European Journal of Molecular & Clinical Medicine

To study the correlation of venous blood lactate level and 6 minute walk test in stable COPD
Patients in tertiary health care centre
Materials & methods: Study was conducted on 50 patients from the Department of Respiratory
Medicine at Index Medical College, Research centre and Hospital, Indore and all the tests was
perform with due permission from the Institutional Ethical Committee and informed consent from the
subjects or their legal relatives. Subjects was included on the basis of their diagnosis of COPD as per
GOLD guidelines & laboratory test of venous blood lactate level.
Result: Fifty participants were recruited and 74% of them were male. The median age of all the
participants was 60.48 years.Based on the Severity classification, 12(24%) of them were mild,
21(42%) moderate, 7(14%) severe and 10(20%) very severe.The participants were under regular
treatment. The median of 6MWT was 280.00 m (IQR 67-53.25, 375–205 m). For Normal Lactic acid
the Mean 6MWT was 336.75 mtrs for 12 samples of Group A of COPD Severity Group, 20 of Group
B, 4 of Group C & 1 of Group D. For Abnormal Lactic acid the Mean 6MWT was 171.92 mtrs for 0
samples of Group A of COPD Severity Group, 1 of Group B, 3 of Group C & 9 of Group D.
Conclusion: In conclusion, in COPD patients 6MWT is useful test to assess severity of disease. Our
study has shown that 6MWT correlates well with pulmonary function and quality of life in patients
with COPD. 6MWT can be used as a novel index in the evaluation of functional status of COPD.
More importantly, steps might give additional indication in addition to distance traveled about the
risk of lung hyperinflation. Considerably more work will be needed to investigate the link between
steps and hyperinflation in patients with COPD.

Globally, chronic obstructive pulmonary disease (COPD) is a major contributor to morbidity, disability, and mortality. ECGs are frequently abnormal in people with chronic obstructive pulmonary disease (COPD). Findings from electrocardiograms (ECGs) could be useful in making clinical decisions about this disease entity.
Aims and objectives: To evaluate the diagnostic values of ECG changes among COPD patients admitted at tertiary care hospital.
Methods:Institutional based cross-sectional study was carried out in Dr. DY Patil Medical College and Hospital, Pune, India. A sample of 130 patients with respiratory illness attending OPD under General Medicine were selected randomly during the study period of 2021-2022.A COPD diagnosis was obtained based on the patient's medical history, chest x-ray findings, and the GOLD criteria based on spirometry. We studied the electrocardiographic profile and its association with severity of the COPD.
Results: Out of the total patients, majority were male. The mean age was 53.96±9.43 years. As per GOLD guidelines, 5% had mild, 38% moderate, 35.3% severe and 21.3% had very severe COPD. Most frequent Symptoms was breathlessness (92.7%) on presentation, followed by cough with sputum (79.3%).The most common ECG changes were P-pulmonalewhich indicates pulmonary hypertension (52.2=7%) and right ventricular hypertrophy (42.7%).Other ECG changes were Low voltage of QRS complex(34.7%), R/S ratio V6<1 (19.3%), R/S ratio V1>1 (24%), Right axis deviation of QRS complex (27.3%), Polymorphic P wave(10.7%), cardiac arrhythmias (5.3%) and right bundle branch block (8.7%). All ECG changes were correlated significantly with severity of the disease except Low voltage of QRS complex.
Conclusion:The results of the study showed a significant correlation between the severity of COPD and electrocardiographic changes such P pulmonale, right ventricular hypertrophy, and right axis deviation. ECG, being simple, noninvasive and inexpensive investigating tool, can be used for cardiac screening of all COPD patients which will behelpful in the assessment of the prognosis, so that proper institution of therapy canbe initiated early to prevent long-term complications of severe pulmonary hypertension and right heart failure

Asthma –COPD overlap is characterized by persistent airflow limitation with several features usually associated with COPD. It is identified in clinical practice by the features it shares with both asthma and COPD. A stepwise approach to diagnosis is advised, with recognition of the presence of chronic airway disease, syndromic categorization as characteristic asthma, characteristic COPD or ACO, confirmation of chronic airflow limitation by spirometry and, if necessary, referral for specialized investigations. The aim of the study was to determine the prevalence and to study various clinical characteristics of the patients with ACO.

