Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 1, Issue 2 - 2014

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation is an open access, peer-reviewed medical/scientific journal dedicated to publishing original research, reviews, and communications related to COPD. Articles are published online as quickly as possible following peer review and editorial acceptance and then aggregated into quarterly issues, and made available to the COPD medical/research community at no charge.

Editorial

Patent Foramen Ovale in COPD and Hypoxia: Innocent Bystander or Novel Therapeutic Target?

Brett E. Fenster, MD,1 John D. Carroll, MD2

Author Affiliations

  1. National Jewish Health, Division of Cardiology, Denver, Colorado
  2. University of Colorado Denver, Division of Cardiology, Aurora

Address correspondence to:

Brett E. Fenster, MD
Division of Cardiology
National Jewish Health
1400 Jackson Street, #J328
Denver, CO 80206
Business Phone: (303) 398-1251
Fax: (303) 595-5282
fensterb@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Fenster BE, Carroll JD. Patent foramen ovale in COPD and hypoxia: Innocent bystander or novel therapeutic target? J COPD F. 2014; 1(2): 151-154. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0146

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Review Articles

Prevention of Exacerbations in Chronic Obstructive Pulmonary Disease: Knowns and Unknowns

Alvar Agustí, MD, PhD, FRCP, FERS,1 Peter M. Calverley, DSc, FMedSci,2 Marc Decramer, MD, PhD,3 Robert A. Stockley, MD, DSc, FRCP, FERS,4 Jadwiga A.Wedzicha, MD5

Author Affiliations

  1. Institut del Tòrax, Hospital Clínic, Barcelona, Spain
  2. Clinical Sciences Center, University Hospital Aintree, Liverpool, United Kingdom
  3. Respiratory Division, University Hospitals, Leuven, Belgium
  4. Lung Investigation Unit, University Hospitals of Birmingham, Edgbaston, Birmingham, United Kingdom
  5. Airways Disease Section, National Heart and Lung Institute, Imperial College London, United Kingdom

Address correspondence to:

Alvar Agustí, MD, PhD, FRCP, FERS
Director, Institut del Tòrax, Hospital Clínic
Villarroel 170, Escala 3
Planta 5, 08036
Barcelona, Spain
Tel: +34 93 227 1701
Fax: +34 93 227 9868
e-mail: alvar.agusti@clinic.ub.es

Abstract

The 2011 recommendations of the Global initiative for chronic Obstructive Lung Disease (GOLD) constituted a major paradigm shift in COPD management since they set 2 major goals for the assessment and management of patients: (1) the reduction of their current level of symptoms (i.e., treat the patient today); and (2) the reduction of their risk of exacerbations (i.e., prevent them tomorrow). Exacerbations are not only an important clinical endpoint in patients with COPD, but they are also a risk factor themselves for additional adverse outcomes since they have been shown to increase the risk for mortality, to accelerate the decline in pulmonary function, and to decrease health status and quality of life. Despite their importance, many unanswered questions related to exacerbations remain. The purpose of this review is to discuss: (1) knowns and unknowns in our current understanding of exacerbations, (2) what known factors increase their risk, and (3) how to best prevent them.

Citation

Agusti A, Calverley PM, Decramer M, Stockley RA, Wedzicha JA. Prevention of exacerbations in chronic obstructive pulmonary disease: knowns and unknowns. J COPD F. 2014; 1(2): 166-184. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0134

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Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease

Shu-Yi Liao,MD, PhD,1 Roberto Benzo, MD,2 Andrew L. Ries, MD, MPH3 and Xavier Soler, MD, PhD3

Author Affiliations

  1. School of Medicine, University of California-Riverside
  2. Pulmonary and Critical Care Division, Mayo Clinic College of Medicine, Rochester, Minnesota
  3. Pulmonary and Critical Care and Sleep Division, University of California, San Diego

Address correspondence to:

