6^th International Conference on Chronic Obstructive Pulmonary Disease May 17-18, 2018 Tokyo

Biography:

Rakesh K Gupta is the Deputy Director, Non-Communicable Diseases, Department of Health & Family Welfare, Punjab. He has expertise in managing National Non-Communicable diseases Programs especially Blindness Control/Tobacco Control Programs and has professional experience of 33 years in service. He has represented MOHFW in WHO ENDS Consultation in Panama 2016 and WHO consultation on Plain packaging in Geneva 2017.

Abstract:

Background and challenges to implementation: Electronic Nicotine Delivery System (ENDS) popularly known as e-cigarettes are highly addicting and potentially lethal products. It is mostly being used by children and youth because these are glamorised by the tobacco industry. Though not generally available in stores, they are widely promoted and sold through E commerce sites with discount offers. Sales are increasing sharply all over the world. Punjab was the first state in India to declare Electronic Nicotine Delivery System (ENDS) as unapproved under Drugs and Cosmetics Act in 2013. Intervention or response: A circular was issued by Government of Punjab regarding declaration of manufacture and sale of ENDS as illegal. To counter the sale on the Ecommerce site, Punjab Government had issued a Demi-Official letter to Cyber Crime cell regarding the sale of E-cigarettes in 2016. Awareness notices were sent to various E commerce sites regarding the sale of E cigarette. District level Task Force effectively implements the ban through conducting raids at suspected point of sale, which is being monitored monthly by Deputy Commissioners of all Districts. Results and lessons learnt: Cyber Crime Cell identified the 26 E commerce sites that were selling the E cigarettes. Letter was sent to these sites regarding the Blocking/banning the sale of e cigarettes. After that No E commerce sites are selling e cigarettes in Punjab Conclusions and key recommendations: The declaration by the Government of Punjab opens the way for other states to follow suit, and prevent ENDS becoming an additional marketing strategy for tobacco companies.

Biography:

Vasileios Andrianopoulos is a clinical exercise physiologist / researcher working as postdoctoral research fellow at Schoen Klinik Berchtesgadener Land in Germany. He has his expertise in COPD pathophysiology, COPD-related cognitive impairment, 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 scientific publications in healthy individuals and COPD patients. Since 2014, he is an active member of the European Respiratory Society (ERS) College of Experts and recently, in 2016, he has been awarded with a prestigious Marie Skłodowska-Curie fellowship co-funded by the European Union (EU) and the European Respiratory Society (ERS) for his project about cognitive dysfunction in patients with COPD

Abstract:

The beneficial effects of Pulmonary Rehabilitation (PR) are well established in COPD. However, data for the effectiveness of PR in patients with COPD and co-existing cognitive impairment are limited. We wish to compare the effect of a Pulmonary Rehabilitation program on cognitive function, health status, and exercise outcomes in cognitively normal (CN) and cognitively impaired (CI) patients with COPD. Methodology & Theoretical Orientation: Sixty COPD patients (FEV₁: 47±15%; 42%women) referred to 3-week in-patient PR and classified as “CN” or “CI” according to the Montreal Cognitive Assessment (MoCA) cutoff-score (≤25points). Domain-specific cognitive function (MoCA, SMMSE, ACER, T-ICS), health status (CAT), health-related quality of life (SF-36), the six-minute walk test (6MWT) and cerebral oxygen availability during cycle endurance test (CET) at 75% of peak Work Rate, were assessed on admission and discharge of PR program. Findings: Twenty-five patients (42%) presented evidences of CI and low performance in cognitive tests. Compared to CN, CI patients improved visuospatial skills and fluency (Effect Size; ES: 0.44; 0.48), whilst similar improvements in memory (ES: 0.75), physical and social function (ES: 0.45; 0.47), vitality (ES: 0.56), general and mental health (ES: 0.47; 0.67) were observed, respectively. CI patients did not improve body pain and limitations from emotional problems as assessed by SF-36 but increased 6MWD (from 378 to 403m, p=0.052), CET (from 10.0 to 12.3min, p<0.001) and SpO₂ nadir ([Δ]: +1.1%, p=0.047) in cycling, whilst CET cerebral oxygen availability remained unchanged. The proportion of CI and CN with clinically relevant improvements in 6MWT, CET and CAT was similar. Conclusion & Significance: CI patients gain significant benefits in cognitive function from PR but are not responsive to improvements in body pain and emotional limitations compared to CN. Persistent body pain may have limited the effectiveness of PR and improvements in the 6MWT in cognitively impaired patients with COPD.

