Suchergebnisse

Hyeon-Kyoung Koo,1 Sung-Woo Park,2 Jeong-Woong Park,3 Hye Sook Choi,4 Tae-Hyung Kim,5 Hyoung Kyu Yoon,6 Kwang Ha Yoo,7 Ki-Suck Jung,8 Deog Kyeom Kim9 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Republic of Korea; 2Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea; 3Department of Pulmonary and Critical Care Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea; 4Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea; 5Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea; 6Department of Internal Medicine, The Catholic University of Korea, Yeouido St Mary's Hospital, Seoul, Republic of Korea; 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea; 8Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea Background and purpose: Chronic cough can be a dominant symptom of chronic obstructive pulmonary disease (COPD), although its clinical impact remains unclear. The aim of our study was to identify phenotypic differences according to the presence of chronic cough or sputum and evaluate the impact of chronic cough on the risk of acute exacerbation of COPD (AECOPD). Methods: In a nationwide COPD cohort including 1,613 COPD patients, patients with chronic cough only, those with sputum only, those with chronic bronchitis (CB), and those without cough and sputum were compared with regard to dyspnea, lung function, quality of life (QoL), and risk of AECOPD. Results: The rates of chronic cough, chronic sputum, and both were 23.4%, 32.4%, and 18.2%, respectively. Compared with patients without chronic cough, those with chronic cough exhibited a lower forced expiratory volume in 1 second (% predicted) and diffusing capacity of the lungs for carbon monoxide (% predicted), more frequent AECOPD, more severe dyspnea, and worse QoL. Pulmonary function, dyspnea severity, and QoL worsened in the following order: without cough or sputum, with sputum only, with cough only, and with CB. Multivariate analyses revealed chronic cough as an independent risk factor for a lower lung function, more severe dyspnea, and a poor QoL. Moreover, the risk of future AECOPD was significantly associated with chronic cough (odds ratio 1.56, 95% CI 1.08–2.24), but not with chronic sputum. Conclusion: Our results suggest that chronic cough should be considered as an important phenotype during the determination of high-risk groups of COPD patients. Keywords: pulmonary disease, chronic obstructive, cough, exacerbation, severity

Tina Riegels-Jakobsen1, Malene Skouboe1, Jens Dollerup2, Christian Buus Andersen2, Louise Barkan Staal1, Rolf BH Jakobsen1, Peter Bo Poulsen21Department of Health Prevention and Promotion, Municipality of Esbjerg, Esbjerg, 2Medical and Access, Pfizer Denmark, Ballerup, DenmarkAbstract: Up to 436,000 adult Danes suffer from chronic obstructive pulmonary disease (COPD), with only one third diagnosed at this time. The Danish National Board of Health recommends early detection of COPD, focusing on smokers/ex-smokers over 35 years of age with at least one lung symptom. A governmental prevention committee has suggested that the municipalities, in addition to general practice, should be a potential arena responsible for early detection of COPD. We undertook a pilot study to investigate the feasibility and effectiveness of early detection of COPD in municipalities following the recommendations of the Danish National Board of Health.Methods: The Municipality of Esbjerg offered spirometry to Danish citizens at risk of COPD without a previous diagnosis of the disease, following the National Board of Health's recommendations. Citizens with evidence of airway obstruction (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] <70%) were advised to visit their general practitioner for diagnosis. These citizens were followed up by telephone interview 3 months later.Results: Of 152 citizens sampled (50% females, mean age 58 years, 51% smokers) 51.3% had evidence of airway obstruction, with 87% being mild to moderate in terms of severity. Seven of ten citizens (71%) then visited their general practitioner, with 85% of these being diagnosed with COPD. The number of smokers embarking on smoking cessation or quitting smoking increased following COPD screening, with the highest frequency in participants with evidence of airway obstruction.Conclusion: In addition to early detection of COPD in general practice, early detection of airway obstruction in defined risk populations in Danish municipalities seems feasible and effective for identifying new patients with COPD. However, additional research is needed in larger samples to confirm the results of the present study.Keywords: chronic obstructive pulmonary disease, screening, spirometry, smoking cessation

