Dissertations / Theses on the topic 'Chronic obstructive pulmonary diseases (COPD)'
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1
Noell, Guillaume. "Multi-Level Integrated Analysis of Chronic Obstructive Pulmonary Disease (COPD) heterogeneity." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667980.
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Non-Communicable Diseases (NCDs), including cancer, cardiovascular (heart diseases or stroke), respiratory (COPD or asthma) and metabolic diseases (diabetes) are chronic conditions that represent a major global health problem of the 21st century. All of them, however, are the end-result of a complex set of gene-environment interactions that develop over years and often lead to several NCDs co-existing in the same individual (multi-morbidity).
Multi-level integrated analysis has the potential to uncover the heterogeneity of NCDs by conceptualizing them as emergent properties of a complex, non-linear, dynamic and multilevel biological system, or network of biological and environmental interactions.
Chronic Obstructive Pulmonary Disease (COPD) is a NCD of increasing prevalence worldwide that is projected to be by 2020 the third leading cause of death worldwide. It is currently viewed as a broad diagnostic term that encompass a continuum of subtypes each characterized by distinct functional or pathobiological mechanisms (endotypes) and is characterized by persistent respiratory symptoms and airflow limitation.
The underlying hypothesis of this PhD Thesis is that multi-level integrated analysis can help us understand highly heterogeneous respiratory diseases such as COPD. Specifically, the following two aspects of COPD heterogeneity will be addressed:
1) Exacerbations of COPD (ECOPD): ECOPD are episodes of worsening of the symptoms whose pathogenesis and biology are not entirely understood. They are heterogeneous events of non-specific diagnosis. Biomarkers analysis and networks medicine were used to uncover novel pathobiological information from the comparison of the multi-level (i.e., clinical, physiological, biological, imaging and microbiological) correlation networks determined during ECOPD and clinical recover. We concluded that ECOPD are characterised by disruption of network homeokinesis that exists during convalescence and can be identified objectively by using a panel of three biomarkers (dyspnoea, circulating neutrophils and CRP levels) frequently determined in clinical practice.
2) Early low lung function and health in later life: In 2015 Lange P. et al. showed that low peak lung function in early adulthood is associated with the diagnosis of COPD later in life. We assessed in three general population cohorts the prevalence of low peak lung function and its association with other clinical or biological parameters - specifically respiratory, cardiovascular, and metabolic abnormalities – as well as incidence of comorbid diseases during follow-up. We concluded that low peak lung function in early adulthood is common in the general population and could identify a group of individuals at risk of early (cardiovascular, metabolic and systemic) comorbidities and premature death.
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Baldrick, Francina Rose. "Diet and chronic obstructive pulmonary disease (COPD)." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527657.
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John, Michelle. "The extra-pulmonary effects of chronic obstructive pulmonary disease (COPD)." Thesis, University of Nottingham, 2014. http://eprints.nottingham.ac.uk/14405/.
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Rationale Cardiovascular disease (CVD) is a leading cause of mortality in patients with COPD. Aortic stiffness, measured using aortic pulse wave velocity (PWV), an independent, non-invasive, predictor of CV risk; and inflammatory markers are increased in COPD. Screening tools for community based identification of increased CVD risk, and a proactive approach to addressing primary prevention of CVD is needed. Statins modulate aortic stiffness and are anti-inflammatory, but are not currently used for primary prevention in COPD. Objectives Proof of principle double-blind Randomised Control Trial (RCT) to determine if six weeks simvastatin 20mg od reduces aortic stiffness, systemic and airway inflammation in COPD. Cross-sectional pilot study comparing a non-invasive measure of oxidative stress (skin “AGE”) in COPD and controls, to lung function and aortic stiffness. Methods Stable patients (n=70) were randomised to simvastatin or placebo treatment. Pre- and post-treatment aortic stiffness, blood pressure, spirometry, circulating inflammatory mediators and lipids were measured; airway inflammatory markers were performed where possible. Predefined subgroup analysis was performed where baseline aortic PWV >10m/s. For the cross-sectional study stable COPD patients (n=84) and controls (n=36) had lung function, arterial stiffness and skin AGE measured. Results In the RCT the active group achieved significantly lower total cholesterol, but no significant drop in aortic PWV compared to placebo group: -0.7(95%CI -1.8,0.5)m/s, p=0.24; or inflammatory markers. In those with higher baseline aortic PWV, n=22, aortic PWV improved in the active group compared to placebo: -2.8(-5.2,-0.3)m/s, p=0.03. Skin AGE was increased in COPD compared to controls, inversely related to lung function, and directly related to aortic stiffness. Conclusions We could not detect any significant difference in the change in aortic PWV in patients with COPD taking simvastatin compared to placebo. We did, however, report a significant and clinically relevant reduction in aortic PWV in those with high baseline aortic stiffness, suggesting a potential for statins to reduce CV morbidity in high risk individuals. The pilot cross-sectional study suggests there is an indication to assess the potential role of skin AGE in patients with COPD as a non-invasive measure of CV risk.
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Alhaddad, Maath. "Cardiopulmonary manifestations in chronic obstructive pulmonary disease (COPD)." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/30008/.
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Rationale Chronic obstructive pulmonary disease (COPD) is a progressive lung condition with extrapulmonary manifestations- cardiovascular diseases (CVD), impaired physical function, activity and increased frailty. Integrating measures of function into community assessments is hindered by the space and time required. The association of function, activity and CVD has not been extensively investigated in COPD. Objectives Explore the potential utility of Time Up and Go (TUG) as a measure of physical function in COPD Assess association of non-invasive measures of haemodynamics to physical function and self-reported activity Explore ambulatory haemodynamics in COPD and controls Methods Subjects with COPD (n=119) and controls (n=58) were recruited. Ethical and governance approvals were obtained. A medical history including falls, spirometry, peripheral and central haemodynamics, self-reported physical activity questionnaires and functional assessments (TUG and six-minute walk distance (6MWD)) were obtained from all subjects. Ambulatory 24-hour haemodynamics including aortic pulse wave velocity (aPWV) and blood pressure were measured in patients (n=20) and controls (n=19). Results TUG mean(SD) was increased in patients 11.9(3.7)s compared to controls 9.5(1.8)s, p < 0.001. In patients, fallers had longer TUG than non-fallers (p=0.02) and a cut-off time of 12s had the highest sensitivity and specificity to detect fallers and non-fallers. Aortic stiffness was not associated to physical function or physical activity, p > 0.05. In the pilot study, significant nocturnal dip in aPWV was seen in controls, p < 0.01, but not in patients, p=0.07. Conclusion TUG could be a useful measure of function and possibly be incorporated into COPD assessment, particularly where time and space are limited. Finally, ambulatory haemodynamic machine, the Mobil-O-Graph, is feasible and offers opportunity to assess 24-hour haemodynamics profile including aPWV as opposed to a one-off measurement.
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McAllister, David Anthony. "Chronic obstructive pulmonary disease, pulmonary function and cardiovascular disease." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5615.
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Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in the systemic vasculature have been proposed as potential mechanisms linking COPD to cardiovascular disease, and patients with COPD may be at increased risk of acute myocardial infarction during acute exacerbations. Notwithstanding causation, FEV1 may be a useful prognostic marker in patients undergoing cardiac surgery. This thesis examined these three aspects of cardiovascular co-morbidity in relation to COPD and FEV1. In 2,241 consecutive cardiac surgery patients, FEV1 was associated with length of hospital stay (p<0.001) and mortality (p<0.001) adjusting for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, chronic pulmonary disease, and type/urgency of surgery. In a survey of Scottish Respiratory Consultants there was no consensus regarding the investigation and management of acute coronary syndrome in exacerbation of COPD. In a case-series of 242 patients with exacerbations 2.5% (95% CI 1.0 to 5.6%) had chest pain, raised serum troponin and serial electrocardiogram changes suggestive of acute coronary syndrome. However, over half reported chest pain, while raised troponin was not associated with chest pain or serial ECG changes. Carotid-radial pulse wave velocity (PWV), aortic distensibility, and aortic calcification were measured to assess the relationship of the systemic vasculature to FEV1 and emphysema severity on CT. In adjusted analyses, emphysema was associated with PWV in patients with COPD (p = 0.006) and, in population based samples, with extent of distal aortic calcification (p=0.02) but not with aortic distensibility (p=0.60). This thesis found that FEV1 was associated with mortality and length of hospital stay in patients undergoing cardiac surgery, and that chest pain and raised troponin were common but unrelated in exacerbation of COPD. In the vascular studies distal but not proximal vascular pathology was associated with FEV1, and if COPD is truly related to systemic arterial disease, the distal arterial tree is implicated.
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Ubhi, Baljit Kaur. "A metabolomic study of chronic obstructive pulmonary disease (COPD) and its phenotypes." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608237.
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McPherson, E. A. "Equine chronic obstructive pulmonary disease (COPD) : publications 1974-1985." Thesis, University of Edinburgh, 1988. http://hdl.handle.net/1842/28607.
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Jones, Sharon Scardina. "Evaluating a Discharge Bundle for Chronic Obstructive Pulmonary Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4861.
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Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the leading causes of hospital readmissions within 30 days. Frequent readmissions negatively affect hospital reimbursements and patient outcomes. Creative strategies, such as COPD care bundles, have been shown to reduce readmission rates according to existing studies. A COPD discharge bundle was developed and implemented at 1 community hospital in response to an identified problem with COPD readmissions. Evaluation of this quality improvement initiative was the purpose of this project study. The practice-focused question was: Have 30-day readmission rates changed following the implementation of a COPD discharge bundle prior to transitioning from hospital to home? The framework selected for this project was the model for improvement. Sources of evidence included existing hospital data to evaluate the change in readmissions. The chi-square test of independence was used to assess the difference in frequency of 30-day readmissions. Pre and post-bundle implementation comparisons of readmission rates showed a decrease for 3 out of the 4 groups compared; these results were not statistically significant. Analysis of the post-bundle intervention groups revealed lower 30-day readmissions for individuals who were bundle compliant versus noncompliant and for those who spoke with a pharmacist within 48 hours of discharge opposed to those who did not; these results were statistically significant. Continued use of the bundle and maintaining the role of the pharmacist was recommended. Reduction of readmissions within 30-days has positive social implications for hospitals through financial gains and for the COPD population by improving overall health outcomes.
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Haddad, Donna L. "Nutritional status indicators in hospitalized patients with chronic obstructive pulmonary disease (COPD)." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=67536.