Background: The hallmark of COPD is airflow obstruction which is typically described by spirometry. Spirometry is a cost efficient method of ordering pulmonary function tests is to start with spirometry and then order further tests in a stepwise fashion to refine the diagnosis.Present study was aimed to study pulmonary function tests in patients of chronic obstructive pulmonary disease.
Material and Methods: Present study was Cross-sectional Observational Study, conducted in patients clinically diagnosed as COPD in OPD or admitted to our wards and having symptoms of COPD (dyspnea, chronic cough or sputum production).
Results: 100 COPD patients were studied, majority were from age group 50 to 59 years (41%) & age group 60 to 69 years (30%). The male to female ratio was 5.67:1. Mean post-bronchodilator FEV₁ % predicted of males in the group was 53.81 ± 19.29) whereas mean FEV₁ % predicted of females in the group was 51.26 ± 15.96.  Mean post-bronchodilator FEV₁/FVC ratio of males in the group was 0.433 ± 0.156 whereas mean FEV₁/FVC ratio of females in the group was 0.411 ± 0.128. 15 patients were in GOLD Stage I (FEV1 ≥ 80% predicted) ,34 patients were in Stage II (50% ≤ FEV1 < 80 % predicted),36 patients were in stage III (30% ≤ FEV1 < 50 % predicted) whereas 15 patients were in stage IV( FEV1 < 30%). The difference between mean post-bronchodilator reversibility in FEV1 (in percentage) in patients in GOLD stage 1 vs stage 2 vs stage 3 vs stage 4 (applying ANOVA) was not found to be statistically significant (P=.869>0.05).
Conclusion: Spirometry is important tool in confirming and assessing severity of airway obstruction in COPD patients. Majority of COPD patients were in stage 2 & 3 (GOLD) of airway obstruction confirmed by spirometry.

Aim: The purpose of this research is to assess the function of CRP as a biomarker in COPD acute exacerbation.
Methods: The Department of Respiratory Medicineconducted this cross-sectional research. After washing their mouths twice with plain water, all patients were advised to collect deep coughed up phlegm into a sterile wide mouth container with a screw cover. The samples were promptly sent to the microbiology laboratory and processed within 30 minutes of being collected. Gram staining was performed on a sputum sample and results were reported using Bartlett's grading method. A appropriate sample was defined as one with a score of 1 or above. Mac Conkey's agar, chocolate agar, and blood agar plates were inoculated with appropriate sputum samples. Standard microbiological procedures established by the American Society for Microbiology were used to identify the isolated organisms. Sputum samples cultured for pathogenic bacteria were classed as Bacterial exacerbations, whereas samples with no pathogenic bacteria or oral commensals were classified as Non bacterial exacerbations.
Results: Among the 100 patients, 65 had bacterial growth on culture and were classed as Bacterial COPD exacerbation. The other 35 instances in which no bacterial growth or oral commensals were found were classed as Non Bacterial COPD exacerbation. Using the crude odds ratio, it was determined that the chances of Bacterial Exacerbation for patients with COPD "≥5 years" are 2.87 (95 percent CI: [1.26,6.88]) times greater than persons with COPD "<5 years." Furthermore, smokers had a 3.77(95 percent CI[1.50,10.28]) greater risk of bacterial exacerbation than nonsmokers. In our investigation, the optimal CRP cut-off point for separating Bacterial COPD patients with Bacterial Exacerbation from those without Bacterial Exacerbation was 8.77 mg/L (sensitivity:97%; specificity:40%; PPV:75%; NPV:87%, AUC:0.77).
Conclusion: Higher CRP levels are related with individuals experiencing Bacterial COPD exacerbations rather than Non Bacterial COPD exacerbations. CRP levels might therefore be utilised to anticipate Bacterial exacerbations and also to recommend antibiotic treatment.

Introduction: Chronic obstructive pulmonary disease (COPD) is a disease state
characterized by airflow limitation that is not fully reversible. An increased
inflammatory response in the lungs plays a central role in the pathogenesis of COPD.
Oxidative stress and systemic inflammation are co-dependent processes. Pulmonary
hypertension is a common complication of chronic obstructive pulmonary disease
(COPD). The present study is an attempt to study the various markers of oxidative
stress in COPD and their co relation with pulmonary hypertensionusing 2D ECHO
findings.
Materials and Methods: The present study enrolled 100 participants, 50 of them
diagnosed cases of COPD and the remaining 50 as control. Apart from the chest X ray,
routine blood investigations, sputum AFB examination and PFT, 6-minute walk test
(6MWT), 2D Echo and levels of above mentioned oxidative and inflammatory markers
were done of the patients. Pulmonary hypertension diagnosed based on the
Transthoracic 2D – ECHO by TR jet method – presence of mPAP more than 25 mmHg
considered as the criteria for defining pulmonary hypertension. As far as the
quantitative data was concerned, comparison between the 2 groups was done using
unpaired t test, and for the qualitative data appropriate data was used.

