Study on clinical and subclinical characteristics of chronic obstructive pulmonary disease patients with lung transplant indication at 103 Military Hospital

To describe some clinical and subclinical characteristics of chronic obstructive pulmonary disease patients with lung transplant indication.

STUDY ON CLINICAL AND SUBCLINICAL CHARACTERISTICS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH LUNG TRANSPLANT INDICATION AT 103 MILITARY HOSPITAL

Bui Khac Hiep 1 ; Mai Xuan Khan 2

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 2 ; 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; FEV 1 was 22.64 ± 6.20%SLT; pulmonary artery pressure was 34.30 ± 9.43 mmHg; PaO 2 : 85.27 ± 38.40 mmHg; PaCO 2 : 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 FEV 1 ; average values of pulmonary artery pressure, assessment of dyspnea level and PaCO 2 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

1 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

1 Thai Binh University of Medicine and Pharmacy

2 103 Military Hospital

Corresponding author: Bui Khac Hiep (hiepydtb@gmail.com)

Date received: 04/10/2019

Date accepted: 20/11/2019

- 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 7 - 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 treatment, non-cooperative patients

2 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)

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]

Table 2: Respiratory symptoms of patients with lung transplant indications (n = 11)

mMRC

6MWD

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

late-stage 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

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

Table 3: Distribution of patients with

lung transplant indications by stage and

disease group

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)

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

Standard chest

Pulmonary

Chest CT images

Interstitial

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:

- 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

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