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Wang Y, Li Z, Li FS. Development and Assessment of Prediction Models for the Development of COPD in a Typical Rural Area in Northwest China. Int J Chron Obstruct Pulmon Dis 2021; 16:477-486. [PMID: 33664570 PMCID: PMC7924122 DOI: 10.2147/copd.s297380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to construct and evaluate a clinical predictive model for the development of COPD in northwest China's rural areas. Methods A cross-sectional study of a natural population was performed in rural northwest China. After assessing demographic and disease characteristics, a clinical prediction model was developed. First, we used the least absolute shrinkage and selection operator regression model to screen possible factors influencing COPD. Then construct a logistic regression model and draw a nomogram. The discriminability of the model was further evaluated by the calibration diagram, C-index and ROC curve system. Clinical benefit was analyzed using the decision curve. Finally, the 1000 bootstrap resamples and Harrell's C-index was used for internal verification of the nomogram. Results Among 3249 patients in the local rural natural population, 394 (12.13%) were diagnosed with COPD. The LASSO regression model was used to find the optimal combination of parameters, and the screened influencing factors included age, gender, barbeque, smoking, passive smoking, energy type, ventilation system and Post-Bronchodilator FEV1. These predictors are used to construct a nomogram. C index is 0.81 (95% confidence interval:0.79-0.83). The combination of the calibration curve and ROC curve indicates that the model has high discriminability. The decision curve shows benefits in clinical practice when the threshold probability is >6% and <58%, respectively. The internal verification results using Harrell's C-Index were 0.80 (95% confidence interval: 0.78-0.83). Conclusion Combining information such as age, sex, barbeque, smoking, passive smoking, type of energy, ventilation systems, and Post-Bronchodilator FEV1 can be easily used to predict the risk of COPD in local rural areas.
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Affiliation(s)
- Yide Wang
- Department of Integrated Pulmonology, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Zheng Li
- Department of Integrated Pulmonology, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.,Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, People's Republic of China
| | - Feng-Sen Li
- Department of Integrated Pulmonology, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.,Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, People's Republic of China
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2
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Divo MJ, Marin Oto M, Casanova Macario C, Cabrera Lopez C, de-Torres JP, Marin Trigo JM, Hersh CP, Ezponda Casajús A, Maguire C, Pinto-Plata VM, Polverino F, Ross JC, DeMeo D, Bastarrika G, Silverman EK, Celli BR. Somatotypes trajectories during adulthood and their association with COPD phenotypes. ERJ Open Res 2020; 6:00122-2020. [PMID: 32963991 PMCID: PMC7487345 DOI: 10.1183/23120541.00122-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) comprises distinct phenotypes, all characterised by airflow limitation. OBJECTIVES We hypothesised that somatotype changes - as a surrogate of adiposity - from early adulthood follow different trajectories to reach distinct phenotypes. METHODS Using the validated Stunkard's Pictogram, 356 COPD patients chose the somatotype that best reflects their current body build and those at ages 18, 30, 40 and 50 years. An unbiased group-based trajectory modelling was used to determine somatotype trajectories. We then compared the current COPD-related clinical and phenotypic characteristics of subjects belonging to each trajectory. MEASUREMENTS AND MAIN RESULTS At 18 years of age, 88% of the participants described having a lean or medium somatotype (estimated body mass index (BMI) between 19 and 23 kg·m-2) while the other 12% a heavier somatotype (estimated BMI between 25 and 27 kg·m-2). From age 18 onwards, five distinct trajectories were observed. Four of them demonstrating a continuous increase in adiposity throughout adulthood with the exception of one, where the initial increase was followed by loss of adiposity after age 40. Patients with this trajectory were primarily females with low BMI and D LCO (diffusing capacity of the lung for carbon monoxide). A persistently lean trajectory was seen in 14% of the cohort. This group had significantly lower forced expiratory volume in 1 s (FEV1), D LCO, more emphysema and a worse BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) score thus resembling the multiple organ loss of tissue (MOLT) phenotype. CONCLUSIONS COPD patients have distinct somatotype trajectories throughout adulthood. Those with the MOLT phenotype maintain a lean trajectory throughout life. Smoking subjects with this lean phenotype in early adulthood deserve particular attention as they seem to develop more severe COPD.
