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

Users Online : 66846

AbstractMaterial and MethodsResultsDiscussionKey MessageReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
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."

Dr Kalyani R
Professor and Head
Department of Pathology
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.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

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

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
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,
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.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
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 ones 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
(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 journalsNo manuscriptsNo 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)
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.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : October | Volume : 5 | Issue : 5 | Page : 990 - 993 Full Version

Lipoprotein Profile in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in South India

Published: October 1, 2011 | DOI:
Niranjan M R ,Dadapeer k, Rashmi B K

MD (General Medicine)., DNB., MNAMS Assistant Professor, Department of Medicine, Hassan Institute of Medical Sciences, Hassan 573201, Karnataka, India.

Correspondence Address :
Niranjan M.R.
Assistant Professor, Dept. of General Medicine,
Hassan Institute of Medical Sciences, Hassan 573201,
Karnataka, India.
Phone: 09448672501


Context: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death world over. COPD has been defined as a disease state characterized by airflow limitation. Spirometric tests like Forced Expiratory Volume in first second (FEV1 ) < 80% and FEV1/FVC (ratio of Forced Expiratory Volume in first second to the Fixed Vital Capacity) 0.7 is the diagnostic criteria for COPD. In COPD smoking is the major risk factor and smoking affects the lipid profile of COPD patients.

Aims: To investigate the levels of total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) and correlating FEV1 and FEV1/FVC ratio with lipid profile.

Settings and Design: A prospective cross-sectional case control study.

Methods and Materials: Fifty cases were selected on the basis of simple random sampling method.

The FEV1, FEV1/FVC ratio and various lipoprotein levels like total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) were studied and a group of 20 non-smoker healthy subjects were selected as controls. FEV1, FEV1/FVC ratio were correlated with lipid profile.

Statistical Analysis: Comparison of various parameters were performed by “t” test, correlation between two variables were performed by Pearson’s correlation co-efficient “r”

Results: Majority of the patients had moderate (50%) and severe (42%) airflow limitation. Mean LDL concentration among cases was 114.89 ± 19.61(mg/dl) as against control group who had mean LDL concentration of 96.22 ± 19.96(mg/dl), which was statistically significant (p-value < 0.05). However no significant difference in LDL, HDL and in triglycerides levels were observed.

Conclusion: Smoking significantly affects the lipid profile in COPD patients.


COPD; Lipoprotein; FEV1, FEV1/FVC ratio; Cholesterol; LDL; HDL; Triglycerides; VLDL

Chronic obstructive pulmonary disease (COPD) is a state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases (1). The clinical importance of hyperlipoproteinemia derives chiefly from the role of lipoproteins in atherogenesis.

In COPD, smoking is the major risk factor and smoking affects the lipid profile of COPD patients. The plasma β-lipoprotein, cholesterol and triglycerides concentration are higher and HDL cholesterol is lower in smoker than in non-smokers (2). There are only few data in India where the lipoprotein in COPD were studied. Gupta et al. 2002 carried out a comparison of the lipid profile in bronchial asthma and COPD and concluded that LDL was significantly higher and VLDL was significantly lower in patients of bronchial asthma and COPD as compared to controls (3).

Hence an attempt was made to investigate the levels of total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) in COPD patients. Moreover, correlation of FEV1 (Forced ExpiratoryVolume in first second) and FEV1/FVC (forced expiratory volume in first second to the fixed vital capacity) ratio with lipid profile was carried out.

Material and Methods

In this study, 50 cases were selected on the basis of simple random sampling method from the Medical Wards, K.R. Hospital, Mysore from June 2005 to March 2006.

As per GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines (1) of COPD, any patient who has symptoms of chronic cough, sputum production, or dyspnoea, and / or a history of exposure to risk factors for the disease were considered and included in the study, and was further confirmed by spirometry. The values FEV1 less than 80% of the expected value and ratio of FEV1/ FVC less than 0.7 (70%), after post bronchodilator inhalation, were included in this study. Patients with bronchial asthma, pulmonary tuberculosis, bronchectasis, known congenital or acquired heart diseases, diabetes mellitus and hypertension, were excluded, and 20 non-smoker healthy subjects were selected as a control group.