Young Ho Jung,1* Doh Young Lee,2* Dong Wook Kim,1 Sung Soo Park,3 Eun Young Heo,3 Hee Soon Chung,3 Deog Kyeom Kim3 1Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 2Department of Otorhinolaryngology-Head and Neck Surgery, Anam Hospital, Korea University Medical Center, 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea *These authors contributed equally to this work Background: Although chronic obstructive pulmonary disease (COPD) is closely associated with gastroesophageal reflux disease (GERD), the clinical significance of laryngopharyngeal reflux (LPR) is not fully understood in COPD.Methods: Prospective cohorts were established among 118 patients with COPD from March 2013 to July 2014. Thirty-two age-matched and sex-matched normal controls, who had routine health check-ups during the study period, were included. Laryngopharyngeal reflux finding scores (RFS) and reflux symptom index (RSI) for LPR were subjected to association analysis with severity and acute exacerbation of COPD during the 1-year follow-up.Results: The mean age of patients enrolled in the study was 69.2±8.8 years, with 93.2% being male. Positive RFS (>7) and RSI (>13) were observed in 51 (42.5%) and six patients (5.0%), respectively. RFS and RSI were significantly higher in patients with COPD than in normal, healthy patients (P<0.001). RFS was significantly correlated with residual volume/total lung capacity (%, P=0.048). Scores for diffuse laryngeal edema, erythema, and hyperemia were significantly higher in the high-risk group (Global Initiative for Chronic Obstructive Lung Disease classification C and D; P=0.025 and P=0.049, respectively), while RSI was significantly higher in the more symptomatic group (Global Initiative for Chronic Obstructive Lung Disease classification B and D; P=0.047). RSI and RFS were significant predictors for severe acute exacerbation of COPD (P=0.03 and P=0.047, respectively), while only RSI was associated with severity of dyspnea.Conclusion: Laryngeal examination and evaluation of laryngeal reflux symptom could be a surrogate clinical indicator related to severe acute exacerbation of COPD. Further studies of LPR in COPD patients should be considered. Keywords: COPD, acute exacerbation, laryngopharyngeal reflux, reflux symptom index, reflux finding scoreA Letter to the Editor has been received and published for this article

Ruolin Mao,1,* Zilong Liu,1,* Yunfeng Zhao,2,* Chunlin Du,3,* Jintao Zhou,4,* Qian Wang,5,* Jinchang Lu,3 Lei Gao,1 Bo Cui,1 Yuan Ma,1 Tieying Sun,6 Lei Zhu,1,7 Zhihong Chen1 1Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University. Shanghai Institute of Respiratory Disease, Shanghai, People's Republic of China; 2Department of Respiratory Disease, Punan Hospital, Pudong New Area, Shanghai, People's Republic of China; 3Department of Respiratory and Critical Care Medicine, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, People's Republic of China; 4Department of Respiratory and Critical Care Medicine, Taicang Hospital Affiliated with Soochow University, Taicang, Jiangsu, People's Republic of China; 5Department of Respiratory Medicine, Jing'an District Zhabei Central Hospital, Shanghai, People's Republic of China; 6Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China; 7Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, People's Republic of China*These authors contributed equally to this workCorrespondence: Zhihong Chen;Tieying Sun Tel +86-21-64041990-2445; +86-10-85132266Fax +86-21-64187165; +86-10-65132969Email chen.zhihong@zs-hospital.sh.cn; suntieying@126.comBackground: Early diagnosis and proper management of a large number of chronic obstructive pulmonary disease (COPD) patients are great challenges for the Chinese health care system. Although tiered medical services have been promoted by the Chinese government since 2015, they have not been ideally implemented for COPD diagnosis and management.Patients and Methods: We designed a cross-sectional study. Eligible COPD patients (n = 648) and physicians (n = 161) were consecutively recruited from 8 hospitals in different tiers in China. COPD characteristics and treatments were compared among hospitals in different tiers. Multivariate logistic regression was performed to identify risk factors associated with airflow limitation, symptoms and acute exacerbation.Results: The PFT rate at first diagnosis was 99%, 69.4% and 29.9% in teaching, second-tier and community hospitals (P < 0.001). Only approximately 10.9%, 1.7% and 9.6% and 21.8%, 6.9% and 32% of COPD patients received influenza or pneumococcal vaccines (P < 0.001). The proportion of patients who did not use inhaled drugs or had irregular inhalation was 2%, 24.6% and 78.8% (P < 0.001). Education level (RR-1 = − 41.26%, P = 0.007), FEV1%pred (RR-1 = − 2.76%, P < 0.001), and influenza vaccination in the last year (RR-1 = − 64.53%, P = 0.006) were all negatively correlated with COPD acute exacerbation (AE). COPD duration (RR-1 = 131.73%, P = 0.009), AE (RR-1 = 151.39%, P < 0.001), and COPD Assessment Test (CAT) scores (RR-1 = 3.82%, P = 0.019) were all positively correlated with COPD airflow limitation severity.Conclusion: Differences exist in the diagnosis, treatment and management of COPD among different tiers of hospitals in China. Teaching hospitals can manage COPD patients relatively well. There are still some gaps compared with developed countries.Keywords: stable chronic obstructive pulmonary disease, tiered medical system, airflow limitation, symptoms, acute exacerbation

