Remark on some clinical, subclinical characteristics of chronic obstructive pulmonary disease patients operated lung volume reduction surgery

To comment some clinical, subclinical characteristics of chronic obstructive pulmonary disease patients undergoing lung volume reduction surgery. Subjects and methods: 31 patients, who were exactly diagnosed with chronic obstructive pulmonary disease undergoing lung volume reduction surgery, were examined and estimated some clinical and subclinical characteristics. Results: The average age was 66.16 ± 5.62, group of age 60 - 69 accounted for the highest percentage (41.94%).

Journal of military pharmaco-medicine no7-2019 REMARK ON SOME CLINICAL, SUBCLINICAL CHARACTERISTICS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS OPERATED LUNG VOLUME REDUCTION SURGERY Le Minh Phong1; Nguyen Truong Giang2; Ta Ba Thang3 SUMMARY Objectives: To comment some clinical, subclinical characteristics of chronic obstructive pulmonary disease patients undergoing lung volume reduction surgery Subjects and methods: 31 patients, who were exactly diagnosed with chronic obstructive pulmonary disease undergoing lung volume reduction surgery, were examined and estimated some clinical and subclinical characteristics Results: The average age was 66.16 ± 5.62, group of age 60 - 69 accounted for the highest percentage (41.94%) Walking distance of minutes was 293.90 ± 70.79 m CAT score was 19.00 ± 6.06 The number of patients with CAT score ≥ 10 was 83.87% mMRC score was 2.35 ± 0.98 Therein, those who had mMRC ≥ accounted for 77.42% Lung function parameters were TLC: 140.61 ± 21.03% predicted, VC: 87.90 ± 21.91% predicted, FVC: 85.77 ± 20.00% predicted, FEV1: 52.00 ± 18.71% predicted, Gaensler: 56.13 ± 15.41, PEF: 50.87 ± 15.82% predicted, MVV: 50.42 ± 20.59%, strongly decreased to severe obstruction of airway that caused alveoli stasis in chronic obstructive pulmonary disease patients with severe emphysema Average emphysema score was 2.67 ± 0.83, most of patients were in level of emphysema (45.16%) * Keywords: Chronic obstructive pulmonary disease; Lung volume reduction surgery; Clinical, subclinical characteristics INTRODUCTION Chronic obstructive pulmonary disease (COPD) - a common, preventable and treatable disease is characterized by persistent airflow limitation that is progressive and associated with an enhanced chronic inflammatory response in the airway and the lung to noxious particles and gases Outbreak and comorbidities contribute to the overall severity in individual patients [3, 9] According to GOLD’s report (2019), COPD is currently ranked the 4th among the causes of death worldwide, it is estimated that by 2020 it will be ranked the 3rd among these causes In 2012 alone, more than million people died from COPD, 175 Military Hospital Vietnam Military Medical University 103 Military Hospital Corresponding author: Le Minh Phong (drminhphong@gmail.com) Date received:06/07/2019 Date accepted: 26/08/2019 128 Journal of military pharmaco-medicine no7-2019 accouting for 6% of all deaths worldwide [9] In Vietnam, in 2010, the study by Nguyen Thi Xuyen performed on 25,000 subjects aged 15 and above, in 70 locations of 48 provinces through the country showed that the rate of COPD in the whole country was 2.2%, in which 3.4% for men, 1.1% for women, mostly in the age group of 40 and above (4.2%) [5] Lung volume reduction surgery (LVRS) is a surgical method that removes emphysema, increases the elasticity of the less damaged lung, to improve function, reduce dyspnoeas, and increase the mobility of patients [9, 11] Although this is considered a safe and effective treatment, not many facilities in Vietnam can implement this technique, and research topics on LVRS in Vietnamese patients are still limited We carried out this study with the aims: Remark some clinical and subclinical characteristics of COPD patients, who have indications for LVRS SUBJECTS AND METHODS Subjects 31 male patients were diagnosed with COPD combined with severe emphysema underwent LVRS in the Department of Thoracic Surgery, 103 Military Hospital from 2013 to 2018 * Selection criteria: - Patients diagnosed with COPD according to GOLD's criteria (2018) [8] - Criteria for selecting patients with LVRS according to NETT (2011) [10] * Exclusion criteria: - Exclusion criteria for patients with LVRS according to NETT (2011) [10] Excluded subjects were patients with other respiratory diseases (pulmonary tuberculosis, cancer, bronchial