Xavier Soler, MD, PhD
Pulmonary and Critical Care and Sleep Division,
University of California, San Diego, California
Phone: (619)543-7333
Email: xsoler@ucsd.edu

Abstract

Reduced physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality (e.g. exacerbations) and eventually leads to disability, depression, and social and physical isolation. Measuring PA in this population is important to accurately characterize COPD and to help clinicians during a baseline evaluation and patient follow-up. Also, it may help increase adherence to PA programs. There are reliable objective and subjective methods available to measure PA. Recently, several new monitors have been developed that have improved accuracy of such measurements. Because these devices provide real-time feedback, they may help to improve participant self-motivation strategies and reinforce daily lifestyle modifications, one of the main goals in COPD management. This review focuses on describing available instruments to measure PA, specifically in patients with COPD. The reliability, validity, advantages, limitations, and clinical applications of questionnaires, pedometers, and accelerometers are discussed. Finally, based on current published literature, we propose recommendations about which methods may be most useful in different research or clinical settings.

Citation

Citation: Liao S, Benzo R, Ries AL, Soler X. Physical activity monitoring in patients with chronic obstructive pulmonary disease. J COPD F. 2014; 1(2): 155-165. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0131

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Original Research

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease

Victor Kim, MD,1 Nishant Goel, MD,1 Jinal Gangar, MBBS, MPH,1 Huaqing Zhao, PhD,1 David E. Ciccolella, MD,1 Edwin K. Silverman, MD, PhD,2 James D. Crapo, MD,3 Gerard J. Criner, MD1 and the COPDGene Investigators

Author Affiliations

  1. Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
  2. Division of Pulmonary and Critical Care Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
  3. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, University of Colorado, School of Medicine, Denver

Address correspondence to:

Victor Kim, MD
785 Parkinson Pavilion
3401 North Broad Street
Philadelphia, PA 19140
(215) 707-5864 (office)
(215) 707-6867 (fax)
Victor.kim@tuhs.temple.edu

Abstract

Background: COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear.

Methods: Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE-, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE.

Results: The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE- group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history.

Conclusions: BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.

Citation

Kim V, Goel N, Gangar J, et al; and the COPDGene Investigators. Risk factors for venous thromboembolism in chronic obstructive pulmonary disease. J COPD F. 2014; 1(2): 239-249. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0133

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Comorbidity Distribution, Clinical Expression and Survival in COPD Patients with Different Body Mass Index

Miguel J. Divo, MD,1 Carlos Cabrera, MD,2 Ciro Casanova, MD,3 Jose M. Marin, MD,4 Victor M. Pinto-Plata, MD,1 Juan P. de-Torres, MD,5 Javier Zulueta, MD,5 Jorge Zagaceta, MD,5 Pablo Sanchez-Salcedo, MD,5 Juan Berto, MD,5 Claudia Cote, MD,6 and Bartolome R. Celli, MD1 for the BODE Collaborative Group

Author Affiliations

  1. Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  2. Pulmonary Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canarias, Spain
  3. Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
  4. Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
  5. Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain
  6. Division of Pulmonary and Critical Care Medicine, the Bay Pines Veterans Affairs Healthcare System, University of South Florida, Tampa

Address correspondence to:

Miguel J. Divo, MD
Pulmonary and Critical Division
Brigham and Women’s Hospital
75 Francis St., Boston, MA 02115
mdivo@partners.org
(857) 307-0310

Abstract

Rationale: Contrary to the general population, in patients with chronic obstructive pulmonary disease (COPD) a low body mass index (BMI) is associated with excess mortality, while obesity appears protective (obesity paradox). We hypothesized that BMI is associated with a distinct number and expression of comorbidities in patients with COPD. The type of comorbidity may relate to mortality variability.

Objectives and Methods: We followed 1659 COPD patients for a median of 51 months [IQR 27-77] with detailed comorbidity records and tracking pulmonary function, exercise capacity, dyspnea, health status, and cause of death. The cohort was categorized into the 5 National Heart Lung and Blood Institute (NHLBI) BMI groups with determination made about each group’s relationship to specific comorbidities, clinical parameters and risk for death.

