STUDY ON SERUM ELECTROLYTES, CHEST X RAY FINDINGS AND SEVERITY IN COPD PATIENTS AS PER GOLD CRITERIA

Abstract

Background: COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough,sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive airflow obstruction. Acute exacerbations of COPD (AECOPD) are important episodes in the natural history of the disease as they adversely affect health status, rate of hospitalization, and disease progression. Materials and Methods: A total number of 160 patients were included in the study. This includes 80 patients of stable COPD and 80 patients of AECOPD of age group of 30 to 60 years. COPD diagnosis was based on history, clinical examination, chest x-ray findings and pulmonary function tests. 5 ml venous blood was drawn from patients; under aseptic precautions with a clot activator tube. Serum was separated by centrifugation and used for the following biochemical analysis. Serum Sodium, Serum Potassium, Serum Chloride, Serum Ionic Calcium were estimated using Electrolyte Analyzer and Serum Magnesium was estimated using automated biochemistry analyser. Two views of chest X-ray (PA and lateral) were performed in each patient. Statistical analysis was analyzed using Student’s t-test and Chi-Square test for the correlation of serum electrolyte levels with the severity of disease. Results: There were significant decrease in the levels of serum sodium, chloride, ionized calcium, and magnesium in acute exacerbation (AE) COPD patients as compared to stable COPD patients (p < 0.001). We did not find statistically significant difference in the levels of serum electrolytes with the severity of the disease. Most common Chest Xray finding in COPD Patient was hyperinflated lungs with low flattened diaphragm. Discussion and conclusion: The present study evaluated the levels of serum electrolytes, calcium and magnesium in Stable and AECOPD patients and they were further classified based on severity into mild, moderate, severe and very severe using GOLDs Criteria. Abnormal levels of electrolytes
such as sodium, potassium, chloride, ionized calcium and magnesium have been linked to higher mortality rates in COPD patients. We found significantly decreased levels of sodium, chloride, magnesium and ionized calcium in AECOPD patients compared to stable COPD patients. Therefore, the present study suggested that serum electrolyte levels help in assess the severity of the disease and provide appropriate treatment. The limitation of the present study is that there may be a correlation between serum electrolyte levels and disease severity; it may not necessarily imply causality. Other factors may be contributing to both the electrolyte imbalance and the disease severity. It is recommended that there should be continuous monitoring of the electrolytes in stable as well as in acute exacerbation (AE) COPD patients and especially in the patients with
comorbidities that increases the risk of electrolyte imbalances. Chest X-ray finding like hyperinflated lungs with flattened diaphragm can help support the diagnosis of COPD, but chest Xray lacks sensitivity in mild COPD cases.