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Joo H, Yoon HK, Hwang YI, Kim SH, Um SJ, Lee WY, Jung KS, Yoo KH, Kim WJ, Rhee CK. Application of the Lancet Commission COPD classification to COPD Cohort Population in South Korea. Respir Med 2024:107679. [PMID: 38797345 DOI: 10.1016/j.rmed.2024.107679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
The Lancet Commissions on COPD recommended a new classification based on five main risk factors. Patients with COPD were prospectively enrolled in a Korean COPD subgroup study cohort between April 2012 and June 2022. Patients were classified according to the etiologies (Type 1: Genetically determined (COPD-G), Type 2: Abnormal lung development (COPD-D), Type 3: Infections (COPD-I), Type 4: Cigarette smoking (COPD-C), Type 5: Biomass and pollution (COPD-P)). The database enrolled 3,476 patients. Among 3,392 patients, 52 (2%), 1,339 (39%), 2,930 (86%), and 2,221 (65%) were compatible with type 2 (COPD-D), 3 (COPD-I), 4 (COPD-C), and 5 (COPD-P), respectively. Most patients (71%, 2,405) had multiple risk factors contributing to their COPD. However, 93, 712, and 182 patients had only type 3 (COPD-I), 4 (COPD-C), and 5 (COPD-P), respectively. Type 3 (COPD-I) only patients were significantly younger, more often female, and had lower lung function. Both the rate and frequency of severe exacerbations were significantly higher in type 3 (COPD-I) only patients (p=0.038 and p=0.048, respectively). Compared with type 5 (COPD-P) only, type 3 (COPD-I) only was significantly associated with the risk of severe exacerbation (Odds ratio, 5.7 [95% CI, 1.0-32.4]; P=0.049, incident rate ratio, 8.7 [95% CI, 1.7 - 44.0]; P=0.009). Many patients were affected by multiple factors. Therefore, it is important to consider not only smoking history, but also other potential risk factors when evaluating patients with COPD. Further research is needed to explore the implications of this new COPD classification system for clinical practice and treatment strategies.
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Affiliation(s)
- Hyonsoo Joo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary`s Hospital, The Catholic University of Korea
| | - Yong Il Hwang
- Department of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Soo-Jung Um
- Division of Respiratory Medicine, Department of Internal Medicine, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, South Korea
| | - Won-Yeon Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju
| | - Ki-Suck Jung
- Department of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Yang X, Du Y, Joost Wisselink H, Zhao Y, Heuvelmans MA, J M Groen H, Dorrius MD, Vonder M, Ye Z, Vliegenthart R, de Bock GH. Ct-defined emphysema prevalence in a Chinese and Dutch general population. Eur J Radiol 2024; 176:111503. [PMID: 38761443 DOI: 10.1016/j.ejrad.2024.111503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/19/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE We determine and compare the prevalence, subtypes, severity, and risk factors for emphysema assessed by low-dose CT(LDCT) in Chinese and Dutch general populations. METHODS This cross-sectional study included LDCT scans of 1143 participants between May and October 2017 from a Chinese Cohort study and 1200 participants with same age range and different smoking status between May and October 2019 from a Dutch population-based study. An experienced radiologist visually assessed the scans for emphysema presence (≥trace), subtype, and severity. Logistic regression analyses, overall and stratified by smoking status, were performed and adjusted for fume exposure, demographic and smoking data. RESULTS The Chinese population had a comparable proportion of women to the Dutch population (54.9 % vs 58.9 %), was older (61.7 ± 6.3 vs 59.8 ± 8.1), included more never smokers (66.4 % vs 38.3 %), had a higher emphysema prevalence ([58.8 % vs 39.7 %], adjusted odds ratio, aOR = 2.06, 95 %CI = 1.68-2.53), and more often had centrilobular emphysema (54.8 % vs 32.8 %, p < 0.001), but no differences in emphysema severity. After stratification, only in never smokers an increased odds of emphysema was observed in the Chinese compared to the Dutch (aOR = 2.55, 95 %CI = 1.95-3.35). Never smokers in both populations shared older age (aOR = 1.59, 95 %CI = 1.25-2.02 vs 1.26, 95 %CI = 0.97-1.64) and male sex (aOR = 1.50, 95 %CI = 1.02-2.22 vs 1.93, 95 %CI = 1.26-2.96) as risk factors for emphysema. CONCLUSIONS Only never smokers had a higher prevalence of mainly centrilobular emphysema in the Chinese general population compared to the Dutch after adjusting for confounders, indicating that factors other than smoking, age and sex contribute to presence of CT-defined emphysema.
