Does mild COPD affect prognosis in the elderly?

<p>Abstract</p> <p>Background</p> <p>Chronic obstructive pulmonary disease (COPD) affects independence and survival in the general population, but it is unknown to which extent this conclusion applies to elderly people with mild disease. The aim of this study was to verify whether mild COPD, defined according to different classification systems (ATS/ERS, BTS, GOLD) impacts independence and survival in elderly (aged 65 to 74 years) or very elderly (aged 75 years or older) patients.</p> <p>Methods</p> <p>We used data coming from the Respiratory Health in the Elderly (Salute Respiratoria nell'Anziano, SaRA) study and compared the differences between the classification systems with regards to personal capabilities and 5-years survival, focusing on the mild stage of COPD.</p> <p>Results</p> <p>We analyzed data from 1,159 patients (49% women) with a mean age of 73.2 years (SD: 6.1). One third of participants were 75 years or older. Mild COPD, whichever was its definition, was not associated with worse personal capabilities or increased mortality after adjustment for potential confounders in both age groups.</p> <p>Conclusions</p> <p>Mild COPD may not affect survival or personal independence of patients over 65 years of age if the reference group consists of patients with a comparable burden of non respiratory diseases. Comorbidity and age itself likely are main determinants of both outcomes.</p

Fifteen-year mortality of patients with asthma-COPD overlap syndrome

Background: The coexistence of asthma and chronic obstructive pulmonary disease (asthma-COPD overlap syndrome: ACOS) is increasingly recognized but data about its prevalence and long-term mortality are needed. Methods: Prevalence of ACOS and 15-year mortality rates were assessed in 1065 subjects aged>. 65. years, enrolled in the SA.R.A. study, with complete clinical, lung functional and follow-up data. Physical performance, disease-related disability, and health-related quality of life (HRQL) were also evaluated. Results: ACOS was found in 11.1% of subjects (29.4% of those previously diagnosed with COPD and 19.7% of those with asthma). ACOS was positively associated with impaired physical performance, functional ability, and HRQL. Individuals with ACOS had higher mortality rates than controls (7.17 per 100 person-years; mortality rate ratio: 1.83). After adjustment for the main confounders, the risk of all-cause mortality remained significantly increased in subjects with ACOS (HR: 1.82), COPD (HR: 2.12), and restriction (HR: 2.41), but not asthma. Conclusions: Long-term prognosis of ACOS was similar to COPD, and worse than asthma and healthy controls. ACOS had a significant impact on physical performance, functional ability, and HRQL

Acute painful paraplegia in a 49-year-old man with allergic asthma

We present a case of a 49-year-old man, with a 10-year history of bronchial asthma and nasal polyposis, who developed acutely painful paraplegia and paresthesias. Laboratory data showed elevated blood creatine kinase levels and myoglobinuria, which were diagnostic for rhabdomyolysis but only partially explained the neurological deficit. Electrophysiological studies revealed a sensorimotor neuropathy of multiple mononeuritis type. The patient also had leucocytosis with marked eosinophilia and antineutrophil cytoplasmic autoantibodies. Bronchial biopsies showed inflammatory infiltrates with a prevalence of eosinophils. All these findings led us to diagnose eosinophilic granulomatosis with polyangiitis, a systemic vasculitis with almost constant respiratory tract involvement and good response to corticosteroid treatment. This can also affect other organs including the nervous system, while muscular involvement is unusual. Some diseases deserve attention in differential diagnosis. Histology can support the diagnosis which remains essentially clinical. Steroid sparing agents/immunosuppressants are suggested for extensive disease

When kidneys and lungs suffer together

A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients may have normal serum creatinine concentration. Lungs and kidneys participate in maintaining the acid-base balance. Compensatory role of the lungs rapidly expresses through an increase or reduction of ventilation. Renal compensation usually requires a few days as it is achieved through changes in bicarbonate reabsorption. Chronic kidney disease and end-stage renal diseases increase the risk of pneumonia. Vaccination against Streptococcus pneumonia and seasonal influenza is recommended for these patients. Vaccines against the last very virulent H1N1 influenza A strain are also available and effective. Acute lung injury and acute kidney injury are frequent complications in critical illnesses, associated with high morbidity and mortality. The concomitant failure of kidneys and lungs implies a multidisciplinary approach, both in terms of diagnostic processes and therapeutic management

