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Author: search.filters.author.Buklioska, AdrianaSubject: search.filters.subject.COPD

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    PREVALENCE OF BRONCHIECTASIS IN COPD PATIENTS
    (2023-01)
    ;
    Mickovski, Ivana
    ;
    Neshovska, Radmila
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    Buklioska, Adriana
    ;
    Trajkova, Vesna
    Introduction - There is increasing recognition that radiological bronchiectasis is present in many patients with COPD. Computed tomography scan images have been used to identify different radiological COPD phenotypes based on the presence and severity of emphysema, bronchial wall thickening, and bronchiectasis. Bronchiectasis is defined as an abnormal dilation of the bronchi, usually as a result of chronic airway inflammation and/or infection. The prevalence of bronchiectasis in patients with COPD is high, especially in advanced stages, estimated prevalence varies from 4% to 50%. Methods - COPD patients underwent chest CT as part of their clinical assessment. Patients were included if COPD was diagnosed based on spirometry and clinical assessment and excluded if there was clinical bronchiectasis. Scoring was by a simplified system based on Smith (Thorax, 1996) and returned a score of 0 (no bronchiectasis), 1 (0–50% of bronchi involved), or 2 (50–100% of bronchi involved) for each lobe, with a total score of 12 including the lingula; emphysema, interstitial lung disease (ILD), or other pathology was noted. A total of 220 COPD patients (77.2% ex- or current smokers, 79.5% male) were consecutively enrolled. Results - Bronchiectasis was present in 54.5% of patients (score ≥2/12) and there was significant inter-observer correlation in the scoring (r=0.63, p<0.0001). Scores were highest in the lower lobes and lowest in the middle lobes (1.66 vs 0.86, p<0.000). Patients with widespread bronchiectasis (score ≥6/12) had a trend towards reduced bronchodilator reversibility (4% vs 9%, p=0.08) than those with limited bronchiectasis. Emphysema was present in 77.2% and ILD in 11.36%. The overall prevalence of emphysema was not different between patients with and without previous pulmonary tuberculosis (PTB) n=30 (13.63%), but in those with previous PTB, a higher number of subjects with middle (p=0.002) and lower (p=0.017) lobe emphysema, higher severity score (p=0.029), higher prevalence of panlobular emphysema (p=0.015), and more extensive centrilobular emphysema (p=0.036) were observed. Conclusions - In this study, we found a higher prevalence of bronchiectasis than previously reported which may reflect the heterogeneity of COPD patients in a general respiratory clinic. Radiological features of bronchial wall thickening and mild bronchiectasis were commonly seen and when widespread this may result in reduced bronchodilator reversibility; however, the presence of radiological bronchiectasis was not related to disease severity. COPD patients with previous PTB had unique features of bronchiectasis and emphysema on HRCT, which were associated with significant dyspnea and higher frequency of severe exacerbations.
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    Chronic Obstructive Pulmonary Disease (COPD) as a risk factor for Metabolic Syndrome (MetS)
    (Slovenian Respiratory Society, 2020-12)
    ;
    Trajkovska, Ivana
    ;
    Buklioska, Adriana
    Background: MetS represents a cluster of risk factors (abdominal obesity, atherogenic dyslipidemia, hypertension and insulin resistance) that predispose affected patients to systemic inflammation, cardiovascular disease and physical inactivity. COPD is a major health problem worldwide, the fourth leading cause of death with prevalence in increase. There is a limited data about the prevalence of MetS in COPD. The aim of the study is to determine the frequency of coexisting MetS in COPD. Methods: Case control study of 120 patients with COPD (82 men and 38 women, aged 40-75 years, mean age 64.2±10.4), diagnosed according to Global Initiative for Chronic Obstructive Lung Disease, 30 healthy non-COPD subjects, randomly selected as controls. Anthropometric measurements, fasting blood sugar (FBS), lipid profile, high-sensitivity C-reactive protein (hsCRP), spirometry, CAT (COPD assessment test) and mMRC (Modified Medical Research Council Dyspnea scale) questionnaires, were assessed. COPD subjects were stratified based on combined assessment test (ABCD criteria) and spirometry (stages I - IV). Results: The presence of MetS was diagnosed in 50(41.67%) of COPD patients vs. 5(16.67%) of controls (p=0.01). The frequencies of the MetS in patients with COPD, GOLD stages I, II, III, and IV, were 50(41,67%), 66(55%), 60(50%), 42(35%) respectively. Frequency of MetS according to combined assessment test (A, B, C, D) was 42(35%), 54(45%), 25(30%), 36(30%) respectively. The presence of MetS was associated with significantly worse cough, sleep and mood (p<0.01) and higher total CAT score (p=0.031). Average BMI was 29.18. There was a correlation between the presence of MetS and hs-CRP (p=0.02) and no correlation with the pulmonary function. FBS was higher in COPD than controls (8.5±1.2mmol/L vs 5.4±1.1mmol/L) with statistical significance (p<0.0001), but HDL was lower in COPD than controls (42.1±5.4mg/dl vs 53±3.6mg/dl) with statistical significance (p<0.0001). Waist circumference and blood pressure were higher in COPD than controls 93.8s±2.4m vs. 92.3±3.1sm, p=0.004, and mean systolic BP 135±10mmHg vs. 113.5±8.1mmHg, p < 0.0001. Conclusion: The high prevalence of MetS in patients with COPD show the urgent need to develop comprehensive strategies for prevention, screening and start of treatment in early stage. Correction of the MetS may have a significant role in prevention of complications related with the COPD.