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Affiliation(s)
- Miguel J. Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marta Marin Oto
- Pulmonary Dept, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova Macario
- Pulmonary Dept and Research Unit, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Carlos Cabrera Lopez
- Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrin, Canary Islands, Spain
| | | | - Jose Maria Marin Trigo
- Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
- CIBER Enfermedades Respiratorias, Instituto Investigación Sanitaria, Madrid, Spain
| | - Craig P. Hersh
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Boston, MA, USA
| | | | | | | | - Francesca Polverino
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, NM, USA
| | - James C. Ross
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dawn DeMeo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Boston, MA, USA
| | - Gorka Bastarrika
- Dept of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Edwin K. Silverman
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Boston, MA, USA
| | - Bartolome R. Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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3
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Balte PP, Chaves PHM, Couper DJ, Enright P, Jacobs DR, Kalhan R, Kronmal RA, Loehr LR, London SJ, Newman AB, O'Connor GT, Schwartz JE, Smith BM, Smith LJ, White WB, Yende S, Oelsner EC. Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults. JAMA Intern Med 2020; 180:676-686. [PMID: 32119036 PMCID: PMC7052787 DOI: 10.1001/jamainternmed.2020.0104] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Chronic bronchitis has been associated with cigarette smoking as well as with e-cigarette use among young adults, but the association of chronic bronchitis in persons without airflow obstruction or clinical asthma, described as nonobstructive chronic bronchitis, with respiratory health outcomes remains uncertain. OBJECTIVE To assess whether nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes in adult ever smokers and never smokers. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 22 325 adults without initial airflow obstruction (defined as the ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity [FVC] of <0.70) or clinical asthma at baseline. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 9 US general population-based cohorts. Thus present study is based on data from 5 of these cohorts. Participants were enrolled from August 1971 through May 2007 and were followed up through December 2018. EXPOSURES Nonobstructive chronic bronchitis was defined by questionnaire at baseline as both cough and phlegm for at least 3 months for at least 2 consecutive years. MAIN OUTCOMES AND MEASURES Lung function was measured by prebronchodilator spirometry. Hospitalizations and deaths due to chronic lower respiratory disease and respiratory disease-related mortality were defined by events adjudication and administrative criteria. Models were stratified by smoking status and adjusted for anthropometric, sociodemographic, and smoking-related factors. The comparison group was participants without nonobstructive chronic bronchitis. RESULTS Among 22 325 adults included in the analysis, mean (SD) age was 53.0 (16.3) years (range, 18.0-95.0 years), 58.2% were female, 65.9% were non-Hispanic white, and 49.6% were ever smokers. Among 11 082 ever smokers with 99 869 person-years of follow-up, participants with nonobstructive chronic bronchitis (300 [2.7%]) had accelerated decreases in FEV1 (4.1 mL/y; 95% CI, 2.1-6.1 mL/y) and FVC (4.7 mL/y; 95% CI, 2.2-7.2 mL/y), increased risks of chronic lower respiratory disease-related hospitalization or mortality (hazard ratio [HR], 2.2; 95% CI, 1.7-2.7), and greater respiratory disease-related (HR, 2.0; 95% CI, 1.1-3.8) and all-cause mortality (HR, 1.5; 95% CI, 1.3-1.8) compared with ever smokers without nonobstructive chronic bronchitis. Among 11 243 never smokers with 120 004 person-years of follow-up, participants with nonobstructive chronic bronchitis (151 [1.3%]) had greater rates of chronic lower respiratory disease-related hospitalization or mortality (HR, 3.1; 95% CI, 2.1-4.5) compared with never smokers without nonobstructive chronic bronchitis. Nonobstructive chronic bronchitis was not associated with FEV1:FVC decline or incident airflow obstruction. The presence of at least 1 of the component symptoms of nonobstructive chronic bronchitis (ie, chronic cough or phlegm), which was common in both ever smokers (11.0%) and never smokers (6.7%), was associated with adverse respiratory health outcomes. CONCLUSIONS AND RELEVANCE The findings suggest that nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes, particularly in ever smokers, and may be a high-risk phenotype suitable for risk stratification and targeted therapies.