asthma ), patients with contraindications to respiratory function test (new heart stroke, pulmonary embolism, pneumothorax, severe heart failure, limited cognitive awareness), or patients refused to join the research group Methods The cross-sectional descriptive study of clinical and subclinical characteristics of severe COPD patients undergoing LVRC CAT score were calculated based on CAT questionnaires (COPD Assessmnet Test) according to GOLD 2015, including questions serveys on the scale of cough, sputum, dyspnea, chest pain, activity, social communication, sleep, health, each sentence was scored from - points The overall average score was calculated by summing of the score of questions The mMRC score was calculated based on the mMRC questionnaires of GOLD 2015 according to the degree of dyspnea, the score was given from - points The level of emphysema was calculated based on the area of emphysema region 0%: point; < 5%: 0.5 point; to < 25%: point; 25 to < 50%: points; 50 to 75%: points and ≥ 75%: points Data processing with software SPSS 22.0 and Excel 2016 129 Journal of military pharmaco-medicine no7-2019 RESULTS AND DISCUSSION Table 1: Characteristics of patient by age group Age group n % < 60 19.35 60 - 69 13 41.94 ≥ 70 12 38.71 Sum 31 100 The average age 66.16 ± 5.62 Min - max 55 - 74 100% of research patients were male, the average age was 66.16 ± 5.62, the age group of 60 - 69 accounted for the highest proportion (41.94%) The youngest and the oldest subjects were 55 and 74, Our results were consistent with the study by Dao Ngoc Bang (2019) with the average age of COPD patients of 65.80 ± 6.96, the age group had the highest percentage was 60 - 69 (45.45%) [1] The results of Nguyen Huy Luc also showed that a high rate in men with age group > 50 (92%) [2] The study by Hruna Akane et al (2010) showed average age of 68.7 ± 7.0, with a male/female ratio was 15.7/1 [6] Table 2: Clinical characteristics Characteristics X ± SD Min Max 6-minute walk test (m) 293.90 ± 70.79 197 440 BMI (kg/m ) 20.46 ± 3.03 15.24 29.04 CAT 19.00 ± 6.06 27 mMRC 2.35 ± 0.98 - 6-minute walking test: 293.90 ± 70.79 m was consistent with Dao Ngoc Bang’s study (2019) (302.82 ± 59.33 m) [1], and Frank C Sciurba (333.9 ± 87.4 m) [7] - BMI of research group was 20.46 ± 3.03 kg/m2, the highest and the lowest values were 29.04 and 15.24, respectively - The result of our study was suitable to the study by Dao Ngoc Bang (2019) 130 (18.26 ± 2.46 kg/m2), and Haruna et al (2010) (21.4 ± 3.0 kg/m2) [1, 6] - The average mMRC score in whole study population was 2.35 ± 0.98 points, the number of patients with mMRC ≥ points was 77.42% - The average CAT score of the study group was 19.00 ± 6.06, of which the number of patients with a CAT score ≥ 10 points was 83.87% Journal of military pharmaco-medicine no7-2019 According to the study by Dao Ngoc Bang (2019), the CAT score was 19.38 ± 3.26 points, and mMRC was 2.38 ± 0.84 points According to Do Quyet and Nguyen Thi Thu Ha (2010), the average CAT score was 18.59 ± 4.66 points [1, 4], the results also showed similarities with the results of our research Table 3: Characteristics of lung ventilation parameters Respiratiry parameters X ± SD Min Max TLC (% predicted) 140.61 ± 21.03 108 227 VC (% predicted) 87.90 ± 21.91 49 144 FVC (% predicted) 85.77 ± 20.00 43 133 FEV1 (% predicted) 52.00 ± 18.71 23 106 Gaensler 56.13 ± 15.41 14 87 PEF (% predicted) 50.87 ± 15.82 22 82 MVV (% predicted) 50.42 ± 20.59 22 104 - Results of our study on respiratory function tests showed TLC of 140.61 ± 21.03% predicted, the result was consistent with the research result of Dao Ngoc Bang (2019), who reported TLC of 140.67 ± 26.17% predicted [1] - The average value of VC and FVC of the research group decreased, in which FVC decreased more than VC The maximum exhaled volume in the first second (FEV1) was significantly reduced: An average of 52.00 ± 18.71% predicted - PEF and Gaensler indexes decreased significantly to 50.87 ± 15.82% predicted and 56.13 ± 15.41% predicted, respectively These results were consistent with the level of severe airway obstruction causing alveolar airway obstruction in COPD patients with severe emphysema - Other parameters included FVC, FEV1, Gaensler, PEF, MVV were higher than those of Dao Ngoc Bang (2019), FVC: 64.18 ± 14.87% predicted, FEV1: 35.02 ± 13.22% predicted, PEF: 31.20 ± 14.22% predicted, MVV: 30.88 ± 12.25% predicted [1] But they were lower than the study by Nguyen Huy