Day 3 :
- Epidemology of COPD | Diagnostic Evaluation of COPD | COPD Exacerbations
RMIT University, Australia
Doris YP Leung
The Chinese University of Hong Kong, Hong Kong
Yeungnam University Hospital, South Korea
Time : 09:00-09:35
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.
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.
RMIT University, Australia
Time : 10:30:11:05
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.
Medical University of Silesia, Poland
Time : 11:05-11:40
Michał Zielinski is a young researcher working in Department of Lung Diseases and Tuberculosis, Medical University of Silesia under the guidance of Professor Dariusz Ziora. His area of specialization is respiratory diseases. Main points of research are: association between environmental factors and respiratory diseases course, sleep disorders (particularly obturative sleep apnea) and their connection with lifestyle, objective quantification of cough.
Aim: The aim of this study was to examine the association between particulate matter concentration and COPD exacerbations. Exposure was evaluated based on atmospheric concentrations in a week preceding hospital admission.
Material and Methods: Data about the COPD exacerbations was obtained from Śląska Baza Sercowo-Naczyniowa database, which provides informations concerning cardiovascular diseases in Silesia region population. It covers 616 413 patients observed from 2006 to 2014. 12889 patients with ICD-10 J44 main diagnosis and exclusion of cardiovascular cause of symptoms were included in the study. Atmospheric particulate matter data was acquired from Śląski Monitoring Powietrza database which covers information about air pollution in Silesia region. Particulate matter exposure was approximated using moving average of atmospheric concentrations of particulate matter with a mean aerodynamic diameter of 2.5μm (PM2.5) and 10μm (PM10). Statistical analysis was performed using generalized linear model with logarithmic link function. Temperature, humidity, wind velocity, atmospheric pressure, season were considered as confounding factors. Poisson distribution was assumed for the dependent variable. Significance level of 0.05 was assumed.
Results: The COPD exacerbations were not depended on PM10 and PM2.5 concentrations (p>0.05). Rise of statistical significance with the observation period was observed for PM2.5, though it never crossed set level of 0.05.
Conclusion: Short term exposure to particulate matter does not affect COPD exacerbations irrespectively of mean aerodynamic diameter. Results justify further study with long term exposure analysis.