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Müller A, Wouters EF, Koul P, Welte T, Harrabi I, Rashid A, Loh LC, Al Ghobain M, Elsony A, Ahmed R, Potts J, Mortimer K, Rodrigues F, Paraguas SN, Juvekar S, Agarwal D, Obaseki D, Gislason T, Seemungal T, Nafees AA, Jenkins C, Dias HB, Franssen FME, Studnicka M, Janson C, Cherkaski HH, El Biaze M, Mahesh PA, Cardoso J, Burney P, Hartl S, Janssen DJA, Amaral AFS. Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study. Pulmonology 2024:S2531-0437(24)00044-8. [PMID: 38614859 DOI: 10.1016/j.pulmoe.2024.03.005] [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: 01/17/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC CONCLUSION The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.
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Affiliation(s)
- A Müller
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - E F Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - T Welte
- Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
| | - I Harrabi
- Faculté de Médecine, Sousse, Tunisia
| | - A Rashid
- RCSI and UCD Malaysia Campus, Penang, Malaysia
| | | | - M Al Ghobain
- King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - A Elsony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - J Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Rodrigues
- Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
| | - S N Paraguas
- Philippine College of Chest Physicians, Manila, Philippines
| | - S Juvekar
- KEM Hospital Research Centre, Pune, India
| | - D Agarwal
- KEM Hospital Research Centre, Pune, India
| | - D Obaseki
- Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
| | - T Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Seemungal
- Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
| | | | - C Jenkins
- Woolcock Institute of Medical Research, Sydney, Australia
| | - H B Dias
- Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
| | - F M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - M Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - H H Cherkaski
- Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
| | - M El Biaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
| | - P A Mahesh
- Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - D J A Janssen
- Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
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Milne KM, Mitchell RA, Ferguson ON, Hind AS, Guenette JA. Sex-differences in COPD: from biological mechanisms to therapeutic considerations. Front Med (Lausanne) 2024; 11:1289259. [PMID: 38572156 PMCID: PMC10989064 DOI: 10.3389/fmed.2024.1289259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous respiratory condition characterized by symptoms of dyspnea, cough, and sputum production. We review sex-differences in disease mechanisms, structure-function-symptom relationships, responses to therapies, and clinical outcomes in COPD with a specific focus on dyspnea. Females with COPD experience greater dyspnea and higher morbidity compared to males. Imaging studies using chest computed tomography scans have demonstrated that females with COPD tend to have smaller airways than males as well as a lower burden of emphysema. Sex-differences in lung and airway structure lead to critical respiratory mechanical constraints during exercise at a lower absolute ventilation in females compared to males, which is largely explained by sex differences in maximum ventilatory capacity. Females experience similar benefit with respect to inhaled COPD therapies, pulmonary rehabilitation, and smoking cessation compared to males. Ongoing re-assessment of potential sex-differences in COPD may offer insights into the evolution of patterns of care and clinical outcomes in COPD patients over time.
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Affiliation(s)
- Kathryn M. Milne
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Reid A. Mitchell
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Olivia N. Ferguson
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Alanna S. Hind
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Jordan A. Guenette
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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Ekström M, Sundh J, Andersson A, Angerås O, Blomberg A, Börjesson M, Caidahl K, Emilsson ÖI, Engvall J, Frykholm E, Grote L, Hedman K, Jernberg T, Lindberg E, Malinovschi A, Nyberg A, Rullman E, Sandberg J, Sköld M, Stenfors N, Sundström J, Tanash H, Zaigham S, Carlhäll CJ. Exertional breathlessness related to medical conditions in middle-aged people: the population-based SCAPIS study of more than 25,000 men and women. Respir Res 2024; 25:127. [PMID: 38493081 PMCID: PMC10944596 DOI: 10.1186/s12931-024-02766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Breathlessness is common in the population and can be related to a range of medical conditions. We aimed to evaluate the burden of breathlessness related to different medical conditions in a middle-aged population. METHODS Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study of adults aged 50-64 years. Breathlessness (modified Medical Research Council [mMRC] ≥ 2) was evaluated in relation to self-reported symptoms, stress, depression; physician-diagnosed conditions; measured body mass index (BMI), spirometry, venous haemoglobin concentration, coronary artery calcification and stenosis [computer tomography (CT) angiography], and pulmonary emphysema (high-resolution CT). For each condition, the prevalence and breathlessness population attributable fraction (PAF) were calculated, overall and by sex, smoking history, and presence/absence of self-reported cardiorespiratory disease. RESULTS We included 25,948 people aged 57.5 ± [SD] 4.4; 51% women; 37% former and 12% current smokers; 43% overweight (BMI 25.0-29.9), 21% obese (BMI ≥ 30); 25% with respiratory disease, 14% depression, 9% cardiac disease, and 3% anemia. Breathlessness was present in 3.7%. Medical conditions most strongly related to the breathlessness prevalence were (PAF 95%CI): overweight and obesity (59.6-66.0%), stress (31.6-76.8%), respiratory disease (20.1-37.1%), depression (17.1-26.6%), cardiac disease (6.3-12.7%), anemia (0.8-3.3%), and peripheral arterial disease (0.3-0.8%). Stress was the main factor in women and current smokers. CONCLUSION Breathlessness mainly relates to overweight/obesity and stress and to a lesser extent to comorbidities like respiratory, depressive, and cardiac disorders among middle-aged people in a high-income setting-supporting the importance of lifestyle interventions to reduce the burden of breathlessness in the population.
