To describe some clinical and subclinical characteristics of chronic obstructive pulmonary disease patients with lung transplant indication.
Jourrnal of military pharmaco-medicine n09-2019 STUDY ON CLINICAL AND SUBCLINICAL CHARACTERISTICS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH LUNG TRANSPLANT INDICATION AT 103 MILITARY HOSPITAL Bui Khac Hiep1; Mai Xuan Khan2 SUMMARY Objectives: To describe some clinical and subclinical characteristics of chronic obstructive pulmonary disease patients with lung transplant indication Subjects and methods: 11 patients were given pulmonary ventilation, 6-minute walk distance, assessment of dyspnea level, Doppler echocardiography to measure pulmonary artery pressure, BMI calculation, chest wall computed tomography scan, posteroanterior chest radiograph, arterial blood gas Results: 100% of patients with lung transplant indications were men, coughing, sputum, dyspnea, emphysema; BMI was 18.91 ± 3.18 kg/m ; assessment of dyspnea level was 2.82 ± 0.60 points; 6-minute walk distance were 193.45 ± 53.34 m; 87.50% of patients had emphysema on CT images; 81.8% had dirty lung images and 72.7% had dirty lung images on standard lung radiograph; FEV1 was 22.64 ± 6.20%SLT; pulmonary artery pressure was 34.30 ± 9.43 mmHg; PaO2: 85.27 ± 38.40 mmHg; PaCO2: 53.45 ± 8.77 mmHg Conclusion: Obstructive pulmonary disease patients with lung transplant indications were 100% coughing, sputum, dyspnea, emphysema; low BMI, 6-minute walk distance and FEV1; average values of pulmonary artery pressure, assessment of dyspnea level and PaCO2 were high * Keywords: Chronic obstructive pulmonary disease; Clinical and subclinical characteristics; Lung transplant INTRODUCTION Chronic obstructive pulmonary disease (COPD) is currently a global disease burden At present, COPD is becoming more prevalence, expected to be the disease with the 3rd highest mortality rate in 2020 with mortality rate increasing by about 30% in the next 10 years [2] Worldwide, lung transplants have been successfully performed in many countries with positive results Lung transplantation is one of the late-stage treatments for COPD Choosing correctly COPD patients with lung transplant indications plays an important role in the success and effectiveness of the technique and prolonging the life time for late-stage COPD patients This study was conducted to: Describe some clinical and subclinical characteristics of COPD patients with lung transplant indication SUBJECTS AND METHODS Subjects - 11 patients diagnosed with COPD and had lung transplant indications treated at the Pulmonary Department of 103 Military Hospital from May 2018 to February 2019 Thai Binh University of Medicine and Pharmacy 103 Military Hospital Corresponding author: Bui Khac Hiep (hiepydtb@gmail.com) Date received: 04/10/2019 Date accepted: 20/11/2019 250 Jourrnal of military pharmaco-medicine n09-2019 - Patients selection criteria: + Patients diagnosed with COPD outside of exacerbation according to GOLD (2018) [3] + Lung transplant indications follow the standards of the International Society for Heart & Lung Transplantation (2006) [4]: BODE from - 10 and with one of the following symptoms: Exacerbation with PaCO2 > 50 mmHg Increase in pulmonary artery pressure or chronic pulmonary heart despite oxygen breathing FEV1 < 20%SLT or DLCO < 20%SLT or homogeneous emphysema on chest wall CT * Exclusion criteria: Patients with heart failure, renal failure, severe hepatic impairment, respiratory infections, under high-dose corticosteroid non-cooperative patients treatment, Methods Prospective, descriptive cross-sectional study - Clinical examination for evaluation: Coughing, sputum, dyspnea, emphysema syndrome, consolidation syndrome, bronchial syndrome, BMI, 6-minute walk distance (6MWD), assessment of dyspnea level (mMRC) - Subclinical: Arterial blood gas, Doppler echocardiography to measure pulmonary artery pressure (PAP), and standard