Day 2 :
- Self-Management and Prevention of COPD | Epidemology of COPD | Diagnostic Evaluation of COPD | COPD Exacerbations
Yeungnam University Hospital, South Korea
Mi Suk Lee
Yeungnam Univ. Hospital, South Korea
Yeungnam University Hospital, South Korea
Time : 10:00-10:30
Dr. Kyeong-Soo Lee is the Head of the Preventive Services Center at the Regional Center for Respiratory Disease, Yeungnam University Hospital. His major is preventive medicine, and he has extensive experience in community health work and professional workforce training. Since 2008, he has been involved in community health survey(CHS) in Korea and has participated in research and projects to promote health promotion, chronic diseases, and infectious diseases at the national or local government level.
Statement of the Problem: Tuberculosis is the disease with the highest incidence and mortality rate among the statutory infectious diseases administered by the state. In Korea, the incidence of tuberculosis increases after 15 years. Students live in the same space and have greater opportunities for exposure because they are more active. Prevention of tuberculosis in schools and prevention of tuberculosis suspected or confirmed cases should be prevented early. In order to prevent effective tuberculosis and prevent the spread of infection, Yeungnam University Hospital and Daegu Metropolitan City jointly produced and distributed 'Manual for School Tuberculosis Response' for middle and high school students.
Methodology & Theoretical Orientation: Daegu Metropolitan City and Yeungnam University Hospital Regional Center for Respiratory Disease for the prevention and management of students. Based on the "National Tuberculosis Control Guideline" issued by the Ministry of Health and Welfare of Korea, and also it was prepared in accordance with the situation of Daegu Metropolitan City. We held nine meetings and two workshops in 2015 to build the manual. Experts from Daegu Metropolitan City Office, Public Health Center, Ministry of Education, and participating medical institutions participating in the PPM national TB project jointly participated.
Findings: This manual contains information on the status of tuberculosis in Daegu Metropolitan City, the stage of preparation for tuberculosis, the response and measures in case of suspected tuberculosis or tuberculosis, and the role of related organizations. In addition, Q & A method is presented for cases of school tuberculosis confirmed cases and how to respond to situations. The manual was distributed to 227 middle and high schools and 24 related institutions in Daegu Metropolitan City and the manual was released on the website of Daegu Metropolitan Office of Education (www.dge.go.kr) so that it can be used in schools.
Conclusion & Significance: It is meaningful that this manual was developed and distributed in accordance with the situation of middle and high schools in Daegu Metropolitan City.
Schoen Klinik Berchtesgadener Land, Germany
Title: Cerebral cortex blood flow response to exercise in COPD patients with and without cognitive impairment
Time : 10:30-11:00
Vasileios Andrianopoulos is a clinical exercise physiologist working as postdoctoral research fellow at Schoen Klinik Berchtesgadener Land in Germany. He has his expertise in COPD pathophysiology, clinical exercise assessment and Pulmonary Rehabilitation programs for COPD patients. Devoting himself to research, he acquired experience in designing research protocols, analyzing data and writing manuscripts as well as in operating several clinical devices. He has numerous publications in healthy and patients with COPD and since 2014 is an active member of the European Respiratory Society (ERS) College of Experts. Recently (2016), he has been awarded with a prestigious Marie Skłodowska-Curie fellowship cofounded by the European Union and the European Respiratory Society (ERS) for his project about cognitive dysfunction in COPD.
Background: Cognitive impairment (CI) is a prevalent extrapulmonary manifestation in COPD. Potential disturbances in cerebral circulation and oxygen delivery due to reduced ventilatory efficiency and ventilatory drive may be associated with higher rates of CI.We assessed cerebral tissue oxygen index (TOI) and cerebral hemodynamics at exertion in COPD patient with and without CI.
Method: 52 COPD patients (aged: 68±8yrs; FEV1: 45±14%; 40%women) underwent a comprehensive cognitive assessment. Patients were assigned to “CI” and “non-CI” groups according to Montreal Cognitive Assessment (MoCA) cutoff score ≤25points. Patients performed cycle endurance test (CET) at 75% of peak work rate while transcutaneous carbon-dioxide partial-pressure (TCPCO2), cerebral tissue oxygen index (TOI) and cerebral hemoglobin responses were recorded by SenTec and Portalite systems, respectively.
Results: 23 patients (44%) presented evidences of CI (MoCA≤25) with also lower scores in other cognitive tests (all p <0.001). A correlation between TCPCO2 and cerebral oxygenated hemoglobin (O2Hb), and total hemoglobin (tHb) at the end of CET was detected (r: 0.34, p=0.021; r: 0.34 p=0.023, respectively). Oxygen saturation (SpO2) at the end of CET was not related with cerebral deoxygenated hemoglobin (HHb) and tHb. Patient with CI developed similar cerebral hemodynamic pattern and TOI compared to non-CI during CET.