Wai Cho Yu,1 Sau Nga Fu,2 Emily Lai-bun Tai,3 Yiu Cheong Yeung,1 Kwok Chu Kwong,1 Yui Chang,1 Cheuk Ming Tam,3 Yuk Kwan Yiu2 1Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong; 2Department of Family Medicine and Primary Healthcare, Kowloon West Cluster, Hospital Authority, Hong Kong; 3Tuberculosis and Chest Service, Department of Health, Government of Hong Kong, Special Administrative Region, Hong Kong Abstract: Spirometry is important in the diagnosis and management of chronic obstructive pulmonary disease (COPD), yet it is a common clinical observation that it is underused though the extent is unclear. This survey aims to examine the use of spirometry in the diagnosis and management of COPD patients in a district in Hong Kong. It is a cross-sectional survey involving four clinic settings: hospital-based respiratory specialist clinic, hospital-based mixed medical specialist clinic, general outpatient clinic (primary care), and tuberculosis and chest clinic. Thirty physician-diagnosed COPD patients were randomly selected from each of the four clinic groups. All of them had a forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio less than 0.70 and had been followed up at the participating clinic for at least 6 months for COPD treatment. Of 126 patients who underwent spirometry, six (4.8%) did not have COPD. Of the 120 COPD patients, there were 111 males and mean post-bronchodilator FEV1 was 46.2% predicted. Only 22 patients (18.3%) had spirometry done during diagnostic workup, and 64 patients (53.3%) had spirometry done ever. The only independent factor predicting spirometry done ever was absence of old pulmonary tuberculosis and follow-up at respiratory specialist clinic. Age, sex, smoking status, comorbidities, duration of COPD, percentage predicted FEV1, body mass index, 6-minute walking distance, and Medical Research Council dyspnea score were not predictive. We conclude that spirometry is underused in general but especially by nonrespiratory physicians and family physicians in the management of COPD patients. More effort at educating the medical community is urgently needed. Keywords: guidelines, pulmonary function tests, specialist

Bai-qiang Cai,1 Shao-xi Cai,2 Rong-chang Chen,3 Li-ying Cui,4 Yu-lin Feng,5 Yu-tong Gu,6 Shao-guang Huang,7 Rong-yu Liu,8 Guang-nan Liu,9 Huan-zhong Shi,10 Yi Shi,11 Yuan-lin Song,6 Tie-ying Sun,12 Chang-zheng Wang,13 Jing-lan Wang,1 Fu-qiang Wen,5 Wei Xiao,14 Yong-jian Xu,15 Xi-xin Yan,16 Wan-zhen Yao,17 Qin Yu,18 Jing Zhang,6 Jin-ping Zheng,3 Jie Liu,6 Chun-xue Bai6 1Department of Pulmonary Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 2Southern Medical University South Hospital, Guangzhou, 3The First Affiliated Hospital of Guangzhou Medical College and Guangzhou Institute of Respiratory Diseases, Guangzhou, 4Affiliate Hospital of Inner Mongolia Medical University, Huhehaote, 5Huaxi Hospital of Sichuan University, Chendu, 6Zhongshan Hospital, Shanghai Medical College, Fudan University and Shanghai Respiratory Research Institute, Shanghai, 7Ruijing Hospital of Shanghai Jiaotong University, Shanghai, 8The First Affiliated University of Anhui Medical University, Hefei, 9The First Affiliated University of Guangxi Medical University, Nanning, 10Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 11General Hospital of Nanjing Military Region, Nanjing, 12Beijing Hospital of the Ministry of Health, Beijing, 13Xinqiao Hospital, Third Military Medical University, Chongqing, 14Qilu Hospital of Shandong University, Jinan, 15Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 16The Second Affiliated Hospital of Hebei Medical University and Hebei Research Institute of Respiratory Medicine, Shijiazhuang, 17The Third Affiliated Hospital of Beijing University, Beijing, 18The First Affiliated University of Lanzhou University, Lanzhou, People's Republic of China Abstract: Chronic obstructive pulmonary disease (COPD) is a common disease that severely threatens human health. Acute exacerbation of COPD (AECOPD) is a major cause of disease progression and death, and causes huge medical expenditures. This consensus statement represents a description of clinical features of AECOPD in the People's Republic of China and a set of recommendations. It is intended to provide clinical guidelines for community physicians, pulmonologists and other health care providers for the prevention, diagnosis, and treatment of AECOPD. Keywords: COPD, AECOPD, recommendations, guidelines