Biography:

Uma Hariharan is a teaching faculty at the Ram Manohar Lohia Hospital, India. She has extensive experience in safe anesthesia for cancer surgeries and robotic surgeries. She is also trained in ultrasound-guided regional anesthesia and Palliative Medicine. She has more than 75 publications to her credit, including several book chapters. She is also on the Editorial Board of several reputed national and international journals. She is also an expert at Trauma care and is an instructor for Advanced Trauma Life Support (ATLS). She is also an expert at Hospital Management (PGDHM). She also has keen interest in Transplant anesthesia and Critical Care.

Abstract:

Mediastinal masses can be a great mimic. Their acute presentation can be mistaken for bronchial asthma, COPD exacerbation or subglottic stenosis. A high index of suspicion, eternal vigilance and prompt action can be rewarding in the emergency scenario. Mediastinal masses can have varied presentations or may even remain silent till very late. There have been numerous articles on anaesthetic management of patients with mediastinal masses. There is paucity of literature on acute presentation and course of events following airway interventions in patients with unrecognized mediastinal masses in the emergency or critical care set up. In the event of their presentation as reactive airway disease or acute airway obstruction, the possibility of a mediastinal mass must be kept in mind, when standard medical management fails to improve the condition or when definitive airway management worsens the condition further. Positive pressure ventilation can be disastrous as it leads to further increases in intra-thoracic pressures. A cardiothoracic surgeon opinion should be sought early and femoral vessels may be cannulated prophylactically. Facilities for institution of life support or ECMO (extra-corporeal membrane oxygenation) is desirable in intensive care units caring for patients with mediastinal masses.

Biography:

Rajathilakam has pursued MBBS and working as a faculty in Department of Pulmonary Medicine, GMC Kollam, India

Abstract:

Background: Chronic obstructive pulmonary disease (COPD) is a common disease, associated with high morbidity and mortality and is a leading cause of hospitalization and death in the elderly. Acute exacerbations contribute considerably to the diminished quality of life (QOL) in patients with COPD. Several etiologic factors alone or in combination cause acute exacerbation of COPD (AECOPD). Prediction of outcome of chronic obstructive pulmonary disease (COPD) is a major concern for long-term management of this disease. No consistent Indian studies are available using the new GOLD update (2013 staging criteria) and for COPD outcome based on composite scores like DOSE, ADO and BODE index.

Aim: The purpose of this study was to classify patients into different severity groups as per GOLD 2013 criteria, to describe the outcomes of patients with COPD in terms of exacerbation or death, to evaluate factors associated with recurrent exacerbations and to determine which of three multidimensional assessment systems (the body mass index, obstruction, dyspnea and exercise capacity (BODE) index, dyspnea, obstruction, smoking, exacerbations (DOSE) index or age, dyspnea, obstruction (ADO) index) is superior for predicting exacerbations. The earlier guidelines determined the severity of disease primarily based on spirometric staging and this study based on the new GOLD updates includes airflow limitation, history of COPD exacerbation and symptoms to classify and grade COPD severity.

Methods: This was a prospective cohort study of COPD patients conducted in the OPD or immediately prior to hospital discharge and followed up monthly for 1 year in a tertiary care centre of North Kerala from January 2014 to June 2015. Data on the outcome measures and associated factors were collected in a stable state. Pulmonary function tests, the 6-minute walk distance (6MWD), modified medical respiratory council (MMRC) dyspnea scores, oxygen saturation levels, body composition, comorbidities, smoking status, age and GOLD staging were analyzed and predictions of exacerbation by the three assessment systems were compared. Statistical analysis was done using SPSS version 18.