All the 50 patients were subjected to a detailed history and thorough clinical examination including anthropometry. Chest X-ray –Postero-Anterior view, spirometry was done on computerized spirometer (kit micro, COSMED, Srl, Rome Italy). Spirometry was performed when the patients were clinically stable with prior proper instructions as per ATS (American Thoracic Society) guidelines (4).

Written consent was taken from both cases and controls, ethical committee clearance were also obtained.

After 12 hour of overnight fast, 5 ml blood samples were drawn in the morning before breakfast from the subjects and controls. Total cholesterol, HDL and triglycerides were directly analysed by using ERBA Mannheim diagnostic equipment (Model-EM 360, V21.0, MADE IN INDIA). LDL cholesterol was calculated by using Friedewalds equation ( LDL cholesterol = (Total cholesterol) – (HDL cholesterol) – (Triglycerides/5) ). VLDL cholesterol was calculated by using the equation, VLDL cholesterol = Triglyceride/5.

Statistical analysis
Comparison of various parameters among male and female subjects with COPD were performed by “t” test, correlation between two variables were performed by Pearson’s correlation co-efficient “r”, analysis was done by using SPSS+ 10.0 computer package for statistics.


Fifty cases of COPD were studied and out of 50 cases studied 44 were males and 6 were females. Mean age of the male patients among cases was 63.32 ± 10.73 years and that of the female in the study was 63 ± 10.18 years.

Majority of the patients in the cases studied were males constituting 88%. The male-female ratio was 7.33:1. Among controls males were 16 and females were 4 in number. The mean age of the males among controls was 57.87 ± 10.20 and that of females was 57.50 ± 8.20

In the present study the duration of illness ranged from 2-20 years with majority belonging to the 6-10 years range.

In our study smoking was the major risk factor. All the 44 male patients were smokers, while history of exposure to smoke of burnt fuels was present in all the female cases (Table/Fig 1).

There was a dose response relationship between the number of pack-years of smoking and decline in lung function. In our study, duration of smoking ranged from 20 pack-years to 60 pack-years (1 pack = 10 cigarettes, calculated by number of packs of cigarette smoked per day multiplied by number of years smoked, which constitutes one pack year). Majority were in 30-50 pack-years of duration of exposure.

Majority of the patients had BMI of < 25.

On viewing chest x-ray, 56% of patients had chronic bronchitis with emphysema. Twenty two percent had chronic bronchitis, 22% had normal chest x-rays. Chest x-rays of all the subjects in the control group were normal.

In spirometry, the expected value is the value given by the computerized spirometer for each patient considering the patient’s age, sex, race, height and weight. The actual value is what the percentage or volume of air the patient breathes out.

The present study (Table/Fig 2) showed the actual mean of FVC as 2.22 ± 0.50 litres, though the expected mean of FVC was 2.92 ± 0.43litres. The actual mean of FEV1 was 1.12 ± 0.34 litres, and the expected mean of FEV1 would be 2.30 ± 0.35 litres. Among the FEV1% and FEV1/FVC ratio the actual mean were 49.76 ± 14.25% and 53.01 ± 14.22% respectively.

All the control group had normal spirometric parameters.

Out of 50 cases studied, 60% of patients were present in FEV1/ FVC ratio of 51-70%, 34% of patients were present in 31-50% group. 6% of patients were present in 21-30% group.

It was observed that mean LDL concentration among cases was 114.89 ± 19.61(mg/dl) as against control group who had mean LDL concentration of 96.22 ± 19.96(mg/dl), which was statistically significant (p-value < 0.05). All other lipid parameters such as Total cholesterol, triglycerides, HDL cholesterol, and VLDL cholesterol were within normal range when compared to controls (Table/Fig 3).

In this study patients with moderate airflow obstruction had mean total cholesterol, HDL, LDL, and triglyceride concentration 180.36 ± 13.80 (mg/dl), 39.88 ± 12.57 (mg/dl), 114.44 ± 20.96 (mg/ dl), 135.60 ± 46.18 (mg/dl) respectively (Table/Fig 4).

The patients with severe airflow obstruction had mean total cholesterol, HDL, LDL, and triglyceride concentration 176.61 ± 17.76 (mg/dl), 41.43 ± 8.23(mg/dl), 114.93 ± 15.90(mg/dl), 137.08 ± 41.15(mg/dl) respectively. As the severity of airflowobstruction increased, no significant difference in lipid profile was observed.


