Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
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Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1533 - 1536

Autonomic Nervous System Changes in Chronic Obstructive Pulmonary Disease (Copd) Patients

Aggarwal S., Arora Meena, Kaur N., Bachhal R., Sidhu R.S.

1. Department of Physiology, Government Medical College, Amritsar, India. 2. Department of Physiology, Government Medical College, Amritsar, India. 3. Department of Physiology, Government Medical College, Amritsar, India. 4. Department of Physiology, Government Medical College, Amritsar, India. 5. Department of Physiology, Government Medical College, Amritsar, India. PLACE OF STUDY: Government Medical College, Amritsar.

Correspondence Address :
R.S. Sidhu
Physiology Department
GMC Amritsar, Punjab, India
E-mail: rs.sidhu@yahoo.com

Abstract

Introduction: In the patho-physiology of chronic obstructive pulmonary disease (COPD), changes in the autonomic control of the cardiopulmonary functions are important. The quantification of the para-sympathetic and the sympathetic activity may be useful in treating COPD patients. Aims And Objectives: To observe the changes in the autonomic activity in COPD patients.

Material And Methods: The present study was conducted on 90 (male) COPD patients and 30 controls. The para-sympathetic activity tests i.e. the heart rate variation with deep respiration, the valsalva manoeuver, the standing to lying ratio and postural changes (30:15) and the sympathetic activity tests i.e. orthostasis, the cold pressor test (CPT) and the blood pressure response to a sustained hand grip were conducted. An FEV1 which was >80% was the criteria for the healthy control subjects.

Results: The heart rate variation to the para-sympathetic stimuli was less in the COPD patients as compared to that in the healthy subjects. The fall in systolic blood pressure (SBP) in response to standing was lesser while the rise in diastolic blood pressure in response to a sustained hand grip was higher in the COPD patients. A significant rise in the SBP in response to CPT was observed.

Conclusion: The cardiac para-sympathetic activity was significantly reduced in COPD, while there was sympathoexcitation.

Keywords

COPD, Valsalva manoeuver, 30:15 ratio, S/L ratio, DBT, CPT, HGT, Orthostasis

How to cite this article :

Aggarwal S., Arora Meena, Kaur N., Bachhal R., Sidhu R.S.. AUTONOMIC NERVOUS SYSTEM CHANGES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Nov 15 ]; 5:1533-1536. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1533-1536&id=1798

INTRODUCTION
Chronic obstructive pulmonary disease (COPD) broadly consists of two pathological conditions i.e. emphysema and chronic bronchitis. These two conditions are clinically grouped together and are referred to as COPD, since many patients have the overlapping features of damage both at the acinar and the bronchial levels (1). Over the past decade, there has been a growing consensus that COPD includes airway obstruction that is not completely reversible (2). The term “partial reversibility” defines patients who in fact have “reversibility” in response to a therapy with corticosteroids or a bronchodilator and yet their best FEV1 and FEV1/FVC ratios classify them as having airflow limitation (3). Globally, by 2020, COPD is expected to rise to the 3rd position as a cause of death and to the 5th position as a cause of loss of disability adjusted life years (DALYs) according to the baseline projections which were made in the Global Burden of Disease Study (GBDS) (4).

Autonomic abnormalities have consistently been found in COPD. These span from a reduction in the heart rate variability, a reduction in the respiratory sinus arrhythmia and a reduction in the baroreflex sensitivity, together with a direct increase in the muscle sympathetic nerve activity (5). COPD is an independent risk factor for cardiovascular disease. Given the established negative connotations of the neurohumoral activation for cardiovascular morbidity and mortality, it is reasonable to hypothesize that the neurohumoral activation in COPD exposes the COPD patients to an increased cardiovascular risk (6).

Material and Methods

The present study was conducted in the department of Physiology, Government Medical College, Amritsar. It was carried out on 90male chronic obstructive pulmonary disease (COPD) patients and 30 healthy controls and these were designated as group-I and group-II, respectively.

The study group subjects (COPD), were selected from the TB and Chest hospital, Amritsar. Thirty healthy controls subjects were selected from the general population. A written informed consent was obtained from the subjects after fully explaining to them the elements which were contained in the research protocol.

A detailed history of the subjects was taken and a physical examination of all the subjects and the patients was carried out. An ECG for autonomic function testing was done by using a Recorder and Medicare System, Chandigarh, by using a standard limb, lead-II. The blood pressure was recorded by using a mercury sphygmomanometer.