Results: Out of 300 patients 12 (4%) patients lost follow up 24 (8%) died during the study period. 62 (20.7%) in group B and 238 (79.3%) in group D of 2013 GOLD staging criteria. The mean annual exacerbation rate was 2.42 events per patients per year. Death and rate of exacerbation correlated significantly with lower predicted forced expiratory volume in 1 second (FEV1) (p value<0.001), lesser 6 MWD (p value<0.001), higher MMRC dyspnea score (p value<0.001), GOLD stage D (p value <0.001) higher DOSE index (p value <0.001), higher BODE index (p value <0.001) and higher ADO index (p value<0.001). For prediction of exacerbation the area under curve were larger for BODE index than for DOSE and ADO index (p value <0.001). Adjusted multiple logistic regression identified the BODE index as a significant predictor of risk of COPD exacerbation.

Conclusion: These composite scores DOSE, ADO and BODE index can be used to assess outcome in COPD in Indian patients. BODE index was a better predictor of COPD exacerbation when compared with DOSE and ADO index.

Biography:

Serap Duru is particularly specialized on chest diseases, has received her MD degree from Çukurova Medical Faculty in 2002. She has worked on chest diseases department in Dıskapı Education and Research Hospital from 2005. She has published numerous scientific papers, as well as presentations and posters. She has worked on asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary embolism, interstitial lung diseases and endobronchial USG. She is a member of Turkish Thoracic Society and European Respiratory Society (ERS).

Abstract:

Diffuse alveolar hemorrhage (DAH) caused by immune and non-immune etiological factors, characterized by diffuse alveolar consolidation often presents with the clinical trial of dyspnea, hemoptysis, anemia, as a result of the disruption of the alveolocapillary membrane of the lung. Oral anticoagulants are the most commonly used drugs in order to prevent thromboembolic complications. Various bleeding complications may occur during treatment with oral anticoagulants but the development of DAH is quite rare. We present four cases, when the patients are over 65 years of age, followed up at our clinic with diffuse alveolar hemorrhage as a rare complication of the uncontrolled use of anticoagulant (Warfarin) therapy. In the thorax CT, patchy ground glass infiltration areas accompanied by scattered alveolar filling defects were seen in the lung. Although normal bronchial systems were observed in the fiberoptic bronchoscopy, hemorrhagic foci were observed on mucosa and transbronchial biopsy was not carried out. In the obtained hemorrhagic lavage fluid, hemosiderin laden macrophages were observed in addition to erythrocytes. Following supportive treatment including oxygen administration, vitamin K replacement and erythrocyte suspension and discontinuation of warfarin, clinical and radiological findings rapidly improved and our cases were discharged uneventfully. Diffuse alveolar hemorrhage is a life threatening complication, which may develop due to many etiologic factors and it is a catastrophic complication of the uncontrolled use of warfarin, a requiring early diagnosis and investigations before respiratory failure develops. In warfarin associated DAH, especially elderly patients that regularly use the drug, they should be warned against the risk of hemorrhage and should be monitored by clinicians.

Biography:

Vasileios Andrianopoulos is a clinical exercise physiologist / researcher working as postdoctoral research fellow at Schoen Klinik Berchtesgadener Land in Germany. He has his expertise in COPD pathophysiology, COPD-related cognitive impairment, 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 scientific publications in healthy individuals and COPD patients. Since 2014, he is an active member of the European Respiratory Society (ERS) College of Experts and recently, in 2016, he has been awarded with a prestigious Marie Skłodowska-Curie fellowship co-funded by the European Union (EU) and the European Respiratory Society (ERS) for his project about cognitive dysfunction in patients with COPD.

