الفهرس 
CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD)
Pulmonary functions tests (spirometry):Only 14 pages are availabe for public view
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Abstract
Chronic obstructive pulmonary disease (COPD) is a term
which refers to a large group of lung diseases
characterized by obstruction of air flow that interferes with
normal breathing, COPD has an extensive &adverse effect on
both patients and the healthcare system. COPD causes physical
impairment, debility, reduced quality of life, and death. Also
COPD causes high resource utilization, which includes frequent
clinician office visits, frequent hospitalizations due to acute
exacerbations, and chronic therapy (eg, long-term oxygen
therapy, medication). This is a consequence of the high
prevalence and chronicity of COPD.
It is important to recognize and diagnose COPD early
because appropriate management can prevent and decrease
symptoms (especially dyspnea), reduce the frequency and
severity of exacerbations, improve health status, improve
exercise capacity, and prolong survival. Despite this, COPD is
under diagnosed, only 15 to 20 percent of smokers are ever
diagnosed with COPD, although the majority develops airflow
obstruction.Prevalence, morbidity and mortality of COPD in Egypt are
still lacking and have to be estimated; however COPD is arising
significant health problem in Egypt.
Fungi may cause lung disease through direct infection of
pulmonary tissue, through infection of pulmonary air
spaces/lung cavities, or through their ability to trigger an
immunological reaction when fungal material is inhaled.
Invasive pulmonary Aspergillosis (IPA) is a life
threatening pneumonia characterized by lung parenchyma
invasion with vasculature erosion and necrosis that is caused by
opportunistic fungi belonging to the species Aspergillus.
Aspergillus fumigates is the most common species recovered
from cases of IPA.
Advanced COPD stages III and IV are correlated with a
higher risk of IPA, The use of broad spectrum antibiotics to
treat acute bacterial exacerbation within 3 months was found to
be a significant predictor of IPA in patients with COPD.
Pulmonary candidasis is the rare condition that is usually
occurs in immunocompromised patient. Presence of candida in
respiratory specimen may be due to contamination &there is no
specific clinical or radiological picture. Conclusive diagnosis
requires demonstration of the organism in tissue. Pulmonary
invasion result either due to dissemination or aspiration from
upper air ways. Candida, a commensal fungus of mucosal surfaces, is the predominant fungal pathogen in humans. The
spectrum of Candida-induced illnesses is broad, ranging from
mild, chronic mucocutaneous infections to life-threatening
acute invasive infections involving potentially any organ.
Also Histoplasmosis was first described by a United States
Army physician in Panama in 1906 and subsequently has
become recognized as a common and usually asymptomatic
infection .Histoplasmosis is the most prevalent endemic
mycosis in the United States. While most infections are
asymptomatic or self-limited, some individuals develop acute
pulmonary infections or severe and progressive disseminated
infection.
Cryptococcosis is caused by infection with the
encapsulated fungus Cryptococcus neoformans, an organism
with a worldwide distribution. Inhalation of C. neoformans
initiates the infection in the lung with hematogenous
dissemination most often involving the meninges. Although
pulmonary infection may be discovered in the presence or
absence of disseminated infection, meningoencephalitis
remains the most commonly diagnosed form of cryptococcal
infection. The spectrum of disease ranges from asymptomatic
pulmonary infection in the immunocompetent host to diffuse
pulmonary disease associated with respiratory failure and
widespread disseminated disease in the immunocompromised
host.The aim of our study was to evaluate prevalance of fungal
infection as well as other ordinary pathogens among COPD
patientspresented with acute infective exacerbation . Our study
was conducted on 50 COPD patients. All participating patients ,
after a verbal consent, were subjected to detailed clinical
history taking with special emphasis on age, occupation and
smoking index, full clinical examination with focus on chest
examination , laboratory investigations including CBC ( WBCs,
HB, Platlets), Fasting and 2 hours postprandial blood sugar,
kidney functions tests (Blood urea, Serum creatinine), liver
functions tests (Serum level of AST and ALT), Chest X Ray,
Pulmonary function tests (FEV1%, FVC%, FEV1/FVC%)
,Microbiological examination of sputum (Gram stain and
ordinary culture as well as Fungal culture of the sputum on
sabouraud agar).
The mean age of our patients was 50.62 ±10.999 years
old. Among the studied group 26% were drivers, 16% were
employers, 12% were tailors, 10% were farmers, 10% were
painters & 6% were plumers, 6% were technicians, 6% were
workers, 4% were carpenters, 4% were electricians. also the
mean smoking index among the studied group was 22.80 ±
8.278.
As aregard to laboratory data the mean WBCS was 10.32
± 3.467, the mean Hb was 12.84 ± 2.093 & that the mean was
PLT 293.98 ± 86.176 among the studied group, the mean Fasting blood sugar was 115.06 ± 36.432& the mean2Hrs PP.
blood sugar was175.30 ±71.948 (there were 6 out of 18 patient
fungal positive were diabetics on the other hand, there were 8
out of 32 fungal negative patients were diabetics), the mean
urea was 45.56±10.434 and the mean creatinine was1.332 ±
0.6387, the mean AST was 31.80 ± 5.276 & the mean ALT was
39.34 ± 8.203.
Sputum culture shows that 46% of the studied group have
Normal flora in their sputum, 20% have no growth of organism,
18% have Streptococcus pneumoniae, 10% have Klebsiella &
6% have Moraxella catarrhalis.
As aregard to sputum fungal finding among the studied
group 64.0% of the studied group have no fungal growth in
their sputum & 36% funagal growth ( 30.0% have candida &
6.0% have Aspirgillus).
As regard the pulmonary function tests the mean FEV1%
was 51.48±20.615%, the mean FVC% Was 65.68±13.164%&
the mean FEV1/FVC %was70.68 ±15.217% .
As regard the chest x ray finding among the studied group
44%of the studied group have free CXR, 28% have
hyperinflated chest, 8% increase bronchovascular marking, 6%
have RT. Upper zone heterogenious opacity, %have LT.upper
zone heterogenious opacity, 4% Lt. upper zone heterogenious opacity, 2% RT. Lower zone heterogenious opacity & 2% RT.
Middle zone heterogenious opacity.
There were no staistically significant relation between age,
smoking index, WBCS count, HB%, PLTs count, fasting and
2HPP blood sugar, urea & creatinine, liver enzymes, FVC,
occupation, CXR finding, sputum culture for organism and the
presence of fungus in the sputum.
On the other hand there was a staistically significant
relation between both FEV1%, FEV1/FVC% &presence of
fungus in the sputum.
from the previous results it could be concluded that , the
prevalance of fungus in the sputum correlates with the
worsening of pulmonary function tests ie (with increase the
obestruction by pulmoary functions tests ,there is increase of
risk of fungal infection in COPD patients presented by
infective exacerbation )and so correlates with the severity of
COPD.