BACKGROUNDAnxiety and depression are two of the commonest and most modifiable comorbidities of chronic obstructive pulmonary disease (COPD) and have an independent effect on health and prognosis. FEV1% has been shown to be a poor predictor of anxiety and depression. The body mass index, degree of airflow obstruction, dyspnea, and exercise capacity (BODE) index is a multidimensional assessment system which may predict health outcome in COPD patients. The purpose of this study was to investigate the predictive validity of the BODE index for anxious and depressive symptoms in COPD patients.

METHODSThis was a multicenter prospective cross-sectional study in 256 patients with stable COPD. Anxious and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). The relationships between anxiety, depression and potential predictors (including the BODE index) were analyzed by a binary Logistic regression model.

RESULTSSubjects who were anxious and depressive walked a shorter six-minute walking distance (6MWD), had more dyspnea, a higher BODE index, and lower health-related quality of life (P < 0.01). Anxiety and depression score was significantly correlated with BODE index, respectively (r = 0.335, P < 0.001; r = 0.306, P < 0.001). The prevalence of anxiety and depression increased with BODE stage increasing (P < 0.05). On the basis of binary Logistic regression, the BODE index was a good and independent predictor of anxiety and depression because it comprised dyspnea and 6MWD, which were shown to be the main determinants.

CONCLUSIONSThe predictive validity of the BODE index for anxiety and depression was demonstrated. We propose that the BODE index should be included in assessment of COPD severity.

Anxiety ; diagnosis ; Cross-Sectional Studies ; Depression ; diagnosis ; Humans ; Multivariate Analysis ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; pathology ; psychology

Adrenal Cortex Hormones ; metabolism ; Adrenergic beta-2 Receptor Agonists ; metabolism ; Humans ; Multiple Pulmonary Nodules ; diagnosis ; metabolism ; pathology ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; metabolism ; pathology ; World Health Organization

OBJECTIVEDiffuse panbronchiolitis (DPB) is a chronic progressive disease of the lower respiratory tract, which is prevalent in Asian population. So far, many DPB cases have been found in adults in China. To our knowledge, no pediatric DPB case has ever been reported in China. We describe the first pediatric DPB case in Chinese literature and the second case in the English-language literature.

METHODThe clinical manifestations, characteristic imaging and histological features of this DPB case were summarized.

RESULTSThe patient was a 13-year old girl complained of chronic productive cough with wheezing. Chest auscultation revealed fine moist rales and wheezing over both lung fields. The chest X-ray showed small nodules and reticular opacities in left lower lobe. High-resolution thorax computerized tomography (HRCT) demonstrated bilateral diffuse small centrilobuler nodules and bronchial wall thickening or bronchiectasis in some parts of the lungs. Histopathological examination of transbronchial biopsy specimen revealed lymphocytes and foamy histocytes infiltrated in the walls of bronchi, respiratory bronchioles and adjacent alveoli. Lymphoid follicles were present around some bronchi. Sinus radiographs revealed sinusitis. Lung function studies showed obstruction and restriction. PaO2 was 65 mm Hg. The diagnosis of DPB was made according to the current diagnostic criteria. Low-dose erythromycin [5 - 10 mg/(kg.d)] was effective.

CONCLUSIONDPB could occur in children in China. The major diagnostic clues may include the following: (1) persistent cough, sputum, and dyspnea; (2) coexistent chronic sinusitis; (3) bilateral diffuse small nodular opacities on HRCT. Low-dose erythromycin was effective in treatment of the case with DPB.

Adult ; Bronchiolitis ; pathology ; China ; epidemiology ; Chronic Disease ; Cough ; blood ; diagnosis ; etiology ; Diagnosis, Differential ; Female ; Humans ; Lung ; pathology ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; pathology ; Respiratory Function Tests ; methods ; Sputum ; microbiology