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Malnutrition, as evidenced by low weight for height, low triceps skinfold thickness and low midarm muscle circumference, is prevalent among COPD patients. A stepped decline in nutritional status has been postulated as a mechanism for malnutrition wherein patients progressively suffer weight loss with each COPD exacerbation. A randomized clinical trial of continuous enteral nutrition could not successfully address whether or not the stepped decline in weight can be prevented. Despite this, sixteen patients admitted for a COPD exacerbation, participated in an observational prospective study wherein anthropometric, biochemical, dynamometric, respiratory, general well-being and energy consumption measures were obtained. Twelve patients had body weights below 90% of ideal weight. The mean energy intake was 107% $ pm$ 30 of estimated resting energy expenditure. Measures were repeated to assess changes during hospitalization. Weight change was a poor indicator of nutritional status. Midarm muscle circumference and handgrip strength appear to be useful as nutritional status indicators among unstable hospitalized COPD patients. Changes in handgrip strength and midarm muscle circumference were closely linked (r =.78, p $<$ 0.0005) and tended to decrease over the course of hospitalization despite clinical improvement. In the absence of adequate nutrition, COPD patients have at least as much risk of developing iatrogenic malnutrition as are other hospitalized medical patients.
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Baril, Jacinthe. "Interaction between circulatory and respiratory exercise adaptation in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF)." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97901.
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Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients show a marked reduction in exercise capacity compared to that of healthy age-matched individuals. While inadequate gas exchange and resulting hypoxemia appears as the primary factor in COPD, an impaired cardiac output is the predominant explanation for the reduced oxygen delivery in CHF. However, the extent of the contributions of other systemic factors remains unclear. In light of the potential interactions between cardiac output (Qc) and pulmonary hyperinflation, there is surprisingly little data thus far on ventilatory constraints in CHF and on the role of blood flow delivery in COPD which may further limit the exercise capacity. Thus, the purpose of this study was to compare the slope of the Qc versus oxygen uptake (VO2) response through several submaximal cycling loads in patients with moderately severe COPD and with that of moderate to severe CHF patients as well as age-matched healthy control subjects (CTRL). Also examined was the possibility that ventilatory constraints such as dynamic hyperinflation contribute to an abnormal stroke volume response in both diseases. Cardiac output was measured using the CO 2-rebreathing equilibrium technique during baseline conditions and cycling at 20, 40 and 65% of peak power in 17 COPD (Age: 64 +/- 8 yrs; FEV 1/FVC: 37 +/- 11%; FEV1: 41 +/- 15 % predicted), 10 CHF (Age: 57+/- 10 yrs; FEV1/FVC: 73.8 +/- 5.6%; FEV 1: 93 +/- 13% predicted) and 10 age-matched CTRL subjects. Inspiratory capacity (IC) was also measured for the determination of dynamic hyperinflation during the steady state exercise bouts. The results indicate that while the absolute Qc values are lower in COPD and in CHF than in CTRL during 65% peak power cycling (11.30 +/- 2.38 vs 12.40 +/- 2.08 vs 15.63 +/- 2.15 L•min-1 respectively, p < 0.01), likely due to their lower exercise metabolic demand. The Qc/VO2 response to increasing levels of exercise intensity was lower or normal in CHF patients compared to CTRL, while normal or hyperdynamic in most COPD patients. Indeed, the majority of patients with COPD exhibited Qc/VO2 slopes greater than 7.0, which may be indicative of a peripheral muscle bioenergetic disturbance that may drive the need for greater oxygen delivery, and thus result in an exaggerated central circulatory response.
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Wadell, Karin. "Physical training in patients with chronic obstructive pulmonary disease - COPD." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-363.
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Bodduluri, Sandeep. "Analysis of chronic obstructive pulmonary disease (COPD) using CT images." Thesis, University of Iowa, 2012. https://ir.uiowa.edu/etd/2441.
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Chronic Obstructive Pulmonary Disease (COPD), a growing health concern, is the fourth leading cause of death in the United States. While people habituated to smoking constitute the highest COPD susceptible population, people exposed to air pollution or other lung irritants also form a major group of potential COPD patients. COPD is a progressive disease that is characterized by the combination of chronic bronchitis, small airway obstruction, and emphysema that causes an overall decrease in the lung elasticity affecting the lung tissue. The current gold standard method to diagnose COPD is by pulmonary function tests (PFT) which measures the extent of COPD based on the lung volumes and is further classified into five severity stages. PFT measurements are insensitive to early stages of COPD and also its lack of reproducibility makes it hard to rely on, in assessing the disease progression. Alternatively, Pulmonary CT scans are considered as a major diagnostic tool in analyzing the COPD and CT measures are also closely related to the pathological extent of the disease. Quantification of COPD using features derived from CT images has been proven effective. The most common features are density based and texture based. We propose a new set of features called lung biomechanical features which capture the regional lung tissue deformation patterns during the respiratory cycle. We have tested these features on 75 COPD subjects and 15 normal subjects. We have done classification of COPD/Non COPD on the dataset using the three feature sets and also performed the classification all these subjects to their corresponding severity stage. It is shown that the lung biomechanical features were also able to classify COPD subjects with a good AUC. It is also shown that, by combining the best features from each feature set, there is an improvement in the classifier performance. Multiple regression analysis is performed to find the correlation between the CT derived features and PFT measurements.
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Lewis, A. "Chronic Obstructive Pulmonary Disease (COPD) : patient experiences of COPD and pulmonary rehabilitation : an applied phenomenological study." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/349087/.
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Attendance at Pulmonary Rehabilitation (PR) in the UK is sub-optimal and reasons for this have been explored. However, Chronic Obstructive Pulmonary Disease (COPD) patient experiences have rarely been explored longitudinally through PR regardless of patient participation. Therefore, understanding sub-optimal attendance remains limited for the broad population who are referred. Furthermore, limited Primary Care PR research has been performed, where many programmes are run in the UK. This research aimed to explore COPD patient experiences before and after PR, whether they completed, did not attend, or dropped out of PR. Twenty five participants with COPD (14 males, 11 females) were recruited from two Primary Care Trusts in the UK. These 25 participants were interviewed before PR. Fifteen of the 25 participants were interviewed again after PR regardless of attendance or completion status. Data were collected during semi-structured interviews using phenomenological research methodology. In the pre-programme interviews, participants experienced uncertainty living with COPD in their past, present and future. Uncertainty manifested itself in participants' experience of panic. However, participants compared their condition with others positively. Participants were uncertain about what to expect from PR and the causes and pathophysiology of their COPD. Prior to PR participation, participants were brought closer to the experience of dying, through their breathlessness. The experience of uncertainty reduced following PR programme completion. Non-completers seemed angry with their care, less able to cope with comorbidities or wished to remain naïve regarding COPD. Pulmonary Rehabilitation seemed to enable participant completers to push their perception of being close to dying further into their future. This appeared to strengthen hope and enable a positive attitude to develop. The importance of social comparison in PR and how to manage patients who wish to remain ‘in the dark’ requires further research.
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Hallin, Runa. "Nutritional Depletion in Chronic Obstructive Pulmonary Disease (COPD) : Effect on Morbidity, Mortality and Physical Capacity." Doctoral thesis, Uppsala universitet, Institutionen för medicinska vetenskaper, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9512.
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The overall aim of this work was to examine the effects of depleted nutritional status on some aspects of Chronic Obstructive Pulmonary Disease (COPD). Morbidity. In paper І, we found that energy intake was lower than the calculated energy demand for all patients. A low body mass index (BMI) at inclusion and weight loss, during the one year follow-up period were independent risk factors for having a new exacerbation (p = 0.003 and 0.006, respectively). Mortality. Nineteen percent of the patients in paper ІІ, where underweight (BMI<20). A significant positive correlation was found between BMI and FEV1, and this correlation remained significant after adjustment for age, sex and pack years (p<0.0001). Being underweight was related to increased overall mortality and respiratory mortality but not to mortality of other causes, 19% of the patients had died within 2 years. The lowest mortality was found among the overweight patients (BMI 25-30 kg/m). Physical capacity and effect of training. In paper ІІІ we investigated baseline characteristics of patients that were starting physical training. We found that peak working capacity was positively related to BMI (r=0.35, p=0.02) and fat free mass index (FFMI) (r=0.49, p=0.004) and negatively related to S-Fibrinogen and serum C reactive protein (S-CRP). BMI and FFMI were significantly related to the 12 minutes walking distance when adjusted for body weight. Fifty to 76% of the variation in physical capacity was accounted for when age, gender, FEV1, FFMI and CRP were combined in a multiple regression model. In Paper ІV the median change in fat free mass (FFM), after 4 months of physical training was 0.5 kg. Old age, low FEV1 and high level of dyspnoea were independent negative predictors of FFM increase after the training period. In conclusion nutritional status is an important determinant of morbidity, mortality and physical capacity in COPD. Low FEV1 and high level of dyspnea are negative predictors for increased FFM after physical training.
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Lethbridge, Mark William. "The role of T cells in chronic obstructive pulmonary disease (COPD)." Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.407475.
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Johnson, Lorna Claire. "Respiratory and peripheral muscle with severe chronic obstructive pulmonary disease (COPD)." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.420413.
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McGorum, Bruce C. "Studies on the aetiopathogenesis of equine chronic obstructive pulmonary disease (COPD)." Thesis, University of Edinburgh, 1992. http://hdl.handle.net/1842/30476.
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Inhalation challenges with antigenic extracts of Micropolyspora faeni and Aspergillus fumigatus induced pulmonary disease, similar to naturally occurring chronic obstructive pulmonary disease (COPD), only in COPD affected horses, implicating these agents in the aetiology of equine COPD. In this study, bronchoalveolar lavage fluid (BALF) cytology examination proved to be the most valuable technique for detecting pulmonary disease. Two methods for standardising the variable recovery of pulmonary epithelial lining fluid (PELF), in BALF, namely the urea and albumen dilution techniques, were evaluated in the horse. While both techniques proved to be satisfactory, the former was considered to be more accurate. Comparison of the cellular and molecular components of BALF collected from different lung segments suggested that the composition of PELF is uniform throughout the lungs of control and symptomatic COPD affected horses. COPD affected horses had a significantly increased PELF histamine concentration at 5h, but not at 0.5h, after 'natural (hay and straw) challenges', suggesting involvement of a late phase, pulmonary mast cell/basophil mediated hypersensitivity response in the pathogenesis of equine COPD. Natural challenge significantly increased the ratios of CD4+ , T helper/inducer lymphocytes and significantly reduced the ratios of CD8+ , T suppressor/cytotoxic lymphocytes in BALF from COPD affected horses, suggesting that T lymphocytes have an important role in the pathogenesis of equine COPD. Prior to challenge, COPD affected horses had significantly higher BALF B lymphocyte ratios than controls, suggesting a role for B lymphocytes in the pathogenesis of equine COPD.