Conclusion: COPD patients have the capacity to autoregulate cerebral cortex blood flow in response to hypercapnia and hypoxemia, at least during exercise, and thus to normalize cerebral tissue oxygenation. These findings suggest that exercise is safe and can be beneficial regarding to cognitive function in COPD.
The Chinese University of Hong Kong, Hong Kong
Title: Self-management behaviors in patients with chronic obstructive pulmonary disease: The role of physical limitation
Time : 11:20-11:50
Dr. Doris Leung, (PhD), now is an Assistant professor at the Netherosle School of Nursing, The Chinese University of Hong Kong. She got hers B Sc in and MPhil in Statistics at The Chinese University of Hong Kong and PhD in Biostatistics at University of California, Los Angeles. Her main interests are in educational and health psychology and scale validation. She has co-authored more than 120 papers/abstracts published in peer-reviewed journals and generated over 150 conference abstracts. She also served on editorial board and invited reviewers in several international journals. Her current research programs include cancer prevention, chronic disease management, palliative care and teaching and learning in higher education.
Background: Self-management has been used for decades as a means to tackle the challenges of chronic obstructive pulmonary disease (COPD). A recent systematic review concluded that interventions promoting self-management among COPD patients were effective in improving patients’ health outcomes, yet the most effective component of these interventions remains elusive. A better understanding of the underlying phenomenon of how COPD patients engage in self-management behaviors is urgently needed. The purpose of this study is to test the goodness-of-fit of an evidence-based theoretical model to explain the factors that affect self-management behaviors in COPD patients.
Methods: A cross-sectional study employing a convenience sampling was conducted. Adult COPD patients were recruited when they had their follow-up visits in six clinics. Structural equation modeling used to test the goodness-of-fit of the hypothesized model utilizing the EQS software. Model modifications were made based on theoretical plausibility and statistical significance.
Results: The findings revealed that ten factors exerted significant total effects on self-management behaviors: eight of them had positive effects while two had negative effects. Among these significant factors, physical limitation had the greatest positive total effect on self-management behaviors, but the direction of the effect was contradicted to expectation. A further analysis on the relationships of self-management behaviors with functional limitations, dyspnea and fatigue suggested inverted U-shape non-linear relationships. Conclusion: This newly developed evidence-based theoretical model provides insight into the understanding of the complex phenomenon of COPD patients’ engagement in self-management behaviors which could be used to guide the development of interventions to promote self-management behaviors in COPD patients.
Recommendations: Future study could replicate the current study and cross-validate the evidenced-based theoretical model using a larger population of COPD patients with different ethnic origins, in particular, the non-linear relationship with severity of the disease.
Albany Medical College, USA
Time : 11:50-12:20
Dr. Yong-Xiao Wang has been a Full Professor in Albany Medical College (USA) since 2006. Dr. Wang has had extensive research experience in basic, translational and drug research concerning pulmonary hypertension, asthma, chronic obstructive pulmonary disease, diabetes, and cardiac arrhythmia for over 30 years. As the Principal Investigator, he has/had numerous NIH R01 research awards, AHA Established Investigator Award, and various other grants, for which he often holds/held 2 – 3 NIH R01 grants with other awards each year. As the corresponding author, first author and key contributor, he has had numerous publications in highly peer-reviewed journals including Antioxid Redox Signal (impact factor: 8.209), Proc Natl Acad Sci USA (9.432), Nature (34.480), Circ Res (9.214), etc. Dr. Wang has been the editor of academic books in the field including one entitled by “Redox Signaling in Health and Disease Pulmonary Vasculature” that has been confirmed for publication by Springer (New York).
Statement of the Problem: Pulmonary hypertension is a common devastating lung disease. It is a primary cause of death in chronic obstructive pulmonary disease (COPD) and numerous other cardiovascular and respiratory disorders. COPD is currently the fourth leading cause of mortality and may become the second leading cause of death by 2020. Currently, no specific and effective drugs are available to treat pulmonary hypertension, and the underlying molecular mechanisms are not well understood.
Purposes: The current research project was to test a novel hypothesis that the reciprocal crosstalks between ion channel-mediated calcium signaling and transcriptional factor-dependent inflammatory signaling are essential for COPD. The current study also sought to determine whether specific genetic and pharmacological targets for these signaling molecules would become effective therapeutics for COPD.
Methodology: Pulmonary artery vasoconstriction, remodeling and hypertension were, respectively, examined using in-situ immunohistological staining, and organ bath technique, and pressure-volume loop method; activity and Ca2+ release of ryanodine receptor/Ca2+ release channel (RyR) were determined using [3H]-ryanodine binding assay and fluorescence imaging; specific gene knockout (KO) mice were generated using standard methods, and association of RyR2 with FK506 binding protein with a molecular weight of 12.6 kDa (FKBP12.6) was determined by assessing RyR2/FKBP12.6 protein ratio using co-immunoprecipitation.