Abstract:

Pulmonary Rehabilitation (PR) is widely recognized as an important therapeutic intervention that improves health status in patients with COPD. However, the extent of the improvements in cognitive function after PR in COPD patients with co-existing cognitive impairment has not yet been adequately investigated. We wish to compare changes in cognitive function after 3-week PR program and at 1-year follow-up in cognitive normal (CN) and cognitive impaired (CI) patients with COPD. Methodology & Theoretical Orientation: Thirty-two COPD patients (FEV₁: 43±14%; 44% women) referred to 3-week in-patient PR and classified as “CN” or “CI” according to the Montreal Cognitive Assessment (MoCA) cutoff-score (≤25points). Face-to-face and telephone-based cognitive assessment was performed at admission and discharge of PR, and at 1-year follow-up, respectively. Overall cognitive performance was assessed by the “Telephone (T-) Interview for Cognitive Status” (T-ICS), whilst domain-specific cognitive evaluation also included T-MoCA and T-SMMSE. Changes in cognitive performance from admission to discharge and at follow-up were compared in CN and CI COPD. Findings: Thirteen patients (41%) showed evidences of CI and low performance in cognitive tests. From admission to discharge, CI patients had comparable increase on overall cognitive performance (Effect Size; ES: 0.53) compared to CN (ES: 0.65) improving memory (ES: 0.55), whilst had positive changes on attention (ES: 0.44), language/ executive (ES: 0.36), and fluency (ES: 0.32). From discharge to follow-up, CI patients had comparable deterioration on overall cognitive performance (ES: -1.26) compared to CN (ES: -1.59) decreasing attention (ES: -1.42), whilst had negative changes on memory (ES: -0.86), language/executive (ES: -0.34), fluency (ES: -0.10). Conclusion & Significance: Cognitively impaired patients with COPD improve to similar extent cognitive function after a 3-week PR program compared to CN and have comparable cognitive deterioration after 1-year. These changes in cognitive function may be dependent on the baseline levels of cognitive performance in COPD.

Biography:

Ginika Egesimba A dynamic individual with abstract thinking skill ever willing to address challenges of the medical world in a fast moving globe through evidence informed medicine. A challenging field remains the focus of my dream and passion of pursuit. I have a mix of clinical practice experience, programming for public health, including evaluation of HIV/AIDS, TB, & Malaria programs, grant proposal writing skills, training and capacity building and knowledge transfer skills, good knowledge of country Monitoring and Evaluation ( M&E) processes and data collection tools, information and data management practices , good clinical practice (GCP), solid grasp of conduct of clinical, health services, and outcome research including process and impact evaluation with experience in research protocol development and data collection tool. Presently working at Institute of Tropical Medicine Antwerp, Belgium

Abstract:

Background: Adolescent age presents transition across biological, psychosocial, educational, disease affectation and other life experiences. Infection with HIV leaves them significantly vulnerable to Tuberculosis infection. This age of transition across a range of life circumstances is associated with complexities of diseases healing particularly TB co-infected with HIV. The paper examined the significance of TB Prevalence among PLHIV Adolescents between the ages of 10-19 and related complexities.

Method: A cross-sectional retrospective review of data collected over a period 15 months from October 1, 2014 to December 31, 2015 using the Pro-ACT MSH Database was analyzed with Excel. Data analyzed were routine monthly data collected from 41 supported comprehensive health facilities.

Result: 787 (M-357; F-430) Adolescent PLHIV were screened for TB out of which 32(M-16; F-16) presumptive TB cases were further evaluated for TB. 20 (M-8; F-12) of them were diagnosed with TB while 15 (M-6; F-9) were commenced on treatment accounting for a 2.5% TB prevalence over the period. In categorizing these adolescents into 10-14 and 15-19 age group, the 10-14 years age group had the highest number of HIV infection and invariable presented more number of adolescents to be screened for TB (416 vs 371). TB preponderance was reported within 15-19 years, females carried more of the burden and more of missed treatment is reported in older adolescent. (4 TB cases for the ages of 15-19 as against 1 for age 10-14).

Conclusions: The highly mobile nature of older adolescent (15-19) may account for preponderance of TB cases in the group. With more presumptive TB cases identified among younger adolescent (10-14), active follow up is required as they transition to the mobile age which are more prone to TB This finding provides opportunity to explore further why older adolescent both carry TB burden among PLHIV as well as missed treatment opportunities.

Biography:

Krasnov D.V. - Chief Researcher in the Novosibirsk Tuberculosis Research Institute, head of the surgical department for tuberculosis patients and he is the scientific leader of a number of research works on phthisiology and thoracic surgery.