pulmonary heart radiograph, chest wall CT, pulmonary ventilation * Data processing: by SPSS 20.0 software RESULTS AND DISCUSSION Table 1: Common characteristics of study patients (n = 11) Characteristics n % Male 11 100 Smoking cigarettes or rustic tobacco 11 100 Average age Average illness duration ( 64.18 ± 7.59 ± SD) (years) 7.59 ± 6.25 ± SD BMI (kg/m ) 18.91 ± 3.18 Thin 36.4 Normal 63.6 The characteristics of age, gender and history of smoking tobacco in our study were similar to those of other domestic and foreign studies: Dao Ngoc Bang et al (2016) encountered an average age of COPD patients of 66.07 ± 6.47; the average BMI was 18.61 ± 2.44 kg/m2, and male accounted for 100% [1] Ghobadi H et al (2015) encountered an average age of 60.53 ± 13.06 years old with 100% of the patients being male [5] The BMI characteristics of our study were much lower than that of other studies in the world, the study by Ghobadi H et al (2015) had BMI of 25.18 ± 3.37 kg/m2 [5] 251 Jourrnal of military pharmaco-medicine n09-2019 Table 2: Respiratory symptoms of patients with lung transplant indications (n = 11) Characteristics n % Cough 11 100 Sputum 11 100 Dyspnea 11 100 Emphysema syndrome 11 100 Consolidation syndrome 45.5 Bronchial syndrome 63.6 ( mMRC ( 6MWD ± SD) 2.82 ± 0.60 2-3 10 90.9 9.1 ± SD) (m) 193.45 ± 53.34 ≤ 149 27.3 150 - 249 63.6 250 - 349 9.1 Compared to studies around the world, our average mMRC value was much higher Sarioglu’s (2009) research studied 88 patients with COPD, gave an average mMRC value of 1.9 ± 1.1 [6] Shih-Feng-Liu’s (2012) research studied 89 patients with COPD, resulted in an average mMRC value of 1.9 ± 1.4 [7] Patients with lung transplant indications had a short average 6MWD (193.45 ± 53.34 m) This result showed that latestage COPD severely affects their quality of life Compared to studies around the world, their average 6MWD were much higher than that of our study The study patiens of Michael I (2013) had an average 6MWD of 369.1 ± 121.7 m [8] The research of Ghobadi H et al (2015) studied 60 patients with COPD showed an average 6MWD of 346 ± 182 m [5] Shih-Feng-Liu’s (2012) research studied 152 89 patients with COPD, resulted in an average 6MWD value of 398.4 ± 115.2 m [7] Sarioglu’s (2009) study gave an average 6MWD value of 375.2 ± 137.0 m [6] This may be because overseas patients detected the disease and treated it earlier, at an early stage and it had not affect the quality of life of patients, on the other hand, our study was conducted on patients with lung transplant indications at late stage when the disease has greatly affected the overall condition and quality of life of patients Jourrnal of military pharmaco-medicine n09-2019 Table 3: Distribution of patients with lung transplant indications by stage and disease group Classification n % 11 100 C 9.1 D 10 90.9 Stage Disease group Most patients with lung transplant indications had moderate and severe obstruction level with many risk factors and many symptoms Our research results were much higher than those of Dao Ngoc Bang et al’s (2016) research: the proportion of patients in the late stage (GOLD3, GOLD4) was predominant (84.47%) [1] This result showed that patients with lung transplant indications in advanced stage, with many symptoms, high risk, need to be applied comprehensively with treatment measures Table 4: Average values of respiratory parameters (n = 11) Parameter ± SD FVC (%SLT) 49.15 ± 12.40 FEV1 (%SLT) 22.64 ± 6.20 FEV1/FVC 37.10 ± 7.54 pH 7.37 ± 0.04 PaO2 (mmHg) 85.27 ± 38.40 PaCO2 (mmHg) 53.45 ± 8.77 PAP (mmHg) 34.30 ± 9.43 In our study, the FEV1 decreased more than the studies in the world A study by Munari Anelise B et al (2018) showed that the average value of FEV1 was 35.1 ± 15.6%SLT [9] The study by Sarioglu N et al (2009) showed that the average value of FEV1 was 53.3 ± 17.4%SLT [6] The average PAP value was 34.30 ± 9.43 mmHg, higher than normal, late-stage COPD