NT-proBNP correlates with the illness scores pneumonia severity index and CURB-65 in patients with pneumonia

Pneumonia severity index (PSI) and CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65) are used to estimate the severity and prognosis of patients with pneumonia. NT-proBNP is a marker of myocardial stress and of sepsis-induced myocardial depression and might be used to predict short and long-term survival in patients with pneumonia. Twenty-three patients [age 79±15 standard deviation (SD); M/F 8/15, CURB-65 2.2±0.9 SD, PSI 118±38 SD, procalcitonin 3.9±5 SD] with pneumonia hospitalized in our Internal Medicine Unit were retrospectively evaluated. NT-proBNP was measured in the first 72 h of hospitalization. CURB-65 and PSI were calculated and correlation with biomarkers investigated. NT-proBNP showed a moderate statistically significant correlation with both PSI and CURB-65 (NT-proBNP vs PSI, r=0.42, P<0.05, NT-proBNP vs CURB-65, r=0.46, P<0.05). These correlations were confirmed also when patients with a diagnosis of heart failure where excluded from the analysis, even if the correlation did not reach the statistical significance. NT-proBNP seems to well correlate with the illness scores PSI and CURB-65 and might be a reliable predictor of severity and survival in patients with pneumonia

Clinical use of Heliox in Asthma and COPD

Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving (> 6 ATM). This mixture has been also used for clinical purposes, particularly in the critical care setting. Due to of its physical proprieties, Heliox breathing reduces air flow resistances within the bronchial tree; in patients with obstructive lung diseases Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Beneficial effects have been documented in severe asthma attacks and in patients with chronic obstructive pulmonary disease. A reduction in WOB during mechanical ventilation and an increase in exercise endurance capacity have also been described in COPD. Heliox has been also used in the treatment of upper airways obstruction, bronchiolitis and bronchopulmonary dysplasia. Despite the encouraging results, Heliox use in routine practice remains controversial because of technical implications and high costs

Bronchodilator effect on ventilatory, pulmonary gas exchange, and heart rate kinetics during high-intensity exercise in COPD

Respiratory mechanical abnormalities in patients with chronic obstructive pulmonary disease (COPD) may impair cardiodynamic responses and convective oxygen delivery during exercise, resulting in slower ventilatory, pulmonary gas exchange (PGE), and heart rate (HR) kinetics compared with normal. We reasoned that bronchodilators and the attendant reduction of operating lung volumes should accelerate ventilatory, PGE, and HR kinetics in the transition from rest to high-intensity exercise. Twelve clinically stable COPD patients undertook constant-work rate cycle testing at 75% of each individual's maximum work capacity after receiving either combined nebulized bronchodilators (BD) or placebo (PL), randomly. Mean response time (MRT) and amplitude of slow component for oxygen uptake (V'O(2)), carbon dioxide production (V'CO(2)), ventilation (V'(E)), and HR together with operating dynamic end-expiratory lung volume (EELV) were measured. Resting and exercise EELV decreased significantly by 0.38 L after BD compared with PL. After BD, V'O(2), V'CO(2), V'(E), and HR MRT accelerated (p < 0.05) by an average of 12, 22, 27, and 22 s, respectively (i.e., 15, 18, 22 and 27%, respectively). The slow component for V'O(2) declined by an average of 55 ml/min compared with PL. Speeded MRT for V'O(2) correlated with indices of reduced lung hyperinflation, such as resting EELV (r = -0.64, p = 0.025) and EELV at isotime (r = -0.77, p = 0.0032). The results confirm an important interaction between abnormal dynamic respiratory mechanics and indices of cardio-circulatory function in the rest-to-exercise transition in COPD patients

