Burden and Characteristics of Severe Chronic Hypoxemia in a Real-World Cohort of Subjects with COPD

Zysman, M.; Deslée, G.; Pérez, Thierry; Burgel, Pierre‐Régis; Chenivesse, Cécile; Brinchault-Rabin, Graziella; Nesme-Meyer, Pascale; Fortune, Isabelle Court; Jébrak, G.; Chanez, Pascal; Caillaud, D.; Paillasseur, Jean-Louis; Roche, Nicolás

doi:10.2147/copd.s295381

Cited by 14 publications

(7 citation statements)

References 20 publications

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“… 49 A significant proportion of COPD patients have varying degrees of decreased oxygen saturation due to decreased spirometry. 50 Our hypothesis proposes that the persistent deficiency of oxygen, known as chronic hypoxia, in patients who suffer from COPD triggers a response in the myocardium which results in the secretion of NT-proBNP. Recent research has suggested plausible hypotheses regarding the elevated NT-proBNP levels observed in patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis

Su¹,

Lei²,

Yu³

et al. 2023

COPD

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Purpose NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD. Methods The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients. Results A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; p =0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV 1 ) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV 1 ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; p =0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; p =0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; p =0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; p <0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; p <0.0001] showed higher NT-proBNP level. Conclusion NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.

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Section: Discussionmentioning

confidence: 99%

NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis

Su¹,

Lei²,

Yu³

et al. 2023

COPD

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“…Furthermore, the accuracy of commercially available pulse oximeters decreases at lower SpO 2 levels (Severinghaus et al., 1989). However, in a clinical setting, it may be expected that exceptionally low PO 2 and SpO 2 levels are experienced by patients routinely, such as in severe obstructive sleep apnoea, or in chronic or acute lung disease cases (Zysman et al., 2021). Therefore, it is possible that the high variability in HVR at lower SpO 2 levels may have clinical relevance in these cases and could affect disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the accuracy of commercially available pulse oximeters decreases at lower SpO 2 levels (Severinghaus et al, 1989). However, in a clinical setting, it may be expected that exceptionally low PO 2 and SpO 2 levels are experienced by patients routinely, such as in severe obstructive sleep apnoea, or in chronic or acute lung disease cases (Zysman et al, 2021) drive is often observed in patients with severe lung injury. The resulting intense respiratory effort can cause additional lung damage through 'patient self-inflicted lung injury' (Spinelli et al, 2020).…”

Section: Summary Of Findingsmentioning

confidence: 99%

The normal distribution of the hypoxic ventilatory response and methodological impacts: a meta‐analysis and computational investigation

Oeung,

Pham,

Olfert

et al. 2023

The Journal of Physiology

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The hypoxic ventilatory response (HVR) is the increase in breathing in response to reduced arterial oxygen pressure. Over several decades, studies have revealed substantial population‐level differences in the magnitude of the HVR as well as significant inter‐individual variation. In particular, low HVRs occur frequently in Andean high‐altitude native populations. However, our group conducted hundreds of HVR measures over several years and commonly observed low responses in sea‐level populations as well. As a result, we aimed to determine the normal HVR distribution, whether low responses were common, and to what extent variation in study protocols influence these findings. We conducted a comprehensive search of the literature and examined the distributions of HVR values across 78 studies that utilized step‐down/steady‐state or progressive hypoxia methods in untreated, healthy human subjects. Several studies included multiple datasets across different populations or experimental conditions. In the final analysis, 72 datasets reported mean HVR values and 60 datasets provided raw HVR datasets. Of the 60 datasets reporting raw HVR values, 35 (58.3%) were at least moderately positively skewed (skew > 0.5), and 21 (35%) were significantly positively skewed (skew > 1), indicating that lower HVR values are common. The skewness of HVR distributions does not appear to be an artifact of methodology or the unit with which the HVR is reported. Further analysis demonstrated that the use of step‐down hypoxia versus progressive hypoxia methods did not have a significant impact on average HVR values, but that isocapnic protocols produced higher HVRs than poikilocapnic protocols. This work provides a reference for expected HVR values and illustrates substantial inter‐individual variation in this key reflex. Finally, the prevalence of low HVRs in the general population provides insight into our understanding of blunted HVRs in high‐altitude adapted groups. imageKey points The hypoxic ventilatory response (HVR) plays a crucial role in determining an individual's predisposition to hypoxia‐related pathologies. There is notable variability in HVR sensitivity across individuals as well as significant population‐level differences. We report that the normal distribution of the HVR is positively skewed, with a significant prevalence of low HVR values amongst the general healthy population. We also find no significant impact of the experimental protocol used to induce hypoxia, although HVR is greater with isocapnic versus poikilocapnic methods. These results provide insight into the normal distribution of the HVR, which could be useful in clinical decisions of diseases related to hypoxaemia. Additionally, the low HVR values found within the general population provide insight into the genetic adaptations found in populations residing in high altitudes.

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“…Inflammatory factors have been shown to be involved in the development of malnutrition through the fusion of multiple mechanisms ( Laviano et al, 2003 ). Hyperinflation plays an important role in chronic hypoxia and hypercapnia ( Zysman et al, 2021 ). Such interactions may further complicate the condition of diaphragmatic dysfunction.…”

Section: Mechanisms Of Diaphragm Dysfunction In Copdmentioning

confidence: 99%

Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease

Cao

Wang

et al. 2022

Front. Physiol.

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Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.

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Burden and Characteristics of Severe Chronic Hypoxemia in a Real-World Cohort of Subjects with COPD

Cited by 14 publications

References 20 publications

NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis

NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis

The normal distribution of the hypoxic ventilatory response and methodological impacts: a meta‐analysis and computational investigation

Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease

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