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Affiliation(s)
- Xiaofei Yang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yihui Du
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hendrik Joost Wisselink
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yingru Zhao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Monique D Dorrius
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marleen Vonder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Ivey MA, Smith SM, Benke G, Toelle BG, Hunter ML, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Abramson MJ. COPD in Never-Smokers: BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2024; 19:161-174. [PMID: 38249822 PMCID: PMC10800088 DOI: 10.2147/copd.s439307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio Conclusion COPD was prevalent in this population of never-smokers aged 40 years and over. This finding highlights the significance of risk factors other than smoking in the development of COPD.
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Affiliation(s)
- Marsha A Ivey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sheree M Smith
- School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Brett G Toelle
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Michael L Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia
| | - Graeme P Maguire
- Curtin Medical School, Curtin University, Perth, WA, 6102, Australia
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Suri TM, Ghosh T, Mittal S, Hadda V, Madan K, Mohan A. Prevalence of chronic obstructive pulmonary disease in Indian nonsmokers: a systematic review & meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 0:reveh-2023-0135. [PMID: 38016010 DOI: 10.1515/reveh-2023-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Nonsmokers with chronic obstructive pulmonary disease (COPD) are neglected despite constituting half of all cases in studies from the developed world. Herein, we systematically reviewed the prevalence of COPD among nonsmokers in India. CONTENT We searched Embase, Scopus, and PubMed databases for studies examining the prevalence of COPD among nonsmokers in India. We used the Joanna Briggs Institute (JBI) checklist to assess included studies' quality. Meta-analysis was performed using random-effects model. SUMMARY Seven studies comprising 6,903 subjects were included. The quality of the studies ranged from 5/9 to 8/9. The prevalence of COPD varied between 1.6 and 26.6 %. Studies differed considerably in demographics and biomass exposure profiles of subjects. Among the four studies that enrolled both middle-aged and elderly Indian nonsmokers not screened based on biomass fuel exposure, the pooled prevalence of COPD was 3 % (95 % CI, 2-3 %; I2=50.52 %, p=0.11). The pooled prevalence of COPD among biomass fuel-exposed individuals was 10 % (95 % CI, 2-18 %; I2=98.8 %, p<0.001). OUTLOOK Limited evidence suggests a sizable burden of COPD among nonsmokers and biomass fuel-exposed individuals in India. More epidemiological studies of COPD in nonsmokers are needed from low and middle-income countries.