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Collins, Peter Francis. "Nutritional screening and nutritional support in chronic obstructive pulmonary disease (COPD)." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/379646/.
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Malnutrition is a common problem in chronic obstructive pulmonary disease (COPD) and associated with poorer prognosis. Currently controversies surround the importance of nutritional intervention and how best to nutritionally manage those identified as at risk of malnutrition. Dietary advice (DA) and oral nutritional supplements (ONS) are two of the most common first line treatments for malnutrition in COPD but the evidence base for DA is lacking and for ONS appears uncertain. To date there have been no randomised trials comparing these two treatments in COPD. The aims of this thesis were three-fold, firstly, to establish the local prevalence of malnutrition in UK outpatients with COPD and examine the impact of malnutrition on clinical outcomes (healthcare use, mortality). Secondly, to perform a systematic review to clarify the current evidence for nutritional support in stable COPD patients and finally, to carry out a randomised trial comparing the effectiveness of a 3-moht intervention of DA versus ONS in improving quality of life (QoL) in stable outpatients with COPD. The prevalence of malnutrition was high in outpatients with COPD (22% at risk), with a lower BMI being a strong significant independent predictor of mortality and increased emergency healthcare use. Contrary to previous reviews, the current systematic review found that nutritional support, mainly involving ONS, resulted in significant improvements in nutritional intake, body weight and anthropometry as well as several functional outcomes. For several reasons, an RCT investigating DA vs. ONS that was undertaken as part of this work was underpowered and did not find any improvements in outcomes of interest although both groups maintained weight and function possibly indicating a treatment effect. When pre- and post-intervention analysis was carried out combining both interventions (ONS + DA) significant improvements in energy and protein intakes, body weight and non-dominant handgrip strength were observed. However, with a small sample and the absence of a control group these results should be interpreted with caution. Nutrition support is effective at treating malnutrition in COPD but the results from this thesis appear to suggest that earlier intervention is required. This highlights to importance of accurate nutritional screening and assessment in this patient group.
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Ravi, Arjun Kumar. "Macrophages, monocytes and interleukin-6 in chronic obstructive pulmonary disease." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/macrophages-monocytes-and-interleukin6-in-chronic-obstructive-pulmonary-disease(806db259-02de-4d50-8c2e-5b57cb2425c0).html.
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Background: COPD is associated with an increased lung macrophage burden. Whilst lung macrophages may self-renew, recruitment of peripheral blood monocytes from the systemic circulation is considered to represent their principal means of replenishment. Through modulating expression of monocytic chemokines CCL2/CCL3 and their respective receptors (CCR2/CCR1+CCR5), IL-6 could play a key role in facilitating the recruitment of monocytes to the lungs of COPD patients. COPD is associated with enhanced pulmonary and systemic IL-6 levels; concentrations of the soluble IL-6 receptor sIL-6R may be an important determinant of IL-6 signalling in COPD. Trans-signalling through sIL-6R, IL-6 may facilitate recruitment of monocytes in COPD by influencing chemokine and chemokine receptor expression. Aims: 1) To compare levels of IL-6, sIL-6R, CCL2 and CCL3 in the plasma and sputum of COPD and controls. 2) To examine of the effects of IL-6 stimulation on monocyte chemokine receptor gene expression (CCR1, CCR2 and CCR5). 3) To compare subtypes (CD14++CD16-, CD14+CD16+, CD14-CD16++) and chemokine receptor expression (CCR1, CCR2, CCR5) of monocytes in COPD (paired stable & exacerbating) and controls. 4) To compare the migratory ability of monocytes from COPD and controls. 5) To compare numbers of marginated CX3CR1+ monocytes in the pulmonary microvasculature and proliferation status (Ki67 positivity) of alveolar macrophages in COPD and controls. Methods: 1) MSD soluble marker analysis was performed on plasma and sputum supernatant. 2) Monocytes underwent stimulation with IL-6 and sIL-6R; chemokine receptor expression was determined by quantitative PCR. 3) Flow cytometry was performed on whole blood to determine monocyte subtype and chemokine receptor expression. 4) Monocyte migration towards sputum supernatant was assessed using a transwell system incorporating fluorescence based detection of DNA from migrated cells. 5) Immunofluorescence and immunohistochemistry was performed on lung tissue (obtained from patients undergoing surgical resection of lung carcinoma) to identify marginated (CX3CR1+CD14+, CX3CR1+CD16+) monocytes and proliferating alveolar macrophages (Ki67) respectively. Results and Conclusion: Levels of sIL-6R were increased in the lungs and systemic circulation of COPD patients implying potential for enhanced IL-6 trans-signalling: monocytes cultured in the presence of IL-6+sIL-6R upregulated expression of the CCR5 gene. A greater proportion of circulating COPD CD14++CD16- and CD14+CD16+ monocytes were demonstrated to express CCR5 compared to controls indicating that CCR5 ligands may have an important influence over monocyte migration in COPD. Levels of CCR5 ligand CCL3 were significantly elevated in COPD sputum supernatant; IL-6 levels were positively associated with CCL3 indicating that IL-6 trans-signalling may mediate lung chemokine expression. Nevertheless, COPD monocytes demonstrated impaired migration towards sputum supernatant and reduced margination to pulmonary microvessels. Despite this, the number of alveolar macrophages in COPD was increased; however this was not likely to be related to self-replication owing to low alveolar macrophage Ki67 expression.
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Bhunthurat, Anurak. "The Vitamin B-6 Status of Patients with Chronic Obstructive Pulmonary Disease." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc500541/.
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The problem of this study is to determine the vitamin B-6 status of patients who have chronic obstructive pulmonary disease (COPD). Erythrocyte aspartate transaminase assay was the method for measuring vitamin B-6 status. The vitamin B-6 status was examined in thirty subjects (ten COPD subjects and twenty control subjects). An unpaired t-test was used to compare the vitamin B-6 status of the COPD group versus the control group. Four determinants (percentage stimulation, ratio of basal to stimulated activity, basal activity, and stimulated activity) were used to determine vitamin B-6 status in both groups of subjects. Percentage stimulation and ratio of basal to stimulated activity were not significantly different (control group versus COPD group) at the .05 level. However, two of ten COPD subjects had values for percentage stimulation that were two standard deviations above the mean, indicating a poor B-6 status. In contrast, basal activity and stimulated activity of erythrocyte aspartate transaminase were found to be significantly lower at the .05 level in the COPD group than the control group. Therefore, the COPD subjects as a group had some biochemical characteristics of a lower level of vitamin B-6 than the controls.
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Pakhale, Smita. "Development and Validation of the new McGill COPD Quality of Life Questionnaire." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=95663.
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Introduction: There is a need for a health-related quality of life questionnaire in COPD that fulfills the advantages of both, generic and disease-specific questionnaires. Objective: To finalize the development of a new, hybrid questionnaire (disease-specific items supplemented with items from the SF-36), the McGill COPD Quality of Life Questionnaire and to evaluate its psychometric properties (reliability, validity, responsiveness) in COPD subjects. [...]Introduction: Il y a nécessité d'avoir accès à un questionnaire de qualité de vie qui pourrait offrir les avantages d'un questionnaire générique et ceux d'un questionnaire spécifique à la MPOC. Objectif: Finaliser l'élaboration d'un nouveau questionnaire hybride le 'McGill COPD Quality of Life Questionnaire' (éléments spécifiques à la maladie complémentés d'éléments génériques issus du SF-36) et évaluer ses propriétés psychométriques (fiabilité, validité, réponse au changement) chez les sujets atteint d'une MPOC. [...]
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Reavell, Colleen Frances. "Resolution of muscle wasting during an acute exacerbation of chronic obstructive pulmonary disease (COPD)." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0031/MQ64435.pdf.
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Arnardóttir, Ragnheiður Harpa. "Physical Training and Testing in Patients with Chronic Obstructive Pulmonary Disease (COPD)." Doctoral thesis, Uppsala University, Department of Medical Sciences, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7632.
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The overall aims of the studies were to investigate the effects of different training modalities on exercise capacity and health-related quality of life (HRQoL) in patients with moderate or severe COPD and, further, to explore two of the physical tests used in pulmonary rehabilitation.
In study I, the 12-minute walking distance (12MWD) did not increase on retesting in patients with exercise-induced hypoxemia (EIH) whereas 12MWD increased significantly on retesting in the non-EIH patients. In study II, we found that the incremental shuttle walking test was as good a predictor of peak exercise capacity (W peak) as peak oxygen uptake (VO2 peak) is. In study III, we investigated the effects of two different combination training programmes when training twice a week for eight weeks. One programme was mainly based on endurance training (group A) and the other on resistance training and callisthenics (group B). W peak and 12MWD increased in group A but not in group B. HRQoL, anxiety and depression were unchanged in both groups. Ratings of perceived exertion at rest were significantly lower in group A than in group B after training and during 12 months of follow-up. Twelve months post-training, 12MWD was back to baseline in group A, but significantly shorter than at baseline in group B. Thus, a short endurance training intervention delayed decline in 12MWD for at least one year. Patients with moderate and severe COPD responded to training in the same way. In study IV, both interval and continuous endurance training increased W peak, VO2 peak, peak exhaled carbon dioxide (VCO2 peak) and 12MWD. Likewise, HRQoL, dyspnoea during activities of daily life, anxiety and depression improved similarly in both groups. At a fixed, submaximal workload (isotime), the interval training reduced oxygen cost and ventilatory demand significantly more than the continuous training did.
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Arnardóttir, Ragnheiður Harpa. "Physical training and testing in patients with chronic obstructive pulmonary disease (COPD) /." Uppsala : Acta Universitatis Upsaliensis, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7632.
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Forslund, Linus, and Emil Sjödin. "Experiences of living with Chronic Obstructive Pulmonary Disease (COPD) : A literature review." Thesis, Umeå universitet, Institutionen för omvårdnad, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-161652.
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Brandén, Eva. "Chronic infection with Chlamydia pneumoniae in COPD and lung cancer." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-344-2/.
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Suh, Sooyeon. "STRESS, ANXIETY, AND HEART RATE VARIABILITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1275495558.
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Kren, Erin McGuire. "Physical Activity and Veteran Status in Obesity and Chronic Obstructive Pulmonary Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4931.
