The impact of COPD on polyneuropathy : results from the German COPD cohort COSYCONET

Background: Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the distinction between direct and indirect effects. Methods: We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy (repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP), and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI, packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and indirect relationships between parameters. Results: 606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations depended on FEV1, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the SEM remained virtually the same. Conclusion: We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All other associations, particularly those with lung function and physical capacity, were indirect. These findings underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic compensation and vascular status

The impact of COPD on polyneuropathy: Results from the German COPD cohort COSYCONET.

Background Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the distinction between direct and indirect effects. Methods We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy (repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP), and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI, packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and indirect relationships between parameters. Results 606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations depended on FEV1, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the SEM remained virtually the same. Conclusion We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All other associations, particularly those with lung function and physical capacity, were indirect. These findings underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic compensation and vascular status

Caracterização da curva do lactato sanguíneo e aplicabilidade do modelo Dmax durante protocolo progressivo em esteira rolante La caracterización de la curva del lactato sanguíneo y la pertinencia del Dmax durante el protocolo progresivo en la cinta rodante Characterization of the blood lactate curve and applicability of the Dmax model in a progressive protocol on treadmill

PROPÓSITO: Caracterizar o comportamento do lactato sanguíneo ([La]), durante protocolo progressivo em esteira rolante, e investigar a aplicabilidade do modelo Dmax na detecção do limiar de lactato (LL) e rendimento esportivo. MÉTODOS: Vinte e sete homens atletas de nível regional executaram protocolo de Heck et al. (1985), com incrementos a cada três minutos. O rendimento esportivo foi obtido pela velocidade média da prova de 10km. O 1º e 2º LL foram determinados através de análise visual da curva das [La] (LLv1 e LLv2) e por interpolação na velocidade referente às concentrações de 2,0 e 3,5mmol.l¹ (LL2,0 e LL3,5). O modelo Dmax identificou o LL em valores medidos (DmaxMED) e preditos pelas funções polinomial (DmaxPOL), linear de dois segmentos (DmaxSEG) e exponencial contínua (DmaxEXP). A característica do lactato sanguíneo durante o teste incremental foi verificada pelos ajustes linear de dois segmentos e exponencial contínua. RESULTADOS: Não houve diferença significativa entre o somatório dos resíduos quadrados dos ajustes de curva, porém, houve tendência de melhor ajuste exponencial contínua em 70,4% da amostra. Enquanto não houve diferença significativa entre os DmaxMED, DmaxPOL, DmaxSEG e DmaxEXP, os métodos Dmax foram maiores do que LLv1, menores do que LL3,5 e não diferentes de LL2,0. Todos os critérios Dmax foram significativamente menores do que a velocidade média da prova de 10km. CONCLUSÕES: Enquanto as [La] tenderam a um aumento exponencial durante protocolos progressivos em esteira rolante, o modelo Dmax apresentou evidências da sua aplicabilidade para a detecção do LL, mas não do rendimento esportivo.<br>PROPÓSITO: Este estudio tenía como los objetivos, para caracterizar la conducta del lactato sanguíneo ([La]), durante el protocolo progresivo en la cinta rodante, y para investigar la pertinencia del Dmax en el descubrimiento del umbral de lactato (LL) y el ingreso deportivo. MÉTODOS: Veintisiete atletas de nivel regional ejecutaron protocolo de Heck et al. (1985), con incrementos cada 3 minutos. El ingreso deportivo se obtuvo por la velocidad de la prueba de 10 km. El 1 y 2 LL sea cierto a través del análisis visual de la curva del [La] (LLv1 y LLv2), y para la interpolación en la velocidad con respecto a las concentraciones de 2,0 y 3,5 mmol.l-1 (LL2,0 y LL3,5). EL Dmax identificó LL en los valores moderados (DmaxMED), y se predijo por el polinomial de las funciones (DmaxPOL), lineal de dos segmentos (DmaxSEG), y exponencial continuo (DmaxEXP). La característica del lactato sanguíneo durante la prueba incremental se verificó por los ajustes lineal de 2 segmentos y exponencial continuo. RESULTADOS: No había diferencia significante entre el sumatoria de los residuos cuadrados de los ajustes de la curva, sin embargo, había una tendencia continua de ajuste exponencial bueno en 70,4% de la muestra. Mientras que no había diferencia significante entre DmaxMED, DmaxPOL, DmaxSEG y DmaxEXP, el método Dmax es más grande que LLv1, más pequeño que LL3,5, y no presenta diferencia con el de LL2,0. Todo el criterio Dmax sea significativamente más pequeño que la velocidad elemento de la prueba de 10 km. CONCLUSIONES: Mientras las [LA] tenderon a un aumento exponencial durante los protocolos progresivos en la cinta rodante, el Dmax ejemplar presentó evidencias de pertinencia mayor el descubrimiento de LL, pero no para rendimiento deportivo.<br>PURPOSE: To characterize the blood lactate ([La]) behavior along a progressive protocol on treadmill, and to investigate the applicability of the Dmax model in detecting the lactate threshold (LT) and the sportive performance. METHODS: Twenty-seven male athletes of regional level performed the Heck et al. protocol (1985) incremented every 3 minutes. The sportive output was attained by the mean velocity of the 10 km-test. The first and second LT were determined through visual analysis of the [La] (LTv1 and LTv2) curve, and by interpolation of the velocity related to the 2.0 and 3.5 mmol.l-1 concentrations (LT2.0 and LT3.5). The Dmax model has identified the LT in measured values (DmaxMED), and was predicted by the polynomial functions (DmaxPOL), the 2-segment linear (DmaxSEG) and the continuous exponential (DmaxEXP). The characteristic of the blood lactate along the incremental test was checked through 2-segment linear adjustments and continuous exponential. RESULTS: There was no significant difference between the sums of the square residues of the curve adjustments, but there was a trend for a better continuous exponential adjustment at 70.4% of the sampling. Although there was no significant difference between the DmaxMED, DmaxPOL, DmaxSEG, and DmaxEXP, the Dmax methods were higher than the LTv1, lower than the LT3.5, and were not different of the LT2.0. Every Dmax criteria were significantly lower than the mean velocity of the 10 km-test. CONCLUSIONS: While the [La] trended to an exponential increase along the progressive protocols on treadmill, the Dmax model presented evidences of its applicability to detect the LT, but not for the sportive output