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Affiliation(s)
- Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Rodríguez García C, Ruano-Ravina A, Pérez Ríos M, Martín Gisbert L, Varela-Lema L, Candal-Pedreira C, Represas-Represas C, Rey-Brandariz J, Valdés-Cuadrado L, Agustí A. Clinical characteristics of chronic obstructive pulmonary disease in never-smokers: A systematic review. Respir Med 2023; 214:107284. [PMID: 37211258 DOI: 10.1016/j.rmed.2023.107284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) is the third cause of death worldwide. While tobacco smoking is a key risk factor, COPD also occurs in never-smokers (NS). However, available evidence on risk factors, clinical characteristics, and natural history of the disease in NS is scarce. Here, we perform a systematic review of the literature to better describe the characteristics of COPD in NS. METHODS We searched different databases following the PRISMA guidelines with explicit inclusion and exclusion criteria. A purpose-designed quality scale was applied to the studies included in the analysis. It was not possible to pool the results due to the high heterogeneity of the studies included. RESULTS A total of 17 studies that met the selection criteria were included, albeit only 2 of them studied NS exclusively. The total number of participants in these studies were 57,146 subjects,25,047 of whom were NS and 2655 of the latter had NS-COPD. Compared to COPD in smokers, COPD in NS is more frequent in women and older ages, and is associated with a slightly higher prevalence of comorbidities. There are not enough studies to understand if COPD progression and clinical symptoms in NS are different to that of ever-smokers. CONCLUSIONS There is a significant knowledge gap on COPD in NS. Given that COPD in NS account for about a third of all COPD patients in the world, particularly in low-middle income countries, and the decrease in tobacco consumption in high income countries, understanding COPD in NS constitutes a public-health priority.
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Affiliation(s)
- Carlota Rodríguez García
- Pulmonology Department, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain; Cross-disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Mónica Pérez Ríos
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Lucía Martín Gisbert
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain; Cross-disciplinary Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Cristina Candal-Pedreira
- Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Represas-Represas
- Respiratory Medicine, Alvaro Cunqueiro University Teaching Hospital, Vigo, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Valdés-Cuadrado
- Pulmonology Department, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Department of Medicine, Faculty of Medicine, University of Santiago, Spain
| | - Alvar Agustí
- Catedra Salud Respiratoria, Universidad de Barcelona, Institut Respiratori, Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Chan HS, Ko FWS, Chan JWM, Choo KL, So LKY, Lam DCL, Sin KM, Wong WY, Cheng YL, Wong MML. Hospital Burden of Chronic Obstructive Pulmonary Disease in Hong Kong - The Trend from 2006 to 2014. Int J Chron Obstruct Pulmon Dis 2023; 18:507-519. [PMID: 37056684 PMCID: PMC10086389 DOI: 10.2147/copd.s394698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 04/15/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common cause for hospital admission. This study aims to review the hospital burden of COPD in Hong Kong (HK) and the trend from year 2006 to 2014. Methods A multi-center, retrospective study of the characteristics of COPD patients discharged from the public hospitals of HK from year 2006 to 2014. Anonymized data retrieval and analysis were performed. The demographic data of the subjects, use of health-care resources, ventilatory support, medications used and mortality of the subjects were analyzed. Results Total patient headcount (HC) and admission number reduced from 10,425 and 23,362 in year 2006 to 9613 and 19,771, respectively, in 2014. There was a progressive reduction of female COPD HC from 2193 (21%) in year 2006 to 1517 (16%) in 2014. The utilization of non-invasive ventilation (NIV) increased rapidly and peaked in 2010 (29%) and decreased thereafter. There was a rapid increase in the prescription of long-acting bronchodilators (from 15% to 64%). COPD and pneumonia were the top causes of death, but death due to pneumonia was rapidly increasing while death due to COPD was progressively decreasing over the period. Conclusion COPD HC and admission number (particularly in female patients) decreased progressively from year 2006 to 2014. There was also a decreasing trend of severity of disease as reflected by lower NIV use (after year 2010) and lower mortality rate due to COPD. Reduced smoking prevalence and tuberculosis (TB) notification rate in the community in the past might have reduced the incidence and severity of COPD and the hospital burden of disease. We observed an increasing trend of mortality due to pneumonia in COPD patients. Appropriate and timely vaccination programs are recommended for COPD patients as in the general elderly population.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