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Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, Lund University, 221 84, Lund, Sweden.
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Andersson
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg, Sweden
- Center for Lifestyle Intervention, Department MGAÖ, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, and Sahlgrenska Academy, Gothenburg, Sweden
| | - Össur Ingi Emilsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Jan Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erik Frykholm
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Sleep Disorders Centre, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - André Nyberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Eric Rullman
- Department of Laboratory Medicine, Section of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Sandberg
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, Lund University, 221 84, Lund, Sweden
| | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hanan Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Suneela Zaigham
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Carl-Johan Carlhäll
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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Olsson M, Björkelund AJ, Sandberg J, Blomberg A, Börjesson M, Currow D, Malinovschi A, Sköld M, Wollmer P, Torén K, Östgren CJ, Engström G, Ekström M. Factors most strongly associated with breathlessness in a population aged 50-64 years. ERJ Open Res 2024; 10:00582-2023. [PMID: 38529345 PMCID: PMC10962452 DOI: 10.1183/23120541.00582-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 03/27/2024] Open
Abstract
Background Breathlessness is a troublesome and prevalent symptom in the population, but knowledge of related factors is scarce. The aim of this study was to identify the factors most strongly associated with breathlessness in the general population and to describe the shapes of the associations between the main factors and breathlessness. Methods A cross-sectional analysis was carried out of the multicentre population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of adults aged 50 to 64 years. Breathlessness was defined as a modified Medical Research Council breathlessness rating ≥2. The machine learning algorithm extreme gradient boosting (XGBoost) was used to classify participants as either breathless or nonbreathless using 449 factors, including physiological measurements, blood samples, computed tomography cardiac and lung measurements, lifestyle, health conditions and socioeconomics. The strength of the associations between the factors and breathlessness were measured by SHapley Additive exPlanations (SHAP), with higher scores reflecting stronger associations. Results A total of 28 730 participants (52% women) were included in the study. The strongest associated factors for breathlessness were (in order of magnitude): body mass index ( SHAP score 0.39), forced expiratory volume in 1 s (0.32), physical activity measured by accelerometery (0.27), sleep apnoea (0.22), diffusing lung capacity for carbon monoxide (0.21), self-reported physical activity (0.17), chest pain when hurrying (0.17), high-sensitivity C-reactive protein (0.17), recent weight change (0.14) and cough (0.13). Conclusion This large population-based study of men and women aged 50-64 years identified the main factors related to breathlessness that may be prevented or amenable to public health interventions.