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Affiliation(s)
- Pallavi P Balte
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paulo H M Chaves
- Benjamin Leon Jr Family Center for Geriatric Research and Education, Florida International University, Miami, Florida
| | - David J Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Paul Enright
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Richard A Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Stephanie J London
- Epidemiology Branch, Genetics, Environment, and Respiratory Disease Group, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Joseph E Schwartz
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Benjamin M Smith
- Department of Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Lewis J Smith
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Wendy B White
- Jackson Heart Study Undergraduate Training and Education Center, Tougaloo College, Tougaloo, Mississippi
| | - Sachin Yende
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Medical Center, New York, New York
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4
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Matheson MC, Bowatte G, Perret JL, Lowe AJ, Senaratna CV, Hall GL, de Klerk N, Keogh LA, McDonald CF, Waidyatillake NT, Sly PD, Jarvis D, Abramson MJ, Lodge CJ, Dharmage SC. Prediction models for the development of COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2018; 13:1927-1935. [PMID: 29942125 PMCID: PMC6005295 DOI: 10.2147/copd.s155675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Early identification of people at risk of developing COPD is crucial for implementing preventive strategies. We aimed to systematically review and assess the performance of all published models that predicted development of COPD. A search was conducted to identify studies that developed a prediction model for COPD development. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies was followed when extracting data and appraising the selected studies. Of the 4,481 records identified, 30 articles were selected for full-text review, and only four of these were eligible to be included in the review. The only consistent predictor across all four models was a measure of smoking. Sex and age were used in most models; however, other factors varied widely. Two of the models had good ability to discriminate between people who were correctly or incorrectly classified as at risk of developing COPD. Overall none of the models were particularly useful in accurately predicting future risk of COPD, nor were they good at ruling out future risk of COPD. Further studies are needed to develop new prediction models and robustly validate them in external cohorts.
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Affiliation(s)
- Melanie C Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Chamara V Senaratna
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Graham L Hall
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Centre of Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Nick de Klerk
- Telethon Kids Institute, Perth, WA, Australia.,Centre of Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nilakshi T Waidyatillake
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Deborah Jarvis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,Population Health and Occupational Diseases, National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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5
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Chakrabarti B, Purkait S, Gun P, Moore VC, Choudhuri S, Zaman MJ, Warburton CJ, Calverley PMA, Mukherjee R. Chronic airflow limitation in a rural Indian population: etiology and relationship to body mass index. Int J Chron Obstruct Pulmon Dis 2011; 6:543-9. [PMID: 22069366 PMCID: PMC3206771 DOI: 10.2147/copd.s24113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Respiratory conditions remain a source of morbidity globally. As such, this study aimed to explore factors associated with the development of airflow obstruction (AFO) in a rural Indian setting and, using spirometry, study whether underweight is linked to AFO. Methods Patients > 35 years old attending a rural clinic in West Bengal, India, took a structured questionnaire, had their body mass index (BMI) measured, and had spirometry performed by an ancillary health care worker. Results In total, 416 patients completed the study; spirometry was acceptable for analysis of forced expiratory volume in 1 second in 286 cases (69%); 16% were noted to exhibit AFO. Factors associated with AFO were: increasing age (95% confidence interval (CI) 0.004–0.011; P = 0.005), smoking history (95% CI 0.07–0.174; P = 0.006), male gender (95% CI 0.19–0.47; P = 0.012), reduced BMI (95% CI 0.19–0.65; P = 0.02), and occupation (95% CI 0.12–0.84; P = 0.08). The mean BMI in males who currently smoked (n = 60; 19.29 kg/m2; standard deviation [SD] 3.46) was significantly lower than in male never smokers (n = 33; 21.15 kg/m2 SD 3.38; P < 0.001). AFO was observed in 27% of subjects with a BMI <18.5 kg/m2, falling to 13% with a BMI ≥18.5 kg/m2 (P = 0.013). AFO was observed in 11% of housewives, 22% of farm laborers, and 31% of cotton/jute workers (P = 0.035). Conclusion In a rural Indian setting, AFO was related to advancing age, current or previous smoking, male gender, reduced BMI, and occupation. The data also suggest that being under-weight is linked with AFO and that a mechanistic relationship exists between low body weight, smoking tobacco, and development of AFO.
