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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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2
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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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3
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De Soomer K, Pauwels E, Vaerenberg H, Derom E, Casas L, Verbraecken J, Lapperre T, Oostveen E. Evaluation of the Global Lung Function Initiative reference equations in Belgian adults. ERJ Open Res 2022; 8:00671-2021. [PMID: 35734771 PMCID: PMC9205329 DOI: 10.1183/23120541.00671-2021] [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: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Over the past decade, the Global Lung Function Initiative (GLI) Network has published all-age reference equations on spirometry, diffusing capacity of the lung for carbon monoxide (DLCO) and lung volumes. Methods We evaluated the appropriateness of these equations in an adult Caucasian population. Retrospective lung function data on subjects who performed tests prior to a diagnostic sleep investigation were analysed. From the medical records, lung healthy, lifetime nonsmoking, nonobese subjects were selected, resulting in a population of 1311 subjects (68% male; age range 18–88 years). Results Multiple linear regression analysis revealed that lung function z-scores did not differ between subjects with and without sleep apnoea but did depend on height and age. The average forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score was 0 but exhibited an inverse association with height in both sexes (p<0.01). Values of FEV1 and FVC in both sexes were larger than predicted (mean±sd z-score +0.30±0.96 or 104±13% pred; p<0.01). Overall, static lung volumes and DLCO were adequately predicted. However, DLCO z-scores were inversely associated with height in males and age in females (p<0.01). For all lung function indices, the observed scatter was reduced compared with the prediction. Therefore, for all indices <5% of the data were below the GLI-proposed lower limit of normal (LLN) threshold. Conclusion GLI reference equations provide an adequate fit in Belgian adults. However, the GLI-proposed LLN is too low for our Antwerp population, resulting in underdiagnosis of disease. Furthermore, airway obstruction and diffusion disorders might be misclassified due to height and age associations. Overall, GLI reference equations for lung function appropriately describe the data in Belgian adults. However, airway obstruction and diffusion disorders might be misdiagnosed at age and height extremes, and the GLI LLN was too low in this population.https://bit.ly/3jdauLE
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Affiliation(s)
- Kevin De Soomer
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Evelyn Pauwels
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Hilde Vaerenberg
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital and University of Ghent, Ghent, Belgium
| | - Lidia Casas
- Social Epidemiology and Health Policy (SEHPO), Dept of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Johan Verbraecken
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Thérèse Lapperre
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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4
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Casselbrant A, Fedorowski A, Frantz S, Engström G, Wollmer P, Hamrefors V. Common physiologic and proteomic biomarkers in pulmonary and coronary artery disease. PLoS One 2022; 17:e0264376. [PMID: 35263363 PMCID: PMC8906634 DOI: 10.1371/journal.pone.0264376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. There is a well-known comorbidity between COPD and CAD, which is only partly explained by smoking and other known common risk factors. In order to better understand the relationship between COPD and CAD, we analyzed myocardial perfusion, pulmonary function and novel cardiovascular biomarkers in patients with symptoms suggesting myocardial ischemia. Methods A total of 396 subjects from the Swedish Biomarkers and Genetics CardioPulmonary Physiology Study (BiG CaPPS) were included, all of whom had been referred to myocardial perfusion imaging due to suspected myocardial ischemia. Subjects performed myocardial perfusion imaging (MPI), pulmonary function tests (PFT) and analysis of 92 proteomic biomarkers, previously associated with cardiovascular disease. Linear regression was used to study the relationship between MPI and PFT results and proteomic biomarkers. Results Subjects with CAD (n = 159) had lower diffusing capacity (DLCO) than patients without CAD (6.64 versus 7.17 mmol/(min*kPa*l); p = 0.004) in models adjusted for common covariates such as smoking, but also diabetes and brain natriuretic peptide (BNP). The association remained significant after additional adjustment for forced expiratory volume in one second (FEV1) (p = 0.009). Subjects with CAD, compared with subjects without CAD, had higher total airway resistance (0.37 vs 0.36 kPa/(l/s); p = 0.036). Among 92 protein biomarkers, nine were associated with a combined diagnosis of CAD and airflow obstruction: VSIG2, KIM1, FGF-23, REN, XCL1, GIF, ADM, TRAIL-R2 and PRSS8. Significance Diffusing capacity for carbon monoxide is decreased in patients with CAD, independently of decreased FEV1, diabetes, and elevated BNP. Several cardiovascular biomarkers are associated with co-existent CAD and airflow obstruction, but none with airflow obstruction only. The current findings indicate that the interaction between CAD and lung function is complex, including mechanisms beyond the known association between CAD and reduced ventilation.