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Affiliation(s)
- Max Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | - Anders J. Björkelund
- Lund University, Faculty of Science, Centre for Environmental and Climate Science, Lund, Sweden
| | - Jacob Sandberg
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | - Anders Blomberg
- Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden
| | - Mats Börjesson
- Dept of Molecular and Cardiovascular Medicine, Center for Health and Performance, Sahlgrenska Academy, Gothenburg, Sweden
- Dept MGAÖ, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Andrei Malinovschi
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Magnus Sköld
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Johan Östgren
- Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Gunnar Engström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Malmö, Cardiovascular Epidemiology, Malmö, Sweden
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
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Müller A, Mraz T, Wouters EF, van Kuijk SM, Amaral AF, Breyer-Kohansal R, Breyer MK, Hartl S, Janssen DJ. Prevalence of dyspnea in general adult populations: A systematic review and meta-analysis. Respir Med 2023; 218:107379. [PMID: 37595674 DOI: 10.1016/j.rmed.2023.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Dyspnea is a commonly described symptom in various chronic and acute conditions. Despite its frequency, relatively little is known about the prevalence and assessment of dyspnea in general populations. The aims of this review were: 1) to estimate the prevalence of dyspnea in general adult populations; 2) to identify associated factors; and 3) to identify used methods for dyspnea assessment. METHODS A systematic literature search was conducted using MEDLINE/PubMed, Embase, CINAHL and JAMA network. Records were screened by two independent reviewers and quality was assessed by using the Joanna Briggs Institute checklist for risk of bias in prevalence studies. Multi-level meta-analysis was performed to estimate pooled prevalence. The protocol was registered on PROSPERO (CRD42021275499). RESULTS Twenty original articles, all from studies in high-income countries, met the criteria for inclusion. Overall, their quality was good. Pooled prevalence of dyspnea in general adult populations based on 11 studies was 10% (95% CI 7, 15), but heterogeneity across studies was high. The most frequently reported risk factors were increasing age, female sex, higher BMI and respiratory or cardiac disease. The MRC or the modified MRC scale was the most used tool to assess dyspnea in general populations. CONCLUSIONS Dyspnea is a common symptom in adults in high-income countries. However, the high heterogeneity across studies and the lack of data from low- and middle-income countries limit the generalizability of our findings. Therefore, more research is needed to unveil the prevalence of dyspnea and its main risk factors in general populations around the world.
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Affiliation(s)
- Alexander Müller
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
| | - Tobias Mraz
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna Healthcare Group, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Emiel Fm Wouters
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Peter Debyeplein 1, 6229 HA, Maastricht, the Netherlands
| | - André Fs Amaral
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK; NIHR Imperial Biomedical Research Centre, The Bays, Entrance 2, South Wharf Road, St. Mary's Hospital, London, W2 1NY, UK
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Wolkersbergenstrasse 1, 1130, Vienna, Austria
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna Healthcare Group, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Daisy Ja Janssen
- Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands; Department of Research & Development, Ciro, Hornerheide 1, 6085 NM, Horn, the Netherlands
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Jacobson PK, Lind L, Persson HL. Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease: Does Comorbid Chronic Heart Failure Matter? Int J Chron Obstruct Pulmon Dis 2023; 18:2055-2064. [PMID: 37744733 PMCID: PMC10517701 DOI: 10.2147/copd.s425592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Chronic heart failure (CHF) is a common comorbidity among patients with chronic obstructive pulmonary disease (COPD). Both exacerbations of COPD (ECOPDs) and exacerbations of CHF (ECHFs) display worsening of breathlessness at rest (BaR) and breathlessness at physical activity (BaPA). Comorbid CHF may have an impact on the vital signs assessed, when the Rome proposal (adopted by GOLD 2023) is applied on ECOPDs. Thus, the aim of the present study was to investigate the impact of comorbid CHF on ECOPDs severity, particularly focusing on the influence of comorbid CHF on BaR and BaPA. Methods We analysed data on COPD symptoms collected from the telehealth study The eHealth Diary. Patients with COPD (n = 43) and patients with CHF (n = 41) were asked to daily monitor BaR and BaPA, employing a digital pen and scales for BaR and BaPA (from 0 to 10). Twenty-eight patients of the COPD patients presented with comorbid CHF. Totally, 125 exacerbations were analysed. Results Exacerbations in the group with COPD patients and comorbid CHF were compared to the group with COPD patients without comorbid CHF and the group with CHF patients. Compared with GOLD 2022, the GOLD 2023 (the Rome proposal) significantly downgraded the ECOPD severity. Comorbid CHF did not interfere significantly on the observed difference. Comorbid CHF did not worsen BaR scores, assessed at inclusion and at the symptom peak of the exacerbations. Conclusion In the present study, we find no evidence that comorbid CHF would interfere significantly with the parameters included in the Rome proposal (GOLD 2023). We conclude that the Rome proposal can be safely applied even on COPD patients with very advanced comorbid CHF.