Because the anatomic location of the cardiovascular autonomic nervous system renders it inaccessible to simple direct physiological testing, a group of clinical tests for measuring the cardiovascular autonomic functions was employed to circumvent this problem. These tests measure the end organ response to various physiological manoeuvres. Based on the cardiovascular reflexes, simple tests of autonomic function that were performed were:

Tests for the parasympathetic system:
1. The heart rate response to postural change (30:15 ratio)

Procedure
The subject is made to lie quietly on a couch while the heart rate is continuously monitored on an electrocardiograph. The subject isthen asked to stand unaided and the point at the starting to stand is marked on the electrocardiograph. The shortest R-R interval at or around the 15th beat is measured, while the longest R-R interval at around the 30th beat after standing is measured. A ratio of less than or equal to 1 is considered as abnormal.

2. The S/L (standing to lying) ratio

Procedure
In this test, the subject is asked to stand quietly and to then lie down without help, while a continuous electrocardiogram is recorded from 20 beats and 60 beats after lying down. The S/L ratio is taken as the ratio of the longest R-R interval during the 5 beats before lying down to the shortest R-R interval during the 10 beats after lying down.

3. Heart rate response to the valsalva manoeuvre (Valsalva ratio)


Procedure
The subject is asked to exhale into the mouth piece which is connected to a mercury manometer, while holding it at a pressure of 40 mmHg for 15 sec. During this manoeuvre and 45 seconds subsequent to this, the ECG is recorded and the vaslava ratio is calculated, which is the ratio between the maximal R-R interval (after the release of the strain) and the minimal R-R interval (during the strain). A ratio of less than or equal to 1.10 is considered as abnormal.

4. Heart rate variation with deep respiration

Procedure
Deep breathing at six breaths a minute is the most convenient and reproducible technique. In this test, the subject is asked to breathe deeply at six breaths per minute i.e. five seconds in and five seconds out for one minute. The ECG is recorded throughout the period of deep breathing with a marker which is used to indicate the onset of each inspiration and expiration. The maximum and the minimal R-R intervals during each breathing cycle are measured by using a ruler and these are converted to beats per minute. The results of this test are expressed as the mean of the difference between the maximum and minimum heart rates for the six measured cycles in beats per minute. A value of less than or equal to 10 beats per minute is considered as abnormal.

Tests for the sympathetic system:

Orthostasis i.e. B.P response to standing and lying

Procedure
This test is performed by measuring the subject’s blood pressure with a sphygmomanometer while he is lying down quietly and one minute after he is made to stand up. The postural fall in B.P. is taken as the difference between the systolic blood pressure while lying and the systolic blood pressure on standing. A fall in the systolic blood pressure of more than or equal to 30 mm is considered as abnormal.

Blood pressure response to a sustained hand grip (HGT)

Procedure
A sustained isometric muscle contraction causes a reflex rise in the blood pressure and the heart rate. The subject is asked to applypressure on a standardized handgrip at his maximum voluntary contraction for one minute. A diastolic blood pressure increase of less than 15 mm Hg is considered as normal.

The cold pressor test (CPT)

Procedure
In this test, the subject is asked to place his hand in cold water (4oC) for one minute while his blood pressure is recorded before the test, during the test and after the test, every 30 seconds, till the blood pressure returns to the pre-test level. An increase in the systolic blood pressure of greater than or equal to 15 mm Hg is considered as normal.

The pre-test heart rate, the respiratory rate, the pulse, the temperature and the FEV1 were recorded in the healthy subjects as well as in the patients.

STATISTICS
The statistical analysis of all the autonomic function tests was done by using the unpaired t-test to compare the autonomic nervous system activity of the chronic obstructive pulmonary disease patients and the normal healthy controls. A p value of <0.05 was taken as significant.

Results

1) In all the subjects, the pre-test pulse rate, the respiratory rate and the systolic and diastolic blood pressures were recorded. The values of all these recordings were found to be significantly higher in group-I (COPD patients) than in group-II (normal subjects) (Table/Fig 1).

2) The results of the tests for the assessment of the sympathetic nervous system activity: (a) Changes in systolic blood pressure (SBP) in response to the cold pressor Test (CPT); b) Changes in systolic blood pressure (SBP) in response to standing and c) Changes in diastolic blood pressure (DBP) in response to the hand grip test (HGT) showed a significant rise in the sympathetic nervous activity in the COPD patients (group-I) as compared to that in the normal subjects (group-II) (Table/Fig 2).

3) The results of the tests for the assessment of the parasympathetic nervous system activity:

(a) The 30:15 ratio; (b) The Standing/Lying ratio; (c) The Valsalva Ratio and d) The Deep Breathing Test (DBT) showed a significant reduction in the parasympathetic nervous system activity in patients of COPD (group-I) as compared to that in the normal healthy subjects (group-II) (Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6).

Discussion

Chronic obstructive pulmonary disease has a chronic long-lasting course which is characterized by an irreversible decline of FEV1 (forced expiratory volume in the first second), an increasing presence of dyspnoea and other respiratory symptoms and a progressive deterioration of the health status (7).

