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%).
Trang 1
REMARK ON SOME CLINICAL, SUBCLINICAL
CHARACTERISTICS OF CHRONIC OBSTRUCTIVE PULMONARY
DISEASE PATIENTS OPERATED LUNG VOLUME
REDUCTION SURGERY
Le Minh Phong 1 ; Nguyen Truong Giang 2 ; Ta Ba Thang 3
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 6 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 ≥ 2 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, FEV 1 : 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 4 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 3 million people died from COPD,
1 175 Military Hospital
2 Vietnam Military Medical University
3 103 Military Hospital
Corresponding author: Le Minh Phong (drminhphong@gmail.com)
Date received:06/07/2019
Date accepted: 26/08/2019
Trang 2
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
1 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
2 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
8 questions serveys on the scale of cough, sputum, dyspnea, chest pain, activity, social communication, sleep, health, each sentence was scored from 0
- 5 points The overall average score was calculated by summing of the score of
8 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 0 - 4 points The level of emphysema was calculated based on the area of emphysema region 0%: 0 point;
< 5%: 0.5 point; 5 to < 25%: 1 point; 25 to
< 50%: 2 points; 50 to 75%: 3 points and
≥ 75%: 4 points
Data processing with software SPSS 22.0 and Excel 2016
Trang 3
RESULTS AND DISCUSSION
Table 1: Characteristics of patient by age group
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
- 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)
(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
≥ 2 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%
Trang 4
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
- 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
Trang 5
Table 4: Emphysema characteristics and grading on computerized tomography
The average emphysema score of the research group on computerized tomography was 2.67 ± 0.83, of which mainly patients with level 4 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
≥ 2 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
- Average emphysema score of research group on computerized tomography was 2.67 ± 0.83, in which the level 4 of emphysema accounted for a higher rate
of 45.16%
REEFERENCES
1 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
2 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, 4 (714), pp.26-29
3 Nguyen Huy Luc Respiratory disease
People's Army Publishing House 2012, pp.41-60
4 Do Quyet, Nguyen Thi Thu Ha Results
of using CAT questionaires to assess the heath
Trang 6
status of patitents with chronic obstructive
pulmonary disease Journal of Practical
Medicine 2010, 12 (745), pp.53-56
5 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, 2 (704), pp.8-11
6 Akane Haruna et al CT-scan findings of
emphysema predict mortality in COPD Chest
2010, 138 (3), pp.635-640
7 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
8 Global Initiative for Chronic Obstructive
Lung Disease Global Strategy for the diagnois,
management and prevantion of chronic obtructive pulmonary disease 2018
9 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