- Correspondence: Hok Sum Chan, Department of Medicine, 6/F, Block J, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, NT, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China, Email
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Johnny Wai Man Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Loletta Kit Ying So
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - David Chi Leung Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Kit Man Sin
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Wei Yin Wong
- Department of Medicine, Haven of Hope Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Yuk Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
| | - Maureen Mo Lin Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong Special Administrative Region (HKSAR), People’s Republic of China
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Yang IA, Jenkins CR, Salvi SS. Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment. THE LANCET. RESPIRATORY MEDICINE 2022; 10:497-511. [PMID: 35427530 DOI: 10.1016/s2213-2600(21)00506-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) was traditionally thought to be caused by tobacco smoking. However, recognition of the importance of non-smoking-related risk factors for COPD has increased over the past decade, with evidence on the burden, risk factors, and clinical presentations of COPD in never-smokers. About half of all COPD cases worldwide are due to non-tobacco-related risk factors, which vary by geographical region. These factors include air pollution, occupational exposures, poorly controlled asthma, environmental tobacco smoke, infectious diseases, and low socioeconomic status. Impaired lung growth during childhood, caused by a range of early-life exposures, is associated with an increased risk of COPD. Potential mechanisms for the pathogenesis of COPD in never-smokers include inflammation, oxidative stress, airway remodelling, and accelerated lung ageing. Compared with smokers who develop COPD, never-smokers with COPD have relatively mild chronic respiratory symptoms, little or no emphysema, milder airflow limitation, and fewer comorbidities; however, exacerbations can still be frequent. Further research-including epidemiological, translational, clinical, and implementation studies-is needed to address gaps in understanding and to advance potential solutions to reduce the burden of COPD in never-smokers.
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Affiliation(s)
- Ian A Yang
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Health, Brisbane, QLD, Australia.
| | - Christine R Jenkins
- Respiratory Group, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Thoracic Medicine, Concord General Hospital, Sydney, NSW, Australia; Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Sundeep S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, Maharashtra, India; Faculty of Health Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India
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Choi JY, Kim JW, Kim YH, Yoo KH, Jung KS, Lee JH, Um SJ, Lee WY, Park D, Yoon HK. Clinical Characteristics of Non-Smoking Chronic Obstructive Pulmonary Disease Patients: Findings from the KOCOSS Cohort. COPD 2022; 19:174-181. [PMID: 35392750 DOI: 10.1080/15412555.2022.2053088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has been regarded as a disease of smokers, but the prevalence of non-smoking COPD patients have been reported to be considerable. We investigated differences in clinical characteristics between smoking and non-smoking COPD patients. We used data from the Korea COPD Subgroup Study (KOCOSS) database, which is a multicenter cohort that recruits patients from 54 medical centres in Korea. Comprehensive comparisons of smoking and non-smoking COPD patients were performed based on general characteristics, exacerbations, symptom scores, radiological findings, and lung-function tests. Of the 2477 patients included in the study, 8.1% were non-smokers and 91.9% were smokers. Non-smoking COPD patients were more likely to be female and to have a higher body mass index and lower level of education. Non-smoking COPD patients had more comorbidities, including hypertension, osteoporosis, and gastroesophageal reflux disease, and experienced more respiratory and allergic diseases. No significant differences in exacerbation rates, symptom scores, or exercise capacity scores were observed between the two groups. Smoking COPD patients had more emphysematous lung according to the radiological findings, and non-smoking patients had more tuberculosis-destroyed lung and bronchiectasis. Lung-function testing revealed no significant difference in the forced expiratory capacity in 1 sec between the two groups, but smokers had more rapid lung-function decline in the 5 years of follow-up data. We found differences in general characteristics and radiological findings between smoking and non-smoking COPD patients. No significant differences in exacerbation or symptom scores were observed, but decline in lung function was less steep in non-smoking patients.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2053088 .