PURPOSE: A new spirometric reference equation was recently developed from the first national chronic obstructive pulmonary disease (COPD) survey in Korea. However, Morris' equation has been preferred for evaluating spirometric values instead. The objective of this study was to evaluate changes in severity staging in Korean COPD patients by adopting the newly developed Korean equation. MATERIALS AND METHODS: We evaluated the spirometric data of 441 COPD patients. The presence of airflow limitation was defined as an observed post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) less than 0.7, and the severity of airflow limitation was assessed according to GOLD stages. Spirometric values were reassessed using the new Korean equation, Morris' equation and other reference equations. RESULTS: The severity of airflow limitation was differently graded in 143 (32.4%) patients after application of the new Korean equation when compared with Morris' equation. All 143 patients were reallocated into more severe stages (49 at mild stage, 65 at moderate stage, and 29 at severe stage were changed to moderate, severe and very severe stages, respectively). Stages according to other reference equations were changed in 18.6-49.4% of the patients. CONCLUSION: These results indicate that equations from different ethnic groups do not sufficiently reflect the airflow limitation of Korean COPD patients. The Korean reference equation should be used for Korean COPD patients in order to administer proper treatment.
Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Humans ; Korea ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/*diagnosis/pathology ; Retrospective Studies ; Spirometry/*methods

To date, clinico-physiologic indices have not been compared with quantitative CT imaging indices in determining the risk of chronic obstructive pulmonary disease (COPD) exacerbation. We therefore compared clinico-physiologic and CT imaging indices as risk factors for COPD exacerbation in patients with COPD. We retrospectively analyzed 260 COPD patients from pulmonary clinics at 11 hospitals in Korea from June 2005 to November 2009 and followed-up for at least one year. At the time of enrollment, none of these patients had COPD exacerbations for at least 2 months. All underwent clinico-physiologic and radiological evaluation for risk factors of COPD exacerbation. After 1 yr, 106 of the 260 patients had at least one exacerbation of COPD. Multiple logistic regression analysis showed that old age, high Charlson Index, and low FEV1 were significant in a clinico-physiologic model, with C-statistics of 0.69, and that increased age and emphysema index were significant in a radiologic model, with C-statistics of 0.64. The difference between the two models was statistically significant (P = 0.04 by bootstrap analysis). Combinations of clinico-physiologic risk factors may be better than those of imaging risk factors in predicting COPD exacerbation.
Aged ; Aged, 80 and over ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/*diagnosis/pathology/*physiopathology ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; *Tomography, X-Ray Computed

OBJECTIVETo retrospectively investigate the clinical characteristics of sternal insufficiency fractures (SIFs) of post-menopausal women.

METHODSFindings on the clinical presentation, associated diseases, and imaging of SIFs in 17 postmenopausal women admitted to our hospital between February 1999 and January 2009 were reported.

RESULTSTwelve patients complained of severe pain in their anterior chest. Other symptoms included cough (5 cases), dyspnoea (3 cases), breathlessness (3 cases), and wheeze (2 cases). Four patients had no discomfort. The sternums of 11 cases were tender to palpation. Seventeen patients had osteoporosis. Other associated diseases were chronic obstructive pulmonary disease (7 cases), rheumatoid arthritis (3 cases), systemic lupus erythematosus (1 case), asthma (1 case), and thoracic vertebral fracture (13 cases). Nine patients had received glucocorticoid treatment. The fractures were located in the body of the sternum in 15 patients, in the manubrium in 1 patient, and in the manubriosternal junction in 1 patient. Displaced fracture was present in 13 cases. Lateral radiography of the sternum showed a fracture line in 14 patients. In the remaining 3 cases, other imaging examinations such as bone scan, computed tomography or magnetic resonance imaging demonstrated the presence of a fracture.

CONCLUSIONSOsteoporosis, glucocorticoid therapy, chronic obstructive pulmonary disease, and rheumatoid arthritis might be risk factors for SIFs. SIFs should be considered in the differential diagnosis of chest pain.

Aged ; Aged, 80 and over ; Arthritis, Rheumatoid ; complications ; epidemiology ; Cohort Studies ; Female ; Fractures, Bone ; diagnosis ; epidemiology ; etiology ; Fractures, Stress ; diagnosis ; epidemiology ; etiology ; Glucocorticoids ; adverse effects ; therapeutic use ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal ; chemically induced ; complications ; epidemiology ; Postmenopause ; physiology ; Pulmonary Disease, Chronic Obstructive ; complications ; epidemiology ; Retrospective Studies ; Risk Factors ; Sternum ; injuries ; pathology