Journal of Korean Society of Occupational and Environmental Hygiene (한국산업보건학회지)

Korean Industrial Hygiene Association (한국산업보건학회)
권호 표지
DOI QR코드

DOI QR Code

Association of Airflow Limitation and COPD Composite Index with Peripheral Oxygen Saturation in Patients with Chronic Obstructive Pulmonary Disease

만성폐쇄성폐질환자에서 기류제한 및 COPD 복합지수와 말초산소포화도의 연관성

  • Jong Seong Lee (Institute of Occupation Environment, Korea Workers' Compensation & Welfare Service) ;
  • Jae Hoon Shin (Institute of Occupation Environment, Korea Workers' Compensation & Welfare Service) ;
  • Jin Ee Baek (Institute of Occupation Environment, Korea Workers' Compensation & Welfare Service) ;
  • Hyerim Son (Institute of Occupation Environment, Korea Workers' Compensation & Welfare Service) ;
  • Byung-soon Choi (Institute of Occupation Environment, Korea Workers' Compensation & Welfare Service)
  • 이종성 (근로복지공단 직업환경연구원) ;
  • 신재훈 (근로복지공단 직업환경연구원) ;
  • 백진이 (근로복지공단 직업환경연구원) ;
  • 손혜림 (근로복지공단 직업환경연구원) ;
  • 최병순 (근로복지공단 직업환경연구원)
  • Received : 2024.01.03
  • Accepted : 2024.03.25
  • Published : 2024.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects. This study aimed to investigate the association between low peripheral oxygen saturation levels (SpO2), and composite indices predicting death in male patients with (COPD). Method: A total of 140 participants with post-bronchodilator FEV1/FVC ratio less than 0.7 were included. Three composite indices (ADO, DOSE, BODEx) were calculated using six variables such as age (A), airflow obstruction (O), body mass index (B), dyspnea (D), exacerbation history (E or Ex), and smoking status (S). Severity of airflow limitation was classified according to Global Initiative for Obstructive Lung Disease (GOLD) guidelines. SpO2 was measured by pulse oximetry, and anemia and iron deficiency were assessed based on blood hemoglobin levels and serum markers such as ferritin, transferrin saturation, or soluble transferrin receptor. Results: Participants with low SpO2 (<95%) showed significantly lower levels of %FEV1 predicted (p=0.020) and %FEV1/FVC ratio (p=0.002) compared to those with normal SpO2 levels. The mMRC dyspnea scale (p<0.001) and GOLD grade (p=0.002) showed a significant increase in the low SpO2 group. Receiver Operating Characteristic analysis revealed higher area under the curve for %FEV1 (p=0.020), %FEV1/FVC(p=0.002), mMRC dyspnea scale (p=0.001), GOLD grade (p=0.010), ADO (p=0.004), DOSE (p=0.002), and BODEx (p=0.011) in the low SpO2 group. Conclusion: These results suggest that low SpO2 levels are related to increased airflow limitation and the composite indices of COPD.

Keywords

Acknowledgement

이 연구는 2022년도 근로복지공단 직업환경연구원에서 수행한 "COPD 환자의 폐기능 악화 예후지표 연구(No. 219993-201910-BR-20-01)"의 일부 연구결과입니다.