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Yee Hyung Kim
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
| | - Jin Hwa Lee
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Soo-Jung Um
- Department of Internal Medicine, Pulmonology Division, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Won-Yeon Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dongil Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Internal Medicine, Division of Pulmonology, College of Medicine, Chungnam National University, Deajeon, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Pulmonology, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Abstract
INTRODUCTION Chronic obstructive pulmonary disease, most commonly caused by tobacco smoking, is increasingly reported in nonsmoking patients exposed to domestic combustion of biomass fuels. This is particularly common among rural women in the low- and middle-income countries. It is highly likely that the disease in these patients is a different clinical phenotype. AREAS COVERED This manuscript covers epidemiological and clinical aspects of biomass-exposed COPD and also dwells upon its different phenotypic characteristics. EXPERT OPINION Chronic obstructive pulmonary disease in biomass-exposed, nonsmoker patients which predominantly presents with features of chronic bronchitis is more likely a distinct phenotype with greater likelihood of small airway involvement.
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Affiliation(s)
- Surinder Jindal
- Emeritus Professor, Department of Pulmonary Medicine, Postgrad Instt Med Edu & Research , Chandigarh, India.,Chest Medicine, Jindal Clinics , Chandigarh, India
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Choi JY, Rhee CK. Diagnosis and Treatment of Early Chronic Obstructive Lung Disease (COPD). J Clin Med 2020; 9:jcm9113426. [PMID: 33114502 PMCID: PMC7692717 DOI: 10.3390/jcm9113426] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic obstructive lung disease (COPD) is responsible for substantial rates of mortality and economic burden, and is one of the most important public-health concerns. As the disease characteristics include irreversible airway obstruction and progressive lung function decline, there has been a great deal of interest in detection at the early stages of COPD during the “at risk” or undiagnosed preclinical stage to prevent the disease from progressing to the overt stage. Previous studies have used various definitions of early COPD, and the term mild COPD has also often been used. There has been a great deal of recent effort to establish a definition of early COPD, but comprehensive evaluation is still required, including identification of risk factors, various physiological and radiological tests, and clinical manifestations for diagnosis of early COPD, considering the heterogeneity of the disease. The treatment of early COPD should be considered from the perspective of prevention of disease progression and management of clinical deterioration. There has been a lack of studies on this topic as the definition of early COPD has been proposed only recently, and therefore further clinical studies are needed.
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-6067; Fax: +82-2-599-3589
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11
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Helvaci A, Izgu N, Ozdemir L. Relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease. J Clin Nurs 2020; 29:2388-2396. [PMID: 32221991 DOI: 10.1111/jocn.15251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/29/2020] [Accepted: 03/14/2020] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES To investigate the relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence and spiritual well-being in patients with COPD has not been explored. DESIGN A descriptive correlational study design was adopted. METHODS A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale-7 (ARMS-7) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The data were analysed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used. RESULTS The CAT score was significantly higher in patients on long-term oxygen therapy and those who had more than three comorbid conditions (p < .05). The mean score of ARMS-7 was significantly associated with age (p < .05). Current smokers had higher ARMS-7 and lower FACIT-Sp scores (p < .001). The FACIT-Sp score was negatively and moderately associated with the CAT and ARMS-7 scores (p < .001). CONCLUSION This study concluded that individuals with higher spiritual well-being had lower symptom burden and higher medication adherence. The need for long-term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well-being and medication adherence. RELEVANCE TO CLINICAL PRACTICE Spiritual well-being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well-being and medication adherence in different populations are warranted.
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Affiliation(s)
- Aylin Helvaci
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Nur Izgu
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Leyla Ozdemir
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
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Helvaci A, Gok Metin Z, Ozdemir L, Ergun P. The Effects of a Nurse-Led Education and Counseling Program on Dyspnea, Health Status, and Care Dependency in Patients With Chronic Obstructive Pulmonary Disease: A Feasibility Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822319850819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this feasibility study was to determine the effects of a nurse-led education and counseling program for chronic obstructive pulmonary disease (COPD-ECP) on dyspnea, health status, and care dependency in patients. A quasi-experimental, pre-posttest research design without a control group was performed on 30 COPD patients. The patients received an 8-week COPD-ECP via home visits during the first 4 weeks and via phone interviews in the subsequent 4 weeks. After completion of COPD-ECP and a 4-week break, a final follow-up was conducted at the end of 12th week. The Dyspnea-12, COPD Assessment Test (CAT), and Care Dependency Scale (CDS) scores were calculated during the first interview, and on the 4th, 8th, and 12th week of the study. The patients completed all sessions of COPD-ECP without side effects. There was a significant decrease in the total Dyspnea-12 scores at the end of the study period. Compared to the baseline assessment, CAT total scores significantly decreased in the 4th, 8th, and 12th week ( p < 0.05), and CDS scores showed a significant reduction at the 12th week ( p < 0.05). In conclusion, COPD-ECP is feasible in regular clinical practice and well accepted by patients, and it seems to improve health status and decrease dyspnea, and care dependency. Future randomized controlled studies are warranted to explore the effects of COPD-ECP on fatigue, cough and sleep problems, and the best innovative strategies to improve the efficiency of COPD-ECP.
