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- Jacobson, Petra, et al.
(författare)
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Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease : Does Comorbid Chronic Heart Failure Matter?
- 2023
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press Ltd. - 1176-9106 .- 1178-2005. ; 18, s. 2055-2064
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic heart failure (CHF) is a common comorbidity among patients with chronic obstructive pulmonary disease (COPD). Both exacerbations of COPD (ECOPDs) and exacerbations of CHF (ECHFs) display worsening of breathlessness at rest (BaR) and breathlessness at physical activity (BaPA). Comorbid CHF may have an impact on the vital signs assessed, when the Rome proposal (adopted by GOLD 2023) is applied on ECOPDs. Thus, the aim of the present study was to investigate the impact of comorbid CHF on ECOPDs severity, particularly focusing on the influence of comorbid CHF on BaR and BaPA. Methods: We analysed data on COPD symptoms collected from the telehealth study The eHealth Diary. Patients with COPD (n = 43) and patients with CHF (n = 41) were asked to daily monitor BaR and BaPA, employing a digital pen and scales for BaR and BaPA (from 0 to 10). Twenty-eight patients of the COPD patients presented with comorbid CHF. Totally, 125 exacerbations were analysed. Results: Exacerbations in the group with COPD patients and comorbid CHF were compared to the group with COPD patients without comorbid CHF and the group with CHF patients. Compared with GOLD 2022, the GOLD 2023 (the Rome proposal) significantly downgraded the ECOPD severity. Comorbid CHF did not interfere significantly on the observed difference. Comorbid CHF did not worsen BaR scores, assessed at inclusion and at the symptom peak of the exacerbations. Conclusion: In the present study, we find no evidence that comorbid CHF would interfere significantly with the parameters included in the Rome proposal (GOLD 2023). We conclude that the Rome proposal can be safely applied even on COPD patients with very advanced comorbid CHF.
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- Jacobson, Petra, et al.
(författare)
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The Exacerbation of Chronic Obstructive Pulmonary Disease : Which Symptom is Most Important to Monitor?
- 2023
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press Ltd. - 1176-9106 .- 1178-2005. ; 18, s. 1533-1541
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Tidskriftsartikel (refereegranskat)abstract
- Background: GOLD 2023 defines an exacerbation of COPD (ECOPD) by a deterioration of breathlessness at rest (BaR), mucus and cough. The severity of an ECOPD is determined by the degree of BaR, ranging from 0 to 10. However, it is not known which symptom is the most important one to detect early of an ECOPD, and which symptom that predicts future ECOPDs best. Thus, the purpose of the present study was to find out which symptom is the most important one to monitor. Methods: We analysed data on COPD symptoms from the telehealth study The eHealth Diary. Frequent exacerbators (n = 27) were asked to daily monitor BaR and breathlessness at physical activity (BaPA), mucus and cough, employing a digital pen and symptom scales (0–10). Twenty-seven patients with 105 ECOPDs were analysed. The association between symptom development and the occurrence of exacerbations was evaluated using the Andersen–Gill formulation of the Cox proportional hazards model for the analysis of recurrent time-to-event data with time-varying predictors. Results: According to the criteria proposed by GOLD 2023, 42% ECOPDs were mild, 48% were moderate and 5% were severe, while 6% were undefinable. Mucus and cough improved over study time, while BaR and BaPA deteriorated. Mucus appeared earliest, which was the most prominent feature of the average exacerbation, and worsening of mucus increased the risk for a future ECOPD. There was a 58% increase in the risk of exacerbation per unit increase in mucus score. Conclusion: This study suggests that mucus worsening is the most important COPD symptom to monitor to detect ECOPDs early and to predict future risk för ECOPDs. In the present study, we also noticed a pronounced difference between GOLD 2022 and 2023. Hence, GOLD 2023 defined the ECOPD severity much lower than GOLD 2022 did. © 2023 Jacobson et al.
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| 4. |
- Jacobson, Petra, et al.
(författare)
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Unleashing the Power of Very Small Data to Predict Acute Exacerbations of Chronic Obstructive Pulmonary Disease
- 2023
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press Ltd. - 1176-9106 .- 1178-2005. ; 18, s. 1457-1473
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In this article, we explore to what extent it is possible to leverage on very small data to build machine learning (ML) models that predict acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods: We build ML models using the small data collected during the eHealth Diary telemonitoring study between 2013 and 2017 in Sweden. This data refers to a group of multimorbid patients, namely 18 patients with chronic obstructive pulmonary disease (COPD) as the major reason behind previous hospitalisations. The telemonitoring was supervised by a specialised hospital-based home care (HBHC) unit, which also was responsible for the medical actions needed. Results: We implement two different ML approaches, one based on time-dependent covariates and the other one based on time-independent covariates. We compare the first approach with standard COX Proportional Hazards (CPH). For the second one, we use different proportions of synthetic data to build models and then evaluate the best model against authentic data. Discussion: To the best of our knowledge, the present ML study shows for the first time that the most important variable for an increased risk of future AECOPDs is “maintenance medication changes by HBHC”. This finding is clinically relevant since a sub-optimal maintenance treatment, requiring medication changes, puts the patient in risk for future AECOPDs. Conclusion: The experiments return useful insights about the use of small data for ML. © 2023 Jacobson et al.
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- Kentson, Magnus, 1982-, et al.