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Affiliation(s)
- Andreas Casselbrant
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
- * E-mail:
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sophia Frantz
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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5
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Bhakta NR, Kaminsky DA, Bime C, Thakur N, Hall GL, McCormack MC, Stanojevic S. Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception. Chest 2021; 161:288-297. [PMID: 34437887 PMCID: PMC8783030 DOI: 10.1016/j.chest.2021.08.053] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 10/27/2022] Open
Abstract
The practice of using race or ethnicity in medicine to explain differences between individuals is being called into question because it may contribute to biased medical care and research that perpetuates health disparities and structural racism. A commonly cited example is the use of race or ethnicity in the interpretation of pulmonary function test (PFT) results, yet the perspectives of practicing pulmonologists and physiologists are missing from this discussion. This discussion has global relevance for increasingly multicultural communities in which the range of values that represent normal lung function is uncertain. We review the underlying sources of differences in lung function, including those that may be captured by race or ethnicity, and demonstrate how the current practice of PFT measurement and interpretation is imperfect in its ability to describe accurately the relationship between function and health outcomes. We summarize the arguments against using race-specific equations as well as address concerns about removing race from the interpretation of PFT results. Further, we outline knowledge gaps and critical questions that need to be answered to change the current approach of including race or ethnicity in PFT results interpretation thoughtfully. Finally, we propose changes in interpretation strategies and future research to reduce health disparities.
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Affiliation(s)
- Nirav R Bhakta
- University of California, San Francisco, San Francisco, CA.
| | | | - Christian Bime
- College of Medicine, The University of Arizona Health Science, Tucson, AZ
| | - Neeta Thakur
- University of California, San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Graham L Hall
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute and School of Allied Health, Curtin University, Perth, WA, Australia
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6
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Johansson H, Wollmer P, Sundström J, Janson C, Malinovschi A. Bronchodilator response in FOT parameters in middle-aged adults from SCAPIS - normal values and relation to asthma and wheezing. Eur Respir J 2021; 58:13993003.00229-2021. [PMID: 33958428 DOI: 10.1183/13993003.00229-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/22/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Henrik Johansson
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden.,Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Clinical Physiology and Nuclear Medicine Unit, Lund University, Lund, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Christer Janson
- 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
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7
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Frija-Masson J, Bancal C, Plantier L, Benzaquen H, Mangin L, Penaud D, Arnoult F, Flamant M, d'Ortho MP. Alteration of Diffusion Capacity After SARS-CoV-2 Infection: A Pathophysiological Approach. Front Physiol 2021; 12:624062. [PMID: 33841169 PMCID: PMC8030254 DOI: 10.3389/fphys.2021.624062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/27/2021] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected millions of people worldwide, and pneumonia affects 90% of patients. This raises the possibility of millions of people with altered lung function. Few data exist to date on pulmonary function after SARS-CoV-2 infection, but alteration of diffusion capacity of CO (DLCO) is the most frequently described abnormality. First, we present original data on lung function at 3 months after SARS-CoV-2 infection and discuss the effect of using European Coal and Steel Community (ECSC) or Global Lung Function Initiative (GLI) reference equations to diagnose diffusion capacity. Second, we review existing data on DLCO alteration after SARS-CoV-2 infection and discuss the implication of restrictive disorder in DLCO alteration. Last, we discuss the pathophysiology of DLCO alteration and try to disentangle vascular damage and fibrosis.
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Affiliation(s)
- Justine Frija-Masson
- Neurodiderot, INSERM, Université de Paris, Paris, France.,Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Catherine Bancal
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Laurent Plantier
- Centre de Ressources et de Compétences de la Mucoviscidose, Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, Tours, France.,CEPR/INSERM, UMR 1100, Université de Tours, Tours, France
| | - Hélène Benzaquen
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Laurence Mangin
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.,Laboratoire Matière et Systèmes Complexes, UMR 7505, CNRS, Paris, France
| | - Dominique Penaud
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Florence Arnoult
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Martin Flamant
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.,INSERM U 1149, Center for Research in Inflammation, Université de Paris, Paris, France
| | - Marie-Pia d'Ortho
- Neurodiderot, INSERM, Université de Paris, Paris, France.,Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
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8
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Ruehland WR, Lanteri CJ, Matsas P, Brazzale DJ. Effect of corrected Global Lung Function Initiative reference equations on carbon monoxide transfer factor interpretation. Eur Respir J 2021; 57:13993003.04459-2020. [PMID: 33602860 DOI: 10.1183/13993003.04459-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Warren R Ruehland
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia .,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Celia J Lanteri
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
| | - Pam Matsas
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia.,Respiratory Medicine, The Alfred, Melbourne, Australia
| | - Danny J Brazzale
- Dept of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Heidelberg, Australia
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9
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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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