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Affiliation(s)
- Aylin Helvaci
- Hacettepe University Faculty of Nursing, Ankara, Turkey
| | | | - Leyla Ozdemir
- Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Pinar Ergun
- Ankara Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
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Zareifopoulos N, Bellou A, Spiropoulou A, Spiropoulos K. Prevalence, Contribution to Disease Burden and Management of Comorbid Depression and Anxiety in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2019; 16:406-417. [DOI: 10.1080/15412555.2019.1679102] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nicholas Zareifopoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Aggeliki Bellou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Agathi Spiropoulou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Kostas Spiropoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
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Wijnant SRA, Lahousse L, De Buyzere ML, Brusselle GG, Rietzschel ER. Prevalence of Asthma and COPD and Blood Eosinophil Count in a Middle-Aged Belgian Population. J Clin Med 2019; 8:jcm8081122. [PMID: 31357728 PMCID: PMC6723474 DOI: 10.3390/jcm8081122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/20/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023] Open
Abstract
Various phenotypes exist in asthma and Chronic Obstructive Pulmonary Disease (COPD). These are important to identify in order to guide treatment decisions. We aim to investigate the prevalence and clinical characteristics of obstructive airway diseases in the middle-aged population. We estimated the prevalence of COPD and/or asthma in the Asklepios cohort study (Belgium), using information from the third European Community Respiratory Health Survey (ECRHS3), medical records, and spirometry. Respiratory symptoms, respiratory medication, and current disease status distinguished clinical from sub-clinical cases. In addition, we compared the blood eosinophil count/µL (median [IQR]) between cases and controls. Of the 2221 participants (mean age 56.1 ± 5.9 years; 48.7% males), 138 (6.2%) participants had clinical current asthma, 22 (1.0%) participants had sub-clinical ever asthma, 102 (4.6%) had sub-clinical spirometry-defined COPD, 104 (4.6%) participants had clinical spirometry-confirmed COPD, and 11 (0.5%) had asthma and COPD overlap (ACO). Clinical current asthma (160.0 [110.0–250.0]), sub-clinical ever asthma (170.0 [110.0–230.0]), and clinical COPD (160.0 [110.0–220.0])—but less sub-clinical COPD (140.0 [90.0–210.0])—had higher eosinophil counts, compared to controls (130.0 [80.0–200.0]). We conclude that obstructive airway diseases are prevalent in the middle-aged Asklepios cohort. Moreover, the systemic eosinophil count is increased in clinical COPD cases, and in asthma cases regardless of clinical remission.