(författare)
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Oxidant status, iron homeostasis, and carotenoid levels of COPD patients with advanced disease and LTOT
- 2018
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Ingår i: European Clinical Respiratory Journal. - : Taylor & Francis. - 2001-8525. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The pathogenesis of chronic obstructive pulmonary disease (COPD) is associated with oxidative stress. Both iron (Fe) and oxygen are involved in the chemical reactions that lead to increased formation of reactive oxygen species. Oxidative reactions are prevented by antioxidants such as carotenoids. Objective: To study the differences in Fe status, carotenoid levels, healthy eating habits, and markers of inflammation and oxidative damage on proteins in subjects with severe COPD ± long-term oxygen therapy (LTOT) and lung-healthy control subjects. Methods: Sixty-six Caucasians with advanced COPD (28 with LTOT) and 47 control subjects were included. Questionnaires about general health, lifestyle, and dietary habits were answered. Lung function tests and blood sampling were performed. Results: COPD subjects (±LTOT) did not demonstrate increased oxidative damage, assessed by protein carbonylation (PC), while levels of soluble transferrin receptors (sTfRs) were slightly elevated. Soluble TfRs, which is inversely related to Fe status, was negatively associated with PC. Levels of carotenoids, total and ß-cryptoxanthin, a- and ß-carotenes, were significantly lower in COPD subjects, and their diet contained significantly less fruits and vegetables. Lutein correlated inversely with IL-6, lycopene correlated inversely with SAT, while ß-carotene was positively associated with a Mediterranean-like diet. Conclusions: Fe could favor oxidative stress in COPD patients, suggesting a cautious use of Fe prescription to these patients. COPD subjects ate a less healthy diet than control subjects did and would, therefore, benefit by dietary counseling. COPD patients with hypoxemia are probably in particular need of a lycopene-enriched diet.
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| 6. |
- Kentson, Magnus, et al.
(författare)
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The influence of disease severity and lifestyle factors on the peak annual 25(OH)D value of COPD patients
- 2018
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : DOVE MEDICAL PRESS LTD. - 1176-9106 .- 1178-2005. ; 13, s. 1389-1398
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Tidskriftsartikel (refereegranskat)abstract
- Background: The prevalence of individuals deficient in vitamin D (defined as a serum level of the stable metabolite 25(OH)D amp;lt; 50 nmol/L) is increasing in countries with low annual ultraviolet (UV) radiation and among individuals unable to perform outdoor activities, for example, COPD patients. Objective: To assess the role of vitamin D deficiency, independently of seasonal variation, the peak annual value of 25(OH)D was measured in subjects with advanced COPD +/- long-term oxygen therapy (LTOT) and lung healthy control subjects. A method to grade the individual annual UV light exposure was designed and tested. Subjects and methods: Sixty-six Caucasians with advanced COPD (28 with LTOT) and 47 control subjects were included, and the levels of 25(OH)D were determined in late summer/ early fall when the annual peak was assumed. Questionnaires about COPD symptoms, general health, lifestyle, dietary habits and QoL were used to collect data. Lung function tests and blood sampling were performed. Results: The peak annual 25(OH)D of COPD subjects was significantly lower than in the control subjects, but there was no significant difference between COPD patients with and without LTOT. Ongoing vitamin D supplementation was the single most important intervention to maintain 25(OH)D levels amp;gt;= 50 nmol/L. Among vitamin D-deficient COPD subjects, 25(OH)D correlated positively with forced expiratory volume in 1 second as % predicted, Modified British Medical Research Council score, blood oxygenation, food portion size, Mediterranean Diet Score and Ultraviolet Score. Conclusion: Vitamin D deficiency was common among healthy individuals and COPD subjects. Peak annual 25(OH)D levels of COPD subjects correlated with clinically important outcomes. The present study emphasizes the need to routinely monitor vitamin D status among patients with advanced COPD and to consider to medicate those with vitamin D deficiency with vitamin D supplementation.
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| 10. |
- Larsson, Elin, et al.
(författare)
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Boric acid as a lubricating fuel additive - Simplified lab experiments to understand fuel consumption reduction in field test
- 2017
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Ingår i: Wear. - : Elsevier BV. - 0043-1648 .- 1873-2577. ; 376, s. 822-830
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Tidskriftsartikel (refereegranskat)abstract
- In field tests, a boric acid based fuel additive has led to reduced fuel consumption. The reduction was substantial, an average of 6 and 10% in passenger cars and diesel generators respectively. Aiming towards improved understanding of mechanisms behind the fuel saving, three methods to mimic the effect of the additive in the piston-ring/cylinder contact have been evaluated. A reciprocating cylinder/flat configuration with ball bearing steel against grey cast iron was used, and it was lubricated with base oil. The different methods were as following: A) repeated spraying of a small amount of the boric acid solution onto the surfaces, B) predeposition of a boric acid layer on the flat surface and C) a combination of method A) and B). The three methods all showed effects of the additive, spanning from about 20% to 50% reductions (in the latter case, from roughly 0.1 to 0.05 in coefficient of friction averaged over the stroke). The greatest potential of the additive was seen with local coefficient of frictions lower than 0.020 in tests at room temperature with Method C. This means a reduction of around 75% compared to the lowest levels measured for the reference tests run without the additive. The most stable friction test was Method A, where a small amount of boric acid solution was repeatedly sprayed onto the lubricated sliding surfaces. In this type of test, friction reductions of roughly 20% and 40% were found at 100 C and room temperature respectively. The tribological and chemical mechanisms of boric acid in this test configuration are yet not fully understood and more studies are needed. However, the observed poor stability of the tribofilms containing boron and oxygen complicates such activities.
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