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6
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Forey BA, Thornton AJ, Lee PN. Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema. BMC Pulm Med 2011; 11:36. [PMID: 21672193 PMCID: PMC3128042 DOI: 10.1186/1471-2466-11-36] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 06/14/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB) and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices. METHODS Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics. RESULTS Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28), current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41) and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94). For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited data show risk decreases with increasing starting age for COPD and CB and with increasing quitting duration for COPD. No clear relationship is seen with duration of smoking. CONCLUSIONS The results confirm and quantify the causal relationships with smoking.
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Affiliation(s)
| | | | - Peter N Lee
- P N Lee Statistics and Computing Ltd, Sutton, Surrey, UK
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7
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Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disease with studies of disease progression generally focusing on measures of airflow and mortality. In nonsmokers, maximal lung function is attained around age 15 to 25 years, and after a variable plateau phase, subsequently declines at approximately 20 to 25 ml/year. Smoking may reduce the maximal FEV(1) achieved, shorten or eliminate the plateau phase, and may accelerate the rate of decline in lung function in a dose-dependent manner. Some smokers are predisposed to more rapid declines in lung function than others, and recent reports suggest that females may be at higher risk of lung damage related to smoke exposure than males. Progressive deterioration in dyspnea, functional status, and health-related quality of life (HRQL) in patients with COPD is well known, but the magnitude and rate of decline and its association with severity of airflow obstruction remains poorly defined. Many studies have identified pulmonary function, in particular the FEV(1), as the single best predictor of survival. An impaired diffusing capacity and overall impairment in functional status have also been associated with impaired survival in COPD. The National Emphysema Treatment Trial has provided additional insight into these features in a large, well-characterized group of patients with severe airflow obstruction and structural emphysema.
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8
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Boschetto P, Quintavalle S, Miotto D, Lo Cascio N, Zeni E, Mapp CE. Chronic obstructive pulmonary disease (COPD) and occupational exposures. J Occup Med Toxicol 2006; 1:11. [PMID: 16756686 PMCID: PMC1513231 DOI: 10.1186/1745-6673-1-11] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 06/07/2006] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in both industrialized and developing countries. Cigarette smoking is the major risk factor for COPD. However, relevant information from the literature published within the last years, either on general population samples or on workplaces, indicate that about 15% of all cases of COPD is work-related. Specific settings and agents are quoted which have been indicated or confirmed as linked to COPD. Coal miners, hard-rock miners, tunnel workers, concrete-manufacturing workers, nonmining industrial workers have been shown to be at highest risk for developing COPD. Further evidence that occupational agents are capable of inducing COPD comes from experimental studies, particularly in animal models. In conclusion, occupational exposure to dusts, chemicals, gases should be considered an established, or supported by good evidence, risk factor for developing COPD. The implications of this substantial occupational contribution to COPD must be considered in research planning, in public policy decision-making, and in clinical practice.
