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Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality

Background

Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD.

 Methods

Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and non-smokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study.

 Results

CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16% predicted), 199 smokers with normal spirometry (54±9 years; FEV1 110±12% predicted) and 71 non-smokers (55±9 years; FEV1 114±14% predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036).

 Conclusions

Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.

The 'anatomic shunt test' in clinical practice; contemporary description of test and in-service evaluation

The 100% oxygen shunt test for detecting right-to-left anatomical shunting was originally described 70 years ago. However, its clinical value is not yet established. We conducted an audit in 80 patients undergoing the test between 1996 and 2012 in a tertiary referral centre. A significant difference (p=0.02) existed between the median shunt percentages where anatomical shunting was identified (10.2%) and absent (5.0%). The area under the curve for a ROC plot was 0.70. A shunt percentage of 8.3 had a sensitivity of 80% and specificity of 75% for detection of an anatomic shunt. We conclude the test is satisfactory for the first-line investigation for anatomic shunting.

Deadly MERS 'camel flu' may now be airborne

Conclusion This genetic research found genetic fragments from the MERS virus in an air sample of a barn housing MERS-infected camels. This raises the possibility that the owner contracted the MERS virus from airborne transmission, rather than through direct contact, as had previously been assumed. However, it is important to realise that, based on this research alone, there is no concrete evidence to suggest the transmission was airborne, only that it is a possibility to investigate further. It was also unusual that the virus was only detected in one of the three air samples, taken 12 days after the onset of illness and four days after the man had been admitted to an ICU. There could be many explanations for this – such as ventilation in the barn.  Either way, it highlights that more...

Annual financial cost of COPD $36 billion in U.S.: CDC report

A new report outlines the total and state-specific medical and absenteeism costs of chronic obstructive pulmonary disease among adults in the United States, and lays out some projections to 2020. Chronic lower respiratory diseases, including COPD, are the third-leading cause of death in the United States. Close to 24 million US adults have evidence of impaired lung function, indicating an underdiagnosis of COPD. Smoking is a primary risk factor of COPD, and approximately 80% of COPD deaths can be attributed to smoking. (Source: ScienceDaily Headlines)

Predictive Value of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma in Tumor Recurrence and Patient Survival [Thoracic Oncology]

Conclusion In lung adenocarcinoma, the IASLC/ATS/ERS classification system has significant prognostic and predictive value regarding death and recurrence. Solid-predominant adenocarcinoma was also a significant predictor in patients undergoing adjuvant chemotherapy. Prognostic and predictive information is important for stratifying patients for aggressive adjuvant chemoradiotherapy. (Source: Journal of Clinical Oncology)

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