Elif Yildirim

Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes

Background Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes. Method This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate <2%), and further subdivided according to place of admission (outpatient clinic, ward, or intensive care unit [ICU]) as an indicator of disease severity. Complete blood count, biochemistry, C-reactive protein (CRP), NLR, PLR, and platelet to mean platelet volume values were recorded from an electronic hospital database system and compared among all groups. Results Of the 10,592 patients included in the study, 7,864 were admitted as outpatients, 2,233 to the wards, and 495 to ICU. Neutrophilic COPD patients (n=6,536, 62%) had increased inflammatory markers compared with eosinophilic COPD patients (n=4,056, 38%); median NLR was 5.11 vs 2.62 (P<0.001), PLR was 175.66 vs 130.00 (P<0.001), and CRP was 11.6 vs 7.7 (P<0.001). All values increased relative to admission to the outpatient clinic, ward, or ICU: median NLR was 3.20, 6.33, and 5.94, respectively, median PLR was 140.43, 208.46, and 207.39, respectively, and median CRP was 6.4, 15.0, and 22.8, respectively. The median NLR values of patients in outpatients/ward/ICU increased in neutrophilic and eosinophilic endotypes: 4.21/7.57/8.60 (P<0.001) and 2.50/3.43/3.42 (P=0.81), respectively. CRP showed a similar increased pattern according to severity of AECOPD endotypes. Conclusion In COPD exacerbation, the inflammatory markers show different increases in each COPD endotypes. These findings may be crucial for defining exacerbation endotypes, the severity of exacerbation, and treatment response during follow-up in COPD patients.

Right ventricular dyssynchrony and its improvements after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Whether pathologic alterations of right ventricle (RV) in chronic obstructive pulmonary disease (COPD) affect intra‐ and interventricular dyssynchrony due to changes in mechanical activation of the septum and RV is unclear. The aim of this study was to determine mechanical activation and its changes after pulmonary rehabilitation program (PRP) with speckle tracking echocardiography (STE) in COPD patients.

Right Ventricular Functional Improvement after Pulmonary Rehabilitation Program in Patients with COPD Determined by Speckle Tracking Echocardiography

Background Although right ventricular (RV) dysfunction in pulmonary diseases has been associated with increased morbidity, tools for RV dysfunction identification are not well defined. Objective The aim of this study was to evaluate the magnitude of RV dysfunction by means of speckle tracking echocardiography (STE) in patients with chronic obstructive pulmonary disease (COPD) and to investigate whether STE could be used as an index of RV improvement after a pulmonary rehabilitation (PR) program. Methods Forty-six patients with COPD undergoing PR program and 32 age-sex matched healthy subjects were enrolled. RV function was evaluated at admission and after PR program by conventional two-dimensional echocardiography (2DE) and STE. In addition, exercise tolerance of subjects was evaluated using the six-minute walk test (6MWT). Results COPD patients had worse RV function according to STE and 2DE as well. STE was more sensitive than conventional 2DE in determining RV improvement after PR program - RV global longitudinal strain (LS): 20.4 ± 2.4% vs. 21.9 ± 2.9% p < 0.001 and RV free wall LS: 18.1 ± 3.4% vs. 22.9 ± 3.7%, p < 0.001). RV free wall LS was directly related to distance walked at baseline 6MWT (r = 0.58, p < 0.001) and to the change in the 6MWT distance (6MWTD Δ) (r = 0.41, p = 0.04). Conclusions We conclude that STE might be as effective as 2DE for evaluation of global and regional RV functions. STE may become an important tool for assessment and follow-up of COPD patients undergoing PR program to determine the relationship between RV function and exercise tolerance.

Are the gains of pulmonary rehabilitation in young and elderly patients same

OBJECTIVE: In this study our research question is whether there is any difference in exercise capacity and the impact on quality of life among younger and elderly(age 65 years and older)patients involved in pulmonary rehabilitation (PR) program. METHODS: Patients involved in PR program with chronic lung disease were evaluated in two groups, younger(under 65 years) and elderly ( 65 years and over).Pre-and post- PR program incremental shuttle walking test (ISWT)or 6-minute walking test, quality of life tests were recorded.Patients accompanied lower and upper extremity strengthening exercises, cycling, treadmill and respiratory exercise training with a physical therapist in a 8 weeks program (2 days per week). RESULTS: A total of 73 patients 58 men and 15 women with mean age 61±10 was evaluated. there were 55 chronic obstructive pulmonary disease(COPD), 18 non-COPD -patients. There were 43 patients in younger patient group with mean age 55±8 43 and 30 patients in elderly group with mean age 69±4.After PR 71±72 m increase in ISWT in younger group and 76±45 m increase in elderly group was recorded. In younger group median(IQR)11,8 (7.5-22.3)point decline in St. George quality of life questionnaire(SGRQ)total score and 9,3(4,8-18,5) point decline in elderly was recorded.In both groups,minimally clinically significant changes in ISWT and SGRQ revealed before and after PR,but there were no significant differences in outcomes of younger and older patients. COCNLUSION: For younger and elderlypatients PR provides significant effects exercise capacity and dyspnoea perception.Pulmonary rehabilitation in elderly patients as an addition to medical treatment is beneficial like younger patients with chronic pulmonary diseases.

Pulmonary rehabilitation in COPD and other chronic lung diseases

Introduction: to investigate the impact of pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic lung disease Materials-method: Patients with chronic lung disease who received pulmonary rehabilitation pre-and post-exercise capacity at incrimental shuttle walking test or 6-minute walking test, quality of life tests were evaluated. Patients received upper and lower extremity strengthening exercises, cycling, treadmill, respiratory exercise training accompanied by a physical therapist, Patients were taken to a total of 2 days per week for 8 week program. The nutritional status of patients, oxygen and noninvasive mechanical ventilation support were evaluated. Results: 14 chronic obstrictive pulmonary disease(copd),9 chronic lung disease other than COPD( 4bronchiectasis, 3 interstitial lung disease,2kyphoscoliosis )with median age of 61.5 and mean 61.46 years were evaluated.Improvement on MMRC mmrc dyspnea scale, shuttle walking test (mean 57m), epworth sleepiness scale and 11 point regression on quality of life questionnaire were detected., There were no significant differences in terms of the outcomes of COPD and non COPD patients who received pulmonary rehabilitation. Conclution: COPD patients are more frequently to guide topulmonary rehabilitation . but non COPD patients with decresased exercise capacity has shown significant effects for the perception of dyspnoea and exercise capacity. It is important to increase awereness that with the increasing number of patients with chronic lung diseases pulmonary rehabilitation is important in addition to the medical treatment in our country.