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Background: Bioelectrical impedance analysis (BIA) is a valuable method for estimating fat-free mass and fat mass in patients with COPD by using specific predictive equations. In addition, raw BIA variables such as high- to low-frequency impedance ratios (IRs) and phase angle, most likely as a result of providing information on muscle quality, have been related to disease severity and mortality in patients with several diseases but never in COPD. The aim of this study was to investigate the predictive role of raw BIA variables on 2-year survival in COPD., Methods: Impedance (Z) at 5-10-50-100-250 kHz and phase angle at 50 kHz were determined in 210 patients with COPD. Three IRs were calculated: Z at 50 kHz/Z at 5 kHz (50/5 IR), Z at 100 kHz/Z at 5 kHz (100/5 IR), and Z at 250 kHz/Z at 5 kHz (250/5 IR). Demographic, respiratory, and body composition data at baseline were recorded. All-cause mortality was assessed during 2 years of follow-up., Results: After the follow-up period, all-cause mortality was 13.8%. Statistically significant differences between nonsurvivors and survivors emerged in terms of age, weight, BMI, FEV 1, inspiratory capacity, and modified Medical Research Council dyspnea score. With respect to nutritional variables, nonsurvivors had lower fat-free mass (P = .031), lower fat mass (P = .015), higher IRs (P < .001 for all the ratios), and lower phase angle (P < .001) compared with survivors. After adjustment for confounding factors, each unit increase of IRs and each unit decrease of phase angle were associated with a higher risk of death., Conclusions: IRs and phase angle, as raw BIA variables, are independent and powerful predictors of all-cause mortality in COPD and should be considered, together with inspiratory capacity and 6-min walk distance, as significant prognostic factors in the short- to middle-term., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Study Objectives: To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister., Design: Randomized crossover trial., Setting: Physiopathology laboratory of three rehabilitation centers., Patients and Interventions: We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality)., Measurements and Results: The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline., Conclusions: This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.

Study Objectives: It is well known that systemic administration of corticosteroids has a dual effect on growth hormone (GH) secretion in man: acute systemic administration stimulates GH release, whereas chronic administration consistently blocks it. In this study, we evaluate whether administration of inhaled corticosteroids could acutely stimulate GH secretion, and whether this effect could be dose related., Design: Double-blind, placebo-controlled, crossover study., Participants: Eight normal male volunteers all recruited at our institution., Interventions: Administration of increasing doses of inhaled beclomethasone dipropionate (BDP; range, 50 to 1,500 mug) or placebo., Measurements and Results: Blood samples for GH determinations were collected at - 15, 0, 60, 120, 180, 240, 300, and 360 min in relation to BDP or placebo administration. The results of this study show a peak GH secretion at 240 min after the administration of BDP at doses > 100 microg. The comparisons among the peaks obtained with increasing doses showed a dose-response effect on GH secretion, starting from 100 to 1,000 microg. BDP 1,500 microg did not induce a peak significantly different from that obtained with 1,000 microg. When we calculated the GH response to BDP as an area under the curve (micrograms per liter x 6 h), the data confirmed that GH secretion was elicited in a dose-related manner., Conclusions: Our data show that inhaled BDP at dose > 100 microg acutely stimulates GH secretion in a strictly dose-dependent manner. We propose this test as a surrogate for systemic absorption and as a valuable test to compare systemic effects among different inhaled steroids.

Bronchoalveolar lavage (BAL) can be performed with the patient undergoing either local or general anesthesia (GA). This study investigates whether the type of anesthesia affects BAL fluid and cell recovery. Eighty patients, were selected for study. Fluid recoveries were significantly less in the GA group for both the bronchial and alveolar lavages. The differences were confirmed for BAL fluid recovery in a subsequent group of 120 unselected patients. Bronchoscope size did not appear to affect recovery, nor did anesthesia time; BAL fluid recovery from patients with respiratory failure who were intubated and mechanically ventilated was similar to that in the GA group, suggesting that lower recovery rates may be due to mechanical ventilation. The BAL fluid cell counts were related to fluid recovery, but airway neutrophils represented a higher percentage of BAL lavage fluid cells in the GA lavages, independent of differences in the volume of lavage fluid recovered.