Faculty of Medicine

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Author: search.filters.author.Mickovski, IvanaSubject: search.filters.subject.COPD

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    METABOLIC SYNDROME (METS) AS ONE OF THE MAJOR COMORBIDITIES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
    (Association of pulmologists from Republika Srpska, 2023-05)
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    Baloski, Marjan
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    Bushev, Jane
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    Mickovski, Ivana
    Aim: We aimed to investigate the association between COPD and MetS, the relation to the severity of airflow limitation. Methods: This is a cross-sectional study including 220 patients with initially diagnosed COPD (IG), aged 40 to 75 years and 58 non-COPD subjects matched by age, smoking status, body mass index, as controls (CG). All study participants underwent anthropometric measurements, fasting blood sugar (FBS), lipid profile, pulmonary evaluation (dyspnea severity assessment, baseline and postbronchodilator spirometry, gas analyses, chest X-ray). Results: Results presented statistically significant difference in presence of MetS in COPD patients compared to controls (32.27% vs 10.34%; P=0.0009). According to the GOLD classification, the frequencies of MetS in COPD patients were categorized in stages I, II, III, IV (17.54%, 37.10%, 34.62%, 40.82%, respectively). The proportion of patients with increased glycemic values was: a) GOLD1 - 18 (31.58%); b) GOLD 2 - 32 (51.61%); c) GOLD3 - 29 (55.77%); and d) GOLD4 - 31 (63.27%). There was no significant difference between IG and CG patients regarding HDL level. According to arterial hypertension the highest proportion was observed in GOLD3 - 22 (42.31%) followed by GOLD4 - 20 (40.82%), and GOLD3 - 22 (35.48 %), smallest in GOLD1 - 17 (29.82%). Conclusion: We found higher prevalence of MetS in patients with COPD even in early COPD stages compared to non-COPD. Our findings suggest an urgent need to develop comprehensive strategies for prevention, screening and start of treatment in early stage.
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    PREVALENCE OF BRONCHIECTASIS IN COPD PATIENTS
    (2023-01)
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    Mickovski, Ivana
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    Neshovska, Radmila
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    Buklioska, Adriana
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    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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    Metabolic Syndrome (MetS) as a comorbidity of Chronic Obstructive Pulmonary Disease (COPD)
    (European Respiratory Society, 2021-09-05)
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    ;
    Mickovski, Ivana
    ;
    Kamchevska, Nade Kochovska
    We aimed to investigate the association between COPD and MetS, the relation to the severity of airflow limitation and the level of serum C-reactive protein (CRP). Cross-sectional study including 120 patients with initially diagnosed COPD, aged 40-75 years and 60 non-COPD controls, matched by age, smoking status, body mass index. All study participants underwent anthropometric measurements, fasting blood sugar (FBS), lipid profile, CRP, pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, chest X-ray). Results presented statistically significant difference in presence of MetS in COPD patients compared to controls (47.5% vs 20.0%, p=0.0004). According to the GOLD classification, the frequencies of MetS in COPD patients were categorized in stages I, II, III, IV (40.0%, 45.8%, 46.7%, 43.0% respectively), and according to combined assessment test in A, B, C, D (29.2%, 37.5%, 35.0%, 41.7% respectively). COPD patients with MetS presented significant association with CRP (p=0.001) and no association with pulmonary function. FBS was higher in COPD compared to controls (8.4±1.1mmol/L vs. 4.9±2.1mmol/L, p<0.0001), but HDL was lower in COPD than non-COPD (39.1±6.4mg/dl vs 49.6±3.9mg/dl, p<0.0001). Waist circumference and blood pressure (BP) were higher in COPD 95.8±3.4cm vs. control group 91.8±2.9cm, p<0.0001. Mean systolic BP was 138.3±12.2mmHg vs. 125.5±6.1mmHg, p<0.0001 in non-COPD. We found higher prevalence of MetS in patients with COPD even in early COPD stages compared to non-COPD group. Our findings suggest an urgent need to develop comprehensive strategies for prevention, screening and start of treatment in the early stage of the disease.
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    Comorbidities of patients with chronic obstructive pulmonary disease (COPD): thyroid abnormalities in stable COPD
    (VM Media SP. zo.o VM Group SK, 2021-09-30)
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    Mickovski, Ivana
    Objective: The aim of the study is to evaluate the prevalence of thyroid abnormalities in patients with stable chronic obstructive pulmonary disease (COPD) and the relationship between thyroid disorder and ventilatory function tests and arterial blood gas analyses. Material and methods: This cross-sectional study was conducted with 60 patients with stable COPD without diagnosed thyroid disorder before the study (37 males and 23 females aged 40-75) as the Investigated Group (IG) and 30 subjects from the general population without COPD as the Control Group (CG). They were matched by age, gender and body mass index with the IG. All patients underwent laboratory tests, thyroid hormones-free thyroxin (fT4), thyroid-stimulating hormone (TSH), and free triiodothyronine (fT3), pulmonary function tests (FEV 1 , FVC%, FEV 1 /FVC, FEF25-75%), and ABG parameters (PH, PaCO 2 , PaO 2 , HCO 3 , O 2 saturation). The severity level in patients with COPD was determined according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria and classified into four stages GOLD I, II, III, and IV. Results: Our results presented a statistically significant difference between prevalence of thyroid hormones abnormalities in stable COPD compared to controls 18 (30.0%) vs 3 (10.0%), p = 0.0355; p < 0.05). Thyroid dysfunction among COPD patients was more common in females than males. Serum level of TSH was lower than the normal range in 18 patients (30.0%) from the IG and in 3 (10.0%) from the CG, with a statistically significant difference, p = 0.0355; p < 0.05. Thyrotoxicosis with low serum TSH and a higher serum level of fT3, according to the referent range, was present in 8 patients (13.3%), and in no patients from the CG 0 (0.0%), p = 0.0375; p < 0.05. The prevalence of subclinical hyperthyroidism with low serum TSH and normal serum level of fT3 was higher in the IG-10 patients (16.7%) compared with 3 (10.0%) of the CG, but the difference was not statistically significant p = 0.3970. Acute exacerbation frequency of IG was significantly higher than in the CG (1.6 ± 0.42 and 0.82 ± 0.79 respectively; p < 0.0001). A positive significant relationship between acute exacerbation frequency and TSH values was found (p < 0.0001; r = 0.82). The mean values of fT3 in the IG were significantly increasing with the increased severity of COPD. The degree of airflow limitation in COPD (FEV 1 as a percentage of the predicted value, FEV 1 %pred) was significantly negatively correlated to fT3, Pearson correlation, (R =-0.525; p = 0.000; p < 0.01). FEV 1 %pred was positively correlated with TSH (R = 0.358; p = 0.005; p < 0.01). Significant negative correlations were present between fT3 levels and both PaO 2 and SO 2 in the IG, and elevation of fT3 was associated with higher PaCO2. Conclusion: The present study confirms that both clinical and subclinical hyperthyroidism was higher in patients with COPD compared to the non-COPD group. TSH and fT3 are related to lung function. A better understanding of the correlation between thyroid gland disorders and COPD may contribute to better care of patients.