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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Distribution of daily physical activity patterns between COPD patients with or without increased blood eosinophils count &#40;BEC&#41;&#59; &#40;B&#41; Relationship between the number &#40;upper panel&#41; or percentage &#40;lower panel&#41; of the BEC and physical activity level &#40;PAL&#41; of patients with COPD&#46; Abbreviation&#58; <span class="elsevierStyleItalic">r</span>&#44; Pearson correlation coefficient&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recently&#44; the relevant role of eosinophils as a marker of sensitivity to inhaled corticosteroids in patients with chronic obstructive pulmonary disease &#40;COPD&#41; has been recognized&#44; particularly in patients with frequent exacerbations&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;2</span></a> In these subjects&#44; peripheral eosinophils have been shown to be closely related to the rates of exacerbations<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a> and mortality<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> as well as the intensity of symptomatic limitation&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> which is a major determinant of daily physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> Indeed&#44; physical activity has become an important therapeutic target in COPD&#44; with emerging evidence showing a relationship between sedentarism and disease progression<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> and even increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite this&#44; the information currently available about the relationship between peripheral eosinophils and daily physical activity in COPD patients is very scarce&#46; To our knowledge&#44; only one previous study described lower self-reported physical activity in patients with asthma-COPD overlap &#40;ACO&#41; than in those with other COPD phenotypes&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> although unconventional ACO criteria and a questionnaire were used to assess physical activity&#46; Therefore&#44; our aim was to compare the level of daily physical activity in COPD patients according to their blood eosinophil count &#40;BEC&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We selected consecutive patients aged 40&#8211;80 years with a previous diagnosis of COPD&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> post-bronchodilator FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>lower limit of normal&#44; and a history of smoking &#40;&#62;10<span class="elsevierStyleHsp" style=""></span>packs&#47;year&#41; who had been clinically stable in the previous 6 weeks&#46; Exclusion criteria were&#58; previous diagnosis of asthma or other respiratory diseases&#44; previous treatment with systemic corticosteroids or other immunosuppressant drugs&#44; clinical evidence of disorders associated with peripheral eosinophilia &#40;drugs&#44; parasitic infections&#44; acute allergic conditions&#44; vasculitis or hypereosinophilic syndromes&#41;&#44; severe cardiovascular or neurological diseases&#44; and cognitive problems or other disabling conditions that may affect physical activity&#46; The study was performed in a single center&#44; and it was approved by the local ethics committee&#44; and all participants signed informed consent forms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Data were collected for anthropometric variables&#44; smoking history&#44; disease duration&#44; dyspnea level using modified Medical Research Council &#40;mMRC&#41; scale and Charlson comorbidity index&#46; Post-bronchodilator spirometry was performed according to ATS&#47;ERS recommendations<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and using Global Lung Initiative &#40;GLI&#41; reference values&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> A 6-min walk test was also performed following ATS guidelines&#44; and the BODE index was calculated&#46; A SenseWear Pro3 accelerometer &#40;Body Media Inc&#44; Pittsburgh&#44; PA&#44; USA&#41; was placed on the patients&#8217; non-dominant arm for 7 consecutive days to measure daily physical activity&#46; Recordings were considered valid if they included at least 10<span class="elsevierStyleHsp" style=""></span>h per day for a minimum of 4 days&#44; including one weekend day&#46; Physical activity level &#40;PAL&#41; was recorded&#44; and patients were classified as&#58; very sedentary &#40;PAL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;40&#41;&#44; sedentary &#40;PAL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;40&#8211;1&#46;69&#41; or moderately active &#40;PAL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;70&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> Simultaneously&#44; a hemogram was determined in the center&#39;s laboratory&#44; and increased BEC was defined as 300 or more cells&#47;&#956;L&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> although other cut-off points were also used&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Between-group comparisons were performed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test or chi-square tests&#46; For comparison of physical activity levels between groups&#44; general linear models were employed&#44; using the presence or absence of increased BEC as a fixed factor and age&#44; body mass index&#44; dyspnea &#40;mMRC&#41;&#44; Charlson index and post-bronchodilator FEV<span class="elsevierStyleInf">1</span> as covariates&#46; Relationship between variables was assessed with Pearson&#39;s rank correlation&#46; The discriminative capacity of several eosinophil cut-off points to identify sedentary patients was analyzed using Receiver Operating Characteristic &#40;ROC&#41; curves and forward stepwise multiple logistic regression&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 123 COPD patients were selected&#44; with a mean age of 63 years&#44; mainly men &#40;72&#37;&#41; who were overweight &#40;mean body mass index &#91;BMI&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and had a history of heavy smoking &#40;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 pack-years&#41;&#46; Mean time since COPD diagnosis was 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 years&#44; with moderate-severe airflow limitation &#40;post-bronchodilator FEV<span