Introduction: A substantial body of evidence indicates that nutrition influences respiratory
health. Much of the nutrition research has focused on the intake of fruits, vegetables, and
antioxidant micronutrients, because lungs are subject to a wide range of oxidant induced insults
and because antioxidant defenses play an important role in protecting the lungs from damage.
Materials and methods: Seventy five patients with COPD were included in the study. In their
baseline clinical examination, malondialdehyde (MDA); red blood cell superoxide dismutase
(SOD) and erythrocyte glutathione peroxides (GPx) levels were measured. All the above
parameters were repeated after 12 weeks of supplementation with 1000 mg vitamin C daily.
Result: Serum MDA levels were significantly lowered, erythrocyte SOD and Gap activity were
significantly higher after supplementation of vitamin C. No significant improvement in FEV1
and FEV1/FVC was observed after 12 weeks of vitamin C supplementation.
Conclusion: The present study shows that the plasma lipid peroxide (MDA) levels were
decreased and antioxidants levels (GPx and SOD) increased after 12 weeks supplementation of
vitamin C in patients with COPD. Exogenous supplementation with vitamin C does not have any
significant effect on the spirometric measurements though it brings down the levels of MDA
showing attenuation of further damage.

COPD is a growing global epidemic and it is estimated to kill around 3 million people every
year. It is currently the 4th largest killer disease in the world and expected to climb to 3rd
position by the year 2030. WHO has estimated that 600 million people worldwide have
COPD. It affects around 5-10% of population over the age of 40 years but still there is wide
variations in the prevalence between countries. Patients underwent Spirometric analysis and
those with post bronchodilator FEV1 < 40% are asked for willingness to participate in the
study. Those who are willing to participate are screened for inclusion into the study. Informed
Consent was obtained from all the patients. GOLD criteria revealed that majority of the
patients in our study i.e.27(45%) were of Grade 1 followed by 22(36.7%) were from Grade 2,
10(16.7%) from Grade 3 and 1(1.7%) were of Grade 4.

COPD currently is considered the 11th leading cause of disability worldwide. Current projectionssuggest that by the year 2020, COPD will be the 5^th leading cause of disability worldwide, behind only ischemic heart disease, major depression, traffic accidents, and cerebrovascular disease. The research students will attend ward rounds on a daily basis and collect cases which are under inclusion criteria. The patients will be randomly divided into intervention and control group. The intervention group of patients will be analysed. Majority of the patients came with complaints of dry cough, wheezing and breathlessness, and a very few patients had complained of fever. Most of the patients were admitted for exacerbation of COPD. It was observed that the patients with exacerbation of COPD were more in number in intervention group.

Introduction-Chronic obstructive pulmonary disease (COPD) is a common respiratory
condition involving the airways and characterized by airflow limitation.
According to the Global Burden of Disease Study 2010, COPD is the fourth leading cause
of death in the world and is projected to be third leading cause by 2020. The chronic course of
this disease is frequently accompanied by acute exacerbations, usuallydue to infections.
Materials and methods- A total of 50 patients were included in the study.The data was
collected using structured proforma including demographic data, clinical history and lab
investigations. Descriptive statistical analysis (such as mean, median, standard deviation and
percentage) has been carried out in the present study.
Results-In the present study of 50 study subjects comprised of 46 males and 4 females with
mean age of 70.5 years. In 38% of the patients, bacteria were determined to be the cause of
AECOPD. [ Klebsiella pneumoniae (52.63%), Escherichia coli ( 31.57%) and Streptococcus
pneumoniae (15.78%)]. Among viral etiology, parainfluenza(44.4%), influenza(27.8%) and
Respiratory syncytial virus(22.2%). Among Atypical organisms Mycoplasma, Chlamydiae and
Legionella accounted for 38.46%, 30.77% and 30.77% of the cases, respectively.
Conclusion-
Present study indicates that gram-negative bacteria play a major role in exacerbation of COPD
in our population .Among bacterial infections, Klebsiella was most common organism.
Para influenza followed by influenza and RSV are common viral etiological agents in
exacerbations.
Present study indicates that a good proportion of COPD exacerbations were caused by atypical
bacteria. Mycoplasma was the most commonly isolated organism followed by Chlamydia
pneumophila and Legionella species.

