Remark on some clinical, subclinical characteristics of chronic obstructive pulmonary disease patients operated lung volume reduction surgery

Journal of military pharmaco-medicine no7-2019

REMARK ON SOME CLINICAL, SUBCLINICAL
CHARACTERISTICS OF CHRONIC OBSTRUCTIVE PULMONARY
DISEASE PATIENTS OPERATED LUNG VOLUME
REDUCTION SURGERY
Le Minh Phong1; Nguyen Truong Giang2; Ta Ba Thang3
SUMMARY
Objectives: To comment some clinical, subclinical characteristics of chronic obstructive
pulmonary disease patients undergoing lung volume reduction surgery. Subjects and methods:
31 patients, who were exactly diagnosed with chronic obstructive pulmonary disease
undergoing lung volume reduction surgery, were examined and estimated some clinical and
subclinical characteristics. Results: The average age was 66.16 ± 5.62, group of age 60 - 69
accounted for the highest percentage (41.94%). Walking distance of 6 minutes was 293.90 ±
70.79 m. CAT score was 19.00 ± 6.06. The number of patients with CAT score ≥ 10 was
83.87%. mMRC score was 2.35 ± 0.98. Therein, those who had mMRC ≥ 2 accounted for
77.42%. Lung function parameters were TLC: 140.61 ± 21.03% predicted, VC: 87.90 ± 21.91%
predicted, FVC: 85.77 ± 20.00% predicted, FEV1: 52.00 ± 18.71% predicted, Gaensler: 56.13 ±
15.41, PEF: 50.87 ± 15.82% predicted, MVV: 50.42 ± 20.59%, strongly decreased to severe
obstruction of airway that caused alveoli stasis in chronic obstructive pulmonary disease
patients with severe emphysema. Average emphysema score was 2.67 ± 0.83, most of patients
were in level 4 of emphysema (45.16%).
* Keywords: Chronic obstructive pulmonary disease; Lung volume reduction surgery;
Clinical, subclinical characteristics.

INTRODUCTION
Chronic obstructive pulmonary disease
(COPD) - a common, preventable and
treatable disease is characterized by
persistent airflow limitation that is progressive
and associated with an enhanced chronic

inflammatory response in the airway and
the lung to noxious particles and gases.
Outbreak and comorbidities contribute to

the overall severity in individual patients
[3, 9].
According to GOLD’s report (2019),
COPD is currently ranked the 4th among
the causes of death worldwide, it is
estimated that by 2020 it will be ranked
the 3rd among these causes. In 2012 alone,
more than 3 million people died from COPD,

1. 175 Military Hospital
2. Vietnam Military Medical University
3. 103 Military Hospital
Corresponding author: Le Minh Phong ()
Date received:06/07/2019
Date accepted: 26/08/2019

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Journal of military pharmaco-medicine no7-2019
accouting for 6% of all deaths worldwide
[9]. In Vietnam, in 2010, the study by
Nguyen Thi Xuyen performed on 25,000
subjects aged 15 and above, in 70
locations of 48 provinces through the
country showed that the rate of COPD in

the whole country was 2.2%, in which
3.4% for men, 1.1% for women, mostly in
the age group of 40 and above (4.2%) [5].
Lung volume reduction surgery (LVRS) is
a surgical method that removes
emphysema, increases the elasticity of
the less damaged lung, to improve function,
reduce dyspnoeas, and increase the
mobility of patients [9, 11]. Although this is
considered a safe and effective treatment,
not many facilities in Vietnam can implement
this technique, and research topics on
LVRS in Vietnamese patients are still
limited. We carried out this study with the
aims: Remark some clinical and subclinical
characteristics of COPD patients, who have
indications for LVRS.
SUBJECTS AND METHODS
1. Subjects.
31 male patients were diagnosed with
COPD combined with severe emphysema
underwent LVRS in the Department of
Thoracic Surgery, 103 Military Hospital
from 2013 to 2018.
* Selection criteria:
- Patients diagnosed with COPD
according to GOLD's criteria (2018) [8].
- Criteria for selecting patients with
LVRS according to NETT (2011) [10].
* Exclusion criteria:

- Exclusion criteria for patients with
LVRS according to NETT (2011) [10].
Excluded subjects were patients with
other respiratory diseases (pulmonary
tuberculosis, cancer, bronchial asthma...),
patients with contraindications to respiratory
function test (new heart stroke, pulmonary
embolism, pneumothorax, severe heart
failure, limited cognitive awareness), or
patients refused to join the research group.
2. Methods.
The cross-sectional descriptive study
of clinical and subclinical characteristics
of severe COPD patients undergoing
LVRC.
CAT score were calculated based on
CAT questionnaires (COPD Assessmnet
Test) according to GOLD 2015, including
8 questions serveys on the scale of
cough, sputum, dyspnea, chest pain,
activity, social communication, sleep,
health, each sentence was scored from 0
- 5 points. The overall average score was
calculated by summing of the score of
8 questions. The mMRC score was
calculated based on the mMRC
questionnaires of GOLD 2015 according
to the degree of dyspnea, the score was
given from 0 - 4 points. The level of

emphysema was calculated based on the
area of emphysema region 0%: 0 point;
< 5%: 0.5 point; 5 to < 25%: 1 point; 25 to
< 50%: 2 points; 50 to 75%: 3 points and
≥ 75%: 4 points.
Data processing with software SPSS
22.0 and Excel 2016.
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Journal of military pharmaco-medicine no7-2019
RESULTS AND DISCUSSION
Table 1: Characteristics of patient by age group.
Age group

n

%

< 60

6

19.35

60 - 69

13

41.94

≥ 70

12

38.71

Sum

31

100

The average age

66.16 ± 5.62

Min - max

55 - 74

100% of research patients were male,
the average age was 66.16 ± 5.62, the
age group of 60 - 69 accounted for the
highest proportion (41.94%). The youngest
and the oldest subjects were 55 and 74,
Our results were consistent with the
study by Dao Ngoc Bang (2019) with
the average age of COPD patients of

65.80 ± 6.96, the age group had the
highest percentage was 60 - 69 (45.45%)
[1]. The results of Nguyen Huy Luc also
showed that a high rate in men with age
group > 50 (92%) [2]. The study by Hruna
Akane et al (2010) showed average age
of 68.7 ± 7.0, with a male/female ratio
was 15.7/1 [6].

Table 2: Clinical characteristics.
Characteristics

X ± SD

Min

Max

6-minute walk test (m)

293.90 ± 70.79

197

440

BMI (kg/m )

2

20.46 ± 3.03

15.24

29.04

CAT

19.00 ± 6.06

8

27

mMRC

2.35 ± 0.98

1

4

- 6-minute walking test: 293.90 ± 70.79 m
was consistent with Dao Ngoc Bang’s
study (2019) (302.82 ± 59.33 m) [1], and
Frank C. Sciurba (333.9 ± 87.4 m) [7].
- BMI of research group was
20.46 ± 3.03 kg/m2, the highest and the
lowest values were 29.04 and 15.24,
respectively.

- The result of our study was suitable
to the study by Dao Ngoc Bang (2019)
130

(18.26 ± 2.46 kg/m2), and Haruna et al
(2010) (21.4 ± 3.0 kg/m2) [1, 6].
- The average mMRC score in whole
study population was 2.35 ± 0.98 points,
the number of patients with mMRC
≥ 2 points was 77.42%.
- The average CAT score of the study
group was 19.00 ± 6.06, of which the
number of patients with a CAT score ≥ 10
points was 83.87%.


Journal of military pharmaco-medicine no7-2019
According to the study by Dao Ngoc
Bang (2019), the CAT score was 19.38 ±
3.26 points, and mMRC was 2.38 ± 0.84
points. According to Do Quyet and

Nguyen Thi Thu Ha (2010), the average
CAT score was 18.59 ± 4.66 points [1, 4],
the results also showed similarities with
the results of our research.

