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Lara de Souza Dias,1 Anna Carolina Galvão Ferreira,1 José Laerte Rodrigues da Silva Junior,2 Marcus Barreto Conte,3 Marcelo Fouad Rabahi1 1Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Goiás, Brasil; 2Faculdade de Medicina, Universidade de Rio Verde, Aparecida de Goiânia, Goiás, Brasil; 3Faculdade de Medicina, Faculdade Arthur Sá Earp Neto, Petrópolis, Rio de Janeiro, BrasilCorrespondence: Lara de Souza Dias Viela Gabriela Augusta Nascimento Qd.B Lt.7H Centro, CEP:75640-000, Piracanjuba, Goiás, BrasilEmail laradias_1@hotmail.comRationale: Frailty in chronic obstructive pulmonary disease (COPD) patients has been associated with a higher rate of incidents, longer duration of hospitalization, poorer quality of life, and higher mortality.Objective: To measure the prevalence of frailty among COPD patients and to evaluate associated variables.Methods: A cross-sectional study. Subjects who visited a State Center for High-Cost Medicines to obtain free monthly COPD medicines were considered eligible. Individuals ≥ 40 years old who had a FEV1/FVC ratio of < 0.7 post-bronchodilation were enrolled. The Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale, Medical Research Council dyspnea scale (MRC), COPD Assessment Test (CAT), a combination of CAT/MRC [(CAT/8)+MRC], and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity scale were used to evaluate the enrolled subjects. Variables associated with frailty were analyzed using an ordered logistic regression and a multivariate logistic regression.Results: The prevalence of frailty and pre-frailty among the 153 COPD subjects enrolled was 50.3% (77/153) and 35.3% (54/153), respectively. Frailty scores were correlated with CAT (correlation coefficient [cc]: 0.52, p < 0.001) and MRC (cc: 0.48, p < 0.001). Ordinal regression models showed that MRC and CAT were associated with fragility (p < 0.0001 for both models). Higher odds of frailty were observed in GOLD groups B (p = 0.04) and D (p = 0.02). Multiple logistic regression revealed that the combination CAT/MRC≥ 5.5 was associated with frailty (OR 6.73; p < 0.0001) and had a specificity of 80.3%, sensitivity of 62.3%, and positive and negative predictive values of 76.2% and67.8%, respectively.Conclusion: Frailty prevalence was high and was correlated with higher MRC and CAT scores. The CAT/MRC combination [(CAT/8)+MRC] ≥ 5.5 was highly associated with frailty, suggesting that an additional specific evaluation for the presence of frailty is indicated.Keywords: frailty, pulmonary disease, chronic obstructive

Daniela Graner Schuwartz Tannus-Silva,1 João Batista Masson-Silva,1 Lays Silva Ribeiro,1 Marcus Barreto Conde,2,3 Marcelo Fouad Rabahi1 1Faculty of Medicine, Federal University of Goias, Goiânia, Goiás, 2Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, Rio de Janeiro, 3Faculdade de Medicina de Petrópolis, Petrópolis, Rio de Janeiro, Brazil Background and objective: COPD, a systemic illness associated with the impairment of different organs, affects patient prognosis and quality of life. The aim of this study was to evaluate the association between right ventricle (RV) function, the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index (a multifunctional scale for the assessment of mortality risk), and quality of life in patients with COPD. Methods: A cross-sectional study was carried out in 107 outpatients presenting with stable COPD who underwent clinical assessment, spirometry, arterial blood gas analyses, a 6-minute walk test, electrocardiography, and echocardiogram and who responded to the Saint George’s Respiratory Questionnaire (SGRQ). Results: Among the study subjects, 53% (57/107) were males, and the mean age was 65.26±8.81 years. A positive correlation was observed between RV dysfunction measured by the myocardial performance index using tissue Doppler (MPIt) and the BODE index, even after adjustment for age and partial pressure of oxygen (r2=0.47; P

Marcelo Fouad Rabahi,1,2 Sheila Alves Pereira,1 José Laerte Rodrigues Silva Júnior,1,2 Aline Pacheco de Rezende,1 Adeliane Castro da Costa,2 Krislainy de Sousa Corrêa,2,3 Marcus Barreto Conde4,5 1School of Medicine, Federal University of Goiás, Goiania, Brazil; 2Clínica do Aparelho Respiratório (CLARE), Goiania, Brazil; 3Pontifical Catholic University of Goiás, Goiania, Brazil; 4Faculdade de Medicina de Petrópolis/FASE, Petrópolis, Brazil; 5Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Background: The diagnosis of chronic obstructive pulmonary disease (COPD) is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods: This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second