Peranut Kitjakrancharoensin,1 Kittipong Yasan,1 Kwanjira Hongyantarachai,1 Kanoot Ratanachokthorani,1 Jutinun Thammasarn,1 Dantham Kuwuttiwai,1 Thunpimol Ekanaprach,1 Rawisut Jittakarm,1 Rungroj Nuntapravechpun,1 Sirasih Hotarapavanon,1 Spain Kulrattanarak,1 Sarisa Tongkaew,1 Sirivimon Deemeechai,1 Mathirut Mungthin,2 Ram Rangsin,3 Virissorn Wongsrichanalai,4 Boonsub Sakboonyarat3 1Phramongkutklao College of Medicine, Bangkok, Thailand; 2Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand; 3Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand; 4Department of Medicine, Phramongkutklao College of Medicine, Bangkok, ThailandCorrespondence: Boonsub SakboonyaratDepartment of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, ThailandTel +66 859545955Email boonsub1991@pcm.ac.thPurpose: The present study aimed to determine the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among agriculturists in a remote rural community in central Thailand.Methods: A cross-sectional study was conducted in January 2020. Face-to-face interviews were conducted using standardized questionnaires to determine demographic characteristics and risk behaviors. COPD was defined by the spirometric criterion for airflow limitation constituting a postbronchodilator fixed ratio of FEV1/FVC < 0.70 following the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2019. Multivariable logistic regression analysis was used to determine the risk factors for COPD, and the magnitude of association was presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI).Results: A total of 546 agriculturists were enrolled in the study. The overall prevalence of COPD was 5.5% (95% CI: 3.6– 7.4). The prevalence of COPD among males was 8.0% (95% CI: 4.7– 11.3), and 3.2% (95% CI: 1.1– 5.2) among females. The risk factors of COPD included age ≥ 60 years old (AOR 2.7, 95% CI: 1.1– 7.0), higher intensity of smoking (AOR 1.1, 95% CI: 1.0– 1.1), swine farm worker (AOR 4.1, 95% CI: 1.7– 10.3), cattle farm worker (AOR 3.3, 95% CI: 1.4– 8.2) and home cooking (AOR 2.7, 95% CI: 0.8– 9.7).Conclusion: Our data emphasized that COPD was one of the significant health problems among agriculturists in a rural community. Agricultural jobs such as animal farmers and behavioral factors such as smoking were associated with COPD. Effective public health interventions, especially, modifying risk behaviors, should be promoted in remote rural areas to prevent the disease and reduce its morbidity and mortality.Keywords: COPD, farmers, swine, cattle, smoking, Thailand

Ying Lan,1 Nan Yang,2 Yirong Wang,1 Yujie Yang,1 Min Xu,1 Qin He1 1Department of Pharmacy, The Third People's Hospital of Chengdu, Chengdu, People's Republic of China; 2West China School of Pharmacy, Sichuan University, Chengdu, People's Republic of ChinaCorrespondence: Ying Lan, Email lanying0212@126.comBackground: Fixed dose dual bronchodilators such as long-acting muscarinic antagonists (LAMAs) plus long-acting β 2-agonists (LABAs) are a new and important inhaled preparation for COPD treatment in China. Among these, umeclidinium/vilanterol (UMEC/VIL) is increasingly being used in China, especially among the elderly.Purpose: This study aimed to assess the cost-effectiveness of maintenance treatment with UMEC/VIL compared with salmeterol/fluticasone (FSC) as one of the main therapeutic drugs for moderate to very severe COPD in China.Methods: A Markov model was developed to estimate the costs and outcomes from a societal perspective in a 10-year time horizon. Patients with moderate-to-very severe COPD were treated with UMEC/VIL (62.5/25μg) or FSC (50/500ug). Data concerning clinical efficacy, costs, utilities, transition probability, exacerbation rate, and mortality were obtained from the published literature and official government datasets. The costs were presented in US dollars based on 2021 prices. The indicators of total costs, life years (LYs), quality-adjusted life-years (QALYs), and mortality were used as the model output. Costs and outcomes were discounted at a 5% annual rate. Incremental cost-effectiveness ratios were calculated considering the threshold recommended by WHO. One-way and probabilistic sensitivity analyses were conducted to assess the stability of results.Results: Compared with FSC, treatment with UMEC/VIL could save $1947.18, with a gain of 0.12 life-years and 0.05 QALYs. Further, 28.0% patients treated with UMEC/VIL and 29.2% patients treated with FSC were predicted to die after 10 years. Incremental cost effectiveness analysis showed that UMEC/VIL was dominant to FSC. Sensitivity analyses confirmed that the results were robust.Conclusion: UMEC/VIL is a cost-effective treatment option compared with FSC among patients with moderate-to-very severe COPD.Keywords: umeclidinium, vilanterol, salmeterol, fluticasone, cost-effectiveness, COPD, Markov