Findings: Like COPD, hypoxic exposure causes significant pulmonary artery vasoconstriction and remodeling in mice, leading to pulmonary hypertension. The activity of RyR Ca2+ release channel is largely enhanced in pulmonary artery smooth muscle cells (PASMCs) from mice with pulmonary hypertension. RyR-mediated Ca2+ release is also augmented as well. Specific RyR2 channel KO abolishes hypoxia-induced pulmonary artery vasoconstriction, remodeling and hypertension. RyR2 KO also completely inhibits the enhanced RyR activity and function (Ca2+ release) in PASMCs of mice with pulmonary hypertension. Subcutaneous administration of tetracaine, a pharmacological RyR blocker, blocks hypoxia-evoked pulmonary artery vasoconstriction, remodeling and hypertension in mice as well. RyR Ca2+ release channel is physiologically associated with FKBP12.6 and thus shows a low activity. RyR2/FKBP12.6 association is significantly diminished in PASMCs of mice with pulmonary hypertension. Specific FKBP12.6 KO promotes hypoxic pulmonary artery vasoconstriction, remodeling and hypertension. Treatment with S107, a RyR2/FKBP12.6 association stabilizer, produces opposite effects.
Conclusion & Significance: RyR2/FKBP12.6 complex is a primary target for pulmonary hypertension, and RyR2 channel blocker and FKBP12.6 stabilizer may become novel and effective drugs in treatment of this disease.
RMIT University, Australia
Time : 12:20-12:50
Associate Professor Ross Vlahos is a Principal Research Fellow and Head of the Respiratory Research Group in the School of Health and Biomedical Sciences, RMIT University. His research aims to identify novel strategies for the prevention and treatment of Chronic Obstructive Pulmonary Disease (COPD) and its co-morbidities with a focus on the cellular and molecular pathways that underpin cigarette smoke-induced lung inflammation and damage. Ross has co-authored more than 80 publications in peer reviewed journals, has had continuous NHMRC Australia funding since 2001 and has played a major role in commercially funded work that has confidentiality/patent agreements. He has served on numerous national and international research funding bodies, several Editorial boards, various conference committees and Chaired sessions at international meetings.
Statement of the Problem: Reactive oxygen species (ROS) are a family of highly reactive molecules that are produced by a variety of cell types in the lung in response to chemical and physical agents in the environment. It is well known that ROS are critical in host defence as they kill invading pathogens, but that their excessive accumulation in the lung results in oxidative damage. Oxidative stress, which is defined as the persistent overproduction of ROS that overwhelms endogenous antioxidant defence systems, has been implicated in both acute (e.g respiratory virus infections, exacerbations of asthma and COPD) and chronic (e.g. COPD) lung diseases.
Aims and Methods: The purpose of this study is to determine whether inhibiting oxidative stress and ROS production may be a novel way to treat acute and chronic lung diseases using clinically relevant models of lung disease.
Findings: We have shown that targeting oxidative stress with the Nox2 oxidase inhibitors and ROS scavengers, apocynin and ebselen can ameliorate influenza A virus (IAV)-induced lung inflammation and pathology, cigarette smoke-induced lung inflammation and acute exacerbations of COPD (AECOPD). In addition, we have found that treating mice with apocynin reduced cigarette smoke-induced skeletal muscle wasting in mice suggesting that this strategy can be useful in treating comorbidities associated with COPD.
Conclusion & Significance: Targeting oxidative stress may be a novel strategy to treat both acute and chronic lung diseases.
Skaraborgs Hospital, Sweden
Time : 13:50-14:50
D.Margaretha Lundin has her expertise in social work and passion in improving the health and wellbeing. She has built this patient education together with her team which includes a doctor, a registered nurse, an urotherapist, a dietician, a dental hygenist, a hospital librarian, an occupational therapist, an enrolled nurse, a physical therapist and a speech therapist. During the process, a group of COPD patients, their relatives and The Swedish Heart and Lung Association were also involved in the process.
Statement of the problem: The primary cause of Chronic Obstructive Pulmonary Disease (COPD) is tobacco smoking. Who predicts that COPD will become the third leading cause of death worldwide by the year of 2030.
Pulmonary rehabilitation based on self-management is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with COPD. However, in Sweden only 42 % of all COPD patients in specialist care participate in self-management education initiatives.
Purpose/Methods: This project aims to help more COPD patients to improve their self-management capabilities. We invite patients and their relatives to iterative and interactive training sessions supported by digital tools. The content and process of the education including the digitalized tools have been co-designed by patients in collaboration with a cross-professional COPD-team.