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Affiliation(s)
- Sara R A Wijnant
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Marc L De Buyzere
- Department of Cardiology, Ghent University Hospital, and Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, and Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ernst R Rietzschel
- Department of Cardiology and Biobanking and Cardiovascular Epidemiology, Ghent University Hospital and Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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15
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Lim JU, Yeo CD, Rhee CK, Kang HS, Park CK, Kim JS, Kim JW, Kim SJ, Yoon HK, Lee SH. Comparison of clinical characteristics and overall survival between spirometrically diagnosed chronic obstructive pulmonary disease (COPD) and non-COPD never-smoking stage I-IV non-small cell lung cancer patients. Int J Chron Obstruct Pulmon Dis 2019; 14:929-938. [PMID: 31118602 PMCID: PMC6503336 DOI: 10.2147/copd.s190244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: A significant proportion of non-small cell lung cancer (NSCLC) patients are never-smokers. However, the clinical impact of spirometrically diagnosed chronic obstructive pulmonary disease (COPD) on the prognosis of never-smoking NSCLC has not been evaluated in the context of treatment modalities and other cancer-related factors. In the present study, we evaluated the clinical impact of COPD in non-smoking NSCLC patients, and correlations between COPD and other previously unevaluated clinical variables. Materials and methods: Lung cancer patients (stages I to IV) diagnosed with NSCLC between January 2008 and December 2015 at six university hospitals were enrolled in the study cohort and retrospectively evaluated. Clinical parameters were compared between spirometrically diagnosed COPD and non-COPD groups. Correlations between COPD status and other variables were evaluated. In order to reduce the effect of potential confounders and selection bias, we performed adjustment for differences in baseline parameters by using propensity score matching (PSM). After PSM, clinical variables were evaluated for their effects on overall survival (OS). Results: Of the 345 patients enrolled in the study, 277 were categorized as non-COPD and 68 as COPD. Old age, male gender, and wild-type EGFR were significantly correlated with COPD. By univariate analysis of 218 patients in a propensity score matched cohort, not receiving active anticancer treatment, advanced stage, and COPD were significantly associated with shorter OS. Multivariate analysis showed that not receiving active anticancer treatment, advanced cancer stage, and COPD (P=0.044, HR: 1.526, 95% CI: 1.012–2.300) were significant predictors of shorter OS. Conclusion: In the present study, never-smoker NSCLC patients with COPD had shorter OS times, compared to non-COPD never-smoker NSCLC patients.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Jindal SK. Chronic obstructive pulmonary disease in non-smokers - Is it a different phenotype? Indian J Med Res 2018; 147:337-339. [PMID: 29998868 PMCID: PMC6057250 DOI: 10.4103/ijmr.ijmr_10_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Surinder K Jindal
- Emeritus Professor, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research & Medical Director, Jindal Clinics, Chandigarh 160 020, India
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17
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Chan HS, Ko FWS, Chan JWM, So LKY, Lam DCL, Chan VL, Tam CY, Yu WC. Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong - computerized data collection and analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:1913-1925. [PMID: 29942124 PMCID: PMC6005303 DOI: 10.2147/copd.s163659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK). Patients and methods It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed. Results In total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies. Conclusion Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | | | | | | | | | - Cheuk Yin Tam
- Department of Medicine and Geriatrics, Tuen Mun Hospital
| | - Wai Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
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Poortinga W, Rodgers SE, Lyons RA, Anderson P, Tweed C, Grey C, Jiang S, Johnson R, Watkins A, Winfield TG. The health impacts of energy performance investments in low-income areas: a mixed-methods approach. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.ObjectivesTo determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.DesignA mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.SettingLow-income areas across Wales.ParticipantsResidents who received energy efficiency measures through the intervention programme and matched control groups.Main outcome measuresPrimary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.MethodsAnonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.Data sourcesThe Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.ResultsThe study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.LimitationsThis was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.ConclusionAlthough there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.Future workOur research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
| | - Sarah E Rodgers
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Chris Tweed
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Charlotte Grey
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Shiyu Jiang
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Rhodri Johnson