class="elsevierStyleInf">1</span> 47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#37; pred&#46;&#41;&#44; dyspnea &#40;mean mMRC scale 2&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#41; and a mean BODE index of 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 points &#40;4-year survival 67&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The frequency of increased BEC in our sample of COPD patients was 14&#46;6&#37; &#40;95&#37;CI&#44; 8&#46;4&#8211;20&#46;9&#37;&#41;&#46; Patients with increased BEC were slightly younger than non-eosinophilic patients &#40;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 vs 64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46; However&#44; both groups were homogeneous for all other anthropometric characteristics&#44; cumulative smoking pattern and intensity&#44; years since diagnosis&#44; baseline dyspnea intensity&#44; Charlson comorbidity index&#44; severity of airflow limitation&#44; or BODE index&#46; No differences were identified for hemoglobin&#44; hematocrit&#44; or total leukocyte levels&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">COPD patients with increased BEC had significantly lower PAL than patients with normal BEC &#40;1&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;32 vs 1&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;31&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; This association is also reflected in the distribution of physical activity patterns of both groups &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The decrease in physical activity performed by patients with COPD and increased BEC remained statistically significant after adjusting for confounding variables&#44; such as age&#44; BMI&#44; dyspnea&#44; Charlson comorbidity index and post-bronchodilator FEV<span class="elsevierStyleInf">1</span> &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#41; &#40;1&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;03 vs 1&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In turn&#44; an inversely proportional relationship between absolute or percentage BEC and PAL was observed &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;533&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;502&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The discriminative capacity of several increased BEC cut-off points to identify sedentary or very sedentary patients was also assessed&#46; The criterion of &#62;150<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L achieved the higher area under the ROC curve &#40;0&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Similarly&#44; the multiple logistic regression model also retained a value of 150<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L as the only cut-off point independently associated with sedentarism &#40;adjusted odds ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;2&#59; 95&#37;CI&#58; 2&#46;83&#8211;13&#46;62&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;227&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The prevalence of increased BEC found in our patients concurred with data from the BODE and CHAIN cohorts&#44; which showed a prevalence of persistent eosinophilia &#40;also defined as &#8805;300<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;L&#41; of 12&#46;3&#37; and 15&#46;8&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> In turn&#44; different studies have correlated the intensity of increased BEC with the severity of airflow limitation&#46; Thus&#44; an analysis of the SPIROMICS cohort indicates that patients with &#8805;200<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L have a lower FEV<span class="elsevierStyleInf">1</span>&#44; slightly increased airway wall thickness&#44; as well as poor health-related quality of life and increased wheezing&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There is little information about the relationship between the physical activity of COPD patients and their inflammatory response&#46; In COPD patients without corticosteroid treatment&#44; increased airway eosinophils have been reported after acute exercise&#44; with a decrease in the peripheral blood eosinophil count and serum levels of proinflammatory cytokines &#40;IL-6&#44; IL-8 and CCL-5&#41;&#44; suggesting an anti-inflammatory effect of exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Moreover&#44; in older adults from the general population&#44; genetic markers associated with increased physical activity were related to lower levels of lymphocytes and eosinophils in peripheral blood&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> Although this decrease has traditionally been considered a certain level of immunosuppression&#44; recent evidence suggests that it might represent an increased state of immune surveillance and regulation&#44; through the transfer of cells to peripheral tissues&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first study that evaluates the relationship between the number of eosinophils in peripheral blood from COPD patients and their level of physical activity&#44; assessed by an objective measurement&#46; Our data show that increased BEC in COPD patients is negatively related to the level of physical activity&#44; independently of other confounding variables such as age&#44; severity of airflow limitation or comorbidity&#46; However&#44; and due to its cross-sectional design&#44; the present study does not allow us to establish a cause-effect association for said relationship or to infer a prognostic value&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Distribution of daily physical activity patterns between COPD patients with or without increased blood eosinophils count &#40;BEC&#41;&#59; &#40;B&#41; Relationship between the number &#40;upper panel&#41; or percentage &#40;lower panel&#41; of the BEC and physical activity level &#40;PAL&#41; of patients with COPD&#46; Abbreviation&#58; <span class="elsevierStyleItalic">r</span>&#44; Pearson correlation coefficient&#46;</p>"
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Scientific Letter
Increased Blood Eosinophil Count Is Related to Less Daily Physical Activity in Patients With Chronic Obstructive Pulmonary Disease
Raúl Galeraa,b, Cristina Mergelinac, Raquel Casitasa,b, Elisabet Martínez-Ceróna,b, Francisco García Ríoa,b,c,
Corresponding author
fgr01m@gmail.com

Corresponding author.
a Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
b Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
c Universidad Autónoma de Madrid, Madrid, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Distribution of daily physical activity patterns between COPD patients with or without increased blood eosinophils count &#40;BEC&#41;&#59; &#40;B&#41; Relationship between the number &#40;upper panel&#41; or percentage &#40;lower panel&#41; of the BEC and physical activity level &#40;PAL&#41; of patients with COPD&#46; Abbreviation&#58; <span class="elsevierStyleItalic">r</span>&#44; Pearson correlation coefficient&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recently&#44; the relevant role of eosinophils as a marker of sensitivity to inhaled corticosteroids in patients with chronic obstructive pulmonary disease &#40;COPD&#41; has been recognized&#44; particularly in patients with frequent exacerbations&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;2</span></a> In these subjects&#44; peripheral eosinophils have been shown to be closely related to the rates of exacerbations<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a> and mortality<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> as well as the intensity of symptomatic limitation&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> which is a major determinant of daily physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> Indeed&#44; physical activity has become an important therapeutic target in COPD&#44; with emerging evidence showing a relationship between sedentarism and disease progression<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> and even increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite this&#44; the information currently available about the relationship between peripheral eosinophils and daily physical activity in COPD patients is very scarce&#46; To our knowledge&#44; only one previous study described lower self-reported physical activity in patients with asthma-COPD overlap &#40;ACO&#41; than in those with other COPD phenotypes&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> although unconventional ACO criteria and a questionnaire were used to assess physical activity&#46; Therefore&#44; our aim was to compare the level of daily physical activity in COPD patients according to their blood eosinophil count &#40;BEC&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We selected consecutive patients aged 40&#8211;80 years with a previous diagnosis of COPD&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> post-bronchodilator FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>lower limit of normal&#44; and a history of smoking &#40;&#62;10<span class="elsevierStyleHsp" style=""></span>packs&#47;year&#41; who had been clinically stable in the previous 6 weeks&#46; Exclusion criteria were&#58; previous diagnosis of asthma or other respiratory diseases&#44; previous treatment with systemic corticosteroids or other immunosuppressant drugs&#44; clinical evidence of disorders associated with peripheral eosinophilia &#40;drugs&#44; parasitic infections&#44; acute allergic conditions&#44; vasculitis or hypereosinophilic syndromes&#41;&#44; severe cardiovascular or neurological diseases&#44; and cognitive problems or other disabling conditions that may affect physical activity&#46; The study was performed in a single center&#44; and it was approved by the local ethics committee&#44; and all participants signed informed consent forms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Data were collected for anthropometric variables&#44; smoking history&#44; disease duration&#44; dyspnea level using modified Medical Research Council &#40;mMRC&#41; scale and Charlson comorbidity index&#46; Post-bronchodilator spirometry was performed according to ATS&#47;ERS recommendations<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and using Global Lung Initiative &#40;GLI&#41; reference values&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> A 6-min walk test was also performed following ATS guidelines&#44; and the BODE index was calculated&#46; A SenseWear Pro3 accelerometer &#40;Body Media Inc&#44; Pittsburgh&#44; PA&#44; USA&#41; was placed on the patients&#8217; non-dominant arm for 7 consecutive days to measure daily physical activity&#46; Recordings were considered valid if they included at least 10<span class="elsevierStyleHsp" style=""></span>h per day for a minimum of 4 days&#44; including one weekend day&#46; Physical activity level &#40;PAL&#41; was recorded&#44; and patients were classified as&#58; very sedentary &#40;PAL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;40&#41;&#44; sedentary &#40;PAL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;40&#8211;1&#46;69&#41; or moderately active &#40;PAL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;70&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> Simultaneously&#44; a hemogram was determined in the center&#39;s laboratory&#44; and increased BEC was defined as 300 or more cells&#47;&#956;L&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> although other cut-off points were also used&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Between-group comparisons were performed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test or chi-square tests&#46; For comparison of physical activity levels between groups&#44; general linear models were employed&#44; using the presence or absence of increased BEC as a fixed factor and age&#44; body mass index&#44; dyspnea &#40;mMRC&#41;&#44; Charlson index and post-bronchodilator FEV<span class="elsevierStyleInf">1</span> as covariates&#46; Relationship between variables was assessed with Pearson&#39;s rank correlation&#46; The discriminative capacity of several eosinophil cut-off points to identify sedentary patients was analyzed using Receiver Operating Characteristic &#40;ROC&#41; curves and forward stepwise multiple logistic regression&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 123 COPD patients were selected&#44; with a mean age of 63 years&#44; mainly men &#40;72&#37;&#41; who were overweight &#40;mean body mass index &#91;BMI&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and had a history of heavy smoking &#40;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 pack-years&#41;&#46; Mean time since COPD