Krasnov D.V. is a recognized expert in the field of tuberculosis surgery, has a degree of Doctor of Medicine. He is a high professional in all methods of surgical treatment in patients with pulmonary tuberculosis. In 2013, he participated in the development and drafting of international recommendations for the surgical treatment of multidrug-resistant tuberculosis for the WHO European Region.

Krasnov D.V. carried out a large amount of research work in the field of surgical treatment of patients with pulmonary tuberculosis and especially drug resistant tuberculosis. Results of his research work were repeatedly reported at international scientific and practical conferences, congresses and symposia.

Abstract:

The article presents a retrospective analysis of treatment results in patients with destructive pulmonary tuberculosis and concomitant chronic nonspecific lung diseases.

The aim of the study was to evaluate the effect of endobronchial valve (EBV) application on the respiratory function.

Materials and methods: 102 patients were included in an open comparative retrospective study. In 49 patients (main group), the EBV was used in the treatment, and 53 patients (comparison group) received standard anti-tuberculous chemotherapy. The parameters of the respiratory function (RF) were measured at three critical points during hospital stage of treatment and in the long-term period.

Results: the installation of EBV led to a slight decrease in the level of vital lungs capacity (VLC) and the forced expiration volume. After removal of the valve, these RF values came to the initial level. Standard anti-TB therapy of patients in the comparison group contributed to a 6% decrease in the VLC values below the baseline, while the level of bronchial patency was preserved. At the final measurement in the main group, the proportion of patients with normal volumetric RF values increased with a simultaneous decrease in the proportion of patients with moderate and significantly reduced rates. Also in the main group, there was an increase in the proportion of patients with normal indices of bronchial patency, and in the comparison group the proportion of patients with normal indices remained at the same level.

Conclusion: EBV application leads to a non-significant (less than 10% decrease in relation to the initial indices) and reversible disruption of both volume and bronchial patency of respiratory function. There is a significant irreversible decrease in the parameters of the respiratory function during the long treatment of patients with infiltrative pulmonary tuberculosis.

Biography:

Dr. Hwa Mu Lee is Clinical Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of California, Irvine College of Medicine, in Irvine, California and Clinical Professor of Medicine at Western University of Health Sciences, in Pomona, California. Dr. Lee is a noted authority on the relation of COPD with cardiovascular disease, including the role of cardiovascular risk assessment in patients with COPD and the role of lung function in the prediction of cardiovascular outcomes. He has published in prestigious journals including CHEST, European Respiratory Journal, and Respiratory Medicine. Dr. Lee regularly presents his work and lectures to trainees, researchers, and practitioners in the field locally and internationally

Abstract:

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the U.S and affecting approximately 64 million worldwide. According to US age-adjusted death rates from 1965 to 1998, while cardiovascular disease (CVD) mortality decreased by 60%, there was a 160% increase in COPD mortality. Furthermore, COPD is significantly underdiagnosed, and the actual prevalence is uncertain due to misdiagnosis, silent COPD, or accompanying comorbidities. Despite continued declines in CVD mortality, it remains the number one leading cause of mortality in the US. There is a strong association between COPD and CVD that is underappreciated. Patients diagnosed or treated for COPD have at least a two-fold greater risk of developing CVD compared to those without COPD; however, there is limited interaction between pulmonologists and cardiologists and misdiagnosis is frequent. Research on COPD and associated factors that increase CVD risk is crucial because of the substantial CVD risk associated with COPD; moreover, there are no proven methods of prevention of COPD except for the cessation of smoking. COPD and CVD have in common many risk factors such as age, smoking, hypertension, diabetes and systemic inflammation. Thus, a concerted effort to manage these risk factors together could reduce the CVD burden associated with COPD. Recently, we evaluated American Heart Association’s Life’s Simple 7 Cardiovascular Health metrics in relation to COPD and demonstrated a strong association between COPD and Life’s Simple 7 scores, indicating that COPD prevention might be benefitted by improved adherence to Life’s Simple 7 measures. Our findings indicated that those at ideal levels of Life’s Simple 7 metrics had higher levels of lung function and lower COPD prevalence. This supports a call-to-action for health professionals to encourage the public to optimize cardiovascular lifestyle-related risk factors not only to maintain CVD health, but also to maintain pulmonary health.