Wei Zhang,1,* Lili Xu,1,* Shen Gao,2 Nan Ding,2 Ping Shu,1 Zhuo Wang,2 Yuping Li1 1Department of Pharmacy, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People's Republic of China; 2Department of Pharmacy, Changhai Hospital Affiliated to The Second Military Medical University, Shanghai 200433, People's Republic of China*These authors contributed equally to this workCorrespondence: Zhuo Wang; Yuping Li Email wztgyx223@163.com; grace_li_2020@126.comBackground: Proper inhaler technique is highly relevant to the effective management of chronic obstructive pulmonary disease (COPD). The tiotropium bromide spray (TBS) (Spiriva® Respimat®) is a soft mist inhaler (SMI) preferred by patients to pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) because of its convenience in use. However, the technique of using TBS inhaler in the real world is unclear.Objective: To evaluate techniques in using TBS inhaler and investigate the association between the patient characteristics and the correct use of TBS inhaler.Methods: This cross-sectional study enrolled 74 COPD patients who used TBS inhaler device for more than 3 months. The sociodemographic and clinical characteristics of the patients were recorded. The technique of using TBS inhaler was evaluated step by step. Incorrect use was defined as the patient's inability to complete the key steps in the inhalation manoeuvre. The percentage of incorrect use was compared between the groups. Risk factors related to incorrect use were analyzed by logistic regression analysis.Results: Of the 74 participants, only 2 (2.7%) patients completed all the steps correctly, and 48 (64.9%) patients misused the key steps in the inhalation manoeuvre. Incorrect preparation of the TBS inhaler for the first use was the most frequently misused step, accounting for 77.0%. Factors associated with misuse of TBS inhaler included the educational background (p=0.010), living state (p=0.031) and COPD assessment test (CAT) score (p=0.005) of the patients. Additionally, logistic regression analysis showed that the COPD duration was significantly associated with the incorrect use (p=0.019). Compared with patients with a higher educational background, patients with an elementary school background [OR 11652.99, CI: 22.72– 5975697.72], junior high school background [OR 7187.78, CI: 16.41– 3146787] and high school background [OR 1563, CI: 4.27– 572329.67] were more likely to misuse TBS inhaler. Patients living with their spouses alone were also more likely to commit errors in using TBS inhaler as compared with those living with their children [OR 12.29, CI of 1.14– 1.96]. Clinical factors like the COPD symptoms were relative to the technical use of the device. Better technique was accompanied by a lower CAT score [OR 1.49, CI of 1.14– 1.96].Conclusion: The incorrect use of TBS inhaler was common in COPD patients. Healthcare providers should not only teach the patients about the drug preparation but help them use the inhaler correctly. Special attention should be paid to patients with a short COPD duration and a low educational background and those who live without the company of their children. Proper use of TBS inhaler can significantly improve the symptom control of COPD patients.Keywords: chronic obstructive pulmonary disease, inhaler technique, soft mist inhaler, incorrect use