COPD is frequently under-diagnosed and under-treated. The pathogenesis and the clinical manifestations of COPD are not restricted to pulmonary inflammation and structural remodelling. Rather, this disorder is also associated with clinically significant systemic alterations in the biochemical and organ functions.

Abnormalities in both the para-sympathetic and the sympathetic nervous systems in the COPD patients were demonstrated inmany studies (8). In COPD, the sympathetic activation and the vagal withdrawal is at least as pronounced as in other chronic conditions, such as severe heart failure (9).

The present study was conducted to record the changes in the autonomic nervous system activity in male patients with COPD (N=90) and those findings were compared to the observations which were recorded in normal subjects (N=30).

The demographic data was comparable among the two groups. The pulse rate, the respiratory rate and the blood pressure of each subject were recorded before the commencement of the autonomic function testing. The statistical analysis showed that the mean values of the pulse rate were higher in the COPD patients (93.1±12.92/min) than in the normal subjects (74.53±2.50/min). The difference of the pulse rate between the COPD patients and the normal subjects was statistically highly significant (p<0.001).

The mean pre-test respiratory rate in the COPD patients was 18.9 ± 1.6/min, whereas its value in the normal subjects was 13.8±1.35/ min. The variation between the two values was statistically highly significant (p<0.001). Our findings were consistent with the observations of many other studies which showed the presence of tachypnoea and dyspnoea in the COPD patients (10).

The mean pre-test systolic blood pressure recording in the COPD patients was 138.27±11.16 mmHg, as compared to 130.27±3.92 mmHg in the normal subjects. The variation in the systolic blood pressure was highly significant (p<0.001). The mean pre-test diastolic blood pressure recording in the COPD patients was 87.20±5.93 mmHg, whereas it was 80.67±3.54 mmHg in the normal subjects. The variation in the diastolic blood pressure was highly significant (p<0.001).

Variations in the blood pressure in response to CPT and HGT were significantly higher in the COPD patients as compared to those in the normal healthy controls. A fall in the systolic blood pressure in response to standing was also significantly lower in the patientsof COPD than in the normal subjects. Thus, an overall increased sympathetic activity was seen in the COPD patients. On the contrary, the tests of the parasympathetic nervous activity i.e. the 30:15 ratio, the S/L ratio, the valsalva ratio and the DBT showed a marked decreased activity in patients of COPD in contrast to those in the normal healthy controls. This finding was consistent with those of a number of studies which were conducted earlier (11),(12).

References

1.
Hussain AN, Kumar V. The Lung. In: Robbins and Cotran Pathologic Basis of Disease. Kumar V, Abbas AK, Fausto N editors. 7th ed. New Delhi (India); Elsevier India Private Ltd. 2004; 717.
2.
Halberd RJ, Isonaka S, George D, Iqbal A. Interpreting the COPD estimates: What is the true burden of the disease? Chest 2003; 123: 1684-92.
3.
David MM. COPD: Epidemiology, prevalence, morbidity, mortality and disease heterogeneity. Chest 2002; 121: 121S-26S.
4.
Jindal SK. Emergence of chronic obstructive pulmonary disease as an epidemic in India. Indian J Med Res 2006; 123: 619-30.
5.
Bernardi L, Casucci G, Haider T, Brandstatter E, Pececco E, Ehrenbourg I et al. ERJ Express. 2008; 10: 1183-292.
6.
Andreas S, Anker SD, Scanlon PD, Somers VK. Neurohumoral activation as a link to the systemic manifestations of chronic lung disease. Chest 2005; 128: 3618-24.
7.
Anto JM, Vermeire P, Vestbo J, Sunyer J. Epidemiology of chronic obstructive pulmonary disease. Eur Respir J 2001; 17: 982-94.
8.
Bir LS, Ozkurt S, Daloglu G, Kurt T. The impaired sympathetic skin response in patients of chronic obstructive pulmonary disease. Tohoku J Exp Med 2005; 207: 243-48.
9.
Raupach T, Bahr F, Herrmann P, Luetjhe L, Heusser K, Hasenfub G, et al. Slow breathing reduces the sympathoexcitation in COPD. Eur Respir J 2008; 32: 387-92.
10.
Scherer TA, Spengler CM, Owasspian D, Imhof E, Boutellier URS. Respiratory muscle endurance training in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 1709-14.
11.
Okada O, Noutou T, Katou K, Tanabe N, Kouchi F, Yamagishi F, et al. The pulmonary hemodynamic effect of the cold pressor test in patients with chronic lung disease. Nihon Kyobu Shikkan Gakkai Zanchi 1993 Feb; 31(2): 206-13.
12.
Lykidis CK, White MJ, Balanos GM. The pulmonary vascular response to the sustained activation of the muscle metaboreflex in man. Exp Physiol 2007: 1-33.

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