References

  1. Agusti A. Thomas a. Neff lecture. Chronic obstructive pulmonary disease-a systemic disease. Proc Am Thorac Soc 2006;3:478-481 (DOI: 10.1513/pats.200603-058MS)
  2. Al-Halawani R, Charlton PH, Qassem M, Kyriacou PA. A review of the effect of skin pigmentation on pulse oximeter accuracy. Physiol Meas. 2023;44(5):05TR01. (DOI: 10.1088/1361-6579/acd51a.)
  3. Amalakanti S & Pentakota MR. Pulse Oximetry Overestimates Oxygen Saturation in COPD. Respir Care 2016;61(4):423-427 (DOI: 10.4187/respcare.04435)
  4. Badireddy M & Baradhi KM. Chronic Anemia. 2023 Aug 7. In: StatPearls [Internet] (PMID: 30521224)
  5. Boeck L, Soriano JB, Brusse-Keizer M, Blasi F, Kostikas K et al. Prognostic assessment in COPD without lung function: the B-AE-D indices. Eur Respir J 2016; 47(6):1635-1644 (DOI: 10.1183/13993003.01485-2015)
  6. Choi JK, Paek DM, Lee JO. Normal Predictive Values of Spirometry in Korean Population. Tuberc Respir Dis 2005;58:230-242 (DOI: 10.4046/trd .2005.58.3.230)
  7. Decramer M, Celli B, Kesten S, Lystig T, Mehra S et al. Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial. Lancet 2009;374(9696):1171-1178 (DOI: 10.1016/S0140-6736(09)61298-8)
  8. Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet, 2012;379 (9823):1341-1351 (DOI: 10.1016/S0140-6736(11)60968-9)
  9. Drakesmith H & Prentice AM. Hepcidin and the iron-infection axis. Science 2012;338(6108):768-772. https://doi.org/10.1126/science.1224577
  10. Duru S, Bilgin E, Ardic S. Hepcidin: A useful marker in chronic obstructive pulmonary disease. Ann Thorac Med 2012;7(1):31-35 (DOI: 10.4103/1817-1737.91562)
  11. Garcia-Gutierrez S, Unzurrunzaga A, Arostegui I, Quintana JM, Pulido E et al. The Use of Pulse Oximetry to Determine Hypoxemia in Acute Exacerbations of COPD. COPD 2015;12(6):613-620 (DOI: 10.3109/15412555.2014.995291)
  12. Jones PW & Agusti AG. Outcomes and markers in the assessment of chronic obstructive pulmonary disease. Eur Respir J 2006;27(4):822-832 (DOI: 10.1183/09031936.06.00145104)
  13. Jones RC, Donaldson GC, Chavannes NH, Kida K, Dickson-Spillmann M et al. Derivation and Validation of a Composite Index of Severity in Chronic Obstructive Pulmonary Disease: The DOSE Index. Am J Respir Crit Care Med 2009;180(12):1189-1195 (DOI: 10.1164/rccm.200902-0271OC)
  14. Joo H, Park J, Lee SD, Oh YM. Comorbidities of chronic obstructive pulmonary disease in Koreans: a population based study. J Korean Med Sci 2012;27(8):901-906 (DOI: 10.3346/jkms.2012.27.8.901)
  15. KATRD(Korean Academy of Tuberculosis and Respiratory Diseases). Guideline for COPD and asthma. Seoul: Seoul Medcus; 2005. p. 26-27
  16. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis 2011;6:199-208 (DOI: 10.2147/COPD.S10611)
  17. Kobayashi M, Fukuda S, Takano KI, Kamizono J, Ichikawa K. Can a pulse oxygen saturation of 95% to 96% help predict further vital sign destabilization in school-aged children?: A retrospective observational study. Medicine 2018;97(25):e11135. (DOI:10.1097/MD.0000000000011135)
  18. Lee JS, Shin JH, Beak JE, Jeong JY, Kim HG et al. Iron deficiency in retired workers exposed to mineral dust with chronic obstructive pulmonary disease. J Korean Soc Occup Environ Hyg, 2019, 29(1) pp. 42-49 (DOI:10.15269/JKSOEH.2019.29.1.42)
  19. Lim S, MacRae KD, Seed WA, Roberts CM. The value of forced expiratory volume in 1 s in screening subjects with stable COPD for PaO2 < 7.3 kPa qualifying for long-term oxygen therapy. Respir Med. 1998;92(9):1122-1126 (DOI:10.1016/s0954-6111(98)90405-x7)
  20. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2095-2128 (DOI: 10.1016/S0140-6736(12)61728-0)
  21. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R et al. ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J 2005;26(2):319-338 (DOI: 10.1183/09031936.05.00034805)
  22. Nasr VG & DiNardo JA. Pulse Oximetry. Pediatr Rev 2019;40(11):605-608 (DOI: 10.1542/pir.2018-0123)
  23. Nickol AH, Frise MC, Cheng HY, McGahey A, McFadyen BM et al. A cross-sectional study of the prevalence and associations of iron deficiency in a cohort of patients with chronic obstructive pulmonary disease. BMJ Open 2015;5(7):e007911 (DOI: 10.1136/bmjopen-2015-007911)
  24. Puhan MA, Garcia-Aymerich J, Frey M, ter Riet G, Anto JM et al. Expansion of the Prognostic Assessment of Patients With Chronic Obstructive Pulmonary Disease: The Updated BODE Index and the ADO Index. Lancet 2009;374(9691):704-711 (DOI: 10.1016/S0140-6736(09)61301-5)
  25. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA et al. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176(6):532-555 (DOI: 10.1164/rccm.200703-456SO)
  26. Sarkar M, Rajta PN, Khatana J. Anemia in Chronic obstructive pulmonary disease: Prevalence, pathogenesis, and potential impact. Lung India 2015;32(2):142-151 (DOI: 10.4103/0970-2113.152626)
  27. Schutz SL. Oxygen Saturation Monitoring by Pulse Oximetry. 2001, American Association of Critical Care Nurses. Available at http://www.aacn.org/WD/Practice/Docs/ch_14_PO.pdf (download 2024.1.22.)
  28. Singhal A, Prafull K, Daulatabad VS, John NA, John J. Arterial Oxygen Saturation: A Vital Sign? Niger J Clin Pract 2023;26(11):1591-1594 (DOI: 10.4103/njcp.njcp_2026_21)
  29. Soler-Cataluna JJ, Martinez-Garcia MA, Sanchez L, Perpina M, Roman P. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir Med 2009;103(5):692-699 DOI:10.1016/j.rmed.2008.12.005)
  30. Tantucci C & Modina D. Lung function decline in COPD. Int J Chron Obstruct Pulmon Dis 2012;7:95-99 (DOI: 10.2147/COPD.S27480)
  31. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2017;195(5):557-582 (DOI: 10.1164/rccm.201701-0218PP)
  32. Wedzicha JA & Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet 2007;370(9589): 786-796 (DOI: 10.1016/S0140-6736(07)61382-8)
  33. World Health Organization(WHO). Assessing the iron status of populations: report of a joint World Health Organization/Centers for Disease Control and Prevention technical consultation on the assessment of iron status at the population level, 2nd ed., Geneva, World Health Organization, 2007. Available from: URL:http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/9789241596107.pdf (download 2018.10.1.)
  34. Zysman M, Deslee G, Perez T, Burgel PR, Le Rouzic O et al. Burden and Characteristics of Severe Chronic Hypoxemia in a Real-World Cohort of Subjects with COPD. Int J Chron Obstruct Pulmon Dis 2021;16:1275-1284 (DOI: 10.2147/COPD.S295381)