diagnosis was 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 years&#44; with moderate-severe airflow limitation &#40;post-bronchodilator FEV<span class="elsevierStyleInf">1</span> 47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#37; pred&#46;&#41;&#44; dyspnea &#40;mean mMRC scale 2&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#41; and a mean BODE index of 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 points &#40;4-year survival 67&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The frequency of increased BEC in our sample of COPD patients was 14&#46;6&#37; &#40;95&#37;CI&#44; 8&#46;4&#8211;20&#46;9&#37;&#41;&#46; Patients with increased BEC were slightly younger than non-eosinophilic patients &#40;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 vs 64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46; However&#44; both groups were homogeneous for all other anthropometric characteristics&#44; cumulative smoking pattern and intensity&#44; years since diagnosis&#44; baseline dyspnea intensity&#44; Charlson comorbidity index&#44; severity of airflow limitation&#44; or BODE index&#46; No differences were identified for hemoglobin&#44; hematocrit&#44; or total leukocyte levels&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">COPD patients with increased BEC had significantly lower PAL than patients with normal BEC &#40;1&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;32 vs 1&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;31&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; This association is also reflected in the distribution of physical activity patterns of both groups &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The decrease in physical activity performed by patients with COPD and increased BEC remained statistically significant after adjusting for confounding variables&#44; such as age&#44; BMI&#44; dyspnea&#44; Charlson comorbidity index and post-bronchodilator FEV<span class="elsevierStyleInf">1</span> &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard error&#41; &#40;1&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;03 vs 1&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In turn&#44; an inversely proportional relationship between absolute or percentage BEC and PAL was observed &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;533&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;502&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The discriminative capacity of several increased BEC cut-off points to identify sedentary or very sedentary patients was also assessed&#46; The criterion of &#62;150<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L achieved the higher area under the ROC curve &#40;0&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Similarly&#44; the multiple logistic regression model also retained a value of 150<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L as the only cut-off point independently associated with sedentarism &#40;adjusted odds ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;2&#59; 95&#37;CI&#58; 2&#46;83&#8211;13&#46;62&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;227&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The prevalence of increased BEC found in our patients concurred with data from the BODE and CHAIN cohorts&#44; which showed a prevalence of persistent eosinophilia &#40;also defined as &#8805;300<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;L&#41; of 12&#46;3&#37; and 15&#46;8&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> In turn&#44; different studies have correlated the intensity of increased BEC with the severity of airflow limitation&#46; Thus&#44; an analysis of the SPIROMICS cohort indicates that patients with &#8805;200<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L have a lower FEV<span class="elsevierStyleInf">1</span>&#44; slightly increased airway wall thickness&#44; as well as poor health-related quality of life and increased wheezing&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There is little information about the relationship between the physical activity of COPD patients and their inflammatory response&#46; In COPD patients without corticosteroid treatment&#44; increased airway eosinophils have been reported after acute exercise&#44; with a decrease in the peripheral blood eosinophil count and serum levels of proinflammatory cytokines &#40;IL-6&#44; IL-8 and CCL-5&#41;&#44; suggesting an anti-inflammatory effect of exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Moreover&#44; in older adults from the general population&#44; genetic markers associated with increased physical activity were related to lower levels of lymphocytes and eosinophils in peripheral blood&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> Although this decrease has traditionally been considered a certain level of immunosuppression&#44; recent evidence suggests that it might represent an increased state of immune surveillance and regulation&#44; through the transfer of cells to peripheral tissues&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first study that evaluates the relationship between the number of eosinophils in peripheral blood from COPD patients and their level of physical activity&#44; assessed by an objective measurement&#46; Our data show that increased BEC in COPD patients is negatively related to the level of physical activity&#44; independently of other confounding variables such as age&#44; severity of airflow limitation or comorbidity&#46; However&#44; and due to its cross-sectional design&#44; the present study does not allow us to establish a cause-effect association for said relationship or to infer a prognostic value&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Distribution of daily physical activity patterns between COPD patients with or without increased blood eosinophils count &#40;BEC&#41;&#59; &#40;B&#41; Relationship between the number &#40;upper panel&#41; or percentage &#40;lower panel&#41; of the BEC and physical activity level &#40;PAL&#41; of patients with COPD&#46; Abbreviation&#58; <span class="elsevierStyleItalic">r</span>&#44; Pearson correlation coefficient&#46;</p>"
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ISSN: 03002896
Original language: English
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