呼吸器・呼吸器内科

Background: COPD is associated with cardiovascular co-morbidities. We examined the prevalence of undiagnosed COPD in our local population of patients with stable cardiovascular diseases and the profile of their respiratory symptoms and functional status.

Methods: Eligible patients with established stable cardiovascular diseases were prospectively recruited from the cardiology outpatient clinic of an urban-based university teaching hospital and evaluated with pre- and post- bronchodilator spirometry testing and interview using standard questionnaire.

Results: Of the 501 subjects recruited, 113 (22.6%) had COPD defined on post-bronchodilator fixed FEV 1 /FVC ratio <70%. 109 (96.5%) had moderate severity while only 4 (3.5%) had severe disease by GOLD classification. Compared to non-COPD, proportionately more COPD patients were older, males, exposed to cigarette smoking (including passive smoking) and had congestive cardiac failure and pulmonary hypertension. Also proportionately more COPD subjects had more cough, sputum and dyspnoae, and poorer scores in MRC dyspnoae scale, NYHA functional class and SGRQ quality of life. These symptoms were generally worst in the evening. They also had significantly higher mean number of unscheduled visits to outpatient clinics, emergency departments and of hospital admissions over the past 12 months. After multivariate analysis, only dyspnoae [odd ratio (95%CI): 4.2 (1.8-9.7); p=0.001] and cigarette smoking [2.8 (1.1-6.80); 0.018] remained independently associated with COPD.

Conclusions: A significant proportion of patients with established cardiovascular diseases have undiagnosed COPD of moderate severity. Dyspnoae and cigarette smoking appear highly predictive of COPD.

Chronic Obstructive Pulmonary Disease (COPD) is increasingly recognized as a systemic disease characterized by progressive airflow limitation as well as respiratory and peripheral muscle weakness. Deficiency in the levels of carnitine “an essential nutrient for optimal muscle function” has been associated with peripheral and respiratory muscle weakness in other diseases, but has not yet been examined in COPD patients. The aim of this study was to investigate whether plasma acyl carnitine fractions were reduced in patients with COPD, and examine if the deficiency correlated with COPD severity.

Patients and methods: A prospective case control study to compare acyl carnitine levels and other parameters in 81 COPD patients treated at the Pulmonology Department, King Fahad Specialist Hospital Dammam, with 48 age and sex matched healthy controls. All subjects participating in the study underwent a complete physical examination and detailed pulmonary function tests (PFTs). Blood samples were taken for acyl carnitine profiles as well as a panel of other tests including albumin, total protein, Iron, CRP and pre-albumin. Acyl carnitine profile was determined using LC-MS/MS analysis.

Results: COPD patients had significantly lower total carnitine levels compared to controls (43.9±6.5 and 22.7±11.9 respectively). Furthermore there was a significantly greater reduction in carnitine levels in patients with very severe COPD compared to patients with mild COPD.

Conclusion: Our study demonstrated a significant deficiency in carnitine levels in COPD patients, and the degree of deficiency correlated with the severity of COPD.

The clinical effects of environmental pollution and climate change on respiratory health is a contemporary debate issue. In this study, the sulfur dioxide (SO 2 ), particulate matter (PM 10 ) levels, and climate conditions in the city of Izmir, have been taken together with the patients with asthma or acute bronchiolitis, who admitted to the children’s emergency departments of the four university/education-research hospitals in Izmir. From September 1, 2007 until August 31, 2008, the 22,467 patients who admitted to these centers because of airway hyperreactivity, were of age 3.05±1.57 on the average, and the male/female ratio was 1.7. Among the patients, 79.3% were having acute bronchiolitis, and 20.7% an asthma attack. As SO 2 and PM 10 levels increase, the daily asthma attacks, patients with acute bronchiolitis, and total of patients with hyperactivity, were observed to increase (p<0.001). In addition, the numbers in the following five days after the increase of air pollution rate, were observed to increase statistically significantly (p<0.001). The number of asthma and acute bronchiolitis patients applying to emergency, was negatively correlated with daily average temperature, but positively correlated with relative humidity, actual air pressure, and sea- level pressure levels (p<0.001). Reflecting on the increase of asthma and acute bronchiolitis in developed societies, there is a necessity of effective reliefs such as effectively monitoring the within-city air quality, taking the industrial centers out of the city, promoting public transportation, and preserving the natural life.

In this study, the effect of dopamine as agonist dopaminergic receptor and alpha and beta adrenergic receptor was studied both in vivo. The effect of tolazoline as an antagonist of alpha-2 adrenergic receptor was also studied in patients with bronchial asthma and persons with increased bronchial reactibility. Parameters of the lung function are determined by body plethysmography. Raw and ITGV were registered and SRaw was calculated as well. Aerosolization is done with standard aerosolizing machines – Asema. Results gained in vivo shows that stimulation of alpha adrenergic receptor with dopamine (4 μg and 300 μg) causes significant contraction (p > 0.1) of the smooth bronchial musculature. Whereas, blockage of alpha-2 adrenergic receptor with tolazoline (20 mg by inhalator ways) does not change the bronchimotor tonus significantly (p>0.1) when compared to the stimulation of beta-2 adrenergic receptor with hexoprenaline (2 inh. x 0.2 mg) and blocker of cholinergic receptor - ipratropium (2 inh. x 1 mg). Reaction of the smooth musculature to dopamine suggests that this substance may cause constriction through alpha adrenergic receptors. Reaction may also be intermediated in indirect ways through dopaminergic receptor of the cholinergic transmission, with intracellular inhibition of the creation of cAMP.