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Affiliation(s)
- Petra Kristina Jacobson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
| | - Leili Lind
- Department of Biomedical Engineering/Health Informatics, Linköping University, Linköping, Sweden
- Digital Systems Division, Unit Digital Health, RISE Research Institutes of Sweden, Linköping, Sweden
| | - Hans L Persson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
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7
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Malinovschi A, Zhou X, Andersson A, Backman H, Bake B, Blomberg A, Caidahl K, Eriksson MJ, Eriksson Ström J, Hamrefors V, Hjelmgren O, Janson C, Karimi R, Kylhammar D, Lindberg A, Lindberg E, Liv P, Olin AC, Shalabi A, Sköld CM, Sundström J, Tanash H, Torén K, Wollmer P, Zaigham S, Östgren CJ, Engvall JE. Consequences of Using Post- or Prebronchodilator Reference Values in Interpreting Spirometry. Am J Respir Crit Care Med 2023; 208:461-471. [PMID: 37339507 DOI: 10.1164/rccm.202212-2341oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/20/2023] [Indexed: 06/22/2023] Open
Abstract
Rationale: Postbronchodilator spirometry is used for the diagnosis of chronic obstructive pulmonary disease. However, prebronchodilator reference values are used for spirometry interpretation. Objectives: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or postbronchodilator reference values generated within SCAPIS (Swedish CArdioPulmonary bioImage Study) when interpreting postbronchodilator spirometry in a general population. Methods: SCAPIS reference values for postbronchodilator and prebronchodilator spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or postbronchodilator reference values, with respiratory burden in the SCAPIS general population (28,851 individuals). Measurements and Main Results: Bronchodilation resulted in higher predicted medians and lower limits of normal (LLNs) for FEV1/FVC ratios. The prevalence of postbronchodilator FEV1/FVC ratio lower than the prebronchodilator LLN was 4.8%, and that of postbronchodilator FEV1/FVC lower than the postbronchodilator LLN was 9.9%, for the general population. An additional 5.1% were identified as having an abnormal postbronchodilator FEV1/FVC ratio, and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%; P < 0.001), and self-reported physician-diagnosed chronic obstructive pulmonary disease (2.8% vs. 0.5%, P < 0.001) than subjects with a postbronchodilator FEV1/FVC ratio greater than the LLN for both pre- and postbronchodilation. Conclusions: Pre- and postbronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of postbronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using postbronchodilator reference values when interpreting postbronchodilator spirometry might enable the identification of individuals with mild disease and be clinically relevant.
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Affiliation(s)
| | - Xingwu Zhou
- Department of Medical Sciences, Clinical Physiology
- Department of Statistics
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, and
| | - Anders Andersson
- COPD Center, Department of Respiratory Medicine and Allergology and
- COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, and
| | - Björn Bake
- Department of Respiratory Medicine and Allergology, Institute of Medicine
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, and
- Department of Molecular Medicine and Surgery
- Department of Clinical Physiology and
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery
- Department of Clinical Physiology and
| | - Jonas Eriksson Ström
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Ola Hjelmgren
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, and
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, and
| | - Reza Karimi
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, and
| | - David Kylhammar
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, and
| | - Per Liv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, and
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adel Shalabi
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - C Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, and
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hanan Tanash
- Department of Sciences, Respiratory Medicine and Allergology, and
| | - Kjell Torén
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Suneela Zaigham
- Department of Medical Sciences, Clinical Physiology
- Department of Clinical Sciences
| | - Carl Johan Östgren
- Centre of Medical Image Science and Visualization, and
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; and
| | - Jan E Engvall
- Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology
- Centre of Medical Image Science and Visualization, and
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8
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Ekström M, Backman H, Mannino D. Addressing the origins and health effects of small lungs. THE LANCET. RESPIRATORY MEDICINE 2023:S2213-2600(23)00185-6. [PMID: 37354918 DOI: 10.1016/s2213-2600(23)00185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Magnus Ekström
- Department of Medicine, Blekinge Hospital, Karlskrona SE-37185, Sweden; Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Helena Backman
- Obstructive Lung Disease in Northern Sweden (OLIN) Unit, Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David Mannino
- Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA; COPD Foundation, Washington, DC, USA
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9
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Zheng B, Vivaldi G, Daines L, Leavy OC, Richardson M, Elneima O, McAuley HJ, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Greening NJ, Pfeffer PE, Hurst JR, Brown JS, Shankar-Hari M, Echevarria C, De Soyza A, Harrison EM, Docherty AB, Lone N, Quint JK, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Heaney LG, Wain LV, Evans RA, Brightling CE, Martineau A, Sheikh A. Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls. THE LANCET REGIONAL HEALTH. EUROPE 2023; 29:100635. [PMID: 37261214 PMCID: PMC10145209 DOI: 10.1016/j.lanepe.2023.100635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 06/02/2023]
Abstract
Background The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01-1.03), male (1.54, 1.16-2.04), neither obese nor severely obese (1.82, 1.06-3.13 and 4.19, 2.14-8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09-2.22) or cardiovascular disease (1.33, 1.00-1.79), and shorter hospital admission (1.01 per day, 1.00-1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care.COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders.