In 2002 COPD was the fifth leading cause of death. Total deaths from COPD are projected to
increase by more than 30% in the next 10 years unless urgent action is taken to reduce the
underlying risk factors, especially tobacco use. Estimates show that COPD becomes in 2030
the third leading cause of death worldwide. Sputum cultureand sensitivity was done
collecting sputum in sterile containers and were incubated on sheep blood agar, chocolate
agar and Mac conkey agar. IgG antibodies against viruses and atypical organisms is done by
indirect immunofluorescent assay(IFA) kit.Sensitivityis 94.6% to 100%and specificity is 90%
to 100%based on micro-organism.Most of them have smoking history with 82% of Exsmokers
and 6% of smokers.Only 12% were non-smokers. Renal failure was seen in 42% of
patients. Chest x-ray showed opacities in only 24% of patients.

Chronic obstructive pulmonary disease is a disease condition characterized by a progressive
and not reversible airflow previously associated with an abnormal inflammatory response in the
lungs to harmful substances. This can overcome the nursing problem in the form of gas transfer
problems. As a nurse, the thing that can be done is to do an independent intervention consisting of
orthopneic position and to try to improve breathing status based on the results of the classification
of nursing results, namely breathing frequency, oxygen saturation, and chest wall retraction. The
study aimed to investigate the combination of orthopneic position and breathing lips on the
respiratory status of COPD patients. The study was quantitative with the quasi-experimental
approach. Seventy-two were sample divide into two groups, namely, 36 control and 36 intervention
group using purposive sampling. Data were analyzed using Wilcoxon signed-rank test and Mann
Whitney Test. The results found significant differences between before and after the intervention
with values for respiratory frequency 0,001, oxygen saturation 0,001, and chest wall retraction
0,005, then found differences between the control group and comparison of respiratory frequencies
and oxygen saturation <0.005. The Intervention of combination orthopneic position and pursedlips
breathing can improve the respiratory status of COPD patients, namely: respiratory frequency,
oxygen saturation, and chest wall retraction.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world but is projected to be the third leading cause of death in 2020. This study aimed to examine the effect of combined chest physiotherapy and Active Cycle Breathing Technique (ACBT) on oxygen saturation and respiratory rate. The research method used was a quasiexperimental approach with pre -test and post-test control group design. The sampling technique used by the researcher was purposive sampling with 60 responde nts, divided into 30 intervention groups and 30 control groups. The results obtained were there were significant differences in the respiratory rate in the control group and the intervention group after being treated with a value of p=0.001 (p <0.05). The difference in the proportion of the ability to excrete sputum in the intervention group was 7 times more productive than the control group. It is hoped that nursing practice and nursing education will increase knowledge and skills in providing chest physiotherapy and ACBT so that they can apply these actions to patients who have sputum retention problems in the airway, especially COPD patients.

Background/aims: COPD is among the significant health complications in entire world; studies have shown that there is systemic inflammation with pulmonary inflammation in case of COPD. To detect the systemic inflammatory response, neutrophil lymphocyte ratio (NLR) in peripheral blood which is important biomarker. NLR hasn’t been studied in patients having chronic obstructive pulmonary disease (COPD). Current study was targeted to determine the importance of NLR as inflammatory marker in patients with COPD.
Methods: The neutrophil and lymphocyte count in the peripheral blood was found out from blood count (CBC) reports. The NLR was determined by dividing neutrophil count from lymphocyte count. COPD patients were diagnosed with Spirometry. Then the NLR was compared in patients having stable COPD (n = 50), and healthy controls (n = 50.
Results: The neutrophil count was considerably greater in COPD patients matched with the healthy individuals (p < 0.001) whereas the lymphocyte count was suggestively lower in patients having COPD patients when compared to perfectly healthy individuals (p < 0.001).NLR values were considerably higher among patients with stable COPD patients than controls (p < 0.001). There were no noteworthy variance in the total leucocyte of COPD patients and healthy individuals.
Conclusion: It is concluded that the increase in the neutrophil-lymphocyte ratio in COPD patients compared to healthy individuals may be an indicator of systemic inflammation in patients with COPD.

Smoking leads to disease and disability and harms nearly every organ of the body. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. It increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. Secondhand smokers are also at great risk of developing certain disease conditions like stroke, lung cancer, and coronary heart disease in adults.