Results: Whereas osteoporosis, substance abuse, abdominal aortic aneurism and peripheral arterial disease were more prevalent in patients with low BMI, metabolic and cardiac problems were more frequent in those with high BMI. The BMI was inversely related to the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC)(FEV1 %), BODE (Body mass index, airway Obstruction, Dyspnea, Exercise capacity) index and hyperinflation, had a “U” shape with dyspnea and the St. George’s Respiratory Questionaire (SGRQ) score and an inverse “U” with exercise capacity. The crude mortality rate was 60%, 43%, 37%, 36% and 28% from the lowest to highest BMI groups (p<.0001). More respiratory deaths were observed in the lowest BMI group even though they had a lower number of comorbidities.

Conclusions: Different BMI categories are associated with distinct clinical expressions of COPD and comorbidity patterns. The relationship between BMI and mortality in patients with COPD remains an unresolved paradox.

Citation

Divo MJ, Cabrera C, Casanova C, et al. Comorbidity distribution, clinical expression and survival in COPD patients with different body mass index. J COPD F. 2014; 1(2): 229-238. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0117

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Azithromycin and COPD Exacerbations in the Presence or Absence of Symptoms or Active Treatment for Gastroesophageal Reflux

Frederick L. Ramos, MD1, Sarah M. Lindberg, MPH2, Jason S. Krahnke, DO1, John Connett, PhD2, Richard K. Albert, MD3, and Gerard J. Criner, MD1, for the COPD Clinical Research Network

Author Affiliations

  1. Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA
  2. Division of Biostatistics, University of Minnesota, Minneapolis
  3. Denver Health, Denver, CO and University of Colorado-Denver, Aurora, CO

Address correspondence to:

Frederick L. Ramos, MD,
785 Parkinson Pavilion, 3401 North Broad Street,
Philadelphia, PA 19140; phone: (215)707-2526;
e-mail: Frederick.ramos@tuhs.temple.edu.

Abstract

Introduction: Gastroesophageal reflux disease (GERD) is common in chronic obstructive pulmonary disease (COPD) and is associated with COPD exacerbations. Since macrolides have prokinetic effects and consequently may decrease GERD, we hypothesized that azithromycin may decrease exacerbations by decreasing GERD.

Methods: We conducted a retrospective review of data collected in a prospective, randomized, controlled trial of azithromycin for preventing COPD exacerbations. Participants were classified as having GERD on the basis of having a history of GERD or having a history or being treated for GERD.

Results: We analyzed 1116 participants, 478 (43%) and 568 (51%) had GERD on the basis of history and history or treatment respectively. Individuals with GERD developed exacerbations sooner and more frequently, and were more likely to be hospitalized than those without GERD but the difference only reached significance when GERD was defined by history or treatment (P = 0.02, 0.02, and 0.03, respectively). Azithromycin reduced exacerbations regardless of the presence of GERD, but had a greater effect in those without GERD.

Conclusions: GERD is associated with more frequent and severe COPD exacerbations. Azithromycin reduces COPD exacerbations regardless of the presence or absence of GERD but does so to a greater degree in individuals without GERD.

Citation

Citation: Ramos FL, Lindberg SM, Krahnke JS, et al. Azithromycin and COPD exacerbations in the presence or absence of symptoms or active treatment for gastroesophageal reflux. J COPD F. 2014; 1(2): 221-228. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0132

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The 2014 Updated GOLD Strategy: A Comparison of the Various Scenarios

Sarah Wilke, MSc,*1 Dionne E. Smid, MSc,*1 Martijn A. Spruit, PhD,1 Daisy J. A. Janssen, MD, PhD,1,2 Jean W. M. Muris, MD, PhD,3 Thys van der Molen, MD, PhD,4 Marjan van den Akker, PhD,3,5 Paul W. Jones, MD, PhD,6 Emiel F.M. Wouters, MD, PhD,1,7 and Frits M.E. Franssen, MD, PhD1