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Affiliation(s)
- Bang Zheng
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Giulia Vivaldi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Olivia C. Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Victoria C. Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
- Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
| | - Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Paul E. Pfeffer
- Barts Health NHS Trust, London, UK
- Queen Mary University of London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Manu Shankar-Hari
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Carlos Echevarria
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Anthony De Soyza
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Population Health Science Institute, Newcastle University, Newcastle, UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- Medical Research Council (MRC) Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Louise V. Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Christopher E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Adrian Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
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10
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Shah NM, Kaltsakas G. Respiratory complications of obesity: from early changes to respiratory failure. Breathe (Sheff) 2023. [DOI: 10.1183/20734735.0263-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Obesity is a significant and increasingly common cause of respiratory compromise. It causes a decrease in static and dynamic pulmonary volumes. The expiratory reserve volume is one of the first to be affected. Obesity is associated with reduced airflow, increased airway hyperresponsiveness, and an increased risk of developing pulmonary hypertension, pulmonary embolism, respiratory tract infections, obstructive sleep apnoea and obesity hypoventilation syndrome. The physiological changes caused by obesity will eventually lead to hypoxic or hypercapnic respiratory failure. The pathophysiology of these changes includes a physical load of adipose tissue on the respiratory system and a systemic inflammatory state. Weight loss has clear, well-defined benefits in improving respiratory and airway physiology in obese individuals.
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11
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Ekström M. Obesity is a major contributing cause of breathlessness in the population. Respirology 2022; 28:303-304. [PMID: 36437515 DOI: 10.1111/resp.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine Lund University Lund Sweden
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12
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Guo YL, Ampon MR, Poulos LM, Davis SR, Toelle BG, Marks GB, Reddel HK. Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults. Respirology 2022; 28:350-356. [PMID: 36336647 DOI: 10.1111/resp.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. METHODS A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. RESULTS Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. CONCLUSION Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.
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Affiliation(s)
- Yue Leon Guo
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Department of Environmental and Occupational Medicine National Taiwan University (NTU) College of Medicine and NTU Hospital Taipei Taiwan
- Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health Taipei Taiwan
| | - Maria R. Ampon
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Leanne M. Poulos
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Sharon R. Davis
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Brett G. Toelle
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Sydney Local Health District Sydney New South Wales Australia
| | - Guy B. Marks
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- School of Clinical Medicine UNSW Medicine & Health, University of New South Wales Sydney New South Wales Australia
| | - Helen K. Reddel
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
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13
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Klepaker G, Henneberger PK, Torén K, Brunborg C, Kongerud J, Fell AKM. Association of respiratory symptoms with body mass index and occupational exposure comparing sexes and subjects with and without asthma: follow-up of a Norwegian population study (the Telemark study). BMJ Open Respir Res 2022; 9:9/1/e001186. [PMID: 35365552 PMCID: PMC8977753 DOI: 10.1136/bmjresp-2021-001186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/22/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Occupational exposure and increased body mass index (BMI) are associated with respiratory symptoms. This study investigated whether the association of a respiratory burden score with changes in BMI as well as changes in occupational exposure to vapours, gas, dust and fumes (VGDF) varied in subjects with and without asthma and in both sexes over a 5-year period. METHODS In a 5-year follow-up of a population-based study, 6350 subjects completed a postal questionnaire in 2013 and 2018. A respiratory burden score based on self-reported respiratory symptoms, BMI and frequency of occupational exposure to VGDF were calculated at both times. The association between change in respiratory burden score and change in BMI or VGDF exposure was assessed using stratified regression models. RESULTS Changes in respiratory burden score and BMI were associated with a β-coefficient of 0.05 (95% CI 0.04 to 0.07). This association did not vary significantly by sex, with 0.05 (0.03 to 0.07) for women and 0.06 (0.04 to 0.09) for men. The association was stronger among those with asthma (0.12; 0.06 to 0.18) compared with those without asthma (0.05; 0.03 to 0.06) (p=0.011). The association of change in respiratory burden score with change in VGDF exposure gave a β-coefficient of 0.15 (0.05 to 0.19). This association was somewhat greater for men versus women, with coefficients of 0.18 (0.12 to 0.24) and 0.13 (0.07 to 0.19), respectively (p=0.064). The estimate was similar among subjects with asthma (0.18; -0.02 to 0.38) and those without asthma (0.15; 0.11 to 0.19). CONCLUSIONS Increased BMI and exposure to VGDF were associated with increased respiratory burden scores. The change due to increased BMI was not affected by sex, but subjects with asthma had a significantly larger change than those without. Increased frequency of VGDF exposure was associated with increased respiratory burden score but without statistically significant differences with respect to sex or asthma status.
