PS179. High Prevalence of Streptococcous Pseudopneumoniae in Sputum of Patients with Acute Exacerbation of COPD
FANNY WS KO2, MARGARET IP2, ALVIN H TUNG1, RITA CHEUNG1, JOJO CHU1, DAVID SC HUI1
1 Dept. of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, 2 Dept. of Microbiology, The Chinese University of Hong Kong, Hong Kong
Introduction Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common condition that leads to unscheduled health care utilization and impaired health status among patients.
Methods This study assessed the infective etiologies related to AECOPD with molecular techniques including viruses such as bocavirus, human metapneumovirus and novel bacteria like Streptococcous pseudopneumoniae. We also studied paired sputum samples for the same panel of viruses for subjects with positive nasophargneal aspirate (NPA). The relationship between the identification of micro‐organisms and short term clinical outcomes of the patients such as hospital length of stay, need for non‐invasive ventilation and mortality at 3 months were assessed.
Results 323 episodes of AECOPD and 30 control COPD subjects at stable state were studied. Overall, about 20% of the subjects had positive NPA. The commonest viruses identified from the NPA of AECOPD patients were rhinovirus, coronavirus and respiratory syncytial virus. For the control subjects, the commonest organisms detected in NPA specimens were atypical organisms like Mycoplasma pneumoniae (6.5%) and Chlamydia pneumoniae (9.7%). 63.4% of AECOPD patients and 20.8% of control subjects had positive sputum bacterial test. Streptococcus pseudopneumoniae was identified in 29.4% of subjects with AECOPD. Among subjects with positive NPA results, 43.3% showed positive results in paired expectorated sputum. Comparisons of the subjects with same organisms identified in both NPA and sputum versus those in NPA only found similar demographic characteristics and short term clinical outcomes.
Conclusion The role of the high prevalence of Streptococcous pseudopneumoniae in sputum of AECOPD patients and atypical organisms like mycoplasma and chlamydia in NPA of stable COPD subjects needs further investigation.
PS180. Serum Uric Acid: An Alternative Test to Assess Degree of Severity of COPD
JUSUF WIBISONO, DANIEL MARANATHA, WIWIN I EFFENDI
Department of Pulmonology and Respiratory Medicine Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
Background Hypoxemia, as a consequent of alveolar hypoxia, increases along with the severity of COPD. Tissue hypoxia triggers the degradation of purine. Serum uric acid (UA), the final product of purine degradation, has been shown to be increased in the hypoxic state. Therefore, serum UA may reflect the severity of hypoxia. We assessed whether the presence of higher values of serum UA is associated with the degree of severity of COPD.
Methods The research was conducted in the outpatient pulmonary clinic of Soetomo Hospital, Surabaya, East Java, Indonesia. We included 38 consecutive patients with COPD. Patients were in clinically stable condition and without other significant comorbid conditions. The degree of severity was then compared with oxygen saturation and values of serum UA.
Results A weak correlation was found between hypoxemia and the degree of severity of COPD (r = −0.375, p = 0.020). There was no patient with level of saturation less than 80%. Correlation between serum UA value and the degree of severity of COPD presented no significant (r = −0.177, p = 0.288).
Conclusion Severity of COPD that is characterized by decrease of lung function (FEV1) did not result in increased levels of serum uric acid in patients with COPD.
PS181. The Role of Tnf Alpha Serum in Nutritional Status of Chronic Obstructive Pulmonary Disease Patients
MUHAMMAD AMIN, RIDMAWAN W JATMIKO
Department of Pulmonology and Respiratory Medicine Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
Background Systemic inflammation may contribute to cachexia in COPD patients. TNF‐α is one of the important biomarker in systemic inflammation. Aim this study was to analyze correlation between systemic inflammation and nutritional status of chronic obstructive pulmonary disease patients.
Methods This case‐control study was conducted in May up to June 2013. The respondents were stable COPD GOLD I‐IV patients, aged 40–80 year. Case was defined as COPD patient with poor nutritional status, control was defined as COPD patient with good nutritional status. Nutritional status was measured using body mass index (BMI), percentage ideal body weight, lean body mass and fat‐free mass. TNF‐α serum was measured using enzyme immunoassay. The correlation between nutritional status and level of TNF‐α serum were analyzed with Univariat and multivariat analysis.