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Affiliation(s)
- Piera Boschetto
- Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
| | - Sonia Quintavalle
- Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
| | - Deborah Miotto
- Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
| | - Natalina Lo Cascio
- Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
| | - Elena Zeni
- Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
| | - Cristina E Mapp
- Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
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9
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Abstract
BACKGROUND Chronic bronchitis is a disease of the bronchi that is manifested by cough and sputum expectoration occurring on most days for at least 3 months of the year and for at least 2 consecutive years when other respiratory or cardiac causes for the chronic productive cough are excluded. The disease is caused by an interaction between noxious inhaled agents (eg, cigarette smoke, industrial pollutants, and other environmental pollutants) and host factors (eg, genetic and respiratory infections) that results in chronic inflammation in the walls and lumen of the airways. As the disease advances, progressive airflow limitation occurs, usually in association with pathologic changes of emphysema. This condition is called COPD. When a stable patient experiences a sudden clinical deterioration with increased sputum volume, sputum purulence, and/or worsening of shortness of breath, this is referred to as an acute exacerbation of chronic bronchitis as long as conditions other than acute tracheobronchitis are ruled out. The purpose of this review is to present the evidence for the diagnosis and treatment of cough due to chronic bronchitis, and to make recommendations that will be useful for clinical practice. METHODS Recommendations for this section of the review were obtained from data using a National Library of Medicine (PubMed) search dating back to 1950, performed in August 2004, of the literature published in the English language. The search was limited to human studies, using the search terms "cough," "chronic bronchitis," and "COPD." RESULTS The most effective way to reduce or eliminate cough in patients with chronic bronchitis and persistent exposure to respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards is avoidance. Therapy with a short-acting inhaled beta-agonist, inhaled ipratropium bromide, and oral theophylline, and a combined regimen of inhaled long-acting beta-agonist and an inhaled corticosteroid may improve cough in patients with chronic bronchitis, but there is no proven benefit for the use of prophylactic antibiotics, oral corticosteroids, expectorants, postural drainage, or chest physiotherapy. For the treatment of an acute exacerbation of chronic bronchitis, there is evidence that inhaled bronchodilators, oral antibiotics, and oral corticosteroids (or in severe cases IV corticosteroids) are useful, but their effects on cough have not been systematically evaluated. Therapy with expectorants, postural drainage, chest physiotherapy, and theophylline is not recommended. Central cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief of coughing. CONCLUSIONS Chronic bronchitis due to cigarette smoking or other exposures to inhaled noxious agents is one of the most common causes of chronic cough in the general population. The most effective way to eliminate cough is the avoidance of all respiratory irritants. When cough persists despite the removal of these inciting agents, there are effective agents to reduce or eliminate cough.
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10
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Barnes PJ. Genetics and pulmonary medicine. 9. Molecular genetics of chronic obstructive pulmonary disease. Thorax 1999; 54:245-52. [PMID: 10325902 PMCID: PMC1745439 DOI: 10.1136/thx.54.3.245] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P J Barnes
- Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, UK
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11
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Koyama H, Geddes DM. Genes, oxidative stress, and the risk of chronic obstructive pulmonary disease. Thorax 1998; 53 Suppl 2:S10-4. [PMID: 10193341 PMCID: PMC1765894 DOI: 10.1136/thx.53.2008.s10] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The first-pass metabolism of foreign compounds in the lung is an important protective mechanism against oxidative stress. We investigated whether polymorphisms in the gene for microsomal epoxide hydrolase (mEPHX), an enzyme involved in this protective process, had any bearing on individual susceptibility to the development of chronic obstructive pulmonary disease (COPD) and emphysema. METHODS We designed PCR-based genotyping assays to detect variant forms of mEPHX that confer slow and fast activity. We used these assays to screen 203 blood-donor controls and groups of patients with asthma (n = 57), lung cancer (n = 50), COPD (n = 68), and emphysema (n = 94), who were attending specialised clinics in Edinburgh, UK. FINDINGS The proportion of individuals with innate slow mEPHX activity (homozygotes) was significantly higher in both the COPD group and the emphysema group than in the control group (COPD 13 [19%] vs control 13 [6%]; emphysema 21 [22%] vs 13 [6%]). The odds ratios for homozygous slow activity versus all other phenotypes were 4.1 (95% CI 1.8-9.7) for COPD and 5.0 (2.3-10.9) for emphysema. INTERPRETATION Genetic polymorphisms in xenobiotic enzymes may have a role in individual susceptibility to oxidant-related lung disease. Epoxide derivatives of cigarette-smoke components may be the cause of some of the lung damage characteristics of these diseases.