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Affiliation(s)
- Geir Klepaker
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul Keefer Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Kjell Torén
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics, Epidemiology and Health Economics, Oslo University Hospital, Oslo, Norway
| | - Johny Kongerud
- Department of Respiratory Medicine, University of Oslo, Oslo, Norway.,Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Kristin Møller Fell
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway.,Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo Faculty of Medicine, Oslo, Norway
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14
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BMI, sex and outcomes in hospitalised patients in western Sweden during the COVID-19 pandemic. Sci Rep 2022; 12:4918. [PMID: 35318438 PMCID: PMC8939489 DOI: 10.1038/s41598-022-09027-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
High body mass index (BMI) is associated with severe COVID-19 but findings regarding the need of intensive care (IC) and mortality are mixed. Using electronic health records, we identified all patients in western Sweden hospitalised with COVID-19 to evaluate 30-day mortality or assignment to IC. Adjusted logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for outcomes. Of totally 9761 patients, BMI was available in 7325 (75%), included in the study. There was a marked inverse association between BMI and age (underweight and normal weight patients were on average 78 and 75 years, whereas overweight and obese were 68 and 62 years). While older age, male sex and several comorbidities associated with higher mortality after multivariable adjustment, BMI did not. However, BMI ≥ 30 kg/m2 (OR 1.46, 95% CI 1.21–1.75) was associated with need of IC; this association was restricted to women (BMI ≥ 30; OR 1.96 (95% CI 1.41–2.73), and not significant in men; OR 1.22 (95% CI 0.97–1.54). In this comprehensive hospital population with COVID-19, BMI was not associated with 30-day mortality risk. Among the obese, women, but not men, had a higher risk of assignment to IC.
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15
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Sandberg J, Olsson M, Ekström M. Underlying conditions contributing to breathlessness in the population. Curr Opin Support Palliat Care 2021; 15:219-225. [PMID: 34610625 PMCID: PMC8631149 DOI: 10.1097/spc.0000000000000568] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Assessment of underlying conditions that contribute to breathlessness is fundamental for symptom management. This review aims to summarize the knowledge from the past two years on the most common underlying conditions among individuals with breathlessness in the general population and to identify research gaps. RECENT FINDINGS Nine studies from the last two years were included in the review; two studies systematically assessed underlying conditions among breathless individuals in the general population. The modified Medical Research Council (mMRC) scale was used in eight of nine studies. Respiratory diseases were the main underlying condition (40-57%), of which asthma was the most common (approx. 25%), and chronic obstructive pulmonary disease was particularly strongly associated with breathlessness. Other conditions prevalent among breathless individuals included heart diseases, anxiety, depression, and obesity, and several conditions often co-existed. SUMMARY Breathlessness in the general population is common and associated with several underlying conditions. Respiratory disease is the most commonly reported underlying condition. Refined methods such as machine learning could be useful to study the complex interplay between multiple underlying causes of breathlessness and impact on outcomes such as quality of life and survival.