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Thomas G Winfield
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
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Fernandes FMDC, Martins EDS, Pedrosa DMAS, Evangelista MDSN. Relationship between climatic factors and air quality with tuberculosis in the Federal District, Brazil, 2003–2012. Braz J Infect Dis 2017; 21:369-375. [PMID: 28545939 PMCID: PMC9428008 DOI: 10.1016/j.bjid.2017.03.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 01/24/2017] [Accepted: 03/27/2017] [Indexed: 12/12/2022] Open
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Leung JM, Tiew PY, Mac Aogáin M, Budden KF, Yong VFL, Thomas SS, Pethe K, Hansbro PM, Chotirmall SH. The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD. Respirology 2017; 22:634-650. [PMID: 28342288 PMCID: PMC7169176 DOI: 10.1111/resp.13032] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 12/16/2022]
Abstract
COPD is a major global concern, increasingly so in the context of ageing populations. The role of infections in disease pathogenesis and progression is known to be important, yet the mechanisms involved remain to be fully elucidated. While COPD pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are strongly associated with acute exacerbations of COPD (AECOPD), the clinical relevance of these pathogens in stable COPD patients remains unclear. Immune responses in stable and colonized COPD patients are comparable to those detected in AECOPD, supporting a role for chronic colonization in COPD pathogenesis through perpetuation of deleterious immune responses. Advances in molecular diagnostics and metagenomics now allow the assessment of microbe–COPD interactions with unprecedented personalization and precision, revealing changes in microbiota associated with the COPD disease state. As microbial changes associated with AECOPD, disease severity and therapeutic intervention become apparent, a renewed focus has been placed on the microbiology of COPD and the characterization of the lung microbiome in both its acute and chronic states. Characterization of bacterial, viral and fungal microbiota as part of the lung microbiome has the potential to reveal previously unrecognized prognostic markers of COPD that predict disease outcome or infection susceptibility. Addressing such knowledge gaps will ultimately lead to a more complete understanding of the microbe–host interplay in COPD. This will permit clearer distinctions between acute and chronic infections and more granular patient stratification that will enable better management of these features and of COPD.
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Affiliation(s)
- Janice M Leung
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada.,Division of Respiratory Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pei Yee Tiew
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Micheál Mac Aogáin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kurtis F Budden
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Sangeeta S Thomas
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kevin Pethe
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Cho HW. What Affects Chronic Obstructive Pulmonary Disease in Korea? Osong Public Health Res Perspect 2017; 7:339-340. [PMID: 28053836 PMCID: PMC5194216 DOI: 10.1016/j.phrp.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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22
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Oh H, Lee YE. Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease among Nonsmokers: Fifth Korea National Health and Nutrition Examination Survey (2010-2012). Osong Public Health Res Perspect 2016; 7:385-393. [PMID: 28053845 PMCID: PMC5194221 DOI: 10.1016/j.phrp.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/10/2016] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The purpose of this study was to determine the prevalence of COPD among non-smoking adults, and to investigate the risk factors that affect disease occurrence. METHODS The data from the 5th Korea national health and nutrition examination survey (KNHNES) has been used, and 5,489 non-smoking adults aged between 40 to 79 years with diagnosable FEV1/FVC were selected therefrom as the subjects of this study. RESULTS The prevalence of COPD in non-smokers was observed to be 6.9%. The development of the COPD showed statistically significant difference among groups; males showed about 2.54 times (95% CI: 1.410∼146.612) higher rates compared to females, subjects aged 70-79 showed about 3.08 times (95% CI: 1.823∼11.437) higher rates compared to those aged 40-49, subjects whose education level was elementary school or less showed about 5.36 times (95% CI: 1.341∼21.393) higher rates compared to those who are college or more, and subjects who are middle school showed about 4.72 times (95% CI: 1.374∼16.217) higher rates compared to the college or more. CONCLUSION It is confirmed that development of the COPD in non-smokers reach significance. For the prevention of the disease, there is a need to identify COPD-related risk factors in males and the elderly and provide appropriate nursing intervention, and to develop health-related education programs for those with low educational background to take in order to promote the improvement of lung health.
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Affiliation(s)
- Heeyoung Oh
- College of Nursing, Eulji University, Daejeon, Korea
| | - Ye-Eun Lee
- College of Nursing, Eulji University, Daejeon, Korea
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