Result Mean of TNF‐α serum level in case group was higher than control group (49,68 ± 19,23 pg/ml vs 22,22 ± 7,65 pg/ml, p = 0,000). Level of TNF‐α serum had correlation with BMI (r = 0,594; p = 0,000), percentage ideal body weight (r = 0,595; p = 0,000), lean body mass (r = 0,594; p = 0,000) and fat‐free mass (r = 0,594; p = 0,000). The odds ratio was 28 (CI 95%, 4,43–176,78; p = 0,000).
Conclusion TNF‐α serum was correlated with decrease of nutritional status in COPD patients.
Keywords TNF‐α, Tumor necrotic factor, systemic inflammation, nutritional status, COPD.
PS182. Physician Knowledge and Perception of COPD Management in Korea and Japan: Continuing to Confront COPD (C2C) Physician Survey 2012–2013
MASAKAZU ICHINOSE1, KOURTNEY J DAVIS2, YEON‐MOK OH3
1 Dept of Respiratory Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan, 2 GlaxoSmithKline, Worldwide Epidemiology, Wavre, Belgium, 3 University of Ulsan College of Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Korea
Background and Aim of Study Few surveys have focused directly on physicians' perspectives on treating COPD. The C2C Physician Survey aimed to describe physician beliefs and behaviors related to COPD diagnosis and treatment, including knowledge of Revised GOLD 2011 Strategy, in 12 countries including Japan and Korea.
Methods Sampled physicians were identified from in‐country professional association databases, including a total of n = 103 in Korea (74% general practitioners [GP], 26% chest physicians [CP]) and n = 101 interviews in Japan (70% GP, 30% CP). Standardized, translated questionnaires were conducted by telephone, face‐to‐face, or online from January to May 2013.
Results Awareness of the GOLD 2011 Strategy was 73% overall in Korea and 54% overall in Japan; knowledge was higher among CPs compared to GPs (Korea 96% vs. 36%; Japan 80% vs. 42%). Spirometry (Korea 86%; Japan 85%) and chest x‐ray (Korea 91%; Japan 97%) were commonly used to establish a COPD diagnosis, while use of patient‐reported outcomes (Korea 58%; Japan 47%) was lower in both countries. Sixty‐five percent of Korean physicians and 47% of Japanese physicians reported that they discuss smoking cessation with their patients at every visit. Perceived patient adherence to prescribed treatment regimen was low, with only 13% of Korean physicians and 17% of Japanese physicians indicating that at least three‐quarters of their patients always complied with their treatment regimen. Both Korean (47%) and Japanese (57%) physicians indicated medication cost as the most common barrier to accessing and adhering to an optimal regimen.
Conclusion Awareness and application of the GOLD 2011 Strategy were high among respiratory specialist physicians in Korea and Japan, and an opportunity to improve general practitioner delivered care of COPD patients was identified. Sponsored by GSK.
PS183. Survey of Subjective Symptoms and the Actual Condition of Patients Receiving Treatment for Chronic Obstructive Pulmonary Disease
MASAKAZU ICHINOSE1, YOSHINOSUKE FUKUCHI2
1 Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan, 2 Department of Respiratory Medicine, Juntendo University, Tokyo, Japan
Objectives We aimed to understand the symptoms, actual daily behavior, and degree of satisfaction of the patients receiving treatment for chronic obstructive pulmonary disease (COPD).
Method A questionnaire survey targeting 500 patients in 27 medical institutions specializing in pulmonary medicine was carried out between April and June 2013. We included patients aged ≥ 40 years patients who were visiting a medical institution after being diagnosed with COPD via pulmonary function testing. Further, all patients provided consent for participation in the survey. The treating doctors provided data on the pulmonary function, number of exacerbations, and treatment regimens of their patients.
Results Most patients were treated using long‐acting inhalational drugs, and the patients indicated a relatively high degree of satisfaction with the treatment. Cough, sputum, and exertional dyspnea, depending on the disease severity, were frequently observed. Most patients reported that cough was the most troublesome, and was accompanied by sputum, during about 2 h after awakening. Exertional dyspnea was also reported to be the most severe on awakening, which continued for about 2 h, and in the afternoon. Patients reported a greater number of exacerbations than did their doctors, which indicated that the doctors probably did not completely understand the suffering of their patients.
PS184. Evaluation of Properties of the COPD Assessment Test (CAT) Vs Sgrq in Predicting Severity of COPD by Gold Criteria
MARIE GRACE L. LUANCING1, TERESITA S. DE GUIA2, ROMMEL T. BAYOT2
1 Philippine Heart Center, East Avenue Quezon City, Philippine, 2 Philippine Heart Center, East Avenue, Quezon City, Philippines
Background The COPD assessment test (CAT) was developed to assist patients and their clinicians assess and quantify the symptoms and impacts of COPD and enable better communication between patients and physicians about these consequences of their disease. It was already validated to other countries as well in the Philippines and also has strong correlation to SGRQ.