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Affiliation(s)
- Jacob Sandberg
- Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden
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16
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Malinovschi A, Zhou X, Janson C, Sundström J, Wollmer P, Hallberg J. Reliability of external impulse oscillometry reference values for assessing respiratory health in Swedish adults. Clin Exp Allergy 2021; 52:355-358. [PMID: 34651350 DOI: 10.1111/cea.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Xingwu Zhou
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Respiratory Medicine, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Cardiovascular Epidemiology Research, Uppsala University, Uppsala, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jenny Hallberg
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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17
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Sandberg J, Ekström M, Börjesson M, Bergström G, Rosengren A, Angerås O, Toren K. Underlying contributing conditions to breathlessness among middle-aged individuals in the general population: a cross-sectional study. BMJ Open Respir Res 2021; 7:7/1/e000643. [PMID: 32978243 PMCID: PMC7520902 DOI: 10.1136/bmjresp-2020-000643] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/27/2023] Open
Abstract
Introduction Breathlessness is common in the general population and associated with poorer health. Prevalence, frequencies and overlap of underlying contributing conditions among individuals reporting breathlessness in the general population is unclear. The aim was to evaluate which conditions that were prevalent, overlapping and associated with breathlessness in a middle-aged general population. Method Cross-sectional analysis of individuals aged 50–65 years in the Swedish CArdioPulmonary bioImage Study pilot. Data from questionnaire, spirometry testing and fitness testing were used to identify underlying contributing conditions among participants reporting breathlessness (a modified Medical Research Scale (mMRC) score ≥1). Multivariate logistic regression was used to identify independent associations with breathlessness. Results 1097 participants were included; mean age 57.5 years, 50% women and 9.8% (n=108) reported breathlessness (mMRC ≥1). Main underlying contributing conditions were respiratory disease (57%), anxiety or depression (52%), obesity (43%) and heart disease or chest pain (35%). At least one contributing condition was found in 99.6% of all participants reporting breathlessness, while two or more conditions were present in 66%. Conclusion In a middle-aged general population, the main underlying contributing conditions to breathlessness were respiratory disease, anxiety or depression, obesity and heart disease or chest pain with a high level of overlap.
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Affiliation(s)
- Jacob Sandberg
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kjell Toren
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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18
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Toren K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall J, Eriksson M, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Persson HL, Sandelin M, Eriksson Ström J, Tanash HA, Vikgren J, Östgren CJ, Wollmer P, Sköld CM. Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study. BMJ Open Respir Res 2021; 7:7/1/e000600. [PMID: 32759170 PMCID: PMC7409993 DOI: 10.1136/bmjresp-2020-000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated with any respiratory symptom (cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. METHODS In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated their z-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI5 and increasing percentiles up to GLI25. We analysed the associations between different strata of percentiles and prevalence of any respiratory symptom using multivariable logistic regression for estimation of OR. RESULTS Among all subjects, regardless of smoking habits, the odds of any respiratory symptom were elevated up to the GLI15-20 strata. Among never-smokers, the odds of any respiratory symptom were elevated at GLI<5 (OR 3.57, 95% CI 2.43 to 5.23) and at GLI5-10 (OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds of any respiratory symptom were elevated from GLI<5 (OR 4.64, 95% CI 3.79 to 5.68) up to GLI≥25 (OR 1.33, 95% CI 1.00 to 1.75). CONCLUSIONS The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.
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Affiliation(s)
- Kjell Toren
- Occupational and Environmental Medicine/School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden .,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine/School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
| | - Anne Lindberg
- Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anders Andersson
- COPD center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Blomberg
- Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Kenneth Caidahl
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Engvall
- Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Clinical Physiology, Linköping University, Linköping, Sweden
| | - Maria Eriksson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Hamrefors
- Clinical Sciences, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - David Kylhammar
- Clinical Physiology, Linköping University, Linköping, Sweden
| | - Eva Lindberg
- Department of Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - Anders Lindén
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hans Lennart Persson
- Department of Respiratory Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Martin Sandelin
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Eriksson Ström
- Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Hanan A Tanash
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Wollmer
- Clinical Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Magnus Sköld
- Department of Medicine, Respiratory Medicine Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, Sweden
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19
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Torén K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall JE, Eriksson MJ, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Lennart Persson H, Sandelin M, Eriksson Ström J, Tanash H, Vikgren J, Johan Östgren C, Wollmer P, Sköld CM. The ratio FEV 1 /FVC and its association to respiratory symptoms-A Swedish general population study. Clin Physiol Funct Imaging 2020; 41:181-191. [PMID: 33284499 PMCID: PMC7898324 DOI: 10.1111/cpf.12684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Abstract
Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.70 after bronchodilation. It is unclear which is the most optimal ratio in relation to respiratory morbidity. The aim was to investigate to what extent different ratios of FEV1/FVC were associated with any respiratory symptom. In a cross‐sectional general population study, 15,128 adults (50–64 years of age), 7,120 never‐smokers and 8,008 ever‐smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41–0.56). Among never‐smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41–0.70). Among ever‐smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16–1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38–0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80–0.85, with similar results among never‐smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Anders Andersson
- COPD Center, Department or Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,COPD Center, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie F Behndig
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linkoping University, Linkoping, Sweden.,Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - David Kylhammar
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anders Lindén
- Unit for Lung & Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hans Lennart Persson
- Department of Clinical Physiology, Linköping University, Linköping, Sweden.,Respiratory Medicine, Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Martin Sandelin
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Eriksson Ström
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Hanan Tanash
- Department of Clinical Science in Malmö, Lund University, Lund, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital and the Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - C Magnus Sköld
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden.,Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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20
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Malinovschi A, Zhou X, Bake B, Bergström G, Blomberg A, Brisman J, Caidahl K, Engström G, Eriksson MJ, Frølich A, Janson C, Jansson K, Vikgren J, Lindberg A, Linder R, Mannila M, Persson HL, Sköld CM, Torén K, Östgren CJ, Wollmer P, Engvall JE. Assessment of Global Lung Function Initiative (GLI) reference equations for diffusing capacity in relation to respiratory burden in the Swedish CArdioPulmonary bioImage Study (SCAPIS). Eur Respir J 2020; 56:13993003.01995-2019. [PMID: 32341107 DOI: 10.1183/13993003.01995-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/26/2020] [Indexed: 11/05/2022]
Abstract
The Global Lung Function Initiative (GLI) has recently published international reference values for diffusing capacity of the lung for carbon monoxide (D LCO). Lower limit of normal (LLN), i.e. the 5th percentile, usually defines impaired D LCO We examined if the GLI LLN for D LCO differs from the LLN in a Swedish population of healthy, never-smoking individuals and how any such differences affect identification of subjects with respiratory burden.Spirometry, D LCO, chest high-resolution computed tomography (HRCT) and questionnaires were obtained from the first 15 040 participants, aged 50-64 years, of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Both GLI reference values and the lambda-mu-sigma (LMS) method were used to define the LLN in asymptomatic never-smokers without respiratory disease (n=4903, of which 2329 were women).Both the median and LLN for D LCO from SCAPIS were above the median and LLN from the GLI (p<0.05). The prevalence of D LCO <GLI LLN (and also <SCAPIS LLN) was 3.9%, while the prevalence of D LCO >GLI LLN but <SCAPIS LLN was 5.7%. Subjects with D LCO >GLI LLN but <SCAPIS LLN (n=860) had more emphysema (14.3% versus 4.5%, p<0.001), chronic airflow limitation (8.5% versus 3.9%, p<0.001) and chronic bronchitis (8.3% versus 4.4%, p<0.01) than subjects (n=13 600) with normal D LCO (>GLI LLN and >SCAPIS LLN). No differences were found with regard to physician-diagnosed asthma.The GLI LLN for D LCO is lower than the estimated LLN in healthy, never-smoking, middle-aged Swedish adults. Individuals with D LCO above the GLI LLN but below the SCAPIS LLN had, to a larger extent, an increased respiratory burden. This suggests clinical implications for choosing an adequate LLN for studied populations.
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Affiliation(s)
- Andrei Malinovschi
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Xingwu Zhou
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.,Dept of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.,Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Björn Bake
- Dept of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Bergström
- Dept of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Dept of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Blomberg
- Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Jonas Brisman
- Dept of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Dept of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Dept of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Dept of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Engström
- Dept of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Maria J Eriksson
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Dept of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Frølich
- Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Kjell Jansson
- Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Dept of Clinical Physiology, Linköping University, Linköping, Sweden.,Dept of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jenny Vikgren
- Dept of Radiology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden.,Dept of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Robert Linder
- Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | | | - Hans L Persson
- Dept of Respiratory Medicine in Linköping and Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - C Magnus Sköld
- Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Kjell Torén
- Dept of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl J Östgren
- Dept of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Wollmer
- Dept of Translational Medicine, Lund University, Malmö, Sweden.,Contributed equally to the present manuscript as senior authors
| | - Jan E Engvall
- Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Dept of Clinical Physiology, Linköping University, Linköping, Sweden.,Dept of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Contributed equally to the present manuscript as senior authors
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