PREVALENCE AND SEVERITY OF HYPOPHOSPHATEMIA IN COPD PATIENTS

Dr. V. Rajesh Babu and Dr. S. Rajagopal*

ABSTRACT

Introduction: Chronic obstructive pulmonary diseases are a major health hazard in the recent years. Bronchial asthma is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms of reversible airflow obstruction and bronchospasm. The mortality rate in patient with Bronchial asthma and COPD is still rising and is being partly attributed to the adverse effects of its treatment. Hypophosphotaemia can worsen respiratory failure in severly ill asthma patients by impairing respiratory muscle performance. This study therefore intends to study the prevalence and severity of hypophosphatemia in COPD patients and also to evaluate the relationship between the type of medications taken for COPD and severity of hypophosphatemia. Methodology: This study was conducted in Government Rajaji Hospital, Madurai as cross sectional study, our study included 75 male patients admitted to hospital with diagnosis of COPD. Patients with COPD as primary diagnosis and also if diagnosis of COPD was made during previous hospitalization or outpatient visits based on history of smoking, clinical and radiologic findings and pulmonary function tests suggestive of COPD were included in study, All patients underwent necessary biochemical investigations. All patients were included in study after getting informed consent. Study permission was received from institutional human ethics committee. Results: In our study group most of the patients were in 61-70 years age group. In our study group 80 percent of patients required two medications in our study group. 12 patients (16%) had hypophosphatemia. Among these patients 2 had mild hypophosphatemia with serum phosphate levels ranging from 2-2.4 mg/dl, 8 patients had moderate hypophosphatemia (1-1.9 mg/dl) and rest 2 patients had severe hypophophatemia with serum phosphate below 1 mg/dl. Next we analysed the related signs and symptoms of hypophosphatemia, Except Prednisolone in patients on other drugs there was significant relation between duration of intake and phosphate levels. Conclusion: The prevalence of hypophosphatemia was significantly higher among COPD patients taking one or more drugs commonly used for COPD due to negative renal phosphate handling. Hypophosphatemia impairs the contractile properties of the diaphragm and can even delay weaning from the ventilator and increase duration of intensive care and hospitalisation. Therefore, any acute deterioration of respiratory function in COPD patients warrants analysis of serum phosphate levels and judicious correction of depleted phosphate levels should be considered whenever necessary.

Keywords: COPD, Hypophosphatemia, Serum Phosphate.