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There are few data available regarding the relationship between physical activity and veteran status in those with combined chronic obstructive pulmonary disease (COPD) and obesity. COPD is a common illness and a leading cause of death in the United States. Veterans represent a distinct subpopulation in the United States and are more likely to have COPD, which is a disease with a high rate of comorbidities such as obesity. Physical activity can improve outcomes for those with COPD and obesity. However, recommendations for physical activity for those with COPD and obesity are vague. This study, based on the self-determination theory, sought to explore the relationship between average weekly physical activity and veteran status while controlling for age, sex, race, ethnicity, smoking status, body mass index (BMI), education level, and annual household income in those with comorbid COPD and obesity. Also, the relationship between not meeting, meeting, and exceeding physical activity recommendations and veteran status, while accounting for variation in for age, sex, race, ethnicity, smoking status, BMI, education level, and annual household income, was explored. A case-control study was done to answer the research questions using multiple regression and ordinal regression analyses, respectively, using data from 1,430 participants from the 2015 BRFSS. Veteran status was not significantly associated with physical activity nor was it significantly associated with falling below, at, or above recommended physical activity amounts. However, it was found that increased BMI was associated with decreased physical activity. The results from this study can be used to inform policies, refine recommendations, and guide interventions for those with COPD and obesity.
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Rittmaster, Dana. "Anthropometric, clinical and lifestyle determinants of exercise energy expenditure in patients with chronic obstructive pulmonary disease (COPD)." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82412.
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Total body fat and muscle mass depletion has been reported in some patients with COPD. This study used simple anthropometric measurements to compare the body composition of patients with moderate-severe COPD to that of healthy controls, and examines relationships between body composition, disease severity, habitual physical activity and resting and exercise energy expenditure. Results show no significant differences in overall Heath-Carter somatotype characteristics, percent body fat, fat free mass and girth measurements between COPD and control subjects although when stratified by gender, female COPD patients exhibited a greater body fat component. Measured VO2 (L/min) at rest or during steady-state exercise was not significantly different between COPD and control subjects despite a higher exercise ventilation in patients. Neither resting or exercise energy expenditure was related to body composition, however it was related to DLCO/VA (ml·min-1·mmHg -1·L-1). Findings from this study suggest that COPD patients capable of participating in dynamic exercise studies do not exhibit total body fat and muscle depletion. Findings in women suggest that the relative decrease in FFM may be related to a relatively higher proportion of body fat and not a decrease in absolute muscle mass.
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De, Souza Melissa. "Central circulatory adaptations to low and high intensity cycling in patients with chronic obstructive pulmonary disease (COPD)." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84021.
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Chronic obstructive pulmonary disease (COPD) is characterized by an expiratory flow limitation, as well as an evident reduced exercise capacity compared to that of healthy age-matched individuals. Clearly, the expiratory flow limitation plays a significant role in this exercise intolerance; however, the extent of the contributions of other systemic factors remains unclear. More specifically, there is little data thus far on the role of blood flow delivery as a possible exercise limitation in COPD, especially in light of the potential interactions between cardiac output (Qc) and pulmonary hyperinflation. Thus, the purpose of this study was to compare the slope of the Qc versus oxygen uptake (VO 2) response through several submaximal cycling loads in patients with moderately severe COPD with that of age-matched healthy control subjects (CTRL). Also examined was the possibility that ventilatory constraints such as dynamic hyperinflation contribute to an abnormal Qc response. Cardiac output was measured using the CO2-rebreathing equilibrium technique during baseline conditions and cycling at 20, 40 and 65% of peak power in 17 COPD (Age: 64 +/- 8 yrs; FEV1/FVC: 37 +/- 11%; FEV1: 41 +/- 15% predicted) and 10 age-matched CTRL subjects. Inspiratory capacity (IC) was also measured for the determination of dynamic hyperinflation during the steady state exercise bouts. The results indicate that while the absolute Qc values are lower in COPD than in CTRL during moderately intense (65% peak power) cycling (11.30 +/- 2.38 vs. 15.63 +/- 2.15 L⋅min -1, p < 0.01), likely due to their lower exercise metabolic demand, the Qc/VO2 response to increasing levels of exercise intensity is normal or hyperdynamic in COPD. Indeed, the majority of patients with COPD exhibited Qc/VO2 slopes greater than 7.0, which may be indicative of a peripheral muscle bioenergetic disturbance that may drive the need for greater oxygen delivery, and thus result in an exaggerated ce
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Farooqi, Nighat. "Nutrition and energy expenditure in women with chronic obstructive pulmonary disease." Doctoral thesis, Umeå universitet, Lungmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128680.
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Aim The overall objective of this thesis was to increase the knowledge and validate methods for assessment of total daily energy expenditure (TEE), energy requirement and energy intake (EI) in women with COPD. We also investigated the relationship of BMI with clinical characteristics of COPD in a population-based study. Due to the substantial and increasing morbidity in women with COPD, special attention was given to this group. Methods Resting metabolic rate (RMR) was measured by indirect calorimetry (IC). TEE was measured by criterion method, doubly labeled water (DLW) (Paper I-III) during a 14-day period. TEE was simultaneously assessed by SenseWear Armband, software version 5.1 and 6.1 (SWA5 respectively SWA6), and ActiHeart (paper I). EI was assessed by diet history interview and 7-day food diary (paper II), and energy requirement was predicted using pedometer-determined physical activity level (paper III). Energy requirement data was also acquired from studies concerning TEE measured by DLW in patients with COPD (paper IV). BMI and other characteristics in subjects with COPD were compared with non-COPD subjects in a population-based study, Obstructive Lung disease in Norrbotten study (OLIN) (paper V). Results There was a large variation in RMR and TEE measured by DLW in this group of women with COPD. The results of energy expenditure study showed that the SWA5 assessed TEE with good accuracy over a 14-day period in free-living women with COPD. However, the SWA6 and ActiHeart methods tend to underestimate TEE. A higher proportion of women were within ± 5% of the TEE individually measured with the DLW method using SWA5 than SWA6 and AH (63%, 47%, 37% respectively). The agreement between the TEE measured by DLW and SWA5 was strong, and with SWA6 and ActiHeart it was lesser. Bland-Altman plots revealed no systematic bias for TEE. The reported EI was underestimated by 28% respectively 20 % when assessed by diet, and the 7-day food diary compared with the criterion method, DLW. More women were identified as valid-reporters based on their 7- day food diaries than on their diet histories (63% vs 32%). The accuracy of reported EI was only related to BMI. The agreement between the DLW and the EI methods was weak. The Bland-Altman plots revealed a slight systematic bias for both methods. The energy requirement predicted by pedometer-determined PAL multiplied by six different RMR equations was within a reasonable accuracy (±10%) of the measured TEE for all equations except one. The agreement between the DLW and four of six predicted TEE methods was strong. The Bland– Altman plots revealed no systematic bias for predicted energy requirement except for one. Estimated PAL from the pedometer was lower by 14 % than the measured criterion PAL. The energy requirement calculation based on available TEE data measured by DLW varied by BW and FFM. Compared to men, women had a lower RMR and TEE/kg BW/day, and higher RMR and TEE/kg FFM/day. The correlates of RMR/kg BW were gender and forced expiratory volume in 1st second (FEV1) % of predicted value, of TEE/ kg BW the correlates were age and gender, and of TEE/kg FFM were age and FEV1 % predicted. BMI decreased significantly with increase in disease severity and correlated significantly to forced expiratory volume in 1st second % predicted. In the population-based study (OLIN), subjects with COPD had lower BMI and a higher prevalence of underweight than in non-COPD, and its sub-groups namely, normal lung function and restrictive spirometry pattern subjects. There was an independent association between COPD and low BMI. Fewer COPD subjects were obese than in the non-COPD, normal lung function and restrictive spirometry pattern groups. Among the subjects with COPD, women had a lower mean BMI and a higher proportion were under-weight than men. In COPD women with under-weight, FEV1 % predicted values increased with an increase in BMI. Conclusion Compared with the gold standard DLW method, the total daily energy expenditure can be assessed reliably by SenseWear Armband 5 in women with COPD, while other devices underestimated TEE. The energy intake was underestimated by diet history and 7-day food diary methods, and energy requirement was predicted with reasonable accuracy using pedometer-determined PAL and common RMR equations, compared with DLW. Furthermore, the energy requirement was determined per kg BW/day and per kg FFM/day, using DLW based TEE data in patients with COPD. In the population-based study (OLIN), subjects with COPD had lower BMI and higher prevalence of under-weight than subjects without COPD. There was a gender difference, which was particularly significant in COPD, for women to have lower mean BMI and a higher prevalence of under-weight. The present findings indicate that low BMI is common in COPD and needs to be intervened. For a successful nutritional treatment, it is imperative to assess the patient’s enerBakgrund/Syfte Kroniskt obstruktiv lungsjukdom (KOL) är en av de stora folksjukdomarna där dödligheten ökar mest globalt sett. I Sverige är ökningen av KOL mest uttalad för kvinnor. Viktminskning är vanligt vid KOL. Låg kroppsvikt, låg andel fettfrimassa och lågt kroppsmasseindex (BMI) är dessutom riskfaktorer för ökad sjuklighet och dödlighet. Det finns därför behov av att ge anpassad kostbehandling for att motverka viktnedgång eller för att uppnå viktuppgång. För framgångsrik kostbehandlingen behövs metoder som på ett tillförlitligt sätt kan bedöma den totala energiförbrukningen, energiintag, och energibehov., Dessa metoder har ännu inte utvärderats väl hos KOL patienter. Det övergripande syftet därför med denna avhandling var att validera och öka kunskaperna om metoder som är tillförlitliga för att kunna bedöma energiförbrukning, energiintag och energibehov hos patienter med KOL. Vidare, jämfördes BMI och kliniska egenskaper mellan personer med och utan KOL in en populations-baserad studie. Metoder Viloenergiförbrukning mättes med indirekt kalorimeter hos kvinnor med KOL. Den totala energiförbrukningen mättes hos dessa kvinnor med dubbelmärktvatten metoden (DLW) (Arbete 1-3) under en 14-dagars period. Samtidigt bedömdes energiförbrukningen med två aktivitetesmätare, SenseWear Armband, mjukvaruversion 5.1 och 6.1 (SWA5 respektive SWA6), och ActiHeart (arbete 1). Energiintaget bedömdes med kostanamnes och 7-dagars matdagbok (arbete 2); energibehovet beräknades med olika viloenergiförbruknings formler och fysisk aktivitetsnivå uppskattad med en stegräknare (arbete 3). En sammanställning och en analys genomfördes av energibehovet baserad på data från flera studier som har mätt TEE med DLW hos KOL patienter (Arbete 4). BMI och kliniska egenskaper jämfördes mellan personer med och utan KOL i ett stort populationsbaserat material från Obstruktiv Lungsjukdom i Norrbotten (OLIN) studien (Arbete 5). Resultat Det fanns en stor variation in viloenergiförbrukningen och energiförbrukning mätt med DLW hos kvinnor med KOL. Energiförbrukningen mätt med aktivitetsmätare SWA5 visade hög tillförlitlighet både på grupp- och individnivå, medan SWA6 och ActiHeart metoderna underskattade energiförbrukningen. Energiintaget bedömd med kostanamnes och 7-dagars matdagbok visade en underskattning med 28% respektive 20% jämfört med DLW metoden. Det rapporterade energiintaget stämde för flertalet kvinnor bättre mot DLW metoden när energiintaget bedömdes med 7-dagars matdagbok jämfört med kostanamnes (63% mot 32%). Det beräknade energibehovet från stegräknare och från fem av sex olika RMR ekvationer låg inom en rimlig marginal (± 10%) jämfört med den uppmätta energiförbrukningen med DLW. Beräkning av energibehov baserat på tillgänglig data om energiförbrukning mätt med DLW varierade utifrån kroppsvikt och fettfrimassa hos patienter med KOL. Kvinnor hade en lägre viloenergiförbrukning och energiförbrukning per kg kroppsvikt och dag, och högre daglig viloenergiförbrukning och energiförbrukning per kg fettfrimassa och dag jämfört med män. I den populationsbaserade studien hade personer med KOL signifikant lägre BMI och högre prevalens av undervikt än personer utan KOL. Det fanns ett oberoende samband mellan KOL och lågt BMI. Färre personer med KOL var överviktiga än personer som inte hade KOL. Kvinnor med KOL hade både lägre BMI och högre andel med undervikt än män med KOL. Slutsats SenseWear Armband med programvaran 5.1 visar sig kunna beräkna den totala energiförbrukningen på ett tillförlitligt sätt hos kvinnor med KOL. Energiintaget beräknat utifrån kostanamnes och 7-dagars matdagbok underskattades. Energibehovet kan beräknas med en rimlig precision med hjälp av stegräknare och viloenergiförbrukningsformler hos dessa kvinnor. De sammanställda data om energiförbrukning mätt med DLW kan användas för att beräkna energibehov per kg- kroppsvikt och fettfri massa hos patienter med KOL i kliniskt syfte. I det populationsbaserade materialet från OLIN-studien noterades ett lägre BMI och högre prevalens av undervikt hos personer med KOL, och detsamma resultat förekom hos kvinnor med KOL jämfört med män med KOL.