Conclusions: The prevalence of COPD is continuously increasing thus putting more pressure on health care delivery. Self-management is an underused but powerful approach for improved care of the disease.
Using COPD education together with new technology we provide COPD patients and their relatives with tools for improved self-managed care thus empowering patients even more. Previous experiences have shown that knowledgeable patients make better choices that also promote health
Klgo. Juan Eduardo Keymer Reyes, born in Chile in 1970. He graduated in 1994 as a kinesiologist at the Universidad Pontificia Catholic University of Chile. Subsequently makes a graduate at the Catholic University of Maule graduating in 1996 as a specialist in respiratory kinesiology. It has been a recognized speaker at national conferences of respiratory and intensive area in Chile. In 2007 it is certified through the Latin American Council of respiratory therapy Respiratory Therapist. In 2010 he works in the union sphere as President Division of Kinesiology Chilean Society of Intensive Care Medicine. In 2015 he is elected nationally and National Treasurer of the College of Physiotherapists of Chile. He currently desmpeña as Technical Head of the UPC in German Clinic of Santiago, is a National Technical Advisory delInstituto Chest of Chile and Director of Graduate Intensive Kinesiology at the University of Chile Development
COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Today it is the 4th leading cause of death in the US and the 9th in Chile, meaning 10% of adult patient hospitalization. The European Union has estimated an expenditure 38.6 billion euros in pac with COPD. COPD can be classified as mild, moderate, severe and very severe. respiratory mechanics is altered due to an increase in lung volume (CRF), with flattening of the diaphragm and loss apposition area of the diaphragm. This is because increase in inflammatory airways with small accumulation of inflammatory cells and edema of mucous plugs in walls bronchioles. The leading cause of hospitalization of these patients is the exacerbation of COPD, which is an event characterized by a change in breathlessness, cough and / or expectoration baseline patient beyond the daily variability, enough to justify a change in treatment . Patients experiencing frequent exacerbations of COPD have a higher mortality, reduced exercise capacity and muscle atrophy. The etiology of exacerbations causes an increase in small airway inflammation, aggravations added co-morbidity and airway damage. The clinical management of exacerbations is mainly to: bronchodilators, corticosteroids, antibiotics, oxygen therapy strategies bronchial hygiene and noninvasive mechanical ventilation. You are the last two are the ones that will develop, showing how to prevent and treat complications of prolonged rest and the benefits of VNI.
Yeungnam University Hospital, South Korea
Time : 15:20-15:50
Dr. Kyeong-Soo Lee is the Head of the Preventive Services Center at the Regional Center for Respiratory Disease, Yeungnam University Hospital. His major is preventive medicine, and he has extensive experience in community health work and professional workforce training. Since 2008, he has been involved in community health survey(CHS) in Korea and has participated in research and projects to promote health promotion, chronic diseases, and infectious diseases at the national or local government level..
Statement of the Problem: The average incidence of tuberculosis in OECD countries is 12.0 per 100,000 population, with a prevalence of 14.8 and a mortality rate of 0.7. The incidence of tuberculosis in Korea is 86 per100,000 population, with a prevalence of 101.0 and a mortality rate of 3.8, the highest among OECD countries. Recently, these indicators are not showing any significant decline. In particular, if a medical or postpartum care agency staff working at a hospital or a teacher/staffs working at a school is infected with TB, it can infect a patient or a student. If a patient occurs in a hospital or school, it may spread to the community. The purpose of this study was to examine the latent TB infection group and prevent latent tuberculosis infection in a university hospital in Korea.
Methodology: We conducted a screening test for latent tuberculosis for 2 months from May to June 2016 in 396 people at one university hospital. The subjects were selected according to ‘the manual of medical institution's latent tuberculosis infection examination’ of KCDC considering the possibility of exposure to tuberculosis and the spreading effect of tuberculosis. The subject of the examination was explained through three briefing sessions. Interferon-Gamma Release Assays (IGRA) were performed on tuberculin skin test (TST) prospectors according to the decision of the Occupational Safety and Health Committee.
Findings: Of the 395 eligible subjects, 381 were tested for TST. Fourteen patients who were pregnant or who had a history of positive TST performed IGRA without TST. 122 patients with TST were also tested for IGRA. As a result, 61 patients were positive, 1 patient was indeterminate, and 74 patients were negative. There was no active tuberculosis in Chest PA test for 61 patients (15.4%) who were positive for IGRA. Patients with latent tuberculosis were prescribed a combination of INH+RIF for 3 months to minimize the duration of treatment and there were no side effects during treatment.
Conclusion & Significance: It is a case of screening and treating latent tuberculosis in one university hospital in Korea for the prevention of the occurrence and transmission of tuberculosis in medical institutions. In order to apply appropriate screening and treatment methods for the detection and treatment of successful latent tuberculosis, understanding and trust between hospital management, medical staff and workers is important.