* Joint first author

Author Affiliations

  1. Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
  2. Centre of Expertise for Palliative Care, Maastricht University Medical Centre, the Netherlands
  3. Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands
  4. Department of General Practice, University of Groningen, University Medical Centre Groningen, the Netherlands
  5. Department of General Practice, KU Leuven, Leuven, Belgium
  6. Division of Clinical Science, St. George’s University of London, United Kingdom
  7. Department of Respiratory Medicine, Maastricht University Medical Centre, the Netherlands

Address correspondence to:

Sarah Wilke, MSc
Department of Research & Education
CIRO+, Centre of Expertise for Chronic Organ Failure
Hornerheide 1, 6085 NM Horn, the Netherlands
Telephone: +31 (0)475 587 603
E-mail: sarahwilke@ciro-horn.nl

Abstract

Background: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George’s Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the different definitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown.

Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV1 54.7 [22.3]% predicted). Health status was assessed by the COPD-specific SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen’s Kappa was used to assess agreement between groups.

Results: Level of agreement in frequency distribution using the modified Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (К = 0.838 or 0.851, p<0.001). Patients classified in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classified in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups.

Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used.

Citation

Citation: Wilke S, Smid DE, Spruit MA, et al. The 2014 updated GOLD strategy: A comparison of the various scenarios. J COPD F. 2014; 1(2): 212-220. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0135

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Longitudinal Computed Tomography and Magnetic Resonance Imaging of COPD: Thoracic Imaging Network of Canada (TINCan) Study Objectives

Miranda Kirby, PhD,1,2 Damien Pike, BSc,3,4 David G. McCormack, MD, FRCPC,5 Don D. Sin, MD, FRCPC,2,6 Stephen Lam, MD, FRCPC,7 Harvey O. Coxson, PhD,1,2* and Grace Parraga, PhD3,4*

*Co-lead principal investigators

Author Affiliations

  1. Department of Radiology, University of British Columbia, Vancouver, Canada
  2. University of British Columbia, James Hogg Research Center and The Institute of Heart and Lung Health, St. Paul's Hospital, Vancouver, Canada
  3. Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Canada
  4. Department of Medical Biophysics, University of Western Ontario, London, Canada
  5. Division of Respirology, Department of Medicine, University of Western Ontario, London, Canada
  6. Department of Medicine, University of British Columbia, Vancouver, Canada,
  7. Department of Integrative Oncology, British Columbia Cancer Agency Research Centre, Vancouver, Canada

Address correspondence to:

Grace Parraga, PhD
Imaging Research Laboratories, Robarts Research Institute
1151 Richmond St, London, Canada
N6A 5B7
Email: gparraga@robarts.ca
T519-913-5265

Abstract

Although the human and societal burden and cost of COPD is staggering, there are few clinical tools that provide earlier diagnoses or a means to regionally monitor disease in a way that might lead to improved therapies and outcomes. In acknowledgement of the current gaps in COPD therapy, the objective of the Thoracic Imaging Network of Canada (TINCan) is to improve COPD patient phenotyping through imaging, to provide methods and imaging-based intermediate endpoints for the development of new treatments, and to evaluate disease progression and patient-based outcomes in COPD patients and those at risk of COPD. Here we summarize and outline the TINCan study protocol and describe our objectives. TINCan is a prospective study that aims to identify and quantify novel COPD phenotypes from thoracic computed tomography (CT) and thoracic hyperpolarized noble gas magnetic resonance imaging (MRI) in 200 ex-smokers, 50 years of age or greater, including asymptomatic ex-smokers with normal pulmonary function and Global initiative for chronic Obstructive Lung Disease (GOLD) Unclassified (U) , and GOLD stages I-IV patients. Baseline and 2-year follow-up measurements will be acquired using spirometry, plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO), St. George’s Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT), thoracic CT and hyperpolarized helium-3 (3He) and xenon 129 (129Xe) MRI. TINCan provides a unique opportunity to quantify and compare novel lung structure-function measurements and investigate their relationship with well-established clinical measurements and outcomes. Such intermediate endpoints of COPD may be used to stratify patients for personalized treatments and to develop new treatments to improve outcomes, a long-standing clinical goal.