Cigarette smoking is clearly the single-most important identifiable etiological factor in COPD (5). About 85% people with COPD develop the disease because of cigarette smoking (6).

COPD is a disease of late adulthood. As the age advances the lung function (FEV1) declines and other risk factors add to the disease process (7). In the present study the mean age was 63.16 ± 10.45. COPD is a male dominant disease, the prevalence in males due to higher prevalence of smoking in this sex, and also males are more susceptible to smoking than females (7). In our study males accounted for 88%, with a male-female ratio of 7.33:1. In the present study all males were smokers, while all 6 female patients were non-smokers but all of them were exposed to smoke of burnt fuels which is very common in rural population. In this part of the country, cooking is predominantly carried out by using wood and cow dung. In a study by Behera and Jindal (1996) respiratory symptoms in India were reported in 13 percent of 3608 non-smoking women involved in domestic cooking (8). In the study by Mishra et al (1990), it was observed that the female population had exposure to kitchen smoke due to cooking with wood, cow dung and coal (9). In a New Guinea household pollution, due to heating and cooking within a small space was responsible for COPD commonly in women than men (10). A study from Jindal et al (2006) showed that the exposure to solid fuel combustion is also shown to be an additive risk factor along with environmental tobacco smoke exposure in causing COPD (11). Hence domestic environmental factors may be of great importance in the aetiology of COPD.

Smoking is a very important risk factor for COPD, seen in 85% of patients who develop COPD. In the present study all males were smokers, when compared with the Thiruvengadam et al (1977) study group, who also had smoking history in all males (12).

Present study consisted of mean value of FEV1/FVC% ratio 53.01 ± 14.22. According to GOLD criteria majority of the patients in the present study belonged to moderate to severe airflow obstruction, which was comparable with that of Tandon (1973) (13) and Singh and Jain (1989) (14) which consisted of FEV1/FVC ratio 56.70% and 48.45% respectively.

Smoking affects the lipid profile in the following ways. The plasma β-lipoprotein, cholesterol and triglycerides concentration are higher and HDL cholesterol is lower in smoker than in non-smokers. Free fatty acid concentration tends to be variable, but inhalation during smoking produces an immediate increase of free fatty acids of about 30% through stimulation of the adrenal medulla, by nicotine which increases the concentration of epinephrine in the plasma and the urinary excretion of catecholamine and their metabolites (15).

In addition, the plasma cortisol concentration may increase by as much as 40% within 5 minutes of the start of smoking, although the normal diurnal rhythmicity of cortisol is unaffected. Smokers excrete more 5-hydroxy indole acetic acid than do non-smokers (15).

The study by Gupta et al (2002) showed a significantly higher LDL and significantly lower VLDL levels when compared to controls (3). The present study also showed significantly elevated LDL levels when compared with controls but VLDL was normal. This may be due to the fact that the present study group had 88% of smokers, which increases VLDL levels also.

The study by Don and Paul (2003) showed no significant differences in the LDL or HDL concentrations and even with severe airflow obstruction, had slightly lower serum concentrations of triglycerides (16). Present study showed no significant difference in LDL, HDL and also in triglycerides levels. This may be due to the study population studied which was much larger (N = 6629) in the former study as compared to the present (N = 50) study. Moreover, the former study had 73.7% of severe form of COPD patients but present study had only 50%.

In an analysis of the 1988-1994 National Health and Nutritional Examination Survey of 18,162 randomly selected adults in the US, Cassano and co-authors explored that higher HDL was associated with better lung function, total cholesterol had little or no association with lung function and lower LDL was associated with better function (6).

Fekete and Mosler (1987) studied plasma lipoprotein fractions in 29 patients with chronic obstructive pulmonary disease (COPD) and compared with non-COPD subjects and found triglycerides were significantly lower in COPD females only, the other parameters being almost identical (17). Marquis et al. (2005) studied 16 men and 18 women with COPD to evaluate the metabolic syndrome in COPD patients who participated in a pulmonary rehabilitation program and concluded that metabolic syndrome was frequent in patients with COPD and waist circumference, fasting lipid profile, blood pressure and fasting glucose should be obtained in all COPD patients, beginning pulmonary rehabilitation program and this would allow a better cardiovascular risk assessment (18).