Ju-Hee Park, Jung-Kyu Lee, Eun Young Heo, Deog Kyeom Kim, Hee Soon Chung Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea Purpose: A low body mass index has been associated with high mortalities in patients with chronic obstructive pulmonary disease (COPD), and studies reveal that obesity aggravates the clinical effects of COPD. We investigated the impact of obesity on patients newly identified with COPD.Patients and methods: This population-based, cross-sectional study, used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2010 to 2012. Through analyses of data from this survey, we compared concurrent comorbid diseases, symptoms, and lung functions between an obese and nonobese group of patients with COPD.Results: In total, 618 participants were diagnosed with COPD and the average forced expired volume in 1 s (FEV1) was 79.47%±0.69%. Of the total, 30.5% of the subjects were categorized into an obese group. Subjects in the obese group were likely to have metabolic syndrome (P<0.001), hypertension (P=0.02), and a higher number of comorbidities compared to the nonobese group (2.3±0.1 vs 2.0±0.1, P=0.02). In addition, subjects in the obese group showed a lower forced vital capacity (FVC) than subjects in the nonobese group, even after adjusting for covariates (average FVC%, 89.32±1.26 vs 92.52%±0.72%, P=0.037). There were no significant differences in the adjusted FEV1% and adjusted FEV1/FVC between the groups.Conclusions: Among subjects newly identified with mild COPD, participants in the obese group had more comorbid conditions and showed a lower FVC compared with subjects in the nonobese group, even after adjustment of covariates. These findings show that a combination of obesity and COPD may be a severe phenotype; therefore, early attention should be paid to obesity for the management of COPD patients. Keywords: COPD, obesity, comorbidity, KNHANES, spirometry, lung function

Jung-Kyu Lee,1 Chin Kook Rhee,2 Kyungjoo Kim,2 Seung Won Ra,3 Jae Ha Lee,4 Ki-Suck Jung,5 Kwang Ha Yoo,6 Yoo-Il Kim,7 Deog Kyeom Kim1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea; 3Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 4Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea; 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea; 7Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of KoreaCorrespondence: Deog Kyeom KimDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, #395 Shindaebang-2-Dong, Dongjak-Gu, Seoul 156-707, Republic of KoreaTel +82-2-870-2228Fax +82-2-831-0714Email kimdkmd@snu.ac.krBackground: Methylxanthines and leukotriene receptor antagonists (LTRA) are not a first-line medical treatment for chronic obstructive pulmonary disease (COPD) but are frequently prescribed despite limited evidence. We aimed to elucidate the real prescribing status and clinical impacts of these agents in early COPD patients.Methods: Patients with mild-to-moderate COPD (FEV1>50%) were selected from the Korean National Health and Nutrition Examination Survey data between 2007 and 2012. Besides analyzing the prescription status of methylxanthines and LTRA and the contributing factors to the prescription, we evaluated the clinical impacts of these drugs on the exacerbation, hospitalization, and medical costs.Results: Of 2269 patients with mild-to-moderate COPD, 378 patients (16.7%) were under medical treatments, and the users of methylxanthines and/or LTRA were 279 patients (12.3%); however, only 139 patients (6.1%) were inhaler users. The contributing factors for the prescription of methylxanthines were a comorbidity of asthma or allergic disease, poor lung function, low quality of life, prescribing doctor from the specialty of internal medicine, and an institution type of private hospital. The prescription of LTRA was associated with the comorbidity of allergic disease. The methylxanthine and/or LTRA users had more hospital utilization but did not have significant differences in acute exacerbations and medical cost for hospital utilization, compared with the non-users.Conclusion: Methylxanthines and LTRA were used in a significant proportion of patients with mild-to-moderate COPD in real fields without favorable impacts on the exacerbations, hospitalizations, or medical costs. The use of more effective inhaled medications should be encouraged.Keywords: pulmonary disease, chronic obstructive, methylxanthine, leukotriene antagonists, drug prescriptions

Renly Lim, Mhairi Kerr, Elizabeth E Roughead Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia Background: It is not known if the medicines and services for COPD are used in Australia according to the COPD-X guideline. This study examined the use of medicines and health services for COPD among an Australian cohort to determine if they were consistent with recommendations.Methods: The administrative claims data from the Australian Government Department of Veterans' Affairs were used and included persons aged ≥50 years who were using medicines for COPD in April 2016. Use of medicines was identified using the Anatomical, Therapeutic and Chemical Classification and Pharmaceutical Benefits Scheme. Use of services was identified using the Medicare Benefits Schedule and Australian Government Department of Veterans' Affairs Fee Schedule.Results: Of the 143,261 persons aged ≥50 years, 12,623 (8.8%) were on medicines for COPD. Of the total COPD population, 42% were managed on monotherapy, 36% on dual therapy, 21% on triple therapy, and 1.5% on more than three COPD medicines. Monotherapy comprised tiotropium (80%) predominantly. Services to practitioners who may provide pulmonary rehabilitation service showed less than 10% of the cohort had a claim for a visit to an exercise physiologist and less than a third had a claim for a physiotherapist visit in the prior 12 months. Services to assist with care coordination in the form of general practitioner management plans were only claimed by half of the cohort, while services supporting appropriate medicine use were claimed by less than one in six cases, despite high levels of inhaler use and multiple inhaler use.Conclusion: More than three-quarters of COPD persons aged 50 years and above were managed on either monotherapy or dual therapy, consistent with the guideline recommendations. Almost one-quarter was on three or more therapies, which will create challenges for multiple device management. Many services that may benefit persons with COPD appear to be underutilized. Keywords: Australia, chronic obstructive pulmonary disease, health services administration, medicine utilization

