Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD

Phenotypic characterization of patients with COPD may have potential prognostic and therapeutic implications. Available information on the relationship between emphysema and the clinical presentation in patients with COPD is limited to advanced stages of the disease. The objective of this study was to describe emphysema presence, severity, and distribution and its impact on clinical presentation of patients with mild to moderate COPD. METHODS: One hundred fifteen patients with COPD underwent clinical and chest CT scan evaluation for the presence, severity, and distribution of emphysema. Patients with and without emphysema and with different forms of emphysema distribution (upper/lower/core/peel) were compared. The impact of emphysema severity and distribution on clinical presentation was determined. RESULTS: Fifty percent of the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%). Upper and core zones had the more severe degree of emphysema. Patients with emphysema were older, more frequently men, and had lower FEV(1)%, higher total lung capacity percentage, and lower diffusing capacity of the lung for carbon monoxide. No differences were found between the clinical or physiologic parameters of the different emphysema distributions. CONCLUSIONS: In patients with mild to moderate COPD, although the presence of emphysema has an impact on physiologic presentation, its severity and distribution seem to have little impact on clinical presentation

Epicardial adipose tissue in patients with chronic obstructive pulmonary disease

EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular event

Is COPD a Progressive Disease? A Long Term Bode Cohort Observation

Background: The Global Initiative for Obstructive Lung Diseases (GOLD) defines COPD as a disease that is usually progressive. GOLD also provides a spirometric classification of airflow limitation. However, little is known about the long-term changes of patients in different GOLD grades. Objective: Explore the proportion and characteristics of COPD patients that change their spirometric GOLD grade over long-term follow-up. Methods: Patients alive for at least 8 years since recruitment and those who died with at least 4 years of repeated spirometric measurements were selected from the BODE cohort database. We purposely included the group of non survivors to avoid a “survival selection” bias. The proportion of patients that had a change (improvement or worsening) in their spirometric GOLD grading was calculated and their characteristics compared with those that remained in the same grade. Results: A total of 318 patients were included in the survivor and 217 in the non-survivor groups. Nine percent of survivors and 11% of non survivors had an improvement of at least one GOLD grade. Seventy one percent of survivors and non-survivors remained in the same GOLD grade. Those that improved had a greater degree of airway obstruction at baseline. Conclusions: In this selected population of COPD patients, a high proportion of patients remained in the same spirometric GOLD grade or improved in a long-term follow-up. These findings suggest that once diagnosed, COPD is usually a non-progressive disease

Epicardial adipose tissue in patients with chronic obstructive pulmonary disease

EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular event

Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. Methods CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome. Results During a median follow up of 65 months (ICR: 36–100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19–1.46, p < 001). Conclusions In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings

Flow diagram of the study population.

<p>Flow diagram of the study population.</p

Patients characteristics.

<p>n = Number of participants for each group; BMI = Body Mass Index; FEV₁ =  Forced Expiratory Volume in the fisrt second; FVC = Forced Vital Capacity; TLC = Total Lung Capacity; MMRC = Modified Medical rtesearch Council; 6 MWD  = 6 Minutes Walk Distance; BODE index: BMI, Obstruction, Dyspnea, Exercise; SBP = Systolic Blood Presure; DBP = Dyastolic Blood Presure; DM = Diabetes Mellitus; LDL-C = Low Density Protein; HDL-C = High Density Protein; EAT = Epicardial Adipose Tissue CRP =  C reactive Protein.</p><p>X ± SD = means ± Standart Desviation; y/n = Yes/No; p25–p75 =  interquartile range.</p

Univariate analysis exploring the independent association of the studied variables with EAT volume in patients with COPD and in smokers.

<p>BMI = Body Mass Index; FEV1% = Forced Expiratory Volume in the first second percent; 6 MWD = Six Minutes Walk distance; MMRC = Modified Medical Research Council Dyspnea Scale; BODE = Body Mass Index, Obstruction, Dyspnea, Exercise; HTN = Hypertension; LDL-C = Low Density Protein Cholesterol; HDL-C = High Density Protein Cholesterol; DM = Diabetes Mellitus; HbA1c = glycosylated haemoglobin.</p

Multivariate analysis exploring the independent association of the studied variables with EAT volume in patients with COPD and in smokers.

<p>(*) Variables included in the model: Pack-years, Gender, BMI, 6 MWD, HDL-C, Glucose.</p