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Higham, Andrew James. "The role of the liver X receptor in chronic obstructive pulmonary disease." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/the-role-of-the-liver-x-receptor-in-chronic-obstructive-pulmonary-disease(b1916ddb-6514-4407-b657-0dede8d7fa28).html.
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COPD is a condition characterised by chronic inflammation in which macrophages arethought to play a central role. Corticosteroids are the most widely used antiinflammatoryagents to treat COPD. There is a subset of inflammatory mediatorswhich are corticosteroid insensitive and so there is a need for novel anti-inflammatorytherapies to treat COPD. One such target is the liver X receptor (LXR), a cholesterolsensing nuclear hormone receptor with anti-inflammatory properties. Before investigating the anti-inflammatory potential of LXR, I aimed to validate thealveolar macrophage in vitro culture model. I investigated the effect of differentculture times on unstimulated and stimulated cytokine release, dexamethasoneinhibition of cytokine release, and transcription factor phosphorylation in alveolarmacrophages from COPD patients and controls. I found that freshly isolatedmacrophages release higher levels of cytokines, are less responsive to dexamethasoneand have increased levels of phosphorylated p38 MAPK.I next investigated LXR gene and protein expression levels in alveolar macrophages andwhole lung tissue from COPD patients and controls, the effect of LXR activation on thesuppression of inflammatory mediators from LPS stimulated COPD alveolarmacrophages, and the effect of LXR activation on the induction of genes associatedwith alternative macrophage polarisation. The levels of LXR mRNA were significantlyincreased in whole lung tissue extracts in COPD patients and smokers compared tonever smokers. The expression of LXR protein was significantly increased in smallairway epithelium and alveolar epithelium in COPD patients compared to controls. Nodifferences in LXR mRNA and protein levels were observed in alveolar macrophagesbetween patient groups. The LXR agonist GW3965 significantly induced the expressionof the LXR dependent genes ABCA1 and ABCG1 in alveolar macrophage cultures. InLPS stimulated alveolar macrophages, GW3965 suppressed the production of CXCL10and CCL5, whilst stimulating IL-10 production. GW3965 did not significantly suppressthe production of TNFα, IL-1β, or CXCL8. The major finding is that LXR activation hasanti-inflammatory effects on CXC10, CCL5 and IL-10 production from alveolarmacrophages. Finally, I investigated whether dysfunctional lipid homeostasis is a feature of COPDalveolar macrophages. I found that alveolar macrophages from current smokers withand without COPD had increased levels of neutral lipids compared to never smokersand ex-smokers with and without COPD. Dysfunctional lipid homeostasis may play arole in COPD.
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Jantarakupt, Peeranuch. "The experience of men who were managing symptoms of COPD." Diss., Columbia, Mo. : University of Missouri-Columbia, 2005. http://hdl.handle.net/10355/5814.
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Thesis (Ph. D.)--University of Missouri-Columbia, 2005.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2005" Includes bibliographical references.
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Akiki, Zeina. "Biological Markers For Chronic Obstructive Pulmonary Disease And Asthma." Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS081/document.
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L’étude des marqueurs biologiques dans la broncho-pneumopathie chronique obstructive (BPCO) et l'asthme, deux maladies respiratoires chroniques affectant des millions de personnes dans le monde, pourrait améliorer leur diagnostic, leur traitement et leur prévention.Cette thèse comprend deux parties. La première visait à évaluer l'association entre un marqueur spécifique des poumons, la protéine surfactant D (SP-D) sérique, et la BPCO, et à trouver un seuil de SP-D capable de discriminer les patients BPCO des témoins. Elle a été réalisée dans le cadre d’une étude cas-témoin au Liban incluant des patients BPCO (n=90), des asthmatiques (n=124) et des témoins (n=180). La deuxième partie visait à évaluer les associations chez les adultes des marqueurs de l’inflammation systémique (protéine C-réactive ultra-sensible, hs-CRP (n=252), et des cytokines (n=283)) et des marqueurs de dommages dus au stress oxydant (8-isoprostanes 8-IsoPs (n=258) du condensat de l’air exhalé) avec les phénotypes de l’asthme.Elle a été réalisée dans le cadre de l'étude épidémiologique longitudinale Française des facteurs génétiques et environnementaux de l'asthme (EGEA).Les résultats ont montré que les niveaux de SP-D sériques étaient associés positivement avec la BPCO et des seuils des niveaux de SP-D chez ces patients ont été identifiés avec d'excellentes valeurs discriminantes. Dans EGEA, aucune association n'a été trouvée entre les niveaux de hs-CRP sériques et le contrôle de l’asthme. Des profils de cytokines sériques (identifiés par analyse en composante principale) avec des niveaux élevés d’interleukine(IL)-1Ra et d’IL-10 ont été associés avec moins de crises d'asthme et un risque plus faible d'un mauvais contrôle de l'asthme sept ans plus tard. Les résultats des analyses préliminaires sur les associations entre les niveaux de 8-IsoPs et les phénotypes de l'asthme sont également présentés.Globalement, ces résultats ont montré l'utilité d'étudier les marqueurs biologiques en lien avec la BPCO et l'asthmeStudying the biological markers in chronic obstructive pulmonary disease (COPD) and asthma, two chronic respiratory diseases affecting millions of individuals around the world, could improve their diagnosis, their treatment and their prevention.This thesis includes two parts. The first aimed to assess the association between a lung-specific biomarker, serum Surfactant Protein D (SP-D), and COPD, and to find cut-off points able to discriminate COPD patients from controls using SP-D levels. It was performed in a case-control study in Lebanon including COPD (n=90) and asthma patients (n=124) and controls (n=180). The second part aimed to assess the cross-sectional and longitudinal associations in adults for systemic inflammatory biomarkers (high sensitivity C reactive protein hs-CRP (n=252) and cytokines (n=283) as well as biomarkers of damage due to oxidative stress (8-Isoprostanes 8-IsoPs (n=258) from the exhaled breath condensate) and asthma outcomes.It was performed in the French longitudinal epidemiological study on the genetics and environmental factors of asthma (EGEA).Results showed that serum SP-D levels were positively associated with COPD and thresholds for SP-D levels in these patients were identified with excellent discriminant values. In EGEA, no association was found between serum hs-CRP levels and asthma control. Serum cytokine profiles (identified by principal component analysis) with high levels of interleukin (IL)-1Ra and IL-10 were associated with less asthma attacks and lower risk of poor asthma control in adults seven years later. The results of the preliminary analyses on the associations between the levels of 8-IsoPs and asthma outcomes are also presented.Overall, these results have shown the usefulness of studying the biological markers related to COPD and asthma
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Machado, Stacey Jerrick. "Reducing 30-Day Readmission Rates in Chronic Obstructive Pulmonary Disease Patients." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6609.
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Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.
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Mantoani, Leandro Cruz. "Role of physical activity in daily life in Chronic Obstructive Pulmonary Disease (COPD)." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31402.
