Stamatoula Tsikrika

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.

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

Acute effects of short term use of e-cigarettes on airways physiology and respiratory symptoms in smokers with and without airways obstructive diseases and in healthy non smokers

BACKGROUND Although the use of e-cigarettes is increasing worldwide, their short and long-term effects remain undefined. We aimed to study the acute effect of short-term use of e-cigarettes containing nicotine on lung function and respiratory symptoms in smokers with airways obstructive disease (COPD, asthma), “healthy” smokers, and healthy never smokers. METHODS Respiratory symptoms, vital signs, exhaled NO, airway temperature, airway resistance (Raw), specific airway conductance (sGaw) and single nitrogen breath test were assessed before and immediately after short term use of an e-cigarette containing 11mg of nicotine among adults with COPD, asthma, “healthy” smokers, and never-smokers. The effect of the use of nicotine-free e-cigarettes among “healthy” never smokers was also studied. RESULTS The majority of participants reported acute cough. Short term use of nicotine e-cigarettes was associated: a) with increased heart rate in all subjects except in the COPD group, b) decreased oxygen saturation in “healthy” and COPD smokers, c) increased Raw in asthmatic smokers, “healthy” smokers, and healthy never smokers, d) decreased sGaw in healthy subjects, and e) changed slope of phase III curve in asthmatic smokers. Short-term use of nicotine-free e-cigarettes increased Raw and decreased sGaw among healthy never smokers. CONCLUSIONS Short-term use of an e-cigarette has acute effects on airways physiology and respiratory symptoms in COPD smokers, asthmatic smokers, “healthy” smokers and healthy never smokers. E-cigarette use was associated with effects in “healthy” never smokers irrespectively of nicotine concentration. More studies are needed to investigate both short and long-term effects of e-cigarette use

Distribution of nontuberculous mycobacteria in treated patients with pulmonary disease in Greece - relation to microbiological data

AIMS The aim was to assess the distribution of nontuberculous mycobacteria (NTM) in treated patients with pulmonary disease (PD) in Greece. PATIENTS & METHODS Patients treated for NTM PD at the two largest chest diseases hospitals in Greece, in the period 1990-2013 were investigated. For the years 2005-2013 data on NTM isolation frequency were recorded. RESULTS M. avium complex (MAC) was the predominant cause of NTM PD disease followed by M. kansasii and rapid growing mycobacteria (RGM). The pathogenicity of RGM was significantly lower than this of MAC and M. kansasii. An increase was observed in the percentage of isolated NTM species that were considered clinically significant over the study period. CONCLUSIONS The increasing number of NTM PD in Greece is a consequence of their isolation being more frequently considered as clinically relevant.