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Affiliation(s)
- H Koyama
- Ion Transport Unit, National Heart and Lung Institute, Imperial College, London, UK
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12
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Jaakkola MS, Ernst P, Jaakkola JJ, N'gan'ga LW, Becklake MR. Effect of cigarette smoking on evolution of ventilatory lung function in young adults: an eight year longitudinal study. Thorax 1991; 46:907-13. [PMID: 1792639 PMCID: PMC463497 DOI: 10.1136/thx.46.12.907] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are few data on the quantitative effects of cigarette smoking on lung function in young adults. These effects are important in the understanding of the early stages of chronic airflow obstruction. METHODS A longitudinal study over eight years was carried out to estimate quantitatively the effect of cigarette smoking on ventilatory lung function in young adults and to examine the possibility that the effect is modified by other factors. The study population were 15 to 40 years of age at initial examination, when they underwent spirometry and completed an interviewer administered questionnaire on respiratory health. Eight years later 391 of the subjects were re-examined (38% response rate). The quantitative effect of cigarette smoking during the study period on the average change of forced expiratory volume in one second (FEV1) over time (delta FEV1) was estimated in two linear regression models that included potential confounders and other determinants of outcome. RESULTS The first model showed a significant dose-response relation between the average rate of smoking during the study period and delta FEV1, giving an estimate of annual change in FEV1 of -0.42 ml for each cigarette smoked per day (-8.4 ml for each pack) (p = 0.04). In the second model, which took smoking before the study period as a potential confounder, the effect of smoking during the study period was slightly smaller (-0.33 ml/year for each cigarette smoked per day). This indicated that smoking before the study period had a marginal latent effect on delta FEV1 during the study. However, neither the effect of smoking before the study nor that of smoking during the study was significant, presumably because of collinearity. Interactions between cigarette smoking and gender, wheezing, atopy, and exposure to environmental tobacco smoke during the growth period were not significant with respect to their effect on the relation between cigarette smoking and delta FEV1. CONCLUSION Cigarette smoking has a dose related adverse effect on the evolution of ventilatory lung function in young adulthood.
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Affiliation(s)
- M S Jaakkola
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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Peat JK, Woolcock AJ, Cullen K. Decline of lung function and development of chronic airflow limitation: a longitudinal study of non-smokers and smokers in Busselton, Western Australia. Thorax 1990; 45:32-7. [PMID: 2321175 PMCID: PMC475638 DOI: 10.1136/thx.45.1.32] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Data collected during seven population health surveys over 18 years in Busselton, Western Australia, were examined to determine the effect of smoking on lung function and to investigate the development of chronic airflow limitation. Lung function was measured and details of respiratory illness and smoking histories were collected from subjects attending surveys at three year intervals from 1966 to 1984. Data from ex-smokers and asthmatic patients (diagnosis based on answer to questionnaire) were excluded. Regression of height adjusted forced expiratory volume in one second (FEV1) on age was calculated individually for 759 non-smokers and 225 regular smokers with four or more observations. Decline in height adjusted FEV1 was similar for men and women. In smokers the rate of decline in FEV1 was greater than in non-smokers and was related to the amount smoked, to the extent that a smoker could expect a 20-30% greater rate of decline than a non-smoker of the same age. Chronic airflow limitation (defined as FEV1/FEV less than 65% or FEV1 less than 65% predicted on at least two occasions) was common, occurring in 24% of men and 18% of women who were regular smokers and in 5% of male and 8% of female non-smokers. These figures are higher than those reported in other populations, especially for women and for non-smokers. Not all chronic airflow limitation was associated with respiratory symptoms, confirming that the condition may be unrecognised until it is advanced.
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Affiliation(s)
- J K Peat
- Department of Medicine, University of Sydney, New South Wales, Australia
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14
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Nemery B, Moavero NE, Brasseur L, Stănescu DC. Smoking, lung function, and body weight. BMJ : BRITISH MEDICAL JOURNAL 1983; 286:249-51. [PMID: 6402057 PMCID: PMC1546528 DOI: 10.1136/bmj.286.6361.249] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In a cross-sectional study of steelworkers aged 45-55 years, smokers (n = 105; mean weight 76.1 kg) were found to weigh significantly less than non-smokers (n = 54; 81.6 kg) and ex-smokers (n = 51; 82.6 kg). The lower weight of smokers was attributable to a group with airflow obstruction (n = 37; forced expiratory volume in one second/vital capacity (FEV1/VC) less than 66%), who weighed less (4.8 kg; p less than 0.05) than smokers with normal FEV1/VC (n = 68). In smokers, but not in ex-smokers or non-smokers, body mass index and FEV1/VC ratio were closely related (r = 0.34; p less than 0.001). This association was apparently not due to an effect of body weight on lung function. Weight loss in smokers may be the consequence of impaired lung function or reflect the effect of cigarette smoking on both the respiratory tract and metabolism in susceptible subjects.
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