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Background: Chronic obstructive pulmonary disease (COPD) is an important common chronic lung condition that is a leading cause of morbidity and mortality worldwide, resulting in a substantial and increasing economic and social burden to health care systems. Physical activity (PA) is the strongest predictor of mortality in this population, playing an important role determining the quality of life in COPD, with better outcomes being reported by those who have higher levels of PA. Therefore, improving PA levels has been considered a key component in the management of patients with COPD. Likewise, it is important to understand the mechanisms that lead to inactivity, as it is to develop accurate methods of measuring PA in this population. Aims of the thesis: 1) To identify and to summarize the interventions able to increase PA levels in patients with COPD; 2) To understand the longitudinal interaction between muscle mass and function and PA levels in COPD; 3) To study the acceptability and the suitability of a new activity monitor (TracMor D - Philips, the Netherlands) for home coaching in daily routine of patients with COPD; and 4) To investigate whether a PA enhancing programme with set targets and feedback would constitute a successful intervention to increase PA levels in patients with COPD attending pulmonary rehabilitation (PR). Methods: To achieve the first aim of the thesis I performed a systematic review summarizing interventional studies that assessed PA as an outcome in patients with COPD. For the second aim, I analysed some multicentric longitudinal data (one year follow-up) on PA and muscle mass/function in COPD. The third aim was achieved with a pilot study I conducted in Edinburgh, where patients with COPD wore three TracMor D in different body places simultaneously with the criterion method (Actigraph GT3x activity monitor) for a week. To accomplish the fourth and main aim of my PhD, I conducted a randomised controlled trial (RCT) where patients with COPD undergoing PR were randomised to either receive PR only or PR plus a PA coaching programme using the TracMor D activity monitor for 12 weeks. Main Results: Study 1: Sixty studies were considered for data extraction in the systematic review. Seven types of intervention with the potential to increase PA levels in patients with COPD were identified. PR programmes with more than 12 weeks of duration and PA coaching programmes with feedback of an activity monitor are promising interventions to increase activity levels in patients with COPD. Overall, the quality of evidence across interventional studies was graded as very low. Study 2: The longitudinal study showed that there were weak correlations between PA levels and muscle strength at baseline (0.19 ≤ r ≤ 0.33 p < 0.001 for all). No correlations were found between changes in PA and muscle strength (-509 [-1295-362] vs -0.4 [-3.5-2.6] - 12 months minus baseline - respectively) and future muscle mass (p > 0.05). Baseline PA levels are related to future muscle strength (0.30 ≤ r ≤ 0.41, p < .0001) but not with muscle mass. Study 3: This study showed that TracMor D had strong correlations with Actigraph GT3x in terms of Kcal consumption in all three positions (necklace, pocket and hip) (0.84 ≥ r < 0.86, p < 0.001 for all). TracMor D was considered comfortable and easy to use at home, receiving a mean usability score of 98 out of 100 maximum points. Study 4: My RCT showed that the proposed PA intervention was effective in changing steps/day (1251 ± 2408 vs control -410 ± 1118, p=0.01), time spent in light activities (21 ± 60 vs -37 ± 55, p=0.004), exercise capacity (99 ± 139 vs 3 ± 83 meters; 85 ± 114 vs 2 ± 62 seconds, p < 0.03 for both) and muscle strength (15 ± 20 vs -5 ± 18, p=0.01) among others when compared to the control group. Conclusions: Strategies focussing specifically on increasing PA and longer PR programmes may have greater impacts on PA levels in COPD. Well-designed clinical trials with objective assessment of PA in patients with COPD are needed. PA levels are not related to one-year changes in muscle mass and muscle strength in patients with COPD. However, higher PA levels at baseline are related to having higher muscle strength at one-year. TracMor D strongly correlated with the criterion method and was highly accepted by patients with COPD in their daily routine, being considered comfortable and easy to use at home. The combination of PR with a physical activity enhancing programme using a PA monitor to set targets and give feedback on activity levels significantly improves PA, exercise capacity, muscle strength, quality of life, and anxiety and depression levels in patients with COPD.
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Shaw, I., JM Loots, L. Lategan, and BS Shaw. "Effectiveness of aerobic exercise training in improving pulmonary function in asthmatics." African Journal for Physical, Health Education, Recreation and Dance, 2009. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001698.
Full textAbstract:
ABSTRACT
Asthma exemplifies a major medical concern
and is a considerable cause of morbidity and
mortality in Western society. Controversy still
exists regarding the most effective mode and
intensity of exercise training for asthmatics.
Thus, the purpose of the study was to
determine whether walking or jogging at 60%
of age-predicted heart rate maximum can
increase effort-dependent pulmonary function
parameters in moderate, persistent asthmatics.
Forty-four sedentary asthmatics were
randomly assigned to either a non-exercising
control (NE) group (n = 22) or an eight-week
moderate-intensity aerobic exercise (AE)
group (n = 22). Results indicated that the
subjects in the AE training group significantly
(p = 0.05) increased their forced vital capacity
(FVC), forced expiratory volume in one
second (FEV1), peak expiratory flow (PEF),
maximal voluntary ventilation (MVV) and
inspiratory vital capacity (IVC). The NE group
did not exhibit any significant changes in any
of the measured variables. Therefore, walking
or jogging at 60% heart rate maximum for 30
minutes three times a week for eight weeks
can effectively improve the effort-dependent
pulmonary parameters in moderate, persistent
asthmatics. This represents a strong argument
to support the inclusion of this mode of
aerobic training in the treatment of moderate,
persistent asthma due to its effectiveness,
inexpensiveness and lowrisk.
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Hodson, Matthew. "Development of a patient reported experience measure in chronic obstructive pulmonary disease (COPD)." Thesis, University of Portsmouth, 2014. https://researchportal.port.ac.uk/portal/en/theses/development-of-a-patient-reported-experience-measure-in-chronic-obstructive-pulmonary-disease-copd(c7bf6540-155f-4245-b764-daa61ea6f73a).html.
Full textAbstract:
The experience of patients living with chronic obstructive pulmonary disease (COPD) and their views on the quality of healthcare they receive is not currently captured in patient reported measures. Aim: To develop and validate a patient reported experience measure to assess experiences of living with COPD and perceived quality of healthcare provision. Method: Previous work with 83 COPD patients identified 38 items for inclusion in a patient reported experience measure. These, together with the COPD Assessment Test and Hospital Anxiety and Depression Scale were administered to patients with COPD. Items demonstrating significant gender or age bias (p<0.05), floor or ceiling effects (set at 40%), missing data >15%, or high item to item correlations (r>0.8) were removed. Rasch analysis was applied to the remaining items. Results: 174 patients (Mean age 71 years, SD 9; 91 female; Mean Forced Expiratory Volume1 59%, SD 21.9) were studied. 29 items were removed, providing a 9-item unidimensional scale (chi-square p=0.33) with a wide scaling range (logits from -0.1 to +0.2). These cover experiences of living with COPD (e.g. I feel that I am in control of my condition) and health care (e.g. I am concerned that my GP won't listen to my point of view). Internal consistency was good (PSI= 0.77) and correlations between the COPD PREM-9, COPD Assessment Test and Hospital Anxiety and Depression Scale were moderate (r=0.42 and r=0.30, respectively). Conclusions: The COPD PREM-9 demonstrated good internal reliability and showed a wide scaling range suggesting, regardless of severity, people with COPD can have good or bad experiences. There were low to moderate correlations with the COPD Assessment Test and Hospital Anxiety and Depression Scale, which suggests the PREM COPD-9 is measuring a different concept. The COPD PREM-9 may be a useful measure of quality of care that complements measures of health status and mood.
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Brozyna, Sheree. "The role of chemokines and chemokine receptors in chronic obstructive pulmonary disease (COPD) /." Title page and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09SB/09sbb8859.pdf.
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Kumar, Manish [Verfasser]. "Senescence, DNA damage and repair in chronic obstructive pulmonary disease (COPD) / Manish Kumar." Gießen : Universitätsbibliothek, 2014. http://d-nb.info/1068772697/34.
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Lytras, Theodoros 1987. "The Role of occupational exposures in Chronic Obstructive Pulmonary Disease." Doctoral thesis, Universitat Pompeu Fabra, 2018. http://hdl.handle.net/10803/586017.
Full textAbstract:
Introduction: Occupational exposures are considered to be one of the newer and important risk factors for Chronic Obstructive Pulmonary Disease (COPD) besides tobacco smoking. However, the evidence mostly comes from smaller and cross-sectional studies and important questions remain unanswered, such as which specific exposures are responsible, the magnitude of the risk involved, and how the risk varies between men and women and between smokers and nonsmokers. The aim of this thesis was to examine the association between objectively assessed occupational exposures and changes in COPD-related outcomes over two decades in the European Community Respiratory Health Survey (ECRHS), a large multicentre population-based longitudinal study.
Methods: General population samples aged 20-44 years were randomly enrolled in the ECRHS between 1991 and 1993, and twice followed up over the course of 20 years. Complete job histories during this follow-up were linked to the ALOHA(+) Job-Exposure Matrix, generating occupational exposures to 12 categories of agents. Spirometries were performed at each study visit. The outcomes of interest were: lung function decline, chronic bronchitis incidence and post-bronchodilator COPD incidence.
Results: Exposure to biological dust, gases & fumes and pesticides was associated with higher COPD incidence, with 21% of all COPD cases attributable to these three agents. Pesticides were associated with higher incidence of chronic phlegm but only in women, and gases & fumes and solvents also with chronic phlegm but only in men. Mineral dust exposure was associated with higher chronic phlegm incidence and metals exposure with hicher chronic bronchitis incidence, in both sexes. All studied exposures except solvents were associated with accelerated decline in the FEV1/FVC ratio, particularly in male smokers. Women exposed to biological dust also tended to have higher declines in FVC, as did men exposed to pesticides.
Conclusions: A substantial proportion of the total COPD burden is attributable to occupational exposures. The effect of occupation on COPD-related outcomes is complex, and depends on exposure type, sex and smoking status. Further research is warranted to provide more details about the observed associations.Introducció: Les exposicions ocupacionals es consideren un dels factors de risc importants per a la malaltia pulmonar obstructiva crònica (MPOC) juntament amb tabaquisme. No obstant això, l'evidència prové principalment d'estudis de mida petita i transversals i preguntes importants segueixen sense resposta, per exemple quines exposicions específiques són responsables, la magnitud del risc involucrat i com el risc varia entre homes i dones o entre fumadors i no fumadors. L'objectiu d'aquesta tesi és examinar l'associació entre exposicions ocupacionals objectivament avaluades i els canvis en els resultats relacionats amb la MPOC durant dues dècades en l'Enquesta de Salut Respiratòria de la Comunitat Europea (ECRHS), un gran estudi longitudinal multicèntric poblacional. Mètodes: La mostra de la població general amb edats compreses entre 20 i 44 anys es va seleccionar aleatòriament a l’ECRHS entre 1991 i 1993, i a els participants se’ls hi va fer seguiment dues vegades en el transcurs de 20 anys. L'historial complet de treballs durant el període de seguiment es va vincular amb la Matriu d'Ocupació-Exposició ALOHA (+), generant estimacions d'exposicions ocupacionals a 12 categories d'agents. Les espirometries es van realitzar en cada visita d'estudi. Els resultats d'interès van ser: disminució de la funció pulmonar, incidència de bronquitis crònica i incidència de MPOC després de broncodilatació. Resultats: L'exposició a pols, gasos i fums biològics i pesticides es va associar amb una major incidència de MPOC, amb un 21% de tots els casos de MPOC atribuïbles a aquests tres agents. Els pesticides es van associar amb una major incidència d’expectoració crònica, però només en les dones, i gasos i fums i dissolvents també amb expectoració crònica, però només en els homes. L'exposició a la pols mineral es va associar amb una major incidència d’expectoració crònica i l’exposició a metalls amb incidència de bronquitis crònica, en ambdós sexes. Totes les exposicions estudiades, excepte els dissolvents, es van associar amb una disminució accelerada de la relació FEV1 / CVF, (VEMS/CVF) particularment en fumadors homes. Les dones exposades a la pols d'origen biològic també van tenir majors disminucions en la capacitat vital forçada (CVF), igual que els homes exposats als pesticides. Conclusions: Una proporció important dels casos de MPOC és atribuïble a exposicions ocupacionals. L'efecte de l'ocupació en els resultats relacionats amb la MPOC és complex i depèn del tipus d'exposició, el sexe i el tabaquisme. Es requereix més investigació per proporcionar més infromació sobre les associacions observades
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Sohanpal, Ratna. "Understanding the reasons for non-participation in self-management interventions amongst patients with chronic conditions : addressing and increasing opportunities for patients with advanced chronic obstructive pulmonary disease to access self-management." Thesis, Queen Mary, University of London, 2015. http://qmro.qmul.ac.uk/xmlui/handle/123456789/15031.