A Simplified Approach for the Estimation of the Ventilatory Compensation Point

ONORATI, P., D. MARTOLINI, G. VALLI, P. LAVENEZIANA, P. MARINELLI, E. ANGELICI, and P. PALANGE. A Simplified Approach for the Estimation of the Ventilatory Compensation Point. Med. Sci. Sports Exerc., Vol. 44, No. 4, pp. 716-724, 2012. Incremental cardiopulmonary exercise test with gas exchange measurement is the gold standard for the identification of the ventilatory compensation point (VCP). It has previously been demonstrated that the change in the slope of increment of minute ventilation over HR (Delta V-E/Delta HR) can be used alternatively to the ventilatory equivalent for CO2 (Delta V-E/Delta CO2) method for detection of VCP in healthy subjects undergoing cycle ergometer (C) incremental exercise. The same evaluation during treadmill (T) incremental exercise and comparison between C and T have not yet been performed. Purpose: We analyzed, during both C and T incremental exercises, the V-E/HR and the respiratory rate (RR)/HR relationships, expressed either as slope or as an absolute value. We hypothesized that changes in the slope of increment of the two relationships could represent a reliable method for VCP detection, regardless of exercise mode and protocol. Methods: Fourteen healthy male subjects (age = 31 +/- 7 yr (mean +/- SD)) underwent two T incremental exercises-fast (F-T) and slow (S-T) protocols (8 km.h(-1), 2% (F-T) and 1% (S-T) grade per minute)-and one C incremental exercise (30 W.min(-1)). O-2 uptake (VO2), VCO2, V-E, HR, and RR were measured breath by breath. Results: A good between-method agreement in the detection of VCP by the Delta V-E/Delta CO2, Delta V-E/Delta HR, and the Delta RR/Delta HR slope changes was found in both T protocols and C. No differences (C vs T and F-T VS S-T) were found in the slope of the Delta V-E/Delta HR and Delta RR/Delta HR relationships after the VCP and in the Delta V-E/Delta HR and RR/HR absolute values at VCP. Conclusions: In healthy young males, the Delta V-E/Delta HR and Delta RR/Delta HR relationships during T and C incremental exercises can be reliably used to detect the VCP as an alternative to the ventilatory equivalent method

Muscle function in COPD: a complex interplay

The skeletal muscles play an essential role in life, providing the mechanical basis for respiration and movement. Skeletal muscle dysfunction is prevalent in all stages of chronic obstructive pulmonary disease (COPD), and significantly influences symptoms, functional capacity, health related quality of life, health resource usage and even mortality. Furthermore, in contrast to the lungs, the skeletal muscles are potentially remedial with existing therapy, namely exercise-training. This review summarizes clinical and laboratory observations of the respiratory and peripheral skeletal muscles (in particular the diaphragm and quadriceps), and current understanding of the underlying etiological processes. As further progress is made in the elucidation of the molecular mechanisms of skeletal muscle dysfunction, new pharmacological therapies are likely to emerge to treat this important extra-pulmonary manifestation of COPD

Cardiopulmonary exercise testing (CPET) in pulmonary emphysema

In patients affected by chronic obstructive pulmonary disease (COPD), cardiopulmonary response to exercise was never related to the severity of emphysema (E) measured by high resolution computed tomography (HRCT). Sixteen patients (age = 65 +/- 8 yrs; FEV(1) = 54 +/- 18%pred; RV = 160 +/- 28%pred) with moderate to severe E (quantified by lung HRCT as % voxels 1 is typically observed in severe E patients; furthermore, the (V)over dotE/(V)over dot(CO2) slope and the PETco, peak values decrease and increase respectively as more as the emphysema is severe. (C) 2011 Elsevier B.V. All rights reserved

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

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

Respiratory Muscle Fatigue following Exercise in Patients with Interstitial Lung Disease

Abstract Background: It is not known whether respiratory muscle fatigue occurs as a consequence of exercise in patients with interstitial lung disease (ILD) and, if so, to what extent it is related to changes in dynamic lung volumes. Objectives: To assess the development of respiratory muscle fatigue in patients with ILD and relate it to the respiratory pattern during exercise. Methods: Sixteen ILD patients (11 women) performed incremental, symptom-limited cycle ergometry with inspiratory capacity manoeuvres used to measure changes in end-expiratory lung volume (EELV). Twitch transdiaphragmatic pressure (TwPdi) and twitch gastric pressure (TwT 10 Pga), in response to magnetic stimulation, were used to assess the development of fatigue