Table 3: Characteristics of lung ventilation parameters.
Respiratiry parameters

X ± SD

Min

Max

TLC (% predicted)

140.61 ± 21.03

108

227

VC (% predicted)

87.90 ± 21.91

49

144

FVC (% predicted)

85.77 ± 20.00

43

133

FEV1 (% predicted)

52.00 ± 18.71

23

106

Gaensler

56.13 ± 15.41

14

87

PEF (% predicted)

50.87 ± 15.82

22

82

MVV (% predicted)

50.42 ± 20.59

22

104

- Results of our study on respiratory
function tests showed TLC of 140.61 ±
21.03% predicted, the result was consistent
with the research result of Dao Ngoc Bang
(2019), who reported TLC of 140.67 ±
26.17% predicted [1].
- The average value of VC and FVC of
the research group decreased, in which
FVC decreased more than VC. The
maximum exhaled volume in the first
second (FEV1) was significantly reduced:
An average of 52.00 ± 18.71% predicted.
- PEF and Gaensler indexes decreased
significantly to 50.87 ± 15.82% predicted
and 56.13 ± 15.41% predicted, respectively.
These results were consistent with the
level of severe airway obstruction causing

alveolar airway obstruction in COPD patients
with severe emphysema.
- Other parameters included FVC, FEV1,
Gaensler, PEF, MVV were higher than
those of Dao Ngoc Bang (2019), FVC:
64.18 ± 14.87% predicted, FEV1: 35.02 ±
13.22% predicted, PEF: 31.20 ± 14.22%
predicted, MVV: 30.88 ± 12.25% predicted
[1]. But they were lower than the study by
Nguyen Huy Luc on FEV1 parameter, type

BB: 53.80 ± 6.86% predicted, type PP:
65.41 ± 15.44% predicted, and parity
similarity Gaensler (type BB: 47.07 ± 6.41;
type PP: 58.84 ± 12.12) [2]. The differences
in above results were probably due to the
differences in disease stages of subjects
selected for the study, but they generally
showed a significant reduction in respiratory
parameters.
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Journal of military pharmaco-medicine no7-2019
Table 4: Emphysema characteristics and grading on computerized tomography.
Characteristics

X ± SD

Emphysema score

2.67 ± 0.83

Grade

n

%

Level 2

5

16.13

Level 3

12

38.71

Level 4

14

45.16

31

100

Sum

The average emphysema score of the research group on computerized tomography
was 2.67 ± 0.83, of which mainly patients with level 4 emphysema (45.16%). The study
by Dao Ngoc Bang (2019) also gave the emphysema score equivalent to 2.76 ± 0.48,
but the level of emphysema, severe level (45.45%), the very severe level (51.52%)
were higher than our research [1].
CONCLUSION
Through a study of 31 patients, we had
some comments as the following:

- The average age was 66.16 ± 5.62,
the lowest and highest ages were 55 and
74, respectively.
- The average mMRC score of research
group was 2.35 ± 0.98 points, therein, the
percentage of patients with mMRC score
≥ 2 accounted for 77.42%. The average
CAT score was 19.00 ± 6.06, in which the
proportion of CAT score ≥ 10 was 83.87%.
- The maximum exhaled volume in the
first second (FEV1) dramatically reduced,
as measured of 52.00 ± 18.71% predicted.
PEF, Gaensler indexes were significantly
decreased to 50.87 ± 15.82% predicted
and 56.13 ± 15.41% predicted, respectively.
These results are consistent with the
level of severe airway obstruction causing
alveolar airway obstruction in COPD patients
with severe emphysema.
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- Average emphysema score of research
group on computerized tomography was
2.67 ± 0.83, in which the level 4 of
emphysema accounted for a higher rate
of 45.16%.
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Journal of military pharmaco-medicine no7-2019
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