COPD

To study the electrocardiography and echocardiography findings in COPD patients and to correlate these findings with duration and severity of the disease and compare the results of clinical, ECG and echocardiographic evidence of RV dysfunction. Patients were selected over one year and studied with a detailed history including symptoms, duration of smoking and physical examination. They were investigated with spirometry, ECG and echocardiography. Patients were graded into Mild, Moderate, Severe and Very Severe categories according to GOLD criteria. Statistical analysis of association was done with Chi-square test and statistical significance were taken as p < 0.05.Mean age was 59.9±10.4 years with male predominance. Mean duration of disease was 5.71 years. Patients had a mean duration of smoking of 23.2 ±3.6 pack years. ECG findings showed significant correlation with severity were low voltage complexes and incomplete RBBB and ECHO findings showed significant correlation with RVH, RVF, Pulmonary Hypertension and Cor pulmonale. Diagnosis of the cor-pulmonale clinically was 36%, ECG 56%, echocardiographically 60%. COPD is more common in males in 5th to 7th decade in  the smoking history of more than 20 pack years. Most patients have advanced disease at presentation. The incidence of the ECG and Echo findings increase as the severity and duration of the disease increases and echocardiography is better than ECG or clinical methods in detecting RV dysfunction.

Based on a review of the literature regarding the pathophysiology of hypersecretion across various conditions involving respiratory dysfunction, it would appear there are three main underlying causes for excessive sputum production: hypersecretion of mucus glycoprotein and other glandular products from mucus-producing cells, increased transepithelial chloride secretion, mediated via PGE2, PGF2α, TxB2, excessive transudation of plasma proteins into the respiratory tract. These factors may operate independently or in combination. Asthma is characterised by inflammation, increased luminal mucus, with an increased ratio of MUC5B/MUC5AC and MUC2 present in the mucus, epithelial fragility with loss of ciliated cells, goblet cell hyperplasia, submucosal gland hypertrophy, ‘tethering’ of mucus to goblet cells and plasma exudation. COPD and CF have a similar presentation but with a higher MUC5B/MUC5AC ratio and susceptibility to infection. In contrast with the copious sputum production commonly seen in bronchioalveolar carcinoma, bronchorrhoea is not a common feature of CF, asthma, COPD or other conditions with bronchiectasis, where sputum volumes are lower, and the clinical issue may be related more to the viscosity of mucus than to its quantity. Although dramatic positive effects on the BAC-related bronchorrhoea were seen with octreotide and gefitinib treatment, it is therefore doubtful whether agonist of the SST receptor is of clinical usefulness in these other conditions. The reduction in sputum production in BAC seen with both octreotide and gefitinib is likely a result of modu­lation of the EGF receptor, which is known to be involved in goblet cell metaplasia, even if other mechanisms of action cannot be ruled out.  As such, the mechanism of action is potentially relevant also for other pathologies, although currently available EGF-R inhibitors (gefitinib, erlotinib) and somatostatin are perhaps less well adapted for chronic therapy. In conclusion, bronchorrhoea appears to be a sporadic rather than characterising manifestation of asthma, COPD, cystic fibrosis and non-CF bronchiectasis. As a therapeutic target, therefore, bronchorrhoea is not perceived as a high value proposition in these indications, considering existing treatment options and the clinical and regulatory complexities inherent in demonstrating a favourable risk/benefit ratio in a medically plausible subset of patients.

A study was undertaken to assess both oxidative stress and inflammation in the lungs of patients with chronic obstructive pulmonary disease (COPD) during mild, chronic, severe and acute exacerbations compared with those with stable COPD, healthy smokers, and non-smokers. Levels of interleukin 8 (IL-8) were measured as markers of airway inflammation and TAS levels were measured as a marker of antioxidant status. MDA levels were measured as a marker of oxidative stress status in the serum of COPD patients. Mean serum MDA levels and levels of IL-8 were significantly high in COPD patients and mean serum antioxidant levels were significantly low in patients as compared to non COPD control. It was further observed that the level of MDA and IL8 elevates while that of total antioxidant level falls with the increase in Gold stage and number of smoking pack years amongst the study subjects. Oxidative stress possibly have role in the pathogenesis of COPD and its complications as indicated by the enhanced levels of lipid peroxidation product malondialdehyde and IL-8 in patients. The lower levels of the antioxidant enzyme status point towards that altered antioxidant defense system in patients. Antioxidant therapeutic use and IL-8 antagonists may have clinical usefulness in the treatment of COPD and in preventing its complication and recurrent exacerbations which may improve disease outcome.