Methods The study was a cross‐sectional, 254 stable COPD patient were included in the study. CAT and SGRQ questionnaires administered as random basis. Data was described as mean ± sd or frequency (no.) and percent distribution. Kappa test was used to determine significance of agreement of cut‐off points of scoring system with severity of COPD as diagnosed by spirometry.
Results The results obtained showed significant impairment in health status that was related to COPD severity. The COPD severity increases the CAT and SGRQ scores also increases significantly (CAT (p = 0), SGRQ (p = 0.001)). However, there was no significant agreement of cut off scores in CAT with COPD severity. (Kappa test: 0.17 p = 0.009).
Conclusion CAT showed significant association in health related impact to COPD severity with good correlation to SGRQ scoring system.
PS185. Risk Factors Associated with Chronic Obstructive Pulmonary Disease Early Readmission
JIAN LIN, YOUZU XU, XIAOMAI WU, MEIFANG CHEN, LING LIN, LIUYANG GONG, JIAXI FENG
Department of Respiratory Medicine, Taizhou Hospital of Wenzhou Medical College, Linhai 317000, Zhejiang, China
Background and Aim of Study 31‐day readmission rate is deemed to be an important indicator of the quality of medical care in China. The objectives of this study were to identify the readmission rate of acute exacerbation for chronic obstructive pulmonary disease (COPD) and to evaluate its associated risk factors.
Methods We retrospectively reviewed patients with acute exacerbation of COPD (AECOPD) to hospital between January 2011 and November 2012. The early readmission group and non‐early readmission group were determined by whether patients were readmitted within 31 days after discharge. Logistic regression analysis was performed to identify risk factors for early readmission following an AECOPD.
Results There were 692 patients with 925 admissions during the 23‐month period, 63 (6.8%) admissions were defined as early readmission. Multivariate analysis showed that chronic pulmonary heart disease (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.26–3.64, p = 0.005), hypoproteinemia (OR 2.02, 95% CI 1.03–3.95, p = 0.040) and the level of PaCO2 (OR 1.03, 95% CI 1.00–1.06, p = 0.027) were the risk factors for early readmission of AECOPD.
Conclusion Readmission rate for AECOPD was high. AECOPD patients with chronic pulmonary heart disease, hypoproteinemia, and high level of PaCO2 are at risk for readmission with 31 days of hospital discharge, and medical care of these patients warrants much greater attention.
PS186. Low Lung Volume Is Associated with Visceral Adipose Tissue Inflammation
SHIGEO KAWASE1, SHINTARO MIYAMOTO1, HIROSHI OHNISHI1, TETSUYA KUBOTA1, TSUTOMU NAMIKAWA2, KAZUHIRO HANAZAKI2, AKIHITO YOKOYAMA1
1 Department of Hematology and Respiratory Medicine, Kochi University, Kochi, Japan, 2 Department of Surgery, Kochi University, Kochi, Japan
Background Chronic obstructive pulmonary disease (COPD) has been recognized as a systemic inflammatory disease. Although visceral adipose tissue inflammation is known to be associated with various lifestyle diseases, such as diabetes mellitus and atherosclerosis, its contribution to the systemic inflammation of COPD remains unclear. The aim of this study was to evaluate the association between lung function and visceral adipose tissue inflammation.
Methods This study included 82 patients who underwent surgical resection due to an early stage of abdominal cancer, such as gastric and colon cancer. Visceral adipose tissue was obtained during the operation with informed consent. We quantified inflammatory cells in the adipose tissues, and evaluated its association with clinical parameters including lung function. This study was approved by an institutional ethics committee.
Results The number of visceral adipose tissue macrophage (ATM) did not show a significant correlation with FEV1% (FEV1/FVC), and was not different between patients with (n = 20) and without airflow limitation (n = 62). However, there was a significant negative correlation between ATM and % predicted VC (r = −0.30, p = 0.006). In addition, there was a significant positive correlation between ATM and body mass index (BMI). The levels of CRP was significantly higher in patients with low % predicted VC. Multivariate analyses demonstrated that % predicted VC and BMI were independently associated with the number of visceral ATM.
Conclusion The adipose tissue inflammation may contribute to the systemic inflammation of advanced COPD with low lung volume, independently from BMI.