Aikaterini Haniotou

The impact of depressive symptoms on recovery and outcome of hospitalised COPD exacerbations.

The impact of depressive symptoms on outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been thoroughly evaluated in prospective studies. We prospectively enrolled 230 consecutive patients hospitalised for AECOPD, without previous diagnosis of depression. Depressive symptoms were evaluated with Becks depression inventory. Pulmonary function tests, arterial blood gases, COPD assessment test (CAT) and Borg dyspnoea scale were recorded on admission and on days 3, 10 and 40. Patients were evaluated monthly for 1 year. Patients with depressive symptoms required longer hospitalisation (mean±sd 11.6±3.7 versus 5.6±4.1 days, p<0.001). Clinical variables improved during the course of AECOPD, but depressive symptoms on admission had a significant impact on dyspnoea (p<0.001) and CAT score (p=0.012) improvement. Patients with depressive symptoms presented more AECOPD (p<0.001) and more hospitalisations for AECOPD (p<0.001) in 1 year. In multivariate analysis, depressive symptoms were an independent predictor of mortality (hazard ratio 3.568, 95% CI 1.302–9.780) and risk for AECOPD (incidence rate ratio (IRR) 2.221, 95% CI 1.573–3.135) and AECOPD hospitalisations (IRR 3.589, 95% CI 2.319–5.556) in 1 year. The presence of depressive symptoms in patients admitted for AECOPD has a significant impact on recovery and is related to worse survival and increased risk for subsequent COPD exacerbations and hospitalisations in 1 year.

Serum uric acid as a predictor of mortality and future exacerbations of COPD

Serum uric acid is increased in respiratory disease, especially in the presence of hypoxia and systemic inflammation. We evaluated serum uric acid as a biomarker for prediction of mortality and future acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Serum uric acid was measured in 314 eligible consecutive patients on admission for AECOPD. Patients were evaluated monthly for 1 year. Uric acid levels were higher in patients with more severe airflow limitation and in those experiencing frequent exacerbations. High uric acid levels (≥6.9 mg·dL−1) were an independent predictor of 30-day mortality in multivariate Cox regression analysis (HR 1.317, 95% CI 1.011–1.736; p=0.044), but not of 1-year mortality. Patients with high serum uric acid required more prolonged hospitalisation, and more often needed noninvasive ventilation and admission to the intensive care unit within 30 days. In addition, high uric acid levels were associated with increased risk and hospitalisation for AECOPD in 1 year in multivariate Poisson regression analysis (incidence rate ratio 1.184 (95% CI 1.125–1.246) and 1.190 (95% CI 1.105–1.282), respectively; both p<0.001). Serum uric acid is associated with increased 30-day mortality and risk for AECOPD and hospitalisations in 1-year follow-up. This low-cost biomarker may be useful in the identification of high-risk chronic obstructive pulmonary disease patients that could benefit from intensive management. Serum uric acid was linked with airflow limitation in COPD and predicted mortality and future exacerbations http://ow.ly/qflaZ

Hyperventilation In Asthma: A Validation Study Of The Nijmegen Questionnaire-Nq

Abstract Introduction: The Nijmegen questionnaire (NQ) has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. Objective: To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. Methods: The NQ (n = 162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test–retest reliability. Results: Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbachs alpha = 0.92) and test–retest reliability (IR = 0.98). Higher NQ scores were found in the following subgroups: women versus men (p < 0.01); participants with moderate versus mild asthma (p < 0.001) or uncontrolled versus controlled asthma (p < 0.001), and participants with breath-hold time (BHT) < 30 versus ≥ 30 s (p < 0.01) or end-tidal CO2 (ETCO2) ≤35 versus >35 mmHg (p < 0.001). A cut-off score of >17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO2 (r = −0.68), RR (r = 0.66) and BHT (r = −0.65). The prevalence of HVS was found 34%. Conclusion: The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild-to-moderate asthma.

Cardiovascular comorbidities in hospitalised COPD patients: a determinant of future risk?

Cardiovascular disease (CVD), diabetes mellitus and arterial hypertension increase the risk of death and hospitalisations of chronic obstructive pulmonary disease (COPD) patients [1]. COPD patients with CVD are at increased risk of COPD-related hospitalisations [2]. Arterial hypertension is one of the most prevalent comorbidities, influencing 40–60% of COPD patients [1]. Diabetes mellitus is more prevalent in moderate to very severe COPD than in the general population [1] and hyperglycaemia during acute exacerbations of COPD (AECOPD) is associated with increased in-hospital mortality [3]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has proposed a multidimensional classification for COPD management [4, 5] that includes symptoms and future risk of AECOPD, based on the severity of airflow limitation and previous exacerbation history. A recent study has shown that the risk of future hospital admission due to COPD and cardiovascular death is higher in the more symptomatic group B compared with group C, regardless the functional advantage of patients in the first group [6]. Our study assessed the effect of CVD, arterial hypertension and diabetes mellitus on the time to first AECOPD, and on exacerbation and hospitalisation risk in groups A–D of the GOLD 2011 and 2013 classification, in a cohort of patients admitted to hospital for AECOPD. Comorbidities are important determinants of future risk in COPD patients and should be considered in the assessment of future risk http://ow.ly/L2qJp

Factors Associated with BMI in Greek Adults with Asthma

Background. The association between asthma and obesity remains controversial and limited to a few studies. Objective. The present study was designed to examine the association between body mass index (BMI) and clinical measures of asthma morbidity in Greek asthma patients. Study Design. A cross-sectional study in 100 outpatients at the asthma department of the “Amalia Fleming” General Hospital in Athens, Greece, was conducted. Asthma diagnosis was confirmed by a specialist, according to Global Initiative for Asthma (GINA) guidelines. Participants were classified, with respect to BMI (kg/m2), in three groups: normal: <25.0, overweight: 25.0–29.9.0 and obese: ≥30.0. Data were modeled through multiple logistic regression analysis for the association of overweight/obesity with the study variables: demographics, asthma severity, smoking, pulmonary function (forced expiratory volume in one second; FEV1), asthma control (Asthma Control Test; ACT), disability associated with dyspnea (Medical Research Council [MRC] breathlessness scale), and physical activity in leisure time. Results. Overweight/obesity was detected in 56 participants (56%). Multivariate regression analysis resulted in an excess risk of overweight/obesity for older participants (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 1.10–2.64 for a 10-year increase in age). Conclusion. Age seems to be highly associated with overweight/obesity in Greek adults with asthma who tend to maintain a similar body weight compared to the general population.