and functional parameters were compared based on the presence of nutritional and endocrinological alterations. A total of 50 patients were included, of whom 30 (60%) were male. The mean age was 70.5 years (standard deviation (SD) 9.6). The median CAT score during exacerbation was 25 (interquartile range (IQR) 17.5-30), and the baseline score was 13.5 (IQR 7-19), which represented a statistically significant difference (p < 0.001). Patients with iron deficiencies had a lower total CAT score (p = 0.041), specifically for items related to daily activity (p = 0.009) and energy (p = 0.007). Diabetic patients exhibited a greater decline in pulmonary function during exacerbation (p = 0.016), while patients with high thyroid-stimulating hormone (TSH) levels had a shorter hospital stay (p = 0.016). For COPD patients admitted due to an exacerbation, the metabolic assessment is useful and relevant in the clinical set-up, as endocrinological comorbidities negatively affect clinical and functional aspects of these patients.

Differences in Survival of Patients With COPD According to the New GesEPOC 2021 Classification of Phenotypes.

Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory pathology with high prevalence, morbidity and mortality. The Spanish COPD guideline (GesEPOC) recommends individualizing treatment according to phenotypes. The phenotype classification was updated in 2021. This study aimed to determine the survival of patients by this new classification and compare the predictive capacity of mortality compared to the previous version. Methods: This observational study of COPD patients involved prospective follow-up for 6 years. Demographic and clinical data were collected at the beginning and evolutionary data at the end of the study. Patients were classified according to GesEPOC 2017 and GesEPOC 2021. Univariate survival analysis and multivariate analysis identified mortality risk factors. Results: Of the 273 patients, 243 (89.0%) were male. Ninety-three patients (34.1%) died during follow-up. Regarding phenotypes, 190 patients (69.6%) were non-exacerbators, 69 (25.3%) belonged to the non-eosinophilic exacerbator phenotype and 14 (5.1%) were of the eosinophilic exacerbator phenotype. Compared with non-exacerbator patients, those with the non-eosinophilic exacerbator phenotype had lower survival (p = 0.009). Risk factors independently associated with mortality were older age (p < 0.001), non-eosinophilic exacerbator phenotype (p = 0.017) and a high Charlson index score (p < 0.001). The new classification presented a worse ability to predict mortality than the previous version (area under the curve 0.632 vs 0.566, p = 0.018). Conclusion: Patients with the non-eosinophilic exacerbator phenotype had worse prognoses. This phenotype, advanced age and high comorbidity were mortality risk factors. The GesEPOC 2021 classification predicts mortality worse than the 2017 version. These data must be considered for more individualized management of COPD patients.

Introducción: La enfermedad obstructiva crónica (EPOC) es una patología respiratoria con elevada prevalencia y alta morbimortalidad. La guía española de la EPOC (GesEPOC) recomienda individualizar el tratamiento según fenotipos. En su última actualización en 2021, se ha actualizado la clasificación de fenotipos. Se realiza este estudio para conocer la supervivencia de los pacientes sobre esta nueva clasificación y para comparar la capacidad predictiva de mortalidad con respecto a la versión previa. Métodos: Estudio observacional de pacientes con EPOC con un seguimiento prospectivo durante 6 años. Se recogieron datos demográficos y clínicos al inicio y datos evolutivos al final del estudio. Se clasificó a los pacientes según GesEPOC 2017 y GesEPOC 2021. Se realizó un análisis univariante de supervivencia y un análisis multivariante para identificar factores de riesgo de mortalidad. Resultados: Del los 273 pacientes, 243 (89,0%) eran varones. Fallecieron 93 sujetos (34,1%) durante el seguimiento. En cuanto a los fenotipos, 190 pacientes (69,6%) eran no agudizadores, 69 (25,3%) pertenecían al fenotipo agudizador no eosinofílico, y 14 (5,1%) eran del fenotipo agudizador eosinofílico. Comparando con los enfermos no agudizadores, los del fenotipo agudizador no eosinofílico tuvieron una menor supervivencia (p = 0,009). Los factores de riesgo independientemente asociados a la mortalidad fueron la edad avanzada (p < 0,001), el fenotipo agudizador no eosinofílico (p = 0,017) y una puntuación elevada en el índice de Charlson (p < 0,001). La nueva clasificación presentó una peor capacidad para predecir mortalidad en comparación con la versión previa (área bajo curva 0,632 vs 0,566, p = 0,018). Conclusión: Los pacientes del fenotipo agudizador no eosinofílico tenían peor pronóstico. Este fenotipo, junto con la edad avanzada y la elevada comorbilidad, fueron factores de riesgo de mortalidad. La clasificación GesEPOC 2021 predice peor la mortalidad con respecto a la versión de 2017. Es importante tener estos datos en cuenta para ofrecer un manejo más individualizado a los pacientes con EPOC.

Influence of Comorbidities on the Survival of COPD Patients According to Phenotypes.

Background: Chronic obstructive pulmonary disease (COPD) usually occurs alongside other conditions. Few studies on comorbidities have taken into account the phenotypes of COPD patients. The objective of this study is to evaluate the prevalence of comorbidities included in the Charlson index and their influence on the survival of patients with COPD, taking phenotypes into account. Methods: An observational study was conducted on a group of 273 patients who had COPD and underwent spirometry in the first half of 2011, with a median prospective follow-up period of 68.15 months. The survival of these patients was analyzed according to the presence of various comorbidities. Results: Of the 273 patients, 93 (34.1%) died within the follow-up period. An increased presence of chronic ischemic heart disease (CIHD), chronic heart failure (CHF), chronic kidney disease (CKD), and malignancy was found in deceased patients. All of these conditions shorten the survival of COPD patients globally; however, when considering phenotypes, only CHF influences the exacerbator with chronic bronchitis phenotype, CKD influences the non-exacerbator phenotype, and malignancy influences the positive bronchodilator test (BDT) and exacerbator with chronic bronchitis phenotypes. In the multivariate model, advanced age (hazard ratio, HR: 1.05; p=0.001), CHF (HR: 1.74; p=0.030), and the presence of malignancy (HR: 1.78; p=0.010) were observed as independent mortality risk factors. Conclusion: The survival is shorter in the presence of CIHD in overall COPD patients and also CHF, CKD, and malignancy for certain phenotypes. It is important to pay attention to these comorbidities in the comprehensive care of COPD patients.