Luc on FEV1 parameter, type BB: 53.80 ± 6.86% predicted, type PP: 65.41 ± 15.44% predicted, and parity similarity Gaensler (type BB: 47.07 ± 6.41; type PP: 58.84 ± 12.12) [2] The differences in above results were probably due to the differences in disease stages of subjects selected for the study, but they generally showed a significant reduction in respiratory parameters 131 Journal of military pharmaco-medicine no7-2019 Table 4: Emphysema characteristics and grading on computerized tomography Characteristics X ± SD Emphysema score 2.67 ± 0.83 Grade n % Level 16.13 Level 12 38.71 Level 14 45.16 31 100 Sum The average emphysema score of the research group on computerized tomography was 2.67 ± 0.83, of which mainly patients with level emphysema (45.16%) The study by Dao Ngoc Bang (2019) also gave the emphysema score equivalent to 2.76 ± 0.48, but the level of emphysema, severe level (45.45%), the very severe level (51.52%) were higher than our research [1] CONCLUSION Through a study of 31 patients, we had some comments as the following: - The average age was 66.16 ± 5.62, the lowest and highest ages were 55 and 74, respectively - The average mMRC score of research group was 2.35 ± 0.98 points, therein, the percentage of patients with mMRC score ≥ accounted for 77.42% The average CAT score was 19.00 ± 6.06, in which the proportion of CAT score ≥ 10 was 83.87% - The maximum exhaled volume in the first second (FEV1) dramatically reduced, as measured of 52.00 ± 18.71% predicted PEF, Gaensler indexes were significantly decreased to 50.87 ± 15.82% predicted and 56.13 ± 15.41% predicted, respectively These results are consistent with the level of severe airway obstruction causing alveolar airway obstruction in COPD patients with severe emphysema 132 - Average emphysema score of research group on computerized tomography was 2.67 ± 0.83, in which the level of emphysema accounted for a higher rate of 45.16% REEFERENCES Dao Ngoc Bang A study on the efficiency of bronchoscopic lung volume reduction with one-way valves in patients with chronic obstructive pulmonary disease Medical Doctoral Thesis Vietnam Military Medical University 2019 Nguyen Huy Luc A study of pulmonary ventilation characteristics and standard X-ray images of the body and disease stages in patients with chronic obstructive pulmonary disease outbreak Journal of Practical Medicine 2010, (714), pp.26-29 Nguyen Huy Luc Respiratory disease People's Army Publishing House 2012, pp.41-60 Do Quyet, Nguyen Thi Thu Ha Results of using CAT questionaires to assess the heath Journal of military pharmaco-medicine no7-2019 status of patitents with chronic obstructive pulmonary disease Journal of Practical Medicine 2010, 12 (745), pp.53-56 Nguyen Thi Xuyen, Dinh Ngoc Sy, Nguyen Viet Nhung et al A study on the situation of chronic obstructive pulmonary disease in Vietnam Journal of Practical Medicine 2010, (704), pp.8-11 Akane Haruna et al CT-scan findings of emphysema predict mortality in COPD Chest 2010, 138 (3), pp.635-640 Frank C Sciurba et al A randomized study of endobronchial valves for advanced emphysema The New England Journal of Medicine 2010, 363 (13), pp.1233-1244 Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the diagnois, management and prevantion of obtructive pulmonary disease 2018 chronic Global Initiative for Chronic Obstructive Lung Disease Pocket guide to COPD diagnosis, management, and prevention (a guide for health care professionals 2019 edition) 2019 10 Francis Cordova Gerard J Criner, Alice L Sternberg, Fernando J Martinez The National Emphysema Treatment Trial (NETT) Part II: Lessons learned about lung volume reduction surgery American Journal of Respiratory and Critical Care Medicine 2011, 184, pp.881-893 11 Eberhardt R Gompelmann D, Herth F Endoscopic lung volume reduction Ann Am Thorax Soc 2013, 10 (6), pp.657-666 133 ... level of emphysema accounted for a higher rate of 45.16% REEFERENCES Dao Ngoc Bang A study on the efficiency of bronchoscopic lung volume reduction with one-way valves in patients with chronic obstructive. .. prevantion of obtructive pulmonary disease 2018 chronic Global Initiative for Chronic Obstructive Lung Disease Pocket guide to COPD diagnosis, management, and prevention (a guide for health care professionals... Nhung et al A study on the situation of chronic obstructive pulmonary disease in Vietnam Journal of Practical Medicine 2010, (704), pp.8-11 Akane Haruna et al CT-scan findings of emphysema predict