Biography:

Vinod Musale (Masters in Pharmacy), He has his expertise in development of pharmaceutical inhalation products. Vinod has good number of years of experience in the field of quality to ensure the delivery of quality Pressurized Metered Dose Inhalers (pMDI) and Dry Powder Inhalers (DPI) to the end users for improving the healthcare. He has taken the specialization in Quality Assurance Techniques at post-graduation level and pursuing PhD in specialization of Pharmaceutical Inhalations, from UTU, University - Gujarat (India). Currently heading the Position of Manager Quality Assurance at Vamsi Pharma Private Limited

Abstract:

The purpose and interest of this research on the In-Vitro study of Pharmaceutical Inhalation/Aerosols, is to highlight the critical aspects of Fine Particle Dose (Respirable Fractions) to justify the efficacy of Pressurised Metered Dose Inhalers (pMDI).  pMDI is the most common dosage form for inhalation by which the micronized drug is delivered from a pressurized container suspended in a liquefied gas (Propellant- HFA134a/HFA 227ea).  Inhalation is the convenient way to deliver drugs to respiratory tract in treatment of respiratory disease like Asthma & Chronic Obstructive Pulmonary Diseases (COPD). Respirable Fraction is defined as the mass of active pharmaceutical ingredient per actuation of the inhaler contained in particles finer than 5.0 μm aerodynamic diameters. Pressurised Metered dose aerosols with particles in the aerodynamic particle size range of 1 to 5μm can penetrate deep into the lungs, permitting ready absorption of the drug into the blood.

The suspension HFA MDI tested in this study contained Salbutamol sulphate and Ipratropium bromide are as active drug substances, and HFA-227ea and 134a are as propellants. The particle size distribution profiles of developed Ipratropium and salbutamol Inhaler MDI product were evaluated with an eight-stage Anderson cascade impactor Copley (ACI, Copley) at flow rate of 28.3 l/min to determine the fine respirable fraction.

The percentage respirable fractions and particle distribution profiles are determined by using Copley Data Analysis Software (CITIDAS).

Table. 01 Shows that the total mass of active ingredients is well within limit 75-125% of the average delivered dose and Fig. 01 Shows Drug Distribution per Discharge.

Hence, the developed formulation was concluded that efficient with achieved respirable fractions by ACI, Copley.

Biography:

Rakesh K Gupta is the Deputy Director, Non-Communicable Diseases, Department of Health & Family Welfare, Punjab. He has expertise in managing National Non-Communicable diseases Programs especially Blindness Control/Tobacco Control Programs and has professional experience of 33 years in service. He has represented MOHFW in WHO ENDS Consultation in Panama 2016 and WHO consultation on Plain packaging in Geneva 2017.

Abstract:

Background and challenges to implementation: Electronic Nicotine Delivery System (ENDS) popularly known as e-cigarettes are highly addicting and potentially lethal products. It is mostly being used by children and youth because these are glamorised by the tobacco industry. Though not generally available in stores, they are widely promoted and sold through E commerce sites with discount offers. Sales are increasing sharply all over the world. Punjab was the first state in India to declare Electronic Nicotine Delivery System (ENDS) as unapproved under Drugs and Cosmetics Act in 2013. Intervention or response: A circular was issued by Government of Punjab regarding declaration of manufacture and sale of ENDS as illegal. To counter the sale on the Ecommerce site, Punjab Government had issued a Demi-Official letter to Cyber Crime cell regarding the sale of E-cigarettes in 2016. Awareness notices were sent to various E commerce sites regarding the sale of E cigarette. District level Task Force effectively implements the ban through conducting raids at suspected point of sale, which is being monitored monthly by Deputy Commissioners of all Districts. Results and lessons learnt: Cyber Crime Cell identified the 26 E commerce sites that were selling the E cigarettes. Letter was sent to these sites regarding the Blocking/banning the sale of e cigarettes. After that No E commerce sites are selling e cigarettes in Punjab Conclusions and key recommendations: The declaration by the Government of Punjab opens the way for other states to follow suit, and prevent ENDS becoming an additional marketing strategy for tobacco companies.