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Marti S, Munoz X, Rios J, et al. Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy

Servei de Pneumologia, Hospital General Vall d'Hebron, and Laobratori de Bioestadística i Epidemiologia, Universitat Autònoma de Barcelona, Spain.
European Respiratory Journal (Impact Factor: 7.13). 05/2006; 27(4):689-96. DOI: 10.1183/09031936.06.00076405
Source: PubMed

ABSTRACT The aim of this study was to investigate the association between clinical variables and all-cause and respiratory mortality in patients with chronic obstructive pulmonary disease (COPD) undergoing long-term oxygen therapy (LTOT). The authors retrospectively studied a historic cohort of 128 patients with COPD (126 males, mean age+/-SD 68.9+/-9.7 yrs, body mass index (BMI) 25.1+/-4.5 kg.m-2, and forced expiratory volume in one second 25.4+/-8.8% predicted), who were being treated with long-term oxygen therapy in a tertiary teaching hospital between 1992 and 1999. Comorbidity, assessed with the Charlson Index, was present in 38% of the patients. Vital status and cause of death were assessed through the population death registry. A total of 78 patients (61%) had died by the end of follow-up. Three-year survival was 55%. Death was due to respiratory causes in 77% of cases. On Cox analysis, BMI<25 kg.m-2, comorbid conditions, age>or=70 yrs and cor pulmonale were associated with all-cause mortality. The BMI and comorbidity were the only significant predictive factors when the analysis was restricted to respiratory mortality. In conclusion, body mass index<25 kg.m-2 and comorbidity were predictors of all-cause and respiratory mortality in a cohort of chronic obstructive pulmonary disease patients treated with long-term oxygen therapy. These factors should be taken into account when considering the management and prognosis of these patients.

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    • "One of the important complications of COPD is RV failure, which is associated with worse outcomes and increased mortality [2,3]. The development of RV failure is thought to be linked to increased afterload due to pulmonary hypertension (PH), but the PH associated with COPD is usually mild compared to PH of other causes [4]. "
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    ABSTRACT: Background Right ventricular dysfunction in COPD is common, even in the absence of pulmonary hypertension. The aim of the present study was to examine the effects of high intensity interval training (HIIT) on right ventricular (RV) function, as well as pulmonary blood vessel remodeling in a mouse model of COPD.Methods42 female A/JOlaHsd mice were randomized to exposure to either cigarette smoke or air for 6 hours/day, 5 days/week for 14 weeks. Mice from both groups were further randomized to sedentariness or HIIT for 4 weeks. Cardiac function was evaluated by echocardiography and muscularization of pulmonary vessel walls by immunohistochemistry.ResultsSmoke exposure induced RV systolic dysfunction demonstrated by reduced tricuspid annular plane systolic excursion. HIIT in smoke-exposed mice reversed RV dysfunction. There were no significant effects on the left ventricle of neither smoke exposure nor HIIT. Muscularization of the pulmonary vessels was reduced after exercise intervention, but no significant effects on muscularization were observed from smoke exposure.ConclusionsRV function was reduced in mice exposed to cigarette smoke. No Increase in pulmonary vessel muscularization was observed in these mice, implying that other mechanisms caused the RV dysfunction. HIIT attenuated the RV dysfunction in the smoke exposed mice. Reduced muscularization of the pulmonary vessels due to HIIT suggests that exercise training not only affects the heart muscle, but also has important effects on the pulmonary vasculature.
    Respiratory Research 09/2014; 15(1):117. DOI:10.1186/s12931-014-0117-y · 3.13 Impact Factor
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    • "As the prevalence of COPD is expected to increase in future decades [27], the medicoeconomic burden of COPDassociated undernutrition will increase. The impact of undernutrition and fat-free mass loss on clinical outcome and survival is independent of respiratory parameters [16] [17] [18] [19]. "
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.
    02/2014; 2014:248420. DOI:10.1155/2014/248420
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    • "Furthermore, a decrease in fat mass has recently been identified as an independent risk factor for mortality in COPD patients, regardless of the fat mass (Schols et al., 2005). Hence, protein depletion may be a negative feature in the prognosis of these patients, even though their weight is normal (Marti et al., 2006). Nutritional assessment should be included in the initial evaluation of all patients and the diagnosis of malnutrition/undernourishment in discharge reports (Landbo et al., 1999; Hallin et al., 2007; Lainscak et al., 2011); however, malnutrition is systematically underdiagnosed, and therefore a long way from being corrected. "
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    ABSTRACT: BACKGROUND: The present study aimed to assess the association of obesity and malnutrition with the mortality of hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and the risk of readmission in <30 days. METHODS: A retrospective chart review of consecutive patients admitted with COPD as the primary reason for discharge in Spain between 1 January 2006 and 31 December 2007 was performed. Patients with a diagnosis of obesity or malnutrition in the hospital discharge clinical report were identified. The in-hospital mortality and re-admittance 30 days after discharge indices of obese and malnourished patients were compared against the subpopulation without these diagnoses. RESULTS: Of the 313 233 COPD admittances analysed, there were 22 582 (7.2%) diagnoses of obesity and 6354 (2.0%) diagnoses of malnutrition. In-hospital global mortality and the re-admittance risk were 12.0% and 16.7%, respectively. Obese patients showed a lower in-hospital mortality risk [odds ratio (OR) = 0.52; 95% confidence interval (CI) = 0.49-0.55] and early re-admittance risk (OR = 0.87; 95% CI = 0.85-0.92) compared to non-obese patients. Malnourished patients had a much higher risk of death when in hospital (OR = 1.73; 95% CI = 1.62-1.85) or of being re-admitted within 30 days after discharge (OR = 1.29; 95% CI = 1.22-1.38), even after adjusting for possible confounding factors. CONCLUSIONS: Obesity in patients hospitalised for COPD substantially reduces in-hospital mortality risk and the possibility of early re-admittance. Malnutrition is associated with an important increase in in-hospital mortality and risk of re-admittance in the 30 days following discharge.
    Journal of Human Nutrition and Dietetics 05/2013; DOI:10.1111/jhn.12088 · 2.07 Impact Factor
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