Bahar et al. (2003) studied lipid profile in 20 patients with COPD and 20 healthy controls and concluded that COPD patients did not show an atherogenic lipid pattern and that the increased HDL levels might be related to the drugs used by these patients (19).

In conclusion smoking significantly affects the lipoprotein profile in COPD patients in the form of increases in LDL levels. Hence all COPD patients who are smokers needs to check their lipoprotein levels. However there was no correlation with severity of airflow obstruction and dyslipidemia, and there is a need for more detailed studies to understand these relationships.

Key Message

Smoking increases LDL levels, hence all COPD patients who are smokers needs to check their lipoprotein levels.


Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD. NHLBI/WHO Workshop Report, Executive Summary; 2004; 1-21.
Burtis A Carl, Ashwood R Edward. Lipids, lipoproteins and apolipoproteins. In: Burtis A Carl, Ashwood R Edward editors, Tietz Textbook of Clinical Chemistry,3rd edition. Philadelphia: WB Saunders Company 1993; 61-62.
Gupta R, Bhadoria DP, Mittal A, Bhandoria P, Gupta S. Lipid profile in obstructive airway disorders. J Assoc Physicians India 2002; 50:186-87.
American Thoracic Society. Lung function testing: Selection of reference values and interpretative strategies. Am Rev Respir Dis 1991; 144:1202-17
Doll R, Peto R. Mortality in relation to smoking: 10 years observation on British doctors. Br Med J 1976; 2:1525.
Susan Lang. Good cholesterol may be healthy for the lungs, too. Am J Epidemiol 2002; 155(9):842-48.
Postma S Dirkje and Kerstjens AM Huib. Epidemiology and natural history of chronic obstructive pulmonary disease. In: Gibson G John, Geddes M Duncan, Costabel Ulrich, Sterk J Peter, Corrin Bryan, editors. Respiratory Medicine. 3rd ed. Saunders 2003; 2:1109-20.
Behera D, Jindal SK. Respiratory symptoms in Indian women using domestic cooking fuels. Chest 1991; 100 : 385-88.
Mishra VN, Malhotra M, Saroj Gupta. Respiratory disorder in females of Delhi. J Indian Med Assoc 1990; 88:77-80.
Pride NB, Stockley RA. Chronic obstructive pulmonary disease. In: Weatherall DJ, Ledingham JGG, Warrell DA Eds. Oxford Textbook of Medicine, Oxford Medical Publications 1996; 2766-78.
Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D’Souza GA, Gupta D, et al. Asthma Epidemiology Study Group. A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure. Indian J Chest Dis Allied Sci 2006; 48 :23-27.
Thiruvengadam KV, Raghavan TP, Bhardwaj KV. Survey of prevalence of chronic bronchitis in madras city. In: Viswanathan R, Jaggi OP, editors. Advances in chronic obstructive lung disease. Delhi; Asthma and Bronchitis Foundation of India 1977; 59-69.
Tandon MK. Correlation of electrocardiographic features with airway obstruction in chronic bronchitis. Chest 1973; 63(2):146-48.
Singh VK and Jain SK. Effects of airflow limitation on the electrocardiogram in chronic obstructive pulmonary disease (COPD). Indian J Chest Dis & All Sci 1989; 31(1):1-8.
Burtis A Carl, Ashwood R Edward. Lipids, lipoproteins and a polipoproteins. In: Burtis A Carl, Ashwood R Edward editors, Tietz Textbook of Clinical Chemistry, 3rd Edition. Philadelphia: WB Saunders Company 1993; 61-62.
Sin D Don, Man Paul SF why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular disease? Circulation 2003; 107:1514-19.
Fekete T, Mosler R. Plasma lipoproteins in chronic obstructive pulmonary disease. Horm Metab Res 1987; 19(12):661-62.
Marquis K, Maltais F, Bezean AM, Jobin J, LeBlane P, Poirer P et al. Evaluation of the metabolic syndrome in patients with chronic obstructive pulmonary disease who participated in a pulmonary rehabilitation program. Journal of Cardiopulmonary Rehabilitation 2005; 25(4):226-32.
Ulubab Bahar, Clmen Filiz, Eryyluaz, Buddaycy Resul, Calykodlu Mukadder. Lipid profile in patients with chronic obstructive pulmonary disease. Turkish Respiratory Journal 2003; 4(3):120-22.

DOI and Others


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)