Comparison of inflammation biomarkers among chronic obstructive pulmonary disease groups: A cross sectional study.

BACKGROUND: The Global Initiative classification (GOLD) for chronic obstructive pulmonary disease (COPD), which relies on the practical issues of treatment of this complex and heterogeneous disease, may not be reliable in predicting disease severity and prognosis as the term of inflammation is excluded from the definition. AIM: The aim of this study was to determine systemic inflammatory markers in GOLD ABCD groups and to compare these parameters according to clinical and functional features. METHODS: The study included 60 COPD patients and 59 healthy subjects. Comparisons were made with the pulmonary function test, transthoracic echocardiography and the six-minute walk test (6MWT). The COPD assessment test (CAT), modified Medical Research Council (mMRC), and index scores of body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) were recorded. The systemic inflammatory state was assessed using C-reactive protein, fibrinogen, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8 and IL-18. RESULTS: The levels of all serum inflammatory markers were higher in the COPD group than in the control group. TNF-α and IL-6 were significantly higher in the symptomatic groups (B and D) than in the less symptomatic groups (A and C) (P < 0.05). Spirometric parameters were more severe in Group D, followed by groups C, B and A, respectively. The 6MWT and the BODE scores were worst in Group D, followed by groups B, C and A. CONCLUSION: The results suggest that bronchodilator treatment alone might be insufficient in Group B patients, as the systemic inflammatory markers in addition to exercise capacity and mortality predictors were at the worst level in Groups D and B.

Nonlinear analysis of heart rate variability of healthy subjects and patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is one of the causes of mortality worldwide with an increasing prevalence. Heart rate variability (HRV) reflects the regulation mechanism of the cardiac activity by the autonomic nervous system. The assessment of HRV by using nonlinear methods is more sensitive for the detection of complexity when compared to linear methods. This study aims to get information about the autonomic dysfunction occurred in patients with COPD by analysing the complexity of HRV. Electrocardiogram signals recorded from healthy subjects, patients with moderate COPD and severe COPD (eight subjects per group) were analysed. The HRV signals were acquired from ECG signals. Signals were reconstructed in the phase space and largest Lyapunov exponent (LLE), correlation dimension, Hurst exponent and approximate entropy (ApEn) values were calculated. It has seen that for the patients with COPD LLE, correlation dimension, Hurst exponent and ApEn values were less than control group. According to this, HRV complexity decreases in the presence of COPD. However, there is no significant difference between COPD groups and the severity of COPD has no effect on the chaoticity of the system. The results revealed that autonomic dysfunction occurred in patients with COPD is associated with reduced HRV complexity.

Modification of the GOLD recommendations for chronic obstructive pulmonary disease to broaden their usage in Turkey.

Despite the introduction of numerous national and international COPD guidelines designed to provide clinicians with optimal evidence-based disease management strategies, COPD remains an underdiagnosed and poorly treated disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend disease specific diagnosis and management strategies, and they are widely used internationally. In this short report we present the outcomes of a meeting of respiratory experts in Turkey who reviewed the GOLD guidelines and their applicability to the Turkish healthcare system. In particular, we were interested to investigate the possibility of developing a simplified version of the combined assessment model which we believe will be more acceptable to Turkish pulmonologists and will increase its use in everyday clinical practice.

Perlite exposure and 4-year change in lung function.

Perlite is a volcanic glass or amorphous aluminium silicate composed of 71-75% SiO(2). When heated to 800-1100 degrees C, it expands to form processed perlite, which has a low density, high surface area, and a low thermal conductivity. The objective was to determine the effect of perlite exposure on pulmonary function tests. Pulmonary function tests in conjunction with chest radiogram were carried out in 36 perlite-exposed workers and 22 unexposed office workers in 1992 and 1996. Respirable dust level exceeded permissible dust levels in work places in the 4 years under study. Transfer coefficient (K(CO)) decline was significant in nonsmoker perlite-exposed workers (n=9), and found to be 5.28+/-0.71 (predicted 4.32+/-0.11) and 3.84+/-0.96 (predicted 4.18+/-0.18) 1/min/mmHg, in 1992 and 1996, respectively (P<0.001). Both smoker perlite workers and office workers showed significant obstruction to airflow in small airways with respect to predicted values and 4-year change in transfer factor (T(L), CO) was significant. Although predicted, 12-year perlite exposure did not lead to a decrease in mean pulmonary function test parameters, there was a tendency to a decline in T(L), CO in the 4-year study period, which may be due to high perlite dust levels. As early effects of perlite dust exposure may not be detected by spirometric measurements alone, the transfer coefficient should be added to spirometry.

Pulmonary function tests in Parkinson's disease.

Morbidity and mortality are usually caused by respiratory disorders in Parkinson's disease (PD) because of pulmonary functional impairments. The purpose of this study was to determine the effects of PD on ventilatory function and that the use of pulmonary function tests (PFT) may serve as an indicator of PD severity. PFT have been performed in 21 patients with PD (15 non-smoker and six exsmoker with 36.17 +/- 26.54 pack-years of smoking history; mean age 64.67 +/- 10.76 years) and 16 normal age-matched control subjects who never smoked. The clinical disability was indicated by a Hoehn-Yahr (H-Y) scale. MEF25% [maximal flow rate at 25% of remaining forced vital capacity (FVC)] and FEV1 (the volume of air expired during the first second of the FVC) in exsmoker PD group was lower than non-smoker PD group (P < 0.05). The two effort dependent variables' peak expiratory flow (PEF) and the maximal flow rate at 75% of the remaining FVC (MEF75%) percent predicted values were 70.66 +/- 24.15 and 69.05 +/- 24.39 in non-smoker PD group whereas 90.18 +/- 17.24 and 90.00 +/- 18.97% predicted were in control group, respectively (P < 0.05). The maximal voluntary ventilation (MVV) was found to be 52.83 +/- 15.52 and 91.52 +/- 13.80% in PD and control group, respectively (P < 0.0001). MVV was the most effected parameter that was inversely correlated with the PD severity (r=-0.87, P < 0.0001). We concluded that less coordinated and less explosive muscle force has contributed to decrease in PEF and MEF75% values, and MVV decreases in PD as a result of the impaired performance and reduced efficiency during repetitive motor tasks which in part reflects abnormal agonist-antagonist muscle activity. So, spirometric studies may serve as a useful indicator of patients' neurophysiological conditions for the purpose of anticipating and preventing complications because of pulmonary impairment.