Differences in the Outcome of Patients with COPD according to Body Mass Index.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), the "obesity paradox" is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). METHODS: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. RESULTS: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24-27.69; 27.70-31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit . Survival was lower in the quartile 1 of BMI with respect to each of the 2-4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03-1.09), low pulmonary function (HR 0.93; 95% CI 0.86-0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01-3.06), high Charlson (HR 1.32, 95% CI 1.18-1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08-3.69) were identified as risk factors independently associated with mortality. CONCLUSIONS: In COPD, low BMI conditions a lower survival, although not for having more acute events.

Influence of Pneumonia on the Survival of Patients with COPD.

BACKGROUND: Pneumonia is a frequent infection. Chronic obstructive pulmonary disease (COPD) can present with comorbidities, including pneumonia. It is known that COPD worsens the evolution of pneumonia, but few studies describe the impact of pneumonia on COPD evolution. This study analyzes the influence of pneumonia on the survival of COPD patients. METHODS: Observational study of a cohort of 273 patients with COPD who attended spirometry in 2011, with a prospective follow-up of six years. Patients were divided into two groups according to their acquisition of pneumonia during follow-up. The difference in survival between the two groups was analyzed. RESULTS: Survival was lower in the group with pneumonia compared with that without pneumonia (p = 0.000), both globally and after stratification by COPD phenotype. Pneumonia (Hazard Ratio -HR- 2.65; 95% Confidence Interval -CI- 1.57-4.48), advanced age (HR 1.08; 95% CI 1.03-1.09), and high Charlson index (HR 1.31; 95% CI 1.17-1.47) were identified as risk factors independently associated with mortality, while a high body mass index (HR 0.92; 95% CI 0.87-0.96) was identified as a protective factor. CONCLUSIONS: Pneumonia is associated with worse prognosis in COPD patients. It is important to take into account this comorbidity for a comprehensive care of these patients.

Analysis of environmental risk factors for chronic obstructive pulmonary disease exacerbation: A case-crossover study (2004-2013).

PURPOSE: We aim to assess if air pollution levels and climatological factors are associated with hospital admissions for exacerbation of chronic obstructive pulmonary disease (COPD) in Spain from 2004 to 2013. METHODS: We conducted a retrospective study. Information on pollution level and climatological factors were obtained from the Spanish Meteorological Agency and hospitalizations from the Spanish hospital discharge database. A case-crossover design was used to identify factors associated with hospitalizations and in hospital mortality. Postal codes were used to assign climatic and pollutant factors to each patient. RESULTS: We detected 162,338 hospital admissions for COPD exacerbation. When seasonal effects were evaluated we observed that hospital admissions and mortality were more frequent in autumn and winter. In addition, we found significant associations of temperature, humidity, ozone (O3), carbon monoxide (CO), particulate matter up to 10 µm in size (PM10) and nitrogen dioxide (NO2) with hospital admissions. Lower temperatures at admission with COPD exacerbation versus 1, 1.5, 2 and 3 weeks prior to hospital admission for COPD exacerbation, were associated with a higher probability of dying in the hospital. Other environmental factors that were related to in-hospital mortality were NO2, O3, PM10 and CO. CONCLUSIONS: Epidemiology of hospital admissions by COPD exacerbation was negatively affected by colder climatological factors (seasonality and absolute temperature) and short-term exposure to major air pollution (NO2, O3, CO and PM10).

COPD phenotypes: differences in survival.

Background: The aim of the study was to analyze the characteristics and survival of a group of patients with COPD according to their clinical phenotype. Patients and methods: The study population was selected from patients undergoing scheduled spirometry between January 1, 2011 and June 30, 2011 at the respiratory function laboratory of a teaching hospital and comprised those with a previous and confirmed diagnosis of COPD and forced expiratory volume in the first second (FEV1) of <70%. The patients selected were classified into 4 groups: positive bronchodilator response, non-exacerbator, exacerbator with emphysema, and exacerbator with chronic bronchitis. Patients were followed up until April 2017. Results: We recruited 273 patients, of whom 89% were men. The distribution by phenotype was as follows: non-exacerbator, 47.2%; positive bronchodilator response, 25.8%; exacerbator with chronic bronchitis, 13.8%; and exacerbator with emphysema, 13.0%. A total of 90 patients died during follow-up (32.9%). Taking patients with a positive bronchodilator response as the reference category, the risk factors that were independently associated with death were older age (HR, 1.06; 95% CI, 1.03-1.09), lower FEV1 (HR, 0.98; 95% CI, 0.96-0.99), and exacerbator with chronic bronchitis phenotype (HR, 3.28; 95% CI, 1.53-7.03). Conclusion: Classification of COPD patients by phenotype makes it possible to identify subgroups with different prognoses. Thus, mortality was greater in exacerbators with chronic bronchitis and lower in those with a positive bronchodilator response.

Conexión venosa pulmonar anómala parcial con hipertensión pulmonar / Partial Anomalous Pulmonary Venous Connection With Pulmonary Hypertension

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