पल्मोनरी एवं श्वसन चिकित्सा

Background: COPD with Pulmonary hypertension (COPD-PH) affects health status and survival adversely; Yet, PH-specific pharmacotherapy has not been recommended for lack of evidence. Recently, post-exercise maximum desaturation (‘desat-máx’) of ≥ 3% has been considered successfully to identify the responders for PH-specific therapy. It is important to validate the observation hemodynamically.

Method: The ‘ desat-máx ’ in 2-chair test was looked for in a cohort of clinico-radio-echocardiographically suggested COPD-PH patients. Their hemodynamic status was elaborated with Right Heart Catheterization (RHC) and those with high (>3%) desat-max were compared to those with low (<3%) desat-max.

Results: Out of 36 patients screened, a total of 15 patients of COPD-PH (all male ex-smokers having mean FEV1 (predicted percentage) as 37.61 ± 15.30) were included. Nine had a ‘desat-max’ ≥ 3% (mean-6.8 ± 2.6) while 6 had <3% (-1.81 ± 1.3). The higher de-saturators had lower FEV1 percentage (33.11 ± 16.88 vs. 44.16 ± 10.64; P=0.17) but had similar systolic pulmonary artery pressure (PAP) (53.2 ± 7.15 vs. 51.83 ± 4.87; p=0.33) and universally present left ventricular diastolic dysfunction (LVDD) in echocardiography. At RHC, the higher desaturators had higher mean-PAP (36.22 ± 7.87 vs. 25.5 ± 1.5; p=0.04), pulmonary wedge pressure (22.11 ± 7.06 vs. 18.83 ± 3.18; p=0.3), Pulmonary vascular resistance (4.0 ± 2.40 vs. 1.72 ± 0.5; p=0.04), transpulmonary gradient (14.11 ± 7.18 vs. 6.67 ± 2.42; p=0.03) with slightly lower cardiac output ((3.81 ± 1.22 vs. 4.18 ± 1.09; p=0.56).

Conclusion: The higher de-saturators (≥ 3%) in 2CT appear hemodynamically distinct with presence of significantly elevated precapillary PAP to be addressed by PH specific therapy. The issue of presence of concomitant class II PH in them needs further investigation.

COPD is an inflammatory disease that can progress with episodes of aggravation known as acute exacerbation (AE). COPD can lead to hospitalizations and death. This work has been carried out to guide actions to prevent AECOPD by highlighting their etiological factors. It was a cross-sectional, descriptive and analytical study including patients with COPD among those hospitalized at the Respiratory Clinic of NHUC of Fann from May 1, 2016, to October 31, 2017. During these 17 months, 90 cases of AECOPD were reported, representing a hospital prevalence of 4.1%. The sex ratio was 21.5. The mean age was 64.1 ± 8.9. The number of exacerbations increased with age and was higher in patients aged 70 years and older. One or more etiologic factors for AECOPD were found in the same patient. Bacterial superinfection occurred in 52.2% of patients. CBS was performed in 36 patients (40%) and returned positive in 13 cases with a predominance of Streptococcus pneumoniae and Klebsiella pneumoniae. The number of patients admitted to the service for AECOPD was positively correlated to the levels of PM10 particulate pollution measured at the Medina and Republic stations with correlation coefficients of 0.8 and 0.9 respectively. Therapeutic disruption was found in 31 patients (34.4%), linked to the high cost of medication in 24 of them (77.4%).