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Background: In chronic obstructive pulmonary disease (COPD), understanding the problem of poor patient participation in evidence-based self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as SM support programmes) is critical. This thesis aimed to improve understanding of poor patient participation and retention in these programmes; how participation might be improved; and how might patients be better supported with their SM. Methods: Using the Medical Research Council guidance on complex interventions this thesis (1) quantified the 'actual' patient participation and completion rates; (2) explained, using theory, the factors that influenced participation in studies of SM support including the programmes among chronic disease and COPD patients; and (3) explored patient and expert stakeholders' perspectives on the reasons for non-participation in SM support programmes, how participation might be improved, how might patients be supported with their SM. Results: (1) Among 56 studies, high study participation rates and completion rates were seen however, the incomplete reporting of participant flow confused the problem of participation. (2) Among 31 studies, participation among patients with chronic disease including COPD was shown to be influenced by their 'attitude' and 'perceived social influence/subjective norms'; 'illness' and 'intervention perceptions'. (3) From 38 interviewees, besides patients' beliefs, non-participation was also influenced by resignation and denial of the illness; health systems; and programme organisational factors. Professionals building relationships and supporting patients with their SM alongside programme organisational improvements might encourage patient participation in SM and the programmes. Conclusions Patient participation is a complex behaviour, besides socio-behavioural factors, participation behaviour can by influenced by a mix of several health system and programme organisational factors. Changing the behaviour of health professionals and indeed the wider health system, towards normalising a patient partnership approach, with implementation of SM support in routine care might help more patients to consider participation in their care and improve patient participation in COPD SM support programmes.
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Stone, Ian. "Effects of COPD and its treatment on cardiovascular structure and function assessed through advanced imaging techniques." Thesis, Queen Mary, University of London, 2016. http://qmro.qmul.ac.uk/xmlui/handle/123456789/23199.
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Significant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease independent of traditional risk factors. A number of different hypotheses exist to explain this association including the contribution arterial stiffness and lung hyperinflation. Non-invasive cardiovascular imaging and assessment are ideal methods through which this relationship can be further studied although a number of the techniques have yet to be validated in COPD. In this thesis we aimed to achieve a number of goals. First, we aimed to assess the reproducibility and level of agreement between different measures of arterial stiffness in stable hyperinflated COPD. Second, we hoped to establish the utility of 3 different measurement techniques for measuring intrinsic cardiac function in stable hyperinflated COPD. Third, in a case-control study we compared surrogates of cardiovascular risk in hyperinflated COPD patients and a group matched for cardiovascular risk with normal lung function. Finally, we sought to understand the impact of pharmacologically reducing lung hyperinflation on cardiovascular structure, function and arterial stiffness. We have firstly demonstrated that non-invasive measures of arterial stiffness are reproducible in stable hyperinflated COPD. Secondly, we have established the level of agreement and reproducibility of three different CMR techniques for measuring intrinsic myocardial function which will provide important information for the powering of future CMR studies in COPD. Thirdly, we have shown that surrogates for cardiovascular outcomes are adversely affected in COPD compared to a group matched for global cardiovascular risk, suggesting that current scoring systems may be suboptimal in risk prediction in COPD. Finally, we have demonstrated that pharmacological lung deflation has consistent and physiologically plausible beneficial effects on cardiac structure, function and the pulmonary vasculature. Whether intrinsic myocardial function can be modulated through prolonged periods of lung deflation is as yet unverified and should be the focus of future clinical trials.
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Ramis, Cabrer Daniel 1993. "From chronic obstructive pulmonary disease to lung cancer : an immunologic approach." Doctoral thesis, Universitat Pompeu Fabra, 2019. http://hdl.handle.net/10803/667310.
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Se ha establecido que un subconjunto de pacientes con cáncer debuta con
infiltrados inmunes que se organizan en agregados en el nicho tumoral y
sus alrededores. Estas estructuras linfoides se desarrollan en respuesta a
estímulos inflamatorios a través de un proceso estrechamente regulado.
Además de su valor pronóstico, las TLSs pueden representar una nueva
vía para las estrategias terapéuticas, pero actualmente se encuentra en
etapas iniciales. En contraste con el papel en la activación inmune de las
TLSs, en ciertos tumores, su efecto puede apuntar hacia la progresión
tumoral como consecuencia de las condiciones altamente
inmunosupresoras mediadas por las células malignas presentes en el
nicho tumoral. Los datos preliminares proporcionados por la siguiente
investigación sugieren que los pacientes con cáncer de pulmón podrían
presentar un perfil inmunitario diferencial respecto a estos mismos que
además subyacen EPOC. Este hecho podría presentar un impacto
potencial en el pronóstico y la terapia de estos pacientes. Por otra parte,
resultados procedentes de la actual investigación también revelan que
ciertos marcadores cruciales presentes en diferentes vías de señalización
involucradas con el estrés oxidativo, la apoptosis y la autofagia podría
sobre expresarse en respuesta a la administración de
inmunomoduladores. Estos datos ponen de manifiesto el interés de
mecanismos adicionales relacionados con la inmunidad que podrían ser
manipulados para asistir a la inmunidad contra el cáncer.It is well established that a subset of cancer patients debuts with immune infiltrates, which organize into aggregates in the tumor niche and its vicinity. These lymphoid structures develop in response to inflammatory stimuli through a tightly regulated process. Besides the prognostic value of TLSs, they also may represent a novel avenue for therapeutic strategies, but it is currently still in its early stages. In contrast with the immune activator role of TLSs, in certain cancers, its effect may point towards tumor progression as a consequence of highly tumor-mediated immunosuppressive conditions present in the tumor niche. Preliminary data provided by the current investigation suggests that a differential immune profile may be present between LC patients and LC patients underlying COPD. This fact could present a potential impact in the prognosis and therapy of these patients. Moreover, crucial markers targeting different signaling pathways involved with oxidative stress, apoptosis, and autophagy were found to be overexpressed in response to immunomodulators administration in the current thesis. These data puts into manifest the interest of additional immunity-related mechanisms that could be targeted in order to assist immunity against cancer.
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Chatila, Wissam M. F. "MicroRNA Expression in Regulatory T Cells in Chronic Obstructive Pulmonary Disease." Diss., Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/333572.
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Microbiology and ImmunologyPh.D.
COPD is characterized by an abnormal regulatory T cell (Treg) response with a shift towards a Th1 and Th17 cell responses. However, it is unclear if the function of Treg cells is impaired by smoking and in COPD. In addition, the miRNA profile of Treg cells in COPD is unknown and whether miRNA deregulation contributes to COPD immunopathogenesis. We set the objective to study Treg cell function isolated from peripheral blood of patients with COPD versus controls and to compare their miRNA profiles. We also were interested in exploring the function of some of the differentially expressed Treg cell miRNAs. We assessed the Treg cell function by observing their suppressive activity on autologous effector T cells and analyzed their miRNA expression initially by microarray analysis then conducted real time RT-PCR validation for selected miRNAs. In Silico target gene analysis for the validated miRNAs suggested that miR-199-5p is particularly relevant to Treg cell physiology so its function was investigated further using CCD-986Sk and MOLT-4 cells. We found no difference in Treg cell function between COPD and controls but we were able to identify 6 and 96 miRNAs that were differentially expressed in COPD versus control Treg cells. We confirmed that miR-199a-5p was repressed by approximately 4 fold in Treg cells of COPD patients compared to cells in healthy smokers. Importantly, miR-199a-5p had significant overrepresentation of its target genes in the Treg cell transcriptome, with many targets associated with the TGF-b activation pathway. We also confirmed the function of miR-199a5p in an in-vitro loss-of-function cell model running TaqMan® arrays of the Human TGF-b Pathway. These findings suggest that the abnormal repression of miR-199a-5p in patients with COPD compared to unaffected smokers may be involved in modulating the adaptive immune balance in favor of a Th1 and Th17 response.
Temple University--Theses
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Tatari, Wisam. "Using Pharmacist-Led Tele-Consultation to Review Patients with Chronic Obstructive Pulmonary Disease." Thesis, University of Bradford, 2018. http://hdl.handle.net/10454/17311.
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Pang, Yu. "Human Anti-Histone 3.3 Antibodies as Potential Biotherapeutics for Chronic Obstructive Pulmonary Disease (COPD)." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/378762.
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Pharmaceutical SciencesM.S.
Chronic Obstructive Pulmonary Disease (COPD), which is characterized by limitation of pulmonary air flow, is now the third major cause of death worldwide. Barrero et al. have reported that the elevation of extracellular hyperacetylated histone H3.3 in the lungs of COPD patients is associated with cytotoxicity and disease progression. They found that extracellular hyperacetylated H3.3 was cytotoxic to lung structural cells and resistant to proteasomal degradation, and that mouse antibodies to either the C- or N- termini of H3.3 could partially reverse H3.3 toxicity in vitro. Thus, we hypothesize that human antibodies directed against H3.3 may be effective biotherapeutics useful to control progression of COPD in vivo. The discovery and development of human monoclonal antibodies (mAbs) is a fast growing field of biotherapeutics. In addition to full length mAbs, antibody fragments also have been used in antibody discovery research. We have used phage display technology in this project to discover human anti-H3.3 antibody Fab fragments. This technology utilizes genetically engineered phage particles containing genes encoding diverse Fab fragments displayed on the particles. The “Ylanthia” library from MorphoSys AG, a synthetic fully human Fab antibody phage display library with 1.3 x 1011 independent clones, was panned against purified recombinant human H3.3 immobilized on 96-well plates. Seven H3.3-binding Fab fragments with unique DNA sequences were isolated after four rounds of panning. Following their expression in E.coli and purification, Fab purities and electrophoretic mobilities were evaluated on SDS-PAGE. The concentration-dependent binding activities of all seven Fabs to human H3.3 were tested by ELISA. All seven Fabs were shown by ELISA to bind H3.3 but not histones 2A, 2B or 4. Since H3.3 is localized to the nucleus, western blotting was used to demonstrate that seven Fabs recognize purified, recombinant H3.3 and denatured natural histone(s) from nuclear extracts of human 293T cells. In order to characterize these molecules further, biological activity assays will be done to test their potential to reverse the toxic effects of H3.3 in cell culture. If these Fabs prove active in cell culture, they will be converted to IgGs and tested in animal models as potential biotherapeutics for COPD.