Sergey N Avdeev,1 Alexander A Vizel,2 Vladimir N Abrosimov3 ,† Andrey A Zaicev,4 Galina L Ignatova,5 Rustem F Khamitov,2 Marina P Mikhaylusova,6 Julia S Shapovalova,7 Elena F Pavlysh,8 Basil I Trofimov,9 Alexander V Emelyanov,10 Tatiana I Martynenko,11 Vladimir A Martynenko,12 Natalia E Kostina,13 Danila A Chizhov,14 Olga Yu Chizhova,10 Natalia A Kuzubova,15 Elena V Makova,16 Ekaterina V Makarova17,18 1I.M. Sechenov First Moscow State Medical University, Moscow, Russia; 2Kazan State Medical University, Kazan, Russia; 3Ryazan State Medical University Named After Academician I.P. Pavlov, Ryazan, Russia; 4The Main Military Clinical Hospital Named After Academician N.N. Burdenko, Moscow, Russia; 5Regional Clinical Hospital No. 4, Chelyabinsk, Russia; 6Pirogov Russian National Research Medical University, Moscow, Russia; 7Chelyabinsk Road Clinical Hospital "Russian Railways", Chelyabinsk, Russia; 8Nikiforov's All-Russian Center for Emergency and Radiation Medicine of the Emergencies, St. Petersburg, Russia; 9I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; 10North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia; 11Regional State City Hospital No. 5, Barnaul, Russia; 12Regional State Clinical Hospital, Barnaul, Russia; 13Voronezh Regional Clinical Hospital No. 1, Voronezh, Russia; 14St. Petersburg State City Polyclinic No. 106, St. Petersburg, Russia; 15St. Petersburg State Vvedenskaya City Clinical Hospital, St. Petersburg, Russia; 16State Samara City Hospital No. 4, Samara, Russia; 17Privolzhsky Research Medical University, Nizhny Novgorod, Russia; 18State City Clinical Hospital No. 10, Nizhny Novgorod, Russia†Professor Vladimir Abrosimov passed away on January 22, 2019Correspondence: Sergey N AvdeevI.M. Sechenov First Moscow State Medical University, 8– 2, Trubetskaya St., Moscow, 119991, RussiaTel +7-495-465-74-15Fax +7-495-465-52-64Email serg_avdeev@list.ruBackground: Chronic cough declines quality of life and increases risk of complications in patients with chronic obstructive pulmonary disease (COPD). Reducing cough severity and associated negative effects is important therapeutic goal in COPD. Rengalin with anti- and protussive activity is based on technologically processed antibodies to bradykinin, histamine and morphine.Aim: To evaluate efficacy and safety of Rengalin in treatment of cough in patients with COPD.Methods: Patients (n=238, mean age 64.3± 8.2 years) with stable COPD and persistent cough despite maintenance therapy (anticholinergics, beta-2-adrenergic agonists, inhaled corticosteroids) were included and randomized in the study. The severity of cough assessment (according to the "Cough Severity Score"), COPD impact on patient's life (COPD Assessment Test, CAT), and spirometry were performed at screening. Patients took Rengalin or Placebo 2 tablets 2 times daily for 4 weeks. The endpoints were proportion of patients who responded to treatment, dynamics of cough severity, and severity of COPD symptoms. Intention-to-treat (per protocol) analysis was performed.Results: Positive response to Rengalin was recorded in 83.6 [85.7]% (vs 72.6 [72.7]% in Placebo group, p=0.0422 [p=0.0163]). Double decrease of cough severity was reported in 42.2 [43.8]% in Rengalin group (versus 32.7 [32.7]% in Placebo; p=0.1373 [p=0.0907]). The total CAT score decreased by 3.3± 4.2 [3.6± 3.9] points (versus 2.5± 4.1 [2.5± 4.2] in Placebo group); the difference between groups was 0.79± 4.16 [1.04± 4.02] points (p=0.0870 [p=0.0416]). The number of patients with adverse events (AEs) in Rengalin (n=13) and Placebo (n=12) groups did not have significant differences (p=1.00). No AEs with certain relationship with study drug were registered.Conclusion: Rengalin is an effective and safe drug in patients with stable COPD and persistent cough, despite stable doses of maintenance therapy according to the GOLD guidelines. Four-week therapy decreases severity of cough by two times in more than 40% of patients.Trial Registration: ClinicalTrials.gov (id: NCT03159091).Keywords: cough, cough management, chronic obstructive pulmonary disease, treatment, Rengalin