patients often had pulmonary hypertension Arterial blood gas of patients with transplant indications had much higher PACO2 than in the study by Dao Ngoc Bang et al (2016) with the average PaCO2 value of 43.56 ± 7.45 mmHg Table 5: Standard chest radiograph (n = 11) and chest CT (n = 8) characteristics Characteristics Standard chest radiograph Chest CT images n % Dirty lung images 72.7 Emphysema 81.8 Emphysema 87.5 Bronchiecfasis 37.5 Pulmonary fibrosis images 25.0 Interstitial thickness images 12.5 Characteristics of thoracic CT images were consistent with the diagnosis of patients preparing for lung transplant The main images encountered were emphysema images Other images are less common This showed the limitation in patients screening, with the disease aspects requiring lung transplant not diverse Our research results were higher than those of Dao Ngoc Bang (2016) with 80.3% of patients encountering emphysema images on thoracic CT films CONCLUSION For COPD patients with lung transplant indications at 103 Military Hospital, we draw some conclusions: 253 Jourrnal of military pharmaco-medicine n09-2019 - 100% of patients were coughing, sputum, dyspnea and emphysema - The average time of illness was 9.73 ± 6.25 years; BMI: 18.91 ± 3.18 kg/m2; mMRC: 2.82 ± 0.60 points; 6MWD: 193.45 ± 53.34 m - FEV1: 22.64 ± 6.20%SLT; PaO2: 85.27 ± 38.40 mmHg; PaCO2: 53.45 ± 8.77 mmHg; PAP: 34.30 ± 9.43 mmHg - Standard pulmonary radiograph: Dirty lung images were seen in 72.7%; emphysema images 81.8% - Thoracic CT showed 87,5% of emphysema images REFERENCES Dao Ngoc Bang, Dong Khac Hung, Ta Ba Thang Changes of some parameters of respiratory funtion measured by whose body plethysmography in patients with stable chronic obstructive pulmonary disease Journal of Military Pharmaco-Medicine 2016, pp.114-121 Mathers C.D, Loncar D Projections of global mortality and burden of disease from 2002 to 2030 Plos Med 2006, (11), p.442 Global Intiative for Chronic Obstructive Lung Disease Global strategy for diagnosis, management and prevention of chronic obstructive pulmonary disease Update 2018 2018 254 Orens J.B, Estenne M, Arcasoy S et al International guidelines for the selection of lung transplant candidates: 2006 update - a consensus report from the pulmonary scientific council of the international society for heart and lung transplantation The Journal of Heart and Lung Transplantation 2006, 25 (7), pp.745-755 Ghobadi H, Fouladi N, Beukaghazadeh K et al Association of hight sensitive CRP level and COPD assessment test scores with clinically important predictive outcomes in stable COPD patients Tanaffos 2015, 14 (1), pp.34-41 N Sarioglu, A.O Alpaydin, A.S Coskun, P Celik et al Relationship between BODE index, quality of life and inflammatory cytokines in COPD patients Respiratory Medicine 2010, (2), pp.84-91 Shih-Feng-Liu, Ching-Wan Tseng, MeiLien-Tu et al The clinical COPD questionnaire correlated with BODE index: A cross-sectional study The Scientific World Journal 2012 Michael I, Pokey, Spruit et al Six minute walk test in chronic obstructive pulmonary disease American Thoracic Society 2013, pp.382-386 Munari Anelise B, Gulart Aline A, dos Santos Karoliny et al Modified medical research council dyspnea scale in GOLD classification better reflects physical activities of daily living Respiratory Care 2018, pp.77-85 ... the disease and treated it earlier, at an early stage and it had not affect the quality of life of patients, on the other hand, our study was conducted on patients with lung transplant indications... of patients encountering emphysema images on thoracic CT films CONCLUSION For COPD patients with lung transplant indications at 103 Military Hospital, we draw some conclusions: 253 Jourrnal of. .. patients with lung transplant indications by stage and disease group Classification n % 11 100 C 9.1 D 10 90.9 Stage Disease group Most patients with lung transplant indications had moderate and severe