Citation

Citation: Kirby M, Pike D, McCormack DG, et al. Longitudinal computed tomography and magnetic resonance imaging of COPD: Thoracic Imaging Network of Canada (TINCan) study objectives. J COPD F. 2014; 1(2): 200-211. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0136

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Saving Time for Patients with Moderate to Severe COPD: Endurance Test Speed Set Using Usual and Fast Walk Speeds

Thomas E. Dolmage, MSc,1,2Dmitry Rozenberg, MD,1,3 Nina Malek,1 Rachael A. Evans, MBChB, PhD, 3,4 Roger S. Goldstein, MD 1,2,3

Author Affiliations

  1. Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
  2. Respiratory Diagnostic & Evaluation Services, West Park Healthcare Centre, Toronto, Canada
  3. Department of Medicine, University of Toronto, Canada
  4. Department of Infection, Immunity and Inflammation, University of Leicester, United Kingdom

Address correspondence to:

Roger S. Goldstein, MD
West Park Healthcare Centre
82 Buttonwood Avenue
Toronto, Ontario M6M 2J5 Canada
Phone: 416-243-3631
Email: roger.goldstein@westpark.org

Abstract

Background: For assessing the effects of interventions on exercise tolerance, the tolerable duration (tlimit) of a high-intensity constant-speed endurance test is recommended. The test intensity is determined by the test speed (stest) which should be individualized to target a tlimit of 3 to 15 minutes. We determined the accuracy of setting the stest to achieve a targeted tlimit of 3 to 15 minutes using the participant’s easily measured and non-fatiguing usual (susual) and fast (sfast) walk speeds.

Methods: Participants with COPD were asked to walk at their usual and fast walk speeds to establish their susual and sfast. This required that they walk for less than 1 minute. The individualized stest was calculated from a previously developed equation (0.57 x [sfast – susual]) + susual. Participants then completed a constant-speed endurance test, walking at this calculated stest to intolerance, to determine if the resultant tlimit occurred within 3 to 15 minutes.

Results: Twenty-nine participants (forced expiratory volume in 1 second [FEV1] standard deviation [SD ]=43 [25] %predicted; FEV1 to forced vital capacity [FVC]ratio= 41 [13]%; susual = 57.3 [10.4] meters per minute (m·min-1 ); sfast = 71.7 [10.7] m·min-1) completed the study. During testing, 24 (83%) participants used supplemental oxygen and 16 (55%) used a walking aid. The derived stest was 65.6 [10.3] m·min-1 with the observed tlimit of 6.0 [5.0] minute. Twenty-four of 29 (83 %) endurance tests were within 3 to 15 minutes.

Conclusion: Using the usual and fast walk speeds provides a simple, quick, inexpensive method for clinicians to set an acceptable endurance walk speed.

Citation

Citation: Dolmage TE, Rozenberg D, Malek N, Evans RA, Goldstein RS. Saving time for patients with moderate to severe COPD: Endurance test speed set using usual and fast walk speeds. J COPD F. 2014; 1(2): 193-199. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0115

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Significance of Patent Foramen Ovale in Patients with GOLD Stage II Chronic Obstructive Pulmonary Disease (COPD)

Dario Martolini, MD,1,2 Rebecca Tanner, BSc,1 Claire Davey, MSc,1 Mehul S. Patel, MS, MBBS, BSc, MRCP,1 Davide Elia, MD,1 Helen Purcell, BSc,1 Paolo Palange, MD,2 Nicholas S. Hopkinson, PhD, FRCP,1 and Michael I. Polkey, PhD, FRCP 1

Author Affiliations

  1. National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, United Kingdom
  2. Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy

Address correspondence to:

Michael I. Polkey, PhD, FRCP
NIHR Respiratory Biomedical Research Unit,
Royal Brompton & Harefield
NHS Foundation Trust and Imperial College, London, UK
m.polkey@imperial.ac.uk

Abstract

Background: Patent foramen ovale (PFO) is a common finding in adults. A PFO is associated with right to left shunting but its importance in the aetiology of hypoxia in early COPD remains uncertain, although it has not proved possible to demonstrate a role for PFOs in the aetiology of hypoxia in patients with Global Initiative for chronic Obstructive Lung Disease (GOLD) stage III/IV disease. We compared the characteristics of GOLD stage II patients with or without a PFO and assessed its impact on exercise performance.

Methods: In 22 GOLD stage II COPD patients we measured exercise performance, arterial oxygen tension and lung function and used contrast transcranial Doppler ultrasonography (TCD) to assess the presence of a PFO. Patients (n=20) underwent TCD measurements during incremental cycle ergometry with respiratory pressures measured using an esophageal balloon catheter (n=13).

Results:Twelve individuals (54%) had a PFO. Patients with a PFO were more hypoxic; mean(SD) partial pressure of oxygen in arterial blood (PaO2)10.2(1.1) kilopascals (kPa) vs. 11.7(0.9)kPa (p<0.01), but the presence of a PFO was not associated with reduced exercise performance either on cycle ergometry or a 6 Minute Walk Test (6MWT). A strong relationship was noted between the esophageal pressure swing (PSwingEs) and the degree of shunting observed during exercise (r=0.7; p<0.001).

Conclusions:The presence of a PFO in GOLD stage II COPD patients does not appear to influence exercise performance despite increased right-to-left shunting.

Citation

Citation: Martolini D, Tanner R, Davey C, et al. Significance of patent foramen ovale in patients with GOLD Stage II chronic obstructive pulmonary disease (COPD). J COPD F. 2013; 1(2): 185-192. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2013.0003

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COPD Treatment Guidelines

The COPD Foundation Pocket Consultant Guide

Byron Thomashow, MD,1 James Crapo, MD,2 Barbara Yawn, MD3 Andrew McIvor, MD, FRCPC,4 Scott Cerreta,5 John Walsh,5 David Mannino, MD,6 Stephen Rennard, MD7

Author Affiliations

1. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
2. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
3. Olmsted Medical Center, Department of Research, Rochester, Minnesota
4. Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario,Canada
5. COPD Foundation, Washington, DC
6. Departments of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, Lexington
7. Pulmonary, Critical Care, Sleep and Allergy Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha

Address correspondence to:

Byron M. Thomashow, MD
161 Ft. Washington Avenue
Suite 3-311
New York, NY 10032
Phone: (212) 305-5261
Email: bmt1@cumc.columbia.edu

Abstract

The COPD Foundation Guide to COPD Diagnosis and Treatment is designed to provide practical advice for the health care provider. Available as a hard copy, online and as a mobile device application (app), the Guide serves as an accessible tool for clinicians. To date, over 400,000 cards have been distributed to health care providers nationwide at no charge. The Guide is updated as necessary and suggestions from the COPD physician and health care provider community are integrated into updates.

Citation

Citation: Thomashow B, Crapo J, Yawn B, McIvor A, Cerreta S, Walsh J, Mannino D, Rennard S. The COPD Foundation Pocket Consultant Guide. J COPD F. 2014; 1(1): 83-87. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2014.0124

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The COPD Pipeline

The COPD Pipeline, XXV

Nicholas Gross, MD, PhD1

Author Affiliations

  1. Stritch-Loyola School of Medicine, Chicago, Illinois

Address correspondence to:

Nicholas Gross, MD, PhD
grossnicholas1@gmail.com

Abstract

This article does not contain an abstract.

Citation

Citation: Gross N. The COPD pipeline XXV. J COPD F. 2014; 1(2): 250-254. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0143

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