Yong Suk Jo,1 Ju-Hee Park,2 Jung Kyu Lee,2 Eun Young Heo,2 Hee Soon Chung,2 Deog Kyeom Kim2 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea Background and objective: There are limited data on pulmonary arterial hypertension (PAH) in patients with tuberculosis-destroyed lung (TDL), a sequela of pulmonary tuberculosis. We identified the risk factors for PAH and their effects on acute exacerbation and mortality in patients with TDL, as well as the clinical differences in patients with chronic obstructive pulmonary disease (COPD) and PAH.Methods: A retrospective cohort study was conducted from 2010 through 2015 in a municipal referral hospital in South Korea. PAH was defined when echocardiographic pulmonary arterial pressure (PAP) was >40 mmHg. The clinical features and course of TDL patients with or without PAH were evaluated and differences between patients with COPD and PAH were analyzed.Results: Among the 195 patients with TDL, echocardiographic data were available in 53 patients, and their mean PAP was 50.72±23.99 mmHg. The PAH group (n=37) had a smaller lung volume (forced vital capacity % predicted, 51.55% vs 72.37%, P<0.001) and more extensively destroyed lungs (3.27 lobes vs 2 lobes, P<0.001) than those in the non-PAH group (n=16). A higher PAP was significantly correlated with a higher frequency of acute exacerbation (r=0.32, P=0.02). Multivariate analyses did not reveal any significant risk factors contributing to PAH in patients with TDL. Compared to COPD patients with PAH, TDL patients with PAH have smaller lung volume but a less severe airflow limitation. Tricuspid regurgitation and a D-shaped left ventricle during diastole were more frequently observed in TDL patients. The risk of exacerbation was not different between patients with PAH in COPD and TDL.Conclusion: PAH in patients with TDL was associated with severity of lung destruction but risk of exacerbation and mortality did not significantly differ between patients with PAH and without PAH. Keywords: tuberculous destroyed lung, pulmonary arterial hypertension, chronic obstructive pulmonary disease, exacerbation, risk factor

Yuichi Tawara,1 Hideaki Senjyu,1 Kenichiro Tanaka,1 Takako Tanaka,1 Masaharu Asai,1 Ryo Kozu,2 Mitsuru Tabusadani,3 Sumihisa Honda,1 Terumitsu Sawai1 1Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; 2Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; 3Center for Industry, University and Government Cooperation, Nagasaki University, Nagasaki, Japan Objective: We established a COPD taskforce for early detection, diagnosis, treatment, and intervention. We implemented a pilot intervention with a prospective and longitudinal design in a regional city. This study evaluates the usefulness of the COPD taskforce and intervention based on COPD case detection rate and per capita medical costs.Method: We distributed a questionnaire to all 8,878 inhabitants aged 50–89 years, resident in Matsuura, Nagasaki Prefecture in 2006. Potentially COPD-positive persons received a pulmonary function test and diagnosis. We implemented ongoing detection, examination, education, and treatment interventions, performed follow-up examinations or respiratory lessons yearly, and supported the health maintenance of each patient. We compared COPD medical costs in Matsuura and in the rest of Nagasaki Prefecture using data from 2004 to 2013 recorded by the association of Nagasaki National Health Insurance Organization, assessing 10-year means and annual change.Results: As of 2014, 256 people have received a definitive diagnosis of COPD; representing 31% of the estimated total number of COPD patients. Of the cases detected, 87.5% were mild or moderate in severity. COPD medical costs per patient in Matsuura were significantly lower than the rest of Nagasaki Prefecture, as was rate of increase in cost over time.Conclusion: The COPD program in Matsuura enabled early detection and treatment of COPD patients and helped to lower the associated burden of medical costs. The success of this program suggests that a similar program could reduce the economic and human costs of COPD morbidity throughout Japan. Keywords: chronic obstructive pulmonary disease, systematic intervention, case detection rate, medical cost, longitudinal study