Temple University--Theses
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Donaire, Gonzalez David. "Measure and effects of physical activity in patients with Chronic Obstructive Pulmonary Disease (COPD)." Doctoral thesis, Universitat Ramon Llull, 2015. http://hdl.handle.net/10803/347216.
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Antecedents: La Malaltia Pulmonar Obstructiva Crònica (MPOC) és una de les principals causes de mortalitat i discapacitat a nivell mundial. L'activitat física és un dels pocs factors modificables que desacceleren l'evolució de la MPOC. No obstant, la dosi i les característiques de l'activitat física responsables de la desacceleració són encara desconegudes. En conseqüència, els objectius d'aquesta tesi són avançar i perfeccionar la metodologia i els instruments per avaluar l'activitat física realitzada pels malalts amb MPOC, aprofundir en el coneixement sobre les característiques i els patrons de la seva activitat física i determinar quines característiques de l'activitat física milloren el pronòstic dels malalts amb MPOC. Mètodes: Han participat 177 individus amb MPOC estable seleccionats de 8 hospitals a Espanya (94% homes, edat mitjana±DE 71±8 anys, volum expiratori forçat en 1 s 52±16% i índex de massa corporal 29±5 kg·m-2). L'activitat física va ser mesurada per un acceleròmetre (SenseWear® Pro2 Armband) i per un qüestionari (Yale Physical Activity Survey, YPAS). Les variables sociodemogràfiques (edat, sexe, estat civil, nivell educatiu, nivell socioeconòmic, situació laboral i hàbit tabàquic) i les variables clíniques (limitació al flux d'aire, hiperinsuflació pulmonar, díspnea, intercanvi de gasos, inflamació sistèmica i local, composició corporal, comorbiditats, qualitat de vida i capacitat d'exercici), es van obtenir utilitzant instruments validats i seguint les normes internacionals. La informació sobre l'evolució de la malaltia (els ingressos hospitalaris i la mortalitat) es va obtenir dels registres dels governs. Resultats: (Objectiu 1) El YPAS és una eina vàlida per a la detecció precoç de la inactivitat dels individus amb MPOC [àrea sota la corba ROC (95% IC) = 0.71 (0,63-0,79)]. (Objectiu 2) El 97% dels individus amb MPOC són capaços de realitzar episodis de 10 minuts d'activitat física moderada-vigorosa. Més del 50% dels individus amb MPOC compleixen amb les recomanacions de l'Organització Mundial de la Salut sobre l'activitat física per a la gent gran. La quantitat d'activitat física, la proporció d'aquesta activitat realitzada en episodis de 10 minuts i la freqüència d'aquests episodis va disminuir amb l'augment de la gravetat de la MPOC. (Objectiu 3) La quantitat i la intensitat de l'activitat física són determinants independents de l'evolució de la MPOC. El risc d'hospitalització per MPOC és un 20% menor per cada 1000 passos diaris addicionals realitzats en baixa intensitat. No obstant, una major quantitat de passos diaris a una alta intensitat mitjana no influeix en el risc d'hospitalització per MPOC (HR = 1.01; p = 0,919). Conclusions: El YPAS és una eina vàlida per a la detecció precoç dels individus amb MPOC físicament inactius. Els pacients amb MPOC greu i molt greu realitzen menys episodis i quantitat d'activitat física, i tenen menor la ràtio entre episodis i quantitat que en aquells en estat lleu i moderat. Una major quantitat d'activitat física de baixa intensitat redueix el risc d'hospitalització per MPOC.Antecedentes: La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una de las principales causas de mortalidad y discapacidad a nivel mundial. La actividad física es uno de los pocos factores modificables que desaceleran la evolución de la EPOC. Sin embargo, la dosis y las características de la actividad física responsables de la desaceleración son todavía desconocidas. En consecuencia, los objetivos de esta tesis son avanzar y perfeccionar la metodología e instrumentos para evaluar la actividad física realizada por los enfermos con EPOC, profundizar en el conocimiento sobre las características y patrones de su actividad física y determinar qué características de la actividad física mejoran el pronóstico de los enfermos con EPOC. Métodos: Han participado 177 individuos con EPOC estable seleccionados de 8 hospitales en España (94% hombre, edad media±DE 71±8 años, volumen espiratorio forzado predicho en 1 s 52±16% e índice de masa corporal 29±5 kg·m-2). La actividad física fue medida por un acelerómetro (SenseWear® Pro2 Armband) y por un cuestionario (Yale Physical Activity Survey, YPAS). Las variables sociodemográficas (edad, sexo, estado civil, nivel educativo, nivel socioeconómico, situación laboral y hábito tabáquico) y las variables clínicas (limitación al flujo aereo, hiperinsuflación pulmonar, disnea, intercambio de gases, inflamación sistémica y local, composición corporal, comorbilidades, calidad de la vida y capacidad de ejercicio), se obtuvieron utilizando instrumentos validados y siguiendo las normas internacionales. La información sobre la evolución de la enfermedad (ingresos hospitalarios y mortalidad) se obtuvo de los registros gubernamentales. Resultados: (Objetivo 1) El YPAS es una herramienta válida para la detección precoz de la inactividad de los individuos con EPOC [área bajo la curva ROC (95% IC) = 0.71 (0.63-0.79)]. (Objetivo 2) El 97% de los individuos con EPOC son capaces de realizar episodios de 10 minutos de actividad física moderada-vigorosa. Más del 50% de los individuos con EPOC cumplen con la recomendación de la Organización Mundial de la Salud sobre actividad física para las personas mayores. La cantidad de actividad física, la proporción de ésta realizada en episodios de 10 minutos y la frecuencia de estos episodios disminuyó con el aumento de la gravedad de la EPOC. (Objetivo 3) La cantidad y la intensidad de la actividad física son determinantes independientes de la evolución de la EPOC. El riesgo de hospitalización por EPOC es un 20% menor por cada 1000 pasos adicionales realizados en baja intensidad media. Sin embargo, una mayor cantidad de pasos diarios a una alta intensidad media no influye en el riesgo de hospitalización por EPOC (HR = 1.01; p = 0,919). Conclusiones: El YPAS es una herramienta válida para la detección precoz de los individuos con EPOC físicamente inactivos. Los pacientes con EPOC grave y muy grave realizan menos episodios y cantidad de actividad física, y tienen menor el ratio entre episodios y cantidad que en aquellos en estado leve y moderado. Una mayor cantidad de actividad física de baja intensidad reduce el riesgo de hospitalización por EPOC.
Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of worldwide mortality and disability. Physical activity is one of the few modifiable factors that decelerate COPD evolution. Nonetheless, the dose and characteristics of physical activity responsible of the deceleration are still unknown. In consequence, the aims of this thesis are to move forward and refine the methodology and instruments to evaluate the physical activity of COPD individuals, go in depth in the knowledge about the characteristics and the pattern of their physical activity, and determine which physical activity characteristics improve the prognosis of COPD patients. Methods: 177 individuals with stable COPD selected from 8 hospitals in Spain have participated (94% male, mean±SD age 71±8 years, forced expiratory volume in 1 s 52±16% predicted and body mass index 29±5 kg·m-2). Physical activity was measured with an accelerometer (SenseWear® Pro2 Armband) and with a questionnaire (Yale Physical Activity Survey, YPAS). The sociodemographic (age, sex, civil status, educational level, socioeconomic status, employment status, and tobacco habit) and clinical variables (airflow limitation, lung hyperinflation, dyspnoea, gas exchange, local and systemic inflammation, body composition, comorbidities, quality of life, and exercise capacity), were obtained using validated tools and following international standards. Information about the evolution of the disease (Hospital Admissions and Mortality) was obtained from government registries. Results: (Objective 1) The YPAS is a valid tool for the detection of COPD individuals’ inactivity [the area under the ROC curve is 0.71 (95% CI: 0.63–0.79)]. (Objective 2) The 97% of COPD individuals are able to perform 10-minutes bouts of moderate-to-vigorous physical activity. More than 50% of the COPD individuals met the World Health Organization recommendation of physical activity for the elderly. The quantity of physical activity, the percentage of activity done in bouts and the frequency of bouts decreased with increasing COPD severity. (Objective 3) The quantity and the intensity of physical activity are independent determinants of the COPD evolution. Every additional 1000 daily steps at low-average intensity reduce by 20% the risk of COPD hospitalisation. However, a greater quantity of daily steps at high-average intensity does not influence the risk of COPD hospitalisation (HR 1.01, p=0.919). Conclusion: The YPAS is a valid instrument for the early screening of COPD patients who run the risk of sedentarism. Patients with severe and very severe COPD perform fewer bouts and less quantity of physical activity, and have lower ratio between bouts and quantity than those in mild and moderate stages. Higher quantity of low-intensity physical activity reduces the risk of COPD hospitalization.
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McCafferty, John. "Respiratory heat and moisture loss in health, asthma and chronic obstructive pulmonary disease (COPD)." Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/29259.
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It was hypothesized that Respiratory heat and moisture loss (RHML) would be altered in patients with Asthma and Chronic obstructive pulmonary disease (COPD) due to the effects of airway inflammation and re-modeling. By designing a novel device incorporating humidity, temperature and flow sensors, RHML was measured in 25 normal controls, 33 asthmatics and 17 patients with COPD. In normal subjects RHML was found to be dependent on breathing pattern as defined by tidal volume and minute ventilation whereas no association was found between RHML and body surface area. At matched breathing patterns asthmatics whether in the exacerbation or stable group showed a small but significantly increased RHML compared to controls (exacerbation group-93.2 (SD=8.0), p=0.0003, stable group - 89.3 (SD=7.4), p=0.025 and controls 85 (SD=4.3) Joules/L). No significant difference was found in RHML between the asthmatics with an exacerbation and those with stable disease. COPD patients showed no significant difference in RHML (stable group-83 (SD=4.8), p=0.23 and exacerbation group-81 (5D=5.8), p=0.06 Joules/L) compared to controls or between exacerbation and stable groups. Evaporative heat loss accounted for the major heat transfer modality (up to 3-times the dry convective heat loss). It can be concluded that asthma is associated with a measurable increase in heat and moisture loss in breath and that this may reflect the inflammatory and vascular changes known to occur in the asthmatic airway. Further studies are required to assess whether the technique developed in this study may provide a practical means to measure inflammation in asthma.
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Lindberg, Anne. "Chronic obstructive pulmonary disease (COPD) : prevalence, incidence, decline in lung function and risk factors." Doctoral thesis, Umeå : Public Health and Clinical Medicine, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-347.
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