Smoking cessation, anxiety, mood and quality of life: reassuring evidences

A close and complex relationship between smoking and mental health problems was found. Different hypotheses have been proposed to explain these associations: 1) smoking and poor mental health may share common causes (genetic factors or environmental mechanisms); 2) for people with poor mental health smoking is a coping strategy to regulate psychiatric symptoms; 3) smokings worsen mental health. Moreover, smokers with psychiatric disorders may have more difficulty quitting and patients with mental diseases who received mental health treatment within the previous year were more likely to stop smoking than those not receiving treatment. Taylor et al. hypothesized that quitting smoking might improve rather than exacerbate mental health, because it allows to avoid multiple episodes of negative affect induced by withdrawal. With the aim to verify this hypothesis, they conducted a systematic review and meta-analysis on longitudinal studies (randomized controlled trials and cohort studies) in which the difference in change in mental health between subjects who stop smoking and subjects who continue to smoke has been explored. A total of 26 longitudinal studies evaluating anxiety, depression, mixed anxiety and depression, positive effect, psychological quality of life, and stress have been included. The study results provided enough evidence to assure that quitting smoking is associated with a reduction of depression, anxiety, and stress, with an improvement of psychological quality of life and positive affect compared with continuing to smoke. The strength of association was similar for both the general population and study enrolled populations, including those with mental health disorders. The results of this meta-analysis have direct clinical implications: the benefits for mental health could motivate physicians and patients to take into account the possibility of smoking cessation

Mechanisms in chronic obstructive pulmonary disease: comparisons with asthma

The mechanisms underlying the pathogenesis and pathophysiology of COPD are complex and have been largely studied; however, the underlying factors are not completely understood. Chronic airway inflammation is a key characteristic of COPD and specific inflammatory abnormalities exist even in the airways of subjects with mild and asymptomatic clinical patterns. In addressing these mechanisms, a comparison with asthma becomes fundamental, since the latter shows clinical and functional aspects that overlap with those observed in COPD. The mechanisms of inflammation in COPD, and their similarities and differences with asthma are therefore discussed in this article. The diagnosis of chronic obstructive diseases may pose important issues regarding on the differentiation between COPD and asthma: lack of, or delayed, recognition of the disease (underdiagnosis), incorrect interpretation of symptoms that are attributed to other respiratory or non-respiratory diseases (misdiagnosis), and erroneous classification of healthy subjects as affected by the disease (overdiagnosis). Underdiagnosis, misdiagnosis and overdiagnosis may all lead to inappropriate therapeutic choices, thus affecting health-related quality of life and prognosis. In this scenario, specific issues accounting for differences between COPD and asthma are also addressed

Asthma-COPD overlap syndrome: recent advances in diagnostic criteria and prognostic significance

The term asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has been proposed for individuals with features of both asthma and COPD. Several attempts have been done to define ACOS on the basis of medical history, symptoms, and functional findings. The main diagnostic criteria include airflow obstruction with a strong although incomplete reversibility to bronchodilation tests, a significant exposure to cigarette or biomass smoke, and a history of atopy or asthma. Additional diagnostic elements include eosinophilic airway and systemic inflammation, a good response to corticosteroid treatment, and a high concentration of exhaled nitric oxide. ACOS should be distinguished from asthma with not fully reversible bronchial obstruction due to airway remodeling, thus the lack of smoking exposure should exclude the diagnosis of ACOS. In patients without a documented history of asthma before 40 years of age, an increase in FEV1 after bronchodilator >400 mL should be required to diagnose ACOS. ACOS has been found to be associated with impaired physical performance, functional ability, and health-related quality of life. The prevalence of ACOS increases with aging, then it is relatively stable in elderly individuals (>65 years). Long-term mortality of subjects with ACOS is similar to COPD, and worse than asthma and healthy controls. Future research is still needed to improve the understanding and management of ACOS