Maria Rosedália de Moraes,1 Adeliane Castro da Costa,2 Krislainy de Sousa Corrêa,2 Ana Paula Junqueira-Kipnis,2 Marcelo Fouad Rabahi3 1Health Sciences of Federal University of Goiás, 2Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil; 3Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil Background: The role of interleukins in the severity and clinical profile of chronic obstructive pulmonary disease (COPD) is not known, but evidence supports the contribution of systemic inflammation to disease pathophysiology. This study evaluated the relationship of serum biomarkers to the severity and clinical parameters of COPD. Methods and findings: Serum levels of high-sensitivity C-reactive protein, interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured in 50 patients with stable COPD and in 16 controls. The levels of these biomarkers were compared with parameters of severity, such as the grading of flow obstruction using the recommendations of the Global initiative for chronic Obstructive Lung Disease, the BMI (body mass index), obstruction, dyspnea, exercise capacity (health index) index, the number of exacerbations within the last year, and peripheral oxygen saturation after the six-minute walk test, and with clinical parameters, such as bronchitis and non-bronchitis phenotypes, the number of associated comorbidities, and the smoking burden. COPD patients exhibited higher levels of IL-6 and IL-8 compared to the control group. Higher levels of IL-6 occurred in COPD groups with body mass index

Purpose: This study aims to define which of the right ventricular myocardial deformation indices best correlates with the classic echocardiographic measurements and indices of right ventricular (RV) dysfunction in patients with stable chronic obstructive pulmonary disease (COPD)., Patients and Methods: Ninety-one patients with stable COPD underwent clinical evaluation, spirometry, a 6-minute walk test, and echocardiographic examination. Patients were divided into two groups: "with RV dysfunction" (≥1 classic parameter) and "without RV dysfunction". We used speckle tracking to estimate myocardial deformation. For all analyses, results were considered significant if p < 0.05., Results: The mean age across all participants was 65 ± 9 years, with 53% (48/91) being male. Patients in the group with RV dysfunction were able to walk shorter distances and had higher estimated right ventricular systolic pressure (RVSP) and mean pulmonary arterial pressure (mPAP). The RV free wall longitudinal strain (RVFWLS) was the only deformation indices that showed a significant correlation with all classic measurements and indices in the diagnosis of RV dysfunction (Wald test, 10.24; p < 0.01; odds ratio, 1.61). In the ROC curve analysis, the absolute value <20% was the lowest cut-off point of this index for detection of RV dysfunction (AUC = 0.93, S: 95.8%, and E: 88%)., Conclusion: In COPD patients, RVFWLS is the myocardial deformation index that best correlates with classic echocardiographic parameters for the diagnosis of RV dysfunction using <20% as a cut-off point., Competing Interests: All authors declare no competing financial interests and report no conflicts of interest for this work., (© 2021 Masson Silva et al.)

Background: The role of interleukins in the severity and clinical profile of chronic obstructive pulmonary disease (COPD) is not known, but evidence supports the contribution of systemic inflammation to disease pathophysiology. This study evaluated the relationship of serum biomarkers to the severity and clinical parameters of COPD., Methods and Findings: Serum levels of high-sensitivity C-reactive protein, interleukin-6 (IL-6), and interleukin-8 (IL-8) were measured in 50 patients with stable COPD and in 16 controls. The levels of these biomarkers were compared with parameters of severity, such as the grading of flow obstruction using the recommendations of the Global initiative for chronic Obstructive Lung Disease, the BMI (body mass index), obstruction, dyspnea, exercise capacity (health index) index, the number of exacerbations within the last year, and peripheral oxygen saturation after the six-minute walk test, and with clinical parameters, such as bronchitis and non-bronchitis phenotypes, the number of associated comorbidities, and the smoking burden. COPD patients exhibited higher levels of IL-6 and IL-8 compared to the control group. Higher levels of IL-6 occurred in COPD groups with body mass index <21 kg/m(2), with more than two exacerbations in the past year, with a higher smoking burden, and with bronchitis. The increase in serum IL-8 was found only in the group with the highest number of exacerbations within the previous year., Conclusion: Increased IL-6 was mainly associated with smoking burden, in patients who had smoked for more than 30 pack-years and exhibited a bronchitis phenotype. No direct association was observed for both IL-6 and IL-8 blood levels with the severity of COPD in ex-smokers.